Salutogenic design in healthcare
I have recently been reading about the theory of salutogenesis, in particular salutogenic design, and would like to share this interesting and pertinent theory. The term ‘salutogenesis’ was developed in the 1970’s by Aaron Antonovsky, a professor of medical sociology. It is derived from the Latin salus meaning health and the Greek genesis meaning origin, so it could be phrased as the 'origins of health'.
The study of health rather than the study of disease
The salutogenic approach to healthcare looks at the origins of health as oppose to the pathogenic approach to healthcare which looks at the origin (or causes) of disease (pathos). Salutogenic theory looks for the root of unhealthiness rather than just treating the disease.
"Visualize a river with a bend. Downstream, where the river has become very turbulent, we find people desperately struggling to keep their heads above water. Using a great variety of weapons, the disease care professionals, with great devotion, skill and arduous effort, seek to save those in danger of drowning. We pay almost no attention to, and invest few resources in, this school cogently points out, what goes on upstream. We do not ask: Who or what is pushing these people into the river?”
Aaron Antonovsky, Lecture at the Congress for Clinical Psychology and Psychotherapy, Berlin, 1990
A sense of coherence
]According to Antonovsky’s theory of salutogenesis, a strong sense of coherence (SOC) promotes good health. Antonovsky divided the notion of SOC into three components; comprehensibility, manageability and meaningfulness. Undoubtedly meaningfulness is the most important of the three as one requires a sense of meaning in their life in order to persist, to carry on and face challenges which life presents them with. Given a sense of meaningfulness, one is motivated to comprehend and manage events in their life.
A science for positive health
This is a school of thought centred on well-being, healing not just the body, but the soul. The advocates of the salutogenic model are not against the pathogenic model, but believe a combination of the two approaches is required to develop a greater understanding of both health and disease. The pathogenic approach focuses on treating or curing the disease, while the salutogenic approach focuses on well-being, promoting and maintaining good health. Salutogenic research has been carried out widely in the medical world but only in recent years is the theory slowly beginning to penetrate practice in the real world and become a part of healthcare policy. In the field of healthcare design, salutogenic theory is becoming incorporated into architecture. It is at long last becoming widely recognized that healthcare buildings need to be uplifting, welcoming spaces, promoting health and well-being, creating positive spaces with light, colour and fresh air. Tragically, the architecture of our healthcare buildings of the past century have offered quite the opposite.
Salutogenic Design in contemporary healthcare architecture:
Above Left: Credit Valley Hospital, Ontario, Canada, by Farrow Partnership ArchitectsAbove Right: The Dana Farber Cancer Institute by Carol R. Johnson Associates
While we are all aware that our physical environment has an impact on our mental well-being, much of the public architecture of the post-war years in the west has not been created with our human needs in mind. The scientific and evidence based research which is being carried out by sociologists, medical professionals and designers to promote the salutogenic model will hopefully justify what Bill Millard refers to in his article in Architect Magazine, as common sense:
“In some respects, salutogenesis applies simple common sense to the relationship of environments, bodies, and minds. What makes it a coherent school of thought is its reliance on interdisciplinary research, connecting biomedical knowledge with an explicit mission to place human well-being—not financial imperatives—at the center of creative strategies.”
Bill Millard, Architect Magazine, January 2012
Read more about salutogenics in my next blog post...
I have merely scratched the surface of this subject, for which there are volumes of research and publications, that continue to promote and develop both theory and practice. I would like to research further and share more thoughts on this here on my blog, but meanwhile here is some recommended further reading on salutogenesis and salutogenic design:
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