COVID-19 – An Opportunity to Redesign Health Policy Thinking

Document Type : Perspective


1 School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia

2 International Society for Systems and Complexity Sciences for Health, Waitsfield, VT, USA

3 School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada

4 Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA


Coronavirus disease 2019 (COVID-19) dramatically unveiled the fragile state of the world’s health and social systems – the lack of emergency health crisis preparedness (under-resourced, weak leadership, strategic plans without clear lines of authority), siloed policy frameworks (focus on individual diseases and the lack of integration of health into the whole of societal activity and its impact on individual as well as community well-being and prosperity), and unclear communication (misguided rationale of policies, inconsistent interpretation of data). The net result is fear – about the disease, about risks and survival, and about economic security. We discuss the interdependencies among these domains and their emergent dynamics and emphasise the need for a robust distributed health system and for transparent communication as the basis for trust in the system. We conclude that systems thinking and complexity sciences should inform the redesign of strong health systems urgently to respond to the current health crisis and over time to build healthy, resilient, and productive communities.


Main Subjects

  1. Boulton J. Complexity theory and implications for policy development. Emergence: Complexity & Organization. 2010;12(2):31-40.
  2. Boswell J, Cairney P, St Denny E. The politics of institutionalizing preventive health. Soc Sci Med 2019;228:202-10. doi:10.1016/j.socscimed.2019.02.051
  3. Tsasis P, Evans JM, Owen S. Reframing the challenges to integrated care: a complex-adaptive systems perspective. Int J Integr Care. 2012;12:e190. doi:10.5334/ijic.843
  4. Dolan SL, García S, Diegoli S, et al. Organisational values as "attractors of chaos": An emerging cultural change to manage organisational complexity. Published 2000.
  5. Heifetz R. Leadership Without Easy Answers. Cambridge, Ma: Harvard University Press; 1994.
  6. Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.
  7. Mathijssen J, Petersen A, Besseling P, et al, eds. Dealing with Uncertainty in Policymaking. Final report on the conference Dealing with Uncertainty in Policymaking, 16 and 17 May 2006, The Hague. The Hague/Bilthoven/Leiden: CPB/MNP/Rand Europe; 2008.
  8. Reis J, Spencer PS. Decision-making under uncertainty in environmental health policy: new approaches. Environ Health Prev Med. 2019;24(1):57. doi:10.1186/s12199-019-0813-9
  9. Ackoff RL. Re-Creating the Corporation: A Design of Organizations for the 21st Century. Cary, US: Oxford University Press;1999.
  10. Rittel HWJ, Webber MM. Dilemmas in a General Theory of Planning Policy Sciences. Policy Sci. 1973;4(2):155-169. doi:10.1007/BF01405730
  11. Weick KE. Making Sense of the Organization. Oxford: Wiley-Blackwell; 2000.
  12. WHO. International Health Regulations. 2nd ed. Geneva: WHO; 2005.
  13. Sturmberg JP, O'Halloran DM, Martin CM. People at the centre of complex adaptive health systems reform. Med J Aust. 2010;193(8):474-478. doi:10.5694/j.1326-5377.2010.tb04004.x
  14. Ackoff RL, Gharajedaghi J. Reflections on systems and their models. Syst Res. 1996;13(1):13-23. doi:10.1002/(SICI)1099-1735(199603)13:13.0.CO;2-O
  15. Pachetti M, Marini B, Benedetti F, et al. Emerging SARS-CoV-2 mutation hot spots include a novel RNA-dependent-RNA polymerase variant. J Transl Med. 2020;18(1):179. doi:10.1186/s12967-020-02344-6
  16. Kissler SM, Tedijanto C, Goldstein E, et al. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science. 2020;368(6493):860-868. doi:10.1126/science.abb5793
  17. Hill G, Connelly J, Hébert R, et al. Neyman's bias re-visited. J Clin Epidemiol 2003;56(4):293-96. doi:10.1016/S0895-4356(02)00571-1
  18. Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection. Ann Intern Med. 2020;M20-3012. doi:10.7326/M20-3012
  19. Ing AJ, Cocks C, Green JP. COVID-19: in the footsteps of Ernest Shackleton. Thorax. 2020;75(8):693-694. doi:10.1136/thoraxjnl-2020-215091
  20. Mizumoto K, Kagaya K, Zarebski A, et al. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance. 2020;25(10):2000180. doi:10.2807/1560-7917.ES.2020.25.10.2000180
  21. Boccia S, Ricciardi W, Ioannidis JPA. What other countries can learn from italy during the COVID-19 pandemic. JAMA Intern Med. 2020 doi:10.1001/jamainternmed.2020.1447
  22. Kurtz CF, Snowden DJ. The new dynamics of strategy: Sense-making in a complex and complicated world. IBM Systems Journal. 2003;42(3):462-83. doi:10.1147/sj.423.0462
  23. Heifetz R, Grashow A, Linsky M. The Practice of adaptive leadership: tools and tactics for changing your organization and the world. Boston, MA: Harvard Business Press; 2009.
  24. Wulf A. The Invention of Nature. Alexander von Humboldt's New World. New York: Alfred A. Knopf; 2015.
  25. Rose G. Sick individuals and sick populations. Int J Epidemiol. 2001;30(3):427-32. doi:10.1093/ije/30.3.427
  26. Archer B. Systematic Method for Designers. London, UK: The Design Council; 1965.
  27. Buchanan R. Wicked problems in design thinking. Design Issues. 1992;8(2):5-21. doi:10.2307/1511637
  28. Brown T. Design Thinking. Harv Bus Rev. 2008;86(6):84-92.
  29. Ellis GFR. Top-down causation and emergence: some comments on mechanisms. Interface Focus 2012;2(1):126-140. doi:10.1098/rsfs.2011.0062
  30. Brown T, Martin R. Design for action. Harv Bus Rev. 2015;93(9):56-13.
  31. Kolko J. Design thinking comes of age. Harv Bus Rev. 2015;93(9):66-69.
  32. Smircich L, Morgan G. Leadership: The Management of Meaning. J Appl Behav Sci. 1982;18(3):257-273. doi:10.1177/002188638201800303