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The Health System Quartet: Four Basic Systems—Cure, Care, Heal, and Deal—To Foster the Co-production of Sustained Health

  • Jan van der KampEmail author
  • Thomas Plochg
Chapter

Abstract

In many areas of society, the question arises how a transition can be reached towards sustainability, with resources that can be made use of, without using them up. This is an important question in healthcare, as at present healthcare systems mainly deliver cure and care services that are used up, consumed. The question is: how intrinsic health building and healing capacities can be helpful to the health care system. How can we learn from living systems?

The natural healing ability remains underexposed. It is of a different order than modern medical interventions. Since the rise of “systems and complexity sciences”, including Systems Biology, there has been an increasing insight in understanding the healing ability—it shows continuous dynamic processes of adaptation and self-organisation in the interactions of systems from the cellular level to the human system as a whole. Life and health behave like an ecosystem: It has an implicit learning capacity and affects the agility of resilience, defensibility and healing.

In the intervention tradition, one wants to know what is wrong and how to fix it. This approach has identified many human behaviours found to endanger human health. While this may be true, in itself it hardly provides the necessary means for health improvement. Behaviour change develops well based on emotional rewarding and a friendly push forward—nudging—as the Nobel Laureates Kahneman and Thaler showed.

A positive appreciation of human behaviour deserves more attention. Basically, humans are competent to rule their lives, including their health. Through their essential involvement, they are natural partners in health. It is good to realise that people are no longer only consumers of health care services but are seen more and more as co-producers of their own health. Self-determinant people develop their commitment and skills to become as independent as possible. Not at least this is facilitated by the information and social media revolution. Empowering competence is a positive goal for better health.

The health care system’s Cure and Care focus can cooperate with people’s agency to Deal with their biological and mental dynamics to Heal. The interactions of Cure, Care, Deal and Heal are at the heart of the Health Systems Quartet, a framework to form a simple basis for the complex transdisciplinary approaches to achieve “health”. It opens a new perspective for sustainable health policy, health system organisation and health praxis. The intrinsic emerging powers of life and well-being have a huge potential to guide health system redesign.

Notes

Acknowledgements

The authors like to acknowledge the useful comments and edits of Joachim Sturmberg on earlier drafts of this chapter.

References

  1. 1.
    Rutter H, Savona N, Glonti K, Bibby J, Cummins S, Finegood DT, et al. The need for a complex systems model of evidence for public health. Lancet. 2017;390(10112):2602–4CrossRefGoogle Scholar
  2. 2.
    Plsek PE, Greenhalgh T. The challenge of complexity in health care. Br Med J. 2001;323: 625–8CrossRefGoogle Scholar
  3. 3.
    Ahn A, Tewari M, Poon C-S, Phillips R. The limits of reductionism in medicine: could systems biology offer an alternative? PLoS Medicine. 2006;3(6):e208. Available at: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030208 CrossRefGoogle Scholar
  4. 4.
    Kurtz CF, Snowden DJ. The new dynamics of strategy: sense-making in a complex and complicated world. IBM Syst J. 2003;42(3):462–83CrossRefGoogle Scholar
  5. 5.
    Friel S, Pescud M, Malbon E, Lee A, Carter R, Greenfield J, et al. Using systems science to understand the determinants of inequities in healthy eating. PLoS ONE. 2017;12(11):e0188872. Available at:  https://doi.org/10.1371/journal.pone.0188872
  6. 6.
    Mitchell M. Complexity: a guided tour. Oxford: Oxford University Press; 2009Google Scholar
  7. 7.
    Sturmberg JP, Martin CM. Complexity in health: an introduction. In: Sturmberg JP, Martin CM, editors. Handbook of systems and complexity in health. New York: Springer; 2013. p. 1–17CrossRefGoogle Scholar
  8. 8.
    Hammond RA. Complex systems modeling for obesity research. Prev Chronic Dis. 2009;6(3):A97PubMedPubMedCentralGoogle Scholar
  9. 9.
    Seale P, Lazar MA. Brown fat in humans: turning up the heat on obesity. Diabetes. 2009;58(7):1482–4CrossRefGoogle Scholar
  10. 10.
    Huber M. Towards a new, dynamic concept of health. Its operationalisation and use in public health and healthcare, and in evaluating health effects of food. Doctoral Thesis, Maastricht University. Enschede: Ipskamp Drukkers; 2014Google Scholar
  11. 11.
    Adelaide Recommendations on Healthy Public Policy. Second International Conference on Health Promotion, Adelaide, South Australia, 5–9 April 1988. http://www.who.int/healthpromotion/conferences/previous/adelaide/en/
  12. 12.
    Sturmberg JP. The personal nature of health. J Eval Clin Pract. 2009;15(4):766–9.CrossRefGoogle Scholar
  13. 13.
    Sturmberg JP, Topolski S, Lewis S. Health: a systems- and complexity-based definition. In: Sturmberg JP, Martin CM, editors. Handbook of systems and complexity in health. New York: Springer; 2013. p. 251–3CrossRefGoogle Scholar
  14. 14.
    Kamp Jan van der. Managing health promotion as an open process: holistic and ecological tools for managing and marketing of innovations. In: Evers A, Farrent W, Trojan A, editors. Healthy public policy at the local level. Colorado: Westview; 1990Google Scholar
  15. 15.
    Plochg T, Klazinga NS, Starfield B. Transforming medical professionalism to fit changing health needs. BMC Med. 2009;7:64. Available at: https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-7-64 CrossRefGoogle Scholar
  16. 16.
    Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA; Fowkes FGon behalf of the TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(1 Suppl):S5–67CrossRefGoogle Scholar
  17. 17.
    Battjes-Fries MCE, Patijn ON, Voshol PJ. Tweede tussenrapportage groepsprogramma Keer-Diabetes-Om. Louis Bolk Institute. December 2017 [In Dutch]Google Scholar
  18. 18.
    Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al.; Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018;391(10137):2368–83CrossRefGoogle Scholar
  19. 19.
    Huber M, Knottnerus JA, Green L, Horst HVD, Jadad AR, Kromhout D, et al. How should we define health? Br Med J. 2011;343:d4163CrossRefGoogle Scholar
  20. 20.
    Sturmberg JP. Health system redesign. How to make health care person-centered, equitable, and sustainable. Cham: Springer; 2017Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Health Systems InnovationsBlaricumNetherlands
  2. 2.Netherlands Public Health FederationAmersfoortNetherlands

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