title: The Challenge of Cardiovascular Diseases and Diabetes to Public Health: A Study Based on Qualitative Systemic Approach.
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.
authors.affiliation: Scientific Computing Program, Oswaldo Cruz Foundation, Antiga Residência Oficial, Rio de Janeiro, RJ, Brazil.
authors.forename: Marilia Sá
authors.initials: MS
authors.lastname: Carvalho
authors.affiliation: Institute for Studies in Collective Health. Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Claudia Medina
authors.initials: CM
authors.lastname: Coeli
authors.affiliation: Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Dóra
authors.initials: D
authors.lastname: Chor
authors.affiliation: Institute for Studies in Collective Health. Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Rejane Sobrino
authors.initials: RS
authors.lastname: Pinheiro
authors.affiliation: Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Maria de Jesus Mendes da
authors.initials: Mde J
authors.lastname: Fonseca
authors.affiliation: Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Luiz Carlos de
authors.initials: LC
authors.lastname: Sá Carvalho
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D019295:Computational Biology / Q000379:methods*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control; D008137:Longitudinal Studies; D011634:Public Health / Q000379:methods*