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Applying Complexity Science to Womens Health Care

Eileen Hoffman, M.D.


Clinical Associate Professor of Medicine, New York University School of Medicine
and

Kathryn Reed, M.D.


Professor of Obstetrics/Gynecology University of Arizona College of Medicine

Where are we coming from?


Dr. Eileen Hoffman Internist Organ Systems Dr. Kathryn Reed

Obstetrician/Gynecologist
Reproductive Medicine

organizational aspects of care


such as

problems in process of care


have a

fragmented service delivery


into

content
inadequate/ inaccurate
reflects due to

affective component

technical component

mental health services

physical health services


into into

invisibility

absence of gender-based medical evidence

determines altered by

quality

gender bias

reproductive care

general medical care

The New Science of Womens Health


Mind is not separate from body Sex differences exist in all organ systems Gender differences exist in how females & males live in and experience their worlds Complex interactions exist between reproductive & all other medical sciences Womens capacity for reproduction holds important insights for global medical applications
Hoffman. Womens Health and Complexity Science. Academic Medicine. 2000.

Optimal Health for Women


Balance and integration of physical, social, emotional, & spiritual elements of life Harmony and stability within family and close relationships Support, empathy, & connection with friends & within communities Equality, power & respect Living within a society that values people, relationships & diversity
Kasle, Wilhelm, Reed. Optimal Health and Well-Being for Women: Definitions and Strategies Derived from Focus Groups of Women. Womens Health Issues. 2002

Old Science
Reductionism Whole=sum of parts Linear Closed system Entropy

New Science
Complexity Whole=interactive network Non-linear Open system Self-organizing

Predictable
Objectivity

Sensitive to initial conditions


Observer bias

Womens Health Science & System from a Complexity Perspective


Scientific Domains (Physicians)
Mind is not separate from body

Optimal Health Meta-themes Complexity Concepts (women)


Support, empathy & connection within communities Value people, relationships & diversity Equality, power & respect (equity) Harmony & stability within family & friendships Balance & integration of physical, social, emotional & spiritual elements (resilience) Interactive Network

Sex differences in all organs

Variability Fractal v. Normal Distribution Open system Dissipative Structure Self-organizing Dynamic Balance Non-linear

Gender differences in how men & women experience their worlds Interactions between reproductive & all organ systems Adaptations/maladaptations to pregnant state have global applications

Womens Health Science & System from a Complexity Perspective


Scientific Domains (Physicians)
Mind is not separate from body Sex differences in all organs Gender differences in how men & women experience their worlds Interactions between reproductive & all organ systems Adaptations/maladaptatio ns to pregnant state have global applications

Optimal Health Meta-themes Complexity Concept (women)


Support, empathy & connection within communities Value people, relationships & diversity Equality, power & respect (equity) Harmony & stability within family & friendships Balance & integration of physical, social, emotional & spiritual elements (resilience) Interactive Network

Policy Implications

Variability Fractal v. Normal Distribution Open system Dissipative Structure Self-organizing Dynamic Balance Non-linear

Womens Health Science & System from a Complexity Perspective


Scientific Domains (Physicians)
Mind is not separate from body Sex differences in all organs Gender differences in how men & women experience their worlds Interactions between reproductive & all organ systems Adaptations/maladaptatio ns to pregnant state have global applications

Optimal Health Meta-themes Complexity Concept (women)


Support, empathy & connection within communities Value people, relationships & diversity Equality, power & respect (equity) Interactive Network

Policy Implications
Process informs outcome Professional modeling Diverse models of care

Variability Fractal v. Normal Distribution Open system Dissipative Structure

Equal quality of care Choice & Voice Informed decision-making Relationality at all levels of care Access, interaction & feedback financial, structural, medical & community social services

Harmony & stability within family & friendships Balance & integration of physical, social, emotional & spiritual elements (resilience)

Self-organizing Dynamic Balance Non-linear

NORMAL DISTRIBUTION

FRACTAL DISTRIBUTION

NORMAL DISTRIBUTION

FRACTAL DISTRIBUTION

70 KG

WHITE
NO. AMERICAN MIDDLE CLASS MALE

SEX RACE RELIGION

AGE
DISEASE TYPE

ETHNICITY GENOME