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AbstractChronic illness is the largest cause of death and source of health care costs in developed countries and a growing problem in developing countries. Here we build on past work in system dynamics and present a generic model of chronic illness, its treatment and prevention, applied to the U.S. population. The model explains the rising prevalence of illness and responses to it, including the treatment of complications and management activities designed to reduce complications. We show how progress in treatment and disease management has slowed since 1980 in the U.S., largely due to competition between health care payers and providers, resulting in price inflation and an unstable climate for health care investments. We demonstrate the impact of moving "upstream" by managing known risk factors to prevent illness onset, and moving even further upstream by addressing behaviors and living conditions linked to the initial development of these risk factors. Copyright © 2007 John Wiley & Sons, Ltd.

Abstract
Stewardship for well-being is an ancient and still-evolving field of practice concerned with any system that affects who thrives, struggles, or suffers. It is a distinctive way of working across boundaries to reframe how people approach routine work, organizational design, and democratic self-governance. It has been paired effectively with a set of interdependent vital conditions that are the focus of a growing consensus about what produces equitable well-being over time. This article explores how system stewardship, centered on the vital conditions, can drive civic renewal on the job in virtually every industry. We begin by discussing who can become a steward and why stewardship depends on building an inclusive sense of belonging and strong civic muscle. Next, we look at one part of the system for well-being—the American healthcare industry—to illustrate what it takes for industry insiders to step into new roles as civic-minded system stewards. Finally, we consider whether a rising cadre of system stewards could open a viable new path in the movement for well-being and justice.

Abstract
Stewardship for well-being is an ancient and still-evolving field of practice concerned with any system that affects who thrives, struggles, or suffers. It is a distinctive way of working across boundaries to reframe how people approach routine work, organizational design, and democratic self-governance. It has been paired effectively with a set of interdependent vital conditions that are the focus of a growing consensus about what produces equitable well-being over time. This article explores how system stewardship, centered on the vital conditions, can drive civic renewal on the job in virtually every industry. We begin by discussing who can become a steward and why stewardship depends on building an inclusive sense of belonging and strong civic muscle. Next, we look at one part of the system for well-being—the American healthcare industry—to illustrate what it takes for industry insiders to step into new roles as civic-minded system stewards. Finally, we consider whether a rising cadre of system stewards could open a viable new path in the movement for well-being and justice.

AbstractDespite knowledge of factors that enable effective system dynamics modeling and organizational change, real‐life application of these tools in community settings remains challenging and often produces mixed results. We undertook a two‐part evaluation of early community use of the ReThink Health Dynamics Model (RTH model). The RTH model is a realistic, but simplified, portrait of a regional health system that supports multisector planning and strategy design. We assessed the contextual characteristics and implementation processes that promoted or undermined effective engagement with the model in five pilot sites. These learnings were used to refine a community readiness framework (Elements Affecting Modeling Use) that was then used to select and design a sixth community engagement. We use the evaluation results to assess the value of this organizing framework to identify communities ready for engagement with validated system dynamics models. Enabling better community–model matches will accelerate model adoption and health system transformation.© 2018 The Authors System Dynamics Review published by John Wiley & Sons Ltd on behalf of System Dynamics Society

AbstractThe authors tell a story of their efforts to broaden evaluation work at this federal scientific agency.

Each decade, the American Heart Association (AHA) develops an Impact Goal to guide its overall strategic direction and investments in its research, quality improvement, advocacy, and public health programs. Guided by the AHA's new Mission Statement, to be a relentless force for a world of longer, healthier lives, the 2030 Impact Goal is anchored in an understanding that to achieve cardiovascular health for all, the AHA must include a broader vision of health and well-being and emphasize health equity. In the next decade, by 2030, the AHA will strive to equitably increase healthy life expectancy beyond current projections, with global and local collaborators, from 66 years of age to at least 68 years of age across the United States and from 64 years of age to at least 67 years of age worldwide. The AHA commits to developing additional targets for equity and well-being to accompany this overarching Impact Goal. To attain the 2030 Impact Goal, we recommend a thoughtful evaluation of interventions available to the public, patients, providers, healthcare delivery systems, communities, policy makers, and legislators. This presidential advisory summarizes the task force's main considerations in determining the 2030 Impact Goal and the metrics to monitor progress. It describes the aspiration that these goals will be achieved by working with a diverse community of volunteers, patients, scientists, healthcare professionals, and partner organizations needed to ensure success.