Implications of COVID-19 for Public Health Theory and Praxis From a Complex Systems Perspective

Document Type : Viewpoint


1 Health Services Management Research Centre, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 Centre for Circular Economy, Exeter University Business School, University of Exeter, Exeter, UK

3 Health Human Resources Research Centre, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran


Main Subjects


Complex systems, in a nutshell, are dynamic networks of interactions and interdependencies among a remarkable number of adaptive agents (e.g., human beings and social institutions). According to system dynamic approach all entities are interrelated and have mutual effects on each other. ...(Read more...)

  1. Sturmberg JP, Martin C. Handbook of systems and complexity in health: Springer Science & Business Media; 2013.
  2. Roche B, Guégan JF. Ecosystem dynamics, biological diversity and emerging infectious diseases. Comptes Rendus - Biologies. 2011;334(5-6):385-392. doi:10.1016/j.crvi.2011.02.008
  3. Rogalski MA, Gowler CD, Shaw CL, Hufbauer RA, Duffy MA. Human drivers of ecological and evolutionary dynamics in emerging and disappearing infectious disease systems. Philosophical Transactions of the Royal Society B: Biological Sciences. 2017;372(1712). doi:10.1098/rstb.2016.0043
  4. Long KM, McDermott F, Meadows GN. Being pragmatic about healthcare complexity: our experiences applying complexity theory and pragmatism to health services research. BMC Med. 2018;16(1):94. doi:10.1186/s12916-018-1087-6
  5. Chandler J, Rycroft-Malone J, Hawkes C, Noyes J. Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice. J Adv Nurs. 2016;72(2):461-480. doi:10.1111/jan.12815
  6. Paley J, Eva G. Complexity theory as an approach to explanation in healthcare: a critical discussion. Int J Nurs Stud. 2011;48(2):269-279. doi:10.1016/j.ijnurstu.2010.09.012
  7. Jones KE, Patel NG, Levy MA, et al. Global trends in emerging infectious diseases. Nature. 2008;451(7181):990-993. doi:10.1038/nature06536
  8. Grewal DS. Network power: The social dynamics of globalization: Yale University Press; 2008.
  9. Joseph Norman YB-Y, Nassim Nicholas Taleb. Systemic risk of pandemic via novel pathogens – Coronavirus: A note: New England Complex Systems Institute;2020.
  10. Kashiwagi Y, Todo Y, Matous P. International propagation of economic shocks through global supply chains: WINPEC Working Paper;2018.
  11. Maria del Rio-Chanona PM, Anton Pichler, François Lafond, Doyne Farmer. Supply and demand shocks in the COVID-19 pandemic: An industry and occupation perspective: INET Oxford Working Paper;2020.
  12. Gao J, Barzel B, Barabási AL. Universal resilience patterns in complex networks. Nature. 2016;530(7590):307-312. doi:10.1038/nature16948
  13. Nash DB. Think globally, act locally. Biotechnol Healthc. 2009;6(5):6.
  14. Vespignani A. The fragility of interdependency. Nature. 2010;464(7291):984-985.
  15. Cheong KH, Jones MC. Introducing the 21st Century's New Four Horsemen of the Coronapocalypse. BioEssays. 2020.
  16. Norman J. Global Decentralization for Risk Mitigation and Security. RESEARCHERS.ONE. 2020.
  17. Grant RL, Hood R. Complex systems, explanation and policy: implications of the crisis of replication for public health research. Critical Public Health. 2017;27(5):525-532.
  18. Kurtz CF, Snowden DJ. The new dynamics of strategy: Sense-making in a complex and complicated world. IBM systems journal. 2003;42(3):462-483.
  19. Gilson L, Elloker S, Olckers P, Lehmann U. Advancing the application of systems thinking in health: South African examples of a leadership of sensemaking for primary health care. Health Research Policy and Systems. 2014;12(1):30.
  20. Van der Merwe SE, Biggs R, Preiser R, et al. Making sense of complexity: using SenseMaker as a research tool. Systems. 2019;7(2):25.
  21. Peipoch M, Brauns M, Hauer FR, Weitere M, Valett HM. Ecological Simplification: Human Influences on Riverscape Complexity. BioScience. 2015;65(11):1057-1065. doi:10.1093/biosci/biv120
  22. Roche B, Broutin H, Choisy M, et al. The niche reduction approach: an opportunity for optimal control of infectious diseases in low-income countries? BMC public health. 2014;14(1):753.
  23. Boulton JG, Allen PM, Bowman C. Embracing complexity: Strategic perspectives for an age of turbulence: OUP Oxford; 2015.
  24. Bento F, Garotti L. Resilience beyond Formal Structures: A Network Perspective towards the Challenges of an Aging Workforce in the Oil and Gas Industry. 2019;5(1):15.
  25. Juarrero A. What does the closure of context-sensitive constraints mean for determinism, autonomy, self-determination, and agency? Progress in biophysics and molecular biology. 2015;119(3):510-521.
  26. Juarrero A. Dynamics in action: Intentional behavior as a complex system. Emergence. 2000;2(2):24-57.
  27. Wilson EO. Consilience: The unity of knowledge. Vol 31: Vintage; 1999.
  28. Wilson EO. Consilience and complexity. Complexity. 1998;3(5):17-21.
  29. Lee K, Brumme ZL. Operationalizing the One Health approach: the global governance challenges. Health Policy and Planning. 2012;28(7):778-785. doi:10.1093/heapol/czs127
  30. Wilcox BA, Aguirre AA, De Paula N, Siriaroonrat B, Echaubard P. Operationalizing One Health Employing Social-Ecological Systems Theory: Lessons From the Greater Mekong Sub-region. Frontiers in Public Health. 2019;7(85). doi:10.3389/fpubh.2019.00085
  31. Williams A, Whiteman G, Kennedy S. Cross-Scale Systemic Resilience: Implications for Organization Studies. Business & Society. 2019;0(0):0007650319825870. doi:10.1177/0007650319825870
  32. Allen CR, Angeler DG, Garmestani AS, Gunderson LH, Holling CS. Panarchy: theory and application. Ecosystems. 2014;17(4):578-589.
  33. Gunderson LH. Panarchy: understanding transformations in human and natural systems: Island press; 2001.

Articles in Press, Accepted Manuscript
Available Online from 19 November 2022
  • Receive Date: 24 April 2022
  • Revise Date: 03 November 2022
  • Accept Date: 16 November 2022
  • First Publish Date: 19 November 2022