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SpringerBriefs in Public Health Forfurthervolume: http://www.springer.com/series/10138 Brian Castellani • Rajeev Rajaram (cid:129) J. Galen Buckwalter (cid:129) Michael Ball (cid:129) Frederic Hafferty Place and Health as Complex Systems A Case Study and Empirical Test 2123 BrianCastellani MichaelBall KentStateUniversity KentStateUniversity Ashtabula,Ohio Ashtabula,Ohio USA USA RajeevRajaram FredericHafferty KentStateUniversity PrograminProfessionalismandEthics Ashtabula,Ohio MayoClinic USA Rochester,Minnesota USA J.GalenBuckwalter InstituteforCreativeTechnologies UniversityofSouthernCalifornia PlayaVista,California USA ISSN2192-3698 ISSN2192-3701(electronic) SpringerBriefsinPublicHealth ISBN978-3-319-09733-6 ISBN978-3-319-09734-3(eBook) DOI10.1007/978-3-319-09734-3 LibraryofCongressControlNumber:2014960229 SpringerChamHeidelbergNewYorkDordrechtLondon © SpringerInternationalPublishingSwitzerland2015 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartofthe materialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation, broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionorinformation storageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilarmethodology nowknownorhereafterdeveloped. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevant protectivelawsandregulationsandthereforefreeforgeneraluse. Thepublisher,theauthorsandtheeditorsaresafetoassumethattheadviceandinformationinthisbook arebelievedtobetrueandaccurateatthedateofpublication.Neitherthepublishernortheauthorsorthe editorsgiveawarranty,expressorimplied,withrespecttothematerialcontainedhereinorforanyerrors oromissionsthatmayhavebeenmade. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) About the Authors Brian Castellani, PhD is professor of sociology and head of the Complexity in Health Group, Kent State University. He is also adjunct professor of psychia- try, Northeastern Ohio Medical University and advisory board member, Center for Complex Systems Studies, Kalamazoo College. Dr. Castellani is interna- tionally recognized for his expertise in computational and complexity science method and their application to several key topics in health and health care, including community and public health. He is specifically recognized for his de- velopment (with Dr. Rajaram) of a new approach to modeling, called case-based complexity. And, he is known for developing the SACS Toolkit: a case-based, mixed-methods platform for modeling the temporal and spatial dynamics of com- plex systems, particularly in large and big data. For more on Castellani, see (http://www.ashtabula.kent.edu/about/facultystaff/faculty/∼bcastel3/). RajeevRajaram,PhDisassociateprofessorofmathematicsandresearchmember of the Complexity in Health Group, Kent State University. As a mathematician, Dr.Rajaramisinternationallyrecognizedforhisapplicationsofstabilityandcontrol theoryofdifferentialequationstomodelingavarietyoftopics,includingcommunity andpublichealth. Heisalsorecognized, withCastellani, forhisdevelopmentofa case-basedcomplexityapproachandtheSACSToolkit. FormoreonRajaram, see (http://www.kent.edu/math/profile/rajeev-rajaram). J. Galen Buckwalter, Ph.D. is research scientist, Institute of Creative Tech- nologies, University of Southern California and founding scientist, TidePool (http://www.tidepool.co/).Dr.Buckwalterhashadanextremelyactivecareerbothas anacademicresearchscientistandasanentrepreneurintheprivatesector.Hisaca- demiccareer, withover100peerreviewedpublications, hasfocusedonadvancing the field of psychometrics and personality testing/assessment, and, more recently, resilienceandallostaticload. Michael Ball, MS is research coordinator, Complexity in Health Group, Kent State University. Mr. Ball is gaining an international reputation for multi-agent modeling and machine intelligence, primarily in application to disease transmis- sionandcommunityandpublichealth.FormoreonBall,visit(http://www.personal. kent.edu/∼mdball/). v vi AbouttheAuthors Frederic Hafferty, PhD is professor of medical education and professionalism, Mayo Clinic. Dr. Hafferty is world-renown for his work in medical profession- alism, the sociology of professions and medical education. He is specifically known for his ground-breaking work in the hidden curriculum and its applica- tion to medical education, as well as his development (with Castellani) of a complex systems view of medical professionalism. For more on Hafferty, see (http://www.researchgate.net/profile/Frederic_Hafferty). Preface Overthelastdecade,scholarshavedevelopedacomplexitiesofplace(COP)approach tothestudyofplaceandhealth.AccordingtoCOP,theproblemwithconventional public health research is that it lacks effective theories and methods to model the complexitiesofneighborhoods,communitiesandsoforth,giventhatplacesexhibit nineessential“complexsystem”characteristics:theyare(1)causallycomplex,(2) self-organizingandemergent,(3)nodeswithinalargernetwork,(4)socio-spatially dynamicandevolving, (5)nonlinear, (6)historical, (7)socio-spatiallyopen-ended withfuzzyboundaries,(8)criticallyconflictedandnegotiated,and(9)agent-based. However, whilepromising, theCOPapproachiscurrentlyfacedwithtwochal- lenges:itscomprehensivedefinitionofcomplexityremainssystematicallyuntested; anditsrecommendedcomputationalandcomplexitysciencemethods(e.g.,geospa- tial modeling, social network analysis, agent-based modeling) have yet to be organizedintoacohesiveframework. ThecurrentstudythereforeconductedanexhaustivetestofallnineCOPcharacter- isticsandsuggestedmethods.Toconductourtestwemadetwoimportantadvances: First,wedevelopedandappliedtheDefinitionalTestofComplexSystems(DTCS)toa casestudyoncommunityhealthandsprawl(acomplexsystemsproblem)toexamine, inlitmustestfashion,theempiricalvalidityoftheCOP’s9-characteristicdefinition. Second,weemployedtheSACSToolkit,whichweusedtoorganizethesuggested listofCOPmethodsintoacohesiveframework.TheSACSToolkitisacase-based, mixed-methodsplatformthatdrawsonthelatestadvancesincomputationalandcom- plexitysciencemethodstomodelthetemporalandspatialcomplexitiesofcomplex systems. For our case study we examined a network of 20 communities, located inSummitCounty,OhioUSA.Inparticular,weexaminedthenegativeimpactthat suburbansprawlishavingonthepoorercommunitiesinthiscounty. Ourdatabase waspartitionedfromtheSummit2010:QualityofLifeProject. Overall, we found the COP’s 9-characteristic definition to be empirically valid anduseful.WealsofoundtheSACSToolkittobeaneffectivewaytoemployand organizethemethodsrecommendedbytheCOPapproach.Nonetheless,someissues didemerge. Forexample, theCOPapproachseemsalmostentirelyfocusedonthe complexities of place. As such, it has yet to develop a sophisticated view of how place, health and health care are intersecting complex systems. Also, while it is vii viii Preface usefultothinkofplacesasagent-basedbased(Characteristic9),therearelimitsto this modeling approach, such as its microscopic view of emergent social structure and its restricted (rule-based) view of agency. Still, despite these challenges, the COPapproachseemstoholdrealempiricalpromiseasausefulwaytoaddressmany ofthechallengesthatconventionalpublichealthresearchseemsunabletosolve;in particular,modelingthecomplexevolutionanddynamicsofplaces,andaddressing thecausalinterplaybetweencompositionalandcontextualfactorsandtheirimpact oncommunity-levelhealthoutcomes. Acknowledgements WewouldliketothankDeanSusanStockerandKentStateUniversityatAshtabula foralloftheirfinancialandadministrativesupport. ix Contents 1 TheComplexitiesofPlaceApproach ............................ 1 2 DefinitionalTestofComplexSystems............................ 11 3 Case-BasedModelingandtheSACSToolkit...................... 15 4 Methods ..................................................... 27 5 PlacesAreComplex ........................................... 35 6 PlacesAreEmergentandSelf-Organizing........................ 39 7 PlacesAreNodeswithinLargerNetworks ....................... 47 8 PlacesAreDynamicandEvolving............................... 51 9 PlacesAreNonlinear .......................................... 55 10 PlacesAreSubjectiveandHistorical............................. 59 11 PlacesAreOpen-EndedwithFuzzyBoundaries .................. 63 12 PlacesArePower-BasedConflictedNegotiations .................. 67 13 PlacesAreAgent-Based........................................ 69 14 Conclusion ................................................... 75 References........................................................ 77 Index ............................................................ 81 xi

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