ORCID Profile
0000-0002-7880-5517
Current Organisation
Institute of Environmental Science and Research Ltd
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: MDPI AG
Date: 07-07-2021
Abstract: The Coronavirus pandemic of 2019–20 (COVID-19) affected multiple social determinants of health (SDH) across the globe, including in New Zealand, exacerbating health inequities. Understanding these system dynamics can support decision making for the pandemic response and recovery measures. This study combined a scoping review with a causal loop diagram to further understanding of the connections between SDH, pandemic measures, and both short- and long-term outcomes in New Zealand. The causal loop diagram showed the reinforcing nature of structural SDH, such as colonization and socio-economic influences, on health inequities. While balancing actions taken by government eliminated COVID-19, the diagram showed that existing structural SDH inequities could increase health inequities in the longer term, unless the opportunity is taken for socio-economic policies to be reset. Such policy resets would be difficult to implement, as they are at odds with the current socio-economic system. The causal loop diagram highlighted that SDH significantly influenced the dynamics of the COVID-19 impact and response, pointing to a need for purposeful systemic action to disrupt the reinforcing loops which increase health inequities over time. This will require strong systems leadership, and coordination between policy makers and implementation at local level.
Publisher: MDPI AG
Date: 28-07-2023
Abstract: Many of society’s most pressing problems, such as climate change, poverty, and waste, are categorized as “wicked” problems because they are seemingly resistant to change. Interventions designed to address these problems can produce unintended consequences, which then perpetuate the problem. Evaluating the effectiveness of such interventions is challenging and requires understanding of the social systems in which the problems are embedded. Multimethodology approaches can support such holistic understanding by combining different methodologies which complement and overlap with each other. This article reports on a study that combined two different methodologies—realist review and qualitative system dynamics. The result was a program theory for waste minimization interventions in Aotearoa New Zealand and a causal loop diagram, which allowed us to identify potential leverage points for change. The two methodologies highlighted different aspects of the problem in complementary ways. For ex le, the first program theory proposition emphasized the important role of people who were critically conscious of the need for sustainability, while the causal loop diagram showed that there needed to be enough critically conscious people for change to be embedded in the system. The program theory’s third and fourth propositions noted the important role of leadership and resource allocation in shifting interventions away from waste management initiatives, such as recycling plastic bags, towards waste minimization initiatives, such as banning single-use plastic bags. The causal loop diagram demonstrated why resource allocation to waste management initiatives, such as recycling, are not effective in addressing the overall problem of waste by showing the feedback loops that operate in the system. Such insights show that realist reviews and qualitative system dynamics can usefully complement each other for greater understanding of wicked problems.
Publisher: Springer Science and Business Media LLC
Date: 07-09-2020
DOI: 10.1186/S12889-020-09446-2
Abstract: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews ( n = 63) and focus group discussions ( n = 12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.
Publisher: SAGE Publications
Date: 2021
Abstract: The effects of waste on the environment and human health continue to increase despite behavioral, technological and policy actions for the management and minimization of waste. We plan to undertake a realist review of waste management and minimization interventions within New Zealand to inform effective approaches to waste minimization and management interventions. This protocol paper describes the steps of the realist review, including the objectives, theoretical frameworks and steps used. Realist review is a theory guided approach that seeks to understand the context-mechanism-outcome configuration of an intervention and generate insights on what works for whom, under what conditions and how. The protocol presents an integrated working theoretical framework comprising of three social theories (Social Learning Theory, Collective Action Theory and Social Practice theory), set within an indigenous Māori implementation framework, He Pikinga Waiora. The initial program theory generated from a first stage rapid review is presented. This initial program theory will be tested through a full literature review and analysis, as well as participatory sense making workshops with key stakeholders. The review will help to generate insights on the generative causal mechanisms of waste minimization interventions in the context of New Zealand. This protocol emphasizes the initial program theory of change as a starting point for further review and design of improved interventions for waste minimization. Through identifying and testing the program theory, with insights from both indigenous and social practice theories, the proposed review will support the design of policies, programs and activities required to achieve the desired outcome of waste minimization in the context of New Zealand.
Publisher: SAGE Publications
Date: 12-04-2021
DOI: 10.1177/17579759211001718
Abstract: Non-communicable diseases (NCDs) are a rapidly emerging global health challenge with multi-level determinants popularly known as social determinants. The objective of this paper is to describe the in idual and community experiences of NCDs in the two case districts of Nepal from a social determinants of health perspective. This study adopted qualitative study design to identify the experiences of NCDs. Sixty-three interviews were conducted with key informants from different sectors pertinent to NCD prevention at two case districts and at the policy level in Nepal. Twelve focus group discussions were conducted in the selected communities within those case districts. Data collection and analysis were informed by the adapted Social Determinants of Health Framework. The research team utilised the framework approach to carry out the thematic analysis. The study also involved three sense-making workshops with policy level and local stakeholders. Three key themes emerged during the analysis. The first theme highlighted that in iduals and communities were experiencing the rising burden of NCDs and metabolic risks in both urban and rural areas. The other two themes elaborated on the participant’s experiences based on their socio-economic background and gender. Disadvantaged populations were more vulnerable to the risk of NCDs. Further, being female put one into an even more disadvantaged position in experiencing NCD risks and accessing health services. The findings indicated that key social determinants such as age, geographical location, socio-economic status and gender were driving the NCD epidemic. There is an urgent need to take action on social determinants of health through multi-sectoral action, thus also translating the spirit of the recommendations made a decade ago by the Commission on Social Determinants of Health in addressing a complex challenge like NCDs in Nepal.
Publisher: Oxford University Press (OUP)
Date: 10-06-2021
Abstract: Public health problems are often complex and ‘wicked’ in nature. Wicked problems have multi-factorial causation, are dynamic and often understood and acted upon differently by different actors. Multi-sectoral collaboration is increasingly emphasized for tackling wicked problems through developing a strategic multi-sectoral plan and then taking collective action. Critical systems thinking can support the development of a shared perspective of the problem, strengthen participation in collective action and foster reflective practices to continuously improve both problem understanding and action. In this paper, we present a critical collaboration model, drawing together two complementary theoretical frameworks, as well as insights from three case studies from New Zealand, to offer a systematic approach to adopting a critical systems perspective in public health collaboration. The model provides six questions to make explicit in iduals’ understandings or assumptions about how others perceive an issue, problem or evidence, and the process of identifying answers strengthens the dialogical and reflective aspects of the collaboration. We indicate some potential areas for the application of the model to integrate critical systems thinking in collaborative practices.
Publisher: Springer Science and Business Media LLC
Date: 03-04-2014
Publisher: Research Square Platform LLC
Date: 29-08-2020
Abstract: Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.
Publisher: Research Square Platform LLC
Date: 19-08-2020
Abstract: Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.
Publisher: Research Square Platform LLC
Date: 29-04-2020
Abstract: Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study was a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (policy, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key interacting themes emerged during the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on prevention by health systems and policy influence of tobacco and alcohol companies were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. These interacting themes were utilised to develop causal loop diagrams and system archetypes. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and policy influence. A multi-sectoral response led by the health system is urgently needed.
Publisher: Public Library of Science (PLoS)
Date: 06-02-2023
DOI: 10.1371/JOURNAL.PONE.0281355
Abstract: Unhealthy dietary habits and physical inactivity are major risk factors of non-communicable diseases (NCDs) globally. The objective of this paper was to describe the role of dietary practices and physical activity in the interaction of the social determinants of NCDs in Nepal, a developing economy. The study was a qualitative study design involving two districts in Nepal, whereby data was collected via key informant interviews (n = 63) and focus group discussions (n = 12). Thematic analysis of the qualitative data was performed, and a causal loop diagram was built to illustrate the dynamic interactions of the social determinants of NCDs based on the themes. The study also involved sense-making sessions with policy level and local stakeholders. Four key interacting themes emerged from the study describing current dietary and physical activity practices, influence of junk food, role of health system and socio-economic factors as root causes. While the current dietary and physical activity-related practices within communities were unhealthy, the broader determinants such as socio-economic circumstances and gender further fuelled such practices. The health system has potential to play a more effective role in the prevention of the behavioural and social determinants of NCDs.
Publisher: SAGE Publications
Date: 09-2017
Abstract: Developing countries such as Nepal are experiencing a double burden of communicable and non-communicable diseases (NCDs) resulting in social and economic losses. In Nepal, more than half of the disease burden is due to NCDs. The major NCDs in Nepal are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Behavioural factors such as tobacco use, alcohol consumption, physical inactivity and unhealthy diet are driving the epidemic of NCDs, which are further influenced by social, economic and environmental determinants. The health system of Nepal has not been able to address the ever-increasing burden of NCDs. With the formulation of the Multisectoral Action Plan for Prevention and Control of NCDs 2014–2020, there has been some hope for tackling the NCDs and their social determinants in Nepal through a primary prevention approach. This paper discusses the systemic challenges and recommends two key actions for the prevention and control of NCDs in Nepal.
Publisher: Research Square Platform LLC
Date: 15-10-2019
Abstract: Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal contributing to rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health system. Systems approach has potential to facilitate understanding of such complex causal mechanism. The objective of this paper was to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study was a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n-12) at different levels (policy, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study based thematic analysis using framework approach and development of causal loop diagram. The study also involved three sense making sessions with key stakeholders. Results: Five key interacting themes emerged during the data analysis. Habit and misconception relating to alcohol and tobacco use contributed to the use and addiction of tobacco and alcohol. Low focus on prevention by health system further contributed to the problem. Decline in community capital and gendered social constructs influenced tobacco and alcohol use. Socio-economic status of families/communities was discussed as a potential root cause of use and addiction of tobacco and alcohol. These interacting themes were utilized to develop iterative causal loop diagrams showing the influence of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Conclusion: Tobacco and alcohol use and addiction causally linked broader social determinants (social, economic and political) to NCD in the context of Nepal. These CLDs showed how socio-economic circumstances was influencing addiction and availability of tobacco and alcohol products in Nepal. A multi-sectoral response led by health system is urgently needed.
Location: New Zealand
No related grants have been discovered for Sudesh Raj Sharma.