Integrating Salutogenesis into Wellness
This is a follow up article in our series on optimal healthy environments. An optimal healthy environment is an environment that supports and stimulates health by addressing the social psychological, physical, spiritual and behavioural components of health and wellbeing.
"It is more important to know what person has the disease than which disease the person has."-William Osler
This is a follow up article in our series on optimal healthy environments. An optimal healthy environment is an environment that supports and stimulates health by addressing the social psychological, physical, spiritual and behavioural components of health and wellbeing.
It consists of four components:
- Inner environment: The focus is on personal intention and wholeness of each individual. Important aspects are the meaning of health to the individual, personal motivation, expectation and work life balance.
- Intra personal environment: The focus is on health in relationships and the health of the organisation as a whole. Communication, mutual respect and support, leadership, decision making and effective use of resources are some of the aspects of importance.
- Behavioural environment: Here, the focus is on healthy lifestyles that include nutrition, exercise, relaxation and stress management as key areas. Integrative health education includes work place wellness, healing orientated practices and cultural competence.
- External environment: Healing spaces with related aspects of occupational safety, hazards such as noise, ergonomics and indoor air quality are addressed. Ecological sustainability focus on environmental green practices and waste management.
In our previous articles we discussed the inner and intra personal environments. In this article we address the behavioural environment and how to challenge people, organisations and health professionals to change the paradigm of focusing only on risks, ill health and disease to the capacity to create health, utilising a person's own resources through the Salutogenic approach.
The term Salutogenesis describes the origins of health and was first introduced by American-Israeli sociologist Aaron Antanovsky as a framework to focus on changing health behaviour. It has become an established concept with more than 500 articles available on the topic. The paradigm differs from the Pathogenesis model that focuses on the origins of disease.
The key elements of Salutogenesis are an orientation towards problem solving and a capacity to use available resources. It allows us to focus on factors that support and increase well-being rather than on factors that merely prevent disease.
Antanovsky viewed health as a movement on a continuum on an axis between total ill health (dis-ease) and total health (-ease). He suggests that people feel a sense of coherence if they are able to comprehend the whole situation and have the capacity to use the available resources. This capacity is a combination of peoples' ability to assess and understand the situation they are in (comprehensibility), to find meaning to move in a health promotion direction (meaningfulness) and also have the capacity to do so (manageability). This also suggests that an orderly and consistent life is more desirable than a chaotic, random and unpredictable life. Sounds familiar? How many of us are constantly faced with changes, asked to stop doing what we are busy with in order to focus on a new more important issue or to solve an immediate problem. Often we have to cancel personal and family commitments due to urgent work matters. We barely find time to sit down and leisurely eat a meal or have to squeeze in some time for exercise during our very long and full day.
Antanovsky also stated that Salutogenesis is an interdisciplinary approach and the focus is not on the individual but on the interaction between people and the structures of society (human resources and conditions of the living context). The theory gives an answer why some people stay well despite stressful situations and hardships. It focuses on mobilising resources as well as the maintenance and improvement of the movement towards health. It is in stark contrast to the Pathogenic concept where the focus is on decreasing health related risks, obstacles and deficits, which is the predominant model used in allopathic healthcare today.
Resources for Salutogenesis:
The resources are found, not only within people bound to their persons and capacity, but also their immediate and distant environments and include both material and non-material qualities from the person to the whole society. To bring about beneficial behaviour change we have to consider genetic, constitutional and psychosocial factors such as people's level of knowledge and intelligence, their ego identity, coping strategy, social support system, religion, philosophy and attitude towards health maintenance. It is a life orientation focused on the ability and capacity to manage oneself.
Sense of coherence:
The original definition by Antonovsky:
"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."
In an article on Salutogenesis, it is stated that a sense of coherence reflects a person's view on life and capacity to respond to stressful situations. It is an orientation to view life as structured, manageable and meaningful or coherent. It is a personal way of thinking, being, and acting with inner trust. It leads people to identify, benefit, use and re-use the resources at their disposal.
In Antonovsky's formulation, the sense of coherence has three components, these are:
Comprehensibility, this is the cognitive component. It refers to the extent to which you perceive the stimuli that confronts you as making cognitive sense. The stimuli are from the internal as well as external environments. To make sense it should be ordered, consistent, predictable, structured and clear.
Manageability is the instrumental/behavioural component. It is the extent to which a person perceives, that the resources at their disposal are adequate to meet the demands posed on them by the stimuli they are bombarded with. These resources are resources under the person’s own control or resources controlled by legitimate others.
Meaningfulness is the motivational component. It refers to the extent to which a person feels that life makes sense emotionally and that problems and demands are worth investing energy in. Problems and demands are seen as challenges rather that burdens and are worthy of commitment and engagement.
Practical application – What can Salutogenesis do for you?
Salutogenesis can be integrated into wellness in every stage of life from an organisational level. I wanted to quote the authors of articles used.
To understand the population of the organisation we intend to create a program for, we need to learn about their common perceptions, passions, knowledge attitudes and behaviours. We need to engage with employees and understand their areas of concern. We need to understand that a person’s life experience is an important factor in whether they are willing to change and what will inspire them to do so. To facilitate health behaviour change, the culture and environment of the organisation need to be supportive.
Some suggestions on how this can be achieved:
• Limit the emphasis on clinical health risks such as hypertension, diabetes, elevated cholesterol.
• Focus initially on improving the morale within the organisation and develop meaningful relationships between employees and the health and wellness practitioners within organisations. This can be done by allowing time to have fun and play in the organisation.
• Emphasise personal changes and organisational changes to increase opportunities to lead a healthy lifestyle. The focus should be on increasing activity levels, controlling body weight, healthy eating and of key importance decreasing stress and anxiety. This may be achieved by introducing workplace programmes to introduce and teach mindfulness and other practical stress reduction programmes, introducing policies that all cafeterias should have healthy options available on the menu's, creating relaxation areas or chill rooms, creating exercise areas, walkways, incentivise employees to exercise by allowing time during work to do it, adopt no-smoking policies, easy access to employee assistance etc. (refer Mindfulness article)
• Include mental health as a key factor in improving people’s wellbeing, with an emphasis on changing attitudes, increasing self-knowledge, becoming responsible and being empowered. Employees could be encouraged to do a 'sense of coherence questionnaire' and have access to an intervention, neuro-somantic (mind-body) practitioners may be contracted to provide services. The next article will provide more information on mind-body practitioners.
• Where primary care is provided aim to recruit health professionals that focus on holistic and integrative management. Integrative practitioners focus on patient centred care. They empower people to heal themselves and focus on relationships of trust. They listen and use the patient's story to link triggers and mediators and use a systems approach to develop a holistic management programme that incorporates the mind, body, emotional and spiritual aspects. Our next article will focus on the Integrative organisational health team.
• Emphasise programmes that are fun rather than competitive or difficult. These may include non-competitive games, fun runs, walking programmes or nutritional pot-lucks.
If we use the Salutogensis approach to expand our current practices associated with health and wellness within our organisations we will expand the opportunities available to improve and move nearer to optimal health within our organisations.
Dr Marina Botha,
EOH Health
