Salutogenic approach is based in promoting sense of coherence by making the person i) comprehend the situation or the challenge ii) find ways to manage it, using general and specific resistance resources and iii) find it meaningful to cope with the challenge and accept the outcome. Using real-life case narratives, this slide set explains how to practice salutogenic approach in patients with diabetes and its complications.

1. Salutogenic approach in cases of
diabetic foot infections:
a Clinician’s Perspective
Senior Prof K.R. Sethuraman. MD,PGDHE,
Currently Dean, Faculty of Medicine.
AIMST University, Malaysia
Ex Vice-Chancellor, SBV (Deemed Varsity),
Puducherry, India. (2013-’18)
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2. And Not merely the absence
of disease
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3. Salutogenesis, the source of
Wellbeing
• Derived from Greek & Latin
Latin: salus = health
Greek: genesis = source of
Salus, the
Roman goddess
of well-being &
safety
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4. PATHOGENESIS <---> SALUTOGENESIS
Pathogenesis
• What causes diseases?
• About Avoiding Problems
• Disease/Illness an anomaly
• Reactive - Absence Disease
• Against pain or Loss
• Prepares one to live
Salutogenesis
• What causes Health?
• About reaching Potential
• Inherently flawed,
• Proactive - Presence Health
• For Gain or Growth
• Discover how to live fully
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5. Originator: Salutogenesis concept
• Aaron Antonovsky
• (1923 – 1994)
• Medical Sociologist
• Coined term in 1968 to
capture an emerging
concept
• Why did some manage
to avoid illness and do
well even under
extreme stress?
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6. Salutogenesis
• Aaron Antonovsky opined thus:
• LESS stressed people had much more
resistance to illness than those who were
MORE stressed.
• Well-being is based on Sense of Coherence,
which is the heart of Salutogenesis
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7. Sense of
Sense of Coherence: 3 components
“My world is
understandable”
“My world is
manageable”
“My world has
meaning”
Coping
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8. Manage with Resistance Resources:
General (GRR) and Specific (SRR)
• GRR is a general resource that helps in managing
the stressor
• eg., funds, care-giver support, health literacy, mentor etc
• SRR is a specific resource to cope with the stressor:
• ‘Off-loading footwear’ to help in the healing of diabetic
foot ulcer is a good example
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9. Vulnerability vs Resistance to Stress
GRR & SRR
Lack of SOC/GRR/SRR
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10. Some Clinical Scenarios of
Diabetic Foot Infections
(1981 – 2006)
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11. Understanding and Meaningfulness often
go together
I have counseled hundreds of cases of mild to moderate
diabetes, who find taking medicines life-long to be
‘meaningless’ and drop-out .
My advice to them has been simple:
• “Controlling the sugar level is like ‘old age insurance’; if
you maintain near-normal level, then you have better
odds of being healthy in old age.”
• “So, if you wish to reduce the risk of problems in your
old age, you should accept control of diabetes, because
once the target organ damage occurs, it can not be
reversed.”
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12. To those who Believe that Modern Medicine is
Harmful and to be avoided…
• My advice to patients with diabetes:
“You can choose to consume 250 grams of
bitter veggies 3 times every day or a tiny
tab for sugar control; please consider the
cost and convenience.
The choice is yours.”
• Most chose the comfort and convenience of
the modern medicine, within the next
month or two.
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13. Manageability: availability of resources to meet
the demands posed by the disease
• A 45 year old roadside-seller, who had Type-2 diabetes
and neuropathy had difficulty in travelling to the
public hospital for treatment.
• Once she had a near-fatal episode, when she was
advised to shift her dwelling to be close to the
hospital.
• She then changed to selling empty bottles for
medicines in front of the hospital.
• She could then attend the hospital at any time of the
day for routine and emergency care. She lived for a
further 15 years with adequate and timely care.
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14. Meaningfulness may Succeed and is far
better than Scaring the Patient!
Have you had a blood test lately to detect Diabetes?
Do you know Diabetics have a high risk of Heart
attack, Blindness, Kidney failure, Stroke (paralytic
attack) and or Amputation ?
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15. Reversing “Psychogenic Insulin
Resistance” (scene a – 1990)
I do not want daily shots
Doc. As I have told you
for ages, I do not mind
dying earlier!
Your foot ulcer is due to
neuropathy, which heals
faster with Insulin.
Just try it until you can
walk well. Then we’ll see!
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16. (Scene B, in Jan-2000)
I have taken 2
insulin shots a
day for the last
10 years Doc!
Thank you for all
the guidance!
Ha ha! To think
that you fought
against daily
shot like it was
your enemy!
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17. Meaning is Based on –
• Life’s Purpose ( ikigai )
• Goals
• Future fulfillment
• Personal Values
• Justify course of action
• Moral decision making
• Self Efficacy
• You can make a
difference
• Self worth
• Skills
• Belonging to groups
you value
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18. SOC approach helps the ‘diseased’
to accept ‘be well’
• Comprehension, Meaningfulness & Manageability
(SOC approach) in chronic diseases keeps the
patients ‘well’ despite the limitations
• Similar to ‘physically disabled’ becoming ‘differently
abled’
• Live one’s life fully with What one has (the assets)
than lament over what one does not have…
• Present focus: “assets based approach to wellness”
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19. Summing up…
• Wellness is NOT merely the absence of pathology
• Wellness is promoted by sense coherence (SoC)
• SoC = Understanding + Manageability + Meaningfulness
• Communicate effectively to mutually understand the often
complex issues involved
• Provide/suggest GRR and SRR to manage the challenges
• Counsel/mentor the patients to make them find meaning in
following the management options
• If these 3 are concordant, then wellness will prevail
despite life’s difficulties and challenges
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20. Did I use Salutogenesis to
promote health & wellness?
Thank You !
From today, Let
us also Wonder…
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