Paper given at the Inaugural World Congress of Environmental Health, Sydney, Australia, 27 September 1988 at which meeting Policy 1 of IFEH, endorsing Alma Ata, was passed. Click for Link
FRED O”BRIEN – Lecturer in Environmental Health, Dublin Institute of Technology. Former Consultant in Public Health Inspection, Ontario Ministry of Health and past Chairman of the Irish Environmental Health Officers’ Association. Professionally qualified in both Ireland and Canada as an Environmental Health Officer. B.A. (Philosophy) University of Waterloo; M.B.A., University College, Galway.
Ronald Spratt (Australia), President IFEH and Fred O’Brien (Ireland), Editor, at the launch of IJEH in Sydney, Australia 1988
The paper explores systems theory as it relates to environmental health management and explains how a systems approach facilitates recognition of the context within which organizations and governments operate, and emphasizes the interrelations among the various activities that are required to accomplish goals.
It argues that managers must design and develop their organizational structure to fit the tasks to be carried out, and that the organizational arrangements for delivery of environmental health services should not be of a mechanistic mode, where highly formalized procedures prevail, but should be organic in character, with the emphasis on group participation.
The paper makes recommendations in relation to national and international strategies for environmental health that rely on collaboration, coordination and input from the social partners and are selected on the basis of their contribution to to human wellbeing in its fullest sense.
Mechanistic Strategies and Fragmentation
Modern man is suffering from a severe fragmentation of his world picture which leads directly to an obsession with isolated parts segmented approaches to problem solving. Increasingly health aspects are being excluded from environmental, agriculture, food, industrial and energy policy decisions and, in many countries, environmental priorities tend to ignore health goals. Ideas have consequences, and, when we pursue the idea that the organization and distribution of business among the various departments of state can be implemented in a sectoral mechanistic fashion the consequences come back to haunt us.
In its Sixth Report on the World Health Situation the World Health Organization (WHO) highlighted the lack of coordination among ministries and among the various levels of government around the world which frequently gives rise to environmental investments with insufficient consideration being taken for their health consequences. It lists the lack of collaboration and coordination at national level as a cause for establishing environmental priorities that tend to ignore health goals.
A recently conducted survey, by WHO Euro, of new and extended hazardous chemical manufacturing facilities in the U.S.A., Canada and Scotland exposed serious deficiencies in the health and safety component of the Environmental Impact Assessments (EIAs) carried out on these plants. None of the EIAs examined assessed the health effects of the atmospheric emissions, or of their combined impact with each other, or with other emissions; and the overall conclusion was that consideration of environmental health effects in these high risk industries was weak.
Subsequent to the showing of the program “Windscale – the Nuclear Laundry” by Yorkshire Television in November 1983 the U.K. Minister for Health established an advisory group, chaired by Sir Douglas Black, to inquire into the possible increased incidence of cancer in the area adjacent to the nuclear reprocessing plant at Windscale (Sellafield). The Advisory Group Report “Investigation of the Possible Increased Incidence of Cancer in West Cumbria”, noting the lack of health input, indicated surprise at “the lack of co-ordination in the assessment of the overall impact of the discharges on the population. Each organization we spoke to had considerable expertise in their particular area of environmental monitoring, but we were unable to identify any organization that had the responsibility for assessing all of the information available and deciding on the overall implication of the discharges with regard to the health of the community.”
In her Editorial in the November/December 1987 issue of the Journal of Environmental Health, Sarah Kotchian deals with the tendency in the USA to downgrade the health element in environmental programs and argues for the reintroduction of health into environmental health.
The Irish Department of Health’s 1987 Consultative Statement on Health Policy “Health – the Wider Dimensions” acknowledges that there is no greater example of a lack of coordination in public administration than that found in the area of environmental health. Having outlined weaknesses in the existing system the report proposes going above departmental level of agreed policy to better provide for the public good.
Sectoral strategies spawn shallow evaluations, ambiguities, overlaps, lack of coordination and blatant failures to assign overall responsibility for the provision of basic services. In the area of health and the environment, in addition to the references and observations listed above, examples of a serious disregard for the public good abound.
While this disregard may be unintentional, an explanation for its cause may be suggested by the late Marshall McLuhan’s thesis that, since the invention of movable type, humankind has received a great proportion of its information from print and has become eye orientated, and distorted in its perception of reality. Nature tends to be viewed as linear and sequential, as made up of separate parts, as fragmented and mechanical. According to McLuhan, were we ear orientated our apprehensive faculties would be more true to nature and we would perceive reality as orchestrated and ecological, which is in keeping with a systems perspective.
Systems Theory and a Systems Approach
While the biologist von Bertalanffy (1952)1 is considered the originator of the general systems theory, elements of the approach can be found in sources going back to ancient times.
Thucydides (c460-c400 BC) interest in science was much encouraged by the new methods instituted by Hippocrates. From him he learned to treat the body politic as analogous to the human body and to accept the corollary that it is impossible to understand the parts without understanding the whole.
Aristotle, in his Nicomachean Ethics, proposes an interlinked hierarchy of means and ends leading to human wellbeing; and again, in the beginning of his “on the Parts of Animals” deals with the nature of specialist and generalist knowledge, referring to the benefits of an overall perspective in judging well in any situation.
For a useful overview of systems theory, a systems approach to management by objectives, and the systems outlook generally refer to Katz and Kahn (1970)2, Mockler ((1968)3, and Weihrich (1977)4.
I intend in my paper to:
1. Briefly introduce the open systems concept;
2. Look at some of the findings in the area of sociotechnical systems and how these may relate to the work of environmental health professionals; and
3. Make some recommendations in relation to international strategies for environmental health that rely on collaboration, coordination and input from the social partners bearing a responsibility in this area.
Technology and Social Structure
In public administration an increasing emphasis on the relationship between the organizational structure and the “technology” or nature of the work being carried out is in evidence. Research findings in this area suggest improved management strategies that have particular relevance to the field of environmental health.
Should work methods and activities be prescribed in detail, or, alternatively, should staff be assigned objectives to be attained? The choice between prescription and discretion will determine the ability of central and local government departments to cater to the needs of their public. Where duties are prescribed the staff are not free to devise new and/or novel techniques and methods. Where objectives are assigned and discretion as to means is the rule then new approaches, methods and techniques can be selected to cater to changing circumstances. How should government services be organized?
The Organization as a System
The concept of the organization as a system has become an important approach in the study of management. A systems philosophy is a way of thinking about complex human endeavors. It facilitates recognition of the context within which organizations operate. It emphasizes understanding the interrelationships among the various activities that are required to accomplish goals. The “open systems” model is a useful framework for understanding organizations and their management and is depicted in Figure 1.
Figure 1 The Organization in its Substantial Environment
The broken line dividing the system from its substantial environment is indicated as being permeable and representing an “open” system.
Systems Concept and the Living Organism Analogy
The systems concept finds a useful explanation in the living organism analogy. From the most simple one-celled bacterium to more complex living organisms one can observe the creature as an “open system” made up of “subsystems”. There are inputs in the form of food, water, oxygen and other material and energy sources. There are the transforming processes of metabolism. And there are outputs of energy and waste products. Subsystems in complex organisms can be identified, such as circulatory, respiratory, digestive, etc..
Human organizations can also be viewed as open systems interacting with their environment. A hospital is an open system made up of subsystems. The patient may be perceived as moving from the community through the hospital and back to the community, with some transforming process taking place within the hospital system. Similarly, student nurses may be viewed as entering the hospital, being transformed by information and practical experience, and leaving the entity as qualified nurses.
In health, the living organism functions as a unified complex of subsystems to the benefit of the total organism. Should an injury or disease attack any subsystem the result has consequences within all the other subsystems of the organism. If the organism cannot maintain its equilibrium – homeostasis – it dies.
As already outlined, human organizations exhibit certain properties akin to those noted in living organisms. An important consequence of viewing entities in this fashion is that it becomes most significant that no part of the organization be examined in isolation. The organization is a complex of subsystems which are interconnected, interrelated and interdependent. If an adjustment is made to one subsystem repercussions extend throughout the whole organization. If the substantive environment within which the entity operates changes, then the entity is affected and tends to adapt, such that a healthy equilibrium is maintained. To a greater or lesser extent the changes in the entity will affect the substantive environment.
Socio Technical Systems
Organizations can be perceived as structured socio-technical systems. “Technology is based upon the tasks to be performed and includes the equipment, tools, facilities, and operating techniques. The social sub-system is the relationship between the participants in the organization. The technological social sub-systems are in interaction with each other and are interdependent.”5
There are social and psychological determinants involved in the formulation of the social sub-system. The task requirements of the organization determine the technical sub-system.
Joan Woodward’s study6 of classical management theory found that line-staff specialization of functions, span of control, number of levels of hierarchy, and staff-worker ratios in 100 British firms had no particular significance as far as organizational success was concerned. What she did find, though, was that her data made sense when all of the firms studied were classified into three productive system categories, no matter what product was involved.
The survey disclosed that “management by committee” was more common in process industry than in the less complex systems. Secondly, “the small spans of control and the long lines of command characteristic of process industry meant that in this type of industry management structure could be represented by a long and narrowly based pyramid. In unit production the pyramid was short and broadly based.”
Burns and Stalker’s study7 into the organization of the electronics industry in Scotland in the 1950’sunderlined the importance of the marketing and social environment in which the firm operates. A firm operating in a mechanistic manner had a good chance of remaining stable and successful if its product market also remained stable; but a turbulent economic environment required a far more informal organization that could quickly produce the appropriate multi-disciplinary task orientated work groups to meet the challenge of change (organic structure). The principles of reporting to only one boss, hierarchical and rigidly separated functional departments, detailed job descriptions and little delegated authority, appear to militate against successful adjustment to rapid change.
This study led them to describe two “ideal types” of management organization which are the extreme points of a continuum along which most organizations can be placed. The mechanistic type is adapted to relatively stable conditions. In it the problems and tasks of management are broken down into specialisms within which each individual carries out an assigned, precisely defined, task. There is a clear hierarchy of control, and the responsibility for overall knowledge and coordination rests exclusively at the top of the hierarchy. Vertical communication and interaction (between superiors and subordinates) is emphasized, and there is an insistence on loyalty to the concern and obedience to superiors.
The organic type of organization is adapted to unstable conditions, where new and unfamiliar problems continually arise which cannot be broken down and distributed among the existing specialist roles. There is, therefore, a continual adjustment and redefinition of individual tasks, and the contributive rather than restrictive nature of specialist knowledge is emphasized. Interactions and communication (information and advice rather than orders) may occur at any level as required by the process, and a much higher degree of commitment to the aims of the organization as a whole is generated. In this system, organization charts laying down the exact functions and responsibilities of each individual are not found, and, indeed, their use may be explicitly rejected as hampering the efficient functioning of the organization.
The impact of technological change at the Durham coalfields was examined by Triste and colleagues8. Their research highlighted the importance of the informal group and they devised strategies to deal with the introduction of new technology so as to reduce friction and low productivity and enhance coordination, status and job satisfaction.
“This study of the effects of technological change led Triste to develop the concept of the working group as being neither a technical system nor a social system, but as an interdependent socio-technical system.”9
Morse and Lorsch looked at the relationship between the social structure and predictability of task, and concluded that “Enterprises with highly predictable tasks perform better with organizations characterized by the highly formalized procedures and management hierarchies of the classical approach. With highly uncertain tasks that require more extensive problem solving, on the other hand, organizations that are less formalized and emphasize self-control and member participation in decision making are more effective. In essence…. managers must design and develop organizations so that the organizational characteristics fit the task to be done.”10
A Social Structure Compatible with the Work Methods
Many organizations have failed to evolve a social structure compatible with their new work methods. Advances in science and technology, growth in the range and complexity of tasks to be performed, and improved levels of education and expertise have resulted in the need for new social arrangements to ensure that duties are more effectively carried out.
In the psychiatric services, with the change from custodial to treatment methods, brought forward with the introduction of the tranquilizing drugs in the early 1950s, the “technology” changed from that characterized by steel bars, padded cells, straight jackets and high walls to a service providing treatment and care, both inside and outside the hospital, and relying on a whole range of new skills, requiring consultation and cooperation among multidisciplinary teams. The tendency to retain old social arrangements in the psychiatric services resulted in significant unrest, industrial disputes and much unhappiness, which can be traced to a mismatch of technology and social structure.
How to move towards a new social structure compatible with the tasks to be performed is not easy to determine. While the socio-technicists can recommend, in general terms, the characteristics of the match, one must still contend with the existing perceptions and aspirations of staff, and their skills and attitudes to change in social structure.
The tendency to define role boundaries appears to work against the need in organic administrative structures to ensure a flexible approach to the carrying out of the work task. The mechanistic approach, to which we appear to be culturally inclined, would have us ensure that each function is neatly packed and placed in its pigeon hole. Additionally, persons who have worked on well defined tasks may not wish to adapt to less well defined roles. In the transition period, where change is planned, staff appear to have to suffer to some extent the process of change. But, hopefully, with retraining and improved communication, social change will be facilitated,
The selection and training of new staff members in the new skills and knowledge required should ensure that, by a process of attrition, the appropriate change will be brought about. This will require conscious planning of structural changes.
Implications foe Environmental Health Management
The choice between opting for a prescriptive or discretionary role for the Environmental Health Officer, or for a blend of both approaches, needs to be examined. When individuals function as enforcement officers prudence directs that they stick rigidly to statutory procedures, lest they overstep their legal authority. However, the professional role of the Environmental Health Officer transcends, by its very nature, the limits of prescriptive detail. The great variety of environmental health problems and challenges encountered require responses of many kinds and require a high level of knowledge, expertise and tact to ensure that optimal solutions are adopted. Environmental health is a function characterized by a wide variety of duties and tasks, so that environmental health officers have to possess a large body of knowledge and range of skills in order to make an effective contribution. In the monitoring of environmental health challenges, the formulation of appropriate responses and the evaluation of results, environmental health professionals must be familiar with the methods of the various sciences and have access to technical resources and information on current environmental health issues. Additionally, the function is susceptible to frequent changes through technical advances, new or changing environmental health problems, legislative requirements and organizational developments.
These characteristics describe a complex and continually evolving situation and suggest that the organizational arrangements for delivery of the service should not be of a “mechanistic” mould, where highly formalized procedures prevail, but should be “organic” in character with the emphasis on group participation. A “Management by Objectives and Results” (MOR) strategy, incorporating the open systems viewpoint, could meet this requirement.
Management by Objectives and Results
Simply stated MOR is a total management system for achieving results. Its three main components are:
Figure 2 illustrates the cycle.
National and International Strategies for Environmental Health – A Systems Approach
“It is a small world. It is one world, and we are each other’s keepers and we are keepers of the whole fragile earth that keeps us all.” Niall O’Brien
“The world belongs to everyone and if it can be healed, that healing will have to be the work of all.” Rosalie Bertell
No society is healthful which tells its members to take no thought for the morrow because the state underwrites its future. Environmental health cannot be successfully promoted by governments and their agencies alone. Some ten years ago now the “Declaration of Alma-Ata”, which introduced the World Health Organization’s “Health for All by the Year 2000” strategy, was drawn up at the International Conference on Primary Health Care held in the Soviet Union. It recognizes that “people have the right and the duty to participate individually and collectively in the planning and implementation of their health care.” Additionally, it seeks to involve, not only the health sector, but all related sectors, singling out in particular agriculture, animal husbandry, food, industry, education, housing, public works and communications sectors to guarantee the coordinated approach required to promote world health.
National and international strategies for environmental health should be adopted and should include input, not only from the health sector, but also from a wide range of social and economic partners, ensuring a coordinated effort in promoting the public health. The newly established International Federation of Environmental Health presents a very real opportunity to bring about new moves towards securing broad based strategies at national and international level in which the potential for input from the social and economic partners can be identified and cooperation secured.
For too long now the many sectors of state, semi-state and private enterprise have pursued programs and practices that were uncoordinated and were not designed to be consistent with, nor contributory towards, the overall public good. Sectoral mechanistic strategies have resulted in overall long term losses, and have produced threats to human health. In a time of increased awareness among the general public that care for the environment is a prerequisite for human health and wellbeing it is most opportune to seek and obtain cooperation from the social and economic partners in agreeing national and international environmental health programs.
Industries, to secure markets, increasingly seek to present a positive image of their products, and are beginning to be persuaded that, by acknowledging a social responsibility for the environment and health, they not only contribute to the overall public good, but also improve their marketing performance. National and international strategies for environmental health should include input from organizations representing agriculture, animal husbandry, food, industry, education, housing, public works and communications interests.
I have no doubt that the International Federation of Environmental Health, given research and program funding, could provide the basic framework for formulating national environmental health plans in keeping with the systems outlook contained in the Alma-Ata Declaration, and is in a position to secure a significant level of cooperation from environmental health professionals worldwide. It is this kind of initiative that is urgently needed.
Triste et al., “Organisational Choice: Capabilities at the Coalface Under Changing Technologies”,
Rosalie BertellI have no doubt that the International Federation of Environmental Health, given research and program funding, could provide the basic framework for formulating national environmental health plans in keeping with the systems outlook contained in the Alma-Ata Declaration, and is in a position to secure a significant level of cooperation from environmental health professionals worldwide. It is this kind of initiative that is urgently needed.