Analyzing Public Health Care as a Complex Adaptive System of Systems.

Formulating policy for public health action can be characterized as designing solutions within a complex adaptive system-of-systems (CASoS). Public health systems are complex due to the large number of interdependencies and non-linear interactions among autonomous agents, such as individuals, health care organizations, and governmental agencies. They are adaptive in that the behaviors of individuals, organizations, and diseases are highly responsive to the behaviors of other such agents, as well as to hazards and natural disasters. System-of-systems structure is evident in their ability to be recursively decomposed into collections of interacting components, generally to an arbitrarily low level of detail. Ultimately, designed solutions (public health care actions) must be shown to be robust to the uncertainties inherent within the CASoS. Adaptive systems, whether natural or artificial, evolve in response most strongly to proximal selective pressure. Insomuch as the environments of adaptation contain stochastic components, these systems will tend to adapt in their ability to remain robust in the face of variable perturbations. However, these perturbations can vary in kind as well as in degree. A system that has evolved robustness to some kinds of perturbations can remain brittle against others, and the highly interconnected, interdependent nature of complex systems can respond to a brittleness-induced failure with a cascading collapse of functionality. We implement a model of a health care system as an entity-based model consisting of actors (including staff and patients), diseases that progress according to a Markov process, resources distributed dynamically through the system and used in medical treatments, and organizational/environmental components, such as medical facilities. We adopt a flexible, component based model of the medical service unit (MSU), which can be used to represent facilities in a multi-scale, multi-network architecture. The MSU can represent medical facilities ranging from field stations 288

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