Complex Systems

Book Review: The Ecology of Childhood: How our Changing World Threatens Children’s Rights

The Ecology of Childhood:  How our Changing World Threatens Children’s Rights

By Barbara Bennett Woodhouse 2020 New York University Press

Review by Shirley Russ

In her book The Ecology of Childhood, Barbara Bennett Woodhouse tells the compelling story of how she initially set out to conduct an ethnographic study comparing children’s well-being in the Cedar Key area of Florida, where there appear to be few social safety nets, and the village of Scanno in the Abruzzo Region of Italy, with its much more generous child welfare policies. However, the Great Recession in 2008 had major impacts on the lives of children in both regions, transforming her study from a comparison of policies to one which instead revealed the power of global forces to threaten the well-being of all children. The author lays out how the direct and indirect effects of the recession and subsequent reactions, including economic stimulus packages in the US, and strict austerity measures in Italy, had an immediate and lasting impact on children and their families, and brought home how closely the fortunes of different countries are tied together. In short, policies developed and enacted in the US affect children in the US, but also affect children in Italy.  Globalization is real and tangible and, Woodhouse argues, a force that must be addressed for children to thrive.

Woodhouse documents a detailed study of the microsystems – e.g. family and peer groups where children’s daily lives unfold; the mesosystems where the microsystems overlap and intersect – e.g. in faith-based schools in local communities; and the exosystems that encircle children’s worlds even though children do not enter them – e.g. parents work place, housing markets, demonstrating how forces in each of these systems impact children’s sense of identity and well-being. What she has to say is not encouraging, with a disturbing number of trends placing ever increasing pressures on the family unit and on children, including climate change, mass migration, job losses and the technological revolution to name but a few. 

The situation appears so acute, and so much at risk of entering a bigger downward spiral, that the author argues a global movement is urgently needed to safeguard children’s well-being. She views the most sensible place to start as the universal adoption of the UN Convention on the Rights of the Child, a Children’s Right treaty that has not currently been adopted by the US. Those who are hesitant about the UN Rights approach frequently cite concerns about the potential erosion of the role of the family as protector, provider and nurturer of children; while supporters of the approach emphasize the profound nature of the global changes occurring in society, and the potential threats to children that families alone would have little power to counteract. In this book, despite making a strong case, I do not think the author will quite succeed in either allaying the fears of the first group, or providing the second with a strong enough argument to win the day. For example, Italy has already adopted the UN Convention on Children’s Rights, but it is unclear what impact that might have had on their response to the great recession. However, she does provide excellent examples of the power of youth and children’s voices, and the need to have them heard and considered by decision-makers at all levels. 

The rights agenda is not all that Woodhouse has to offer. In her previous writings she has developed the idea of “ecogenerism,” a child-centered and environmentally-informed perspective on events. Its guiding philospophy regards a commitment to the welfare of future generations as the mark of a just and sustainable society. This leads on to proposals for a child-centered value system as a measure of how well a society is truly functioning.  Here, the author is on solid and familiar ground. In Chapter 5, she explores two current crises largely attributable to exosystemic factors: the sharp decline in birth rates in developed countries, and the migration of young people from rural to urban areas. Her arguments are well developed, balanced and compelling. Do we really want a future where young people are afraid to have children for fear of not being able to support them, or one where younger generations must leave behind older in search of ever-moving jobs and affordable housing, severing family and social ties in the process? These are real and immediate issues affecting almost all families worldwide, and the author’s sincerity in making the case for the need to address them urgently makes for particularly strong writing.  

Woodhouse’s ecogenerism idea resonates strongly with life course approaches to health development. Both are “future-leaning” in their orientation, arguing that investments early on pay dividends later in ways that are good not just for some but for the whole of society. As stewards of the environment, we must look to the future, considering not just the immediate impact of our actions, but the likely impact 10, 50 even 100 years from now. Children benefit from spending time in nature in ways that we are only beginning to fully understand, and one of the most powerful incentives for finding the best ways to interact with our environment is to leave behind a world where children can thrive. This “intergenerational perspective” has yet to permeate the political arena in a meaningful way, and this book goes a long way towards making the argument for an “ecogenerative” or “life course” lens to be applied to all contemporary decision-making.  

In the final chapter, Woodhouse returns to a “small is beautiful” approach, urging grassroots actions that incorporate the principles of children’s rights, advancing child-friendly communities, and building a world fit for children. This book has much to offer anyone interested in children’s rights, and an ecological approach to the study of children’s well-being. It is an excellent and informative resource for anyone studying – or teaching – on child development, and will be sure to spark much classroom debate.

Complex Systems Cross-Cutting Issues

Book review: Complex Systems and Population Health

Complex Systems and Population Health: A Primer

Yorghos Apostolopoulos, Kristen Hassmiller Lich, Michael Kenneth Lemke


Oxford University Press 2020

Very few books are truly revolutionary- but this might just be one of them. Released coincidentally, but perhaps tellingly, in the middle of the COVID-19 pandemic, the book proceeds to make the case for both the wisdom and necessity of applying complex systems thinking to any study of population health. As Sandro Galea, Professor of Public Health at Boston University, points out in his foreword, even a decade ago systems science and population health science were strangers, with the latter largely relying on reductionist analytic strategies to identify single causes and disease states. While this approach historically served medicine well in identifying, for example, the causative role of smoking in lung cancer, it has been much less useful in addressing the so-called “modern” health challenges such as obesity, mental health problems, and neurodevelopmental issues. In addition, it has done little to address stubbornly persistent health inequities in areas including infant mortality rates. What is needed now is a much deeper understanding of how some of the most intractable population health challenges of our time are embedded in, shaped by, and/or consist of complex systems, and a willingness to apply complex systems science approaches to solve them. This book is the first to response to that need.

Made up of five sections broadly addressing concepts, theory, research design, methodology and analytic techniques, the book aims to blend old, current and new thinking to move the population health field forward, and improve the health of all people as equitably and efficiently as possible. Chapter 3 by Scott Page and Jon Zelner is particularly strong, arguing that population health outcomes and disparities need to be understood as the products not of isolated complex systems, but as the end result of a complex adaptive system of systems (CASoS). Consequently, each system must be understood both in isolation and in terms of its interaction with other systems if we are to truly understand what is going on in producing the whole picture. Chapter 7 by Leah Frerichs and Natalie R. Smith addresses ways to design population health research so that it is grounded in this new complex systems science, while another particularly strong contribution by Michael Lemke in Chapter 8 introduces model thinking and formal modeling as a way to improve our mental models in population health research. In Chapter 12, Nathaniel Osgood makes the case for dynamic (simulation) models as a central tool in this “science of the whole”. These models express dynamic hypotheses about the underlying processes that are driving systems, and are particularly important for intervention science. They hold promise for understanding system vulnerabilities and leverage points, identifying areas where investments could secure the greatest improvements. Later chapters address agent-based modeling, hybrid simulation modeling, and microsiumulation models, and the tremendous potential they have to inform health policy.

At a time when we appear to be at a “tipping point” for solving the pressing health problems of our time this book provides a new perspective, along with new tools and techniques that together form a new paradigm that will allow us to “dig deeper,” expanding our understanding of the deep systemic drivers of modern health challenges. Despite its methodologic and analytic content this book is as advertised – a primer. It will be useful reading for academics wanting to incorporate systems science into their own work or into their student mentoring, for graduate students, public and population health and healthcare professionals from all disciplines, and policymakers. The book has few weaknesses, but it is text heavy with very few figures and diagrams. Greater attention to visual representations of modeling concepts and pictorial representations of system maps could add to the book’s appeal and might be useful for future editions. Regardless, this book is both welcome and timely, and is highly recommended for anyone with an interest in population health.

Shirley Ann Russ MD MPH

Consultant to LCIRN