Applying Complexity Science

to Women’s 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 Dr. Kathryn Reed

Internist Obstetrician/Gynecologist
Organ Systems Reproductive Medicine
 organizational
aspects of care
such as

problems in fragmented content

process of service inadequate/
inaccurate
care delivery
have a into reflects due to

mental physical absence of

affective technical gender-based
component component health health invisibility
services services medical
evidence

determines altered by into into

gender reproductive general

quality
bias care medical care
 The New Science of
Women’s 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
• Women’s capacity for reproduction holds
important insights for global medical
applications
Hoffman. Women’s 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. Women’s Health Issues. 2002
Old Science New Science

• Reductionism • Complexity
• Whole=sum of parts • Whole=interactive network
• Linear • Non-linear
• Closed system • Open system
• Entropy • Self-organizing
• Predictable • Sensitive to initial conditions
• Objectivity • Observer bias
 Women’s Health – Science & System
from a Complexity Perspective

Scientific Domains Optimal Health Meta-themes

Complexity Concepts
(Physicians) (women)
Mind is not separate from body Support, empathy & connection Interactive Network
within communities

Sex differences in all organs Value people, relationships & Variability

diversity Fractal v. Normal Distribution

Gender differences in how men & Equality, power & respect Open system
women experience their worlds (equity) Dissipative Structure

Interactions between Harmony & stability within family Self-organizing

reproductive & all organ systems & friendships Dynamic Balance

Adaptations/maladaptations to Balance & integration of physical, Non-linear

pregnant state have global social, emotional & spiritual
applications elements (resilience)
 Women’s Health – Science & System
from a Complexity Perspective

Scientific Domains Optimal Health Meta-themes

(Physicians) (women) Complexity Concept Policy Implications
Mind is not separate from Support, empathy & Interactive Network
body connection within
communities

Sex differences in all Value people, Variability

organs relationships & diversity Fractal v. Normal
Distribution
Gender differences in Equality, power & respect Open system
how men & women (equity) Dissipative Structure
experience their worlds

Interactions between Harmony & stability Self-organizing

reproductive & all organ within family & Dynamic Balance
systems friendships

Adaptations/maladaptatio Balance & integration of Non-linear

ns to pregnant state have physical, social,
global applications emotional & spiritual
elements (resilience)
 Women’s Health – Science & System
from a Complexity Perspective

Scientific Domains Optimal Health Meta-themes

(Physicians) (women) Complexity Concept Policy Implications
Mind is not separate from Support, empathy & Interactive Network Process informs outcome
body connection within Professional modeling
communities

Sex differences in all Value people, Variability Diverse models of care

organs relationships & diversity Fractal v. Normal
Distribution
Gender differences in Equality, power & respect Open system Equal quality of care
how men & women (equity) Dissipative Structure Choice & Voice
experience their worlds Informed decision-making

Interactions between Harmony & stability Self-organizing Relationality at all levels of

reproductive & all organ within family & Dynamic Balance care
systems friendships

Adaptations/maladaptatio Balance & integration of Non-linear Access, interaction &

ns to pregnant state have physical, social, feedback – financial,
global applications emotional & spiritual structural, medical &
elements (resilience) community social services
“NORMAL” DISTRIBUTION
FRACTAL DISTRIBUTION
“NORMAL” DISTRIBUTION
FRACTAL DISTRIBUTION
 70 KG
WHITE
NO. AMERICAN
MIDDLE CLASS
MALE

SEX
AGE
DISEASE TYPE
RACE
ETHNICITY
RELIGION GENOME