The Challenge of Cardiovascular Diseases and Diabetes to Public Health: A Study Based on Qualitative Systemic Approach

PLoS One. 2015 Jul 14;10(7):e0132216. doi: 10.1371/journal.pone.0132216. eCollection 2015.

Abstract

The most common modeling approaches to understanding incidence, prevalence and control of chronic diseases in populations, such as statistical regression models, are limited when it comes to dealing with the complexity of those problems. Those complex adaptive systems have characteristics such as emerging properties, self-organization and feedbacks, which structure the system stability and resistance to changes. Recently, system science approaches have been proposed to deal with the range, complexity, and multifactor nature of those public health problems. In this paper we applied a multilevel systemic approach to create an integrated, coherent, and increasingly precise conceptual framework, capable of aggregating different partial or specialized studies, based on the challenges of the Longitudinal Study of Adult Health - ELSA-Brasil. The failure to control blood pressure found in several of the study's subjects was discussed, based on the proposed model, analyzing different loops, time lags, and feedback that influence this outcome in a population with high educational level, with reasonably good health services access. We were able to identify the internal circularities and cycles that generate the system's resistance to change. We believe that this study can contribute to propose some new possibilities of the research agenda and to the discussion of integrated actions in the field of public health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cardiovascular Diseases / epidemiology*
  • Computational Biology / methods*
  • Diabetes Mellitus / epidemiology*
  • Humans
  • Hypertension / epidemiology
  • Hypertension / prevention & control
  • Longitudinal Studies
  • Public Health / methods*

Grants and funding

MSC, DC and RSP received a grant from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (http://www.cnpq.br/) under award numbers 309692/2013-0, 300694/2010-5 and 309728/2012-6, respectively. MSC received a grant from FAPERJ - Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (http://www.faperj.br/)E_26/2014-203577.