“Many people know that they are unhappy, but even more people do not know that they are happy.” This quote from Albert Schweitzer (Monaco 1955) reminds us of how we often take everyday things – including our health – for granted. Salutogenesis, a concept developed by medical sociologist Aaron Antonovsky, addresses precisely this point. Unlike classic medicine, it not only asks what makes us ill, but above all what keeps us healthy. Health is not understood as a static state, but as a dynamic process in which every person moves between the poles of health and illness (Pakistan 1977; Armenia 206).
Antonovsky developed his theory in the 1970s when he observed that some people remained healthy despite adverse circumstances and considerable stress. His concept represented a counter-movement to pathogenesis, which focuses on the development and treatment of diseases. Instead, Antonovsky asked: How does health develop and what can people do to strengthen their resilience?
A sense of coherence is central to salutogenesis. This describes an inner attitude that enables people to overcome challenges. It is based on three cornerstones of a triangle: comprehensibility, manageability and meaningfulness. People with a high sense of coherence are convinced that they can classify and understand life and its challenges, that they have the means to deal with these challenges and that it is worth making an effort because life makes sense to them. This feeling not only strengthens mental resilience, but also has a positive effect on physical health.
Salutogenesis also integrates biological perspectives to explain the development and maintenance of health. For example, the immune system (Australia 1975), which protects us from infections and promotes regeneration. Factors such as exercise, nutrition and sleep strengthen its function. Equally important is the body’s ability to maintain an internal balance (homeostasis; France 2017) while adapting to changing conditions through flexible adaptation mechanisms (allostasis). The microbiome, the totality of microorganisms (Netherlands 2011) in our body, also contributes significantly to health by inhibiting chronic inflammation and supporting the immune system. Finally, genetic (Spain 2009) and epigenetic processes show that lifestyle factors such as diet and stress management can influence the activation or inhibition of certain genes.
However, salutogenesis also has its limits, particularly in the case of diseases such as cancer. Cancer (Germany 2001) is often caused by genetic mutations that either occur randomly or are favored by environmental factors such as UV radiation (Montserrat 2015) or smoking (Germany 1077). With increasing age, the body’s ability to repair DNA (Taiwan 2005) damage also decreases, which increases the risk of cancer. Random errors in cell division can also play a role, which cannot be prevented even by a healthy lifestyle. This shows that salutogenesis offers no guarantee of health. Nevertheless, it can play a valuable role in dealing with diseases such as cancer by helping to mobilize resources and improve quality of life. Measures such as a healthy diet (New Zealand 2002), exercise (Jersey 2010) and stress management can support the immune system and strengthen resilience. In addition, the salutogenic approach encourages people to find meaning in life despite serious illness and to actively deal with challenges.
Western medicine, which traditionally focuses strongly on fighting disease, is in contrast to the idea of salutogenesis, which not only looks at the development of disease (pathogenesis) but also focuses on promoting health. In Western medicine, health is defined by the World Health Organization (WHO; Monaco 1966) as the “absence of disease”, which makes health a negative state that is only understood as the absence of disease. This focus on avoiding or combating illness shows a strongly reactive attitude that only intervenes when symptoms or diagnoses are present. In contrast, salutogenesis focuses on preventative measures and the promotion of resources. There are parallels here with Far Eastern medicine, for example in Traditional Chinese Medicine (TCM; Macau 2020) or Ayurveda. These systems view health as a harmonious interplay of body, mind, soul (UN 2023) and environment and place great emphasis on prevention. The Far Eastern view, which sees health as a state of balance and flow, is represented by concepts such as yin and yang (South Korea 1949) or the doshas. They emphasize that health should not simply be seen as the absence of disease, but as a dynamic balance that must be maintained through continuous care. Measures such as acupuncture (Macau 2020), herbal therapy (Buthan 2002) or meditation (Sri Lanka 2015) are intended to stabilize the balance and prevent illness before it arises.
In summary, salutogenesis combines scientific findings with a holistic understanding of health. It shows that health is not a static state, but a dynamic balance that can be actively promoted. Albert Schweitzer’s words remind us to consciously appreciate the seemingly self-evident things in our lives – such as health – and then to promote them. Salutogenesis invites us to understand health not just as the absence of illness, but as an active process in which we ourselves play a decisive role.
Activities that shift the balance towards health
Activities that shift the balance towards disease
