Salutogenesis

"What makes people sick?" This is a very important question in medical science. Scientists try to understand the aetiology of diseases and to influence it in a positive way. Psychologists as well traditionally deal with morbid influences from this perspective, e. g. in the case of stress. In the recent past, the reversion of the question has expanded the perspective.

"How do people stay healthy?". This is the critical question a scientist came to by coincidence. He had noticed that, among a traumatized group of women from a concentration camp in Germany during World War II, some women stayed healthier than others. The classical perspective („What is making them sick?“) investigated the group of mentally and physically severely traumatized women. Antonovsky, however, by examining the group of women who had stayed more healthily, tried to find reasons that had enabled them to cope better with the stressors. Antonovsky defined stressors as challenges in life that humans must cope with.
Furthermore, he wanted to verify if these reasons were also valid for other people. The critical question is if a person has resources of resistance to counter stressors. It’s a well-known phenomenon that many people are exposed to the same germs, but only a part of them fall sick. In a wave of common cold, some people get a cold while others do not. This phenomenon is usually explained with a better state of the powers of resistance of some people, which prevent a transmission of the germs. But why do some people have stronger or weaker powers of resistance than others? The concept trying to explain the origin of health and illness is called the „concept of salutogenesis“ (i. e. of the origin of health).

Stressors, resources of resistance and the continuum of health and illness. Antonovsky’s basic idea in his salutogenetic approach is that every human possesses healthy and ill parts. From his view, health and illness are two poles of a continuum.
The health of humans depends on the stressors they are exposed to and the resources of resistance they possess to counter them. The balance between straining and protective factors determines the health state (see image below).

Effect of stressors: They create a situation of stress that can or cannot be coped with and may lead to health (salutogenesis) or illness (pathogenesis) (continuum of health and illness).

Continuum of Health and Illnes Antonovsky described his basic ideas in a metaphorical description; please read a quotation below: "...my fundamental philosophical assumption is that the river is the stream of life. None walks the shore safely. Moreover, it is clear to me that much of the river is polluted, literally and figuratively. There are forks in the river that lead to gentle streams or to dangerous rapids and whirlpools. My work has been devoted to confronting the question: ´Whereever one is in the stream - whose nature is determined by historical, socio-cultural, and physical environmental conditions - what shapes one's ability to swim well?" (Antonovsky, 1987, p.90)

The salutogenetic approach focuses on the way in which a person copes with stressing factors positively. Here are some examples for resources of resistance that allow a positive coping with stressors:

• Sufficient powers of resistance (immune system ) of the body against pathogens and other stressors,
• The capacity to avoid stressors actively (to evade them through health-conducive behaviour / prevention),
• Intelligence and mental flexibility to be able to adapt to living conditions or to actively change them,
• Material resources to ensure protection, nutrition, shelter etc.
• Social support in social networks (e. g. friends, family, co-workers).

According to Antonovsky, an individual with a strong Sense of Coherence reacts to demands (stressors) by considering them as challenges and activating his/her sources of resistance. Someone with a weak Sense of Coherence, however, will soon consider the demand as overload.
Sense of Coherence, then, is a positive and active self-image about one’s own capabilities of coping that is combined with the confidence to be able to control and organize one’s life.
The stronger the Sense of Coherence, the higher is the probability to cope with stressors successfully and with positive effects for one’s health. Thus it is a challenge for health promotion projects in schools to help teenagers develop a positive Sense of Coherence.