Pathogenesis or Salutogenesis?

Health is beyond the absence of disease or infirmity. Health is a state of complete physical, mental and social wellbeing. It’s a basic human right, essential for a long and happy life, and something we should all strive for.

Traditionally in medicine and health studies, pathogenesis works retrospectively from disease to determine how individuals can avoid, manage, and/or eliminate that disease to create health. While salutogenesis works prospectively by considering how to create, enhance, and improve physical, mental, and social well-being. By understanding these two concepts and the role they play can we work towards improving the health of individuals and societies across the world.

Leave your drugs in the chemist’s pot if you can heal the patient with food.


The words of Hippocrates illustrates that dietary guidance has been a part of human society throughout history. Throughout the ages, healers have provided advice on eating, food choices, and food preparation has been incorporated into both philosophy and religion in many ethnicities across the world. As we look back into history, the germ theory of disease in the late 1800s, science, associated with medicine and public health became the basis of current recommendations.

By the early 1900s, Casimire Funk proposed the vitamin theory of disease. Whereas the germ theory of Pasteur focused on diseases in which contaminants of food and water could serve as vectors, the vitamin theory proposed that the absence of specific factors from food could also be the basis of disease. In the late 1940s, both the Twin Cities Study and the Framingham Study began examining the association between dietary factors and risk for cardiovascular disease.

The results from these trials in conjunction with the 7 Countries Study began a new era of focus on dietary excesses that increase risk for chronic degenerative diseases. Increasingly we recognize that health is more than the absence of disease and is associated with well-being and overall quality of life. As our understanding of the role of food and nutrition has evolved, so has the nature of our dietary guidelines. Diet, nutrition and lifestyle choices are factors in promotion of health and achieveing optimum health.

A Comparison

Pathogenesis assumptionsSalutogenesis assumptions
Start point = disease / problem; the ideas move back from the disease and problem to figure out the cause of the problem and eliminate the causes to create healthStart point = health / potential; must start with a new reality, something we want to create, then we think how do we achieve the reality. You must started with an idealized outcome. What do you want to create and what do we need to do to achieve that idealized outcome?
About avoiding problemsAbout approaching potential
Reactive – treat disease
Proactive / generate better health or new outcome that does not exist
Humans inherently healthyHumans inherently flawed; somewhat susceptible to problems and we must cause ourselves to be healthy
Idealistic – naturally healthyRealistic – go get health; instead of waiting to get sick, do something now and create that health and be as healthy as you can be. Then when something does happen, which in likelihood, it will, then we can recover much faster or not even have a problem associated to it because we have such good health.  
2nd law of thermodynamics – a system left to itself moves toward chaos – and so we must cause good things to happen and do what we need to do in order to turn something into what we want. If you do nothing, then nothing will happen.
In Happier by Tal Ben-Shahar – it is found that happiness takes work and we have to do something to create happiness. IF you want happiness then just do nothing, it’s almost assured to happen then.
Against pain or lossCreating a gain or growth
Prepares one to liveDiscover how to live fully
About not falling back or having a problemHow we can move forward to become and be who we want to be
Avoid getting worseContinuous improvement – how do we keep moving forward
End point = measure neutral or minimized problemsProgress point = measure gain and optimized potential


Becker, CM, Glascoff, MA & Felts, WM 2010, ‘Salutogenesis 30 years later: where do we go from here?’, International Electronic Journal of Health Education, vol. 13, pp. 1–8.

Ericksson, M & Lindstrom, B 2008, ‘A salutogenic interpretation of the Ottawa Charter’, Health Promotion International, vol. 23, no. 2, pp. 190–199. 

Schneeman, BO 2003, ‘Evolution of dietary guidelines’, Journal of the American Dietetic Association, vol. 103, no. 12, pp. 5–9.ISSN: 1878-3570