SALUTOGENESE HELSE – LIVSKVALITET – HELSEFREMMING

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PROFESSOR BENGT LINDSTROM

GWG-SALUTOGENESIS, ISH NTNU NO

SALUTOGENESE

HELSE – LIVSKVALITET – HELSEFREMMING

SARPSBORG 04.12.2015

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[email protected] MD, PhD, DrPH

Professor of Salutogenesis

IUHPE GLOBAL WORKING GROUP ON SALUTOGENESIS HEAD QUARTERS :

Research Center for Health Promotion and Resources at STV/NTNU.

Trondheim, Norway www.rchpr.org

DATA BASE: www.salutogenesis.hv.se

www.rchpr.org

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Bengt Lindström

MD, PhD, DrPH, Pediatrics

Professor of Salutogenesis, SVT/NTNU, 2011 - , NO

Professor II of Health Promotion, HiBu, 2008-2011, NO Professor of Public Health and Health Promotion, NHV 2006, SE (Emeritus 2013)

Associate Professor Social Policy, Åbo Akademi Vasa, 2007 -, FI

Associate Professor Child Public Health , NHV 2002, SE Associate Professor Public Health Tampere Univ. 2002, FI Head of the Health Promotion Research Programme at Folkhälsan Research Center, Helsinki, 2005 – 2011 , FI Visiting Professor Wageningen University 2011- , NL Visiting Professor Cagliari University Italy 2015, IT

THESIS: THE ESSENCE OF EXISTENCE – On The QoL of Children and Families in the Nordic Countries 1994 NHV

Chair of the IUHPE Global Working Group on Salutogenesis 2007 -see www.rchpr.org

www.salutogenesis.hv.se

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Millennium Development Goals 1Eradicate extreme poverty and hunger

2Achieve universal primary education

3Promote gender equality and empower women

4Reduce child mortality 5Improve maternal health 6Combat HIV / AIDS, malaria and other diseases

7Ensure environmental sustainability

8Develop a global partnership for development

1. Norway 0.890 (Steady) 2. Australia 0.856 (Steady) 3. Sweden 0.851 (Increase 5)

4. Netherlands 0.846 (Decrease 1) 5. Iceland 0.845 (Increase 5)

6. Ireland 0.843 (Steady) 7. Germany 0.842 (Steady) 8. Denmark 0.842 (Increase 4) 9. Switzerland 0.840 (Steady) 10. Slovenia 0.837 (Increase 7) 11. Finland 0.833 (Increase 7) 12. Canada 0.829 (Decrease 7)

2012 List of countries by inequality-adjusted HDI

UNITED NATIONS DEVELOPMENT PROGRAMME

HDI HUMAN DEVELOPMENT INDEX

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1 Japan 2 Singapore

3 Andorra

4 Iceland

5 Cyprus

6 Israel 7 France 8 Italy

9 South Korea 10 Canada

Countries with highest healthy life expectancy, both sexes, 2013

I ”Norden” har vi en relativt hög

förväntad livslängd – cirka 82 år för båda könen – men antalet år med god hälsa är betydligt färre: knappt 70 år. Faktum är att Norden førutom Island inte kvalar in på tio i topp-listan. En lista där Japan följt av Singapore, Andorra, Island och Cypern hamnar allra högst.

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POSITIVE HEALTH?

??

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Health, Disease, Quality of Life

H- --- H+

D- --- D+

QoL- --- QoL+

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Health, Disease, Quality of Life

H- --- H+

D- --- D+

QoL- --- QoL+

EFFECT OF A STRONG SALUTOGENESIS

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THE INNER QUALITY OF LIFE (MENTAL HEALTH)

Active

in the sense of: being interested and engaged in something outside yourself (hobby, work, politics, religion, art) which you experience as meaningful, having an appetite for life.

Self–esteem

in the sense of: knowing yourself, feeling good as a human being, being aware of your skills, feeling useful, satisfied with your achievements, morally valuable and reaching set standards.

Good interpersonal relations

in the sense of: having a close, mutual and warm relationship to at least one human being, having an active satisfying sexual relation, finding friendship and loyalty and a feeling of participation and belonging (to friends, neighbours, working companions, friends).

Basic mood of joy

in the sense of: having rich intense feelings of beauty, feeling close to nature, open and receptive, secure, harmonious, the absence of worry, anxiety and

restlessness, a state of joy and compassion, finding life rich and rewarding, the absence of emptiness, depression, pain and discomfort

(Siri Naess 1974, 1979)

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MODIFIEcCATION OF THE CLASSIC ”RIVER OF HEALTH” ( JOHN MAC KNIGHT 1972)

BUT?? ?

??

REDUCE RISK

THE TRADITIONAL APPROACH TO HEALTH

UNDERSTAND

R

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Probably the most important Health Policy change so far:

The WHO HFA Strategy 2000 of 1984

- Adding Years to Life (AYL) - Adding Life to Years (ALY)

- A Sustainable Development - Equity in Health

- Intersectoral Action..and 38 Targets.

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THE OTTAWA CHARTER

FOR HEALTH PROMOTION

1986

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THE FIVE ACTION AREAS

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AARON

ANTONOVSKY

Photo Bengt Lindström

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Conceptually salutogenesis means the movement towards the health end of the ease--- disease continuum

Aaron Antonovsky in Health Stress and Coping 1798

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Sense of Coherence

... is a global life orientation – a way of viewing life as coherent, structured, manageable and meaningful.

... is a confidence to be able to identify internal and external resources, use and reuse them in a health promoting manner.

... is a way of thinking, being and taking action as a human being.

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Generalized Resistance Resources

Material (money, housing…)

Biological/mental (self-esteem, intelligence …)

Emotional (contact with your feelings, social relations …)

Physical (heredity, healthy orientation

…)

Existential (beliefs, religion, meaning of life …)

Meaningful activities

(Antonovsky 1979, 1987)

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The Key ...

i t is not only about the resources at

disposal but the ability and flexibility to use them in a health promoting manner.

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BUILDING BLOCKS FOR HEALTH PROMOTION PROCESSES -- A SALUTOGENIC INTERPRETATION

MEANINGFULNESS

MANAGEABILITY UNDERSTAND

GRRs

SOC

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LIFE ORIENTATION

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HEALTH IN THE RIVER OF LIFE

SALUTOGENESIS IS A LIFE ORIENTATION

LIFE

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The development of a strong SOC

THE KEY GRRs:

1. Being in contact with ones inner feelings

2. GOOD Intimate relationships

3. Enjoying good Social support

(Antonovsky 1979, 1987; Shawn et al. 2007)

4. Having meaningful everyday activities

5. Existential coordinates in place

CHILDHOOD CONDITIONS INCLUDE

A load balance and consistency

(Sagy & Antonovsky 1996)

Participation in shaping the

outcomes (empowerment)

(Sagy & Antonovsky 1996)

Appropriate childhood conditions

Absence of family conflict good neighbourhood cohesion

(Shawn et al.

2007)

Introspection and reflection about job engagement

(Forbech Vinje &

Mittelmark 2007)

Psychoemotional rather than socioeconomical factors

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Modified after Bauer G Pelikan J Davies JK et al 2006 Bengt Lindström 2014

spiritual

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THE EVIDENCE

A. Antonovsky wrote:

“I am, of course, persuaded that the salutogenic model has much cogency. We are now at a point where this persuasion must be tested by empirical research.

Where such research will bring the model a decade hence cannot be predicted.”

Aaron Antonovsky 1987

But, Aaron Antonovsky died in July 1994 after a malignant myeloma was

diagnosed and he received his first chemotherapy treatment

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SOC and AGE

0 20 40 60 80 100 120 140 160 180

15 21 23 37 39 41 44 46 48 50 69 75 78 80 81 SOC

Mean age

Mean SOC by Mean Age

based on 15-81-year-aged general populations (16 studies using SOC-13, 1993-2003)

0 20 40 60 80 100 120 140 160 180

18 19 20 23 36 37 43 48 50 55 60 67 76 77 81 SOC

Mean age

Mean SOC by Mean Age

based on 18-81-year-aged general populations (15 studies using SOC-29, 1994-2008)

Eriksson M, Lindström B. Life is more than survival: Exploring the links between Antonovsky's salutogenic theory and the concept of resilience, some conceptual considerations. In: Gow KM, Celinski MJ, editors. Wayfinding through life's

challenges: Coping and survival. New York: Nova Science Publishers; 2010.

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… protects against anxiety, depression, burnout and hopelessness

… is strongly and positively related to health resources such as optimism, hardiness, control, and coping

... predicts good health and QoL from childhood to adulthood

… the stronger the SOC the fewer the symptoms of mental illnesses

Generally - A strong SOC ...

Eriksson M, Unravelling the Mystery of Salutogenesis, 2007; Nielsen AM, Hansson K Stress and Health 2007;23(5):331-341; Sagy S, Braun-Lewensohn O. Global Health Promotion 2009;16(4):5-15;

Simonsson B, Nilsson KW, Leppert J, Diwan VK. BioPsychoSocial Medicine 2008;2(4):doi:10.1186/1751- 0759-2-4; Buddeberg-Fischer B, Klaghofer R, Schnyder U. Soz Praventivmed 2001;46(6):404-410...

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The stronger the SOC the better the QoL of children, adults and in families.

Findings from both quantitative and

qualitative studies support the SOC to be a factor enhancing good QoL.

Results from longitudinal studies

confirmed the findings from the cross- sectional ones.

Most of the studies are using specific questionnaires for measuring HRQL on varying samples (patients).

Studies measuring QoL on general populations are scarce.

Eriksson M, Lindström B. J Epidemiol.

Community Health 2007;61:938-944

Mental

health

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The X and Y Chromosomes

A supportive family

environment in childhood enhances the level and

heritability of sense of

coherence in early adulthood

Silventoinen H. Volanen SM. Vuoksimaa E. Rose RJ Suominen S. Kaprio J. Soc Psychiatry Psychiatr Epidemiol DOI 10.1007/s00127-014-0851-y (2014)

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OUTCOMES RELATED TO A STRONG

SALUTOGENIC CAPACITY (SOC)

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30 BILLION EUROS

EQUALS

ONE DAY OF WORK FOR THE WHOLE POPULATION /A YEAR:

i. e. A 4 DAYS WORKING WEEK IN FINLAND

If SOC Strong Peope tend to Return to Working Life

18 BILLION DOLLARS/YEAR

^{in USA}

spent on Caesarean Sections without medical indications

If SOC is Strong Women Prefer Natural Birth

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THE

HFA 2000 POLICY

AND OUTCOMES RELATED TO

DO-WELL FACTORS

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”JAG VAR MED LIVET

OCH LIVET VAR MED MIG

VÄL TILLFREDS....”

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“Mental health … refers to the location, at any point in the life cycle, of a person on a continuum which ranges from excruciating emotional pain and total

psychological malfunctioning at one extreme to a full, vibrant sense of psychological wellbeing at the other.

It is about understanding how people move from the use of unconscious psychological defense

mechanisms toward the use of conscious coping

mechanisms; from the rigidity of defensive structures to the capacity for constant and creative inner

readjustment and growth; from a waste of emotional energy toward its productive use; from emotional

suffering toward joy; from exploitation of others

toward reciprocal interaction” Antonovsky, 1985).

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The determinants of mental health

Societal structures & resources

 Transport, housing

Socio-cultural values

 Human rights, equity

 Stigma

Individual factors

 Biology, genes

 Health behaviour,

 Emotions, coping,

 Self-esteem, etc

Health and Social Services

Environmental Factors

Water, sanitation Economic factors

Global

Climate, seasons Resources

Information flow Migration

Macro-

Social factors

Meso- Micro-

Settings

Family

Cattan M 2009

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The logic formula for health promotion action

HP

^(OC)

= (SAL+QoL) HR

Health promotion, according to the Ottawa charter (OC) has an overall aim:

To enable people lead an active and productive life, or enjoy a good quality of life (QoL).

This can be achieved throrugh a salutogenic (SAL) process.

However, all has to be filtered thorugh the declaration of human rights were people can act as active participating sublects in their own life (HR)

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The same salutogenic question – why do some people stay well regardless of severe hardships and others do not

Antonovsky stress – Resilience risk

Antonovsky GRRs – Resilience protective factors No commonly accepted definition

A concept – not a theory

The SOC scale – Different scales to measure resilience A process of recovery in a continuum

Applicable at an individual, a group and a societal level

Resilience

(Garmetzy 1988, Werner 1982, Rutter 1985, Luthar 2003)

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1. The Political or Socio Economic Dimension (STRUCTURE):

The reduction of Inequity, Bridging the Gap 2. The Inner Dimension: The Substance (CONTENTS) The Psycho-Emotional dimension

Are they like the hen and the egg? The development of a strong SOC acts on both !?

Overall Aim to develop a Collective SOC?

THE SALUTOGENIC SOCIETY

Two Areas to Combine to bring coherence in and between life spheres and settings in the life

course

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Health Education - Empowerment:

There have been different methods and concepts introduced regarding the “education” part of the concept;

healthcommunication, healthfostering,

healthpedagogics, healthknowledge.

The latest in line is healthliteracy

There has been too little focus on the “health” part

of the concept many times meaning only you deal

with Issues that cause risks to health.

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Healthy learning is a lifelong process where people and systems increase the control over, improving health,

wellbeing and quality of life through the creation of learning environments characterized by clear structures and

meaningful empowering conditions where one become

active participating subject in mutual interaction with others.

(Lindström and Eriksson 2011)

WE TAKE BOTH A STRUCTURAL/ENVIRONMENT POSITION AND AN INTERACTICE LEARNING POSITION AIMING AT LONG TERM LIFE COURSE GOALS

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Simon Flem Devold .Morten 11 år,

Cappelens (1995)

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SOME

BOOKS

ONGOING PRO ONGOING 2015

HANDBOOK ON SALUTOGENESIS

Hitchhiker in NORWEGIAN 2015

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JUST LOAD DOWN FROM THE INTERNET

'Fair Society Healthy Lives' (The Marmot Review)

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REFERENCES:

Bartley M. (2013) Life Gets Under Your Skin. ESRC International Centre for Life course Studies in Society and Health, UCL Research Department of Epidemiology and Public Health

Bronfenbrenner, U. (1979). The ecology of human development - Experiments by nature and human design.

Cambridge, Massachusetts: Harvard University Press

Antonovsky A. (1979) Health Stress and coping, SF, Jossey Bass

Antonovsky A. (1987) Unravelling the mystery of Health, SF, Jossey Bass

Antonovsy A (1996) The Salutogenic Model as a theory Guide to Health Promotion Health Promotion International 1:1 pp 11-18.

Antonovsky A. (1985) The life cycle, mental health and the sense of coherence., Isr J Psychiatry Relat Sci, 22, 273-280

Eriksson M Lindstrom B. A Salutogenic Interpretation of the Ottawa Charter HPI Advance Access March 2008.

Health in All Policies (HiAP): Seizing opportunities, implementing policies. online version www.smt.fi May 23 2013

Eriksson M. (2007) Unravelling the mystery of salutogenesis Folkhalsan Research Report 1

Lindstrom B Erkisson M. (2010) The Hitchhiker´s Guide to Salutogenesis Folkhälsan Research Report 2.

Lindström B . (1994) The Essence of Existence- on the QoL of Children and Families NHV Report 3.

UN (1986) The UN Convention on the Rights of the Child

Lindstrom B Eriksson M. (2011) From health education to Healthy Learning SJPH

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Se Websida www.salutogenesis.hv.se

Der finnes databas på salutogen forskning som du kan registrere dig fri of charge Der kan du og bestelle Antonovskys bøger via hans son free of charge

Og 2016 finnes der Handbook on Salutogenesis der du kan ladde ner kapitel open access free of charge

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REFERENCES

Allardt, E., Att, Ha., Att, Älska., Att, Vara., (1980). Om välfärd i Norden. Borgholm: Argos.

Bartley M. Life Gets Under Your Skin. ESRC International Centre for Life course Studies in Society and Health, UCL Research Department of Epidemiology and Public Health

Bronfenbrenner, U. (1979). The ecology of human development - Experiments by nature and human design. Cambridge, Massachusetts:

Harvard University Press

Freire, P. (1996). Pedagogy of the oppressed. Harmondsworth: Penguin.

Jahoda, M. (1958). Current concepts of positive mental health. New York: Basic Books.

Lindström, B. (1994). The Essence of Existence. On the quality of life of children in the Nordic countries - Theory and practice in public health. (Doctoral thesis). Göteborg: Nordic School of Public Health

Lindström B. Quality of life: A model for evaluating health for all. Conceptual considerations and policy implications. Soz.-Präventivmed 1992;37:301-306

Mackenback JP. The persistance of inequality in modern welfare states: The explanation of a paradox .Social Science & Medicine 75 (2012) 761 -769

Marmot M. The Commission of Social Determinants of Health .WHO

Naess, S. (1987). Quality of life research: concepts, methods and applications. Oslo: Institute of Applied Social Research

Nilsson, L. (2003). The encounter between health promotion and schools in theory and in practice. In Swedish. [Doctoral thesis.]. Örebro:

Örebro University.

Nutbeam, D. (1993). Advocacy and mediation in creating supportive environments for health. Health Promotion International, 8:165-166.

OECD. (2009). Society at a Glance 2009 – Organisation for Economic Cooperation and Development Social Indicators.

www.oecd.org/els/social/indicators/SAG cited May 2009.

Raphael, D. (2002). Evaluation of quality of life initiatives in health promotion. In: Evaluation in Health Promotion. Geneva: WHO.

Resnick, M. D., Bearman, P. S., Blum, W., et al. (1997). Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA, 278(10):823-832.

Ringen, S. (1988). Approaches to the measurement of welfare. Oslo: Statistisk Sentralbyrå.

Swedner, H. (1983). Social work - a framework for thought. In Swedish. Stockholm:

Whitehead, M. & Diderichsen, F. (2001). Social capital and health: tip-toeing through the minefield of evidence. Lancet, 358:165-166.

Rootman Raphael Being belonging and becoming , Toronto .The Gradient Evaluation Framework GEF University of Brighton