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According to the 'hardening hypothesis', average nicotine dependence will increase as less dependent smokers quit relatively easily in response to effective public health interventions, so that sustained progress in reducing smoking prevalence will depend on shifting the emphasis of tobacco control programs towards intensive treatment of heavily dependent smokers (who comprise an increasing fraction of continuing smokers). We used a system dynamics model of smoking behaviour to explore the potential for hardening in a population of smokers exposed to effective tobacco control measures over an extended period. Policy-induced increases in the per capita cessation rate are shown to lead inevitably to a decline in the proportion of smokers who are heavily dependent, contrary to the hardening hypothesis. Changes in smoking behaviour in Australia over the period 2001‒2016 resulted in substantial decreases in current smoking prevalence (from 23.1% in 2001 to 14.6% in 2016) and the proportion of heavily dependent smokers in the smoking population (from 52.1% to 36.9%). Public health interventions that have proved particularly effective in reducing smoking prevalence (tobacco tax increases, smoke-free environment legislation, antismoking mass media campaigns) are expected to also contribute to a decline in population-level nicotine dependence.

AbstractSystem dynamics models are increasingly being used to understand the underlying dynamics of populations and hypothesize causal system structures that can account for changes in a population's disease burden. A considerable challenge for public health modeling is understanding how changes in underlying determinants of a problem impact a population's measure of public health, such as the prevalence of a disease. Additionally, it is common to have limited insights and data for the dynamics of these determinants. This article presents an analytical method of estimating underlying distributions using model‐generated prevalence relying on a minimum number of model stratum. This method models the evolution of the underlying distribution parameters by combining statistical distribution theory and system dynamics models. This article provides general equations for various applications and an in‐depth example using body mass index. © 2023 The Authors. System Dynamics Review published by John Wiley & Sons Ltd on behalf of System Dynamics Society.

BACKGROUND: The right to the highest attainable standard of mental health remains a distant goal worldwide. The Report of the UN Special Rapporteur on the right of all people to enjoyment of the highest attainable standard of physical and mental health pleaded the urgent need for governments to act through appropriate laws and policies. We argue that Australia is in breach of international obligations, with inadequate access to mental health services, inconsistent mental health legislation across jurisdictions and ongoing structural (systematic) and individual discrimination. DISCUSSION: Inadequate access to mental health services is a worldwide phenomenon. Australia has committed to international law obligations under the Convention on the Rights of Persons with Disabilities (CRPD) to 'promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disability, with respect to their inherent dignity'. This includes people with mental health impairment and this convention includes the right to 'the highest attainable standard of mental health'. Under the Australian Constitution, ratification of this convention enables the national government to pass laws to implement the convention obligations, and such national laws would prevail over any inconsistent state (or territory) laws governing mental health service provision. SUMMARY: The authors argue that enabling positive rights through legislation and legally binding mental health service standards may facilitate enhanced accountability and enforcement of such rights. These steps may support critical key stakeholders to improve the standards of mental health service provision supported by the implementation of international obligations, thereby accelerating mental health system reform. Improved legislation would encourage better governance and the evolution of better services, making mental health care more accessible, without structural or individual discrimination, enabling all people to enjoy the highest ...

For more than a decade, suicide rates in Australia have shown no improvement despite significant investment in reforms to support regionally driven initiatives. Further recommended reforms by the Productivity Commission call for Federal and State and Territory Government funding for mental health to be pooled and new Regional Commissioning Authorities established to take responsibility for efficient and effective allocation of 'taxpayer money.' This study explores the sufficiency of this recommendation in preventing ongoing policy resistance. A system dynamics model of pathways between psychological distress, the mental health care system, suicidal behaviour and their drivers was developed, tested, and validated for a large, geographically diverse region of New South Wales; the Hunter New England and Central Coast Primary Health Network (PHN). Multi-objective optimisation was used to explore potential discordance in the best-performing programs and initiatives (simulated from 2021 to 2031) across mental health outcomes between the two state-governed Local Health Districts (LHDs) and the federally governed PHN. Impacts on suicide deaths, mental health-related emergency department presentations, and service disengagement were explored. A combination of family psychoeducation, post-attempt aftercare, and safety planning, and social connectedness programs minimises the number of suicides across the PHN and in the Hunter New England LHD (13.5% reduction; 95% interval, 12.3–14.9%), and performs well in the Central Coast LHD (14.8% reduction, 13.5–16.3%), suggesting that aligned strategic decision making between the PHN and LHDs would deliver substantial impacts on suicide. Results also highlighted a marked trade-off between minimising suicide deaths versus minimising service disengagement. This is explained in part by the additional demand placed on services of intensive suicide prevention programs leading to increases in service disengagement as wait times for specialist community based mental health services and dissatisfaction with quality of care increases. Competing priorities between the PHN and LHDs (each seeking to optimise the different outcomes they are responsible for) can undermine the optimal impact of investments for suicide prevention. Systems modelling provides essential regional decision analysis infrastructure to facilitate coordinated federal and state investments for optimal impacts.

To assist with proactive and effective responses to the global COVID-19 crisis, the scientific community has been rapidly deploying our most advanced analytic tools to model the dynamics of disease transmission based on existing (albeit imperfect) knowledge, data, and available human and material resources. The multifactorial, multilevel influences on transmission dynamics and the disease's pervasive impact at the individual, community, and global levels have required the use of the analytic techniques of complex systems science, namely, systems modeling and simulation, to forecast the trajectory of the disease under different conditions, to quantify uncertainty, and to inform effective responses (1–3). These methods have been deployed by infectious disease epidemiologists for over a century (4), maturing into a robust interdisciplinary field intersecting mathematics, computational epidemiology, ecology, evolutionary biology, immunology, behavioral science, and public health (5). As a result, there have been numerous advances that have informed policies to control infectious diseases, facilitate epidemic and bioterrorism preparedness, and provide governments with critical tools for managing complexity and weighing alternative responses in the midst of the confusion of an evolving crisis (6–14). The field's commitment to achieving rapid response capability in the face of changing conditions has led to advances in rapid assessment of the impact of the pandemic, and data assimilation methods that combine theory with empirical observations in a continuous knowledge feedback process facilitating continuous hypothesis development, testing, and refinement in the service of more effective decision making (15–19).