Personal and planetary health: We need a salutogenic approach!
Personal and planetary health are fundamentally interconnected! Just as the root causes of ill health in individuals run deep into how we make meaning and give significance, so are the root causes of the converging crises that are affecting our ailing planet to be found in our culturally dominant worldview and value system, as well as, our approach to health and wellbeing.
Romy Fraser and Sandra Hill emphasize in The Roots of Health that “we cannot sustain health without addressing what is needed throughout the interconnected systems of our lives; our selves as individuals, our physical health, our psychological health, our relationships with our families, our communities and our environment.” They suggest that: “In regaining the roots of our health, we may learn to be better stewards of the earth as well as of ourselves” (Fraser & Hill, 2001, p.73).
“Oh, what a catastrophe for man when he cut himself of from the rhythms of the year, from the unison with the sun and the earth. Oh, what a catastrophe, what a maiming of love when it was made personal, merely personal feeling,taken away from the rising and setting of the sun,and cut off from the magical connection of the solstice and equinox. This is what is wrong with us.We are bleeding at the roots.” — D.H. Lawrence
The healing of humanity’s relationship to the rest of the community of life and to the health sustaining cycles of natural process lies at the heart of salutogenesis (this concept will be explained further in the section on ‘salotogenesis’ below). Creating healthier societies and healthier lifestyles will ultimately heal ecosystems and the planet. Conversely, engaging in widespread restoration projects aimed at increasing the resilience and health of local ecosystems, not only engages in planetary healing, but also helps the healing of individuals and communities.
[This article is an excerpt from the Worldview Dimension of Gaia Education´s online programme in Design for Sustainability. The course is based on four dimensions plus a design studio. I wrote this course for Gaia Education in 2012 and revised and updated this dimension in 2016.]
We already briefly addressed in module one of the Ecological Dimension that health is fundamentally scale-linking. That means the health of individuals; their families, their communities, the health of the ecosystems and bioregions they inhabit; and ultimately the health of the biosphere, are all fundamentally linked and interdependent.
The roots of human health are growing in the healthy soils of resilient and diverse ecosystems. When we talk about sustainability, in many ways what we are trying to sustain is the ‘pattern that connects’, the health of the whole system from the local to the global. David Waltner-Toews (2004) proposes that the common goal of improving health can effectively be employed to provide a persuasive common interest across a wide range of cultures.
“Health is generally accepted by most reasonable people as a non-negotiable, trans-ideological goal. Indeed, I have found that health — rooted as it is in particular histories and cultures, but universally understood in some basic sense — can serve an important role in developing the new cross-cultural symbolic language which Panikkar suggests is necessary to promote convivial and sustainable human life on this planet.”— David Waltner-Toews (2004, p.89)
Human health and planetary health are fundamentally interconnected. As biological organisms and natural participants in nature’s scale-linking processes, all human beings can, and do, affect the health of individuals, communities, ecosystems and the planet as a whole. We are only slowly waking up to the cumulative, time-delayed, and spatially removed effects human actions are having on the planet’s health. Since planetary and human health are fundamentally linked, preventing environmental damage and maintaining healthy ecosystems is the most effective long-term strategy to promote health in humans. In 1992, the ‘Commission on Health and Environment’ created by the World Health Organization (WHO) published a report entitled Our planet, our health. Its opening statement reads:
“The maintenance and improvement of health should be at the centre of concern about the environment and development. Yet health rarely receives high priority in environmental policies and development plans, rarely figures as an important item in environmental or development programmes, despite the fact that the quality of the environment and the nature of development are major determinants of health. … Serious environmental health problems are shared by both developed and developing countries. … Health also depends on whether people can obtain food, water, and shelter. Over 1000 million people lack the income or land to meet such basic needs. Hundreds of millions suffer from undernutrition. It is a requirement of health that global cycles and systems on which all life depends are sustained. Population growth and the way resources are exploited and wastes generated threaten the environmental base on which health and survival depend and transmit the growing costs to future generations. The toll they extract on human health and natural resources and systems could be enormously reduced by better environmental management.”— WHO Commission on Health and Environment (1992, pp.xiii-xiv).
In this section we will explore the link between human, ecosystems, and planetary health. We will look at health as a holistic pattern, explore salutogenesis — the generation of positive health — as an alternative to the disease-focussed approach on health, and look at how design can play a role in improving health and resilience at a local, regional and global scale. The WHO report proposes: “Health depends on our ability to understand and manage the interaction between human activities and the physical and biological environment.” The report stresses: “We have the knowledge for this but have failed to act on it, although we have the resources to meet current and future needs sustainably” (WHO, 1992, p.xiv). For an update and overview of human health conditions globally you can take a look at the recent WHO report Health in 2015 — From MDGs to SDGs.
Salutogenesis
The salutogenic model of health and the associated concept of salutogenesis was first discussed by the sociologist of health Aaron Antonovsky, in his book Health, Stress and Coping (Antonovsky, 1979). Antonovsky distinguished between a ‘pathological orientation”, which “seeks to explain why people get sick, why they enter a disease category,” and a “salutogenic orientation (which focuses on the origins of health)” (Antonovsky, 1987, p.xii). Antonovsky’s own discussions of the concept do not go into detail regarding the environmental foundations for a healthy society. His focus is mainly on the social and societal dimensions of the phenomenon of health.
Antonovsky hypothesised that “generalized resistance resources” like “money, eco-strength, cultural stability, social supports, and the like” were providing individuals with the ability to resist against the continuous stressors their environments exert. Variable resistance to omnipresent stressors “ranging from the microbial to the societal-cultural levels” explained why some people are healthy in conditions that lead to the manifestation of disease in others.
Antonovsky proposed the “sense of coherence concept (SOC)” to understand all community based processes that improve the “generalized resistance resources” of individuals and their communities. The common element among these processes is that they provide all participants with a way of “making sense out of the countless stressors with which we are constantly bombarded.” Doing so repeatedly over time allows for the emergence of a strong sense of coherence (Antonovsky, 1987, p.xiii). It is this sense of coherence that makes individuals and societies more resilient and healthy.
Antonovsky suggested that one key component of a high sense of coherence is the extent to which a safe and healthy future could reasonably be predicted. The sense of coherence is highest in people who live in highly socially cohesive and place-based communities of human scale, who have an intimate knowledge of their local environment and a long tradition of successfully adapting to environmental changes and of meeting their needs effectively without damaging their local environment. “Salutogenesis”, according to Antonovsky (1987, p.9), “leads us to focus on the overall problem of active adaptation to an inevitably stressor-rich environment.” He described salutogenesis as a strategy that counteracts the universal decay towards greater entropy.
“The key term becomes negative entropy, leading to a search for useful inputs into the social system, the physical environment, the organism and lower-order systems down to the cellular level to counteract the immanent trend toward entropy. … [Salutogenesis] opens the way for cooperation between biological and psychosocial scientists … When one searches for effective adaptation of the organism, one can move beyond post-Cartesian dualism and look to imagination, love, play, meaning, will, and the social structures that foster them. Or, as I would prefer to put it, to theories of successful coping.”— Aron Antonovsky (1987, p.9)
In the way that Antonovsky described the “salutogenic orientation”, it is derived from “the fundamental postulate that heterostasis, senescence, and increasing entropy are core characteristics of all living organisms.” Based on this postulate Antonovsky described a number of characteristic of a salutogenic orientation, which are summarized in the Box below.
Characteristics of Antonovsky’s Salutogenic Orientation:
(Based on Antonovsky, 1987, pp.12–13)
- It leads us to reject the dichotomous classification of people as healthy or diseased in favour of their location on a multidimensional health ease/disease continuum.
- It keeps us from falling into the trap of focusing solely on the etiology [direct causes] of a given disease rather than always searching for the total story of a human being, including his or her sickness.
- Instead of asking, “What caused (or will cause, if one is prevention-oriented) a person to fall prey to a given disease?” — that is, instead of focusing on stressors — we now ask, “What are the factors involved in at least maintaining one’s location on the continuum or moving towards the healthy pole?” that is, we come to focus on coping resources.
- Stressors come to be seen not as a dirty word, always to be reduced, but as omnipresent. Moreover, the consequences of stressors are viewed not as necessarily pathological but as quite possibly salutary, contingent on the character of the stressor and the successful resolution of tension.
- In contradistinction to the search for magic-bullet solutions, we are urged to search for all sources of negative entropy that may facilitate active adaptation of the organism to the environment.
- Finally, the salutogenic orientation takes us beyond data obtained from pathogenic inquiry by always looking at the deviant cases found in such inquiry.
While Anotonovsky’s exposition of salutogenesis was focussed on human health, it is equally applicable and relevant to ecosystems and planetary health. When working along the spectrum that reaches from positive health and resilience to ill health and disease, it is always possible to either focus on treating the symptoms of already manifest disease or to focus on systemically increasing the health and resilience of the organism, community, and ecosystem by taking a salutogenic approach.
The salutogenic approach tries to strengthen the ‘hidden harmony’ of health. Antonovsky emphasized that there was clearly a “complementary relationship” between a pathogenic and a salutogenic orientation. He argued for “a more balanced allocation of intellectual and material resources” to both approaches (Antonovsky, 1987, p.13).
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[This article is an excerpt from the Worldview Dimension of Gaia Education´s online programme in Design for Sustainability. The course is based on four dimensions plus a design studio. I wrote this course for Gaia Education in 2012 and revised and updated this dimension in 2016. … Much of this section is based on work I did for my PhD in Design for Human and Planetary Health at the University of Dundee’s ‘Centre for the Study of Natural Design’ (2006). … You might also enjoy my book Designing Regenerative Cultures published by Triarchy Press in 2016. ]
