Individual Agency vs. Social Structure in Population Health: How Complex Systems Perspectives Can Help Us to Keep the Balance in Research, Praxis, and Policy

Dear Colleagues,

There seems to be a conflict in Population Health Science regarding the priority of systems (upstream) over individuals (downstream) when it comes to theory, methodology, praxis, and policy making in and about the population’s health and health inequalities. This has mostly been the case in the long history of public health where individualistic and behavioural (lifestyle) approaches were the dominant paradigm of scholarship and praxis for decades. However, the dawn of the social determinants approach tilted the leverage towards societal and systemic approaches to population health, and these approaches have become the dominant mode of thinking in current public health (the new public health). The problem with the former paradigm, however, was its blindness to the social context in which a healthy lifestyle takes shape, and the problem with the latter is its relative ignorance to the agency of individuals in shaping and reshaping the social structures/contexts within which individuals (and their health lifestyles) are nested.

In recent decades, a complex systems informed paradigm, in which co-poiesis, co-evolution, reciprocity, and coupling of agency and structure in social systems are the focus, has led to exciting theoretical developments where justice is done to both agency of individuals and structure of social entities at the same time. Morphogenetic social theory of Margaret Archer, habitus theory of Pierre Bourdieu, assemblage theory of Manuel Delanda, actor-network theory of Bruno Latour, dialectic critical realism of Roy Bhaskar, complex realism of David Byrne, and the general framework of complex adaptive systems (CAS) theory are of the best examples of such theoretical developments under the hood of complexity paradigm.

At the same time, a diverse range of methodologies have also been germinated that aim to ease the understanding of complex systems. Soft-system methodologies, system dynamics, network analysis, agent-based modelling, microsimulation, qualitative comparative analysis (QCA), and ergodicity methodologies (e.g., multidimensional recurrence quantification) are of the main methodological developments in the complexity paradigm.

Despite such developments, however, the co-poiesis and coupling of agency and structure in social systems in regard to health, population health, and health inequalities have been of less interest, and complexity science use in population health has so far been mostly limited to its methodological innovations. To be precise, there is a lack of studies in which complexity-informed theories and methodologies sit together to explain the ways agency and structure co-produce each other and, as a result, co-produce health and health inequalities in populations/societies as complex systems. This matter is of huge importance as practices and policies out of such a complexity-informed theory–method fuse can keep the balance in tackling the complex causes of ill health and health inequalities.

The Sustainability journal, therefore, has decided to dedicate a Special Issue to this important topic in population health science and invite scholars and researchers to synthesise a path forward in understanding public’s health through the interplay of agency and structure using complexity-informed theories and methods.

Dr. Jonathan Wistow
Dr. Esmaeil Khedmati Morasae
Guest Editors

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• complex systems
• agency
• structure
• co-poiesis
• population health
• lifestyle
• health inequalities