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

GENERALISEDRESISTANCERESOURCES

‘GRR’

SPECIFICRESISTANCERESOURCES

‘SRR’

•“

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.

Antonovsky’s ideas about resources…

An unsatisfactory state of affairs…

•E

mphasis on GRR shadows importance of SRR

•H

ealth promotion has a major role in strengthening GRR and SRR

•G

RR & SRR have different sources & are strengthened differently

•S

alutogenesis 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)

Social network embeddedness

Religious belief and ritualGRR

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).

GRR

SUCCESSFULCOPING

HEALTH

GRR SOC

SUCCESSFULCOPING

HEALTH

GRR SOC

SUCCESSFULCOPING

HEALTH

PSYCHOSOCIAL

GRR SRRSOC

SUCCESSFULCOPING

HEALTH

PSYCHOSOCIAL

INSTITUTIONAL

A SSR is anewly

engaged

1. material asset

2. skill

3. talent

4. ability

5. strength

6. expertise

7. proficiency

8. adeptness

of an

1. individual

2. group

3. community

4. setting

that isactivated

specifically to

1. impart control over

2. avoid

3. reinterpret

4. adapt to

a specificstressor

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

GRR SRRSOC

SUCCESSFULCOPING

HEALTH

PSYCHOSOCIAL

INSTITUTIONAL

HEALTH PROMOTION AND HEALTH EDUCATION

Well-being indicator Predictors R Square

Resilience GDP (PPP USD) & Unemployment rate .50Welfare expenditure .67

Satisfying life GDP (PPP USD) & Unemployment rate .57Welfare expenditure .70

Absence of negative feeling GDP (PPP USD) & Unemployment rate .63Welfare expenditure .77

Overall personal well-being GDP (PPP USD) & Unemployment rate .68Welfare expenditure .78

GENERALISEDRESISTANCERESOURCES

SPECIFICRESISTANCERESOURCES

Life experiences

•degrees ofconsistency

•underload-overload •participation

•autonomy

Life Situation

•culture•social forces•social position•gender•ethnicity•age•orientations•predispositions•genetics

•luck

•choices -work/play -association -risk taking -etc.

PublicInstitutions

Shocks

Ubiquitouslife course

stress exposures

(chronic)

Generalisedresistanceresources•support

•skills•hardiness

etc.Well-being

Sense of coherencewish to cope – meaningfulness

challenge understood - comprehensibility

resources to cope - manageability

Specificresistanceresources

•newly engaged

•specifically activated

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.

A Salutogenic Model of Well-being with SRR

Acute stressors