“The mind…can make a heaven of hell, a hell of heaven.” ― John Milton

At present, America’s healthcare industry focuses on pathogens – figuring out what’s wrong with you and hoping fixing it after the fact. The United States has world’s best medical personnel, medical technology and research and treatment facilities. But the entire ecosystem still revolves around fixing – and most often fixing isolated individual parts of us, seldom addressing the larger issues affecting the intertwined workings of the entire human body and spirit.

What if we focused on what we had to do to minimize our chances of entering the “system” in the first place? What if we put at least as much emphasis on our physical and mental fitness? And what if we also addressed the social aspect of our lives – and our interactions with our community and extended support structure? Not only would we significantly lower our chances of getting sick … we’d have much more fulfilling lives during the times we’re well.



Salutogenesis is a term coined by Aaron Antonovsky, a former professor of medical sociology in the United States. The term describes an approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the “salutogenic model” is concerned with the relationship between health, stress, and coping. Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum.”

In 2008 Scotland, specifically Chief Medical Officer Sir Harry Burns, adopted salutogenesis as national public health policy. Burns helped Scotland conceptualize health improvement differently, being aware that the small gains that resulted from a range of interventions can add up to produce significant overall improvements. Much of these interventions were and are aimed at empowering the populace through engagement with their own health outcomes.


Engagement and Self-Efficacy

Engagement creates agency and self-efficacy. Self-efficacy is defined as the extent or strength one believes in their own ability to complete tasks and reach goals. The more a person believes their actions will help their situation, the more likely they are to try. The key is to “get the ball rolling” by nudging activity and engagement – personally, socially and civically. The more a person does, the more they’re likely to do. And the more they do, the more they feel what they’re doing is helping … creating a cascade of positive results and well-being.

In America there is little effort put into getting people to engage directly with their health and personal well-being on the part of the established healthcare industry. Providers seem to be reluctant to relinquish control. However transferring some of this responsibility to the patients will prove beneficial to them. And it’s not just focusing on themselves physically that causes impact. Nurturing altruism and benevolence by doing good things for other people takes their minds off of their own ailments and gives them purpose beyond just their condition. If they can’t actively participate in hands-on volunteer projects, then they can at least feel they’re part of the solution by experiencing the joy of giving vicariously through attendance.

Behavior, Self-efficacy and Well-being:

  • Choices regarding behavior: People generally avoid tasks where self-efficacy is low, but undertake tasks where self-efficacy is high. Research shows that the optimum level of self-efficacy is slightly above ability; in this situation, people are most encouraged to tackle challenging tasks and gain experience. Our goal should be then to improve one’s level of self-efficacy through engagement and the process of learning.
  • Health behaviors: Choices affecting health, such as smoking, physical exercise, dieting, condom use, dental hygiene, seat belt use, and breast self-examination, are dependent on self-efficacy. Self-efficacy beliefs are cognitions that determine whether health behavior change will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and failures. Self-efficacy influences how high people set their health goals (e.g., “I intend to reduce my smoking,” or “I intend to quit smoking altogether”).
  • Locus of control: Difference in self-efficacy correlates to fundamentally different world views. People with high self-efficacy generally believe that they are in control of their own lives, that their own actions and decisions shape their lives, while people with low self-efficacy may see their lives as outside their control.

The salutogenic perspective focuses on three aspects. First, the focus is on problem solving/finding solutions. Second, it identifies actions or engagements that help people to move in the direction of positive health. Third, it identifies a global and pervasive sense in individuals, groups, populations or systems that serves as the overall mechanism or capacity for this process. These three make up a person’s collective sense of coherence.

Components of Engagement and Well-being:

  • Engagement with your Body:
    • Nutrition
    • Exercise
    • Habit management
  • Engagement with your Mind:
    • Artistic and creative expression (exposure and participation)
    • Cross-pollinated cerebral expansion
    • Vocational
  • Engagement with your Community:
    • Connection (empathy and altruism)
    • Hands-on volunteering


Well-being, Hope and Role of Community

What if we designed our communities around the idea of maximizing the engagement level for all residents, therefore raising the collective self-efficacy. Imagine if a chance to engage, whether it was physical, mental or social was just around the corner. And what if opportunities to self-actualize through helping others were part of the fabric our daily lives. What if our physical security and well-being was not dependent on government assistance or the whims of a fickle market driven economy. What if the neighborhood was the safety net, a safety net that knew best what was needed in a neighbor’s time of need. What if the streets of your communities became mixing pots of serendipity – places where curiosity was bred and benevolence was the norm.

What if engagement and well-being was how a community measured itself, not obtuse economic activity often distorted through a one-dimensional filter? What if we fixated on what we “could,” rather than what we “can’t.” And what if getting up in the morning was a chance to experience and nurture our hope … and help others do the same.