SALUTOGENESIS- A True Health-Care Theory Whose Time has Come!


Pathogenesis vs. Salutogenesis- Disease/ Health theories

Every time we turn on the news, there is yet another report about pain, stress, opioids and/or drug overdoses.  No matter how much time, energy or money we throw on the problems, the outcome is the same.  No lasting improvement is achieved, and fear continues; we keep getting more of the same.  Time for a fresh, new perspective… Salutogenesis!It is crystal clear that Western medicine is focused on disease (pathogenesis) today, instead of health and well-being.  Becker (2010) explains pathogenesis, which was pioneered and developed by Williamson and Pearse in 1966, as the theoretical framework for American health professionals. “Formally, pathogenesis is the study of disease origins and causes.  Pathogenesis starts by considering disease and infirmity and then works retrospectively to determine how individuals can avoid, manage, and/or eliminate that disease or infirmity” (p. 26).  Based on this description, the current pain scale (10- worst pain ever) is understandable- pain is viewed as an infirmity which must be avoided, managed, and/ or eliminated.

“Problems cannot be solved with the same mindset that created them.” – Albert Einstein

Another, newer, health model is that of Salutogenesis.  Honestly, I had never heard of it until 2016, yet I am SO glad to have discovered it.  My gut has known THIS is the foundation on which effective HealthCare in America should be built.  The brief overview of Salutogenesis focuses on Health Promotion (positive focus), instead of disease orientation/ prevention (negative focus) and risk factors.   The author, Aaron Antonovsky (1996), who introduced Salutogenesis in 1979 (when I graduated high school), harkens us back in time .  “In the 1930’s it was revolutionary to suggest that something in the mind could lead to somatic diseases” (p. 11). Today, he suggests that all human distress is the result of a psychic, somatic and social aspect (all of which are crucial for the integrated organism known as human beings).He presents an analogy of health and disease prevention as they relate to swimmers.  “The bias of the downstream focus, i.e. the devotion of the disease care system to saving swimmers drowning downstream by heroic measures, rather than asking ‘Who or what is pushing them into the river in the first place?’” (p. 12) As Antonovsky reminds us in his article, the World Health Organization (WHO) defines health as, “a state of optimal physical, mental and social well-being, and not merely the absence of disease and infirmity” (p. 12). It is Salutogenesis (not pathogenesis) then, which exemplifies a solid foundation on which to build the WHO vision of true health.

“If you change the way you look at things, the things you look at change.”  -Wayne Dyer

This makes so much more sense to me now.  As we are aware, the only things certain in life are death and taxes as the old joke reminds us… yet we fight SO hard against death (and against pain), with unrealistic expectations that we can “get out alive”.  I embrace his realistic perspective and I share this view.  We have limited energy each day, and instead of fighting AGAINST something (like death/ illness) which is inevitable, we could better focus that energy on resilience and maximizing our status today, regardless of where we are on the continuum… our lives and health are exactly perfect as they are, we simply need to make the best choices we can, based on current situation (always changing).I believe that our bodies are always striving to communicate with us; yet we are often too busy to listen.  As a result, we have lost touch with the normal ebb and flow of life.  Each time we happen to feel something, we often assume it is some tragic disease or ailment which must be silenced or treated externally.  What if we viewed these sensations/ feelings as important feedback on the larger spectrum of health and well-being… signals of whether we were currently “on track” or not?By finally listening to our bodies’ messages, instead of constantly suppressing them, we can focus our energies proactively on TRUE health, well-being and quality of life.  What we need, however, is a new vision for Comfort (instead of pain).  Building on Salutogenesis, I offer Comfort Quest… still 0-10, yet aiming TOWARDS what we desire- Vitality and Wholeness!  Eternally optimistic that we can turn the tide in a positive direction before my 40th High School Reunion...   It's time has come! Nursing Pain through a Positive Lens Antonovsky, A. (1996). The salutogenic model as a theory to guide health promotion. Health Promotion International. Vol. 11, No.1, pp 11-18.Becker et. al (2010). Salutogenesis 30 Years Later. International Electronic Journal of Health Education, 2010; 13: 25-32. 

SUMMARY- Perspectives on Disease and Health

Pathogenesis (1966) Salutogenesis (1979)
Start Point = Disease or Problem Start Point = Health Potential
About avoiding problems and its causes About approaching potential and its causes
Works to eliminate risk factors Works to create health (salutary) factors
Reactive- react to signs, symptoms, and indications of disease Proactive - create conditions of physical, mental, and social well-being
Disease or infirmity is an anomaly Humans flawed and subject to entropy
Idealistic perspective - treat disease Realistic perspective - go get health
Focus is to prevent pain or loss Focus is to promote gains or growth
Prepares or help prepare one to live Enhance capacities and potential so can live fully
Wants to help avoid or prevent a person from being pushed backward Wants to help or enhance a person’s ability to move forward
Against Disease and infirmity For Health
For those who need healing cures For those who want better health
Primary focus - Prevention of negative health Primary focus - Promotion of positive health
Secondary benefit - Health Promotion Secondary benefit - Prevention of disease and infirmity
Outcome - Absence of problem Outcome - Presence of a gain
Keep from making situation worse Continuous Improvement
Minimization of problems Optimization of potential
Disease Management Health Promotion

 Adapted from Table 1. Complementary Perspectives on HealthBecker et. al (2010). Salutogenesis 30 Years Later. International Electronic Journal of Health Education, 2010; 13: 25-32.