Future directions for the concept of salutogenesis: a position article.

Aaron Antonovsky advanced the concept of salutogenesis almost four decades ago (Antonovsky, Health, Stress and Coping. Jossey-Bass, San Francisco, CA, 1979; Unravelling the Mystery of Health. Jossey-Bass, San Francisco, CA, 1987). Salutogenesis posits that life experiences shape the sense of coherence (SOC) that helps to mobilize resources to cope with stressors and manage tension successfully (determining one's movement on the health Ease/Dis-ease continuum). Antonovsky considered the three-dimensional SOC (i.e. comprehensibility, manageability, meaningfulness) as the key answer to his question about the origin of health. The field of health promotion has adopted the concept of salutogenesis as reflected in the international Handbook of Salutogenesis (Mittelmark et al., The Handbook of Salutogenesis. Springer, New York, 2016). However, health promotion mostly builds on the more vague, general salutogenic orientation that implies the need to foster resources and capacities to promote health and wellbeing. To strengthen the knowledge base of salutogenesis, the Global Working Group on Salutogenesis (GWG-Sal) of the International Union of Health Promotion and Education produced the Handbook of Salutogenesis. During the creation of the handbook and the regular meetings of the GWG-Sal, the working group identified four key conceptual issues to be advanced: (i) the overall salutogenic model of health; (ii) the SOC concept; (iii) the design of salutogenic interventions and change processes in complex systems; (iv) the application of salutogenesis beyond health sector. For each of these areas, we first highlight Antonovsky's original contribution and then present suggestions for future development. These ideas will help guide GWG-Sal's work to strengthen salutogenesis as a theory base for health promotion.

The health promoting hospital (HPH): concept and development.

Health promoting hospitals (HPH) is a concept for hospital development that builds upon the health promotion concept of the WHO Ottawa Charter for health promotion, where the reorientation of health care services is considered as one of five major action areas for an overall health promotion development. The article outlines what such a re-orientation may mean for the main hospital functions. These include: the health promoting hospital setting; health promoting workplaces, the provision of health (related) services, training, education and research; the hospital as an advocate and "change agent" for health promotion in its community/environment; the "healthy" (metaphorically speaking) hospital organisation. Based on the concept, an international network of WHO, Europe has been developing since the late 1980s. The main projects of the international network so far were the first model project "health and hospital" (Vienna, 1989-1996), the European pilot hospital project of HPH (1993-1996), and the development of national/regional HPH networks (ongoing since 1995). It is argued that the further development of the HPH network will have to take into account some major changes that have occurred in the hospital landscape since the start of the network: the quality movement and, as a sub-set of this, the increasing importance of evidence based medicine.