I was fortunate to meet Aaron Antonovsky and it profoundly changed my life. 45 years ago, in 1976, by a series of unanticipated events I wound up being accepted to be part of the 4th class of the newly established medical school in Beer Sheva. Professor Antonovsky, a medical sociologist at Ben Gurion University in Israel, interviewed me when I applied for admission to the fourth class of the newly established medical school. As a medical sociologist and anthropologist, he was interested in understanding the origins of health, and what allowed individuals to cope and thrive. Aaron, as he liked to be called, had a tremendous role in shaping the medical school’s curriculum. The curriculum was informed and shaped by an understanding that life experiences shape the person’s sense of coherence, a central aspect of helping them mobilize general resistance resources to cope with stressors and manage the inevitable complexity and unpredictability of life. In addition to the traditional foundations of medical practice including basic science such as physiology, anatomy, histology, and body system approach to disease, the curriculum featured courses, discussions, and engagement with people and organizations to better understand contributors to the creation and maintenance of health. Such exposure and orientation was the basis for the salutogenic model that Aaron was developing. Today, retired from nearly 40 years of clinical practice as a psychiatrist, more than ever I recognize and appreciate the importance of the salutogenic philosophy, theory, and models that he was evolving and instilling in us. Recently, I have re-engaged with Salutogenesis, a model for framing health and well-being that was proposed by Aaron Antonovsky. I have resumed my interest in salutogenesis and have set out to build on Antonovsky’s model a paradigm that goes beyond the healthcare ecosystem .
Antonovsky was intrigued by the results of his study and observation of the function of holocaust survivors in Israel. He found that while many exhibited psychological pathology associated with their traumatic experience, others appeared to function well, if not to thrive. Rather than explaining their pathology, he was intrigued and asked what allowed the survivors to not only survive but also achieve a healthy level of well-being and thrive. Based on the research he conducted, he posed the core salutogenic question:
How, despite the continual state of risk and threat around us, are people not constantly in a state of illness and pathology?
Since his death in 1994 Salutogenesis has gained popularity mostly in europe. Multiple research projects testing the salutogenic model have been undertaken. Salutogenic informed interventions have been proposed.
That changed when I came across a talk by Dr. Sir Harry Burns titled What causes wellness? Dr. Burns, who was the chief medical officer of Scotland, discovered Antonovski and salutogenesis and introduced salutogenic informed interventions to address the opioid epidemic ravaging his country in the early 80s. Building on his experience and observations as a surgeon Dr. Burns found that salutogenesis is well-positioned to provide a framework to explore an individual’s health in a complex world and to suggest and inform interventions on the individual, community, and societal levels to address the immense challenges facing society.
The original focus has been expanded beyond health care.
Revisiting Antonovski’s work on salutogenesis, I found that his formulation of health is particularly relevant to the challenges faced within our healthcare system and society more broadly. I have come to see and explore the ways the salutogenic model can provide a more coherent way to see and respond to our current circumstances. Such an exploration led to better understanding and conceptualizing the interaction of the individual within their cultural, political environments.
I believe that the salutogenic model is better suited, and can complement current frameworks guiding health care practice and policy including the biopsychosocial-spiritual approach, population health, public health, the culture of health, social determinants of health, positive health, community health, and many others that have received academic, practice and policy attention in the past decades. In many ways, the salutogenic orientation and approach can empower individuals as political agents within their communities, states, and the nation, to address marginalization and alienation that is so toxic for individual and societal well-being.
Salutogenesis translates research findings into an individual-based action plan. For example, there is research evidence that people with a strong sense of coherence are able to understand the stressor (i.e., comprehensibility), are able to select an appropriate strategy to deal with the stressor (i.e., manageability), and have a strong feeling that engaging with the stressor is a meaningful process (i.e., meaningfulness). Without labeling my process of coping with the challenges confronting our nation, I engaged in my own salutogenic effort to maintain and flourish as a citizen. Feeling marginalized and helpless in the face of the array of existential problems facing our country and the world; the increasing polarization in our country; the expanding inequality and social injustice, and climate change I have come to realize that to truly have an impact, I would need to have a better understanding of the political ecosystem of the US and to find ways to impact that system as a citizen.
By recognizing the important role of the social factors resources and understanding the individual in their environment; considering healing as a multi-factorial process; the importance of mobilizing social, and spiritual resources to achieve well-being.
Incorporate the changes brought about by digital technology, and leveraging that technology for salutogenic mapping of the various ecosystems has made building the paradigm more meaningful and powerful.
Salutogenesis in general and the paradigm in particular have become a central part of my effort to “reclaim my role as a citizen” with the Citizenism Project and the media company Moonshot Press.
The Institute for Salutogenesis is a vehicle for my own salutogenic path and to honor my political agency. The multi-year effort is framed with the salutogenic lens. We the People @ 250, is the road map that builds on the recognition of the work in progress that is the United States and provides a plan to expand the promise of our founders memorialized in the Declaration of Independence. The project offers a year-by-year citizen-initiated and driven effort to create a salutogenic experience for all Americans. We seek to achieve by 2026 an America that more closely resembles the American Creed articulated in 1776.
“We hold these truths to be self-evident. That all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness; that, to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed; that whenever any form of government becomes destructive of these ends, it is the right of the people to alter or to abolish it, and to institute new government, laying its foundation on such principles, and organizing its powers in such form, as to them shall seem most likely to effect their safety and happiness.”
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