Changing the tobacco use management system: Blending systems thinking with actor-network theory

Managing wicked issues like the tobacco epidemic is addressed using a combination of Open Systems Thinking (OST) and Actor-Network Theory (ANT). OST was used to construct a model of the tobacco problem as a management system acting in a broader environment. This highlighted several problems with the current system but provided no mechanism for reform. ANT, the sociology of translation, was used for understanding how change occurs. Unlike systems thinking, ANT focuses the contest for change on heterogeneous networks of human and nonhuman actors that must be constructed through a process of defining and defending models of change, building alliances, gaining public acceptance, and finally achieving institutional acceptance of the reform (or of some compromise). We then show how this dual approach can shed light on a current challenge in controlling tobacco, the issue of product regulation, and the broader issue of harm reduction versus harm elimination.