Transcript specific resistance resources - Nederlands Congres Volksgezondheid

RESISTANCE RESOURCES IN THE
CONTEXT OF HEALTH PROMOTION
PRACTICE AND RESEARCH
Maurice B. Mittelmark
Professor and Head
Department of Health
Promotion and Development
University of Bergen
Investing in Communties: Principle, Panacea or Placebo?
The Wilhelmina Rouwenhorstlezing Lecture
2nd National Netherlands Conference on Health Promotion and Education
Arnhem, 11 January, 2001
Resistance resources are
“the most exciting things to be studied”
Antonovsky A (1973) Address to Stressful Life Events Conference
SPECIFIC
RESISTANCE
RESOURCES
‘SRR’
GENERALISED
RESISTANCE
RESOURCES
‘GRR’
Antonovsky’s ideas about resources…
• “Because the demands which are made on people are so
variegated and in good part so unpredictable, it seems
imperative to focus on developing a fuller understanding of
those generalized resistance resources that can be applied to
meet all demands.” (p. 541)
Antonovsky A (1972) Breakdown. A needed fourth step in the conceptual armamentarium of modern medicine.
Social Science and Medicine, 6:537-544.
Antonovsky’s ideas about resources…
“This is not to deny the importance of specific resistance resources.
They are many and are often useful in particular situations of
tension… but these are all too often matters of chance or luck as well
as being helpful only in particular situations.” (p. 99).
Antonovsky A (1979) Health, Stress and Coping. Jossey-Bass Publishers, San Francisco.
An unsatisfactory state of affairs…
• Emphasis on GRR shadows importance of SRR
• Health promotion has a major role in strengthening GRR and SRR
• GRR & SRR have different sources & are strengthened differently
• Salutogenesis is more relevant to health promotion with SRR
All of us throughout life are continuously exposed to stressors
Exposure to stressors is not from very low to very high
“It is, rather, from fairly serious and lifelong… to the unbelievable hell on earth of
so large a part of the world’s population” (p. 77)
Antonovsky A (1979) Health, Stress and Coping. Jossey-Bass Publishers, San Francisco.
unhappy experiences of others in our social networks
fear of aggression, mutilation and destruction
life phase-specific psychosocial crises
inherent conflicts in all social relations
gaps between our aspirations and our achievements
Antonovsky A (1979) Health, Stress and Coping. Jossey-Bass Publishers, San Francisco.
Money
Knowledge, intelligence, ego identity
Coping strategy (rationality, flexibility, farsightedness)
GRR
Social network embeddedness
Religious belief and ritual
Antonovsky A (1979) Health, Stress and Coping. Jossey-Bass Publishers, San Francisco.
Guttman, Louis (1959) A structural theory for intergroup beliefs and action. American Sociological Review,
Vol. 24, No. 3 (Jun., 1959), pp. 318-328 (Facet theory and sentence mapping).
HEALTH
SUCCESSFUL
COPING
GRR
HEALTH
SUCCESSFUL
COPING
GRR
SOC
HEALTH
SUCCESSFUL
COPING
GRR
SOC
PSYCHOSOCIAL
HEALTH
SUCCESSFUL
COPING
GRR
SOC
PSYCHOSOCIAL
INSTITUTIONAL
SRR
1. material asset
2. skill
A SSR is a
newly
engaged
3. talent
4. ability
of an
5. strength
6. expertise
7. proficiency
8. adeptness
1. impart control over
1. individual
2. group
3. community
4. setting
that is
activated
specifically to
2. avoid
3. reinterpret
a specific
stressor
4. adapt to
and thus prevent tension from being transformed into stress.
Mittelmark MB (2013). Resources for Health in the Salutogenic Model: Specific Resistance Resources contra Generalised Resistance
Resources in the Context of Health Promotion Practice and Research. Netherlands Congres Volksgezondheid 2013, 3 April, 2013.
Institutional…
• GRR
• Public schools
• HP schools
• HP workplaces
• Public health campaigns
• Well baby checks
• Public vaccination services
• Water & sewage services
• Social security system
• Police services
• Parks & recreation services
• SRR
•
•
•
•
•
•
•
•
•
•
Suicide prevention hotlines
Clean needle clinics
Medical emergency clinics
Disaster relief teams
Illness recovery help groups
HP prisons
Handicap accessibility infrastructure
Refugee resettlement programmes
Home health care
Excursions for the home-bound
HEALTH
SUCCESSFUL
COPING
GRR
SOC
SRR
PSYCHOSOCIAL
INSTITUTIONAL
HEALTH PROMOTION AND HEALTH EDUCATION
Well-being indicator
Predictors
R Square
Resilience
GDP (PPP USD) & Unemployment rate
Welfare expenditure
.50
.67
Satisfying life
GDP (PPP USD) & Unemployment rate
Welfare expenditure
.57
.70
Absence of negative feeling GDP (PPP USD) & Unemployment rate
Welfare expenditure
.63
.77
Overall personal well-being GDP (PPP USD) & Unemployment rate
Welfare expenditure
.68
.78
SPECIFIC
RESISTANCE
RESOURCES
GENERALISED
RESISTANCE
RESOURCES
A Salutogenic Model of Well-being with SRR
Life
Situation
•culture
•social forces
•social position
•gender
•ethnicity
•age
•orientations
•predispositions
•genetics
Ubiquitous
life course
stress
exposures
(chronic)
Generalised
resistance
resources
•support
•skills
•hardiness
etc.
•luck
•choices
-work/play
-association
-risk taking
-etc.
Public
Institutions
Shocks
Life
experiences
•degrees of
consistency
•underloadoverload
Specific
resistance
resources
•newly
engaged
•specifically
activated
•participation
Sense of coherence
wish to cope –
meaningfulness
challenge understood comprehensibility
Well-being
resources to cope manageability
•autonomy
Acute
stressors
Mittelmark MB (2013). Resources for Health in the Salutogenic Model: Specific Resistance Resources contra Generalised Resistance
Resources in the Context of Health Promotion Practice and Research. Netherlands Congres Volksgezondheid 2013, 3 April, 2013.