SALUTOGENESIS-

WORK –LIFE---

BERN 15.09.2016
PROFESSOR BENGT LINDSTROM ISH NTNU
NORWAY
Bengt Lindström
MD, PhD, DrPH, Pediatrics
Professor of Salutogenesis, SVT/NTNU,
2011 - , NO
Professor II of Health Promotion, HiBu, 2008-2011, NO
Professor of Public Health and Health Promotion, NHV
2006, SE (Emeritus 2013)
Associate Professor Social Policy, Åbo Akademi Vasa,
2007 -, FI
Associate Professor Child Public Health , NHV 2002, SE
Associate Professor Public Health Tampere Univ. 2002, FI
Head of the Health Promotion Research Programme at
Folkhälsan Research Center, Helsinki, 2005 – 2011 , FI
Visiting Professor Wageningen University 2011- , NL
Visiting Professor Cagliari University Italy 2015, IT
THESIS: THE ESSENCE OF EXISTENCE – On The QoL of Children
and Families in the Nordic Countries 1994 NHV
Memberof the IUHPE Global Executive Board 2016
Chair of the IUHPE Global Working Group on
Salutogenesis 2007 - 2016 www.rchpr.org
www.salutogenesis.hv.se
THE INNER QUALITY OF LIFE (MENTAL HEALTH)

Active in the sense of: being interested and engaged in something outside yourself
(hobby, work, politics, religion, art) which you experience as meaningful, having an
appetite for life.

Self–esteem in the sense of: knowing yourself, feeling good as a human being, being
aware of your skills, feeling useful, satisfied with your achievements, morally valuable and
reaching set standards.

Good interpersonal relations in the sense of: having a close, mutual and warm
relationship to at least one human being, having an active satisfying sexual relation,
finding friendship and loyalty and a feeling of participation and belonging (to friends,
neighbours, working companions, friends).

Basic mood of joy in the sense of: having rich intense feelings of beauty, feeling close to
nature, open and receptive, secure, harmonious, the absence of worry, anxiety and
restlessness, a state of joy and compassion, finding life rich and rewarding, the absence of
emptiness, depression, pain and discomfort
(Siri Naess 1974, 1979)
 Health, Disease, Quality of Life

H- --------------------------------------------- H+

D- --------------------------------------------- D+

QoL- ------------------------------------------- QoL+

 Health, Disease, Quality of Life

H- --------------------------------------------- H+

D- --------------------------------------------- D+

QoL- ------------------------------------------- QoL+

EFFECT OF DO-WELL-FACTORS??
 THE TRADITIONAL APPROACH TO HEALTH

?
BUT?? ?
?

R REDUCE RISK

UNDERSTAND
MODIFIEcCATION OF THE CLASSIC ”RIVER OF
HEALTH” ( JOHN MAC KNIGHT 1972)
THE ZERO VISION

THE SWEDISH
PARLIAMENT

THE DEPARTMENT
OF TRAFFIC SAFETY
 Different policies and strategies
Traditional approach
Accidents
Individual road user behavior
Vision Zero approach
Injuries
The system is not designed
according to human capability
and human tolerance against
external violence – in other
words what the human body
can stand.

Road user has primary System designer has primary

responsibility responsibility
Change individual road user Change the environment (road
behavior environment, vehicles, social
environment)

Risk reduction Eliminate fatalities and serious

injuries

VISION ZERO aims to achieve a highway system with no Mats-åke belin

fatalities or serious injuries in road traffic.
Mats-åke Belin Trafikverket,SE
Mats Åke Belin Trafikverket
Mats-åke Belin Trafikverket, SE
Probably the most important Health
Policy change so far:
The WHO HFA Strategy 2000
of 1978 and 1984
- Adding Years to Life (AYL)
- Adding Life to Years (ALY)
- A Sustainable Development
- Equity in Health
- Intersectoral Action..and 38 Targets.
WHO 1948 HEALTH ”A STATE”

THE OTTAWA CHARTER

FOR HEALTH PROMOTION
1986:
HEALTH ”AS A PROCESS”
1986 The Implementation Strategy the
Ottawa Charter for Health Promotion

”Health Promotion is the Process Enabling

People to Gain Control over their Health
Determinants Thereby Improving their Health
and allowing them to lead an Active and
Productive Life”
The ”Genetic Code of Health Promotion”.
AARON
ANTONOVSKY
Photo Bengt Lindström
Salutogenesis, the exploration of the origin of
health, emphasising human strengths and not just
weaknesses, human capacities and not just limits,
well-being and not just illness, and so on…
Professor Maurice Mittelmark
It is a system approach to health that also can be
applied on organisations like schools, hospitals,
communities, cities, business organisations....
Professor Bengt Lindstrøm
41
Conceptually salutogenesis means the
movement towards the health end of
the ease--------- disease continuum
Aaron Antonovsky in Health Stress and Coping 1798
The Key ...
it is not only about the resources at
disposal but the ability and
flexibility to use the resources to
promote a healthy development.
what Antonovsky called “Sense of
Coherence” (SOC)
 Sense of Coherence
... is a global life orientation – a
way of viewing life as coherent,
structured, manageable and
meaningful.

... is a way of ... is a confidence to be able to

thinking, being identify internal and external
and taking action resources, use and reuse them
as a human being. in a health promoting manner.

© Monica Eriksson 2010

Generalized Resistance Resources
(Antonovsky 1979, 1987)

Material (money, housing…)

Biological/mental (self-esteem,
intelligence …)
Emotional (contact with your feelings,
social relations …)
Physical (heredity, healthy orientation
…)
Existential (beliefs, religion, meaning
of life …)
Meaningful activities

© Monica Eriksson 2010

 BUILDING BLOCKS FOR HEALTH PROMOTION PROCESSES
-- A SALUTOGENIC INTERPRETATION
UNDERSTAND

SOC
MEANINGFULNESS

MANAGEABILITY

GRRs
47
LIFE ORIENTATION
HEALTH IN THE RIVER OF LIFE

LIFE

SALUTOGENESIS IS A LIFE ORIENTATION

Two Areas to Combine to bring coherence in and
between life spheres and settings in the life
course
1. The Political or Socio Economic Dimension (STRUCTURE):

The reduction of Inequity, Bridging the Gap

2. The Inner Dimension: The Substance (CONTENTS)

The Psycho-Emotional dimension

Are they like the hen and the egg? The development of a strong SOC
acts on both !?

Overall Aim to develop a Collective SOC?

THE SALUTOGENIC SOCIETY
 The development of a strong SOC
Psychoemotional rather than socioeconomical factors
THE KEY GRRs:
1. Being in contact with ones
inner feelings
(Antonovsky 1979, 1987)
2. GOOD Intimate relationships
(Antonovsky 1979, 1987)
3. Enjoying good Social support
(Antonovsky 1979, 1987; Shawn et al. 2007)
4. Having meaningful everyday
activities
(Antonovsky 1979, 1987)
5. Existential coordinates in
place (Antonovsky 1979, 1987)
CHILDHOOD CONDITIONS INCLUDE
A load balance and consistency
(Sagy & Antonovsky 1996)
Participation in shaping the
outcomes (empowerment)
(Sagy & Antonovsky 1996)
Appropriate childhood conditions
(Antonovsky 1979, 1987)
Absence of family conflict good
neighbourhood cohesion (Shawn et al.
2007)
Introspection and reflection about
job engagement (Forbech Vinje &
Mittelmark 2007)
48
© Monica Eriksson 2010
THE EVIDENCE
A. Antonovsky wrote:

“I am, of course, persuaded that the salutogenic model

has much cogency. We are now at a point where this
persuasion must be tested by empirical research.

Where such research will bring the model a decade hence

cannot be predicted.”
Aaron Antonovsky 1987

But, Aaron Antonovsky died in July 1994 after a malignant myeloma was
diagnosed and he received his first chemotherapy treatment
 SOC and AGE
Mean SOC by Mean Age Mean SOC by Mean Age
based on 15-81-year-aged general populations based on 18-81-year-aged general populations
(16 studies using SOC-13, 1993-2003) (15 studies using SOC-29, 1994-2008)
180 180

160 160

140 140

120 120

100 100
SOC SOC
80 80

60 60

40 40

20 20

0 0
15 21 23 37 39 41Mean
44 age
46 48 50 69 75 78 80 81 18 19 20 23 36 37Mean
43 age
48 50 55 60 67 76 77 81

© Monica Eriksson 2009 © Monica Eriksson 2009

Eriksson M, Lindström B. Life is more than survival: Exploring the links between Antonovsky's salutogenic theory and the
concept of resilience, some conceptual considerations. In: Gow KM, Celinski MJ, editors. Wayfinding through life's
challenges: Coping and survival. New York: Nova Science Publishers; 2010.
© Monica Eriksson 2010
 Generally - A strong SOC ...

… protects against anxiety, depression, burnout and hopelessness

… is strongly and positively related to health resources such as
optimism, hardiness, control, and coping
... predicts good health and QoL from childhood to adulthood
… the stronger the SOC the fewer the symptoms of mental
illnesses

Eriksson M, Unravelling the Mystery of Salutogenesis, 2007; Nielsen AM, Hansson K Stress and Health
2007;23(5):331-341; Sagy S, Braun-Lewensohn O. Global Health Promotion 2009;16(4):5-15;
Simonsson B, Nilsson KW, Leppert J, Diwan VK. BioPsychoSocial Medicine 2008;2(4):doi:10.1186/1751-
0759-2-4; Buddeberg-Fischer B, Klaghofer R, Schnyder U. Soz Praventivmed 2001;46(6):404-410...
Mental The stronger the SOC the better the QoL
of children, adults and in families.
health Findings from both quantitative and
qualitative studies support the SOC to be
a factor enhancing good QoL.
Results from longitudinal studies
confirmed the findings from the cross-
sectional ones.
Most of the studies are using specific
questionnaires for measuring HRQL on
varying samples (patients).
Studies measuring QoL on general
populations are scarce.

Eriksson M, Lindström B. J Epidemiol.

Community Health 2007;61:938-944
 The X and Y Chromosomes

A supportive family
environment in childhood
enhances the level and
heritability of sense of
coherence in early adulthood
Silventoinen H. Volanen SM. Vuoksimaa E. Rose RJ
Suominen S. Kaprio J. Soc Psychiatry Psychiatr Epidemiol
DOI 10.1007/s00127-014-0851-y (2014)
OUTCOMES RELATED TO A STRONG
SALUTOGENIC CAPACITY (SOC)
30 BILLION EUROS
EQUALS

ONE DAY OF WORK FOR THE WHOLE POPULATION /A YEAR:

i. e. A 4 DAYS WORKING WEEK IN FINLAND

If SOC Strong Peope tend to Return to Working Life

18 BILLION DOLLARS/YEAR in USA

spent on Caesarean Sections without medical indications
If SOC is Strong Women Prefer Natural Birth
THE HFA 2000 POLICY AND OUTCOMES RELATED TO DO-WELL FACTORS
spiritual

Modified after Bauer G Pelikan J Davies JK et al 2006

Bengt Lindström 2014
REFERENCES:

Bartley M. (2013) Life Gets Under Your Skin. ESRC International Centre for Life course Studies in Society and
Health, UCL Research Department of Epidemiology and Public Health

Bronfenbrenner, U. (1979). The ecology of human development - Experiments by nature and human design.
Cambridge, Massachusetts: Harvard University Press

Antonovsky A. (1979) Health Stress and coping, SF, Jossey Bass

Antonovsky A. (1987) Unravelling the mystery of Health, SF, Jossey Bass

Antonovsy A (1996) The Salutogenic Model as a theory Guide to Health Promotion Health Promotion
International 1:1 pp 11-18.

Antonovsky A. (1985) The life cycle, mental health and the sense of coherence., Isr J Psychiatry Relat Sci, 22,
273-280

Eriksson M Lindstrom B. A Salutogenic Interpretation of the Ottawa Charter HPI Advance Access March 2008.

Health in All Policies (HiAP): Seizing opportunities, implementing policies. online version www.smt.fi May 23
2013

Eriksson M. (2007) Unravelling the mystery of salutogenesis Folkhalsan Research Report 1

Lindstrom B Erkisson M. (2010) The Hitchhiker´s Guide to Salutogenesis Folkhälsan Research Report 2.

Lindström B . (1994) The Essence of Existence- on the QoL of Children and Families NHV Report 3.

UN (1986) The UN Convention on the Rights of the Child

Lindstrom B Eriksson M. (2011) From health education to Healthy Learning SJPH

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SOME

BOOKS

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