The Heritage of the Ottawa Charter in the context of Mental Health

The Heritage of the Ottawa Charter in the context of Mental Health

CHRONOLOGY

1939-1945 World War II, The Holocaust 1948 UN Declaration of Human Rights

1948 WHO Protection of HRs from a Health Perspectiv The Birth of the Modern Public Health

1948 WHO Definition of Health

Absolute Health with 3 Dimensions: Physical, Social and Mental Wellbeing

Social Science

1950 – 1970ies The Welfare Society, Standard of Living, Welfare; Quality of Life

1973 E. Allard, Having, Loving, Being= QoL objective and subjective measures

happiness and wellbeing

On the Health Side

!960 – 1970´s Prevention, Risk - Behaviour Approach Towards Health Promotion:

1974 Lalonde Report Canada Beyond Lifestyle 1978 WHO/UNICEF Alma Ata Conference PH 1984 WHO Health For All Strategy Global Strategies 1986 WHO Ottawa Charter and Health Promotion “HPITPWEPTGCOTHDTITHABELAAAPL”

1986 – 2009 Seven WHO Health Promotion Conferences (Nairobi Oct 2009 on Primary Health)

Social Psychology Mental Health – Quality of Life

1958 Maria Jahoda The Joint commission on Mental Illness and Health, USA Criteria for good Mental Health

Positive self conception Being an integrated person

Active and able to develop ones capabilities Able to make independent decisions

Perform actions without isolation from others Having a good sense of reality and empathic skills

Being able to create deep and lasting relationships at least one to the opposite sex

1974, Siri Naess, Norway

Mental Health – Inner Quality of Life Criteria:

Being Active

Having Good Inter-Personal Relationships A Good Self Esteem and Perception A Basic Mood of Joy

Contextual Models

The Welfare Society Allardt, Swedner Bronfenbrenner´s Ecological Model Bordieu Habitus

Hancock HP Settings for Health

Being Belonging Becoming Canadian HP QoL The Essence of Existence Lindström QoL

Positive Psychology Flourishing, Keyes C

Signs of Mental Health

(Keyes, 1998, 2002 2005)

Hedonic Well-Being

1. Happy with life 2. Interest in life

3. Satisfaction with life

Eudaimonic Well-Being

4. Contribution to society 5. Social integration

6. Social growth and potential 7. Acceptance of others

8. Social interest and coherence 9. Self acceptance

10. Environmental mastery 11. Positive relations with others 12. Personal growth

13. Autonomy 14. Purpose in life

HEALTH PROMOTION, MENTAL HEALTH,

SALUTOGENESIS

Only risk approach-health behaviour Only measure SOC

MISCONCEPTION

Facilitator enable people Serve as a GRR

PROFESSIONAL ROLE

A better health, active productive life Mental health, Quality of Life, Perceived health

OUTCOME Settings Contextual system APPROACH Comprehensibility, Manageability, Meaningfulness ELEMENTS

Enable control over health determinants (Empowerment) Ability to use GRRs to develop a SOC

KEY MECHANISMS

Health determinants Generalized Resistance Resources

RESOURCES

No? Health promotion? SOC, GRR

KEY CONCEPTS

A Process As a life long learning process

HEALTH

Health Promotion

Life Orientation FOCUS

Human Rights, i.e. active participating subjects

Human Rights, i.e. active participating subjects FUNDAMENT

Principles, Policy, ideology Theory, evidence

STATUS

1986 Antonovsky 1978, 1987

TIME REFERENCE

UN Declaration of Human Rights WHO Definition of Health The Holocaust and its Survivors

PROLOGUE

THE OTTAWA CHARTER THE SALUTOGENESIS

© Bengt Lindström, Monica Eriksson 2008

Healthy learning: Salutogenesis as a learning process in the context of health promotion.

WHO

SOC

IAL DETERMINANTS

GWG-SAL SOC-DETERMINANTS

ABILITY TO SEE THE INSIDE NOT ONLY THE CLASSIC

PROFESSIONAL OUTSIDE PERSPECTIVE

FROM OUTCOME TO THE LIFE PROCESS

Eriksson M, Lindström B. A Salutogenic Interpretation of the Ottawa Charter. Health Promotion International 2008;doi: 10.1093/heapro/dan014

SELF TUNING - REFLECTION

Vinje, H. F. & Mittelmark, M.B (2006). Deflecting the path to burnout among

community health nurses: How the effective practice of self-care renews job engagement

LEARNING MODEL REFLECTION

Minimalism in Learning Theory, Learning and Teaching

Life experiences •degrees of consistency •underload-overload balance •participation Life situation •culture •social forces •social position •gender •ethnicity •age •orientations •predispositions •genetics •luck •choices -work/play -association -risk taking -etc

The Salutogenic Model, revised

Life course stress exposures •Acute •chronic Generalised resistance resources •support •skills •hardiness etc •Well-being •Health (dis-ease/ease) •Functioning Sense of coherence Motivational component (wish to cope - meaningfulness)

Cognitive component

(belief challenge understood - comprehensibility) Behavioural component

(belief resources to cope available - manageability)

Based on: Antonovsky A (1996) The salutogenic model as a theory to guide health promotion. Health Promo Intl. 11(1), 11-18

A critique

The whole model deserves attention

Mittelmark MB. Building healthy public policy the salutogenic way. The International Seminar on Salutogenesis Resources of Health and Quality of Life: Research, Policy and Practice and The 1st Meeting of the IUHPE Thematic Working Group on Salutogenesis, Helsinki Finland, May 12-13, 2008.

Salutogenesis is more than measuring Sense of Coherence

The salutogenic umbrella – some convergent concepts and theories contributing to the explanation of health and quality of life. Submitted 2008.

© Monica Eriksson 2009

Salutogenesis

An assets approach

Individual/Group/Society

(Bourdieu) Social capital (Putnam) Coping (Lazarus) Empowerment (Freire) Resilience (Werner) Will to meaning (Frankl) Locus of control (Rotter) Wellbeing (Becker) Quality of Life (Lindström) Learned optimism (Seligman) Self-efficacy (Bandura) Connectedness (Blum) Ecological system theory (Bronfenbrenner) Flourishing (Keyes) Interdiciplinarity (Klein) Learned hopefulness (Zimmerman) Action competence (Bruun Jensen)

Conceptually, salutogenesis is defined as the process

of movement toward the health end of a health

ease/dis-ease continuum.

Aaron Antonovsky

…..

It is on the leading edge of a class of academic movements

that wish to emphasize human strengths and not just

weaknesses, human capacities and not just limits,

well-being and not just illness

Eriksson M, Lindström B. A salutogenic interpretation of the Ottawa Charter. Health Promotion International 2008;23(2):190-199.

Salutogenesis …

… is the processes enabling people to live the life

they want to live.

Lindström B, Eriksson M. The salutogenic approach to the mking of

HiAP/Healthy Public Policy: illustriated by a case study. Global Health

Promotion 2009;16(1):17-28.

References:

The UN Declaration on Human Rights UN, New York 1948 WHO Constitution, WHO, Geneva 1948

Mahler H On the Role of Schools of Public Health, NHV Report 1987 Allardt E Att Ha, att Älska att Vara, Lund, Aldus 1975

Bronfenbrenner U The Ecology of Human Development, Cambridge, Massaschusets Harvard University Press, 1979

Jahoda M Current Concepts of Positive Mental Health New York Basic Books 1958 Naess S Quality of Life Research, concepts, methods and applications Oslo, Institute of Applied Research, 1987

Lindström B,The Essence of Existence, On the Quality of Life of Childern, Dissertation, NHV Report 1994:3, Göteborg

Keyes K Flourishing American Psychological Association, Washington DC, 2003 Swedner H Socialt Arbete, en tankeram Stockholm, Liber, 1983

UN Convention on the Rights of the Child, 1989 WHO Alma Ata Conference, WHO, Geneva,1978

Forbech Vinje H. ,Thriving despite adversity:Job engagement and self-care among community nurses Academic Dissertation, Bergen University 2007

Mittelmark M Personal Communication, First Research Seminar on Salutogenesis, Helsinki 2008

Hermansen M Minimalism in Learning Theory, Learning and TeachingRelearning,

Århus 2005

Antonovsky A Health Stress and Coping Jossey Bass, San Francisco, 1978

Eriksson M Unravelling the mystery of salutogenesis, Dissertation, Folkhälsan Report 2007