Open Access Open Access  Restricted Access Subscription Access


Joachim Sturmberg


As previously described health is an experiential state resulting from the dynamic interactions between the somatic, psychological, social and semiotic or cognitive domains that characterize a person’s integrity. Contrast that with the prevailing discrete disease and economic rationalist approaches to managing the healthcare, or should one better say disease management, system. The epidemiology of health in the community indicates that 96% of the community does require something other than those highly specific and successful discrete disease interventions offered in the secondary and tertiary care environment. A healthcare system build around the experience of health of the community will organise care in a much broader though highly sophisticated way. It will in particular include a focus on health promoting/destroying local community circumstances. Such a systemic approach is illustrated by the healthcare vortex model.


Complex adaptive systems, healthcare reform, healthcare vortex, metaphor, non-linear dynamics patient-centered health, patient experience, philosophy of health, philosophy of medicine, primary care reform

Full Text:



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.). New York: Springer.

White, K., Williams, F. & Greenberg, B. (1961). The Ecology of Medical Care. New England Journal of Medicine 265 (18) 885-892.

Green, L., Fryer, G., Yawn, B., Lanier, D. & Dovey, S. (2001). The Ecology of Medical Care Revisited. New England Journal of Medicine 344 (26) 2021-2025.

Liang, J., Liu, X., Tu, E. & Whitelaw, N. (1996). Probabilities and Lifetime Durations of Short-Stay Hospital and Nursing Home Use in the United States, 1985. Medical Care 34 (10) 1018-1036.

Carreras, M., Ibern, P., Coderch, J., Sanchez, I. & Inoriza, J. (2013). Estimating lifetime healthcare costs with morbidity data. BMC Health Services Research 13 (1) 440.

Alemayehu, B. & Warner, K.E. (2004). The Lifetime Distribution of Health Care Costs. Health Services Research 39 (3) 627-642.

Hoover, D.R., Crystal, S., Kumar, R., Sambamoorthi, U. & Cantor, J.C. (2002). Medical Expenditures during the Last Year of Life: Findings from the 1992–1996 Medicare Current Beneficiary Survey. Health Services Research 37 (6) 1625-1642.

Bortz, W. (2010). Disuse and Aging, 2009. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 65 (4) 382-385.

Brown, P. (1995). Naming and Framing: The Social Construction of Diagnosis and Illness. Journal of Health and Social Behavior 35, Special Issue 34-52.

Sturmberg, J.P., O’Halloran, D.M. & Martin, C.M. (2010). People at the centre of complex adaptive health systems reform. Medical Journal of Australia 193 (8) 474-478.

Sturmberg, J.P., O'Halloran, D.M. & Martin, C.M. (2013). Health Care Reform - The Need for a Complex Adaptive Systems Approach. In: Handbook of Systems and Complexity in Health, (Sturmberg, J.P. & Martin, C.M. eds.), pp. 827-853. New York: Springer.

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.

Sweet, M. (2011). Understanding Miller. Inside Story [serial on the Internet]. Available from:, published 28 March 2011.

Eisenhardt, K.M. & Sull, D.N. (2001). Strategy as Simple Rules. Harvard Business Review 79 (1)107-116.



  • There are currently no refbacks.