Systems thinking, especially with simulation models, facilitates understanding of complex health policy problems. Using a simulation model to educate legislators, educators, and health experts about the policies that have the greatest short- and long-term impact should encourage strategic investment in low-cost, high-return policies.

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In response to limited examples of opportunities for state policymakers to learn about and productively discuss the difficult, adaptive challenges of our health system, the Georgia Health Policy Center developed an educational initiative that applies systems thinking to health policymaking. We created the Legislative Health Policy Certificate Program – an in-depth, multi-session series for lawmakers and their staff – concentrating on building systems thinking competencies and health content knowledge by applying a range of systems thinking tools: behavior over time graphs, stock and flow maps, and a system dynamics-based learning lab (a simulatable model of childhood obesity). Legislators were taught to approach policy issues from the big picture, consider changing dynamics, and explore higher-leverage interventions to address Georgia's most intractable health challenges. Our aim was to determine how we could improve the policymaking process by providing a systems thinking-focused educational program for legislators. Over 3 years, the training program resulted in policymakers' who are able to think more broadly about difficult health issues. The program has yielded valuable insights into the design and delivery of policymaker education that could be applied to various disciplines outside the legislative process.

Background:This study analyzed the effect of school practices regarding the provision of physical education (PE) on the physical fitness of children and youth.Methods:Using an untapped sample of approximately 5000 5th and 7th graders from 93 schools in Georgia in 2006, individual-level and merged school-level data on physical education were analyzed. Multivariate regression analyses were conducted to estimate the potential influence of the school environment on measured health outcomes. Controls were included for grade, gender, race/ethnicity, urbanicity, and county of residence.Results:Variables measuring 8 school-level practices pertaining to physical education were found to have significant effects on cardiovascular fitness as measured by the FitnessGram, with signs in the expected direction. These variables, combined with demographic variables, explained 29.73% of the variation in the Progressive Aerobic Cardiovascular Endurance Run but only 4.53% of the variation in the body mass index.Conclusions:School-level variables pertaining to PE practices were collectively strong predictors of physical fitness, particularly cardiovascular fitness. Schools that adopt these policies will likely encourage favorable physical activity habits that may last into adulthood. Future research should examine the causal relationships among physical education practices, physical activity, and health outcomes.

As investments are made to engage communities in childhood obesity prevention efforts, an approach to better understand local communities' readiness to implement evidence-based strategies is needed. The Community Readiness Model (CRM) was used to assess the readiness of 15 communities in Georgia actively working to prevent childhood obesity. Seventy-nine key informant interviews were conducted assessing six dimensions of readiness. Data were analyzed and scored using the CRM protocol. Overall community readiness scores ranged from 2.8 to 5.1 on a 9-point scale. The mean readiness score, 4.3 (SD = 0.5) corresponds with a preplanning level of readiness. Findings suggest that communities are recognizing the problem, organizing stakeholders, and beginning to develop solutions. There is a need for funders to match their community-based funding initiatives with the readiness levels of the communities being supported. Communities should focus their attention to the six dimensions of readiness while utilizing evidence-based frameworks and guidance on prevention.