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This paper proposes a categorization of existing approaches to healthcare-related engineering design based on systems thinking principles. Three existing approaches to healthcare-related engineering design are isolated which contribute differently to health systems fundamental purposes and interconnections. The three approaches are labeled as 'silent', 'overt', and 'convergent' health design. Each approach is defined and illustrated through an example. Following, practical advantages and disadvantages of each approach are discussed. A reflection is offered on the expected relevance of the convergent health design approach for present and future societal challenges in the health domain, and specifically on the recently growing field of e-health. Finally, open methodological challenges related to convergent health design are outlined and characterized as opportunities for future research.

The societal and technical problems faced by low-income markets are increasingly seen as more complex due to environmental, social, and economic concerns. The enormous negative impacts of complex societal problems and the inability of designers to deal with complexity cannot be overcome without a paradigm shift in how we understand, engage with, and teach about such issues. In light of this challenge, one can pose the question, “What is the best approach to deal with a complex societal problem?”. A traditional approach to deal with a complex problem is to simplify it. Alternatively, as here, research may aim to provide a novel approach to handle complex societal problems, thereby embracing complexity. Thus, this thesis contends that embracing complexity represents a significant shift from the traditional design approach to a systems design approach for sustainable development. To help designers to bring about such a transition, the four main contributions provided in this doctoral research are: (I) Exploring the integration of systems thinking into design, particularly by adopting a systems design approach to sustainable energy solutions for low-income markets; (II) Extending the scope of product-service system design through the introduction of four major systems thinking tenets: a holistic perspective; a multilevel perspective; a pluralistic perspective; and complexity-handling capacity; (III) Proposing heuristic tools for the integration of systems thinking into design, which allows for developing new and strengthening existing systems design approaches; and, (IV) Increasing capacity building for a systems design approach to address complex societal problems through design education.