Harry Rutter
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12/6/16 1 Obesity, systems and complexity Harry Rutter @harryrutter Evidence trajectories Time Hunch-based Level of activity Evidence-based All possible interventions Evidence of cost-effectiveness Evidence of effectiveness The dangerous olive of evidence… Source: Swinburn et al, Lancet 2011 + research difficulty
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Transcript of Harry Rutter
12/6/16
1
Obesity, systems and complexity
Harry Rutter@harryrutter
Evidencetrajectories
Time
Hunch-based
Levelofactivity
Evidence-based
All possible interventionsEvidence of cost-effectiveness
Evidence of effectiveness
Thedangerousoliveofevidence…
Source: Swinburn et al, Lancet 2011
+ research difficulty
12/6/16
2
Obesitystrategyanalysis
Source: Johnston, Matteson, Finegood, Simon Fraser University: personal communication
12/6/16
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GeoffreyRose
ChangeintheadultBMIdistributionHealthSurveyforEngland1991to1993and2011to2013
Adults aged 18+ population weighted
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4
http://en.wikipedia.org/wiki/File:Colosseum_in_Rome,_Italy_-_April_2007.jpg
2014SurgeonGeneral’sReport,Fig2.1.ThankstoCliffDouglas@cdoug
12/6/16
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Source: Swinburn et al, Lancet 2011
Evidencebase
Public/media/politicaldiscourse
Politicalmandate
Source: Swinburn et al, Lancet 2011
Evidencebase
Public/media/politicaldiscourse
Politicalmandate
Conclusions
• Don’ttreatcomplexsystemsassimple:ofcoursemanythingsappearnotto'work’,we'rejudgingthemonthewrongcriteria
• Linearcauseandeffectis(relatively)easytolookfor,butthatdoesn’tmeanit’salwayshelpfultodoso
• Shiftfromreductionist,linear,singleperspectivethinkingtotransdisciplinary,non-linearsystemsthinking
• Don’tforgetthelessonsofRose:populationlevelpreventioninvolvesshiftingthepopulationcurveinwaysthatmaybeindiscernibleatindividuallevel
• Conceptualiseactionsasdrivingperturbationswithinsystems,notashammersappliedtonails
• Movefrom‘doesitwork?’to‘doesitcontribute?’
