Salutogenesis

Salutogenesis is a medical approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the "salutogenic model" is concerned with the relationship between health, stress, and coping. The term was coined by Aaron Antonovsky,<ref name=Antonovsky1979>Antonovsky, A. "Health, Stress and Coping" San Francisco: Jossey-Bass Publishers, 1979</ref> a professor of medical sociology.

Antonovsky's theories reject the "traditional medical-model dichotomy separating health and illness". He described the relationship as a continuous variable, what he called the "health-ease versus dis-ease continuum".<ref name=Antonovsky1979/>

Derivation

The word "salutogenesis" comes from the Latin salus = health and the Greek genesis = origin. Antonovsky developed the term from his studies of "how people manage stress and stay well"<ref name=Antonovsky1987>Antonovsky, A. Unraveling The Mystery of Health - How People Manage Stress and Stay Well, San Francisco: Jossey-Bass Publishers, 1987</ref> (unlike pathogenesis which studies the causes of diseases). He observed that stress is ubiquitous, but not all individuals have negative health outcomes in response to stress. Instead, some people achieve health despite their exposure to potentially disabling stress factors.

In his 1979 book, Health, Stress and Coping, Antonovsky described a variety of influences that led him to the question of how people survive, adapt, and overcome in the face of even the most punishing life-stress experiences. In his 1987 book, Unraveling the Mysteries of Health, he focused more specifically on a study of women and aging; he found that 29% of women who had survived Nazi concentration camps had positive emotional health, compared to 51% of a control group. His insight was that 29% of the survivors were not emotionally impaired by the stress. Antonovsky wrote: "this for me was the dramatic experience that consciously set me on the road to formulating what I came to call the 'salutogenic model'."<ref name=Antonovsky1987/>

In salutogenic theory, people continually battle with the effects of hardship. These ubiquitous forces are called generalized resource deficits (GRDs). On the other hand, there are generalized resistance resources (GRRs), which are all of the resources that help a person cope and are effective in avoiding or combating a range of psychosocial stressors. Examples are resources such as money, ego-strength, and social support.

Generalized resource deficits will cause the coping mechanisms to fail whenever the sense of coherence is not robust to weather the current situation. This causes illness and possibly even death. However, if the sense of coherence is high, a stressor will not necessarily be harmful. But it is the balance between generalized resource deficits and resources that determines whether a factor will be pathogenic, neutral, or salutary.<ref name=Antonovsky1979/><ref>Aaron,

 Unravelling the Mystery of Health, 
  
 San Francisco:Jossey-Bass Inc., 
 1987,</ref>

Antonovsky's formulation was that the generalized resistance resources enabled individuals to make sense of and manage events. He argued that over time, in response to positive experiences provided by successful use of different resources, an individual would develop an attitude that was "in itself the essential tool for coping".<ref name=Antonovsky1979/>

Sense of coherence

The "sense of coherence" is a theoretical formulation that provides a central explanation for the role of stress in human functioning. "Beyond the specific stress factors that one might encounter in life, and beyond your perception and response to those events, what determines whether stress will cause you harm is whether or not the stress violates your sense of coherence."<ref>At everydaypsychology.com: The Sense of Coherence</ref> Antonovsky defined Sense of Coherence as:<ref name=Antonovsky1987/><ref name=Antonovsky1990>Antonovsky, Aaron. Studying Health vs. Studying Disease, Lecture at the Congress for Clinical Psychology and Psychotherapy, Berlin, 19 February 1990. available online from the Universidade Nova de Lisboa</ref>

"a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement." <ref>Aaron,

 Unravelling the mystery of health. online version, 
  
 Josey Bass Publishers, 
 1987, 
  
  
 ISBN 978-1-55542-028-4, 
  
  
  
 Pages: 19,</ref>

In his formulation, the sense of coherence has three components:

• Comprehensibility: a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.
• Manageability: a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.
• Meaningfulness: a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.

According to Antonovsky, the third element is the most important. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His essential argument is that "salutogenesis" depends on experiencing a strong "sense of coherence". His research demonstrated that the sense of coherence predicts positive health outcomes.

Fields of application

Health and medicine

Antonovsky viewed his work as primarily addressed to the fields of health psychology, behavioral medicine, and the sociology of health.<ref name=Antonovsky1987/> It has been adopted as a term to describe contemporary approaches to nursing,<ref>England, M., & Artinian, B. (1996). Salutogenic Psychosocial Nursing Practice. Journal of Holistic Nursing, 14(3), 147-195.</ref> psychiatry,<ref>Bergstein, M., Weizman, A., & Solomon, Z. (2008). Sense of Coherence Among Delusional Patients: Prediction of Remission and Risk of Relapse. Comprehensive Psychiatry, 49, 288-296.</ref> integrative medicine,<ref>Rakel D, Fortney L. The Healing Encounter. In: Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:20-26.</ref> and healthcare architecture.<ref>Dilani, A. P. D. (2008). Psychosocially supportive design: A salutogenic approach to the design of the physical environment. Design and Health Scientific Review, 1(2), 47-55.</ref><ref name=Golembiewski>Golembiewski, J. (2010). Start making sense; Applying a salutogenic model to architectural design for psychiatric care. Facilities, 28(3).</ref> The salutogenic framework has also been adapted as a method for decision making on the fly; the method has been applied for emergency care<ref>Golembiewski, J. (2009). Moving from theory to praxis on the fly; Introducing a salutogenic method to expedite mental healthcare provision. Paper presented at the Australian Rural and Remote Mental Health Symposium.</ref><ref>Golembiewski, J A,

 Moving from theory to praxis on the fly; Introducing a salutogenic method to expedite mental healthcare provision., 
 The Australian Journal of Emergency Management, 
 
 Vol. 27(Issue: 2),
 pp. 42–47,</ref> and for healthcare architecture.<ref name=Golembiewski/><ref>Golembiewski, J A, 
 Start making sense; Applying a salutogenic model to architectural design for psychiatric care., 
 Facilities, 
 
 Vol. 28(Issue: 3/4),
 pp. 100–117,
 DOI: 10.1108/02632771011023096,</ref><ref>Golembiewski, Jan A, 
 Psychiatric design: Using a salutogenic model for the development and management of mental health facilities, 
 World Health Design Scientific Review, 
 
 Vol. 5(Issue: 2),
 pp. 74–79,
 
 
 
 
 Full text,</ref><ref>Golembiewski, Jan A, 
 Salutogenic design: The neural basis for health promoting environments, 
 World Health Design Scientific Review, 
 2012,
 Vol. 5(Issue: 4),
 pp. 62–68,
 
 
 
 
 Full text,</ref>

Workplace

The sense of coherence with its three components meaningfulness, manageability and understandability has also been applied to the workplace.<ref>Gregor J. Jenny, Georg F. Bauer, Hege Forbech Vinje, Katharina Vogt, Steffen Torp, The Application of Salutogenesis to Work. In: The Handbook of Salutogenesis, 3 September 2016, pp. 197-210. DOI 10.1007/978-3-319-04600-6_20.</ref><ref name="pmid22184959">,

 [Salutogenesis--new approach to health and disease], 
 Przeglad Epidemiologiczny, 
 2011,
 Vol. 65(Issue: 3),
 pp. 521–7,
 
 PMID: 22184959,</ref>

Meaningfulness is considered to be related to the feeling of participation and motivation and to a perceived meaning of the work.<ref name="lindmark-etal">U. Lindmark, P. Wagman, C. Wåhlin, B. Rolander,

 Workplace health in dental care – a salutogenic approach, 
 International Journal of Dental Hygiene, 
 
 Vol. 16(Issue: 1),
 pp. 103–113,
 DOI: 10.1111/idh.12257,
 PMID: 27860378,
 PMC: 5811775,</ref> The meaningfulness component has also been linked with Job control and with task significance. Job control implies that employees have more authority to make decisions concerning their work and the working process. Task significance involves "the experience of congruence between personal values and work activities, which is accompanied by strong feelings of identification with the attitudes, values or goals of the working tasks and feelings of motivation and involvement".<ref name="BauerJenny2013-p81">, 
  
 Salutogenic organizations and change: The concepts behind organizational health intervention research. online version, 
  
 Springer Science & Business Media, 
  
  
  
 ISBN 978-94-007-6470-5, 
  
  
  
 Pages: 81,</ref>

The manageability component is considered to be linked to job control as well as to access to resources.<ref name="lindmark-etal"/> It has also been considered to be linked with social skills and trust. Social relations relate also to the meaningfulness component.<ref name="BauerJenny2013-p82">,

 Salutogenic organizations and change: The concepts behind organizational health intervention research. online version, 
  
 Springer Science & Business Media, 
  
  
  
 ISBN 978-94-007-6470-5, 
  
  
  
 Pages: 82,</ref>

The comprehensibility component may be influenced by consistent feedback at work,<ref name="BauerJenny2013-p82"/> for example concerning the performance appraisal.

See also

• Determinants of health
• Logotherapy
• Public health
• The Peckham Experiment
• Pathogenesis

Further reading

• Becker, C. M., Glascoff, M. A., & Felts, W. M. (2010). "Salutogenesis 30 Years Later: Where do we go from here?" International Electronic Journal of Health Education, 13, 25-32. Can access at: http://files.portfolioeducacional.webnode.pt/200000064-08f0a09ea3/Orienta%C3%A7%C3%A3o%20Salutog%C3%A9nica.pdf
• Studying Health vs. Studying Disease - Aaron Antonovsky. Lecture at the Congress for Clinical Psychology and Psychotherapy, Berlin, 19 February 1990.
• Coping with Existential Threats and the Inevitability of Asking for Meaningfulness - Peter Novak. A philosophical perspective
• https://usyd.academia.edu/JanGolembiewski/Papers/290160/Start_Making_Sense - Start Making Sense; Applying a salutogenic model to architectural design for psychiatric care - Jan Golembiewski. A method of appliying salutogenic theory.
• Salutogenesis
• Bengt Lindström, "Salutogenesis – an introduction"
• Golembiewski, J. (2012). "Salutogenic design: The neural basis for health promoting environments." World Health Design Scientific Review 5(4): 62-68.https://www.academia.edu/2456916/Salutogenic_design_The_neural_basis_for_health_promoting_environments
• Mayer, C.-H. & Krause, C. (Eds.)(2012): Exploring Mental Health: Theoretical and Empirical Discourses on Salutogenesis. Pabst Science Publishers.
• Mayer, C.-H. & Hausner, s. (Eds.) (2015): Salutogene Aufstellungen. Beitraege zur Gesundheitsfoerderung in der systemischen Arbeit. - Vandenhoeck & Ruprecht
• Mittelmark,M.B., Sagy, S., Eriksson, M. (Eds.) (2016):The Handbook of Salutogenesis.- Springer Publisher.
• Mittelmark, M.B., Sagy, S., Eriksson, M., Bauer, G., Pelikan, J.M., Lindström, B., Espnes, G.A. (Eds.): Comprehensive overview of salutogenesis and its contribution to health promotion theory. https://www.springer.com/us/book/9783319045993