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Salutogenesis: What keeps people healthy?

Salutogenesis is a health concept that focuses on what keeps people healthy, rather than what causes disease – a perspective developed by Aaron Antonovsky.

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Things worth knowing about "Salutogenesis"

Salutogenesis is a health concept that focuses on what keeps people healthy, rather than what causes disease – a perspective developed by Aaron Antonovsky.

What is Salutogenesis?

The term salutogenesis combines the Latin word salus (health, well-being) and the Greek word genesis (origin, creation). The concept was developed in the 1970s by the Israeli-American medical sociologist Aaron Antonovsky. Its central question is: What keeps people healthy? – rather than the traditional medical focus on why people become ill (pathogenesis).

Salutogenesis views health and illness not as two separate, distinct states, but as a continuum. According to this model, a person is always located somewhere between the poles of complete health and complete illness. The goal of the salutogenic approach is to support individuals in moving along this continuum toward better health.

The Sense of Coherence as the Core Element

The central pillar of salutogenesis is the concept of the Sense of Coherence (SOC). Antonovsky described this as a fundamental orientation toward life consisting of three components:

Comprehensibility: The belief that events in life are understandable, ordered, and predictable – even when they are challenging.
Manageability: The feeling that sufficient resources are available to cope with demands and challenges.
Meaningfulness: The conviction that life has meaning and that it is worthwhile to invest energy in facing challenges.

The stronger a person's Sense of Coherence, the better they are able to handle stress and maintain their health over time.

Generalized Resistance Resources

Another key concept in salutogenesis is that of Generalized Resistance Resources (GRRs). These are biological, psychological, and social factors that help a person cope with stressors and remain healthy. Examples include:

Physical health and genetic constitution
Knowledge and intelligence
Social support from family, friends, and community
Financial stability
Cultural and spiritual beliefs
Preventive health behaviors

These resources help individuals experience stressors as manageable rather than threatening, thereby strengthening the Sense of Coherence.

Distinction from Pathogenesis

While classical pathogenesis asks what factors cause disease and how these can be treated, salutogenesis shifts focus to protective factors and personal resources. Both approaches complement each other and are equally relevant in modern medicine and health promotion. Salutogenesis is therefore not an alternative to conventional medicine, but a valuable addition that considers the person as a whole.

Relevance in Health Promotion and Prevention

The salutogenic model has had a lasting influence on health promotion and disease prevention. It forms an important theoretical foundation for the WHO Ottawa Charter (1986), which defines health promotion as a process of enabling people to gain greater control over their own health. In practice, the concept is applied in:

Workplace health management
School health education
Psychotherapy and rehabilitation
Nursing and elderly care
Community-based healthcare

Criticism and Scientific Classification

The concept of salutogenesis has been widely appreciated but also critically discussed. Some criticisms concern the difficulty of measuring the Sense of Coherence and the question of whether a strong Sense of Coherence actually causes better health or is simply a marker of already existing good health. Nevertheless, the model has inspired a large number of scientific studies and is considered a significant framework in modern health sciences.

References

Antonovsky, A. (1987). Unraveling the Mystery of Health. How People Manage Stress and Stay Well. Jossey-Bass Publishers, San Francisco.
World Health Organization (WHO). Ottawa Charter for Health Promotion (1986). Available at: https://www.who.int/publications/i/item/ottawa-charter-for-health-promotion
Bengel, J., Strittmatter, R., Willmann, H. (2001). What Keeps People Healthy? Antonovsky's Model of Salutogenesis – Discussion and Relevance. Federal Centre for Health Education (BZgA), Cologne.

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