Creating long-term, lasting change in a complex system

The third podcast episode from TRUUD explores the complexity of achieving long-term, lasting change within urban development to foster healthier lives. Host Andres Kelly discusses with Dr Krista Bondy, University of Stirling, and Dr Neil Carhart, University of Bristol, how current systems struggle to address interconnected challenges, often leaving practitioners feeling powerless. 

The conversation emphasises the necessity of an interdisciplinary approach and systems thinking to understand the various influencing factors and overcome short-term perspectives. 

This episode investigates how to create interventions that are sustainable and prioritise health and equity for current and future generations, suggesting a need to reconsider societal values and decision-making processes.

Funded by the UK Prevention Research Partnership which aims to reduce non-communicable diseases such as cancers, type-2 diabetes, obesity, mental ill-health and respiratory illnesses, TRUUD is providing evidence and tools for policy-makers in government and industry.

Find more at the TRUUD website: https://truud.ac.uk/

Recommended reading from episode

Krista Bondy:

Are We Smart Enough to Know How Smart Animals Are? by Frans de Waal

Justice and the Politics of Indifference by Iris Marion Young

Neil Carhart:

Thinking in Systems by Donella Meadows

Andrew Kelly:

The Good Ancestor: How to Think Long Term in a Short Term World by Roman Krznaric

Music credit: New York London Tokyo by Petrenj Music

Produced by Beeston Media.

Transcript

00:00:03 Andrew Kelly

Welcome to the Third TRUUD podcast from the University of Bristol – how can we create long term lasting change in a complex system. I'm Andrew Kelly. So far we've discussed how we can value urban health better and getting government action on healthier people and places. But how do we make change happen and stick, especially in the long term?

TRUUD, which looks at how we can all shape places for healthier lives, found that Urban Development currently is not well suited to respond to complex issues such as climate change and health crises. And there's a bigger problem in the practitioners know that the system or systems are not delivering what they could, and they also feel powerless to improve those systems, so that HealthEquity is more central in their work.

To address complex problems, short-termism and solve the lack of joined up thinking, we need an interdisciplinary approach for change. I'm joined by Doctor Krista Bondy from Sterling Business School, who leads TRUUDs changing mindsets, intervention program, and Doctor Neil Carhart, University of Bristol, who leads the TRUUD system approaches research program. 

Krista, why is this so complex, and why are interdisciplinary approaches needed? You come from this from a management and sustainability perspective.

00:01:18 Dr Krista Bondy

Yes, thank you. I think the reason it's so complex is because there are many different parts of the puzzle and each of them interrelate in important ways. And often, we don't yet have the evidence that fully understands what the relationships are between those different puzzle pieces. And so, we can't all understand the entire complex system. And So what we need to do is we need to create silo so that we can understand in depth any particular piece of the puzzle, but then bringing them together can be very difficult. 

And so, for instance, from a sustainability perspective, issues around health and HealthEquity are absolutely interlinked to questions about the environment, climate change, pollution and those kinds of things. So those are two parts of the puzzle that actually fit very well from my perspective.

00:01:58 Andrew Kelly

And just tell us about the changing mindsets intervention program as part of TRUUD.

00:02:03 Dr Krista Bondy

Sure, the changing mindsets intervention was designed to recognise the fact that information alone is not enough to change the ways in which people think and behave with regard to anything, but health and HealthEquity. Being one of those. And so, what we did was we using information from the first phase of TRUUD, where practitioners talked about feeling, powerlessness, about feeling the difficult challenge of trying to push against the dominant ways of doing business and what was accepted is the dominant ways of doing business in the right way. And so we tried to bring those things together to help create a feeling of more desirability and more acceptability to act on health and HealthEquity within professional practice by in particular our target group, which was developers and land agents.

00:02:53 Andrew Kelly

And one of the things I like a lot about food is you bring in all these different disciplines, so what are the disciplines are involved in in TRUUD work?

00:03:03 Dr Krista Bondy

Yeah, there's a wide range of them. We did a mapping exercise towards the beginning, didn't we? And we have policy scientists, we have systems engineers, management scholars, psychologists, real estate investors. We also have people that cross the sectors as well. So we have the academic component and those are some of the disciplines I've just said. But then we also have people who for instance on our on our intervention we had industry partners. So we bring people from across sectors and across disciplines to try and bring their pieces of the puzzle together, and try to interlink those in ways that are meaningful for change.

00:03:35 Andrew Kelly

Now, Neil, you're an assistant specialist. You run the systems approaches research program. It can often appear complicated and, actually I should say, are we talking about one system or many different systems is perhaps another layer of complexity. But doesn't it all boil down to in the end what Aristotle said that it's, you know, the whole being worth more than the sum of its parts? Is that too simplistic?

00:03:58 Dr Neil Carhart

It's a good way of capturing it, I think, and Krista spoke about the pieces of the jigsaw puzzle and how they fit together and I think that's where the systems approach is aspect comes into the TRUUD project. It's a recognition that there are lots of different moving parts. Some of them might be systems in their own right. And by that I mean they're controlled by a particular group with particular aims and goals, and objectives and that system is interacting with another system which has its own aims and goals and objectives, and it's about whether those aims and goals are compatible or aligned, and understanding how all of those different pieces of the puzzle fit together. 

So in Urban Development, decision making, it's about understanding who all of the different actors are, what their aims are from that system, what their role is within the system, what's incentivising them to make the decisions they make, what sorts of things they're considering when they make those decisions, how do they interact with the different stakeholders and all the different organisations and specialists within that system. 

So the systems approach is peace is providing methods and tools that help us to understand the complexity of all of those different pieces and how they work together.

00:05:04 Andrew Kelly

And how does Urban Development for example interact with health when it comes to those systems?

00:05:11 Dr Neil Carhart

Yeah. So that's a really good question too. I mean, I think there's lots of different ways in which it does, and which it doesn't, and which maybe it should do, and that's part of the thing that TRUUD is kind of looking to investigate is those sorts of things. 

So in our project, we're looking to see the ways in which health factors into decision making at different points within that system, and different stakeholders will be considering health, we're valuing health in different ways. Sometimes those ways are compatible, sometimes they're not. But really, understanding that system end to end as a process and understanding how all of those things influence one another is where we're trying to bring these systems aspects in.

00:05:46 Andrew Kelly

Now, one thing that comes up in the discussions with TRUUD, but all the time in all of our work, is about how we create that long term change. You know how we do things now which will have long term impact. And we're sometimes not very good at this in this country. You know, there are many problems about will and vision, prevailing ideologies, money. But your research, Krista, you found this issue about powerlessness at all levels. In fact, it wasn't just at one level, just talk us through that.

00:06:18 Dr Krista Bondy

Yeah, it was a really interesting finding that came out of the phase one interviews, in TRUUD, and it was talking about, across that system of Urban Development, across those groups of stakeholders that we looked at, who all are parts and bring parts of the puzzle together, many of them felt that they weren't in a position to be able to say yes, let's act on health. They felt that they wanted to. They thought it was important, but they felt that they were not in a position to be able to make the final call.

It was always somebody else and it was, you know, depending on if you think of the delivery of an urban project as a supply chain, so in this case we'll just think of it in a line as something somewhat linear. And if you think to places that are earlier in the supply chain, almost always there is somebody who what's didn't have enough power. So for instance, I spoke predominantly with private sector people and the client is always right, so you can ask the client questions. You can challenge them, but if the client says no, it doesn’t happen. So that was one example of the type of powerlessness. But we saw that within local government, authorities say the developer has the power here, and it it didn't matter. So those are just a couple of examples across that supply chain.

00:07:26 Andrew Kelly

Hmm. And. And Neil, when it comes to this issue, how does when it comes to short termism, how does systems thinking help us?

00:07:34 Dr Neil Carhart

I think one of the reasons that we tend towards short termism is because we're not great at dealing with complexity and uncertainty. So both from a kind of mindsets perspective, but also in terms of the tools available to us to help navigate that complexity and uncertainty. And the longer into the future you project, the more uncertainty there is, the more complexity the web of cause and effect becomes, bigger and bigger, and it becomes harder to manage that. And so we like to, we feel more comfortable, when we're focusing on short term things where the relationship between taking an action and seeing the outcome from it are more certain, there are less other factors to take into account as that web of cause and effect spreads out over time. So from that systems that lack of being able to understand the complexity and the uncertainty in the system feeds into our short termism, in some ways.

I think in health, though the interesting angle is that most people do want to see healthier cities, and they do want to see the health outcomes, even those ones that are distant in time and space, so that that need for it, that recognition, that that will be a nice thing to have is shared by most people, if not everyone.

00:08:49 Andrew Kelly

When I looked at TRUUD research you saw that although there was a, you know, feeling of powerlessness, you also had this wish to make these connections better, so there was a there's a TRUUD film, for example, which shows the property developer talking a local government officer talking about how not only they wish to make those connections, particularly between health and housing, but also that it used to be much stronger connection in the past.

00:09:17 Dr Krista Bondy

Yes, it's certainly the view of members of the trade team that in the UK the link between health and housing was stronger and that that has been eroded over time. In terms of powerlessness and how people are feeling about their ability to act it, you know, as we've both been commenting on so far, people want to do it. People want to act on how they see it as being important, but often they don't know what to do. 

And because the system is so dispersed with different bits of the puzzles being done in places that are relatively opaque, so they're not transparent enough for people to be able to see what other people are doing. They don't necessarily see the trend towards more happening, and so can be, can become quite nervous about doing something themselves, particularly because health is quite complex in and of itself. How do I understand what it is that I need to do as a practitioner in my role, to be able to act on health in a meaningful way in my professional practice?

00:10:10 Andrew Kelly

And Neil, do you find when, when have you been able to talk to, say, politicians about this or civil servants about how, how they can intervene in these areas, these complex areas, so that there is more joined up thinking for example?

00:10:25 Dr Neil Carhart

So the TRUUD project has spoken to people at different levels of local and national government and private and public sector across a range of different perspectives. And we factored that into our systems mapping work to try and understand how the system works. And then we created these maps which in themselves can be quite complicated or even complex, both structurally and dynamically and we found that speaking to people about those maps, that does still present the idea of it's nice to understand the complexity, but I now still don't know what to do with this knowledge. I've maybe got a better understanding of how all the different pieces fit together, what's incentivizing health or disincentivizing the consideration of health, but still where to act and how to act is less certain from that. And one of the advantages of having built maps like that is that there are processes from the system sciences from systems approach, from systems thinking that can help us to identify where leverage points in the system might be. So as well as systems thinking, offering ways to kind of understand that complexity and uncertainty, it also offers tools helping us to understand where to intervene in the system.

00:11:32 Andrew Kelly

And do you find that in, in terms of sustainability as well, that systems mapping is helpful in terms of interventions that can be made?

00:11:40 Dr Krista Bondy

Absolutely. I mean, certainly in management, we are only just starting to come to understand and appreciate what systems tools can do for us and management. 

Sustainability is such a complex set of issues and being able to bring some of those mapping techniques into it has helped tremendously just in our own research. So, for instance, in the changing mindsets intervention we've worked with Neil and our other systems engineer to create a systems map just of how different psychological and sociological variables come together to shift the ways in which people decide whether to act or not on health in their professional practice. So it's been incredibly useful just on this project, but in sustainability more generally, it's an incredibly powerful tool for being able to bring more of those puzzle pieces together so that we can create more meaningful and in particular, longer lasting interventions, which is really where sustainability is trying to focus.

00:12:37 Andrew Kelly

And when it comes to longer lasting interventions, Neil, how do you build into your thinking the idea of protecting future generations? For example, this is, this is really key to TRUUDs work. I think that.

00:12:49 Dr Neil Carhart

Making these things stick, I think is really the key. I think we do have a reasonable understanding of how the urban environment affects people's health and there's lots of discussion, you know, upstream within the TRUUD project about how we can introduce different ways to incentivise the consideration of health, making that stick over the long term, that's a key challenge for everyone to be thinking about and dealing with. When the TRUUD project is over, how do we go on to make these interventions stick?

So thinking about intergenerational equity, how can we help people to make decisions in the short term that have outcomes that might be beneficial to generations in the future, is a key consideration for these things now. So systems thinking, I think if we can understand the system, we can put in place feedback mechanisms that help us to steer the system over a longer period of time to monitor the direction in which it's trending and correct that. If it we see it going in the wrong direction. 

But I think ultimately it still comes down to there needs to be a steers person – there needs to be leadership to actually guide that and govern that system through that process over the long term.

00:13:56 Andrew Kelly

We we're getting into the complications of financing this kind of research and so on. But Krista, how do you think you can make your finding stick even if the TRUUD project has actually finished its work, you know all this valuable research is done, and it's not a question for just TRUUD. It's a question for all research, in a way, because people move on to other things. How do you make it stick?

00:14:19 Dr Krista Bondy

That's a fantastic question and I think it's something that we all ask ourselves quite frequently. I think part of it is how do you cut through the noise to get to the right people? And I think that in and of itself is tricky, especially with all the things that are going on in society at the moment. 

I think that from my perspective, one of the key things that I think we need to be doing to create the kinds of changes that Neil has been discussing is we need to be shifting what we value and when we shift what we value, you're not having to push through the noise, it becomes a taken for granted part of what it is that we do. And so then the question for me becomes, so how do we change what we value? And it's not that we're adding something new into the mix. We already value health, we already value sustainability, but it's, how do you create conditions in which that value – the important bit there moves to the top when you're making your decisions rather than something else?

So for me, that comes down to a lot of this change around how do we help people to recognize the legitimacy of acting in the common good. So how do we get people to think more about your community, your colleagues, and valuing that as a top priority along with the other priorities that we have that are part of the system that is. So for me that normative side of things is really important in driving the kinds of changes and then sticking in that longer term.

00:15:41 Andrew Kelly

We're about to embark on a major program of house build. All the government would like to us to embark on a major programme of house building and that's surely the opportunity to make those systemic connections to health, housing and health and how does that fit in with, with, with your thinking? And is that an opportunity?

00:15:58 Dr Neil Carhart

I think when we have things that we recognise our priorities, then that is an opportunity to reflect on how health can be better integrated into things that we're already addressing and dealing with or already have a plan to address and deal with. But I think the housing issue also raises a good point about how we prioritize the many different pressures and things that we read about in the headlines. 

So most people will recognise that housing is an issue in the country, particularly young people who are trying to get onto the housing ladder. There are problems there and house building might be a solution to that, but there are many other things that are competing with that too that we have to deal with around defence, inequality, education, justice, all these sorts of things are competing for our attention and resources. 

I think one of the things the systems approaches helps us to understand is that health is interwoven into all of those. It's a cross cutting issue, and indeed, all of them are so actually seeing them as separate issues is part of the problem, and part of the challenge for being able to deal with things like health, so maybe even reframing the question of how do we integrate health into this? How do we prioritize health? isn't necessarily the helpful question and actually just understanding how we recognize that health is integrated into everything else and in fact everything is integrated into everything else.

00:17:14 Andrew Kelly

Krista, we, we, you've, you've done all this research, you've got a massive amount of evidence. But, there's always a delay between research and action. How? How can we make that work better in the future? How can we get earlier action, do you think?

00:17:33 Dr Krista Bondy

That's a really interesting question. I don't know if we want earlier action. And what I mean by that is I think one of the problems that we have is that we're trying to make decisions so quickly that we're not understanding enough of the complexity of what's going on. And so we make decisions that have perhaps some, and normally some short term benefit for a particular group of people, and not every intervention or every decision that we make is going to be able to cut across all of that. Absolutely. 

But I think that one of the things that we need to do is slow down the ways in which we make decisions, the ways in which we create policies to try and understand more of that complexity, because without it, we know that we know that many interventions really only deal with a small percentage of the problem, and often only with a very, very discrete group of people. But we need to be looking at how these cross cutting issues fit together so we can start to really maximize the impact and the lasting impact of the work that we do. 

So with TRUUD, we have spent a great deal of time working across you know you asked the question before about the different kinds of disciplines. We have a whole huge range of disciplines working together. And what was interesting is when we work together like that, we find out that there's really not really any new solutions? There's not any really new ideas, but actually what you create when you bring people together is you get a much more robust, holistic understanding of a range of puzzle pieces. And so actually now, instead of having five puzzle pieces, you've got a smaller part of the picture and you can start to manage that smaller part of the picture in much more efficient ways. 

So I've kind of gone away from your question a little bit, but I think in terms of TRUUD specifically and how do we get some of those quick wins, I think those quick wins are through the discussions that we've already had and that we will continue to maintain through our research and through the connections that we've made, in TRUUD and that's where we're going to really have a lot of value, yeah.

00:19:26 Andrew Kelly

And. And just before we come to our final question, how optimistic are you that the work you've done will lead to change happen? It's a question for both of you. I'll start with you, Krista.

00:19:38 Dr Krista Bondy

I'm actually fairly optimistic and as a sustainability person, sometimes I don't feel that way very often. I'm fairly optimistic because we've had, we've now had almost six years of working together, working with our industry partners, working with our stakeholders where we are in constant contact with, there's been a lot of discussion and conversation. And I think that is the basis upon which better decisions are made and in which we're more likely to find those points within the system that we can create more effective interventions.

00:20:07 Andrew Kelly

And Neil, optimistic?

00:20:09 Dr Neil Carhart

About this, I think I am and I think like Krista, I wouldn't necessarily describe myself as an optimist generally, but about this issue and from working on the TRUUD project, I've seen that the range of different stakeholders and different people that recognise the importance and value of health is vast. It cuts across different people from different backgrounds, the public and private sector and I think through mechanisms that allow us to slow down, understand the complexity of the problem, develop proper solutions and collaborate and involve everyone in developing those proper solutions, does give me optimism that that we can tackle this.

00:20:45 Andrew Kelly

Now we asked you both to come up with a book you'd recommend, and I'll stay with you, Neil, and then come to Krista. What would you recommend?

00:20:51 Dr Neil Carhart

Yeah, so I'd recommend Thinking in Systems by Donella Meadows, which is really a great text to begin with if you want to understand complex systems and how we can understand the world around us through a systems lens.

00:21:01 Andrew Kelly

Krista?

00:21:05 Dr Krista Bondy

Can I just say that's a fantastic book. That's a great recommendation. I'm going to be cheeky and say two, and it's because they're related to each other – in my head, perhaps other people wouldn't see it this way. 

The first one is Frans de Waal, Are we Smart Enough to Know how Smart Animals are, and the other is Iris Marion Young's Justice and the Politics of Indifference. For me, those two books come together and basically say we need to be humble as a species. We don't know enough of what's going on out there, and we're making these decisions that have significant ramifications on others. And those could be others within our species, but could be others outside of that. And so when we start to become more humble and recognize that we have a real responsibility – and this this isn't for stewardship, to do to, to protect those – but it's actually to Createspace for others to live their own lives and having the space and resources to do that.

00:22:01 Andrew Kelly

Well, three fantastic choices. I'll add my own, which is a book called The Good Ancestor: How to Think Long Term in a Short Term World by Roman Krznaric, who's been very helpful in my own thinking on this.

My takeaways from the discussion: we do have the solutions, things are complex, but we should always seek to understand systems and systems thinking. Always make the links from a sustainability perspective, for example, issues around health and HealthEquity are interlinked with the environment climate change and pollution, for example.

We need to understand who all of the different actors are, what their aims are, from working in the systems they operate in, what their roles are, and what's incentivising them to make the decisions they make. In terms of intergenerational equity, we need to help people to make decisions in the short term that have outcomes that might be beneficial to generations in the future. And let's not rush things so we can help as many as we can and get things right. 

Thank you, Krista Bondy and Neil Carhart for joining me today. Our next podcast looks at how we involve more people and communities in developing better and healthier places. The Trude website, trude.ac.uk has links to all podcasts, background research and issues and recommendations discussed today. 

Thank you very much!