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Context:
Chronic, preventable conditions remain the leading global cause of morbidity and mortality, despite advances in diagnostics and therapeutics. A deeper explanatory framework is needed to account for the persistence of this paradox.
Objective:
To propose the failure cascade model as a unifying framework for understanding the propagation of dysfunction across individual, policy, and medical domains, and to articulate its counterpart — the coherence cascade — as a pathway to resilience.
Design:
Conceptual analysis informed by epidemiologic evidence, health systems research, and clinical analogies from multi-organ dysfunction and systems engineering. Case studies are used to illustrate practical applications.
Findings:
- Failure cascades arise when breakdowns at individual, policy, and medical levels reinforce one another, producing cycles of disease and disengagement.
- Coherence cascades demonstrate that alignment across levels can generate reinforcing cycles of health and resilience.
- Case studies provide empirical evidence that coherence-promoting interventions yield measurable improvements in outcomes.
Implications for Practice:
Clinicians should reframe chronic disease not as a matter of personal blame but as an emergent property of systemic misalignment. Trauma-informed care, integration of social determinants, advocacy for supportive policies, and adoption of systems-based models represent practical applications.
Conclusions:
Reframing health as systemic coherence offers clinicians, policymakers, and researchers a paradigm for moving beyond crisis management toward regenerative health systems.
