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, 2010. – Please use this citation when referring to material in this
presentation.
From risks to resources…
What could that mean?
The risk mentality in medicine and public health
Skolbekken JA (1995) The risk epidemic in medical journals. Soc Sci Med 40(3),291-305.
What he says, in a diagram…
Proximal causes:
Risk factors
Illness:
ICD-10
Death:
„Premature‟
mortality
Proximal causes:
Risk factors
Pathogenic questions:
illness:
ICD-10
Death:
„Premature‟
mortality
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?
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
Health promotion
Resources
Individual
determinants
of health
mental, social, physical
Risk
factors
Protection – Prevention -- Care
Environmental
determinants
of health
•social
•ecological
•economic
health
Positive health
salutogenesis
Ill health
pathogenesis
Bauer G, et al (2006). The EUPHID health development model for the classification of public health indicators.
Health Promotion International, 21(2), 153-159
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
The Salutogenic Orientation with Sense of Coherence in Focus
Life situation
•culture
•social forces
•social position
•gender
•ethnicity
•age
Life course
stress exposures
•Acute
•chronic
Life
experiences
Sense of coherence
•degrees of
consistency
•orientations
•predispositions
•genetics
•luck
•choices
-work/play
-association
-risk taking
-etc
Generalised
resistance
resources
•support
•skills
•hardiness
etc
•underload-overload
balance
•participation
Motivational component
(wish to cope - meaningfulness)
Cognitive component
(belief challenge understood - comprehensibility)
Behavioural component
(belief resources to cope available - manageability)
Based on: Antonovsky A (1996) The salutogenic model as a theory to guide health promotion. Health Promo Intl. 11(1), 11-18
Movement
towards
Health
The Salutogenic Orientation with Sense of Coherence in Focus
Life situation
•culture
•social forces
•social position
•gender
•ethnicity
•age
Life
experiences
Sense of coherence
•degrees of
consistency
•orientations
•predispositions
•genetics
•luck
•choices
-work/play
-association
-risk taking
-etc
What is health?
Life course
stress exposures
•Acute
•chronic
Generalised
resistance
resources
•support
•skills
•hardiness
etc
•underload-overload
balance
•participation
Motivational component
(wish to cope - meaningfulness)
Cognitive component
(belief challenge understood - comprehensibility)
Behavioural component
(belief resources to cope available - manageability)
Based on: Antonovsky A (1996) The salutogenic model as a theory to guide health promotion. Health Promo Intl. 11(1), 11-18
Movement
towards
Health
What other
resources besides
SOC might be
important to health?
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
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”
„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, 10:253-265.
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
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
Resources,
intrapersonal
Accumulating
lifetime
experience
Individual
differences
Generalised
Resistance
Resources
Sense
of
Coherence
(resource)
Risks,
stress,
Life
Health
Resources,
environmental
•
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
•
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
Symposium
“What is Health Promotion
Research?”
Torill Bull
Monday 1430-1600
Thank you