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


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.



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


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

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

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