A Wicked Public Health Problem of the West: Clinical Perspectives and Organizational Dynamics for Preventing Suicide in Utah
MetadataShow full item record
CitationSobelson, Morissa. 2019. A Wicked Public Health Problem of the West: Clinical Perspectives and Organizational Dynamics for Preventing Suicide in Utah. Doctoral dissertation, Harvard T.H. Chan School of Public Health.
AbstractOur most intractable social problems—like poverty, climate change, and terrorism—are highly complex, contradictory, and cross-cutting. Often termed "wicked” or “adaptive” problems, they differ from the complicated yet resolvable nature of ordinary “tame” or “technical” issues in that there is limited consensus about the etiology of the problem, difficulty deciphering effective responses, a significant degree of overlap with other problems, and a high likelihood of conflict arising between groups trying to solve it. Using a healthcare lens, this DELTA project considers how Utah’s high rate of suicide is an example of a wicked problem, and the implications of such characteristics on efforts to reduce suffering and save lives. The qualitative methodology included: 1) interviews with 30 primary care providers to elicit their experiences, perceptions, and practices regarding suicide assessment and management at a clinical level and to compare their input to a previous study sample of 30 mental health providers; and 2) an ecosystem analysis at Intermountain Healthcare, the non-profit, integrated network that hosted this DELTA project, to understand the organizational and leadership dynamics surrounding suicide prevention at a healthcare delivery system level.
Drawing on analysis of these firsthand perspectives, the research finds that suicide is a wicked problem characterized by a high level of uncertainty surrounding the problem and solutions, a high level of interconnectedness with other problems, and high potential for social and political conflict. It identifies key areas of collaborative action needed to facilitate coherent response, and offers recommendations for the host organization as it embarks on a system-wide initiative to prevent suicide. It concludes that only by focusing the healthcare system, including primary care providers, on population-oriented and collaborative approaches—especially reductions in access to firearms—can Utah begin to move the dial on suicide. This project is the first known in-depth application of the wicked problem framework to the issue of suicide. It offers immediate opportunities for improving collaboration and problem-solving on suicide prevention in Utah, and provides a practical model for actionable applications of research to highly-complex public health problems.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:42066787