WHAT IS SALUTOGENESIS?

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Sense of coherence: sense of wellbeing Collectively, resources promote the development and maintenance of a strong 'sense of coherence', which is synonymous with health. The stronger the sense of coherence a person has, the better ability they have to employ cognitive, affective and instrumental strategies which are likely to improve coping 2 and thus wellbeing. There is not one coping strategy but many, and a person who copes well, who has a strong sense of coherence, is able to select the best way of dealing with the particular stressor. Each person's sense of coherence, or sense of wellbeing, requires certain inherent prerequisites for coping successfully, as follows: 1) Meaningfulness: the deep feeling that life makes sense emotionally; that life's demands are worthy of commitment. It is essentially seeing coping as desirable. 2) Manageability: the extent to which people feel they have the resources to meet the demands, or feeling that they know where to go to get help. 3) Comprehensibility: the extent to which a person finds or structures their world to be understandable, meaningful, orderly and consistent instead of chaotic, random and unpredictable. 3 The extent to which a person develops these prerequisites - the extent to which a person has pervasive, enduring and dynamic feelings of confidence that things will work out as well as can be reasonably expected - is determined by that person's sense of coherence. 4 This is firmly grounded in the person's own context and culture and Antonovsky emphasises that a person's socialisation is fundamental to how a person sees the world and how strong their sense of coherence will be. For this reason salutogenesis considers social and health capital as determining factors in the creation of a sense of coherence. Social capital can be described as levels of reciprocity in the community, trust, co-operation and social cohesion. Health capital are those factors which influence health and could include socio-economic background, childhood history and coping skills. From theory to practice The possible conclusions from Antonovsky's work are that one can expose a child to life experiences which will contribute to a strong sense of coherence and therefore increase that child's overall wellbeing. Although he feels it is less likely to be able to successfully intervene in adult perceptions of health and coping strategies, others would say it is possible to maximise their resources and accessibility to a strong sense of coherence and thus wellbeing. Antonovsky's theory postulates that health visitors should be given the resources to experiment with salutogenesis in a public health promotion facet. This will contribute greatly to a NHS which is conversing only in disease and clinical rhetoric. Salutogenesis is a research tool which can be used as a starting point by all those concerned with promoting health. By being able to understand how people manage their health, what resources they use (they could be negative, for example a neighbour may suggest adding alcohol to milk to pacify a baby) and then working to increase that person's positive resources. This may then extend to working with people in the community, from housing planners, social workers to community groups. This is the essence of salutogenesis; that experts should be open "to what is going on in seemingly unrelated fields in an attempt to 2
consider the underlying problems shared by many, and, above all to learn from coping successes" 5 in order to improve health. Salutogenesis applied to birth Used in the context of birth, salutogenesis would recognise women and their ways of seeing and of birthing. It would entail respect for the subtle hormonal interaction between mother and infant, which is intrinsic and essential to the wellbeing of both in the future. A salutogenic birth would generate positive short and long-term wellbeing for the mother, baby, family and caregiver. It would follow the same pattern of assessing a woman's resources, sense of coherence and thus wellbeing. Fundamentally, instead of looking at 'risk factors' it would look at health factors. It is acknowledged that although the concept of salutogenesis is not immediately user-friendly, its components are essentially applicable to the maternity service. 6 Downe argues the concept is, "fundamentally both a descriptor of a normal birth process and an outcome of that birth process". And equally importantly, includes "the possibility that the small number of women who may need technological help could birth positively if the presence" of manageability, comprehensibility and meaningfulness for each woman is held to be the measure of optimum birth. 7 The theory can fit easily with birth because it is about the promotion of wellbeing - 'health creation'. It also goes some way to examine why certain sectors of society are disadvantaged in their health-seeking options and the care they receive. By looking at the process by which people draw on their internal and external resources, midwives will be able to ascertain why their health and that of their baby is suffering. They can also work in a public health role to increase a woman's resources - manageability and meaningfulness and overall wellbeing. It will also influence a woman's ability to adapt to motherhood and to be a competent parent. In a way it is helping to empower women - not treating just the clinical but the social, economic, political, personal factors which this theory postulates determine the resources a woman can draw on to both promote health and combat illness. References 1. Antonovsky A (1993) The implications of salutogenesis: an outsiders's view. In: Turnbull AP, Patterson JM, Behr SG et al (eds.) Cognitive coping: families and disability. Baltimore: Brookes 2. ibid. 3. Colorado State University Counseling Center: Stress Management Services. Effective selfhelp for stress (http://www.colostate.edu/Depts/Counseling/SMP/ezstress.htm) 4. Cowley S, Billings J (1999) Resources revisited: salutogenesis from a lay perspective. Journal of Advanced Nursing 29(4): 994-1004 5. Antonovsky A (1993) The implications of salutogenesis: an outsiders's view. In: Turnbull AP, Patterson JM, Behr SG et al (eds.) Cognitive coping: families and disability. Baltimore: Brookes 6. Downe S (2001) Defining normal birth. MIDIRS Midwifery Digest 11(Supp 2): S31-3 7. ibid. May 2002 Royal College of Midwives Virtual Institute for Birth: Salutogenesis in support of normality 3
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WHAT IS SALUTOGENESIS?

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