The Salutogenic Model of Health

Imagine yourself walking along a riverbank. The sun is shining, skies are blue, birds are singing, the flowers are blooming, and you are smiling; life is good and you are healthy! Until… Boom! You fall into the river. You have become ill. Immediately, doctors swim toward you, trying to save you from drowning – that is, to cure you. Sometimes they succeed, sometimes they don’t. This is Curative Medicine; it focuses on your illness.

At some point, people appear on the riverbank trying to prevent you from falling in. They tell you: "You don't want a heart attack? Don't eat fatty foods and don't smoke. You don't want diabetes? Don't eat too much sugar. You don't want to experience stress? Don't work too hard." These are the practitioners of Preventive Medicine, and it, too, is focused on illness, asking: how can we prevent your disease?

For centuries, Western medicine has centered on sickness. Its guiding questions are: "What causes illness? How do we diagnose illness? How do we treat illness? What can prevent illness?"

Then, in the early 1970s, my late father, Prof. Aaron Antonovsky – a medical sociologist and one of the founders of the Medical School at Ben-Gurion University of the Negev – was summarizing the results of a study on Israeli women’s adaptation to menopause. Among the participants were two groups of women born in Germany in the 1920s: one group had arrived before World War II in Israel (which was still under the British Mandate), and the second group immigrated after the State of Israel was established, having survived the horrors of Nazi concentration and extermination camps.

The study found, among other things, that life satisfaction and self-perceived health were significantly higher among the women who had arrived before the War compared to the Holocaust survivors who immigrated afterward. This finding was hardly surprising, not to say trivial. "Do we really need a scientific study for this?" my father wondered. It seemed obvious that women who had gone through such a horrific experience would experience physical, mental, and social difficulties later in life.

And then, suddenly, a realization struck him: he wasn't focusing on the right thing at all. "Idiot!" he said to himself. "The important thing isn't the expected difference between these groups of women, but rather the fact that even among the Holocaust survivors, about 30% reported high life satisfaction: ‘We have a family, we have work, we go out, we feel fine physically and mentally; it’s not that there aren't memories or occasional dreams, but overall, life is really okay.’"

Prof. Antonovsky realized that the important question – the mystery – was not why most Holocaust survivors experience difficulties decades after the War, but rather: How is it that a substantial portion of them are satisfied with their lives and managed to overcome the many challenges they had faced during and following the World War?

For the first time, as a sociologist researching health and as the person responsible for admitting generations of candidates to medical school, he asked a question that had never been systematically investigated in Western medicine: What is the origin of health? What were the resources that enabled these women to cope with life's challenges? What strengthened their physical and mental well-being?

Western medicine, focused on illness, has a common term: "Pathogenesis," which literally means "the origin of disease." This could be a virus, an injury, a tumor, or any other source of illness. But for the question "What is the origin of health?", there was no term in the medical world. To fill this void, Prof. Antonovsky coined the term "Salutogenesis": Salus in Latin means "health," and Genesis means "origin" or "creation."

The salutogenic question, then, is: "What helps people move toward health?" on an ease/dis-ease continuum. Unlike the pathogenic medical model, which is dichotomous (you are either diagnosed with a disease, or you are not), according to the salutogenic model, each of us, at any given moment, is located somewhere on a continuum between total illness and total health.

What is the Answer to the Salutogenic Question?

In the model published in his 1987 book, Unraveling the Mystery of Health, Prof. Antonovsky proposed the answer: The Sense of Coherence (henceforth SOC).

The sense of coherence is a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one's internal and external environments in the course of living are structured, predictable, and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement. (Antonovsky, 1987, p. 19)

Thus, the more a person understands the challenges in their life and can anticipate them (the Comprehensibility component); the more a person perceives they have relevant resources to deal with these challenges (the Manageability component); and the more a person finds meaning and motivation to face these challenges (the Meaningfulness component), the greater the likelihood that the person will be able to cope successfully with life’s challenges.

Returning to the river metaphor: according to the salutogenic approach, we are all in the river all the time. Life is not perfect until someone falls into the river; rather, it is full of ongoing stressors – not only health-related ones. Who among us hasn't had to deal in the last month with an argument with a partner, a bank overdraft, car trouble, a sick child, being late for a meeting, or something bigger, like a national security threat, death of a loved one, a serious illness, or losing a job? Life is full of challenges, and according to the Salutogenic Model, the stronger the SOC, the more successfully we can face them (I ask not to confuse this with the concept of "resilience," which I explain separately elsewhere on this page).

As an internationally recognized expert in the field of salutogenesis, I can attest to thousands of studies conducted over the last few decades – from New Zealand to Finland, from Japan to Brazil, from Israel to South Africa. These studies have found that the SOC can predict:

1. "Positive" phenomena, for example: recovery ease and speed from heart attacks, self-efficacy, coping among parents of children with autism, academic success, and operational performance in the military (i.e., the stronger the SOC, the better the outcome).
2. "Negative" phenomena, for example: depression, suicidality, PTSD, cancer, heart disease, and occupational burnout. (i.e., a strong SOC acts as a protective factor against these outcomes).

Alongside research I conducted with the Israel Defense Forces, I was involved in developing training and interventions aimed at strengthening soldiers' SOC. My colleagues and I found, among other things, that the stronger a soldier's SOC, the fewer adjustment difficulties they experienced, the lower their chances of developing post-traumatic symptoms or suicidal thoughts, and the more successful they were in operational missions.

Burnout and the Modern Workplace

One topic receiving significant attention in recent years in this context is Occupational Burnout. Burnout is very common in organizations and is measurable. Employees often report: "I feel emotionally exhausted and have no energy to get up for work," or "I find myself treating clients as if they were objects," or "I have no sense of personal accomplishment."

Studies worldwide consistently indicate that employees’ SOC is strongly inversely related to burnout. Therefore, managers in organizations should be exposed to the Salutogenic Model and be given tools to strengthen their employees' SOC. This impacts not only Human Resources but also the organization's financial bottom line; after all, an employee who thrives is an employee who delivers.

The SOC is measured using a questionnaire developed by Prof. Antonovsky, which (as of the end of 2025) has been translated into close to 70 languages and used in more than 50 countries. While the original questionnaire measures the individual's SOC, versions today are adapted for groups (families, communities, work teams, military units) and even nations. A special version was developed for children.

Recent findings and theoretical developments in health, education, work, architecture, and more can be found in the comprehensive Handbook of Salutogenesis (2nd edition, 2022). Current research addresses questions such as: How does SOC develop? How stable is it throughout life? Can it be strong in one area of life but weak in another? What is the nature of the relationships between the three components of SOC? Information regarding the latest developments, as well as news on webinars, blogs, and conferences organized by the Society for Theory and Research on Salutogenesis can be found on the STARS website.

Conclusion

The two models I mentioned – the pathogenic and the salutogenic – can and should coexist; they are not two sides of the same coin. Without the questions of the pathogenic model, we would not have discovered cures for serious diseases, invented imaging technologies, or developed innovative treatments.

But when you think about your own life, do not focus only on the difficulties, what causes them, and what their consequences might be. Also reflect on ways to reduce uncertainty regarding life's inevitable challenges, so they become more comprehensible to you (the "What?" question); remember the coping resources you have, such as friends, family, finances, or physical fitness (the "How?" question); and emphasize for yourself the meaning found in action and in facing these challenges (the "Why?" question).

In other words, ask yourself the salutogenic question: How can I swim upstream – and even enjoy it?