Salutogenic Theory Research Articles

Living on the margin: a salutogenic model for socio-economic differentials in health

Research into health inequalities shows that socio-economic position (SEP) is strongly associated with differentials in health. Yet at present there is no adequate model to explain the causal link between the social and the biological variables: in particular why the association between SEP and health is found in all societies; and why inequalities are not simply a reflection of poverty causing sickness, but are also seen among the wealthiest classes in the wealthiest societies. In this paper we propose a model which brings together many diverse strands of research, and helps to explain how stratification by socio-economic position may be seen in terms of differentials in the margin of resources. Resource differentials lead to stratified health outcomes owing to the differential capacity of individuals and groups to realise 'universal' psychological aspirations of a broadly 'health promoting' nature. The margin model builds upon a previously described salutogenic theory of health. On average, the relative size of the margin will predict differential health outcome. This prediction is empirically testable and opens up a new agenda for research on health differentials; it also provides a framework for understanding, planning and evaluating health promotion.

Sense of coherence and sociology of emotions

The aim of this study was to investigate the relationship of hostility and anger expression to sense of coherence (SOC) and their role as predictors of health-related quality of life (HQL). It was hypothesised that SOC would mediate the impact of hostility and anger on HQL.This is a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial, which evaluates different treatment strategies to prevent cardiovascular disease in hypertensive patients. At baseline, SOC was assessed with a short form measure, and hostility–anger with the Cynical Distrust scale and with the Anger Expression scales. HQL was assessed at 6 months with the RAND-36. The sample comprised of 774 subjects (77.5% men).Results showed that strong SOC associates with ability to control expression of anger and with low levels of suppressed or openly expressed anger. Anger control and SOC were related to good HQL; cynicism, anger-out, and anger-in correlated negatively with HQL. Path models revealed that SOC was the strongest predictor of HQL while hostility and anger lost their direct impact on HQL.Given the significant associations of hostility and anger with SOC, it is concluded that the salutogenic theory of Antonovsky (A. Antonovsky, Health, Stress, and Coping: New Perspectives on Mental Health and Physical Well-Being, Jossey-Bass Inc, San Francisco, 1979) should be extended to include hostility-related constructs. The impact of hostility and anger on HQL is, to a great extent, mediated through SOC, which implies that in future studies, the role of hostility as a risk factor of ill health should be reconsidered from the SOC theory perspective.