Sturmberg Joachim P, Martin Carmel M, Moes Mark M
Department of General Practice, Monash University, Australia, and Newcastle University, Australia.
Perspect Biol Med. 2010 Summer;53(3):341-56. doi: 10.1353/pbm.0.0169.
Contemporary views hold that health and disease can be defined as objective states and thus should determine the design and delivery of health services. Yet health concepts are elusive and contestable. Health is neither an individual construction, a reflection of societal expectations, nor only the absence of pathologies. Based on philosophical and sociological theory, empirical evidence, and clinical experience, we argue that health has simultaneously objective and subjective features that converge into a dynamic complex-adaptive health model. Health (or its dysfunction, illness) is a dynamic state representing complex patterns of adaptation to body, mind, social, and environmental challenges, resulting in bodily homeostasis and personal internal coherence. The "balance of health" model-emergent, self-organizing, dynamic, and adaptive-underpins the very essence of medicine. This model should be the foundation for health systems design and also should inform therapeutic approaches, policy decision-making, and the development of emerging health service models. A complex adaptive health system focused on achieving the best possible "personal" health outcomes must provide the broad policy frameworks and resources required to implement people-centered health care. People-centered health systems are emergent in nature, resulting in locally different but mutually compatible solutions across the whole health system.
当代观点认为，健康和疾病可被定义为客观状态，因此应决定卫生服务的设计与提供。然而，健康概念难以捉摸且颇具争议。健康既不是个体的构建，也不是社会期望的反映，更不仅仅是没有疾病。基于哲学和社会学理论、实证证据以及临床经验，我们认为健康同时具有客观和主观特征，这些特征汇聚成一个动态的复杂适应健康模型。健康（或其功能失调，即疾病）是一种动态状态，代表着对身体、心理、社会和环境挑战的复杂适应模式，从而导致身体内稳态和个人内在的一致性。“健康平衡”模型——新兴、自组织、动态且适应性强——构成了医学的本质基础。该模型应成为卫生系统设计的基础，也应为治疗方法、政策决策以及新兴卫生服务模式的发展提供指导。一个专注于实现最佳“个人”健康结果的复杂适应健康系统必须提供实施以人为本的医疗保健所需的广泛政策框架和资源。以人为本的卫生系统本质上是新兴的，会在整个卫生系统中产生局部不同但相互兼容的解决方案。
