Towards Health Promotion: 1974 Lalonde Report ... 1986 WHO Ottawa Charter and Health Promotion .... Allardt E Att Ha, at
The Heritage of the Ottawa Charter in the context of Mental Health Bengt Lindström
CHRONOLOGY 1939-1945 World War II, The Holocaust 1948 UN Declaration of Human Rights 1948 WHO Protection of HRs from a Health Perspectiv The Birth of the Modern Public Health 1948 WHO Definition of Health Absolute Health with 3 Dimensions: Physical, Social and Mental Wellbeing
:
1987 4th dimension Spiritual Wellbeing and totality of Quality of Life, Halfdan Mahler
Social Science 1950 – 1970ies The Welfare Society, Standard of Living, Welfare; Quality of Life 1973 E. Allard, Having, Loving, Being= QoL objective and subjective measures happiness and wellbeing
On the Health Side !960 – 1970´s Prevention, Risk - Behaviour Approach Towards Health Promotion: 1974 Lalonde Report Canada Beyond Lifestyle 1978 WHO/UNICEF Alma Ata Conference PH 1984 WHO Health For All Strategy Global Strategies 1986 WHO Ottawa Charter and Health Promotion “HPITPWEPTGCOTHDTITHABELAAAPL” 1986 – 2009 Seven WHO Health Promotion Conferences (Nairobi Oct 2009 on Primary Health)
Social Psychology Mental Health – Quality of Life 1958 Maria Jahoda The Joint commission on Mental Illness and Health, USA Criteria for good Mental Health Positive self conception Being an integrated person Active and able to develop ones capabilities Able to make independent decisions Perform actions without isolation from others Having a good sense of reality and empathic skills Being able to create deep and lasting relationships at least one to the opposite sex
1974, Siri Naess, Norway Mental Health – Inner Quality of Life Criteria: Being Active Having Good Inter-Personal Relationships A Good Self Esteem and Perception A Basic Mood of Joy
Contextual Models The Welfare Society Allardt, Swedner Bronfenbrenner´s Ecological Model Bordieu Habitus Hancock HP Settings for Health Being Belonging Becoming Canadian HP QoL The Essence of Existence Lindström QoL
Positive Psychology Flourishing, Keyes C
Signs of Mental Health (Keyes, 1998, 2002 2005)
Hedonic Well-Being 1. Happy with life 2. Interest in life 3. Satisfaction with life
Eudaimonic Well-Being 4. Contribution to society 5. Social integration 6. Social growth and potential 7. Acceptance of others 8. Social interest and coherence 9. Self acceptance 10. Environmental mastery 11. Positive relations with others 12. Personal growth 13. Autonomy 14. Purpose in life
HEALTH PROMOTION, MENTAL HEALTH, SALUTOGENESIS Healthy learning: Salutogenesis as a learning process in the context of health promotion. THE SALUTOGENESIS
THE OTTAWA C HARTER
PROLOGUE
The Holocaust and its Survivors
UN Declaration of Human Rights WHO Definition of Health
TIME REFERENCE
Antonovsky 1978, 1987
1986
STATUS
Theory, evidence
Principles, Policy, ideology
FUNDAMENT
Human Rights, i.e. active participating subjects
Human Rights, i.e. active participating subjects
FOCUS
Life Orientation
Health Promotion
HEALTH
As a life long learning process
A Process
KEY CONCEPTS
SOC, GRR
No? Health promotion?
RESOURCES
Generalized Resistance Resources
Health determinants
KEY MECHANISMS
Ability to use GRRs to develop a SOC
Enable control over health determinants (Empowerment)
ELEMENTS
Comprehensibility, Manageability, Meaningfulness
APPROACH
Contextual system
Settings
OUTCOME
Mental health, Quality of Life, Perceived health
A better health, active productive life
PROFESSIONAL ROLE
Serve as a GRR
Facilitator enable people
MISCONCEPTION
Only measure SOC
Only risk approach-health behaviour © Bengt Lindström, Monica Eriksson 2008
WHO GWG-SAL
SOCIAL DETERMINANTS SOC-DETERMINANTS
ABILITY TO SEE THE INSIDE NOT ONLY THE CLASSIC PROFESSIONAL OUTSIDE PERSPECTIVE
FROM OUTCOME TO THE LIFE PROCESS
Eriksson M, Lindström B. A Salutogenic Interpretation of the Ottawa Charter. Health Promotion International 2008;doi: 10.1093/heapro/dan014
SELF TUNING - REFLECTION
Vinje, H. F. & Mittelmark, M.B (2006). Deflecting the path to burnout among community health nurses: How the effective practice of self-care renews job engagement TheInternational Journal for Mental Health Promotion.Vol 8 (4), pp 36-47.
LEARNING MODEL REFLECTION
Minimalism in Learning Theory, Learning and Teaching Mads Hermansen Relearning (2005)
The Salutogenic Model, revised
Life situation •culture •social forces •social position •gender •ethnicity •age
Life course stress exposures •Acute •chronic
•choices -work/play -association -risk taking -etc
Life experiences Sense of coherence •degrees of consistency
•orientations •predispositions •genetics •luck
A critique
Generalised resistance resources •support •skills •hardiness etc
•underloadoverload balance
Motivational component (wish to cope - meaningfulness) Cognitive component (belief challenge understood - comprehensibility) Behavioural component (belief resources to cope available - manageability)
•Well-being •Health (dis-ease/ease) •Functioning
•participation
The whole model deserves attention Based on: Antonovsky A (1996) The salutogenic model as a theory to guide health promotion. Health Promo Intl. 11(1), 11-18
Mittelmark MB. Building healthy public policy the salutogenic way. The International Seminar on Salutogenesis Resources of Health and Quality of Life: Research, Policy and Practice and The 1st Meeting of the IUHPE Thematic Working Group on Salutogenesis, Helsinki Finland, May 12-13, 2008.
Salutogenesis is more than measuring Sense of Coherence
The salutogenic umbrella – some convergent concepts and theories contributing to the explanation of health and quality of life. Submitted 2008.
Salutogenesis An assets approach Individual/Group/Society Learned resourcefulness (Rosenbaum) Hardiness Cultural capital Learned optimism (Bourdieu) (Kobasa) (Seligman) Quality of Life Self-efficacy Learned hopefulness (Lindström) (Bandura) (Zimmerman) Connectedness (Blum) Sense of coherence (Antonovsky) Action competence (Bruun Jensen)
Coping (Lazarus) Empowerment Locus of control Social capital (Freire) (Rotter) (Putnam) Will to meaning Wellbeing Resilience (Frankl) (Becker) (Werner) Ecological system theory Flourishing (Bronfenbrenner) (Keyes) Interdiciplinarity (Klein) © Monica Eriksson 2009
Conceptually, salutogenesis is defined as the process of movement toward the health end of a health ease/dis-ease continuum. Aaron Antonovsky
….. It is on the leading edge of a class of academic movements that wish to emphasize human strengths and not just weaknesses, human capacities and not just limits, wellbeing and not just illness Maurice Mittelmark
Eriksson M, Lindström B. A salutogenic interpretation of the Ottawa Charter. Health Promotion International 2008;23(2):190-199.
Salutogenesis … … is the processes enabling people to live the life they want to live. Lindström B, Eriksson M. The salutogenic approach to the mking of HiAP/Healthy Public Policy: illustriated by a case study. Global Health Promotion 2009;16(1):17-28. References: The UN Declaration on Human Rights UN, New York 1948 WHO Constitution, WHO, Geneva 1948 Mahler H On the Role of Schools of Public Health, NHV Report 1987 Allardt E Att Ha, att Älska att Vara, Lund, Aldus 1975 Bronfenbrenner U The Ecology of Human Development, Cambridge, Massaschusets Harvard University Press, 1979 Jahoda M Current Concepts of Positive Mental Health New York Basic Books 1958 Naess S Quality of Life Research, concepts, methods and applications Oslo, Institute of Applied Research, 1987 Lindström B,The Essence of Existence, On the Quality of Life of Childern, Dissertation, NHV Report 1994:3, Göteborg Keyes K Flourishing American Psychological Association, Washington DC, 2003 Swedner H Socialt Arbete, en tankeram Stockholm, Liber, 1983 UN Convention on the Rights of the Child, 1989 WHO Alma Ata Conference, WHO, Geneva,1978 Forbech Vinje H. ,Thriving despite adversity:Job engagement and self-care among community nurses Academic Dissertation, Bergen University 2007 Mittelmark M Personal Communication, First Research Seminar on Salutogenesis, Helsinki 2008 Hermansen M Minimalism in Learning Theory, Learning and Teaching Relearning, Århus 2005 Antonovsky A Health Stress and Coping Jossey Bass, San Francisco, 1978 Eriksson M Unravelling the mystery of salutogenesis, Dissertation, Folkhälsan Report 2007
