Health System Complexity A/Prof Joachim Sturmberg University of Newcastle - Australia University of Amsterdam - Institute for Advanced Study {IAS) 13-Mar-2018
Health – what is it? Health Systems – not what we have today Health System Complexity – from the macro to the micro scale Where to from here – Health System Redesign
Health - what is it?
• Old English “hal” meaning “whole” • Health thus means wholeness • A person being healed is one who has “become whole” again
Health as an application to human nature in all its parts, operations, levels, and dimensions – the physical, psychological, social, and spiritual. (Plato)
Ultimate health is obtained through self-realisation. Man must search for meaning on his own grounds and live in accordance with his own values, skills and free dispositions. (Maslow)
Health and happiness are the expressions of the manner in which the individual responds and adapts to the changes that he meets in everyday life. (Dubos)
Health depends on many interconnected aspects of life: belonging to one’s local environment/land, the sense of freedom, cultural and spiritual belonging, and the sense of dignity and security (Ingstad)
The Dynamics of the Somato-psycho-socio-semiotic Model genetics germs accidents toxins
friends work housing Infrastructure
mental well-being education exp erlence of paychologlcal llln111
sense-making understanding justice spirituality
Attractors in Health and Illness
experience of 1ociosemlollc Illness
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Bircher. Med Health Care Philos. 2005;8(3):335-41.
Sturmberg. 2018
Macklem. J Appl Physiol. 2008;104(6):1844-6.
Dantzer R. Brain Behav Immun. 2004;18(1):1-6.
In health, variability measures show a high degree of variation and complexity, whereas illness is characterized by a variable losing its variability and complexity. The magnitude of loss of variability correlates with the severity of the illness. The current approach to understanding disease as resulting from perturbations of individual organ systems is enormously useful, but fails in the appreciation and study of the interconnected whole system, its complexity, adaptability and overall health of the human organism. Emerging evidence suggests that the organism’s network interconnectedness and complexity can be described by the degree and complexity of biologic rhythm variability. The interconnected relationships of the various systems described point to HRV reflecting a global measure of an individual’s current functional health state. Sturmberg JP, Bennett JM, Picard M, Seely AJE. The trajectory of life. Decreasing physiological network complexity through changing fractal patterns. Frontiers in Physiology. 2015;6:169.
Human social signal transduction. Social signal transduction is the process by which subjectively perceived social conditions and historically and developmentally derived anticipatory worries alter genomewide transcriptional dynamics. (a) Socialenvironmental threats are neurocognitively appraised and converted into changing patterns of activity in the sympathetic nervous system (SNS) and hypothalamicpituitary-adrenal (HPA) axis. Slavich GM, Cole SW. The Emerging Field of Human Social Genomics. Clinical Psychological Science. 2013;1(3):331-48.
This information cannot be derived in a bottomup way, because it implicitly embodies information about environmental niches. It would be different in a different environment. Hence, higher level conditions influence what happens at the lower levels, even if the lower levels do the work. … , while lower levels generally fulfil necessary conditions for what occurs on higher levels, they only sometimes (very rarely in complex systems) provide sufficient conditions. It is the combination of bottom-up and topdown causation that enables same-level behaviour to emerge at higher levels, because the entities at the higher level set the context for the lower level actions in such a way that consistent same-level behaviour emerges at the higher level. Ellis – Top-down and Bottom-up Causation. Interface Focus. 2012;2(1):126-40. Sturmberg. 2018
Health Systems - not what we have today
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The Relative Impact of :Medical Care
Pareto Distributions of Community Health
Barnett K et al. Lancet. 2012;380(9836):37-43
People Invariably Experience GOOD HEALTH Self-assessed Health Status, 2011-12
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Source(s): Australian Health Survey: Updated Results, 2011-12 hUp://www.abs.gov.au/
[email protected]/4364.0.55.003Chapler2002011 · 2012
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Self-assessed Health Status, 2014
Self-assessed health rating scale: Poor Soure6(S): General Social Swvey: summary Results, Austmffa, 2014 l'lttp;JMww.ebs,gov.eul•u•
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Excell ent
people with disability
Sturmberg JP, Bennett JM, Martin CM, Picard M. ‘Multimorbidity’ as the manifestation of network disturbances. J Eval Clin Pract. 2017;23(1):199-208.
Health System Spending
Others
Primary Health Care
Community & Public Health AIHW-Australia's health 2014
Sturmberg JP, O'Halloran DM, Martin CM. J Eval Clin Pract. 2012;18(1):202-8.
Inverse Care Law ... and Beyond
EQUALITY
EQUITY
Health System Complexity - from the macro to the micro scale
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