Traditionally, the medical field has been heavily focused on pathogenesis, which studies the origin and development of diseases. Derived from Greek, "pathogenesis" means "the origin of sickness." The approach emphasizes identifying and treating illnesses to alleviate symptoms and restore health by combating the underlying causes of not feeling well. We work by identifying the pathogens and designing cures for these pathogens.

Pathogenesis has driven advancements in life sciences and pharmaceuticals for centuries, leading to impressive discoveries, solutions, and achievements. Each decade, we witness groundbreaking innovations that were once only imagined. For instance, COVID-19 vaccines were developed in under a year, a process that previously took four to ten years.

While this approach has led to many medical breakthroughs and saved countless lives, it is not without its limitations.

Salutogenesis, on the other hand, is a relatively newer concept that shifts the focus from being ill to being healthy. This term is also Greek and means the “creation of health” or, more poetically, “the origin of healthy.” Coined by medical sociologist Aaron Antonovsky out of Yale University back in the 1970s, salutogenesis examines the factors that promote health and well-being, emphasizing the importance of understanding and cultivating resilience in individuals and communities.

... we are coming to understand health not as the absence of disease, but rather as the process by which individuals maintain their sense of coherence and the ability to function in the face of change

Aaron Antonovsky, PhD, GBU (1979)

The approach seeks to identify the resources and strategies that enable people to maintain and improve their health, also, when not yet ill. We see the focus has shifted from seeking medical advice during sickness to also seek advice in time of health. This difference is succinct. Treatment extends beyond addressing pathogenic illnesses; it is treating the potential in health and targets, therein, the quality of life and health span.

We can never fully cure cancer, we know, but we can create a future where it never develops

Dr. James Peyer (paraphrased/a talk at the Tech BBQ Copenhagen conference 2023)

We see this perspective translating into the market forces and the movement of capital in and around Silicon Valley. The health space here includes a much broader spectrum of services than the classical perspective on life science typically covers. In the wake of the pandemic, the fastest-growing commercial marketplace category in Silicon Valley isn't pharma as one might guess, nor is it pets, games, or even food. As we see in the figure below, it's health, wellness, and mental health. Nearly 200% higher than the runner-up. This is significant, not only as a general cursor for an episodic trend in the health space; it underscores a foundational change in the market that increasingly incorporates the salutogenesis point of view.

Besides untapped business opportunities and an eagerness to invest and explore within the Silicon Valley ecosystem, there are several more applicable perspectives behind the growing interest in and adoption of the salutogenesis approach:

1. Research: Cutting-edge research in medicine is beginning to target the mechanistic drivers of aging more and more; first as treatments and then as preventive medicines. Examples of a good mix of salutogenesis and pathogenesis approaches are within the area of longevity, such as the fields of rapamycin, maintaining telomeres, reprogramming of cell age, senolytics manipulation, the science of geroprotectors, hormonal manipulation, AMPK activators, and more - all aiming at biological optimization and resilience.
2. Holistic Health: Salutogenesis encourages a more comprehensive view of health, encompassing not just the absence of disease but also the overall well-being of individuals. This holistic perspective acknowledges the importance of mental, emotional, and social factors in maintaining good overall health, leading to more integrated and effective healthcare strategies.
3. Preventative Care: By focusing on factors that promote health, salutogenesis supports the development of preventative measures to help individuals and communities avoid or mitigate the impact of diseases. A more encompassing approach can reduce healthcare costs, improve quality of life, and better the business of the payors.
4. Patient Empowerment: Salutogenesis emphasizes the role of individual agency in maintaining health and well-being. By identifying and leveraging personal and environmental resources, patients can take greater control of their health and make informed and proactive decisions about their care, and lifestyle.
5. Chronic Conditions: Managing chronic conditions, such as heart disease and diabetes, require ongoing medical care and lifestyle adjustments. Salutogenesis, with its focus on resilience and adaptability, is a complementary framework for addressing the full impact of such conditions.
6. Health Tech: Digital health technologies, such as wearable devices and telemedicine platforms, increasingly empower individuals to monitor and manage their health proactively. These advancements align with the salutogenesis framework, enabling people to leverage data and insights to make more informed and personal decisions, keeping pathogens at bay.
7. Health Equity: Salutogenesis recognizes the significance of social determinants of health, such as socioeconomic status, education, and access to healthcare resources. By addressing these factors, the approach can help reduce health disparities and promote health equity for all members of society.
8. Global Health Challenges: The ongoing challenges posed by global health threats, such as pandemics and climate change, demand a more proactive and adaptive approach to healthcare and quality of life.

This observable shift in the market, including an interplay with both pathogenesis and salutogenesis, signifies a substantial trend in our perception and approach to health and well-being. It underscores a balanced focus on health promotion, resilience, and adaptability, in tandem with curing deceases. And it should, as there is a dilemma, would we not.

Salutogenesis is not merely a discussion of a better mouse trap for “improving quality of life and health span.” We have had that discussion forever and will continue to have it. No, this is a realization of an inherent issue that calls for fixing. The occurrence of non-communicable diseases (NCDs), such as diabetes, heart disease, and obesity, has escalated in recent decades. In Denmark alone, chronic illnesses have experienced a 60% surge in the past decade, and this trend shows no signs of stopping. The increase in NCDs persists even as we continue to achieve remarkable progress in combating pathogens more effectively than ever before. As pointed out in the beginning of this article by Dr. Vijay Pande, from a16z BioHealth; once cancer is cured something else is waiting to kill us. Even as monumental as curing all cancers won’t move the needle too much (by four years the data shows).

One might argue that this dilemma of pathogenesis arises from its effectiveness. Due to medical breakthroughs, enhanced sanitation, and widespread vaccination initiatives, the prevalence of many infectious diseases has significantly decreased. Child mortality rates have drastically declined, and life expectancy continues to rise. Nevertheless, the population remains a complex and ever-changing entity. Prolonging life brings about novel diseases and even unfamiliar challenges, suggesting that as the spectrum of illnesses shifts and transforms over time, so too must our approach to healthcare.

The salutogenesis approach offers a solution to the pathogenesis dilemma by recognizing that the afflicted population (represented by the red area in Figure 3) is sustained by the healthy population (represented by the blue area). Keeping efforts on the red, will not change this relationship. To truly reduce the red area, the blue area must also be vigorously addressed.

A more comprehensive and proactive approach to healthcare and being healthy will lead to improved outcomes for individuals and communities alike. It further ignites cross-industry thinking innovations, combining markets and solutions that used to work independently of each other, thus bringing a sum that is greater than its parts.

As we continue to confront emerging global health challenges, with increasing innovation and creative ideas from cross-collaborations between the US and Denmark and Danish startups, the salutogenesis framework can serve as a valuable foundation for developing lasting solutions and promoting more equitable, sustainable, and resilient healthcare systems.

The future does not favor one approach over the other but is sure to be a hybrid combining strengths from both - this is the trend we see in Silicon Valley. The quality of life and health span are best served not from one over the other but from both these perspectives.