Salutogenesis: Real Healthcare Reform

By William Appelgate, PhD, CPC
Founder and President Clinical Health Coach ®
October 2017

“The body is a temple, that’s what we’re taught. I’ve treated this one like an old honky-tonk. Greasy
cheeseburgers and cheap cigarettes, one day they will get me if they ain’t got me yet.”

Kenny Chesney song lyrics from Living in Fast Forward

National healthcare expenditures in the U.S. will likely exceed $3.0T in the current year. This means
that we will spend an average of more than $9,000 per individual in just one year! For adults with
chronic conditions, we will spend nearly $30,000 for each with heart failure, $23,000 for each with
COPD, and $17,000 for each with diabetes. Sadly, 80% of these national healthcare expenditures come
from individuals with these and other chronic conditions. Even more disheartening, 80% of those costs
are derived from hospitalizations and ED visits.

The reality—training, reimbursement and focus of healthcare professionals has been predominately
based on pathogenesis, or the origin and treatment of disease. We train these individuals to treat the
ill, minister to the sick and fix the broken. Then we take it a step further and pay those professionals
almost exclusively for services, interventions, treatments and medications built for the ill and those with
disease. Seldom do we reward healthcare professionals substantively for actually building health. The
result is a seriously unbalanced system.

Looking again at national healthcare expenditures of $3.0T, it is significant to note that we spend 94% of
that total on fixing what is broken, addressing symptoms, and treating chronic disease.

In contrast, we spend only 6% of that total on prevention, wellness, and screenings. U.S. medical care
and sick care may be top drawer yet our health status has been declining and health risks increasing.

The truth—a transformational shift from fixing what is broken to building and maintaining health is
long overdue.
The World Health Organization (WHO) stated in 1946 that “health is a state of complete
physical, mental and social well-being and not merely the absence of disease or infirmity.” This was an
early planted seed of a profound idea. To truly play forward this powerful idea we need a wellcare
system—an entirely new strategy, a new path, built around a new concept. It is a health system
designed to build, support, foster, create and maintain health.

In the 1970’s, a physician named Aaron Antonovsky, developed a concept with a vital new view of
health. The term for this concept was salutogenesis. Quite the flip side of pathogenesis, it is the origin
and maintenance of health, where individuals are considered more or less healthy, while being more or
less ill. Rather than a dichotomy separating health and illness, Antonovsky described a continuum
with health-ease at one end and dis-ease at the other. This is a logical, yet profound shift in the culture
of health, and healthcare as we know it.

Salutogenesis is derived from the Latin “salus” meaning health, well-being, and happiness and the
Greek “genese” meaning origin. It is an assets approach to health which focuses upon promoting,
educating, preventing, protecting and curing—always with health as the true end game.

By placing the emphasis upon health as the defined intention, we contribute to the stabilization or
improvement in our health status concomitant with reduction in health risk regardless of age, or present
condition. This concept takes a bold step beyond simple prevention. By reclaiming focus upon health,
we are more likely to improve our health, reduce our utilization of heath care, and reduce health care’s
cost to society, all at once. What a wonderful world that would be!