bengt lindström - Legeforeningen

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”JAG VAR MED LIVET
OCH LIVET MED MIG
VÄL TILLFREDS”
HVA GIR GOD HELSE ?
TROMSÖ 26.09.2012
BENGT LINDSTRÖM
BENGT LINDSTRÖM
MD, PhD, DrPH, (Barnlege FI, SE, NO o DK)
Professor i Salutogenes og Helsefremming 2011
Research Center for Health Promotion and Research
www.rchpf.org SVT/NTNU, NO
Professor Emeritus in Health Promotion and Public Health 2012
NHV, SE
Chair IUHPE Global Working Group on Salutgogenesis
www.rchpr.org
Disputas: The Essence of Existence –
On the Quality of Life of´Children and Families
in the Nordic Countries, NHV Report: 4 , 1994
VAD HAR VI SOM HÄLSOPROFESSIONELLA GJORT:
BUT??
?
?
?
REDUCE RISK
MODIFIED AFTER THE CLASSIC ”RIVER OF HEALTH"
Mc KNIGHT 1972)
FOKUS I FORSKNING OCH
PRAKTIK IDAG:
HÄLSA SOM EN PROCESS
TILL VÄLBEFINNANDE
(WELLBEING)
LIVSCYKELPERSPEKTIV
HÄLSA I KONTEXT
ADDING LIFE TO YEARS
BYGGSTENAR VID HÄLSOFRÄMJANDE PROCESSER
(ev SALUTOGENA PROCESSER)
The determinants of mental health
Global
Macro-
Resources
Climate, seasons
Societal structures & resources
 Transport, housing
MesoSocial factors
Settings
MicroIndividual factors
Economic factors
 Biology, genes
 Health behaviour,
 Emotions, coping,
 Self-esteem, etc
Health and Social
Services
Information flow
Socio-cultural values
 Human rights, equity
 Stigma
Environmental
Factors
Water, sanitation
Family
Migration
AARON ANTONOVSKY 1979,1987
SALUTOGENESIS
SENSE OF COHERENCE THEORY
SALUTOGENIC APPROACH
SAQLUTOGENIC FRAMEWORK
V
ENG: SENSE OF COHERENCE
NORSK: OPPLEVELSE AV SAMMANHANG
SVENSK: KÄNSLA AV SAMMANHANG
THE SALUTOGENIC UMBRELLA
PARALLELL THEORIES ON THE SALUTOGENIC APPROACH AND FRAMEWORK
BYGGSTENAR VID HÄLSOFRÄMJANDE PROCESSER
(ev SALUTOGENA PROCESSER)
FÖRSTÅ
MENINGSFULLT
HANDLING
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, NOVA NO
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
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
Positive Psychology Corey Keyes Flourishing
GeoSal Projektet
WEBSITE
Department of Health Promotion and Development HEMIL Sentret, UiB,
NORWAY
Resources - Positive Health Indicators
Positive Health Indicators
Researchers at the Department of Health Promotion and Development have
created a database for positive health indicators in order to give researchers
interested in positive dimensions of health ideas and access to measurement
tools.
Access to Database
STRUKTUR
versus
INNEHÅLL
VISION ZERO
• October 1997 the Swedish Parliament passed a new
bill on Road Traffic Safety
• long-term goal no one should be killed or seriously
injured as the result of an accident within the road
transport system
• the design and functioning of the road transport
system must be adapted to the requirements
resulting from this ruling.
Mats-åke belin
Different policies and strategies
Traditional approach
Vision Zero approach
Accidents
Injuries
Individual road user behavior
The system is not designed
according to human capability
and human tolerance against
external violence – in other
words what the human body
can stand.
Road user has primary
responsibility
System designer has primary
responsibility
Change individual road user
behavior
Change the environment (road
environment, vehicles, social
environment)
Risk reduction
Eliminate fatalities and serious
injuries
Mats-åke Belin
Mats-åke Belin Trafikverket,SE
Probability of Pedestrian Fatality by Impact Speed
Mats-åke Belin Trafikverket, SE
Mats-åke Belin Trafikverket, SE
The development of a strong SOC
Psychoemotional rather than socioeconomical factors
THE KEY GRRs:
1. Being in contact with ones
inner feelings
(Antonovsky 1979, 1987)
2. GOOD Intimate relationships
(Antonovsky 1979, 1987)
CHILDHOOD CONDITIONS INCLUDE:
A load balance and consistency
(Sagy & Antonovsky 1996)
Participation in shaping the
outcomes (empowerment)
(Sagy & Antonovsky 1996)
Appropriate childhood conditions
3. Enjoying good Social support
(Antonovsky 1979, 1987)
(Antonovsky 1979, 1987; Shawn et al. 2007)
Absence of family conflict good
neighbourhood cohesion (Shawn et al.
4. Having meaningful everyday
activities
(Antonovsky 1979, 1987)
2007)
Introspection and reflection
(Forbech Vinje & Mittelmark 2007)
5. Existential coordinates in
place (Antonovsky 1979, 1987)
© Monica Eriksson 2010
meaning
zest
vitality
(and desire to protect these)
THE SELFTUNING
MODEL
job
engagement
sense of
calling
vocation/calling
match
introspection ► sensibility ► reflection
Triggers:
adaptive coping
(real change)
in:
sense of duty
self-demand
self-responsibility
responsibility to others
overload; fatigue
burnout
(and desire to avoid these)
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
The International Journal for Mental Health Promotion, 8 (4), pp 36-47.
RISKBEGREPPET
ABSOLUT
eller
RELATIVT?
VID PROCESSPERSPEKTIV
TRATTKANTARELLER
HEALTH IN THE RIVER OF LIFE
The River of Life
Resource
Risk
• What puts children at risk for abnormal development?
– Environment does not meet developmental needs, or suppresses
development
– Failure to invest time and resources during the early years may results in
foster care, health problems, learning deficits, social mal-adjustment
– Unmet health needs (medical examination, immunization
• What makes children healthy, happy and well-adjusted?
– Safe, stimulating environment -- home, school, neighbourhood
– Good food, sleep, exercise, play, immunisation, medical care
– Unconditional loving attention, praise, positive regard, encouragement
– Acceptance for who they are
– Encouragement to develop skills, talents, interests, exploration, inclusion, empathy
– Rich and responsive language environment, fostering of cultural development
– Celebration of developmental advances
– Boundaries and supervision, discipline, stable & predictable living conditions
WHO OPTIMAL CHILD GROWTH CONDITIONS
An Equal Start: Improving outcomes in Children's Centres
Improving outcomes in Children's Centres Executive Summary http://bit.ly/S3skua
An Evidence Review http://bit.ly/QSFDP4
The Institute of Health Equity was commissioned by 4Children to identify the most
important outcomes Children’s Centres should be striving for in order to give all
children positive early-years experiences.
The IHE have published both an executive summary (which includes the outcomes
framework), and a full evidence review, which call for a renewed focus on supporting
good parenting and the environment in which parents live and work.
The work builds on existing frameworks and draws together the best available evidence
of what is important in early years, the views of practitioners and parents, and the
work that government continues to take forward around the early years.
Moving on, the Institute will be involved in further work with Children’s Centres to
help ensure that the outcomes framework becomes a useful tool which also identifies
how best to measures these outcomes….”
The development of a strong SOC
Psychoemotional rather than socioeconomical factors
THE KEY GRRs:
1. Being in contact with ones
inner feelings
(Antonovsky 1979, 1987)
2. Having GOOD Intimate
relationships (Antonovsky 1979, 1987)
3. Enjoying good Social support
(Antonovsky 1979, 1987; Shawn et al. 2007)
4. Having meaningful everyday
activities
(Antonovsky 1979, 1987)
CHILDHOOD CONDITIONS INCLUDE:
A load balance and consistency
(Sagy & Antonovsky 1996)
Participation in shaping the
outcomes (empowerment)
(Sagy & Antonovsky 1996)
Appropriate childhood conditions
(Antonovsky 1979, 1987)
Absence of family conflict good
neighbourhood cohesion (Shawn et al.
2007)
Introspection and reflection
(Forbech Vinje & Mittelmark 2007)
5. Existential coordinates in
place (Antonovsky 1979, 1987)
© Monica Eriksson 2010
OUTOCOMES
OF
SALUTOGENESIS
SOC and AGE
Mean SOC by Mean Age
based on 15-81-year-aged general populations
(16 studies using SOC-13, 1993-2003)
Mean SOC by Mean Age
based on 18-81-year-aged general populations
(15 studies using SOC-29, 1994-2008)
180
180
160
160
140
140
120
120
100
100
SOC
SOC
80
80
60
60
40
40
20
20
0
0
15 21 23 37 39 41Mean
44 age
46 48 50 69 75 78 80 81
18 19 20 23 36 37Mean
43 age
48 50 55 60 67 76 77 81
© Monica Eriksson 2009
© Monica Eriksson 2009
Eriksson M, Lindström B. Life is more than survival: Exploring the links between Antonovsky's salutogenic theory and the
concept of resilience, some conceptual considerations. In: Gow KM, Celinski MJ, editors. Wayfinding through life's
challenges: Coping and survival. New York: Nova Science Publishers; 2010.
© Monica Eriksson 2010
SALUTOGENES DEVELOPMENT OF A STRONG SOC AND OUTCOMES
A NEW DEFINITION OF HEALTH??
(BASED ON WELLBEING AND A SALUTOGENIC APPROACH)
HEALTH IS WHAT IT
TAKES TO MAKE LIFE
WORTH LIVING
”HEALTH IS NOT BOUGHT WITH
THE DOCTORS PILLS OR THE CUT
OF THE SURGEONS KNIFE
HEALTH IS NOT ONLY THE
ABSENCE OF ILLS
BUT THE FIGHT FOR THE
FULLNESS OF LIFE”
PIET HEIN 1988
WHO 40th ANNIVERSARY
NEW BOOK
DECEMBER 2010
CAN BE ORDERED FROM
bengt.lindstrom@svt.ntnu.no
REFERENCES:
Antonovsky A. Unraveling the myth of health, Jossey Bass 1987
Eriksson M. Unravelling the myth of salutogenesis, FH Research Report 1, 2007
Lindström B Eriksson M. The Hitchhikers Guide To Salutogenesis, Folkhalsan
Health Promotion Research Report 2, 2010
Eriksson M Lindstrom B Shifra S. A salutogenic aspect on mental health across
the life time. Cultural aspects of Sense of Coherence in (ed) Mayer & Krause
Salutogenesis and Cultural Aspects i(n press )2012
Lindström B. A Journey to the Center of Health.
The Trondheim HP Research Seminar August 6-9.2012 www.rchpr.org
MUSIK: Älska mig för den jag är Ainbusk Singers (Youtube)
VIDEO : Jakten på Nazismen SVT.
Målet i Siktet SVT
WEB: www.salutogenesis.fi, www.rchpr.org ,
ENJOY THE ART OF BEING
THANK YOU