Conceptualising population health: from mechanistic thinking to complexity science

The mechanistic interpretation of reality can be traced to the influential work by René Descartes and Sir Isaac Newton. Their theories were able to accurately predict most physical phenomena relating to motion, optics and gravity. This paradigm had at least three principles and approaches: reductionism, linearity and hierarchy. These ideas appear to have influenced social scientists and the discourse on population health. In contrast, Complexity Science takes a more holistic view of systems. It views natural systems as being 'open', with fuzzy borders, constantly adapting to cope with pressures from the environment. These are called Complex Adaptive Systems (CAS). The sub-systems within it lack stable hierarchies, and the roles of agency keep changing. The interactions with the environment and among sub-systems are non-linear interactions and lead to self-organisation and emergent properties. Theoretical frameworks such as epi+demos+cracy and the ecosocial approach to health have implicitly used some of these concepts of interacting dynamic sub-systems. Using Complexity Science we can view population health outcomes as an emergent property of CAS, which has numerous dynamic non-linear interactions among its interconnected sub-systems or agents. In order to appreciate these sub-systems and determinants, one should acquire a basic knowledge of diverse disciplines and interact with experts from different disciplines. Strategies to improve health should be multi-pronged, and take into account the diversity of actors, determinants and contexts. The dynamic nature of the system requires that the interventions are constantly monitored to provide early feedback to a flexible system that takes quick corrections

Inheriting library cards to Babel and Alexandria: Contemporary metaphors for the digital library

Librarians have been consciously adopting metaphors to describe library concepts since the nineteenth century, helping us to structure our understanding of new technologies. We have drawn extensively on these figurative frameworks to explore issues surrounding the digital library, yet very little has been written to date which interrogates how these metaphors have developed over the years. Previous studies have explored library metaphors, using either textual analysis or ethnographic methods to investigate their usage. However, this is to our knowledge the first study to use bibliographic data, corpus analysis, qualitative sentiment weighting and close reading to study particular metaphors in detail. It draws on a corpus of over 450 articles to study the use of the metaphors of the Library of Alexandria and Babel, concluding that both have been extremely useful as framing metaphors for the digital library. However, their longstanding use has seen them become stretched as metaphors, meaning that the field’s figurative framework now fails to represent the changing technologies which underpin contemporary digital libraries

The national evaluation of Sure Start local programmes in England

In the latter part of the 20th century evidence was accumulating about the effectiveness of various intervention programmes for young children in disadvantaged families. Some small-scale interventions were evaluated by randomised control trials as in the case of the Abecedarian project (Ramey et al., 2000), the High/ Scope Perry Preschool Project (Schweinhart, Barnes, & Weikart, 1993) and evaluations of home visiting (e.g. Olds, 1997). Others were evaluated by quasi-experimental methods as with the large-scale Head Start project (e.g. Barnett, 1995; Kresh, 1998). Despite some weaknesses in the evidence for large-scale interventions, the accumulating evidence of the benefits of early intervention was very influential in the planning and launch of the Sure Start programme (Glass, 2003), now known as Sure Start local programmes. Sure Start local programmes are central to the UK government’s policy for combating the adverse effects of poverty and disadvantage on young children and their families. Hence they have potentially great importance in the lives of hundreds of thousands of families and young children. By 2004 there will be 524 Sure Start local programmes in disadvantaged areas in England that will be serving over 300,000 children and their families. Scotland, Wales and Northern Ireland have their own Sure Start programmes. This initiative represents a unique approach to early intervention for children aged 0–4, their families, and communities. The aim of Sure Start is: To work with parents-to-be, parents and children, to promote the physical, intellectual and social development of babies and young children – particularly those who are disadvantaged – so that they can flourish at home and when they get to school, and thereby break the cycle of disadvantage for the current generation of young children. Sure Start local programmes are designed to be comprehensive, community-based projects adapted to local needs, and making maximal use of local expertise and enthusiasms. Such a focus on local autonomy may capitalise on shared concerns of people for their community (Oliver, Smith, & Barker, 1998). The issue of whether preventative interventions should be targeted or universal in application is dealt with by Sure Start by targeting distinct areas of disadvantage and making the services universal within those areas. In this way there are the advantages of economy associated with targeted interventions and also the stigma-free advantage of universal provision. While some research has reliably documented the benefits of early intervention, there has been much prevention work that has either not been evaluated or where evaluations are so flawed as to preclude meaningful conclusions (see Mrazek & Brown, 2002; Webster- Stratton & Taylor, 2001). The Sure Start programme recognised the need for rigorous evaluation and after a competitive commissioning process the National Evaluation of Sure Start (NESS) was initiated. Rather than providing a specific service, Sure Start local programmes involve changes to existing services. Improved services and community functioning are presumed to lead to enhanced family and community functioning that in turn enhance child development. This approach raises the following questions for NESS. 1. Do existing services change? (How and, if so, for which populations and under what conditions?) 2. Are delivered services improved? (How, and if so, for which populations and under what conditions?) 3. Do children, families, and communities benefit? (How, and if so, for which populations and under what conditions?) NESS addresses these questions through four core research components: (1) implementation evaluation that considers how programmes are operating and changing; (2) impact evaluation that considers effects of Sure Start local programmes upon children and families; (3) local context analysis that considers communities as units of analysis and how they function and change over time; and (4) cost-effectiveness analysis that examines economic return on investment of the Sure Start local programmes. The NESS team also provides technical support to smaller scale evaluations being conducted by local Sure Start programmes themselves. The four core research modules of the evaluation are described in turn