Salutogenesis: A bona fide guide towards health preservation

Abstract

Preserving health requires a holistic approach involving the component of physical, mental, social, and spiritual well-being as stated by World Health Organisation. Salutogenesis concept focuses on the factors responsible for well-being rather than the disease pathogenesis in contrary to pathogenesis concept. This evidence-based summary tries to shed a light on existing concept called salutogenesis which is much required in the current scenario.

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© 2020 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer - Medknow 16
Introduction
Taking care of one’s own health is probably the most neglected
part of an individuals’ life. We often consult a doctor when we
are ill but never introspect on the conditions which are keeping
us in good health. If we compare our health with an elastic band
that stretches itself till it breaks, it may not be wrong. Aren’t we
doing the same with our health (not disease), stretching it with
many in apparent pathologic conditions and waiting for it to break
one day which will terminate either with a disability or death?
Health and disease are two contrary situations in which the
whole medical industry relies upon. Maintaining health and
treating disease are two difcult tasks which are still to be
conquered. Modern medicine mostly talks about pathology and
the pathogenesis of a disease condition. However, there is a
whole different concept called “Salutogenesis” which focuses
exactly opposite to modern medicine – not the pathogenesis but
health factors that keep in good health.
An Israeli American Sociologist named Aaron Antonovsky who
rst conceptualized the theory of “Salutogenesis” in accordance
with maintaining good health by conducting an epidemiological
experiment on menopausal women of Israel, who were survivors
of the Nazi concentration camps of Second World War. In his
book “Health, Stress, and Coping” he presented the theory of
“Salutogenesis” for the rst time where his idea was to focus more
on people’s potential of sustaining health and well‑being than
on pathogenesis of the disease.[1] The theory boldly accepts that
sufferings are part and parcel of life which are inevitable. However,
many people who are in the same circumstances are able to cope
up with their anxiety and pressure when compared to others. As
it is evident from the examples of holocaust survivors of second
world war that every stressful situation of life may not end up
in disease or ill‑being but may be due to insufciently managed
Salutogenesis: A bona de guide towards health
preservation
Sudip Bhattacharya1, Keerti Bhusan Pradhan2, Md Abu Bashar3, Shailesh
Tripathi4, Arulmani Thiyagarajan5, Abhay Srivastava1, Amarjeet Singh6
1Department of Community Medicine, Himalayan Institute of Medical Sciences, Dehradun, 2Department of Healthcare
Management, Faculty Healthcare Management, Chitkara University, Rajpura, Punjab, 3Department of Community Medicine,
MM Institute of Medical Sciences and Research, MMDU, Mullana, Haryana, 4Directorate of Health Services, Health
Administrator, Uttar Pradesh Government, Lucknow, Uttar Pradesh, 5School of Public Health, Public Health Specialist, SRM
University, Chennai, Tamil Nadu, 6Department of Community Medicine, PGIMER, Chandigarh, India
Abs t rA c t
Preserving health requires a holistic approach involving the component of physical, mental, social, and spiritual well‑being as stated
by World Health Organisation. Salutogenesis concept focuses on the factors responsible for well‑being rather than the disease
pathogenesis in contrary to pathogenesis concept. This evidence‑based summary tries to shed a light on existing concept called
salutogenesis which is much required in the current scenario.
Keywords: Health, preservation, promotion, salutogenesis
Evidence‑Based Summary
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DOI:
10.4103/jfmpc.jfmpc_260_19
Address for correspondence: Dr. Sudip Bhattacharya,
Dehradun ‑ 248 140, Uttarakhand, India.
E‑mail: drsudip81@gmail.com
How to cite this article: Bhattacharya S, Pradhan KB, Bashar MA,
Tripathi S, Thiyagarajan A, Srivastava A, et al. Salutogenesis: A bona
de guide towards health preservation. J Family Med Prim Care
2020;9:16-9.
This is an open access journal, and articles are distributed under the terms of the Creative
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For reprints contact: reprints@medknow.com
Received: 29‑03‑2019 Revised: 11‑11‑2019
Accepted: 15‑11‑2019 Published: 28‑01‑2020
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Bhattacharya, et al.: Salutogenesis and health promotion
Journal of Family Medicine and Primary Care 17 Volume 9 : Issue 1 : January 2020
tension. This implies that the assumption that all anxiety‑ridden
life experiences are intrinsically unpleasant is wrong.
Pathogenesis vs Salutogenesis
In medical science, the pathogenesis concept is important to
understand diseases process; how the diseases develop and how
through the application of this knowledge, healing mechanisms,
or interventions can be developed. Salutogenesis concept, on the
other hand, contributes to our understanding of the development
and maintenance of health. The curative resources, potential for
active adaptation to unaccustomed situation and changes made
to reduce risk alleviation and resource development are given
much emphasis.
According to Antonovsky’s idea, it is more important to focus on
people’s resources and dimensions to create health and well‑being
than the classic focus of medical fraternity on risks, ill health, and
disease. In salutogenic model, health is considered as a position
on health ease and disease continuum, instead of positioning
health and disease opposite to each other, i.e. dichotomy which
is main the feature of pathogenic model. Antonovsky also stated
that disease and stress occur everywhere and all the time and it
is part of life and natural condition. So, it is incorrect to assume
that stressful life experiences are inherently bad. Stress causes
a state of tension in an individual, but the physical outcome of
that tension is dependent on the adequacy of the individual’s
tension management.
To explain this, Antonovsky formulated two key terms
“Sense of Coherence” (SOC) and “General Resistance
Resources” (GRRs).
Antonovsky[2,3] defined SOC as “a global orientation that
expresses the extent to which one has a pervasive, enduring
though dynamic feeling of condence 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 stimuli.
3. These demands are challenges, worthy of investment and
engagement”.
SOC is a theoretical concept that is dened to characterize the
belief that what happens in life is understandable, controllable,
and signicant; which is hypothesized as a exible and adaptive
dispositional orientation of life that enables effective coping
with adverse experience and the maintenance of good health.
In the traditional disease‑oriented (pathogenic) model of health,
the focus is on causes of disease. Accordingly, the disease control
strategies target these causes e.g. smoking, overweight and so on.
In salutogenic model, the emphasis is put on the factors which
cause global well‑being. It focuses on creation and maintenance
of good health rather than to look for the cause of specic
diseases. This is opposite of traditional pathogenic model which
focus on risk factors involved in disease generation. From the
therapeutic point of view, the pathogenic model implies the use
of external healing devices and interventions to eliminate the
pathogenic factors.
As a contrast, in the salutogenic model, the emphasis is on our
internal healing resources and potential for active adaptation to
new circumstances. The aim of both approaches is to attain good
health. The Salutogenesis model focuses on positive aspects.
Sense of coherence (SOC) in health preservation
The SOC is dened as “the way of perceiving life and ability to
manage successfully the innite number of stressors that one
encounters in one’s life”. SOC is our capability to perceive that
we can manage independently whatever is happening in our
lives. One could say that SOC functions as our “sixth sense” for
survival and helps in the generation of our health‑promoting
ability. Antonovsky claimed that SOC can be learned and that
it develops over the lifespan. But it uctuates dynamically
throughout life. Antonovsky postulated that SOC was mainly
formed in the rst decades of life.[4‑6]
Types under SOC
SOC are of three types‑
1. Comprehensibility – To understanding the problem
2. Manageability – To realize that threat can be managed with
the available resources and
3. Meaningfulness – To extract something meaningful from the
stress.
Becker et al. in their review article have introduced the theory of
pathogenesis as “Retrospective” and theory of Salutogenesis as
“Prospective” and suggest the expansion of salutogenic model
into science of positive health.[6] The relationship between sense
of coherence and coronary heart disease has been worked out by
Poppius et al. in which they reveal that workers with high SOC
had nearly half the risk of CHD when compared to individuals
with low SOC.[7]
The salutogenic model also substantiates signicant relationship
between mother’s SOC and their children’s dental caries status.[8]
A major threat to global public health has emerged in the form
of type 2 diabetes mellitus for which salutogenesis has been
used as an instrument to study biopsychosocial domains of the
disease and health‑related communications.[9] Other evidence also
suggested that the salutogenic concept was applied to different
areas of treatment successfully.[10‑12] The model can be elaborated
for preventive approaches in national health programs especially
in noncommunicable diseases.
General Resistance Resources (GRR)
To describe the development of the SOC, Antonovsky used
the concept of GRRs ‑ each of which can simplify evading or
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Bhattacharya, et al.: Salutogenesis and health promotion
Journal of Family Medicine and Primary Care 18 Volume 9 : Issue 1 : January 2020
opposing a wide variety of stress and hardships. These GRRs are
individual characteristics assimilated by means of socialization
and genetics. It is found within people as resource‑bound;
their immediate and distant environment as of both material
and nonmaterial capabilities from the individual to the entire
society.[13]
But the key issue is, not what resources are existing but whether
the person is able to use and reuse them appropriately for the
envisioned purpose. When a person experiences the obtainability
of GRRs, a solid SOC cultivates in them.[14] Hence, both are
interrelated as strong SOC person can bring the necessary GRR
in play.[15‑17]
Typical GRRs are
1. Physical and Chemical (money, housing, clothing, food,
power, intact neurological and immune system, healthy
behaviors, etc.)
2. Cognitive (intelligence, knowledge, experience, education)
3. Emotional (self‑esteem)
4. Interpersonal Relations (social support, interaction).
5. Macrosocial (culture, religion)
GRRs help us to make sense of the countless stressors and
hardships which we constantly confront. The strong SOC
is positively associated with higher‑level education, income,
other psychosocial characteristics including self‑esteem,
self‑motivation, etc., and negatively associated with depression,
psychological distress, anxiety, and negative affectivity.[18]
A parallel may be drawn with Bhagavata Gita, the Hindu scripture,
which also tries to rationalize and help us accept whatever adverse
things happen to us.[19‑21] Gita says, whatever has happened was
OK, whatever is happening is also OK, and whatever will happen
will also be OK. Gita also tries to explain and rationalize whatever
is happening to us or in our lives. Similarly, the SOC concept
also focuses on “action” along with putting our minds at ease.
Relationship between SOC and health behaviors
SOC has been associated with several health behaviors. It is
hypothesized to be a salutogenic resource inuencing the etiology
and recovery from diseases through effective coping. This kind of
coping may include the avoidance of behaviors that directly interfere
with health, such as smoking, excessive drinking, an unhealthy diet,
and a sedentary lifestyle.[22] A study done among Finnish polytechnic
students concluded that physical activity is correlated to the level
of SOC while other studies correlate the lower rates of cigarette
smoking and alcohol consumption with strong SOC.[23] It was
also found that SOC correlates signicantly with healthier dietary
habits.[24] Consistent results obtained that higher SOC is correlated
with healthy lifestyle including regular exercise when compared to
persons engaged in less physical activity.
Researchers suggested that in nonsmokers, an improvement in
exercise enhances immunity by acting on natural killer cell activity
through an increased SOC. Midanik et al. found to have higher
SOC levels in a subsample of light drinkers who reported no
alcohol problem compared to a subsample of persons who were
heavy drinkers, reported alcohol problems at least once in the
previous year. A study among homeless persons who were treated
under the drug recovery program for drug‑abusing revealed that
persons with stronger SOCs have shown fewer risk behaviors
compared to other persons who have less SOC.[25]
The possibility of recognizing the social environment as stressful
is decreased among persons with stronger SOC. It reduces the
probability of adverse neurophysiological response from the
stress taking which further lowers the health‑damaging effects
of perceived chronic stress. However, SOC also has an inuence
on individual’s health.
Research studies suggest that SOC is consistently linked with
good health and high well‑being.[26,27]
Studies have suggested SOC is positively associated with health
conditions and perceived health status among older population.
A strong SOC was found to be associated with decrease in
mortality conditions from cardiovascular diseases.[28] Reduction
in the neck‑shoulder pain was found to have correlation with
SOC.[29] Similarly, SOC also found to have associated with
decrease in anxiety, depression, and clinical variables of rheumatic
disorder.[30]
Salutogenic concepts also have a potential to explain
socioeconomic differentials in health. However, SOC does not
intercede the consequence of childhood factors on adult health.
Studies have shown that SOC act as psychosocial factor has a
possibility in intervention of healthy relationship and income.[31]
Conclusion
Studies suggest that there exists a positive association between
well‑being and SOC, and an inverse association between SOC and
disease, disabilities, and symptoms including health complaints,
dysfunctions and distress, physical symptoms and illness,
burnout, sickness absence frequency, and self‑rated health. It
has also been anticipated that the SOC scale may serve as an
assessment tool in a recovery or rehabilitation program. Thus,
salutogenesis model hence proves to be consistent in preserving
health through SOC and GRRs.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
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