Vi vet hva vi vil, men får vi det til? - en salutogen strategi for å nå målet. v/professor i Salutogenese Bengt Lindstrøm, NTNU

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1 Vi vet hva vi vil, men får vi det til? - en salutogen strategi for å nå målet. v/professor i Salutogenese Bengt Lindstrøm, NTNU

2 BENGT LINDSTRÖM, PhD, DrPH, MD Barn, ungdoms och familje hälsa Professor of Salutogenesis, SVT/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

3 RCHPR 2012 NORSJÖ NK UH 1972 FH 2005 NSP WHO EURO x

4 IUHPE GLOBAL WORKING GROUP ON SALUTOGENESIS SINCE 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

5 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

6 HÄLSA ETT PROBLEM ATT LÖSA?

7 THE NORTH KARELIA PROJECT 1972

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9 The North Karelia Project Nothing FINLAND AND SCOTLAND FINNISH CVD MORTALITY MASSIVE INTERVENTIONS FROM 1972 ONWARDS THE NORTH KARELIA PROJECT THE GLOBAL FLAGSHIP FOR CVD PREVENTION and COMMUNITY INTERVENTIONS SCOTTISH CVD MORTALITY NO INTERVENTIONS AT ALL NOTHING except for HAGGIS, WHISKY AND A SMOKE, and SOME EXELLENT DEPRIVATION STRATEGIES

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11 HOW DOES ONE EXPLAIN THE CVD EPIDEMIC IN FINLAND?? Genetics Lifestyle (alcohol, tobcco, Food exercise...) The social gradient Not good to be poor at all Mental problems A great stressor behind the border Soviet Union (FI) What about epi-genetics? What about stress theories? What about history? Was North Carelia only timed right by chance?? However The Research and Intervention gave us a lot of experience to build on further BUT at the same time a belief in a paradigm that has been impossible to break over 40 years!!

12 FOKUS I FORSKNING OCH PRAKTIK IDAG: HÄLSA SOM VÄLBEFINNANDE HÄLSANS SOCIALA DETERMINANTER HÄLSA SOM EN LIVSLÅNG PROCESS HÄLSA I ALLA POLICY SAMMANHANG

13 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.

14 THE OTTAWA CHARTER FOR HEALTH PROMOTION 1986

15 Lindström and Eriksson 2010 The Genetic Code of Health Promotion THE EMBEDDED PRINCIPLES AND VALUES P H H P I T E P T G C O T H D T I T H I O T L O A A A P L Lindström B, Eriksson M. The Hitchhiker s Guide to Salutogenesis. Salutogenic pathways to health promotion. Helsinki

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17 HÄLSA 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 BARNET ETT AKTIVT HANDLANDE SUBJEKT Hälsa undersöks mest i form av avsaknad av sjukdom Vad om vi skulle se på tillstånd av välbefinnande?

18 ETT TILLSTÅND AV VÄLBEFINNANDE

19 c

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24 INDIVIDNIVÅ INRE LIVSKVALITET (MENTAL HÄLSA) ATT VARA AKTIV ATT HA GODA SOCIALA RELATIONER ATT HA SJÄLVKÄNSLA OCH SJÄLVKÄNNEDOM ATT HA EN GRUNDSTÄMNING AV GLÄDJE SAMFUNDS NIVÅ (SIRI NAESS 1972) KOMBINERAT MED EN KONTEXTUELL QoL MODELL MED FYRA LIVSSFÄRER

25 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

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

27 Struktur vs Innehåll VÄLFÄRD - HÄLSA VÄLBEFINNANDE- - LIVSKVALITET STRUKTUR INNEHÅLL UNCRC

28 Struktur

29 EVIDENSBASERADE VISIONER NOLLTOLERANS INFÖR DÖDSFALL OCH SKADOR I TRAFIKEN VÄGVERKET SVENSKA STATEN RIKSDAGSBESLUT

30 Mats-åke Belin Trafikverket,SE

31 Mats Åke Belin Trafikverket

32 Mats-åke Belin Trafikverket, SE

33 RISK ABSOLUT VS RELATIVT

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36 TRATTKANTARELLER

37 HÄLSA SOM PROCESS LIVSSCYKEL FRÅN BARNDOM TILL LIVETS SLUT

38 TVÅ OLIKA INRIKNINGAR PÅ HÄLSOFORSKNING

39 INNEHÅLL MENING TEORI EVIDENS PRAXIS

40 AARON ANTONOVSKY copyright Bengt Lindström

41 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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43 HEALTH IN THE RIVER OF LIFE

44 GENERELLA MOTSTÅNDSRESURSER SALUTOGENES (SOC-TEORIN, ANTONOVSKY) RESURSFAKTORER FÖR ATT UTVECKLA HÄLSA KÄNSLA AV SAMMANHANG (SOC) förmågan att kunna använda sina resurser 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.

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

46 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

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

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

49 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):

50 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:

51 Develop personal skills Health behaviour The stronger the SOC the healthier behaviour in general A person with a strong SOC has a lower level of alcohol consumption, less use of tobacco and drugs, exercise more frequently and makes healthier food selection Parent s SOC has an impact on meal and food intake pattern of their children Ray, Suominen, Roos J Epidemiol Community Health 2009, Andersen S, Berg JE. Addiction Research & Theory 2001;9(3): ; Bergh H, Baigi A, Fridlund B, et al. Public Health 2006;120: ; von Ah D, Ebert S, Ngamvitroj A, et al. Tobacco Induced Diseases 2005;3(1):27-40; Hassmén P, Koivula N, Uutela A. Prev Med 2000;30:17-25; Lindmark U, Stegmayr B, Nilsson B, et al. Nutr J 2005;4(9):doi: / ; Myrin B, Lagerström M. Scand J Caring Sci 2006;20:

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

53 30 BILLION EUROS EQUALS ONE DAY OF WORK FOR THE WHOLE POPULATION /A YEAR: i. e. A 4 DAYS WORKING WEEK IN FINLAND If SOC Strong Peope tend to Return to Working Life 18 BILLION DOLLARS/YEAR in USA spent on Caesarean Sections without medical indications If SOC is Strong Women Prefer Natural Birth

54 THE SALUTOGENA PARAPLYET

55 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

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

57 ATT GE BARNET OCH FAMILJEN EN KÄNSLA AV SAMMANHANG GENOM ATT SJÄLV SOM PROFESSIONELL HA EN KÄNSLA FÖR SAMMANHANG, DVS FÖRSTÅ VILKA RESURSER OCH KOMPETENSER SOM BEHÖVS FÖR EN GOD UTVECKLING FÖR BARNETS BÄSTA

58 WEB DATA BASE Order at

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60 International Health Promotion Forum: "Next Health" august 2014 i Trondheim SEE: in cooperation with IUPHE GWG SALUTOGENESIS

61 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 Report 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 Videos: Målat i siktet (SVT) och Bagaren Trond Viggo Pictures: private Bengt Lindstrom