VAR KOMMER BARNEN IN

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1 VAR KOMMER BARNEN IN

2 VAR KOMMER BARNEN IN FALUN

3 ...JAG VAR MED LIVET OCH LIVET VAR MED MIG VÄL TILLFREDS... FALUN

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5 BENGT LINDSTRÖM, PhD, DrPH, MD Barn, ungdoms och familje hälsa Professor of Salutogenesis, HIST/NTNU, 2011-, NO Professor II of Health Promotion, HiBu, , NO Professor of Public Health and Health Promotion, NHV 2006-, SE Docent in Social Politik, Åbo Akademi Vasa, , FI Docent in Child Public Health, NHV 2002, SE Docent in Public Health Tampere Univ. 2002, FI Head of Health Promotion Research Programme at Folkhälsan Research Center, Helsinki, FI THESIS: THE ESSENCE OF EXISTENCE On The QoL of Children and Families in the Nordic Countries 1994 NHV Chair of the IUHPE Global Working Group on Salutogenesis se

6 IUHPE GWG-SAL UNRAVELLING THE MYSTERY OF SALUTOGENESIS M.E RESEARCH SEMINARS ON SALUTOGENESIS (2012 TRONDHEIM) THE HITCHHIKER S GUIDE TO SALUTOGENESIS EN 2010 ES 2011 (+ CAT + E-BOOK) FR 2012 DE 2013 NATIONAL NETWORKS THE CORE GROUP 2010: 12 CENTERS THE SALUTOGENIC SOCIETY RESEARCH AGENDA WE ARE COMING THE NEW KIDS ON THE BLOCK

7 THE IUHPE GWG SAL EMERY, USA Health Promotion and Resources, NO Hemil Senter, NO Högskolan Väst, SE UK: Steno HP Research, DK U of Newcastle NICE Society and Health, Wageningen, NL U of Zurich, CH; Vienna AUT WHO EURO, Venice, It U of Girona ES Ben Gurion Univ, IL

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9 MY OWN ENTRY POINT THE EXCAVATION OF HEALTH THROUGH QUALITY OF LIFE From MEDICINE to PUBLIC HEALTH & HEALTH PROMOTION then SALUTOGENESIS and finally LIFE PROMOTION PROVADIA, BULGARIA ( BC EUROPES OLDEST CITY)

10 HÄLSA?

11 The WHO Definition from 1948 stating: Health is a state of complete physical, mental and social wellbeing and not only the absence of disease or Infirmery WHO som en av FNs special organisationer har som grunduppgift Att skydda Mänskliga Rättigheter från ett hälsoperspektiv BARNKONVENTIONEN Hälsa undersöks mest i form av avsaknad av sjukdom Vad om vi skulle se på tillstånd av välbefinnande?

12 Hälsa, Sjukdom, Livskvalitet H H+ S S + SJUK FRISK QoL Qol HA DET HA DET B BRA BRA + FAKTOR FAKTOR VAD KAN HA DET BRA (SALUTOGENES) BIDRA MED

13 FOKUS I FORSKNING OCH PRAKTIK IDAG: HÄLSA SOM ETT TILLSTÅND AV VÄLBEFINNANDE HÄLSA SOM EN PROCESS

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19 Well-being measures WHO Five Well-being Scale Quality of Well-being Scale Warwick-Edinburgh Mental Well-being Scale 16 Item How Do You Feel Scale? General Well-being Index Ryff psychological Well-being Scales Satisfaction with Life scales Happiness scales Silver lining questionnaire Spiritual Well-being Scale Plus many more

20 INRE LIVSKVALITET (MENTAL HÄLSA) **note A ATT VARA AKTIV ATT HA GODA SOCIALA RELATIONER ATT HA SJÄLVKÄNSLA OCH SJÄLVKÄNNEDOM ATT HA EN GRUNDSTÄMNING AV GLÄDJE (SIRI NAESS 1972) KOMBINERAT MED EN KONTEXTUELL QoL MODELL MED FYRA LIVSSFÄRER PERSONLIG INTERPERSONELL SOCIOEKONOMISK SAMHÄLLETS FYS/MENT/SPIR FAMILJ FUNKTION EKO/UTB/BOENDE SYN/VÄRDERING (BENGT LINDSTRÖM 1994)

21 KONVENTIONEN RIKTAR SIG TILL KONTEXT (BARN-FAMILJ-SAMHÄLLE) SOM ALLA PRAKTIKER VET ÄR KONTEXT ALLTID CENTRAL NÄR DET GÄLLER BARN SVÅRGHETEN ÄR ATT RENODLA BARNETS INTRESSE OCH BARNETS BÄSTA SOM KAN VARA I KONFLIKT MED FAMILJEN VEMS AGENT ÄR MAN SOM PROFESSIONELL?? PERSONLIG INTERPERSONELL SOCIOEKONOMISK SAMHÄLLETS FYS/MENT/SPIR FAMILJ/FUNKTION EKO/UTB/BOENDE SYN/VÄRDERING (BENGT LINDSTRÖM 1994)

22 Probably the most important Health Policy change so far: The WHO HFA Strategy 2000 of Adding Years to Life (AYL) - Adding Life to Years (ALY) - A Sustainable Development - Equity in Health...and 38 Targets.

23 VAD VILL BEFOLKNINGEN? - LEVA LÄNGE - LEVA ETT GOTT LIV, LEVA DET LIV MAN VILL LEVA - UNDVIKA SJUKDOM - OM SJUK FÅ ALL HJÄLP SOM FINNS OMEDELBART

24 Struktur vs Innehåll VÄLFÄRD - HÄLSA VÄLBEFINNANDE- - LIVSKVALITET STRUKTUR INNEHÅLL

25 NOLLTOLERANS INFÖR DÖDSFALL OCH SKADOR I TRAFIKEN VÄGVERKET SVENSKA STATEN RIKSDAGSBESLUT

26 Mats-åke Belin Trafikverket,SE

27 Mats Åke Belin Trafikverket

28 Mats-åke Belin Trafikverket, SE

29 HUR HAR HÄLSOPROFESSIONEN NÄRMAT SIG HÄLSA? BUT????? REDUCE RISK MODIFIED AFTER THE CLASSIC RIVER OF HEALTH" Mac KNIGHT 1974

30 ABSOLUT VS RELATIVT

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33 TRATTKANTARELLER

34 TVÅ OLIKA INRIKNINGAR PÅ HÄLSOFORSKNING

35 H P I T P E H P T G C O T H D T I T H I O T O L A A A P L Den Genetiska Koden till Hälsofrämjande Lindström and Eriksson 2010 Lindström B, Eriksson M. The Hitchhiker s Guide to Salutogenesis. Salutogenic pathways to health promotion. Helsinki 2010.

36 HÄLSA SOM PROCESS LIVSSCYKEL FRÅN BARNDOM TILL LIVETS SLUT

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38 AARON ANTONOVSKY copyright Bengt Lindström

39 Salutogenesis, the exploration of the origin of health, is on the leading edge of a class of academic movements that emphasise human strengths and not just weaknesses, human capacities and not just limits, well-being and not just illness, and so on It is a system approach to health that also can be applied on organisations like schools, hospitals, business organisations... (Maurice Mittelmark)

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41 V Hur kunde någon någonsin klara det och behålla hälsan??? Survivors Non concentration camp + 28% 63% - 72% 37% p< did well in menopausis - problems in menopausis Table... Antonovsky s four field plot that made him discover Salutogenesis.

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45 SALUTOGENES (SOC-TEORIN ANTONOVSKY) RESURSFAKTORER FÖR ATT UTVECKLA HÄLSA 1)KÄNSLA AV SAMMANHANG förmågan att kunna använda sina resursrer i en hälsofrämjande riktning En faktor med tre dimensioner BEGRIPLIGHET (kognitiva) HANTERBARHET (beteende/instrumentella) MENINGSFULLHET (motivation) Antonovsky 1987) MULTIDIMENSIONELLT BEGREPP Feldt 2000; Eriksson 2007 m.fl. 2) GENERELLA MOTSTÅNDSRESURSER ERIKSSON, M. & LINDSTROM, B Validity of Antonovsky's sense of coherence scale: a systematic review. Journal of Epidemiology and Community Health, 59,

46 VAD OM VI SER PÅ EFFEKTEN AV EN STARK SALUTOGEN FÖRMÅGA HOS FAMILJ OCH BARN ISTÄLLET FÖR ATT BARA SE PÅ EGENSKAPERNA I SOC

47 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) 3. Enjoying good Social support (Antonovsky 1979, 1987; Shawn et al. 2007) 4. Having meaningful everyday activities (Antonovsky 1979, 1987) 5. Existential coordinates in place (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 about job engagement (Forbech Vinje & Mittelmark 2007) Monica Eriksson 2010

48 BYGGSTENAR I HÄLSOFRÄMJANDE PROCESSER (eller SALUTOGENA PROCESSER) FÖRSTÅ MEANINGFULLT HANTERA

49 HEALTH IN THE RIVER OF LIFE

50 Global (Macro) Political realities - Youth laws/policies - Historical events - Cultural context - Peace - Security - Safety Human Rights (UN) Convention on the rights of children (UN) Access to alcohol, tobacco, drugs TV/video watching, Internet Social env ironment (Exo) Risk Protection Promotion School enrolment Health care facilities Health care utilization Healthy Public Policy/HiAP Strengthening personal skills Integrating the salutogenic perspective School Group (Meso) Risk Protection Promotion Poor academic performance Size of schools Retention Absence Suspension Connectedness to school School policies Consistency of school attended Connectedness to school Engagement Flourishing Empowerment School policy Family Low parental education Family mental illness Maternal stress Poverty Authoritarian and/or neglectful parenting style Exposure to family violence Connectedness Attachment Parental presence Parental attitudes Family cohesion Sense of Coherence (FSOC) Connectedness to community Empowerment Attachment QoL/Life satisfaction Peers Prejudice from peers Perception of threat Social isolation Participation in deviant culture Being treated fairly by peers Having low-risk friends Peers with pro social norms Sense of Coherence (SOC) Sense of belonging Connectedness to peers Empowerment Flourishing Indiv idual (Micro) Risk Biological vulnerability Low self-esteem Unhealthy behaviour Stress reactivity Feelings as an outsider Un-connectedness Protection Social skills Spirituality/meaning Higher self-esteem Higher self-efficacy Perceived importance of parents Peers/significant others Sense of Coherence (SOC) Promotion Sense of Coherence (SOC) Family SOC Connectedness Empowerment Quality of Life/Happiness Flourishing (trivsel). Implementing salutogenesis in health promotion research and practice a coherent research model. Modified after Bronfenbrenner (1979), Blum et al. (2002) and Sun and Stewart (2007). Monica Eriksson Continue

51 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

52 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

53 SOC and Age Nilsson KW Journal of Epidemiology and Community Health 2009;19:19 August doi: /jech Monica Eriksson 2009

54 Generally - A strong SOC... protects against anxiety, depression, burnout and hopelessness is strongly and positively related to health resources such as optimism, hardiness, control, and coping... predicts good health and QoL from childhood to adulthood the stronger the SOC the fewer the symptoms of mental illnesses Eriksson M, Unravelling the Mystery of Salutogenesis, 2007; Nielsen AM, Hansson K Stress and Health 2007;23(5): ; Sagy S, Braun-Lewensohn O. Global Health Promotion 2009;16(4):5-15; Simonsson B, Nilsson KW, Leppert J, Diwan VK. BioPsychoSocial Medicine 2008;2(4):doi: / ; Buddeberg-Fischer B, Klaghofer R, Schnyder U. Soz Praventivmed 2001;46(6):

55 Mental health The stronger the SOC the better the QoL of children, adults and in families. Findings from both quantitative and qualitative studies support the SOC to be a factor enhancing good QoL. Results from longitudinal studies confirmed the findings from the crosssectional ones. Most of the studies are using specific questionnaires for measuring HRQL on varying samples (patients). Studies measuring QoL on general populations are scarce. Eriksson M, Lindström B. J Epidemiol. Community Health 2007;61:

56 THE SALUTOGENA PARAPLYET

57 THE HFA 2000 POLICY AND OUTCOMES RELATED TO DO-WELL FACTORS

58 Bauer G Davies JK et al Advancing a model for health, EJPH 2003,

59 Two Areas to Combine to bring coherence in and between life spheres and settings in the life course 1. The Political or Socio Economic Dimension: The reduction of Inequity, Bridging the Gap 2. The Inner Dimension: The Psycho-Emotional dimension Are they like the hen and the egg? The development of a strong SOC acts on both!? Overall Aim to develop a Collective SOC?

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61 HPOC = (SAL+QoL) HR HHG Salutogenesis 2010 Modified Bengt Lindstrom

62 HÄLSA IGEN??

63 A NEW DEFINITION OF HEALTH?? HEALTH IS WHAT IT TAKES TO MAKE LIFE WORTH LIVING HÄLSA ÄR DET SOM GÖR LIVET VÄRT ATT LEVA Bengt lindström 2010

64 VAR KOMMER BARNEN IN ELECTION DAY NOV 6th 2012 CHICAGO

65 WE ARE COMING THE NEW KIDS ON THE BLOCK

66 ENJOY THE ART OF BEING

67 NEW BOOK DECEMBER 2010 order at :

68 References: Antonovsky A. Health Stress and Coping, Jossey Bass, SF, 1979 Antonovsky A. (1985) The life cycle, mental health and the sense of coherence., Isr J Psychiatry Relat Sci, 22, Antonovsky A. Unravelling the mystery of health, Jossey Bass, SF, 1987 Eriksson M. Unravelling the mystery of Salutogenesis, FH Research Report I Lindstrom B Eriksson M. The Hitchhikers s Guide to Salutogenesis Lindström B Spencer N. Textbook on Social Pedatrics Oxford Univ Press, Oxford 1995 FH Research Reportt 2, 2010 Eriksson M, Lindström B. A Salutogenic Interpretation of the Ottawa Charter. Health Promotion International, 2008 Eriksson M, Lindström B. Antonovsky's Sense of Coherence Scale and It's Relation With Quality of Life - A Systematic Review. J Epidemiol Community Health, 2007;61: Koelen M, Lindström B. Making healthy choices easy choices: the role of empowerment. European Journal of Clinical Nutrition 2005;59(suppl 1): Bauer G Davies JK et al Advancing a model for health, EJPH 2003, Lindström B. The Essence of Existence NHV Report Lindström B. The UN Convention on The Rights of the Child in Lindström B Spencer N Textbook on Social Pediatrics, Oxford University Press, Oxford 1996 Websites: and Pictures: private Bengt Lindstrom