Advancing a social complexity imagination to disrupt place-based health complexities -- IRSPM Conference Presentation

It was great to present with my colleague Jonathan Wistow at the International Research Society for Public Management (IRSPM) Conference, hosted by the University of Bologna, Italy.

For those who attended our presentation or are just interested in what we discussed, here is an overview with links to a PDF of our presentation and our methods platform, COMPLEX-IT. See, also, this blog post by my co-author, Jonathan Wistow, as background for our argument. 

ABSTRACT

Advancing a social complexity imagination to disrupt place-based social complexities: Health inequalities and multiple conjunctural causation 

The complexity and persistence of health inequalities pose significant challenges to public management and service delivery, affecting both their understanding and response strategies (Wistow et al., 2015). For Salway and Green (2017), part of the problem is the miss-specification of system boundaries in public policy that fails to go far enough up the causal chain. Policy and research have neglected the complex causal factors that produce the socio-economic inequalities in which health inequalities are (re)produced, (Doyal with Pennell, 1979, Navarro, 2009, and Schrecker 2017), which leads us to extend a theoretical exploration of the issue, meeting a key aim of this panel. One potential solution is to employ a social complexity framework and corresponding methods that embrace rather than simplify these persistent complexities (Wistow et al., 2015).

 

We develop a ‘social complexity imagination’ as a form of creative destruction designed to drive science and its relationship with practice (Castellani and Gerrits, 2024). We do so by framing multi-level and multi-actor governance system responses to the deeply embedded and ‘wicked challenge’ of health inequalities within debates about how the social contract and political economy influences place-based social complexities (i.e., trajectories of unequal social and economic outcomes) and the scope and capacity for policy systems to respond to these (Wistow, 2022). Health inequalities are a key measure of the unequal and deeply embedded trajectory of places in a post-industrial society like England and require disruption to the social contract in order to enable policy and public management to be more effective.

As demonstration, we analyse a longitudinal (pre and post) place-based dataset of all English local authority administrative areas. This was designed around a social determinants of health (SDH) perspective (see, Marmot et al., 2020) and Public Health Outcomes Framework (Office for Health Improvement & Disparities, n.d.) for England alongside some additional health service and place-based contextual data. The dataset covers a wide-range of factors relating to social complexities and trajectories of place.

In terms of methodological innovation, we will use the COMPLEX-IT platform to explore place-based complex conjunctural causation around two significant health inequalities outcomes – life expectancy and healthy life expectancy, which represent systems outcomes at the level of local authorities (as places and policy systems). COMPLEX-IT is a case-based, multi-methods platform employing the tools of computational social science to facilitate exploring and analysing complex data and support applied social inquiry (Schimpf and Castellani 2022). COMPLEX-IT provides a bespoke suite of techniques: cluster analysis, machine learning, data visualisation, data forecasting, case-based scenario simulation and, case-based systems mapping.

Through the findings and analysis, we identify elements of health inequalities that are amenable to local complexity-informed public management policies and service delivery and those that are less tractable to interventions at the local level alone and, therefore, require intervention higher up the causal chain via national place-sensitive policy and interventions. Through the methodological exploration of the issue, we contribute to the second aim of the panel and use this to extend our theoretical exploration, which contributes to the first aim.

 

CLICK HERE for the PDF of our Presentation

CLICK HERE to explore our methods platform, COMPLEX-IT