Open Access Open Access  Restricted Access Subscription Access

Person-centeredness - A Paradigm Shift for Healthcare? From Disease as a “Structural Problem” to Health, Illness and Disease as the “Emergent Outcomes of Complex Adaptive Physiological Network Function”

Joachim Sturmberg


Health and disease are largely seen as structural phenomena - visible changes in tissues and organs, rather than the result of complex adaptive physiological dynamics within the person, constrained by his internal structures and external environments. Health and disease are ecological phenomena; internal structures and external environments provide the landscapes in which the functions - physiological network interactions at the micro and behavioural interactions at the macro level - occur. These interactions are the functional responses in the quest for health and life.

Embracing the person as a whole, that is, being person-centered, is thus an expression of a paradigm shift, a shift from the reductionist focus on disease to the complex-adaptive understandings of the person experiencing health, illness and disease.


Complex adaptive systems thinking, history of health and disease, nonlinear dynamics, paradigm shift, person-centeredness, philosophy of health and disease

Full Text:



Sturmberg, J.P. (2007). The Foundations of Primary Care. Daring to be Different. Oxford, San Francisco: Radcliffe Medical Press.

Mackenbach, J.P. (2004). Carl von Linne, Thomas McKeown, and the inadequacy of disease classifications. European Journal of Public Health 14 (3) 225.

Sedivy, R. (2004). Jahre Rokitansky - sein Vermächtnis für die heutige Pathologie. Wiener klinische Wochenschrift 116 (23) 779-787.

Goh, K-I. & Choi, I-G. (2012). Exploring the human diseasome: the human disease network. Briefings in Functional Genomics 11 (6) 533-542.

Cole, S.W. (2013). Social Regulation of Human Gene Expression: Mechanisms and Implications for Public Health. American Journal of Public Health 103 (Supplement 1) S84-S92.

Ader, R. & Cohen, N. (1975). Behaviorally Conditioned Immunosuppression. Psychosomatic Medicine 37 (4) 333-340.

Sturmberg, J.P., Bennett, J.M., Picard, M. & Seely, A.J.E. (2015). The trajectory of life. Decreasing physiological network complexity through changing fractal patterns. Frontiers in Physiology 6, 169.

Bennett, J.M., Reeves, G., Billman, G. & Sturmberg, J.P. (2018). Inflammation, nature’s way to efficiently respond to all types of challenges: Implications for understanding and managing “the epidemic” of chronic diseases. Frontiers in Medicine 5, 316.

Engel, G.L. (1977). The Need for a New Medical Model: A Challenge for Biomedicine. Science 196 (4286) 129-136.

Engel, G.L. (1980). The Clinical Application of the Biopsychosocial Model. American Journal of Psychiatry 137 (5) 535-544.

Sturmberg, J.P. (2009). The personal nature of health. Journal of Evaluation in Clinical Practice 15 (4) 766-769.

Sturmberg, J.P. (2013). Health: A Personal Complex-Adaptive State. In: Handbook of Systems and Complexity in Health. Sturmberg, J.P. & Martin, C.M. (Eds.), pp. 231-242. New York: Springer.

Sturmberg, J.P., Picard, M., Aron, D.C., Bennett, J.M., Bircher, J., deHaven, M.J., Gijzel, S.M.W., Heng, H.H., Marcum, J.A., Martin, C.M., Miles, A., Peterson, C.L., Rohleder, N., Walker, C., Olde Rikkert, M.G.M. & Melis, R.J.F. (2019). Health and Disease - Emergent States Resulting From Adaptive Social and Biological Network Interactions. Frontiers in Medicine 6, 59. doi: 10.3389/fmed.2019.00059

Cole, S.W. (2014). Human Social Genomics. PLoS Genetics 10 (8) e1004601.

Duncan, N.W., Hayes, D.J., Wiebking, C., Tiret, B., Pietruska, K., Chen, D.Q., Rainville, P., Marjańska, M., Ayad, O., Doyon, J., Hodaie, M. & Northoff, G. (2015). Negative childhood experiences alter a prefrontal‐insular‐motor cortical network in healthy adults: A preliminary multimodal rsfMRI‐fMRI‐MRS‐dMRI study. Human Brain Mapping 36 (11) 4622-4637.

Sturmberg, J.P. & Martin, C.M. (2013). Complexity in Health: An Introduction. In: Handbook of Systems and Complexity in Health. Sturmberg, J.P. & Martin, C.M., (Eds.), pp. 1-17. New York: Springer.

Sturmberg, J.P. (2019). If you change the way you look at things, things you look at change. Max Planck's Challenge for Health, Health Care and the Healthcare System. In: Embracing Complexity in Health The Transformation of Science, Practice, and Policy. Sturmberg, J.P., (Ed.). Charm, Switzerland: Springer.

McWhinney, I.R. (1989). ‘An Acquaintance with Particulars ...’ Family Medicine 21 (4) 296-298.

Sturmberg, J.P. (2018). Hype and Tension in Hypertension. Debating the Latest Hypertension Guidelines. European Journal for Person Centered Healthcare 6 (1) 128-137.

Mayo Clinic. (2007). Our Shared Committment - Mayo Clinic 2007 Annual Report.

Mackenbach, J.P. (2009). Politics is nothing but medicine at a larger scale: reflections on public health’s biggest idea. Journal of Epidemiology and Community Health 63 (3) 181-184.

Sturmberg, J.P. (2017). Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer.

Plsek, P. (2001). Appendix B: Redesigning Health Care with Insights from the Science of Complex Adaptive Systems. In: Committee on Quality of Health Care in America - Institute of Medicine, (Ed.). Crossing the Quality Chasm: A New Health System for the 21st Century, pp. 309-322. Washington DC: National Academy Press.

Glouberman, S. & Zimmerman, B. (2002). Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? Ottawa: Discussion Paper No 8. Commission on the Future of Health Care in Canada.

Begun, J.W., Zimmerman, B. & Dooley, K. (2003). Health Care Organizations as Complex Adaptive Systems. In: Advances in Health Care Organization Theory. Mick, S.M. & Wyttenbach, M., (Eds.), pp. 253-288. San Francisco: Jossey-Bass.

Sturmberg, J.P., O’Halloran. D.M., & Martin, C.M. (2012). Understanding health system reform - a complex adaptive systems perspective. Journal of Evaluation in Clinical Practice 18 (1) 202-208.

Bloom, G. & Wolcott, S. (2013). Building institutions for health and health systems in contexts of rapid change. Social Science & Medicine 96, 216-222.

Ramey, J. (2015). Neoliberalism as a political theology of chance: the politics of divination. Palgrave Communications 1, 15039.

Annas, G.J. (1995). Reframing the Debate on Health Care Reform by Replacing Our Metaphors. New England Journal of Medicine 332 (11) 745-748.

Sturmberg, J.P. & Farmer, E.A. (2008). Educating capable doctors - A portfolio approach. Linking learning and assessment. Medical Teacher 31 (3) e85-e89.

Upshur, R.E.G. (2002). If not evidence, then what? Or does medicine really need a base? Journal of Evaluation in Clinical Practice 8 (2) 113-119.

Ioannidis, J.P.A. (2005). Why Most Published Research Findings Are False. PLoS Medicine 2 (8) e124.

Sturmberg, J.P. (2009). EBM: a narrow and obsessive methodology that fails to meet the knowledge needs of a complex adaptive clinical world: a commentary on Djulbegovic, B., Guyatt, G. H. & Ashcroft, R.E. (2009) Cancer Control 16, 158-168. Journal of Evaluation in Clinical Practice 15 (6) 917-923.

Tonelli, M.R. (2010). The challenge of evidence in clinical medicine. Journal of Evaluation in Clinical Practice 16 (2) 384-389.

Fernandez, A., Sturmberg, J., Lukersmith, S., Madden, R., Torkfar, G., Colagiuri, R. & Salvador-Carulla, L. (2015). Evidence-based medicine: is it a bridge too far? Health Research Policy and Systems 13 (1) 66.

Saini, V., Garcia-Armesto, S., Klemperer, D., Paris, V., Elshaug, A.G., Brownlee, S., Ioannidis, J.P.A. & Fisher, E.S. (2017). Drivers of poor medical care. Lancet 390 (10090) 178-190.

Manrai, A.K., Patel, C.J. & Ioannidis, J.A. (2018). In the era of precision medicine and big data, who is normal? Journal of the American Medical Association 319 (19) 1981-1982.

Scott, J.G., Cohen, D., DiCicco-Bloom, B., Miller, W.L., Stange, K.C. & Crabtree, B.F. (2008). Understanding Healing Relationships in Primary Care. Annals of Family Medicine 6 (4) 315-322.

Epstein, R.M., Mauksch, L., Carroll, J. & Jaén, C.R. (2008). Have You Really Addressed Your Patient's Concerns? Family Practice Management 15 (3) 35-40.

Sturmberg, J.P. & Cilliers, P. (2009). Time and the consultation - an argument for a ‘certain slowness’. Journal of Evaluation in Clinical Practice 15 (5) 881-885.

Scott, J.G. (2013). Complexities of the Consultation. In: Handbook of Systems and Complexity in Health. pp. 257-277. Sturmberg, J.P. & Martin, C.M., (Eds.). New York: Springer.



  • There are currently no refbacks.