Medical sociologist Aaron Antonovsky (1923–1994) developed the model of salutogenesis as an alternative and complement to pathogenesis. Salutogenesis (salus = healthy; genesis = origin) refers to the origins and development of health and, in addition to explaining how health originates, is also meant to explain how people can remain healthy in the face of health risks and how health can be promoted.

Looking at the origins of health

Antonovsky describes health and disease not as states but as the opposing poles of the „health ease/dis-ease continuum” In salutogenesis, each person is initially an expert on his or her own health. Antonovsky illustrated this using the metaphor of the human being as a swimmer in a river with a wide variety of influences and dangers: „…my fundamental philosophical assumption is that the river is the stream of life. None walks the shore safely. Moreover, it is clear to me that much of the river is polluted, literally and figuratively. There are forks in the river that lead to gentle streams or to dangerous rapids and whirlpools. My work has been devoted to confronting the question:

„Wherever you are in the river, whose nature is determined by historical, socio-cultural and physical environmental conditions, how do you become a good swimmer?“

(Aaron Antonovsky, Unraveling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco: Jossey-Bass, 1987; p. 90.)

Consequently, he assumed that human beings – as good swimmers – cope with many impasses on their own initiative. Only when we can no longer stay afloat by ourselves do we need help.

The seeds that would grow into this concept were laid when Antonovsky studied the health of menopausal women in Israel. In his questionnaire, he included a question asking whether these women had been in a concentration camp. What surprised him was that about a third of these women coped well not only with menopause, but also with the consequences of imprisonment, deprivation in the concentration camp and resettlement to a new culture, a new language and a new job.

The concept of salutogenesis

Antonovsky’s attempts to explain the characteristics that had allowed these women to weather these tremendous challenges so well developed into the concept he called salutogenesis.

During the interview, he discovered that the thriving women shared the following characteristics:

  1. They had an idea of what was happening around them – an understanding that enabled them to do something.
  2. They saw themselves as able to influence – no matter in how small a way – their situation if they applied themselves. In short, they experienced manageability, or in other words: self-efficacy.
  3. They were able to find meaning in their life and their actions, such as being there for other people, for their children, for a better world, for their beliefs.

Antonovsky defined this group of three elements as Sense of Coherence (SOC).

This basic understanding is also found in the concept of Positive Health, developed by Machteld Huber of the Positive Health Institute (founded in Holland in 2015).