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What does Salutogenesis have to do with it?

I knew from the start that I wanted to adopt a strengths-based approach in my research, and I knew a little about the history of salutogenesis. It wasn't until recently that I felt confident in my understanding of the topic and clear on how and why I was using this approach. 

Health sociologist, Aaron Antonovsky coined the term salutogenesis in 1979 when he published his research into "how people stay well". The term salutogenesis stems from Latin, salus (health, wellbeing) and Greek, genesis (origin); literally meaning 'originating with health'; it's the opposite of pathogenesis, which means 'originating with disease' as the Greek word, pathos, means suffering, disease. The contrast between staying well and preventing disease may be subtle but is vital and necessitates a change of focus from the medicalised view of health and illness. 

The contrasts between the salutogenic model vs the pathogenic model of health can be summarised as follows: 

Salutogenic Pathogenic

The belief that the "human system (as all living systems) is inherently flawed, subject to unavoidable entropic processes (chaos) and unavoidable final death"

The belief that the "human organism is a splendid system, a marvel of mechanical organisation, which is now and then attacked by a pathogen and damaged"
Focus on salutary factors Focus on risk factors
Focus on the whole person in all their human complexity Focus on the disease itself

Antonovsky uses the metaphor of a river to explain these differences, suggesting that instead of trying to prevent people falling into the river (pathogenic — the human mechanism is perfect) all humans are already in the river of life (salutogenic — humans are already flawed). Furthermore, with all humans already on the health/dis-ease continuum (i.e. in the river), the focus needs to be on factors that move people towards the health end of the continuum (salutary factors), rather than being content to avoid risk factors. Considering the whole individual, rather than just the disease – shifting the focus from a pathogenic approach to a salutogenic approach - incorporates asking questions like, how dangerous is our river? How well can we swim? Each person's river of life is unique, and each individual has varying physical, social, economic, and cultural differences that impact their health journey.

This evolving recognition of health as holistic not merely "the state of being free from illness or injury" (Oxford Dictionary) is reflected in the World Health Organisation's evolving definition of health. In the 1948 Constitution, health is described as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" (p.1). The Ottawa Charter on Health Promotion endorsed in 1986 takes this definition further stating that "health is…a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities" (1986, p.1).

Antonovsky's work on how people stay well reflects these definitions of health and the focus on social and personal resources. His research culminated in the development of the "sense of coherence" construct; or more simply, the characteristics that differentiated people who stayed well and coped with stressors in their lives from those who didn't. A person's sense of coherence is a continuum and an orientation towards life and includes the extent to which the person perceives the world as meaningful (i.e. has the will or motivation to cope), comprehensible (understands the challenge) and manageable (i.e. believes the resources to cope are available). By assisting individuals to enhance any of these three factors, Antonovsky's theory of salutogenesis contends that individuals will move towards the healthier end of the continuum, especially when faced with stressors in life, which may be physical challenges (i.e. disease, injury) or otherwise (i.e. changes in social, economic, other dimensions). Importantly, the sense of coherence the person possesses and can develop is culturally sensitive with each individual, depending on their background, drawing meaning from different sources and utilising various resources in their health-related problem-solving. 

The salutogenic concept has distilled into considering the whole individual (including social, economic, cultural dimensions) while working to enhance their particular resources and strengths. Unsurprisingly, the approach has become synonymous with a 'strengths-based approach' which has been adopted in diverse areas of society including criminal justice, social work, psychology, medicine and education. For example, the Australian Curriculum for Health and Physical Education (AC:HPE), identifies "take[ing] a strengths-based approach" as one of the five inter-related underpinning principles of the curriculum document, and "affirms that all students and their communities have particular strengths that can be nurtured to improve their own and others' health and wellbeing" (ACARA, accessed 4 Feb 2020). The AC:HPE includes two additional relevant propositions, i) "develop health literacy" and ii) "include a critical inquiry approach" which both directly relate to the factors of comprehensibility and manageability which Antonovsky identified as integral to maintaining individuals' sense of coherence and thereby their good health.

What does any of this have to do with the Selfies & Health project? 

Salutogenesis is relevant to this project for three reasons. First, in researching the statistics on young people's health in Australia, I was intrigued to note, as was the lead writer of the AC:HPE Doune Macdonald (Macdonald, 2013) "the majority (93%) of Australian young people rate their health as good, very good or excellent". This is in contrast with media reports on the dire state of youth health in Australia. What was even more intriguing (for me) however is that 26% of the same age group report a mental disorder and 60% live with a chronic health condition. These statistics resonate very much with Antonovsky's first premise of the salutogenic approach; we are all on a continuum of ease/dis-ease. It is clear that young people, despite having a health condition, still believe themselves to be healthy. If this means that 93% of young people in Australia have a strong sense of coherence, how and where are young people gaining their sense of meaningfulness? Where do they get the understanding and resources to manage their health? How can we support more young people to be able to do that?  My research aims to help answer these questions.

Second, salutogenesis focuses on existing strengths and resources and how they are used in maintaining health. Instead of partaking in the risk discourse associated with social media use, I am curious to understand if and how social media, in particular the selfie, may be a resource young people use in developing, maintaining, building, and refining their perceptions of their health. An increasing number of scholars recognise social media as an important part of young peoples lives (Third et al., 2011;   Livingstone & Third, 2017; Livingston, Mascheroni & Staksrud, 2018) and advocate for the role of education, particularly health and digital education to enhance the skills of young people to use social media effectively to enhance their health (Quennerstedt, 2019). To do this, however, academics, policymakers, teachers and parents need to understand more fully the nuanced ways young people are using social media as it relates to their health. Some work has already been done in this area, see for example Goodyear & Armour's work on social media and health (2018) and Livingstone's work on children's rights, but more is required. 

Third, salutogenesis encompasses the whole person and recognises the interplay between physical, mental, social, and emotional aspects in people's lives. While much has been written on the body/mind duality, which warrants another blog post, I subscribe to the view that the body and mind are interrelated and interdependent. This interdependence requires reflexive consideration of the whole person, not just their physical manifestation of health. 

References

Antonovsky, A. (1979). Health, stress and coping. Jossey-Bass, London. 

Antonovsky, A. (1996). The salutogenic model as a theory to guide health promotion. 11(1), 11 18. https://doi.org/10.1093/heapro/11.1.11

Goodyear, V. A., & Armour, K. M. (2018). Young People's Perspectives on and Experiences of Health-Related Social Media, Apps, and Wearable Health Devices. 7(8), 137 15. https://doi.org/10.3390/socsci7080137

Goodyear, V. A., Armour, K. M., & Wood, H. (2018). Young people and their engagement with health-related social media: new perspectives. 1, 1–16. https://doi.org/10.1080/13573322.2017.1423464

Livingstone, S., Mascheroni, G., & Staksrud, E. (2017). European research on children's internet use: Assessing the past and anticipating the future. 20(3), 1103–1122. https://doi.org/10.1177/1461444816685930

Livingstone, S., & Third, A. (2017). Children and young people's rights in the digital age: An emerging agenda. 19(5), 657–670. https://doi.org/10.1177/1461444816686318

Macdonald, D. (2013). The new Australian Health and Physical Education Curriculum: a case of/for gradualism in curriculum reform? 4(2), 95–108. https://doi.org/10.1080/18377122.2013.801104

Quennerstedt, M. (2019) Social media as a health resource: A salutogenic perspective in Goodyear, V. A., & Armour, Kathleen M. (Eds.).  Young People, Social Media and Health. Routledge.

Third, A., Collin, P., Rahilly, K., & Richardson, I. (2011). The Benefits of Social Networking Services.  http://www.uws.edu.au/__data/assets/pdf_file/0003/476337/The-Benefits-of-Social-Networking-Services.pdf

World Health Organisation (1946). Constitution of the World Health Organisation. 

World Health Organisation (1986). Ottawa Charter for Health Promotion.