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By Dr. Wilma Waterlander, Department of Public and Occupational Health at the Amsterdam UMC/University of Amsterdam
This is how I opened my presentation at ISBNPA in Auckland: “Systems thinking is HOT!” And it’s true. But what exactly is systems thinking—and perhaps more importantly—how do you do it in practice?
When I say “systems,” I’m not talking about tidy, bounded entities like hospital systems or school systems (that’s more systematic thinking). What I mean is systemic thinking: the messy, fascinating interplay of many interrelated factors and feedback loops that, together, explain why things emerge the way they do. In Auckland, I shared how we applied system dynamics theory to a local obesity prevention approach, and the lessons we learned along the way.
We came away with three key lessons:
1. Interdependency between programme & context
Like any systems project, we started by “understanding the system.” Group Model Building, Participatory Action Research, Causal Loop Diagrams, Social Network Analysis… we threw the whole systems science toolkit at it.
What we underestimated was the context: how long it takes to understand who relevant stakeholders are outside the public health domain, how local government is organized, what’s brewing beneath the surface, and where momentum for change is hiding. And because context shifts over time (sometimes faster than your CLD drawing skills), you have to stay on top of it—constantly.
2. The dynamic and adaptive character
Instead of a standard, one-size-fits-all intervention, we developed an adaptive action programme, targeting different levels of the system. But here’s the catch: not every co-created action is a good action. Focus matters. Low-hanging fruit is tempting, but sometimes you need to reach higher branches. And momentum is precious—grab it when it comes. This does create a dilemma: what do you do with actions that have already started, or with stakeholders who are (understandably) attached to them?
3. Governance, governance, governance
Equal partnership between academia, policy, and practice? Regular meetings? Participatory Approach? We did it all. And yet… it was incredibly hard to maintain a true systems perspective. It is very easy to slip back into the comfort of the traditional path: fixed interventions, clear outcomes, neatly bounded budget sheets. Systems thinking demands that you ask, over and over: are we still on the systems path—or have we quietly wandered back to business as usual?
Conclusion: Systems thinking in practice is equal parts enlightening and humbling. It certainly isn’t about new tools or methods. It’s about flipping your perspective entirely. Think of the Kiwi “world upside-down” map: the land is the same, but the view is refreshingly different.
More information on the LIKE project?
● Waterlander WE, Luna Pinzon A, Verhoeff A, Den Hertog K, Altenburg T, Dijkstra C, Halberstadt J, Hermans R, Renders C, Seidell J, et al. A System Dynamics and Participatory Action Research Approach to Promote Healthy Living and a Healthy Weight among 10–14-Year-Old Adolescents in Amsterdam: The LIKE Programme. Int J Environ Res Public Health. 2020;17:1–18. doi: 10.3390/ijerph17144928. – [link]
● Waterlander WE, Singh A, Altenburg T, Dijkstra C, Luna Pinzon A, Anselma M, Busch V, Van Houtum L, Emke H, Overman ML, et al. Understanding Obesity-Related Behaviors in Youth from a Systems Dynamics Perspective: The Use of Causal Loop Diagrams. Obes Rev. 2021;22:1–16. doi: 10.1111/obr.13185 – [link]
● Luna Pinzon A, Stronks K, Emke H, Van den Eynde E, Altenburg T, Dijkstra SC, Renders CM, Hermans R, Busch V, Chinapaw MJM, Kremers SPJ, Waterlander W. Understanding the system dynamics of obesity-related behaviours in 10- to 14-year-old adolescents in Amsterdam from a multi-actor perspective. Front Public Health. 2023;11:1128316. doi: 10.3389/fpubh.2023.1128316. – [link]
● Emke H, Altenburg T, Dijkstra C, Pinzon AL, Stronks K, Waterlander W, et al. Applying systems thinking in youth-centred participatory action research for health promotion in an underserved neighbourhood. Frontiers in Public Health. 2024;Volume 12 – 2024. – [link](https://pubmed.ncbi.nlm.nih.gov/38887247/)
● Luna Pinzon A, Waterlander W, de Pooter N, Altenburg T, Dijkstra C, Emke H, et al. Development of an action programme tackling obesity-related behaviours in adolescents: a participatory system dynamics approach. Health Research Policy and Systems. 2024;22(1):30. – [link]
● Luna Pinzon A, Stronks K, Dijkstra C, Renders C, Altenburg T, Den Hertog K, Kremers SPJ, Chinapaw MJM, Verhoeff AP, Waterlander W. The ENCOMPASS Framework: A Practical Guide for the Evaluation of Public Health Programmes in Complex Adaptive Systems. Int J Behav Nutr Phys Act. 2022;19:1–17. doi: 10.1186/s12966-022-01267-3. – [link]
● De Pooter N, Luna Pinzon A, den Hertog K, Altenburg T, Busch V, Dijkstra C, et al. Monitoring and adaptation of a system dynamics approach to prevent childhood overweight and obesity: findings from the LIKE programme. Health Research Policy and Systems. 2025;23(1):30. – [link]
● Luna Pinzon A, Stronks K, Verhoeff A, Vaandrager D, den Hertog K, Waterlander W. Applying a participatory system dynamics approach to childhood overweight and obesity in the local context: reflections from the LIKE project. Health Research Policy and Systems. 2025;23(1):66. – [link]
Would you like your project in the spotlight? Contact Eline Meuleman (e.m.meuleman@vu.nl) or Naomi de Pooter (n.depooter@uu.nl).
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