Allostatic Change And Why It Matters

Allostasis is a term that can make a big difference in shaping our understanding of change and what it means for us.

Biological processes can provide explanations and metaphors that guide how we view and approach change. Among the most popular is homeostasis. Homeostatic processes view things from a set point or baseline and view things in relation to that point with the aim to return things to that point when things are disrupted.

It’s your home. It’s the return to normal.

While useful for some things — especially mechanical things — it is a poor metaphor or descriptor of human life. When we make a change in a complex system — one that describes most human systems like organizations and communities — we change it forever. That change could be minor or profound in its scope, but the point is that we don’t go back.

To illustrate, consider a non-dressed salad with pre-cut components versus a soup. If you throw some vegetables or fruit into a bowl and toss them around, you can conceivably sort them out and return them to the same state they were when you started (assuming you’re working quickly and maybe doing this in a walk-in fridge — I know, it’s a strange example). That’s more in line with homeostatic thinking. However, if you took those same vegetables or fruit and put them in a blender to create a soup or smoothie, you’ve changed the system in a way that can’t be reversed. Both have the same ingredients, yet both are fundamentally different.

The latter is a closer example of allostatic change. Allostasis is what allows us to adapt, homeostasis allows us to return to baseline.

From Disruptions to Load Factors: The Case of COVID-19

The distinction between two types of models of change matter because it shapes our expectations and how we design for change.

When the COVID-19 pandemic hit and public health units went into emergency response mode, they were initially approaching the problem as one of homeostasis. The focus was on reducing the exposure, limiting health damage, and returning the population back to health. The expectation among many was that the emergency phase of the pandemic would last weeks or months, not years. As the pandemic wore on and the nature, scope, and persistence of the threat became clear, public health practitioners started to see COVID-19 in more allostatic terms. Things had changed and plans for ‘post-pandemic’ activities were modified to be framed as a next, not an end.

I worked with public health leaders for two years to support them in their efforts to plan and adapt to a post-emergency state. This entire approach was taken with the assumption that there was no going back to the way things were. That was what public health leaders and their staff told me. The effects of long hours, profound uncertainty, rapidly changing situations, and threats from COVID (and even the public) all contributed a physical and mental toll on staff. To add to the complexity, the way these stressors affected people was highly varied, which means the load on them varied, too.

And just like a physical load, the psychosocial and physiological experience on people was varied.

Allostatic load is defined as the perturbation of several physiological systems toward consistently high or low or non-adaptive states even when stressors remit, whose combined perturbations lead to wear and tear on the body.

Frontiers in Neuroendocrinology, 2018

What affected load were things like:

  • Home situation: Did people have supports at home? Did they feel safe? Were they in a setting where they could concentrate, rest, recover, and create as needed? Were the technological (e.g., Internet, computer, equipment) requirements sufficient?
  • Support: Were there others in their life — spouses/partners, family, colleagues, supervisors — that they could rely on for support when and how they needed or preferred it? What was the level of public support for the work? Were they able to take advantage of the supports made available to them, whether personal or professional?
  • Care requirements: Did people have others they were caring for? Were their loved ones safe? Did they have to look after children or elderly relatives while doing their work and what was available to help that? Were they able to engage in the appropriate self-care activities that they prefer and work for them?
  • Mission: Were they given appropriate resources and support given the circumstances? Did they have clarity in their work? Was the ambiguity, disruption, and stress of the work acknowledged or compensated for? Were they able to sufficiently mobilized their skills, knowledge, tools, and experience to bring to the mission?
  • Leadership: Were the direction, mission, and actions of the organization and partners clearly communicated? Was feedback solicited and considered? Was their work situation and products acknowledged and understood? How much power or influence do we have over decisions that affect us and things that matter to us? How much responsibility were we given and were we provided the means to take appropriate actions commensurate with those responsibilities?

How people responded to these questions determined how the load was balanced and how much energy was available to them to carry this load.

And just like a real, physical load that people carry (e.g., groceries), how long, how far, and to what effects the load has depend on many things and produces varied outcomes. Today, public health organizations are recovering as they shift to new priorities all the while remembering what they’ve been through.

The way this manifested — and continues to do so — across these organization depends on these factors.

No Going Back

The river that I step in is not the river that I stand in.


The public health case is one example. Another is climate change. Consider the climate-related disruptions created by wildfires, floods, extreme heat, and drought and you can see cases that vary in their extreme, have onsets that are rapid or slow, and consequences that extend in wildly different ways. Whereas flooding might have intense local effects, the influence of wildfires can extend across the globe.

These examples are natural systems colliding with human systems, but even entirely human-created systems can yield similar effects. Labour market participation, supply chains, or capital markets can create the same effects. So can human policy decisions. Consider the global supply of housing and the effects caused by changing demographics (e.g., declining birth rates) and mass migrations (e.g., refugees).

When we take an allostatic view of a situation, we don’t look to go back. We might take things from the past and carry them forward as much as we can, but we know that they won’t be entirely the same in the new reality.

When you design for allostatic change in mind, you’re looking to cultivate resilience, discover and amplify what positive effects come from the situation and seek to minimize the negatives. Conducting a lessons learned review with a foresight scan allows you to look back and look ahead. Sensemaking enables you to match the findings from both together.

Strategic design is what takes you forward. It’s what prepares you for the loads you’re carrying and those that are ahead.

Strategic design can bring together good planning with health promotion and care. If you’re looking to create healthy spaces and capacity to transition and transform, let’s talk.

Image Credits: Cameron Norman, Kevin Butz on Unsplash and Timothy Neesam via Flickr

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