About

Kristen Hassmiller Lich, PhD, is a Professor in the Department of Health Policy and Management at the UNC Gillings School of Global Public Health. Her academic background includes a BS in Psychology and Gerontology from the University of Akron, an MHA in Public Health from the University of Michigan, and a PhD in Health Services Organization and Policy from the University of Michigan. Her research focuses on applying operations research and econometrics tools to complex health systems, including tobacco policy, infectious disease modeling, and tuberculosis control. She has contributed to strategic planning to reduce stroke burden among veterans using simulation modeling and has explored the effects of psychiatric hospital waitlist policies, hormone therapy initiation among breast cancer survivors, and dissemination of systems science methods in health research. Dr. Lich has been recognized as an inaugural Systems Science Scholar by Academy Health in 2015 and has authored numerous publications in her field.

Research topics

• Political Science
• Computer Science
• Medicine
• Sociology
• Social Science
• Psychology
• Engineering
• Management science
• Criminology
• Pedagogy
• Virology
• Knowledge management
• Law
• Environmental health
• Biology
• Medical education
• Intensive care medicine
• Internal medicine
• Psychiatry
• Nursing
• Gender studies
• Geography
• Economic growth
• Public relations

Selected publications

• A Mixed Methods Analysis of Risk and Support Factors for Prenatal Alcohol and Substance Use Among American Indian/Alaska Native Birthing People

  Journal of Racial and Ethnic Health Disparities · 2026-04-23

  article
  PublisherDOI

• Reliability, Validity and Measurement Invariance of the WHO’s Quality of Life Scale among Women of Reproductive Age Living with HIV in Ethiopia - a Quasi-Experimental Study

  UNC Libraries · 2025-04-09

  articleOpen accessSenior author
  PublisherDOI

• “What Do You Consider Use?” Perspectives of Black Youth on Cannabis Use

  UNC Libraries · 2025-05-03

  articleOpen access
  PublisherDOI

• Strengthening methods for tracking adaptations and modifications to implementation strategies

  UNC Libraries · 2025-12-19

  articleOpen access
  PublisherDOI

• Supporting reproductive health among birthing persons with chronic conditions in the United States: A qualitative multilevel study using systems thinking to inform action

  UNC Libraries · 2025-04-03

  articleOpen access

  OBJECTIVE (STUDY QUESTION): To use systems thinking with diverse system actors to (a) characterize current problems at the intersection of chronic conditions (CCs) and reproductive health (RH) care and their determinants, (b) determine necessary system actors for change, and (c) document cross-system actions that can improve identified problems in the United States. DATA SOURCES/STUDY SETTING: Data were collected from six groups of system actors via online focus groups. STUDY DESIGN: This is a qualitative multilevel study using the iceberg systems thinking framework. DATA COLLECTION/EXTRACTION METHODS: Data were collected by note-taking and recording six focus groups; analysis incorporated perspective triangulation using the systems thinking iceberg and system mapping to visualize interconnected system challenges, actors, and action ideas. PRINCIPAL FINDINGS: Participants described eight necessary system actors: health care institutions, medical leaders, medical providers, patient advocates and foundations, patients and families, payors, policy makers, and research funders. Forty pain points were identified, spread across each of the four levels of the systems thinking iceberg: undesirable outcomes (6), concerning trends (9), system structure flaws (15), and problematic mental models (10). In response to these pain points, a set of 46 action ideas was generated by participants and mapped into nine action themes: (1) adjust QI metrics, incentives, and reimbursement, (2) bolster RH medical education and training, (3) break down medical silos, (4) enrich patient education, (5) expand the health care team, (6) improve holistic health care, (7) modify research and programmatic funding to prioritize RH and CC, (8) spur innovation for patient visits, and (9) support professional champions and leaders. CONCLUSIONS: By embracing system complexity, creating visual maps, and pushing participants to identify actionable strategies for improvement, this study generates a set of specific actions that can be used to address pain points across the multiple system levels that make improving reproductive care for people with CCs so challenging.

  PublisherDOI

• Using systems science to advance health equity in tobacco control: a causal loop diagram of smoking

  UNC Libraries · 2025-06-11

  articleOpen access1st authorCorresponding

  OBJECTIVES: Develop and use a causal loop diagram (CLD) of smoking among racial/ethnic minority and lower-income groups to anticipate the intended and unintended effects of tobacco control policies. METHODS: We developed a CLD to elucidate connections between individual, environmental and structural causes of racial/ethnic and socioeconomic disparities in smoking. The CLD was informed by a review of conceptual and empirical models of smoking, fundamental cause and social stress theories and 19 qualitative interviews with tobacco control stakeholders. The CLD was then used to examine the potential impacts of three tobacco control policies. RESULTS: The CLD includes 24 constructs encompassing individual (eg, risk perceptions), environmental (eg, marketing) and structural (eg, systemic racism) factors associated with smoking. Evaluations of tobacco control policies using the CLD identified potential unintended consequences that may maintain smoking disparities. For example, the intent of a smoke-free policy for public housing is to reduce smoking among residents. Our CLD suggests that the policy may reduce smoking among residents by reducing smoking among family/friends, which subsequently reduces pro-smoking norms and perceptions of tobacco use as low risk. On the other hand, some residents who smoke may violate the policy. Policy violations may result in financial strain and/or housing instability, which increases stress and reduces feelings of control, thus having the unintended consequence of increasing smoking. CONCLUSIONS: The CLD may be used to support stakeholder engagement in action planning and to identify non-traditional partners and approaches for tobacco control.

  PublisherDOI

• Accelerating birth equity using collaborative systems mapping

  UNC Libraries · 2025-10-23

  articleOpen access
  PublisherDOI

• Depicting “the system”: How structural racism and disenfranchisement in the United States can cause dynamics in community violence among males in urban black communities

  UNC Libraries · 2025-07-15

  articleOpen access1st authorCorresponding
  PublisherDOI

• Accelerating birth equity using collaborative systems mapping

  Health Research Policy and Systems · 2025-10-13

  articleOpen accessSenior author

  BACKGROUND: Recognizing the complexity of cross-sector collaboration, holistic and innovative approaches are required to achieve birth equity. This project applied systems thinking and the Remove, Repair, Remediate, Restructure, and Provide (R4P) framework to understand and address systemic barriers to birth equity. This paper describes the systems thinking activities used to identify system actors and critical actions they can take to advance birth equity. METHODS: We applied systems thinking tools through the R4P lens in a series of collaborative and iterative activities. We conducted an environmental scan and synthesis of reports with recommendations to improve birth equity. In addition, we engaged a diverse group of birth equity actors, including those from federal agencies, state and local health departments, community-based organizations, funders, academic institutions, health systems and national nonprofits, through systems mapping workshops to co-create a series of birth equity tools. RESULTS: Our collaborative efforts produced an innovative Birth Equity Ecosystem Map, Birth Equity Iceberg, and interactive Birth Equity Action Map. The Birth Equity Ecosystem Map is a comprehensive synthesis of recommendations defining an equitable ecosystem, while the Birth Equity Iceberg summarizes insights on systemic barriers to achieving birth equity most critical to address in the next 5 years. The Birth Equity Action Map is an interactive and strategic tool, synthesized from diverse system actors' experiences and perspectives, that describes needed actions and responsible actors for each systemic barrier identified. We probed for and organized actions by the five dimensions of the R4P framework to encourage comprehensive action to achieve equity. The Birth Equity Action Map and connected resources developed through this project help actors identify actions they can work on to overcome identified systemic barriers to birth equity in their community and key partners for each. CONCLUSIONS: The tools we developed demonstrate how systems thinking and R4P can offer a more holistic and effective approach to tackling issues of birth equity and lead to more actionable insights, thereby contributing significantly to the public health goal of achieving equity. These tools can be used by birth equity advocates to assess and leverage their strengths, resources and unique context to identify priorities and collectively advance birth equity.

  PublisherOA PDFDOI

• Embracing Causal Complexity in Health Disparities: Metabolic Syndemics and Structural Prevention in Rural Minority Communities

  UNC Libraries · 2025-08-29

  articleOpen access
  PublisherDOI

Frequent coauthors

• J Morrissey

  104 shared

• Elizabeth M. La

  62 shared

• Rebecca Wells

  St George's, University of London

  52 shared

• Alan R. Ellis

  North Carolina State University

  51 shared

• Marvin S. Swartz

  American Society of Law, Medicine and Ethics

  51 shared

• Ruoqing Zhu

  University of Illinois Urbana-Champaign

  51 shared

• Stephanie B. Wheeler

  University of North Carolina at Chapel Hill

  42 shared

• María E. Mayorga

  North Carolina State University

  37 shared

Awards & honors

• Inaugural Systems Science Scholar 2015, Academy Health