Catálogo de publicaciones - libros

In highly organised societies, understanding how organisations influence employees’ health, customers’ health and population health is crucial for health promotion. As the immediate influence on employee health is particularly strong, the chapter focuses on this aspect. Based on a review of ongoing changes of the economy, of organising work and of the roles of employees, we argue that agency for organisational health lies and needs to be strengthened within the organisation. Consequently, we define Organisational Health Development (OHD) as both the reproduction and the improvement of health in organisations as social systems, based on the interaction (process dimensions) of individual and organisational capacities (structural dimensions).

We review conceptual and empirical research of OHD as well as of health-oriented interventions in organisations that at least partly follow the salutogenic orientation. This review leads to an OHD model that shows how individual and organisational capacities co-produce both pathogenic and salutogenic processes in organisations, which taken together influence the sustainable performance of organisations. Such a framework allows to specify the general salutogenic model for the context of organisations. It serves as a joint group action theory for all stakeholders, generating a common language, compatible perspectives and mutual action to improve OHD. Additionally, it supports for well-structured, comparable intervention research on capacity building for OHD. The main challenge for the future will be to hold organisations accountable to be a healthy organisation—being low in producing pathogenic processes, but high in producing salutogenic processes for its members, customers and the larger environment.

The chapter compares the salutogenic orientation with the health promoting school approach and comparisons are made with regard to key concepts and principles of the two approaches to children’s health.

A brief literature overview compares the usage of salutogenic concepts to the usage of overlapping concepts, such as self-efficacy, resilience and health literacy in relation to school health. Furthermore, main findings indicating links between schools and young people’s sense of coherence are presented. Finally, a number of projects using the health promoting school approach are described as examples of major interventions in the field and the evidence on health and behavioural outcomes are summarized.

The main conclusion is that a closer merging of the salutogenic orientation and the health promoting school development is fruitful as the former has the potential to enrich the health promoting school development with an overall philosophy, and that intervention studies based on the health promoting school model have the potential to strengthen the intervention dimension of a salutogenic approach in schools.

This chapter focuses on how health can be created, maintained and supported in university settings. It first explores the higher education context and introduces key concepts that underpin ‘healthy universities’ and the application of a settings approach within this sector. While it can be argued that there are semantic differences between terms such as ‘health promoting settings’ and ‘healthy settings’, the reality is that they have often been used interchangeably. For the purposes of this chapter, the term ‘Healthy Universities’ is used throughout, even though the discussion draws on literature that has used a diversity of terminology, including ‘Health Promoting Universities’ and ‘Healthy Campus’. It then presents a summary of key developments and of theoretical and empirical research in the field, reflecting on the relationship to salutogenesis, before discussing key themes emerging and outlining challenges for the future.

Key observations emerging from this chapter include:

This chapter introduces the emerging literature on salutogenesis in corrections workers. Correctional officers have one of the most stressful jobs in our society yet have been largely neglected in occupational safety and health research. Correctional officers are at increased risk for cardiovascular, musculoskeletal, and posttraumatic stress disorders, and suffer from suicide rates nearly triple of those observed among the general population and in other related occupations. Actuarial tables indicate a 12–15-year life expectancy gap between correctional officers and the general population. In an effort to examine some of the root causes of these health problems in corrections, we begin by reporting findings that emerged from a focus group study on correctional officer stress, and highlight why Antonovsky’s theory is so relevant to correctional officers. Existing research is then reviewed that provides evidence for the potential role individual sense of coherence and salutogenic health promotion programs could play in mitigating the effects of workplace stress. A set of recommendations are made for planning salutogenic interventions in corrections, including assessing the organizational health climate and correctional officers’ perceptions of the health-promoting qualities of their workplace. Salutogenic aspects of a programmatic approach that has been used successfully to engage corrections staff in the design of workplace interventions to benefit both worker health protection and promotion are reviewed, and an experimental officer-led health mentoring program is described that was shaped, in part, by application of salutogenic principles. Future research needs and application areas in corrections are also discussed.

The application of salutogenesis in curative settings is specific, since it is about implementing salutogenesis into a territory which is still predominantly dominated by the paradigm of pathogenesis. But a case can be made that health care and its different curative settings would profit by integrating the principles of salutogenesis into their quality philosophy and management. Health gain for patients, their families, for health care professionals, and citizen could be improved by using a salutogenic orientation, parts of the salutogenic model and the concept and instrument of the sense of coherence in health care practice, research, and policy. This chapter summarizes how and why this could be done in different kinds of curative and other health care settings and what the actual status of practice and research using concepts and instruments from salutogenesis in these settings already is and how it could be further developed. The specific health care settings included are: Even, if for most health care settings health promotion practice still is limited, and outside hospitals salutogenic research is scarce, there exists enough promising evidence to recommend more extended integration of salutogenesis into health care practice and more and more systematic and complex salutogenic research in health care settings.

The term ‘salutogenic’ is widely used in healthcare architecture, even though very few healthcare architects have much of a handle on what the term means. Here, we clarify the key concepts of salutogenesis, demonstrate how they work and show how they have been designed into healthcare facilities to yield exemplary results.

The central idea is that there are three resources that combine to provide a Sense of Coherence—a forward thrust that resists the entropic forces of illness and infirmity. The sense of coherence is made up of resources that improve manageability—the capacity to maintain homeostasis and physical function; resources that improve comprehensibility—an ability to negotiate circumstances in order to maximise their benefit; and resources that enrich a sense of meaningfulness—the desires, causes and concerns that give us the need to resist illness in the first place.

We relate Antonovsky’s concepts of salutogenesis (Antonovsky, 1979; 1993) to the hospital setting. We argue that salutogenesis is particularly challenging to this setting—and vice versa. However, we also demonstrate that salutogenesis, if understood as one dimension of hospital quality, could considerably contribute to the health gains of both patients and staff (and to a certain degree also to the health gains of people in a hospital’s neighborhood and catchment area). Drawing on a comprehensive literature search, we contrast our theoretical considerations with available research to assess which aspects of salutogenesis in relation to hospitals the scientific literature already covers. We also consider the application of salutogenesis in Health-Promoting Hospitals, one of the WHO-initiated setting-oriented health promotion networks. We conclude by outlining needs for further research.

Research shows that sense of coherence is especially related to mental health. Thus, the relevance of applying salutogenesis in clinical settings is obvious. At the individual level, the professional healthcare worker aspires to be an expert and to create a conversational and interactional climate that will promote desirable change for, and in, the recipient of the mental healthcare service. This chapter emphasizes high quality social support in interplay with positive identity development as crucial resistance resources in a salutogenic approach in mental healthcare settings. Social support and identity are relevant in any discussion of group therapy, and a salutogenic orientation gives explicit attention to their interplay as resistance resources. While intervention research is still quite limited, some experimental evidence is presented in this chapter that indicates both the feasibility and the effectiveness of taking a salutogenic orientation into the mental health therapy setting.

In this chapter, we describe an empirically developed educational strategy that health profession training programmes could use to infuse students in the health professions with salutogenesis thinking and capability in their approach to patient care and health promotion activities. This strategy is based on years of research and teaching mental health, health promotion, and salutogenesis to students on bachelor, postgraduate, masters, and continuing education levels. Any educational strategy aiming to teach salutogenic practice should be grounded in the ontological stance that salutogenesis represents, and it should comprise salutogenesis as a body of knowledge, as a continuous learning process, as a way of working, and as a way of being. The overall objective is not the healing of diseases, but the facilitating and supporting of health-promoting processes leading to a person’s or group’s adaptive coping and enhanced ease and well-being. A key outcome of such training is that the student develops the capacity to manage herself in the salutogenic way. This means developing the capability called “self-tuning,” which is habitual self-sensitivity, reflection, and mobilizing of resources to maintain and improve one’s own health (“ease,” in Antonovsky’s terms). This is a form of self-care, the principles of which can be used by health professionals to assist patients and others to experience good health and well-being. A health professional’s “salutogenic capacity” is her degree of skill to help a person or group examine, mobilize, and deploy sufficient resources to achieve a shift towards the experience of good health and well-being. Salutogenic capacity can be expanded as part of the professional training, as described in this chapter. The methods learned can be applied after training, such that salutogenic capacity is strengthened and reinforced during the course of one’s career.

Vocational rehabilitation is a process of increasing awareness, enabling people to manage tension, to reflect about, identify, and mobilize internal as well as external resistant resources, and to promote effective coping by finding solutions. The relevance of a salutogenic orientation in vocational rehabilitation and in designing rehabilitation interventions, is shown in several studies. A salutogenic orientation may enhance professionals’ ability to appreciate clients’ coping strategies and resources in order to facilitate return to work. The main foundation of the concept of sense of coherence is to create coherence between structures and systems, which is considered as a significant challenge in the process of return to work. A salutogenic orientation in outpatient early rehabilitation, where the rehabilitation program and the development of working circumstances progress side by side, give however promising results. To improve return to work rates, this indicates a need for a greater part of the rehabilitation process to take place in the workplace/context to which the person is supposed to return after the rehabilitation period.