Planetary Salutogenesis: Reimagining Health in the Age of the Anthropocene
What will it take to make us feel well again?
For centuries, Western medical practice has focused on what makes us sick. Yet as the Earth’s systems fray under the cumulative stress of industrial modernization, a more radical proposition is emerging: what if the key to health lies not merely in avoiding illness, but in understanding and supporting the conditions that make well-being possible in the first place?
Today I and five coauthors published a piece in Noema proposing just this. Introducing the concept of “planetary salutogenesis,” the essay builds on a sociological theory from the 1970s and extends it to the planetary scale. In the process, it calls for a dramatic revision in how humanity conceives of health — one commensurate to the geophysical drama of our time.
The foundational idea derives from the work of Aaron Antonovsky, an Israeli-American medical sociologist who, in the late 1960s, was studying Holocaust survivors to understand how extreme trauma manifested in later life. Many exhibited the many markers of mental and physical ill-health that one would expect from people who had undergone such a horrific experience. But strikingly, “a third of the survivors appeared no different at all, living as if they had undergone no agony all those years ago.” Antonovsky asked, “What was the miracle?” His answer became the theory of salutogenesis — literally, the “origins of health” — as opposed to pathogenesis, the origins of disease.
Antonovsky’s radical thesis was that health is not merely the absence of illness, nor something restored only through biomedical intervention. Rather, it is “the overall problem of active adaptation to an inevitably stressor-rich environment.” But if adaptation is the true measure of health, then the environmental context in which that adaptation occurs matters greatly.
Today, that environment is undergoing what geologists dryly refer to as a phase shift. The Anthropocene — our new epoch, in which humanity’s effects on the planet rivals planetary forces — is producing a polycrisis. “The cascading crises of the Anthropocene,” the we argue, “aren’t merely inconvenient background noise — they are becoming the foundational context that dictates the terms of human existence.” One major effect of the Anthropocene is a pandemic of ill-feeling.
Thus the case for a new conceptual frame: planetary salutogenesis.
This concept isn’t just a fusion of public health with environmentalism. We argue that instead it is best seen as “a radical revision of how we understand what constitutes collective human health.” The dominant medical model, we observe, still treats the environment as an external variable to be managed or mitigated. Planetary salutogenesis flips the script: the health of the planet is not an input — it is the substrate. Personal and public health, in our view, are emergent properties of planetary well-being.
To grasp the implications, we unpack Antonovsky’s core concept of a “sense of coherence” (SOC) — a kind of internal compass that allows individuals to navigate life’s challenges. SOC consists of three interrelated pillars:
Comprehensibility: The world is structured and predictable.
Manageability: One has the resources to cope.
Meaningfulness: Life feels worth engaging with.
In stable times, coherence is achievable. But in the Anthropocene, this coherence is unraveling. “How can the world feel comprehensible,” we ask, “when established climate patterns dissolve into unfathomable extremes… when ecological webs unravel with terrifying speed?” Climate chaos, zoonotic pandemics, microplastic pollution — these are not temporary deviations from a stable baseline, but the definition of a new planetary norm. The environment is no longer a stable backdrop; it has become a source of radical uncertainty.
Manageability, too, is evaporating. “What personal savings, community initiatives or even national resources feel adequate against the existential threat of runaway climate change?” The mismatch in scale between planetary crises and individual coping mechanisms breeds paralysis. Meaningfulness collapses under the weight of despair. “Too often the magnitude of the predicament induces anxiety, solastalgia, or a retreat into cynical denialism.”
The prognosis is grim. But our prescription is clear: reconceptualize health not as an individual pursuit, but as a collective capacity emergent from planetary balance.
Planetary salutogenesis rejects the methodological individualism of most modern medical care. Human beings, we insist (following Scott Gilbert), are not self-contained units but rather are holobionts, that is, “complex ecosystems” comprised of and dependent upon microbial, atmospheric, and ecological networks. Our internal terrain reflects the external one. Soil affects gut microbiota; biodiversity shapes immune systems; pollution permeates not only air and water, but wombs and brains.
In such a context, a health system focused solely on individual intervention is “like carefully tending a wilting flower while ignoring the poisoned soil, acid rain and encroaching desert around it.”
As so often on this substack, we return to the 1970s to rediscover paths proposed but not taken. In Medical Nemesis (1975), the radical priest Ivan Illich lambasted modern medicine’s tendency to create new forms of dependency and disease — iatrogenesis — even as it claimed to cure. “The medical establishment,” he warned, “has become a major threat to health.” He critiqued the illusion of health as a commodified product. True health, Illich argued, lay in the capacity to live meaningfully amid frailty and limitation.
Planetary salutogenesis follows Antonovsky and Illich in breaking from the pathogenic paradigm. “From a focus on eliminating disease to supporting well-being”; from “treatment to prevention,” and from “individualism to mutualism.” We champion a shift in focus “from genome to exposome” — that is, from genetic determinism to environmental exposure over a lifetime. We call for “continuous engagement,” not crisis response; “adaptation” rather than “fixing”; and most radically, for a move from “anthropocentric to ecocentric” models of health.
These transitions, we argue, are not abstract ideals. They must become operational principles for governance, economics, and culture. The economy must trade perpetual growth for ecological balancing. Healthcare must become less about heroic intervention, and more about systemic stewardship. Urban design, agriculture, and education must be rewired for planetary participation.
Rebuilding coherence
The good news is that coherence can be rebuilt — if not at the level of the individual alone, then through collective systems of understanding and action. A planetary frame, far from being paralysing, can in fact be empowering. “Paradoxically,” the paper notes, “confronting the complexity of the scale of human impact… can, over time, foster a robust form of comprehensibility.” Learning to see wildfires, dead zones, and mass migrations not as disconnected catastrophes but as systemic outcomes offers, if not comfort, then at least clarity.
Manageability, too, can be reclaimed through collective mobilisation, developing regenerative agriculture, implementing circular economy principles, restoring key ecosystems, building resilient local communities. The goal is not omnipotence, but participation in planetary-scale efforts.
Even meaningfulness can be rediscovered. In a time when traditional narratives of progress have failed, we suggest a new telos toward the deeply rewarding project of co-creating a habitable future — something that we believe can (indeed must) become the central meaning-giving task of our time.
In sum, Planetary Salutogenesis argues that the future of health cannot be carved from the body alone. It must be cultivated in the soil, seeded in the air, woven into ecosystems and institutions alike. It is not merely about surviving a sickened world — it is about becoming well together, or not at all. Our final line is unequivocal: “The future of health will be planetary, or there will be no future health at all.”