Traditional, complementary and integrative health within universal systems: a transdisciplinary integrative approach to chronic conditions in the Brazilian SUS

In universal health systems such as the Brazilian Unified Health System (SUS), chronic conditions and multimorbidity threaten the sustainability of care. This Perspective connects Traditional, Complementary and Integrative Health (TCIH) with a Transdisciplinary Integrative Health Approach to reframe chronic conditions. Grounded in three pillars (complexity, a multidimensional conception of the human being, and the logic of the included third) the approach understands health and disease as emergent properties of living systems integrating physical, metabolic, vital, mental and supramental (spiritual and systemic) dimensions. We summarize limitations of linear risk-factor models, describe how TCIH practices can act at different dimensions and levels of ‘downward causation', and present arterial hypertension with obstructive sleep apnoea as an illustrative case from the Brazilian SUS, including a vignette involving continuous positive airway pressure (CPAP) and multidimensional transdisciplinary diagnosis. Rather than opposing the biomedical model, the framework positions conventional care, TCIH practices and community-based, nature-based interventions as complementary resources within universal systems. We conclude with implications for training family health teams, designing lines of care and using epidemiological segmentation to plan responses centered on the person and the territory that are clinically effective, culturally resonant and ecologically responsible. By integrating TCIH with a transdisciplinary perspective, chronic conditions can be addressed in ways that support both individual wellbeing and the broader agenda of sustainable and equitable universal health systems.