Chapter three

Complexity

ome decades ago researchers were eager to explain things by causal chains whereby everything had its cause. The same was the case with health and disease: each disease had its specific cause, be it bacterial, toxicological or psychological. These causal models were, over time, replaced by multifarious explanations: a disease was the result of several factors working at the same time or in sequence. Perhaps the best example of this thinking has been the diverse nature of heart disease. A plethora of behavioural characteristics, genetic predispositions and psychological factors seem to be involved in this prominent threat to public health.

Simple issues such as smoking have also become entangled in webs of complexity. To be able to understand smoking one needs to wield the knowledge of several branches of science at the same time. Process models have added another dimension to this convoluted situation. Smoking can be seen as a process that is affected by many different factors during a person's lifetime. It serves the needs of people, it helps them socialise and is the key to access to certain groups. This means that we not only have to know about smoking; we have to understand it. This has led to the need for more qualitative information and the demand to listen more intensively to those who know what smoking is all about out of experience.

Postmodern society has been viewed as essentially chaotic. It is sometimes helpful to realise that from the angle of health promotion this is a chaos of processes. But how to survive in this disorder of processes? One way might be to take a closer look at the directions of care less from within the processes themselves, but in order to identify their common elements and through that build support networks for health promoters. Through this prism the various programmes to influence smoking may be more easily realised and their position in the overall puzzle better understood.
Harri Vertio

Complexity Entangled threads The multiple faces of dependency

Smoke Free Europe - A Forum for Networks - 14 AUG 1997

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