Torill Bull

The salutogenic model of health in health promotion research.

Despite health promotion’s enthusiasm for the salutogenic model of health, researchers have paid little attention to Antonovsky’s central ideas about the ease/dis-ease continuum, defined in terms of ‘breakdown’ (the severity of pain and functional limitations, and the degree medical care is called for, irrespective of specific diseases). Rather, salutogenesis research has a strong focus on how sense of coherence relates to a wide range of specific diseases and illness endpoints. We address two questions: Why has Antonovsky’s health concept failed to stimulate research on breakdown, and how can the present emphasis on disease be complemented by an emphasis on positive well-being in the salutogenic model? We show that (i) the breakdown concept of health as specified by Antonovsky is circular in definition, (ii) it is not measured on the ‘required’ ease/dis-ease continuum, (iii) it is not measureable by any validated or reliability-tested assessment tool, and (iv) it has not so much been rejected by health promotion, as it has not been considered at all. We show that Antonovsky came to view breakdown as but one aspect of well-being. He was open to the idea of well-being as something more positive than the absence of pain, suffering and need for medical care. We suggest ways to move salutogenesis research in the direction of well-being in its positive sense.

Work life and mental wellbeing of single and non-single working mothers in Scandinavia.

Background: This study examined levels and predictors of mental wellbeing in Scandinavian working single and non-single mothers, with a special focus on financial stress, job characteristics and work—family conflict. Methods: The European Social Survey Round 2 (2005) provided questionnaire data from 73 single and 432 non-single working mothers in Denmark, Sweden and Norway. Respondents answered questions about the outcome variables life satisfaction, happiness, and positive affect, and predictor variables financial stress, job characteristics, work—family conflict, and social support. Hierarchical multiple regression was used to assess the relationships between predictor variables and mental wellbeing outcomes. Results: Single working mothers scored significantly lower on life satisfaction and happiness, but not on positive affect, than did non-single mothers. Financial stress was higher in the single mother group. There were no significant differences in levels of enriching or stressful job characteristics, or in levels of social support. While financial stress and work—family conflict were important predictors in both groups, the relationship between financial stress and wellbeing was far stronger in the single mother group. Confidant support was a significant predictor only in the single mother group, and social participation only in the non-single mothers group. Conclusions: This study suggests that the Scandinavian welfare democracies have not yet been successful in relieving the financial pressure experienced by single working mothers. Development of efficient financial support systems should be prioritized. Ways to reduce work—family conflict in both single and non-single mothers in Scandinavia should also be given increased attention.

Culture in salutogenesis: the scholarship of Aaron Antonovsky:

Aaron Antonovsky wrote extensively, although disjointedly, about the roles of culture in salutogenesis. This paper provides a synopsis of his work in this arena. A literature review identified those of his English language writings in which culture was a subject, and relevant text segments were analysed using an inductive followed by a deductive method. Using thematic network analysis, text segments were sorted inductively by open coding and then analysed. This was followed by deductive text segment coding guided by the constructs of the salutogenic model of health. The analysis revealed that Antonovsky had an expansive interest in the roles of culture in salutogenesis. His writings included attention to the role of culture in: (a) shaping life situations; (b) giving rise to stressors and resources; (c) contributing to life experiences of predictability, load balance and meaningful roles; (d) facilitating the development of the sense of coherence and (e) shaping perceptions of health and well-being. Antonovsky’s writings about culture were sometimes conjectural, as well as being obviously influenced by his life experience in the USA and then in Israel, and by the spirit of the times in which he lived. However, he also drew extensively on his own and others’ empiricism, leading him to view culture as an integral aspect of the salutogenic model of health. The present analysis provides salutogenesis scholars with a roadmap of Antonovsky’s reflections, ponderings and conclusions about culture in the context of salutogenesis. It provides assistance in the form of an overview of Antonovsky’s treatment of culture in the context of salutogenesis.

‘My Happiest Moment is when I have Food in Stock’: Poor Women in Northern Ghana Talking about their Happiness

The aim of this study is to increase understanding of subjective well-being in small-area contexts in very poor ruralities. When daily challenges revolve around survival, what contributes to feeling good and being satisfied with life? These issues were explored in group interviews with women in a remote and extremely poor area of Northern Ghana. The data indicate that, in this agricultural setting with a patriarchal culture, womens happiness was elevated by meeting survival needs such as attaining food security, having a level of health good enough to engage in work, and having a marital relationship characterised by affection and support. For the development of health promotion programmes, the findings may suggest that, in addition to the obvious priority of securing basic material needs, initiatives to promote supportive husband behaviour toward wives might be a way to enhance the subjective well-being of women living in very poor, patriarchal rural areas.

Assets for well-being for women living in deep poverty: through a salutogenic looking-glass

This paper explores assets for health and well-being for women in extremely poor rural areas in Ghana, Haiti, India, the Philippines, and Tanzania. Data were collected through individual interviews and focus group interviews with local women. The paper asks (i) which assets women draw on for well-being in resource-poor settings, and (ii) whether an assets approach, as understood in the Salutogenic Model, is appropriate and meaningful in the most deprived areas. Low levels of natural, material and infrastructural resources were reported by the respondents to cause stress, and assets of a human, social and cultural character were identified as being important in coping with this stress. By mobilizing the capacity and assets of people and places, local development initiatives will make sense logically (comprehensibility), they will be perceived to be practically realistic (manageability), and they will be motivating because they are meaningful, based on involvement in decision-making (meaningfulness). The assets focus must co-exist with initiatives to improve distributional justice. We conclude that an asset approach to well-being is not only appropriate, but also necessary, in even the poorest contexts.

Work life and mental well-being: single and coupled employed mothers in Southern Europe and Scandinavia

Many European mothers, single and coupled, combine work outside the home and family life. The effects of this on their mental well-being may vary depending on the level of support available from the State’s welfare system, since welfare may buffer working mothers from some of the stress that can arise from trying to manage significant responsibilities on the job and at home. Welfare may be especially important for single working mothers, for whom the burden of multiple roles may be even heavier. The present study assessed levels and predictors of well-being of single and coupled employed mothers in Greece, Portugal and Spain, where welfare support is relatively limited. Results were compared to a parallel study with data from Denmark, Norway and Sweden, where welfare support is relatively comprehensive. Coupled mothers in Scandinavia had significantly lower financial hardship, longer education, higher life satisfaction, more enriching jobs, practical support, financial support and social participation than coupled mothers in the Southern European sample. On the other hand, the Scandinavian coupled mothers had higher levels of work family conflict than coupled mothers in Southern Europe. Single mothers in Scandinavia, compared to single mothers in Southern Europe, had significantly longer education, higher life satisfaction and positive affect, more enriching jobs, confidant support, practical support, financial support and social participation. Level of job stress was the same for all mother groups. All groups differed significantly from each other in level of financial hardship, with Scandinavian coupled mothers being best off, followed by Scandinavian single mothers, Southern European coupled mothers, and Southern European single mothers. The regional differences suggest that single motherhood per se need not be a risk factor for poorer well-being, and that welfare policies may have a protective effect for the mental well-being of single mothers. (Global Health Promotion, 2009; 16(3): pp. 06—16)

Social determinants of rest deprivation amongst Ghanaian women: national and urban-rural comparisons with data from a cross-sectional nationally representative survey

BackgroundRest deprivation (rest/napping/sleep 6 or less hours daily) is a clinically recognised risk factor for poor health, but its epidemiology is little studied. This study reports prevalences and social correlates of rest deprivation in Ghana.MethodsData are from the 2008 Ghana Demographic and Health Survey. Women ages 15-49 were recruited in a national sampling design. Respondents were 4,916 women in the national sample, a sub-sample of 530 women in the three northernmost rural regions and a sub-sample of 853 women in urban Greater Accra.ResultsPrevalences of rest deprivation were 0.13% nationally, 14.5% in Greater Accra and 16.8% in the North. The significant correlates nationally were age, education, wealth index, Christian religion and literacy. In Accra, they were age, wealth index, having household electricity, and possession of a refrigerator, a stove and a mobile phone. In the North, they were education, occupation, drinking water source, possession of motorcycle/scooter, Christian religion, literacy, and possession of a clock and a cupboard. In logistic regression analyses controlling for age in the national sample, the significant odds ratios were 1.40 for no education compared to secondary and higher education, 0.78-0.43 for the four poorer wealth quintiles compared to the richest wealth index quintile, and 0.55 for Christian religion compared to all others.Also controlling for age, the significant odds ratios in Accra were 2.15 for the second richest wealth quintile compared to the richest quintile and 0.16 for possession of a mobile phone. In the North they were 0.49 for Christian religion compared to all others, 1.87 for having a protected compared to an unprotected water source, and 0.41 for having a cupboard in the home.ConclusionsEducation, wealth and religion were related to rest deprivation nationally but not in the urban and rural regions (except for religion in the North). This suggests caution in generalising about the social correlates of rest deprivation at a regional level, based on national-level data. Qualitative research in local contexts is needed in order to illuminate the social determinants of rest pattern, and to provide guidance about better ways to measure such determinants in future survey research.

Does health promotion need a Code of Ethics? Results from an IUHPE mixed method survey.

Background. Health promotion is an ethically challenging field involving constant reflection of values across multiple cultures of what is regarded as good and bad health promotion practice. While many disciplines are guided by a Code of Ethics (CoE) no such guide is available to health promoters. The International Union for Health Promotion and Education (IUHPE) has been nominated as a suitable candidate for developing such a code. It is within this context that the IUHPE Student and Early Career Network (ISECN), through its Ethics Working Group, has taken up the challenge of preparing the foundations for a CoE for health promotion. Methods. An online survey comprising open and closed-answer questions was used to gather the opinions of IUHPE members regarding the need for a CoE for health promotion. The quantitative data were calculated with descriptive analyses. A thematic analysis approach was used to analyze and interpret the qualitative data. Results. IUHPE members (n = 236) from all global regions responded to the survey. The majority (52%) of the respondents had 11 years’ experience or more in the field of health promotion. Ethical dilemmas were commonly encountered. The need for a CoE for health promotion was expressed by 83% of respondents. Respondents also offered their views of possibilities, ideas and challenges regarding the development of a CoE for health promotion. Conclusions. Considering that health promoters encounter ethical dilemmas frequently in their practice, this study reinforces the need to develop a CoE for the field. The recommendations from the survey provide a good basis for future work to develop such a code.

Social determinants of health in very poor ruralities.

Globally, research on social determinants of health has built a considerable knowledge base over the last decade. Still, not much of this research has been carried out in the extremely poor areas of the world, like for instance Africa south of the Sahara. In very poor ruralities, classic indicators of socioeconomic status are not well suited. Few people have any education, monetary income is not a good measure of material standing and people cannot be classified by occupation as they make their livelihood from a variety of activities. For efforts towards health equity to benefit the poorest of the poor, more suitable indicators of social health determinants must be identified. Health research might benefit from knowledge developed in neighbouring fields like development research, anthropology and sociology. (Global Health Promotion, 2009; 16 (1): pp. 53—56)

Subjective Well-Being Among Employed Lone Mothers in Europe: the Effects of Level of Work/Family Conflict and Self-Enhancement Versus Self-Transcendence Value Orientation

The study investigated the relationship of subjective well-being (SWB) to (1) work/family conflict, (2) self-enhancement/self-transcendence values and (3) the interaction between work/family conflict and values. SWB was represented by measures of life satisfaction (LS), positive affect (PA) and happiness. The data were from a cross-national sample (17 countries) of 484 employed lone mothers in the European Social Survey. Participants with higher levels of work/family conflict had lower levels of SWB. Participants who valued self-enhancement had lower levels of LS, but not lower levels of PA and happiness. There were no interaction effects between work/family conflict and values. The findings support the distinction between happiness and LS as separate constructs. The present results add to the literature on work/family conflict and SWB by addressing this topic in a little studied but important population segment, employed lone mothers.