Homeostasis and Health: From Balance to Change

Abstract All living systems need to regulate themselves and coordinate the activities of their parts to maintain themselves under changing conditions. Historically, homeostasis is one of the central ideas that have been employed to understand biological regulation. In this article we examine the application of the concept of homeostasis to medicine and its implications for understanding health. We argue that while using homeostasis to characterize health is in line with current criticisms of ideas of health as a complete state of well-being or absence of disease, such an endeavor has been hindered by the adoption of a narrow cybernetic interpretation of homeostasis based on feedback mechanisms and setpoints. This latter interpretation emphasizes stability and balance as the hallmarks of health: a stable physiological state that needs to be preserved or to which an organism needs to return after a perturbation, with change or imbalance as something to be counteracted. William Bechtel has contributed to criticizing this view and reframing the concept of homeostasis by focusing on the organism as a whole. By building on this work and looking at regulation beyond error correction as the organism’s ability to modify its internal dynamics in response to varying conditions, we apply this interpretation of homeostasis to health by advocating for a change of perspective: from a notion of health based on stability and balance to one based on adaptive change. We propose an alternative perspective that emphasizes the capability for change as a new lens through which to understand health.