Salutogenesis—building health instead of managing disease
Health is not simply an absence of symptoms or disease.
And yet, Western healthcare is fixated upon this idea.
They say ‘healthcare’, but really, it’s disease-management.
If we’ve learned anything over the past 100 years, it’s that health cannot be understood—or meaningfully created—by studying disease alone.
Pathogenesis—the origins of disease
This is the dominant medical model in the West.
It’s an attempt to understand—and ultimately reverse-engineer—health through the study of disease.
The etymology of the word can be traced back to Greek, ‘pathos’ meaning suffering, or disease, and ‘genesis’ meaning origin or beginning.
This model has served us well in some ways—our understanding of infectious disease, and how to mend broken bones, for example—is quite good.
However, in the fight against chronic, degenerative diseases—like cancer, diabetes, obesity, heart disease, neurological diseases and autoimmune conditions—we are losing badly.
Chronic disease eats GDP for breakfast. The economic burden of disease is now costing global taxpayers trillions each year. Currently, in the United States alone, ‘health-care’ costs account for 20% of national Gross Domestic Product (~ $4 trillion USD).
The overwhelming majority (≥ 90%) of these costs are spent on managing chronic diseases.
Surgeries don’t address the root causes of malfunction.
Neither do our pharmaceuticals, which are over-prescribed, and typically come with a litany of unwanted side-effects.
These modern tools are not capable of reversing disease states that stem from decades of biological insults and poor behaviours.
It’s no longer viable (was it ever?) to put all our eggs in the pathogenesis basket.
Salutogenesis—the origins of health
The term ‘salutogenesis’ was coined by Israeli-American academic Aaron Antonovsky.
It also derives it’s nomenclature from Greek, ‘saluto’, meaning health.
Rather than focus on risk factors, ill health and disease, Antonovsky believed it more important to highlight our individual capacity to create health, and to provide people with the necessary resources to do so.
It’s outsourcing health-care to individuals, instead of centralising it to doctors and hospitals.
Salutogenesis is the antithesis of pathogenesis, but both models can work in complementary fashion.
The World Health Organisation (WHO) eventually came to support Antonovsky’s work, and redefined our understanding of health…
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
— Ottawa Charter, 1986
The salutogenic health-care model seeks to empower individuals with the knowledge and tools they need to remain healthy, functional, robust and disease-free.
Modern humans have been led to believe that doctors and insurance companies will take better care of our health than we ever could.
That’s bullshit.
It’s also a defensive approach—which leaves us blind and vulnerable.
Human beings, armed with the right knowledge and resources, are incredibly capable and powerful.
We need to go on the offence—to ensure our health instead of insuring it.
If we implemented some of these ideas on a grand scale, it would significantly reduce our current suffering, spending, and unhealthy dependence on disease-management.
Tools in the toolbox
Drugs and surgeries are the primary disease-management tools in the toolbox of Western medicine.
The salutogenic model leverages a much wider range of tools and applications.
Lifestyle, behavioural interventions, like diet and exercise, are just two of these tools.
They are safe, efficacious, and only come with positive side-effects, providing they are well-prescribed.
Such tools are best employed proactively (before disease develops), instead of reactively (when disease has taken hold).
However, most interestingly, these salutogenic tools have been successfully employed in a reactive manner, achieving reversals in disease states, like diabetes, that modern technologies, like drugs, have failed to remedy.
Information overload and poor implementation
The salutogenic model is not without problems.
The endless stream of data and information we modern folk experience does not serve us very well.
Overexposure to data and contradictory information creates a kind of ‘paralysis by analysis’ situation.
When we do manage to find good information, and then implement it, we don’t seem capable of allowing the necessary time to elapse for the implementation to have the desired (long-lasting) effect.
In other words, we are too quick to decide “well, that didn’t work, on to the next thing”.
The abundance of options, coupled with short attention spans, leaves us prone to chopping, changing and over-correcting.
This is analogous to a hamster on a wheel—there’s a lot of action, and effort, but zero forward progress is often being made.
This approach can dig the hole even deeper, and give salutogenic tools a bad reputation (“it’s ‘alternative / complementary’ and doesn’t actually work…”).
Poor implementation usually results in people giving up, or turning to drugs or supplements as ‘quick fixes’ to their problems.
The remedy to all this confusion is a return to the fundamentals.
Our ancient biological systems have certain expectations and we should be giving these our full attention.
Here’s my own take on what modern humans need to prioritise in order to build health and avoid chronic disease.
A list of salutogenic fundamentals
Clean air
Quality sleep
General movement
Resistance training
Restorative practices
Obviously, this is a strategy-level view, and each of these priorities deserves a separate discussion.
But the point is; if we focused our efforts on these fundamentals—and we dropped our ADHD-like obsession with mainstream media and click-bait bullshit—we’d be much better off.
Side note: This list is missing specific instances of addressing one’s social, spiritual or psychological health, but I think they can, in a significant fashion, be ‘baked into the cake’ of numbers 3, 5, 6 and 7.
Recap
The dominant ‘healthcare’ paradigm of the 20th and 21st centuries has been focused on studying—and managing—disease.
This has helped in many ways, but there’s clearly room for improvement.
Health, it seems, cannot be understood—or meaningfully created—by studying disease alone.
We need to diversify our approach to healthcare, and the salutogenic model can help us do just that.
Need help?
Check our Services, sign up to the Newsletter, and reach out if you need support.
References
Centers for DIsease Control and Prevention (CDC) 2021, Health and Economic Costs of Chronic Diseases, viewed at <https://www.cdc.gov/chronicdisease/about/costs/index.htm>
Lindstrom, B 2005, ‘Salutogenesis’, Journal of Epidemiology & Community Health, vol. 59, no. 6, pp. 440–442.
Potvin, L & Jones, CM 2011, ‘Twenty-five Years After the Ottawa Charter: The Critical Role of Health Promotion for Public Health’, Canadian Journal of Public Health, vol. 102, no. 4, pp. 244–248.
Young, J, McGrath, R & Adams, C 2018, ‘Fresh air, sunshine and happiness: Millennials building health (salutogenesis) in leisure and nature’, Annals of Leisure Research, vol. 21, no. 3, pp. 324–346.