Effective progress on many major health issues confronting us today will require a shift in focus “upstream,” from treating diseases, to promoting wellness before the fact. In line with this shift, a growing body of evidence underscores the importance of Social Determinants of Health (especially in behavioral diseases, such as obesity, diabetes, and certain heart conditions) for efforts to achieve better outcomes and greater health equity. With an annual U.S. cost of $245 billion for diabetes alone, and total U.S. healthcare costs consuming 17.6% of GDP, the stakes are high.

However, there have been few concerted efforts to understand these concepts as a complex dynamic system, and how the interplay of individual, cultural, community, and policy factors creates (or fails to create) a supportive wellness environment.

The Concept

The Wellness as a Complex System (WCS) project will take a systems approach to understanding an individual’s health and wellness, the local community context, and the dynamic interplay between the two, along with other pertinent factors. social-ecologicalmodel

It will utilize principles of “user-centered design” in focusing on the individual’s perception of his or her condition and path to better health; principles of “agent-based modeling,” in seeing how the combination of many individuals creates larger-scale patterns and effects, and leads to emergent behaviors; and principles of “complex adaptive systems” in understanding how all this works together dynamically.

This understanding can then be used to identify highly effective points of inflection, often not previously visible, which can materially improve individual and community health.

Factors bearing on individuals and/or the system, which will be explored, may include these various social “determinants”:

  • Individual, family, and gender expectations and behaviors
  • Community mores
  • Culture and tradition
  • History and geography
  • Policy and politics

The Individual Health Plan

Through the lens of these social determinants, we will endeavor to understand each individual’s particular needs and challenges, and work with them to create an “Individual Health Plan” (IHP). These plans will be designed to help individuals achieve their wellness goals through their own choices and actions. This focus on the individual as the primary source of information and guidance reverses the standard patient/provider paradigm, and offers an opportunity to accelerate innovation.

With a sufficient number of IHP’s in hand, we will then also:

  • Aggregate the anonymized granular data to reach community-level conclusions
  • Factor in community leadership and civic organizations’ perceptions, power, and resources
  • Design targeted interventions (e.g., policies, tools and technologies, structures, procedures) at the appropriate level (i.e., individuals, community, State, region, or even nation)
  • Consider broader community benefits derived from targeted programs, and investments

Trial implementations with baseline and outcome measurements will be used to evaluate the effectiveness of the approach, and inform the design of future efforts. If the approach is deemed sufficiently effective, subsequent stages of development will include efforts to diffuse it broadly to interested communities, so as to achieve maximum impact.

The Pilot Project

WCS will begin with a small-scale pilot project, in collaboration with a particular community and population with evident wellness challenges. The pilot scope will focus on design and testing of the IHP process, data capture, and aggregation. As noted above, we will utilize a “user-centered design” approach, placing the individual at the center of the process, and designing all aspects with his or her experience and perceptions foremost in mind.

This will include a specially designed physical environment for the Individual Health Plan interviews, with a rich array of media and tools available to encourage interviewees to think imaginatively and expressively about their challenges, and how to chart solutions.

The estimated cost for the pilot project is $50,000, leading to the following results, deliverables, and outcomes:

  • Statistical findings from the IHPs and interview results
  • System-level aggregation (which may include simulation and modeling), and hypothetical experimentation with identifying interventions
  • Community engagement in the process, and the basis for moving forward to an implementation/trial Phase 2, with measurement of outcomes
  • Publication and dissemination, with an online public resource-base

Interested funders should contact the Project Director.


The following highly qualified individuals comprise the initial project team:

Justina Trott, M.D., Medical & Policy Director: Justina is a senior fellow and Co-Director of Women’s Health Policy at the Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico. In 2006 she was appointed chair of the New Mexico Governor’s Women’s Health Advisory Council.

David Breecker, Project Director: David is founder and President of the Santa Fe Innovation Park, a real-world R&D lab catalyzing transformative innovation in social systems. He holds an MBA from Harvard University, and directs SFIP’s current projects in energy, finance, and communications systems.

Laurel McCloskey, Advisor: Laurel is Executive Director of the Chronic Disease Prevention Council (CDCP), a multidisciplinary body of experts seeking to reduce chronic disease in New Mexico. CDPC is responsible for the facilitation of the New Mexico Shared Strategic Plan for the Prevention and Control of Chronic Disease, created by a statewide leadership team in 2010.

David Karshmer, Advisor: David is a user-centered design expert, who has served as IDEO’s health and medical practice lead. He has also worked with medical corporations and venture capital firms with health portfolios. He consults independently, and with the innovation firm Collective Invention.

Eli Stefanski, Advisor: Eli is Chief Market Maker for the Business Innovation Factory (an SFIP affiliate), leading BIF’s development efforts. She also leads BIF’s Children’s Wellness Experience Lab, an innovation initiative with Children’s Hospital in Dallas, TX.

Kathy Armijo-Etre, Advisor: Kathy is Vice President of Community Health at Christus St. Vincent Regional Medical Center in Santa Fe, NM. She has a keen interest in population health and wellness issues, and systems-level approaches to these challenges.