Systems thinking to create change

Rachel Baker
Rachel Baker • 22 November 2023

“We cannot accept things the way they are because business-as-usual is leading to earth systems collapse.” George Monbiot.

This blog post is written in response to the discussion at Exeter University's Global Systems Institute with George Monbiot about the role of universities in a time of climate crisis which is well worth a listen.

One of his key arguments was about the necessity for complex systems thinking approaches that draw on interdisciplinary practices and research, a challenge that universities should be well-placed to meet.

So how might the training programmes at HEI's for Allied Health Professionals and specifically our domain of Speech and Language Therapy also meet this challenge? A first step might be to just recognise and analyse the nature of the systems we currently use and experience on our doorsteps, in my case, at my university (Marjon

During a class on ethical practice in healthcare, the tutor, to illustrate a point about understanding the limits of personal agency and choice within a given system, used the analogy of getting on a bus to travel from A to B as opposed to driving a car. I.e we exercise a choice in getting on the bus, but we don't have any choice on how the bus is driven. I got the point, but I thought it was perhaps an unfortunate, if revealing, analogy. In fact, as someone who does not drive a car for various reasons and is dependent on public transport, I don't actually have much of a choice about it and many of my fellow passengers don't either. As a demographic, we bus users are generally on low incomes and are entirely subject to the vagaries of a public transport system that has been privatised, cut back and degraded to a level of eye-watering dysfunctionality and unreliability. In a neoliberal economy, exercising 'choice' is the highest ideological value but is in fact deeply contingent and contained.

The Marjon campus is situated in Derriford, a “care-industry” suburb of the city of Plymouth near the main hospital that serves the city. I am always curious to see who is sharing my bus journey and am acutely aware of those who are evidently struggling with ill-health, often elderly, trying to get to the hospital. Unfortunately, the pandemic provided an opportunity for bus companies to cut key bus services to Derriford, including from the Plymouth train station to the hospital, affecting students and hospital patients/employees alike. It lengthened the journey, pushed more cars onto an already congested route, increased tailbacks and levels of air pollution. The idea of exercising individual choice to not breathe the toxic city air, to not get stuck in a traffic jam, to not be late for a hospital appointment, or university lecture, starts to feel less and less possible.

The principles and culture of healthcare and net zero are stated commitments in both Derriford hospital and Marjon college But the elephant in the room is that the location of these institutions has designed-in private car dependency, with car parking spaces and road systems a dominant feature of the built environment and experience here. Parking and parking permits is an unending headache for college admin whose time and capacity is constantly overwhelmed by trying to meet the demand for this carbon-heavy state of affairs.

I wondered what the air pollution scales would register in Derriford if measured. In fact, Derriford Hospital itself is a point source for collecting pollution data by the National Atmospheric Emissions Inventory At the time of writing Derriford measures NO2 pollution at 9.5 tonnes, PM2.5 at 0.12 tonnes and Carbon at 1703.500 tonnes. These all exceed the recommended levels set by the World Health Organisation, who also point to research that shows how air pollution damages every organ in the body.

Dementias, strokes, lung and throat cancers, aggravated airways are all conditions that form part of the treatment syndromes in the SLT profession and are all linked to, or even caused by, air pollution (

When I entered my first year at Marjon I did try to institute a car-sharing network via the student union. It was notable how little interest there was in this idea because of how central the car is to young people's sense of identity and autonomy, particularly in rural areas where the public transport is abysmal. Equally, it has to be acknowledged how important the private car is to the agency and autonomy of the disability community. Community paediatrics for example is largely contingent on private car use in a given 'community' which is generally designated as covering a large area. This leads me to re-thinking communities as neighbourhoods, and also about the concept of 15 minute cities ( We've seen how making it more expensive to drive polluting private vehicles in ULEZ has reduced air pollution and congestion in urban areas While it's important to exempt the disability community from these carbon-taxing measures, it's also urgent to think about how we redesign communities and neighbourhoods to make healthcare services much closer to users.

This is all to highlight the interrelated infrastructural systems that contribute to cementing in a culture of ill-health and ecological destruction. Put simply, public transport is a healthcare and ecological issue, not just a means of getting to work or getting to a client. So, as an SLT-to-be, I will continue promote and campaign for 15 minute cities, car-sharing networks at my college, and better public transport generally





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