Salutogenesis: Why the crucial question isn’t what makes you ill

The term coined by Antonovsky for this concept is derived from the Latin salus, meaning ‘health’, and the Greek genesis, meaning ‘origin’. In other words, the ‘origin of health’.

Medicine, as we know it, thinks in pathogenetic terms. It asks: What makes people ill, and how do we get rid of it? This is not a weakness, but an enormous strength – when you have a broken bone or pneumonia, that is precisely the question you want answered.

However, it does not answer everything. It does not explain why two people experiencing the same stress, the same lack of sleep and the same strain end up in completely different situations. The salutogenic question turns the perspective on its head: not what makes people ill, but what keeps them healthy.

The term crops up on every other wellness website these days, usually as a gimmick to promote a massage offer. Antonovsky meant something far more uncomfortable.

He described it as a river, and this image remains the best illustration of the concept to this day.
Imagine that life is a river – with a current, rapids, eddies and unpredictable bends. Conventional medicine stands downstream and, with astonishing technical sophistication, fishes out those who are drowning. In doing so, it rarely asks how people ended up in the river in the first place, or why some go under whilst others do not.

Antonovsky’s question was a different one: How does one become a good swimmer, regardless of where one happens to be in the river?

That is where the second point lies. For him, health is not a switch that can be set to ‘healthy’ or ‘sick’. It is a continuum, and we all move back and forth along it throughout our lives. No one is entirely at one end. So the relevant question is never whether you are healthy, but in which direction you are currently moving.

So what sets good swimmers apart? Antonovsky identified a common denominator and called it sense of coherence, as in the original term ‘sense of coherence’. It consists of three parts.

Comprehensibility means: I can make sense of what is happening to me. My body is not some unpredictable thing to me that works sometimes and doesn’t at others. When I’m tired, I have a rough idea why.

Manageability means: I have the means to deal with it. Not for everything, but for enough. I’m not at the mercy of it.

And meaningfulness means: it’s worth making the effort. The whole thing has a meaning for me that goes beyond simply ticking boxes.

Anyone involved in training will recognise this immediately. The reason why people stop going to the gym after eight weeks is almost never a lack of discipline. It’s usually one of these three things that’s missing. They don’t understand what the programme is doing for them. Or they feel they can’t manage it anyway. Or it simply means nothing to them.

It is precisely at this point that theory becomes something you can book. The Alpenresort Schwarz on the Mieminger Plateau in Tyrol is one of the few establishments in the Alpine region that explicitly describes its health approach as ‘salutogenic’ – and also explains the term on its own website, rather than simply using it. The medically supervised health programmes have been running there for around ten years.

The structure follows the logic of the model. Four areas are interlinked: nutrition, exercise, regeneration and mindfulness. None of these on its own is the solution, and none works without the others. This is supported by a team of doctors led by Dr Heidi Pirktl, Dr Irene Brunhuber and Dr Julia Cordin , as well as around forty health experts on site.

The real difference, however, lies not in the facilities, but in the intention. A massage makes you feel more relaxed for two hours. An analysis that explains how your metabolism is currently working changes something about your understandability. A training plan that you can also follow at home helps improve your manageability. And a week in which you realise that you are actually feeling better helps improve your sense of purpose.

The facilities support this: the Bliss House fitness area covering around 300 square metres, up to nine open yoga classes per week, and a 5,500-square-metre spa. Add to that a plateau at an altitude of 800 to 1,000 metres with over 2,000 hours of sunshine a year – a rare instance where the location itself is part of the programme.

There is an uncomfortable truth in the health sector: The ideal plan that you don’t understand is worse than the sound plan that you do understand. This applies to exercise, nutrition and sleep.

That is why salutogenesis is not a ‘soft’ concept for people who want to take the easy way out. It is more demanding than any treatment, because it turns you into an active participant rather than a passive recipient. No one can simply hand you understanding on a plate. You can only build it up for yourself – and to do that, you need someone who explains rather than treats.

Ultimately, this is also the most useful yardstick for determining whether a health retreat is any good. It’s not about how many pieces of equipment there are in the building. It’s about whether, after a week, you know more about your own body than you did before.

Antonovsky sought out the people who were able to swim, even though the river had thrown everything at them. He found them. And the reassuring thing about his findings is that nobody is born a good swimmer.

What does ‘salutogenesis’ mean, explained simply?

Salutogenesis is the study of what keeps people healthy – in contrast to pathogenesis, which examines what makes people ill. The term was coined by the medical sociologist Aaron Antonovsky (1923–1994) and is derived from salus (health) and genesis (origin). Health is not a state that one either has or loses, but rather a continuum along which one moves.