“…• occurs when a number of simple entities (agents) operate in an environment, forming more complex behaviours as a collective • arises from intricate causal relations across different scales and feedback -interconnectivity • the emergent behaviour or properties are not a property of any single such entity, nor can they easily be predicted or deduced from behaviour in the lower-level entities: they are irreducible appearance of superbugs in response to antibiotic therapies appearance of previously unknown infectious disease epidemics like SARS [41] emergence of drug side effects in particular individuals emergence of new patterns of morbidity/gene expression, as the population ages brain function from complex cellular self-organization prevention paradox -inequities emerge when 'innovative' health promotion guidelines are put into place without considering social and cultural assumptions between public health practitioners and target groups as is seen in screening programmes well baby checks teenage pregnancy education smoking cessation programmes [42] the addition of nurse practitioners to primary care did not alter costs or efficiencies did address considerable other unmet needs [43] Pattern of interaction • different combinations of agents lead to the same outcome, or • the same combination of agents leads to different outcomes sinus-rhythm heart-rate variability in patients with severe congestive heart failure [44] loss of beat-to-beat variability in autonomic neuropathy [45] Cheyne-Stokes breathing [44] most patients with cancer display drastically different patterns of genetic aberrations [46] many biological factors (genetic and epigenetic variations, metabolic processes) and environmental influences can increase the probability of cancer formation, depending on the given circumstances [47] patterns of maternity provider interaction appropriate for the local context influence the emotional well-being of rural mothers [48] international comparison shows that many diverse multifaceted health services lead to remarkably similar outcomes smoking cessation successes [49] obesity challenges exist across diverse cultures and levels of development despite evidence based national dietary guidelines [50] Adaptation and evolution • in the clinical context, numerous diseases develop over many years, during which time the 'whole body system' has adapted to function in the altered environment • changes involve the whole system and are not restricted to a few clinically measurable factors • adaption leads to a new homeostasis with new dynamic interactions [51] hypothyroidism coronary artery disease due to stable plaques 'burnt-out' rheumatoid arthritis stable chronic obstructive airways disease celiac disease cataract hearing impairment adjustments to the health care system due to challenges in health care delivery financing the rate of development of new health technologies rising community expectations [52] stable ritual of clinical care delivery despite ongoing reforms, research and interventions [53] healing tradition ...…”