System Health: An Evaluation Framework

Climate change, biodiversity loss, ocean acidification and rising pollution are all clear signs that humanity is damaging the health of the global biosphere ¹. In doing so, we are undermining our own health² and undermining the ability of the biosphere to support us¹.

In A theory-based approach to designing interventions for Planetary Health, Brouselle et al. proposed a practical approach to designing interventions that should result in healthier outcomes for both human and natural systems.

In this whitepaper, we explore another related approach: a universal framework for evaluating interventions (i.e. policies and projects) that centralizes 'health' as the single metric of concern. We use 'health' as a catchall for human health, systemic resilience, adaptability, and positive environmental impact. A healthy system is stable, adaptable, and in a harmonic flow with its environment³.

This approach marks a shift from current evaluation systems that tend to reflect narrow policy goals, fail to incorporate systemic responses (i.e. unintended consequences), employ politically charged language that inadvertently escalates harmful socio-political dynamics, or rely on overly complicated concepts that are inaccessible to some stakeholders. ⁴

Herein, we propose an evaluation framework that:

• can be successfully applied across domains to all types of open systems (i.e. systems that interact with their environment), and socio-technical systems in particular,
• aligns with established sustainability and development goals and values, including the UN Sustainable Development Goals (SDGs)),
• leverages the universal and politically neutral concept of health,
• can be understood (and applied) intuitively to ensure broad stakeholder engagement and relatability.

Our goal is beneficial societal system change. We envision an ecosystem of projects, policies, and technology that produce healthier outcomes for humans and and their environment.

1. What is 'System Change'?

1.1. What do we mean by 'system'?

A system is a set of interacting or interdependent components forming an integrated whole. A system can be a living organism, a machine, a social group, an ecosystem, a market, a community, a government, a business, a family, a computer, a computer network, etc.

Human society can be understood as a system of systems, a vast ecosystem of humans and their technology, what Eric Smith referred to as sociotechnical systems⁵.

Sociotechnical systems are what Nobel prize-winning chemist Ilya Prigogine called "dissipative systems" ⁶: subject to the laws of thermodynamics, constantly changing and adapting to their environment, while also changing their environment in turn.

1.2. What do we mean by 'system change'?

Change in such systems follows the introduction of disturbances or fluctuations, like new technologies or social innovations, leading to phase transitions where the system reorganizes at a higher level of complexity. This reorganization is analogous to how chemical or biological dissipative systems evolve when subjected to external or internal fluctuations. These fluctuations might be policy changes, new technology, or shifts in societal values or conceptual models, leading to a new order or structure that is better adapted to its environment.

Positive (or reinforcing) feedback mechanisms play a crucial role in the dynamics of dissipative systems by amplifying changes and driving the system away from its current state toward a new state. This mechanism is essential for the evolution and self-organization of the system, as it allows small perturbations to grow, potentially leading to significant transformations.

In sociotechnical systems, a positive feedback loop can accelerate a particular process or trend once it is initiated. For example, in economic systems, an initial increase in demand for a product can lead to increased production, which might lower costs and further boost demand, thereby creating a growth cycle. Similarly, in social networks, the more people join a platform, the more valuable it becomes to others (network effect), attracting more users and fueling the rapid expansion and evolution of the network.

1.3. Homeostasis, Allostasis, and Balance

Homeostasis is a state of equilibrium or stability where the system actively maintains its internal stability by adjusting its processes and behaviors in response to changes in its environment.

Allostasis refers to the process by which a system maintains stability (homeostasis) through change, adapting to predictable and unpredictable challenges. When applied to dissipative sociotechnical systems, allostasis can describe how these systems adapt and maintain functionality amidst significant internal or environmental changes. An allostatic system does not merely strive to return to a previous equilibrium state but instead adjusts to new conditions and stresses, establishing a new balance while remaining functional and viable.

Both of these terms are used to describe a system's ability to maintain its balance (ie. its stability and functionality), but they differ in their approach to environmental or internal disturbances. Homeostasis reflects a system's ability to maintain stability by resisting change and returning to a previous state, while allostasis reflects a system's ability to maintain stability by adapting to change and establishing a new balance.

A healthy system uses both strategies, maintaining stability through homeostasis when possible and adapting to change through allostasis when necessary. The ideal balance between these strategies depends on the system's context and the nature of the changes it faces, at any given point in time.

H = (S + A)/2

where 
0 ≤ S ≤ 1
0 ≤ A ≤ 1

where H is the system's health, and S and A are the system's homeostatic capacity (or range of stability) and allostasic capacity (or range of adaptability), respectively.

Allostasis in sociotechnical systems reflects how these systems respond adaptively to changes and stresses by reorganizing and evolving rather than merely attempting to resist change or return to a previous state. Positive feedback loops are integral to this process, as they can lead to rapid reorganization and adaptation, helping the system to navigate and stabilize in new and potentially more complex environments. This adaptive change is crucial for the resilience and evolution of sociotechnical systems, enabling them to respond to and integrate changes from their environment to sustain their ongoing development and functionality.

4. Defining Health - Current Models

We've begun describing a system's definition of health. Next, we'll look at medical definitions of health. Ideally, we can find a way to understand the human organism as a dissipative system, and apply lessons from medicine to sociotechnical systems and vice versa. A universal definition of health with the goal of aligning it with our systems model. Various models conceptualize health, starting with the WHO's normative definition, emphasizing a "state of complete physical, mental, and social well-being."

5.1. The Biomedical Model of Health:

The Biomedical Model is an approach that posits that health is "the absence of disease." According to the biomedical model, 'disease' is considered to be any pathogen that causes a disturbance to the normal or natural functioning of the body, and ill health results from physical or biological factors, including injury, pathology, or genetic abnormalities. It is grounded in modern Western medical treatment and often involves diagnosing and treating illnesses with a strong emphasis on medication, surgery, or other medical interventions.⁷

• Key Features: This model focuses primarily on physical processes that affect health, such as pathology, biochemistry, and disease physiology. It does not consider the role of social factors or individual subjectivity, emphasizing illness from a purely biological standpoint.
• Limitations: Critics of the biomedical model argue that it neglects the psychological, environmental, and social influences on health, which are often critical in the onset and progression of illness. ⁸

5.1. Social Determinants of Health Model:

This model acknowledges that social, economic, and environmental factors significantly impact an individual's health outcomes. It suggests that societal factors—such as education level, income, housing, gender, ethnicity, and geography—are instrumental in determining the health of individuals and communities.

• Key Features: It encompasses various social and economic injustices that lead to health disparities and emphasizes the need for societal change to promote health equity and improve public health outcomes.
• Limitations: The complexity of social interactions makes it challenging to create definitive causal links between social factors and health outcomes. Also, this model requires multi-sectoral policy responses, which can take time to coordinate. ⁹

6. A Systems Model of Health

6.1. First, Let's talk about Recursive Definitions

Recursive definitions are particularly useful in the context of complex dynamic systems for several reasons:

1. Clarity and Simplicity: Recursive definitions help simplify complex structures by defining them in terms of more minor instances of themselves, making it easier to understand and analyze the system's behaviour, and allowing us to focus on the simple case and the rule for building up complexity.

2. Self-Similarity: Many complex dynamic systems exhibit self-similar structures, where the whole system has a similar pattern to one or more of its parts. Recursive definitions naturally capture this self-similarity, making them ideal for describing fractals, certain types of networks, and other systems where self-similar patterns occur.

3. Hierarchical Organization: Recursive definitions can express the hierarchical nature of complex systems. By defining a system in terms of its components, which in turn are defined in terms of their components, and so on, recursive definitions can capture the multi-level structure of complex systems.

4. Modeling Dynamics: In dynamic systems, the state of the system at one point in time often depends on its state at previous points in time. Recursive definitions can model this by defining the system's state at time (t) in terms of its state at time (t-1), (t-2), etc. This approach is beneficial in systems where the past predictably influences the future.

5. Computational Efficiency: In computational models, recursive definitions can be efficient for memory use and computation. They allow the representation of complex structures with minimal code and can be computationally efficient when implemented with techniques like memoization.

6. Solving Complex Problems: Recursive approaches are often used in algorithms to solve complex problems, breaking them down into simpler sub-problems. This strategy is seen in divide-and-conquer algorithms, where a problem is divided into smaller pieces, each solved recursively and then combined to form a solution to the original problem.

7. Defining Infinite Structures: Recursive definitions allow for the description of potentially infinite structures in a finite manner, particularly useful in theoretical computer science and mathematics, where such structures are common.

8. Simplification of Complexity: Complex dynamic systems often exhibit behaviour that emerges from the interaction of numerous interdependent components. Recursive definitions help break down this complexity into more manageable, self-similar parts, enabling a clearer understanding of the overall system.

9. Modularity and Scalability: One can create a modular and scalable evaluation framework by defining system components recursively. This modularity means that the same evaluation criteria can be applied at different scales or levels of the system, facilitating a consistent assessment approach across various subsystems.

10. Hierarchical Understanding: Recursive definitions align well with the inherently hierarchical nature of many dynamic systems, where processes at one level are built upon processes at a lower level. This alignment helps construct a multi-layered evaluation framework that mirrors the system's hierarchy, allowing for targeted analysis at each level.

11. Predictive and Analytical Power: In dynamic systems, understanding the rules at one recursion level can provide insights into the system's behaviour at a higher level. This property is crucial for predictive modelling and analysis within an evaluation framework, as it allows for the extrapolation of system behaviour based on its recursive structure.

12. Adaptability and Feedback: Recursive definitions facilitate the incorporation of feedback mechanisms into the evaluation framework, which is essential for dynamic systems that evolve over time. By understanding how outcomes at one stage feed back into the system, evaluators can better adapt their frameworks to capture these evolving dynamics.

In essence, recursive definitions provide a powerful tool for deconstructing and understanding the complexity of dynamic systems, making them invaluable in crafting compelling and nuanced evaluation frameworks.

By leveraging recursion, researchers and practitioners can construct and deconstruct complex dynamic systems, analyze their behaviour, and design solutions to problems within these systems in a manageable and structured way.

6.2. A Recursive Definition of Health

Base Case: An elementary system is healthy if it maintains a stable state without any interaction with an external environment (i.e., it retains structural and functional integrity independently). This hypothetical scenario is primarily to establish a foundational concept of health.

Recursive Case: A more complex system existing within an environment is healthy if it meets the following criteria:

1. It maintains its structural and functional integrity (per the base case).
2. It contributes positively to the health of its surrounding environment, meaning its actions or existence should facilitate the maintenance or enhancement of the environment's structural and functional integrity.
3. It is, in return, positively influenced by the health of its environment, meaning the system's health is, in part, a reflection of the health of its surrounding environment.

Using this recursive definition, we continuously evaluate a system's health based on its interaction with its environment and its ability to contribute to its health, forming a feedback loop characteristic of systems theory.

The cancer cell example fits as a counter-example in this framework: While a cancer cell may maintain its structural and functional integrity (seemingly "healthy" from a narrowly defined, internal perspective), it fails criterion 2 as it harms the surrounding environment (the body it inhabits) by uncontrollably proliferating, consuming excessive resources, and often, secreting harmful substances. Additionally, by harming its environment, it sets conditions for its eventual demise, failing criterion 3, as the environment's deterioration (due to the cancer's harmful influence) ultimately undermines the cancer's long-term health.

This definition attempts to encompass the interdependence of a system and its environment in determining "health," highlighting the necessity for balance and positive contribution to sustained health in a broader ecological and systemic context.

This paper proposes defining health as a system's resilience and its positive contribution to the health of its environment. And resilience is understood to mean a system's ability to maintain its balance amidst external shocks and change when the needs and structure of its environment; or, put another way, "the capacity of a dynamic system to adapt successfully to disturbances that threaten the viability, the function, or the development of that system." ¹⁰

An important thing to note is that this is a recursive definition, and it demands an analysis that extends beyond the immediate system to its broader community and environmental context and impact.

1.4 System Change by Design

Humans can design and implement interventions that can cause system change. These interventions can be policies, projects, technology, or other activities designed to cause a reinforcing feedback loop that will eventually change the structure and function of a system or stabilize it in a new and better-adapted state.

In system change design, the standard process is to

1. Understand the context: Map or model the system with tools like System Dynamics, Agent-Based Modeling, or Network Analysis to understand the system's structure and function, and to identify the reinforcing feedback loops that are driving the system's current state),
2. Identify the goal: Specify what we want the system to look like after the change,
3. Identify leverage points: Specify components of the system that are particularly vital to the system's overall function and are also accessible to manipulation,
4. Design Interventions: Design interventions as reinforcing feedback loops that will cause sufficient structural changes to a subsystem to cause structural changes to the larger system, and so on, until the ecosystem is in a new state,
5. Support the change: Design simultaneous interventions that will support the primary feedback loop(s) through its various stages, and
6. Stabilize the system: Design other interventions to stabilize it in its new state.

Like a doctor prescribing a remedy to a patient, our goal is to interrupt the current, unhealthy functioning of the community or market with policies or projects that will put it on a path to better health.

2. The Role of Evaluation in System Change

Evaluation can be a powerful leverage point in shaping the trajectory of sociotechnical systems. Wielded by policy makers, designers, and funders, evaluation can serve as a critical mechanism for providing feedback that either reinforces ongoing changes or introduces balancing feedback to stabilize the system in a newly adapted state.

1. Reinforcing Feedback through Evaluation: Evaluation, especially involving stakeholders, creates reinforcing feedback loops that drive system change. For instance, when an evaluation reveals that a prototype is yielding positive outcomes, this can attract more investment and interest from various stakeholders. Increased funding and resources amplify the adoption and refinement of the innovation, driving further change within the system. Stakeholder engagement during this process ensures that the feedback is rooted in diverse experiences and expectations, which can accelerate the adoption and scaling of successful innovations.

2. Balancing Feedback to Stabilize the System: On the flip side, evaluation can also provide balancing feedback, which is crucial for keeping it aligned with broader goals and stabilizing the system after it changes. Suppose evaluations indicate that specific changes are leading to unsustainable practices or adverse outcomes. Adjustments are then triggered to mitigate risks or dampen the pace of change.

3. Stakeholder Engagement for Adaptive Learning: Stakeholder engagement in the evaluation process ensures consideration of multiple perspectives in assessing the performance and impact of changes within the system. This inclusive approach fosters a deeper understanding of how changes manifest on the ground, allowing for more nuanced and adaptive strategies for system improvement. It ensures that the system's evolution is aligned with the needs and values of those it serves, enhancing the system's relevance and effectiveness.

4. Evaluation from Funders: Funders often have a broad view of the fields they invest in, enabling them to provide strategic feedback that can guide large-scale system change. Their evaluations can highlight emerging best practices, identify areas for improvement, and set new benchmarks for success. By tying funding to specific outcomes or practices, funders can significantly influence the direction and pace of change within sociotechnical systems, encouraging innovation and adaptation while ensuring accountability and alignment with broader goals.

3. Health as the Evaluating Frame

Assuming we have made a compelling argument for 1) the inevitability of system change, and 2) the role of evaluation in guiding system change to desired outcomes, the focus becomes: What kind of evaluation framework do we need to steer social system change to the most significant benefit for humanity and the natural world?

What follows is an argument for why 'health' is a robust frame for provoking adaptive change in sociotechnical systems that also serve our highest goals.

Health is a paradigmatic concept. As an overriding value of all life, health is an evolutionarily honed instinct. Our intuitive understanding of the concept is so deeply ingrained that it transcends cultural, political, and economic boundaries.

Unfortunately, modern humans have built a complex sociotechnical ecosystem on top of the natural world, becoming so disconnected from our environment that we have lost our ability to evaluate whether any given activity or policy is health-promoting. Nevertheless, there is still time for a reset. It is time to adapt our felt sense of health to the new world we have created.

• Political Neutrality: Health, when defined systemically, avoids political or cultural bias, focusing on holistic and objective outcomes. It surpasses parochial interests, enabling projects to align with broader, universally valued objectives.

• Universality Across Domains: Systemic health applies across all domains, given that each operates as a system comprising interdependent components. This universality allows for consistent evaluation criteria, regardless of a project's focus area.

• Intuitive Understanding: The concept of health resonates with human experience, allowing stakeholders to connect with project goals and outcomes on a fundamental level. This intuitive connection fosters deeper engagement and facilitates more transparent participant communication and understanding.

6.3 Limiting Scope: The Markov Blanket

However, how far should the analysis go? A system's health depends on (and impacts) the health of systems within systems. Should we look at the system's health and its impact on community, regional, national, and global networks, and so on?

The concept of the Markov blanket, derived initially from statistical mechanics, is used in various fields, including system theory and biology, to describe the boundary of a node in a system that represents all the variables relevant to that node, separating it from external influences.

Suppose we consider a project as a node in a Bayesian network. In that case, we can limit our evaluation to immediate dependencies (parents), its effects (children), and the other entities influencing those effects (parents of children). This approach streamlines analysis, delimiting it to the most relevant variables.

Here is how we do it:

1) Evaluate the project's impact on the health of stakeholders (their health as individuals): This can be seen as part of the "children" in the Markov blanket. How the project directly affects the health of individuals involved is a consequence (outcome) of the project's actions and state. The project directly influences these individuals, and changes in their health might be given as input, affecting future states of the project through various adjustments and adaptations (for example, improved safety protocols in response to health risks).

2) Evaluate the project's health: This represents the internal state of the node itself. The project's health is determined by how well it maintains dynamic equilibrium or resilience when faced with challenges, adaptability, and ability to effectively and efficiently achieve its objectives. This aspect is influenced by both the "parents" (inputs that directly affect the project, like resources, stakeholder engagement, and environmental conditions) and the "children" (outcomes of the project actions).

3) Evaluate the project's impact on the health of its environment: This can be viewed as part of the "parents" and "children" in the Markov blanket. As a "parent," the environment provides input that affects the project's health (e.g., rules, resources, cultural context). As a "child," the environment is also affected by the project's outputs and activities (e.g., ecological impact and socioeconomic changes). This interrelationship indicates the system's interconnectedness, where the project's outputs become inputs for its environment and vice versa.

7. The Health Evaluation Framework in Practice

Check out the Appendix at the end of this post for the entire survey.

7.1 The Importance of Intuition and Simplicity in Evaluation Design

The framework utilizes intuitive questions to leverage evaluators' inherent understanding of health, ensuring inclusivity and accessibility of the evaluation process while capturing meaningful input across all stakeholders.

7.2 Three Questions

The proposed framework, using a Likert scale approach, simplifies the evaluation to three questions, each answered on a -3 to +3 scale:

1. What are the health impacts of this project on you, personally?
2. What is the health of the project itself?
3. What is the health impact on the project's environment (i.e. community and local ecosystem)?

This approach captures direct, project, and environmental health impacts and leverages human intuition, thereby gathering rich, experiential data. The simplicity of this method encourages broader participation and captures more honest, less analytically hindered perspectives.

Question 1. Personal Health Impact:

• "On a scale of -3 to +3, how would you rate the project's impact on your personal health, where -3 is a very negative impact, 0 is no impact at all, and +3 is a very positive impact?"

Responses highlight personal experiences, reflecting the direct effects of the project on individuals' physical, mental, and social well-being. High variability in scores may indicate unequal impacts, which is crucial for understanding inclusivity and equity considerations within the project.

Question 2.Project Team's Health:

• "On a scale of -3 to +3, how would you rate the project's impact on the health and well-being of the project team members, where -3 is a very negative impact, 0 is no impact at all, and +3 is a very positive impact?"

Responses will reveal the perceptions of how the project affects those working on it directly. Positive scores indicate a healthy work environment, good team morale, and effective management, which are critical for sustainable operations and the project's long-term success. Negative scores highlight stress, burnout, or dysfunction that must be addressed.

Question 3. Community Health Impact:

• "On a scale of -3 to +3, how would you rate the project's impact on the community's health, where -3 is a very negative impact, 0 is no impact at all, and +3 is a very positive impact?"

Responses reveal the broader impact of the project beyond immediate stakeholders. Positive impacts indicate community benefits, alignment with local needs, and social approval, enhancing the project's social license to operate. Negative impacts signal potential issues with community relations, environmental health implications, or other externalities that need addressing.

8. What the Assessment Reveals:

Together, these questions provide a 360-degree view of the project's health dynamics, considering internal (team) and external (personal and community) impacts.

• Identifying Areas for Improvement: Differences between these scores can also be revealing. For instance, if the project team's health scores are high, but the community health impact scores are low, it might indicate a disconnect between the project's operations and the community's needs or experiences. Such discrepancies are essential for identifying blind spots and areas for improvement.

• Informing Strategy and Communication: These scores can inform not only direct health-related strategies but also communication efforts, stakeholder engagement, and broader operational and strategic directions. They can serve as a barometer for stakeholder sentiment, clearly indicating where efforts are working and where they are not.

9. Practical Application: Using Health as a Metric in Project Evaluation

Consider a prescribed burn wildfire mitigation project. Evaluators would assess the project's 'health' by its resilience to changing conditions (e.g., weather), its adaptability (e.g., altering strategies based on real-time data), and its positive contribution to environmental health (e.g., reducing long-term wildfire risk, promoting forest regeneration).

Stakeholders, ranging from project team members to local residents, would answer the three questions. Personal health impacts might involve temporary inconveniences versus long-term safety benefits. Evaluating the project's health could involve assessing team preparedness, strategic execution, and response to unexpected developments. Environmental health impact analysis would encompass immediate effects on air quality, wildlife, and vegetation against the backdrop of future wildfire risk reduction and ecosystem benefits.

By encapsulating immediate to long-term impacts, this intuitive, three-question framework offers a comprehensive, accessible, and nuanced tool for evaluating projects aimed at social good. It transcends traditional metrics, emphasizing systemic health and universal human values, encouraging more comprehensive application for diverse, meaningful initiatives.

10. Appendix: Surveys and Prompts

10.1 The Survey

Subject: Introduction to Our Health Impact Survey: A Holistic Approach to Evaluating Project Value

Dear [Participant's Name/Community Member/Colleague],

We are excited to introduce you to our innovative Health Impact Survey, an integral part of our evaluation framework for [Project Name]. This survey is designed to assess the project's value, not just through traditional metrics, but by focusing on health — a vital indicator of sustainable success and positive impact.

In this evaluation framework, we define "health" broadly, recognizing its complexity and the many factors that contribute to it. Health, as we consider it, is not merely the absence of illness; it encompasses physical, mental, and social well-being. It relates to individuals (personal health), groups (such as our project team), and the larger population (community health). Moreover, health indicates the resilience and adaptive capacity of individuals and communities to maintain balance and thrive amidst change or challenges.

A project's value extends beyond conventional performance indicators like cost-effectiveness and time management. While these factors are essential, they don't capture the full picture. Our project's impact on health offers deeper insights into its effectiveness and sustainability. Positive impacts on health signal a project that not only meets its immediate objectives but also contributes to the well-being of individuals, fosters a thriving project team, and supports the holistic health of the community. Conversely, identifying any negative impacts allows us to address these issues proactively, showcasing our commitment to continuous improvement and the welfare of all stakeholders involved.

This health-centric approach to evaluating our project's value is effective for several reasons:

1. Comprehensive Understanding: By considering personal, team, and community health, we gain a more holistic understanding of our project's impact. This comprehensive view helps us identify unforeseen consequences, whether beneficial or detrimental and take appropriate actions.

2. Sustainability and Resilience: Projects that contribute positively to health tend to be more sustainable and foster resilience. They support strong relationships, community development, and environmental well-being, creating a supportive ecosystem that sustains long-term success.

3. Stakeholder Engagement: This approach prioritizes the experiences and perceptions of those most closely involved with or affected by the project. By valuing your input and insights, we can align our actions more closely with stakeholder needs and expectations, enhancing the project's relevance and impact.

4. Ethical Responsibility and Reputation: Demonstrating a commitment to health reflects ethical responsibility and can significantly enhance the project's reputation and social license to operate. It shows that the project is not only concerned with its objectives but also with its broader social and ethical implications.

Your participation in this survey is crucial. By providing honest feedback, you're helping us understand the project's health impacts from multiple perspectives, which is invaluable for our learning and growth. The survey consists of questions related to your personal health, the project team's health, and the community's health, with a scoring system to quantify the project's impact.

Thank you for contributing to this important evaluation. Your insights will help assess and improve the current project and shape future initiatives, ensuring they are health-oriented, sustainable, and valuable in the most comprehensive sense.

Sincerely,

[Your Name] [Your Position] [Project Name]

10.2 The Survey

Personal Health Impact:

As an integral community member, your personal well-being is paramount to us. We understand that any project, directly or indirectly, can significantly impact the individuals within its sphere. This impact can span various aspects of health, including physical, mental, emotional, and social well-being. By asking about the project's impact on your personal health, we aim to discern whether our activities are enhancing individual health and quality of life or if there are areas where we might be inadvertently causing strain or harm. Your insight is crucial in helping us maintain a human-centric approach, ensuring that the project contributes positively to the lives of those it touches.

Before you respond, please consider a few hypothetical scenarios that might affect your personal health:

1. Imagine that you were to experience a serious health diagnosis. Would this project help or undermine your capacity to deal with that crisis?
2. Suppose you were to lose your job or source of income; would this project help or undermine your capacity to manage the effects?
3. Consider if you were going through a challenging emotional period, like losing a loved one; would your involvement or association with this project provide a sense of community and support, or would it add to your stress?
4. Imagine you wanted to pursue personal development, such as further education or a fitness goal; does this project encourage and facilitate such personal growth?
5. If you were to experience a significant change in your living situation, perhaps due to relocation or changes in family dynamics, would this project contribute to your stability and well-being during this transition?

Question: "Considering the above scenarios, on a scale of -3 to +3, how would you rate the impact of the project on your personal health, where -3 is a very negative impact, 0 is no impact at all, and +3 is a very positive impact?"

Followup: "Please explain your rating. What factors contribute to the project's impact on your personal health, and what factors detract from it?"

**Bonus Question: ** "Besides the direct influence of the project, what other factors or circumstances have been affecting your health and well-being during the project's lifecycle? How do these factors interact with the project's effects on your health?"

Project Health:

The health of our project is multifaceted, encompassing the well-being and cohesion of our team members and the project's resilience in navigating challenges, changes, and unexpected hurdles. This resilience becomes apparent through our ability to adapt to fluctuations in funding, navigate the complexities of public perception and media representation, and steer clear of systemic traps like policy resistance or misaligned goals. By understanding your perspective on the project's health, we can gain invaluable insights into our strengths and vulnerabilities, informing strategies that enhance team welfare, improve adaptive capacities, and ensure our objectives remain aligned with community needs and systemic realities.

Before answering, please consider these hypothetical situations that might challenge the project's health and resilience:

1. Imagine the project were to have trouble with their fundraising; would the project team be able to adapt?
2. Suppose the project receives feedback from the community that shows a significant misunderstanding of the project's goals, leading to resistance from certain community members. Can the project team adapt their approach or messaging to overcome this resistance without losing sight of their original goals?
3. If a key team member were to leave suddenly, does the project have the resilience to cope with such a change without derailing?
4. Imagine a scenario where unexpected legislative changes negatively impact the project's operations. Does the project have the strategic foresight and flexibility to navigate this?
5. Consider a situation where the project faces a sudden surge in demand for its services or products. Can the project scale effectively without compromising on its values and quality?

Question: "Considering the above scenarios, on a scale of -3 to +3, how would you rate the health of the project, considering both the well-being of the team and the project's resilience amid changing environments, where -3 is very poor health, 0 is neutral, and +3 is excellent health?"

Followup: "Please explain your rating. What factors contribute to the project's health, and what factors detract from it?"

Bonus Question: "When considering the resilience and equilibrium of the project, what external influences or conditions, apart from the project's immediate actions, have had a significant impact on the project's health? How have these influences either complemented or conflicted with the project's objectives and operations?"

Community Health Impact:

Our project exists within the broader context of our community, and we are deeply committed to contributing positively to this communal ecosystem. The community's health reflects various factors, including social cohesion, environmental conditions, economic stability, and access to essential services and opportunities. Our inquiry into the project's impact on community health is rooted in our belief that true success lies in uplifting the entire community. Your feedback will help us understand the ripple effects of our project, allowing us to celebrate positive impacts and address areas where our presence may be creating challenges or strains.

Please reflect on these hypothetical scenarios concerning community health:

1. Does the project improve or undermine the community's capacity to respond to a natural disaster?
2. Does the project improve or undermine the community's impact on the health of the environment? For example, does it reduce the community's GHG emissions? Does it help the community protect nature or lead to further harm?
3. Does the project improve or undermine the community's ability to respond to a public health emergency?
4. Consider if the project inadvertently creates social divides or inequalities within the community. Does it foster unity and inclusiveness, or does it contribute to segregation and disparity?
5. Imagine the economy takes a downturn. Does the project contribute to the economic resilience of the community, or does it exacerbate vulnerabilities?

Question: "Considering the above scenarios, on a scale of -3 to +3, how would you rate the impact of the project on the health of the community, where -3 is a very negative impact, 0 is no impact at all, and +3 is a very positive impact?"

Followup: "Please explain your rating. What factors contribute to the project's impact on community health, and what factors detract from it?"

Bonus Question: In addition to the project's direct activities, what other elements in the community or broader environment have been influencing the health of the community? Can you discuss how these elements, in conjunction with the project's actions, might shape the overall health impact on the community?"

References

Footnotes

1. Rockström, J., Steffen, W., Noone, K. et al. A safe operating space for humanity. Nature 461, 472–475 (2009). https://doi.org/10.1038/461472a ↩ ↩²

2. Brousselle, A., McDavid, J., Curren, M., Logtenberg, R., Dunbar, B., & Ney, T. (2022). A theory-based approach to designing interventions for Planetary Health. Evaluation, 28(3), 330-355. https://doi.org/10.1177/13563890221107044 ↩

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