SALUTO-WHAT?
There is a concept in medicine called pathogenesis.
path·o·gen·e·sis | \ ˌpa-thə-ˈje-nə-səs \
: the origination and development of a disease
I often remember the term simply by the first part of the word, path. When you study pathogenesis, you are studying the path of a disease: where it starts, and how it eventually makes a patient sick. A thorough understanding of pathogenesis has led to remarkable feats of medicine and technology.
For example, by recognizing the abnormal functions of a specific surface protein, researchers can develop a specific drug to block the receptor. The HER2 receptor is over-expressed in approximately 20-30% of breast cancers, and a drug called Trastuzumab has been shown to interfere with the receptor in a cancer therapy regimen.
When arteries become clogged with cholesterol and fatty substances, this build up can form what is known as a plaque. Plaque can occlude the artery, and limit oxygen-rich blood flow from reaching areas where oxygen is needed. This process is called atherosclerosis. Worse yet, if a piece of the plaque breaks off it can form a clot, which can then cause a heart attack or stroke. Understanding the process of atherosclerosis led researchers to develop statins, a powerful and life saving drug that reduces cholesterol levels, and thus the risk of heart attack or stroke.
To understand pathogenesis is to understand disease.
Treating diseases is one side of a coin. The other side is preventing disease.
How do you prevent pathogenesis from occurring in the first place?
According to the late Aaron Antonovsky, America-Israeli medical sociologist, we must seek to understand salutogenesis.
sa·lut·o·gen·e·sis | \ sə-ˌlü-tō-ˈje-nə-səs \
: an approach to human health that examines the factors contributing to the promotion and maintenance of physical and mental well-being rather than disease with particular emphasis on the coping mechanisms of individuals which help preserve health despite stressful conditions
Antonovsky viewed health as a continuum; one side is total ill health (dis-ease) and the other side is total health (ease). Not only did he view health as a continuum, but health was also an interplay between people, society and resources.
Key questions posed by Antonovsky: what resources do people have, and how do people use their resources to maintain and improve their movement towards health? His questions led him to an idea called sense of coherence. An individual’s sense of coherence allowed them to comprehend their situation in life, find meaning in it, and manage it in a way that moved them towards health.
These concepts are the core of preventative and public health efforts. In other words, is it possible to reduce someone’s risk of breast cancer and risk of atherosclerosis by focusing and improving their baseline physical and mental well-being?
years of mounting evidence says yes.
However, promoting salutogenesis is difficult. When you consider all the factors in one’s life—familial, communal, social, political, and economic to name a few— you realize that health can be affected by all of them. In the United States specifically, we are facing a health care crisis, where expenses have exploded but successful outcomes have not.
By incentivizing healthy choices within each factor of life, people have an easier time moving toward the total health side of the spectrum.
Figuring out how to make healthy choices the default is a key challenge that all health care stakeholders should pursue.