RESISTANCE RESOURCES IN THE CONTEXT OF HEALTH PROMOTION PRACTICE AND RESEARCH Maurice B. Mittelmark...
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Transcript of RESISTANCE RESOURCES IN THE CONTEXT OF HEALTH PROMOTION PRACTICE AND RESEARCH Maurice B. Mittelmark...
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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
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Investing in Communties: Principle, Panacea or Placebo?
The Wilhelmina Rouwenhorstlezing Lecture
2nd National Netherlands Conference on Health Promotion and Education
Arnhem, 11 January, 2001
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Resistance resources are
“the most exciting things to be studied”
Antonovsky A (1973) Address to Stressful Life Events Conference
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GENERALISEDRESISTANCERESOURCES
‘GRR’
SPECIFICRESISTANCERESOURCES
‘SRR’
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•“
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…
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“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…
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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
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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.
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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.
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Money
Knowledge, intelligence, ego identity
Coping strategy (rationality, flexibility, farsightedness)
Social network embeddedness
Religious belief and ritualGRR
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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).
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GRR
SUCCESSFULCOPING
HEALTH
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GRR SOC
SUCCESSFULCOPING
HEALTH
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GRR SOC
SUCCESSFULCOPING
HEALTH
PSYCHOSOCIAL
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GRR SRRSOC
SUCCESSFULCOPING
HEALTH
PSYCHOSOCIAL
INSTITUTIONAL
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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.
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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
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GRR SRRSOC
SUCCESSFULCOPING
HEALTH
PSYCHOSOCIAL
INSTITUTIONAL
HEALTH PROMOTION AND HEALTH EDUCATION
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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
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GENERALISEDRESISTANCERESOURCES
SPECIFICRESISTANCERESOURCES
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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
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