Background:
Despite major advances in biomedical science, the global burden of preventable chronic disease continues to rise. Traditional frameworks, which emphasize individual responsibility, have proven insufficient to explain this paradox.
Methods:
This conceptual analysis introduces the failure cascade model, adapted from systems medicine and critical care, to describe how dysfunction propagates across three levels: (1) individual, through constrained agency, stress, and trauma; (2) policy, through obesogenic environments, socioeconomic inequality, and underinvestment in prevention; and (3) medical knowledge and practice, through reductionism, fragmented classifications, and misaligned metrics.
Findings:
When these levels interact, they amplify one another, producing downward spirals of morbidity and multimorbidity. Conversely, the same recursive logic allows for coherence cascades, in which alignment across biological, psychosocial, structural, and clinical domains reinforces resilience. Case studies — including the Blue Zones, Amsterdam’s childhood obesity program, New Zealand’s Wellbeing Budget, Curitiba’s urban planning, and Indigenous health frameworks — illustrate the feasibility of coherence-oriented interventions.
Interpretation:
Health should be reframed not solely as the absence of disease but as systemic coherence: the adaptive alignment of physiologic regulation, psychosocial stability, supportive environments, and integrative clinical practice. This framework offers actionable implications for clinicians, policymakers, and researchers to move beyond disease management toward regenerative health systems.
