Taking stock: whole system approaches in Scotland

Obesity Action Scotland took on an enhanced role in supporting the Whole Systems Approach for Diet and Healthy Weight when a number of other national partners were diverted by the Covid-19 pandemic. Here, our National Co-ordinator for the work, Fran Eatwell-Roberts, reflects on this year’s activities.

“We’re 8 months late, and better off for it” is my verdict for Scotland’s Whole System Approaches to Diet and Healthy Weight at the end of 2020.

By now, had it not been for COVID-19, the eight diet and healthy weight pilots supported by Obesity Action Scotland should be approaching completion. Public Services across eight local authority areas would have developed and started to implement whole system action plans; the findings of an independent evaluation would have been used for Scotland’s Public Health Reform; and, our 16 local leads would have joined us on a peer support tour – inspiring others to instigate whole system approaches to address Scotland’s Public Health Priorities.

But, because of our programme’s (pandemic induced) hiatus, we’re behind schedule. We’ve yet to develop our action plans and most of us are still defining the systems that compromise our diets and risk our healthy weight.

So, given these delays, why our collective optimism?

In part it’s because local leads and national partners returned to their pilots in September 2020 and have since made rapid progress.

However, it’s mostly because, having lived through this turbulent year, more people than ever seem to get what it takes to work in a whole systems way. The buzz and jargon surrounding Whole System Approach has, for many, been internalised as lived experience. It’s as if the urgency, scale and breadth of the COVID-19 response has instilled whole system characteristics into people’s ways of doing things. And, dare I hope it’s done this quicker and more sustainably than our pilot was ever likely to?

For example, since our pilot’s recommencement in September, here’s some anecdotal developments plotted against some of Public Health Scotland’s core characteristics of a whole system approach:

Systems thinking

Since the pandemic all pilots have identified food insecurity as a priority cause for them to address. When asked why their focus is on inequality, many cited their first-hand experience of working with food banks during spring’s lock-down. For many, that really helped to highlight the problems in our food system and the causal links between poverty and unhealthy diets.

Creativity, innovation and learning culture

The upheaval wrought by COVID-19 seems to have encouraged many to respectfully challenge the ways things have always been done and got them thinking of ways to improve. For example, of the many innovative ideas discussed during pilot workshops, initiatives to build healthier highstreets appear to be a common aspiration.

Collective and adaptive leadership

The online workshops we’ve hosted since resuming have been fantastically well attended by professionals of all stripes. For example, this morning’s problem definition workshop in Dundee exceeded our capacity of 60 people, despite the pressures of the ongoing pandemic.

Purposeful engagement

The year seems to have sharpened people’s understanding of public service. Professional participants have been more likely to stress the need to do this pilot “with” rather than “to” communities. Whereas, community participants have been more confident in demanding that it’s their knowledge and lived experience that should help define and design local heath interventions. All active pilots are exploring how to build their programmes around proper community engagement.

Sustainable collaborative working

Local decision makers have cited strengthened relations with Public Health colleagues as a consequence of 2020. This is probably not surprising, given the difficult, evidence-based decisions taken this year. However, it’s interesting to think of what else might come of these strengthened relationships over the years to come.