An eco-bio-psychosocial approach to individualized care, adaptive capacity, and lasting health.
Two people can share a symptom or diagnosis and need different healthcare. Two people can follow the same recommendations and experience different results. Even the same person can respond differently to an intervention as their health, environment, demands, and resources change. These differences sit at the center of precision healthcare: how do we make better decisions for this person, in these circumstances, at this point in time?
Recent literature is broadening the discussion beyond genetic matching toward individualized prevention, treatment, and monitoring informed by physiology, behavior, environmental exposures, and longitudinal response. A 2025 Nature Communications perspective emphasizes that even highly personalized interventions still require rigorous evaluation of their benefits and effects.[1] We propose connecting precision healthcare with an eco-bio-psychosocial understanding of the person and an adaptive view of health.
This contemporary aim is to understand the individual within the conditions of their life, identify what is limiting their function, and help expand their capacity to meet present and future demands. This is a proposed synthesis of established concepts and an adaptive capacity framework, rather than an externally validated symptom- or condition-based clinical protocol.
Precision begins with a better model of the person
Precision medicine (precision healthcare) often refers to moving away from a one-size-fits-all approach to tailoring prevention or treatment to individual characteristics, sometimes by identifying subgroups more likely to benefit, or stratifying individuals not by how their symptoms manifest, or by how well a treatment works, but on the basis of what caused the symptom or condition in the first place.
Precision healthcare extends that ambition toward maintaining health and anticipating risk by viewing a patient as an individual living in their own unique environmental variables. Precision healthcare, as used here, is the practical delivery of those ideas through assessment, decisions, treatment, education, and follow-up.
Technology can support this work, but it cannot define its quality. A detailed laboratory panel is useful when its results improve a meaningful decision. A wearable is useful when its information changes care or behavior in a beneficial way. A molecular explanation is useful when it is sufficiently supported and helps clarify what to do next. In a longitudinal study of 109 participants enriched for diabetes risk, researchers combined clinical assessment, multi-omics/poly-omics, and wearable monitoring to identify potentially actionable findings.[2] This demonstrated promise, rather than establishing that everyone benefits from comprehensive profiling or that more testing necessarily improves outcomes. The practical standard is therefore straightforward: collect information in proportion to its reliability, relevance, and ability to improve care.
The eco-bio-psychosocial model: the organizing lens
The eco-bio-psychosocial model understands health through the interaction of environment, biology, psychological experience, and social conditions over time. In this article, the term makes the ecological dimension explicit within a whole-person approach. It builds on the biopsychosocial tradition articulated by George Engel, without claiming that this expanded synthesis is a single standardized clinical protocol.[9]
These four dimensions are interconnected perspectives on one person:
1) Ecological: physical surroundings, environmental exposures, and conditions for health
Which environmental conditions are relevant to symptoms, recovery, safety, or opportunity for change? How do this person’s living, working, and recreational environments influence their health, daily rhythms, behavior, safety, and capacity to recover and thrive? Which environmental demands or barriers could be reduced, and which resources or changes could better support their wellbeing and participation in daily life?
Examples: housing quality, indoor and outdoor air quality, water quality, light exposure, noise, temperature and climate, environmental pollutants, occupational exposures, ergonomics, accessibility, neighborhood safety, transportation, walkability, and access to nature, nutritious food, and spaces for movement, rest, and restoration.
2) Biological: physiological function, regulation, and adaptive capacity
What is impaired, what remains well supported, and what requires treatment or investigation? How do this person’s biological characteristics, health history, and interacting body systems influence their health, development, daily function, and capacity to respond to changing demands? What strengths and reserves can be supported, which impairments or constraints need attention, and what requires further investigation, treatment, or monitoring?
Examples: genetics and epigenetics, developmental and aging processes, disease and injury, neurological function, metabolic and mitochondrial function, immune regulation and inflammation, hormonal signaling, cardiovascular and respiratory function, digestion and microbiome activity, nutritional status, circadian rhythms and sleep, musculoskeletal function, physical fitness, medication effects, and physiological recovery and reserve.
3) Psychological: inner experience, mental functioning, and patterns of adaptation
How is this person experiencing their condition, and what would help them understand and navigate it? How do this person’s experiences, perceptions, cognitive abilities, emotions, beliefs, and behavioral patterns influence how they interpret challenges, make decisions, relate to themselves and others, and pursue health? What strengths, skills, and support could help them develop greater understanding, flexibility, agency, and wellbeing?
Examples: thoughts, coping, motivation, and meaning, cognition, attention, memory, emotional regulation, beliefs and expectations, learned associations, coping strategies, habits, motivation, self-efficacy, identity, values, meaning and purpose, psychological flexibility, and the influence of past experiences.
4) Social: relationships, belonging, and societal conditions
What support is available, which demands compete with recovery, and what barriers need addressing? How do this person’s relationships, social roles, cultural context, and access to resources influence their health, opportunities, daily demands, and capacity to thrive? Which connections and structures provide support, meaning, and belonging, and which relational pressures or systemic barriers need attention?
Examples: family and intimate relationships, friendships, social support, loneliness and isolation, community participation, cultural identity and expectations, faith communities, communication and boundaries, relationship safety, work conditions, caregiving responsibilities, education, financial security, discrimination, and access to healthcare and social services.
The boundaries overlap. Housing has physical and social dimensions. Food has nutritional, cultural, financial, and emotional dimensions. Work can provide purpose and connection while also shaping sleep, movement, and exposure patterns. The clinical task is to determine which relationships matter in this person's case. Attention to psychological or social factors must never become a reason to dismiss symptoms or bypass appropriate medical evaluation.
The ecological perspective also connects to the exposome, the broad set of non-genetic exposures across a patient’s lifespan. A 2026 Nature Medicine study mapped exposure–phenotype associations while emphasizing that causal attribution requires additional research.[6] This supports attention to context without treating every measured exposure as a proven cause or treatment target.
A precise plan therefore considers both biological appropriateness and real-world feasibility. Advice about sleep should account for shift work, noise, and caregiving. Nutrition recommendations should account for food access, culture, preparation skills, and tolerability. Exercise prescription should account for health status, current capacity, available facilities, and recovery opportunities.
Understanding the person includes understanding the conditions in which the person is trying to get well.
Systems biology: understanding relationships
Systems biology examines how interactions among biological components produce the behavior of the whole. Systems thinking translates that perspective into clinical reasoning: look for feedback, constraints, relationships, and change over time. An isolated result may identify an important problem, but its significance depends on context. Fatigue, for example, does not identify a single mechanism.
A careful evaluation must consider the history, examination, possible disease, medications, sleep, nutrition, activity, and circumstances before selecting investigations. A systems perspective does not require investigating everything. It requires a coherent explanation of what matters, what remains uncertain, and what evidence could distinguish competing explanations. Systems biology helps explain interactions within the organism. The eco-bio-psychosocial lens broadens the clinical map to include the person’s experience and circumstances. Together, they help make complexity clinically manageable while keeping explanations testable.
Biological relativity: no automatically privileged explanation
The relevant scientific term is biological relativity, associated with physiologist Denis Noble. Its central proposition is that no level of biological organization should automatically be granted causal priority before examining the evidence.[3] Genes, cells, tissues, organs, and whole-organism processes interact. Molecular mechanisms matter, and their behavior also depends on the conditions in which they operate. This is different from saying that every influence is equally important, that objective disease criteria are merely relative, or that biology is whatever an individual believes it to be.
For healthcare, the implication is a disciplined openness: the most useful intervention may address a molecular target, an organ system, a behavior, or an environmental constraint. The evidence and clinical situation should determine the level of action. Combined with the eco-bio-psychosocial model, this suggests a practical discipline: consider relevant influences across levels, then use evidence to determine where intervention is likely to matter most. Neither framework proves a particular causal pathway simply because that pathway sounds plausible.
Adaptive capacity: connecting today's condition with tomorrow's demands
Adaptive capacity is the ability to acquire, organize, allocate, and renew resources to maintain function and respond effectively to changing demands. This offers a way to connect several questions: What demands is this person facing? What resources can they access? What constraints limit their response? How effectively can they recover and reorganize? What can they sustain without progressively sacrificing function?
The eco-bio-psychosocial model identifies the domains to examine; adaptive capacity asks how the person functions across those domains under changing demands. A person may have substantial physical capacity while lacking recovery time or social support. Another may live with chronic disease while developing effective skills, support, and accommodations that improve participation.
Adaptive capital describes available resources.
Adaptive reserve describes the portion that can be mobilized when demands increase.
Adaptive capacity concerns how effectively the person can use and renew those resources over time.
These are organizing concepts, not a validated composite score or a replacement for diagnosis. They also do not imply that illness reflects a failure of effort or attitude. The perspective has an established conceptual parallel: a 2011 BMJ article proposed emphasizing the ability to adapt and self-manage when thinking about health.[4]
Our framework develops that orientation into a practical clinical question: what would help this person function better now while preserving more options for the future? Allostasis, the active adjustments involved in maintaining physiological stability, adds another useful distinction. An adjustment may help meet an immediate demand while carrying costs if it becomes prolonged or poorly regulated.[5] Consequently, apparent performance alone does not tell us whether that performance is sustainable.
Functional medicine: a contribution to reasoning
Functional medicine contributes a personalized, systems-oriented emphasis on biological, behavioral, and environmental contributors to health. Within this framework, its role is to help identify potentially modifiable burdens and constraints, then select appropriate interventions. Lifestyle medicine provides another practical contribution through evidence-based attention to nutrition, physical activity, sleep, stress management, and other relevant behaviors. Health coaching helps translate selected recommendations into skills and feasible routines.
The eco-bio-psychosocial perspective keeps this work attentive to the patient’s circumstances: a physiological intervention and support for implementation may both be necessary. That contribution must remain accountable to the evidence for each test, interpretation, and treatment. A retrospective Cleveland Clinic study found greater improvement in patient-reported physical health at six months among matched functional medicine patients than among primary care comparators. Its observational design cannot establish causation or validate every practice offered under the functional medicine label.[7]
A useful systems approach welcomes multiple contributors without assuming that every abnormal finding is causal or that every patient has one hidden “root cause.” It complements appropriate diagnosis, medication, referral, rehabilitation, and preventive care.
Prognostic levers: choosing what can change the trajectory
A prognostic factor helps predict an outcome. A prognostic lever, as used in this framework, is an actionable factor with credible potential to improve that outcome when changed. The distinction matters. A marker can predict risk without being an effective treatment target. Improving a measurement is not automatically equivalent to improving health.
Candidate levers should therefore be judged by:
Evidence: Does changing this factor improve the outcome that matters?
Relevance: Is it contributing meaningfully in this person's case?
Modifiability: Can we realistically influence it?
Net benefit: Do likely benefits justify risks, costs, and burdens?
Timing: Is this the right intervention now?
Verification: How will we know whether it helped?
A lever may reduce a burden, restore impaired function, improve access to care, or build capacity. It can arise in any eco-bio-psychosocial domain: a relevant environmental modification, treatment of an established biological disorder, appropriate psychological care, or help overcoming a practical barrier to care. Each still requires its own clinical rationale and evidence.
Upstream thinking adds the question: can we change a condition that repeatedly produces the problem? Its value depends on identifying actionable contributors rather than continually managing their consequences. The most sophisticated explanation is not necessarily the most useful starting point.
Root-cause thinking asks what underlying conditions allow this problem to develop, persist, or return. Like removing a weed by its roots rather than cutting it at ground level, the aim is to address the contributors that enable recurrence. In healthcare, these “roots” may involve several interacting biological, psychological, social, and environmental factors. Identifying and addressing them can support lasting improvement while reducing the likelihood that the same problem repeatedly resurfaces.
N-of-1 care: learning from the individual
Population research provides essential starting probabilities. Individual follow-up helps determine whether a reasonable plan is delivering benefit for the person receiving it. A practical N-of-1 orientation begins with a clear hypothesis, baseline measures, an agreed intervention, a reassessment interval, and criteria for continuing, changing, or stopping. However, personalized care and formal N-of-1 trials are different. Formal trials use structured experimental methods, often repeated treatment comparisons, to assess effects within one person. Simple before-and-after tracking is useful but cannot by itself establish causation.[8]
The broader principle is intellectual humility: begin with the best available evidence, make the reasoning explicit, and revise the plan when the patient's response challenges it.
The Adaptive Precision Healthcare Framework
This is a proposed clinical synthesis, not an externally validated protocol. Its purpose is to connect assessment with action and action with learning. The eco-bio-psychosocial model supplies the map; systems thinking examines relationships; biological relativity keeps the level of explanation open; adaptive capacity organizes the clinical aim; prognostic levers guide priorities; and N-of-1 learning informs revision.
Stage 1: Define the Destination
What does better health allow this person to do?
Stage 2: Establish Safety and Diagnosis
What requires urgent attention, investigation, treatment, or referral?
Stage 3: Map the System
Which ecological, biological, psychological, and social relationships matter?
Stage 4: Assess Demands and Capacity
Where do demands exceed accessible resources, and what limits recovery (or functioning and performance)?
Stage 5: Select Prognostic Levers
Which feasible changes offer the greatest expected benefit now?
Stage 6: Personalize Implementation
What dose, pace, support, and delivery fit this individual?
Stage 7: Measure and Update
Are outcomes improving, and does the explanation still fit?
Stage 8: Consolidate Capacity
Can gains be sustained under real-world demands?
Several principles run through every stage:
Use the simplest sufficient assessment.
Order additional testing when it is likely to resolve uncertainty or change management.
Sequence care around constraints.
A sound intervention can fail if the patient lacks the capacity or support to implement it.
Match the outcome to the claim.
Symptom relief, functional improvement, risk reduction, and prevention are different outcomes and require appropriate evidence.
Measure life as well as biology.
Laboratory and physiological findings should sit alongside patient-reported outcomes, daily function, and participation.
Learn at two levels.
Adjust the intervention when needed, and reconsider the underlying explanation when results repeatedly fail to match expectations. This is the practical value of single-loop and double-loop learning.
What this looks like in practice
Consider a hypothetical patient whose goal is to return to exercise without exhaustion. The process starts with a clinical history, examination, and appropriate evaluation of potential causes. The eco-bio-psychosocial lens then organizes relevant questions:
Eco: Does the home or work environment interfere with sleep, safety, or activity?
Bio: Is there an underlying condition, medication effect, nutritional issue, or limitation in exercise tolerance requiring attention?
Psycho: What has the patient experienced, what concerns do they have, and what support would make the plan understandable and manageable?
Social: Do work, finances, caregiving, transport, or access to care limit the available options?
These are questions, not assumed explanations. Testing follows clinical indications. If a treatable condition is identified, it receives appropriate care. If an implementation barrier is also present, the plan addresses it directly. Adaptive-capacity reasoning then asks what the person can currently tolerate, what recovery resources are available, and how to progress without repeatedly exceeding that capacity. The team selects a small number of prognostic levers, defines meaningful measures, and agrees when to reassess.
Success might include greater daily function, improved activity tolerance, fewer symptoms, more reliable recovery, and renewed participation in valued activities. Biological measures are interpreted alongside those outcomes. If progress stalls, the team revisits both the intervention and its explanation. This preserves the distinction between adjusting the plan and reconsidering the model behind it.
Precision with a human purpose
This model brings together five commitments: predictive, preventive, personalized, pragmatic, and participatory care.
Prediction informs anticipation;
prevention addresses avoidable risk;
personalization fits care to the individual;
pragmatism makes it workable;
and participation connects it to the patient's goals.
The eco-bio-psychosocial model makes the person’s full circumstances visible.
Systems thinking connects relevant influences.
Adaptive capacity supplies the organizing purpose: reduce avoidable burdens, restore impaired function, and build the resources and skills needed for future demands.
This gives precision a human purpose: helping people gain sustainable function, greater independence, and more freedom to participate in the lives they value. The question becomes larger than “Which treatment fits this diagnosis?” It becomes:
“What is limiting this person's health, what can we meaningfully change, and how will we know that their life is becoming more possible?”
That is the ambition of adaptive precision healthcare.
Selected references
Schork NJ, Goetz LH. From precision interventions to precision health. Nature Communications. 2025;16:5024. https://doi.org/10.1038/s41467-025-60395-z
Schüssler-Fiorenza Rose SM, et al. A longitudinal big data approach for precision health. Nature Medicine. 2019;25:792–804. https://doi.org/10.1038/s41591-019-0414-6
Noble D. A theory of biological relativity: no privileged level of causation. Interface Focus. 2012;2:55–64. https://doi.org/10.1098/rsfs.2011.0067
Huber M, et al. How should we define health? BMJ. 2011;343:d4163. https://doi.org/10.1136/bmj.d4163
Karatsoreos IN, McEwen BS. Psychobiological allostasis: resistance, resilience and vulnerability. Trends in Cognitive Sciences. 2011;15:576–584. https://pubmed.ncbi.nlm.nih.gov/22078931/
Patel CJ, Ioannidis JPA, Manrai AK. An atlas of exposome–phenome associations in health and disease risk. Nature Medicine. 2026;32:1501–1510. https://doi.org/10.1038/s41591-026-04266-0
Beidelschies M, et al. Association of the functional medicine model of care with patient-reported health-related quality-of-life outcomes. JAMA Network Open. 2019;2:e1914017. https://doi.org/10.1001/jamanetworkopen.2019.14017
Vohra S, et al. CONSORT extension for reporting N-of-1 trials (CENT) 2015 Statement. BMJ. 2015;350:h1738. https://doi.org/10.1136/bmj.h1738
Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–136. https://doi.org/10.1126/science.847460