Tag: primary health care

Book cover: Noncommunicable Disease and the Worlds We Conserve; silhouette inside pastel concentric rings with leafy accents; by Dr. Bichara Sahely, May 27, 2026.

Noncommunicable Disease and the Worlds We Conserve: A Maturana-Informed Framework for Organism–Niche Coherence, Clinical Care, and Public Health | ChatGPT-5.5 Thinking and NotebookLM

Noncommunicable diseases (NCDs) are conventionally understood as chronic biomedical conditions shaped by behavioral, metabolic, environmental, commercial, social, and genetic risk factors. That framing remains indispensable for surveillance, prevention, and evidence-based clinical care. Yet it is incomplete when it treats the body as the primary site of disease while under-describing the recurrent organism–niche relations through which chronic disease patterns are generated, conserved, and transmitted across daily life.

This white paper develops a Maturana-informed framework for NCDs grounded in autopoiesis, structural coupling, cognition as living, emotioning, languaging, and the biology of love. It proposes that many NCD patterns can be understood as stabilized organism–niche miscouplings: conserved ways of living in which biological, emotional, relational, commercial, ecological, and institutional conditions recursively reproduce disease-producing trajectories. The framework does not replace biomedical diagnosis, pharmacotherapy, surgery, oncology, renal medicine, emergency care, or public-health best buys. It places those interventions within a wider biology of living in which healing requires transformations in the relational conditions that make healthier patterns of living possible.

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Cover of 'Civil Commons in Practice' featuring a circular tree diagram with segments for Water, Health, Ecology, Education, Governance, and Integrative Case, around a central tree emblem.

Civil Commons in Practice: Comparative Cases in Water, Health, Education, Ecology, and Governance | ChatGPT-5.5 Thinking and NotebookLM

This paper develops the empirical and institutional extension of the Life-Coherent Peace project through comparative case studies in water, health, education, ecology, and governance. Building on the theoretical framework of Life-Coherent Peace, the tragic-choice methodology of the Life-Coherence Arbitration Protocol, and the non-reductionist Life-Coherence Dashboard, the paper asks how civil commons appear in practice and how they can be evaluated without romanticization. The central argument is that civil commons are not defined by public ownership alone, nor by service delivery alone, but by whether institutions secure means of life, expand life-capacities, prevent structural and cultural violence, protect ecological life-ground, enable participatory legitimacy, and remain accountable to repair.

The paper examines five primary cases: Paris water remunicipalization and Eau de Paris; Costa Rica’s EBAIS primary health care model; Finland’s comprehensive public education system; Costa Rica’s Payments for Ecosystem Services program; and Porto Alegre’s participatory budgeting. It also includes Te Awa Tupua / Whanganui River as an integrative case of ecological, Indigenous, legal, and relational governance. Each case is treated as a partial, situated, imperfect approximation of life-coherent institutional design. The analysis asks: What life-good is at stake? What money-sequence or bureaucratic pressures threaten life-coherence? What civil commons mechanism has been built? What life-capacities are enabled? What risks of capture, exclusion, reversal, or reduction remain?

The paper concludes that Life-Coherent Peace does not require perfect institutions. It requires institutions that are organized to serve life before money, administration, or power; that can detect where they disable life; and that can be corrected through participation, accountability, ecological humility, and repair.

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