chapter  7
1 Pages


This book is about the way we think about health and the way we organize health services. It suggests that we really have no excuse for not rethinking health in ways that correspond better to what we are learning about some of health’s complexities and the importance of context. Specifically, I suggest that present dominant ways of thinking and doing do not sufficiently respect, in general, the agency of the person and their interaction with their environment. The book presents the idea – not new to many cultures and even to parts of the globalized western culture – that health is the dynamic interaction between the life force of the person (and by extrapolation, the community) and the environment, this understood as the total biological, social, economic and political context in which people live out their lives. The global popular and professional ‘health’ culture is often focused on the pathological and pathogenic. In this book the notion of salutogenic is borrowed from Antonovsky as a way of moving towards thinking and doing health rather than focusing narrowly on disease and the pathological. I expand the notion of ‘salutogenic’ to include those parts of the environment which, when encountered by our life force, can nourish it and our responsibility to make our social, cultural, economic and political environments as health-enhancing as possible: that is what I mean by salutogenic environments. Although I never met Antonovsky, an Israeli scholar, my Palestinian colleague, Professor Rita Giacaman, introduced me to his widow in Jerusalem in the early 1990s. Mrs Antonovsky assured me that my expanded use of the expression was consistent with his thoughts.