This volume was first published by Inter-Disciplinary Press in 2013. Chronicity is about people rather than medical conditions. It may best be understood as a complex phenomenon in which multiple elements interact with each other in unpredictable ways to bring about unanticipated changes. Making sense of chronicity, therefore, requires that we not only pay attention to all aspects of experiencing the condition, but also think about the relationships between them.

This book addresses the principle that successful treatment incorporates a remarkably broad range of clinical variables. Clinicians must identify the extent to which each factor contributes to the success of the treatment process, and how to utilize this information strategically so that their combination enhances outcome. Complex clinical situations involve numerous macroscopic and microscopic components and their interactions. This book describes clinical practices and variables, that should be weighted according to their relevance for achieving treatment precision and improved results. The book is divided into sections, each containing topically organized chapters. Sections build from identifying discrete components of the clinical field to combined variables as they impact treatment progression. The clinical narratives that make up the latter part of the book elaborate on the course of care and the challenges involved in managing complex clinical situations. Cases range from primary care patients with systemic medical and psychiatric co-morbidity to more complex cases requiring the involvement of medical specialists, allied health professionals, and multiple health care systems. Scholarly, practical, and comprehensive, Complexity in Health Care enables clinicians to incorporate previously underappreciated health-related factors into their thinking and practice.

"Overall, the book walks a delicate balance between evidence and advocacy regarding the care of people with chronic conditions. Nolte and McKee conclude the volume with the following: 'A first step is to recognize that something must be done. A second, which we hope will be facilitated by the evidence provided in this book, is to realize that something actually can be done, and that they can do it (p. 240)'. The overarching desire to match the need for evidence with the reality that advocates (including policy-makers) need a reasoned voice makes the book well suited to health policy deliberations." International Journal of Integrated Care The complex nature of many chronic diseases, which affect people many different ways, requires a multifaceted response that will meet the needs of the individual patient. Yet while everyone agrees that the traditional relationship between an individual patient and a single doctor is inappropriate, there is much less agreement about what should replace it. Many countries are now experimenting with new approaches to delivering care in ways that do meet the complex needs of people with chronic disorders, redesigning delivery systems to coordinate activities across the continuum of care. Yet while integration and coordination have an intuitive appeal, policy makers have had little to help them decide how to move forward. The book systematically examines some of the key issues involved in the care of those with chronic diseases. It synthesises the evidence on what we know works (or does not) in different circumstances. From an international perspective, it addresses the prerequisites for effective policies and management of chronic disease. Taking a whole systems approach, the book: Describes the burden of chronic disease in Europe Explores the economic case for investing in chronic disease management Examines key challenges posed by the growing complexity in healthcare including prevention, the role of self-management, the healthcare workforce, and decision-support Examines systems for financing chronic care Analyses the prerequisites for effective policies for chronic care Caring for People with Chronic Conditions is key reading for health policy makers and health care professionals, as well as postgraduate students studying health policy, health services research, health economics, public policy and management. Contributors: Reinhard Busse, Elisabeth Chan, Anna Dixon, Carl-Ardy Dubois, Isabelle Durand-Zaleski, Daragh K Fahey, Nicholas Glasgow, Monique Hejmans, Izzat Jiwani, Martyn Jones, Cécile Knai, Nicholas Mays, Martin McKee, Ellen Nolte, Thomas E Novotny, Joceline Pomerleau, Mieke Rijken, Dhigna Rubiano, Debbie Singh, Marc Suhrcke.

This Open Access book highlights the ethical issues and dilemmas that arise in the practice of public health. It is also a tool to support instruction, debate, and dialogue regarding public health ethics. Although the practice of public health has always included consideration of ethical issues, the field of public health ethics as a discipline is a relatively new and emerging area. There are few practical training resources for public health practitioners, especially resources which include discussion of realistic cases which are likely to arise in the practice of public health. This work discusses these issues on a case to case basis and helps create awareness and understanding of the ethics of public health care. The main audience for the casebook is public health practitioners, including front-line workers, field epidemiology trainers and trainees, managers, planners, and decision makers who have an interest in learning about how to integrate ethical analysis into their day to day public health practice. The casebook is also useful to schools of public health and public health students as well as to academic ethicists who can use the book to teach public health ethics and distinguish it from clinical and research ethics.

Since 1938 and 1941, nutrient intake recommendations have been issued to the public in Canada and the United States, respectively. Currently defined as the Dietary Reference Intakes (DRIs), these values are a set of standards established by consensus committees under the National Academies of Sciences, Engineering, and Medicine and used for planning and assessing diets of apparently healthy individuals and groups. In 2015, a multidisciplinary working group sponsored by the Canadian and U.S. government DRI steering committees convened to identify key scientific challenges encountered in the use of chronic disease endpoints to establish DRI values. Their report, Options for Basing Dietary Reference Intakes (DRIs) on Chronic Disease: Report from a Joint US-/Canadian-Sponsored Working Group, outlined and proposed ways to address conceptual and methodological challenges related to the work of future DRI Committees. This report assesses the options presented in the previous report and determines guiding principles for including chronic disease endpoints for food substances that will be used by future National Academies committees in establishing DRIs.

In response to a request by the Health Care Financing Administration (HCFA), the Institute of Medicine proposed a study to examine definitions of serious or complex medical conditions and related issues. A seven-member committee was appointed to address these issues. Throughout the course of this study, the committee has been aware of the fact that the topic addressed by this report concerns one of the most critical issues confronting HCFA, health care plans and providers, and patients today. The Medicare+Choice regulations focus on the most vulnerable populations in need of medical care and other services-those with serious or complex medical conditions. Caring for these highly vulnerable populations poses a number of challenges. The committee believes, however, that the current state of clinical and research literature does not adequately address all of the challenges and issues relevant to the identification and care of these patients.