Origin and Concept
The concept of salutogenesis was developed by the American-Israeli medical sociologist Aaron Antonovsky (1923-1994) as a result of a critical examination of the existing illness-oriented health care system. Antonovsky dealt with a new question: ”What is it that keeps individuals healthy despite stress and critical events in life?“ This fresh look at health brought up the concept of salutogenesis, a concept focusing on health rather than on illness.
It assumes that sickness and health are not mutually exclusive conditions, but rather two contrary poles of a continuum. For Antonovsky health is not a state of equilibrium, instead it is the result of a dynamic interaction between stressing and protecting factors. This means that health needs to be constantly reproduced and maintained through everyday challenges and accomplishments. This conception leads to the principal question of how challenges can be best met and how a shift towards the pole “health” could be encouraged. Antonovsky’s answer to this question was the search and description of coping resources by developing what he called “generalized resistance resources” including physical, personal, mental, interpersonal, socio-cultural and material resources. These resources represent a person’s potential; they are coping skills for constructively conquering tensions und stress.
The Sense of Coherence Model
His focus on generalized resistance resources led Antonovsky to develop the sense of coherence (SOC) model. He views the sense of coherence as a general orientation which manifests itself in a stable, yet dynamic sense of confidence. The sense of coherence consists of three components: the sense of comprehensibility, the sense of manageability and the sense of meaningfulness.
- Sense of comprehensibility refers to the individual’s capability to perceive everyday information or situations – including external and internal states of experience – as structured or explicable and to assemble this structured information into a consistent pattern.
- Sense of manageability describes the individual’s conviction that difficulties can be resolved. It refers to an instrumental trust and a realistic assessment that one has suitable resources to deal with challenges.
- Sense of meaningfulness refers to the extent that individuals consider their lives as meaningful and sensible. The feeling of meaningfulness can be interpreted as a motivation and incentive to tackle and resolve difficulties, to attach importance to this experience as well as to learn from it.
Antonovsky’s hypothesis is: The stronger the sense of coherence, the more likely a person will - within the continuum of the two poles - move in the direction of the pole “health”. A well developed sense of coherence empowers individuals to respond flexibly to challenges and stress and to activate the appropriate resources.
As a paradigm the salutogenic perspective - with its focus on resources – has to this day established itself mostly in the field of health promotion. In research, the operationalization by the sense of coherence is still controversial. Nonetheless, research approaches generally focusing on protective factors or resources have gained significance.
The salutogenic way of thinking represents a major pillar for health promotion. What does this mean for the specific implementation of salutogenesis? In a metaphorical image Antonovsky compares life with a dangerous river, in which we are swimming. The salutogenic intention is not to keep people from swimming in the river, but rather to search the river for dangerous spots and to improve the swimmer’s skills in order to make swimming safer. Strictly following the salutogenic perspective in the practice of health promotion means:
- investing in conditions that are generally contributing to human health and
- involving individuals in change processes so that they have more freedom of choice and more input as well as resistance resources.
Achieving this requires knowledge of and respect for the different worlds of the affected groups. Getting people to commit in change processes (participation) and strengthening and fostering resources (empowerment) is crucial.
- Antonovsky, A. (1979). Health, stress and coping: New Perspectives on Mental and Physical Well-Being. San Francisco: Jossey Bass.
- Antonovsky, A. (1987). Unraveling The Mystery of Health - How People Manage Stress and Stay Well, San Francisco: Jossey-Bass.
- Bengel, J., Strittmatter, R., & Willmann, H. (1999). What keeps people healthy? The current state of discussion and the relevance of Antonovsky's salutogenetic model of health (Volume 4). Cologne: Federal Centre for Health Education (FCHE). [Link/Download]
- Lindström, B.; Eriksson, M. (2006) Contextualizing salutogenesis and Antonovsky in public health development. Health Promotion International. Vol 21 No 3. [Link/Download]
- Although you know of the concept of salutogenesis, you have never asked yourself how a strict salutogenic perspective could be implemented in a project.
- You find it easier and more concrete to deal with risk factors and risk behaviours rather than with protective factors and resources.
- You influence and change conditions that have a sustainable influence on health.
- You can rely on a positive definition of health that enables you to address and motivate people.
Take a more in-depth look at the concept of salutogenesis and discuss with your team what this approach can really do for your project and how it could be implemented.
- In your project, what would be the difference between a salutogenic and a pathogenic viewpoint?
- From the perspective of your target groups, where could meaningfulness, comprehensibility and manageability be jeopardized?