{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T14:34:07Z","timestamp":1782484447394,"version":"3.54.5"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sociol."],"abstract":"<jats:p>\n                    This Perspective develops a sociological model of\n                    <jats:italic>safe harboring<\/jats:italic>\n                    to explain how governance design shapes the capacity of health systems to sustain integrated care. Drawing on long-standing relational familiarity with Lakota governance practices, articulated here as the \u201cSundance Ecosystem,\u201d the analysis examines women's health\u2014and Primary Ovarian Insufficiency in particular\u2014as a structural stress test for contemporary health systems. Women's health routinely spans multiple physiological systems, social roles, and time horizons, exposing limitations in governance arrangements organized around administrative silos and episodic coordination. The Sundance Ecosystem is treated as an orienting relational governance model rather than as an object of study or empirical case. It informs the articulation of\n                    <jats:italic>safe harboring<\/jats:italic>\n                    as a governance condition defined by continuity, distributed responsibility, and legitimacy grounded in sustained participation rather than hierarchical control. This orientation complements, rather than replaces, sociological theory by clarifying governance features often obscured within institution-centered systems. The manuscript argues that fragmentation in women's health research persists not as a technical failure of coordination but as a structural consequence of governance design.\n                    <jats:italic>Safe harboring<\/jats:italic>\n                    reframes integration as a governance property, emphasizing the conditions under which health systems can sustain continuity, relational accountability, and interpretive coherence across complex, intersecting health needs. This Perspective articulates these concepts for the governance of Primary Ovarian Insufficiency care and human investigation, demonstrating how continuity, responsibility, and interpretive integration can be structurally supported across both clinical and research domains.\n                  <\/jats:p>","DOI":"10.3389\/fsoc.2026.1793764","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T04:48:06Z","timestamp":1776055686000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Safe harboring and governance: Lakota relational systems as context for women's health integration"],"prefix":"10.3389","volume":"11","author":[{"given":"Lawrence Merle","family":"Nelson","sequence":"first","affiliation":[{"name":"Mary Elizabeth Conover Foundation, Inc.","place":["McLean, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e089026","DOI":"10.1136\/bmjopen-2024-089026","article-title":"Unintended patient safety consequences of healthcare technologies","volume":"14","author":"Abdelaziz","year":"2024","journal-title":"BMJ Open"},{"key":"B2","volume-title":"Sacred Fireplace (Oceti Wakan): Life and Teachings of a Lakota Medicine Man","author":"Catches","year":"1999"},{"key":"B3","volume-title":"God is Red: A Native View of Religion","author":"Deloria","year":"1994"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1653839","DOI":"10.3389\/fpubh.2025.1653839","article-title":"Health systems as human systems: reflexivity, relationships, and resilience in the pursuit of the SDGs","volume":"13","author":"Gilson","year":"2025","journal-title":"Front. Public Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1177\/1363461513487669","article-title":"Redressing First Nations historical trauma: theorizing mechanisms for Indigenous culture as mental health treatment","volume":"50","author":"Gone","year":"2013","journal-title":"Transcult. Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1111\/j.1468-0009.2009.00578.x","article-title":"Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method","volume":"87","author":"Greenhalgh","year":"2009","journal-title":"Milbank Q."},{"key":"B7","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1057\/s41271-024-00535-9","article-title":"An integrated framework to guide evidence-informed public health policymaking","volume":"46","author":"Haby","year":"2025","journal-title":"J. Public Health Policy"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1136\/bmj.327.7425.1219","article-title":"Continuity of care: a multidisciplinary review","volume":"327","author":"Haggerty","year":"2003","journal-title":"BMJ"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1560089","DOI":"10.3389\/fpubh.2025.1560089","article-title":"Trust, trust repair, and public health: a scoping review","volume":"13","author":"Kalulu","year":"2025","journal-title":"Front. Public Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1186\/s12913-024-11440-y","article-title":"Associations among claims-based care fragmentation, self-reported gaps in care coordination, and self-reported adverse events","volume":"24","author":"Kern","year":"2024","journal-title":"BMC Health Serv. Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1177\/070674371105600203","article-title":"Rethinking resilience from indigenous perspectives","volume":"56","author":"Kirmayer","year":"2011","journal-title":"Can. J. Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/0160-7987(78)90014-5","article-title":"Concepts and a model for the comparison of medical systems as cultural systems","volume":"12","author":"Kleinman","year":"1978","journal-title":"Soc. Sci. Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"qxaf216","DOI":"10.1093\/haschl\/qxaf216","article-title":"Patient administrative burden: a scoping review","volume":"3","author":"Kyle","year":"2025","journal-title":"Health Aff. Sch."},{"key":"B14","doi-asserted-by":"publisher","first-page":"101326","DOI":"10.1016\/j.lanepe.2025.101326","article-title":"The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions","volume":"53","author":"Menon","year":"2025","journal-title":"Lancet Reg. Health Eur."},{"key":"B15","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1056\/NEJMcp0808697","article-title":"Clinical practice. Primary ovarian insufficiency","volume":"360","author":"Nelson","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e021161","DOI":"10.1136\/bmjopen-2017-021161","article-title":"Continuity of care with doctors\u2014a matter of life and death? A systematic review of continuity of care and mortality","volume":"8","author":"Pereira Gray","year":"2018","journal-title":"BMJ Open"},{"key":"B17","doi-asserted-by":"publisher","first-page":"8782","DOI":"10.34172\/ijhpm.8782","article-title":"Building trust and trustworthiness in public institutions: essential elements in placing trust at the heart of health policy and systems","volume":"13","author":"Peters","year":"2024","journal-title":"Int. J. Health Policy Manag."},{"key":"B18","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1136\/bmj.323.7313.625","article-title":"Complexity science: the challenge of complexity in health care","volume":"323","author":"Plsek","year":"2001","journal-title":"BMJ"},{"key":"B19","volume-title":"Oglala Religion","author":"Powers","year":"1977"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e0003193","DOI":"10.1371\/journal.pgph.0003193","article-title":"Relational community engagement within health interventions at varied outcome scales","volume":"4","author":"Redvers","year":"2024","journal-title":"PLoS Glob. Public Health"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e003542","DOI":"10.1136\/bmjph-2025-003542","article-title":"Governance for public health across health and allied sectors: a scoping review","volume":"3","author":"Saikat","year":"2025","journal-title":"BMJ Public Health"},{"key":"B22","volume-title":"Lakota Society","author":"Walker","year":"1982"}],"container-title":["Frontiers in Sociology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsoc.2026.1793764\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T04:48:20Z","timestamp":1776055700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsoc.2026.1793764\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":22,"alternative-id":["10.3389\/fsoc.2026.1793764"],"URL":"https:\/\/doi.org\/10.3389\/fsoc.2026.1793764","relation":{},"ISSN":["2297-7775"],"issn-type":[{"value":"2297-7775","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]},"article-number":"1793764"}}