From risks to resources

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Alaina Spencer
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1 From risks to resources MB Mittelmark Department of Health Promotion and Development University of Bergen Mittelmark MB. From risks to resources. In: Exploring the SOCdeterminants for health. The 3rd International Research Seminar on Salutogenesis and the 3rd Meeting of the IUHPE GWG-SAL, Geneva, Switzerland, July 11, Please use this citation when referring to material in this presentation.

2 From risks to resources What could that mean?

4 The risk mentality in medicine and public health Skolbekken JA (1995) The risk epidemic in medical journals. Soc Sci Med 40(3),

5 What he says, in a diagram Proximal causes: Risk factors Illness: ICD-10 Death: Premature mortality

6 Proximal causes: Risk factors illness: ICD-10 Death: Premature mortality Pathogenic questions: Resources: Intra-personal Social Material Social services What is the morbidity and mortality burden in a population? What are the (potentially modifiable) risk factors that cause morbidity? Can risk factors be reduced, thereby reducing morbidity and mortality? What resources buffer the impact of risk factors and thereby reduce illness?

7 Problems with the pathogenic orientation Feeds an all-consuming concern with risk factors Assumes that health is the normal state & that risk factors break health People are characterised by their disease (the leg in bed 7) Views resources (mainly) as buffers against poor health

8 Health promotion Resources Environmental determinants of health social ecological economic Individual determinants of health mental, social, physical Risk factors Protection Prevention -- Care Positive health health Ill health salutogenesis pathogenesis Bauer G, et al (2006). The EUPHID health development model for the classification of public health indicators. Health Promotion International, 21(2),

9 Antonovsky poses the salutogenic questions How can we understand movement of people in the direction of the health end of the continuum? all people, wherever they are at any given time, from the terminal patient to the vigorous adolescent How can one be helped to move to greater health, in all aspects, and regardless of diagnoses? We cannot be content with an answer limited to ' low on risk factors' To answer the question requires another concept: salutary factors reverse entropy, becoming more in order Factors that actively promote health

10 The Salutogenic Orientation with Sense of Coherence in Focus Life situation culture social forces social position gender ethnicity age orientations predispositions genetics luck choices -work/play -association -risk taking -etc Life course stress exposures Acute chronic Generalised resistance resources support skills hardiness etc Life experiences degrees of consistency underload-overload balance participation Sense of coherence Motivational component (wish to cope - meaningfulness) Cognitive component (belief challenge understood - comprehensibility) Behavioural component (belief resources to cope available - manageability) Movement towards Health Based on: Antonovsky A (1996) The salutogenic model as a theory to guide health promotion. Health Promo Intl. 11(1), 11-18

11 The Salutogenic Orientation with Sense of Coherence in Focus Life situation culture social forces social position gender ethnicity age orientations predispositions genetics luck choices -work/play -association -risk taking -etc Life course stress exposures Acute chronic Generalised resistance resources support skills hardiness etc Life experiences degrees of consistency underload-overload balance participation Sense of coherence Motivational component (wish to cope - meaningfulness) Cognitive component (belief challenge understood - comprehensibility) Behavioural component (belief resources to cope available - manageability) What is health? Movement towards Health What other resources besides SOC might be important to health? Based on: Antonovsky A (1996) The salutogenic model as a theory to guide health promotion. Health Promo Intl. 11(1), 11-18

12 What is health? A healthy state of wellbeing [is that] free from disease Health is metabolic efficiency, disease is metabolic inefficiency Health is the general condition of a person in all aspects From the Old English hale ; wholeness, a whole being, sound, well Health is the word used to describe how your body feels

13 What is health? Antonovsky (1996) Moving towards greater health must relate to all aspects of the person Health is complex (multi-dimensional) We are subject to unavoidable entropic processes and death WHO -- Health is a state of optimal physical, mental and social well-being, and not merely the absence of disease and infirmity

14 Health endpoints in SOC studies Subjective state of health (selfdefined) Psychological distress Circulatory illness Physical aches and pains Subjective complaints and symptoms Anxiety Depression Anger Burnout Hostility Hopelessness PTSD Negative and positive affectivity Survival Chronic medical conditions Th/Ts ratios Natural killer cells Cortisol level Immunoglobulin level Functional ability Chronic medical conditions Post-traumatic growth* Almedom AM (2005) Resilience, hardiness, SOC and postraumatic growth. J Loss & Trauma, 10:

15 Well-being measures WHO Five Well-being Scale Quality of Well-being Scale Warwick-Edinburgh Mental Well-being Scale 16 Item How Do You Feel Scale? General Well-being Index Ryff psychological Well-being Scales Satisfaction with Life scales Happiness scales Silver lining questionnaire Spiritual Well-being Scale Plus many more

16 What other resources besides SOC might be important to health? Salutary factors move us towards health SOC moves us towards health Therefore SOC is a (decisive) salutary factor But Antonovsky refers to salutary factors, so we may assume there are others Therefore, the salutogenic model is not synonymous with the SOC hypothesis

17 Resources, intrapersonal Accumulating lifetime experience Generalised Resistance Resources Sense of Coherence (resource) Risks, stress, Life Health Individual differences Resources, environmental

18 What puts children at risk for abnormal development? Environment does not meet developmental needs, or suppresses development Failure to invest time and resources during the early years may results in foster care, health problems, learning deficits, social mal-adjustment Unmet health needs (medical examination, immunization

19 What makes children healthy, happy and well-adjusted? Safe, stimulating environment -- home, school, neighbourhood Good food, sleep, exercise, play, immunisation, medical care Unconditional loving attention, praise, positive regard, encouragement Acceptance for who they are Encouragement to develop skills, talents, interests, exploration, inclusion, empathy Rich and responsive language environment, fostering of cultural development Celebration of developmental advances Boundaries and supervision, discipline, stable & predictable living conditions

20 Symposium What is Health Promotion Research? Torill Bull Monday

21 Thank you

Building Healthy Public Policy. the Salutogenic Way

Building Healthy Public Policy the Salutogenic Way Maurice B. Mittelmark Research Centre for Health Promotion University of Bergen Mittelmark MB. Building healthy public policy the salutogenic way. The