Prihodnost zdravja na poškodovanem planetu

Prihodnost zdravja bo planetarna, sicer prihodnosti zdravja sploh ne bo.

V poznih 60. letih prejšnjega stoletja je sociolog Aaron Antonovsky začel preučevati ženske, ki so preživele holokavst, v okviru študije o ženskah v menopavzi, da bi razumel dolgoročne učinke travme. Ugotovil je, da je bila večina žensk, ki so preživele holokavst, manj zdrava kot ženske, ki ga niso doživele. Toda tretjina preživelih se ni nič razlikovala od drugih in je živela, kot da pred leti ne bi doživela nobene grozote.

To ga je pripeljalo do vprašanja: Kaj je bil čudež? Odgovor na to vprašanje ga je pripeljal do razvoja koncepta salutogeneze – izvor (geneza) zdravja (saluto). Takrat, pa tudi danes, je temelj zdravja kot poklica in ideje patogeneza – izvor trpljenja ali bolezni. Antonovsky je trdil, da bolezen sama po sebi ni bila pravi vzrok za zlom, ampak da je zdravje odvisno od prilagodljivosti. Salutogeneza preusmerja pozornost z zdravljenja bolezni na spodbujanje odpornosti v stresnem okolju.

Planetarna salutogeneza

Pol stoletja kasneje se zdravje še vedno večinoma opredeljuje na individualni ravni. Sledimo patogenom, genom in tveganjem, povezanim z življenjskim slogom. Patogeneza je napredovala v medicini, vendar ne upošteva širšega konteksta. Ker se planetarni sistemi upogibajo pod industrijskim pritiskom, je ta pogled nezadosten. Krize antropocena niso več le hrup v ozadju – oblikujejo človeški obstoj in zahtevajo novo vizijo blaginje.

Antonovskyjeva salutogeneza ponovno pridobiva na pomenu: zdravje morda ni odvisno od posameznika, ampak od odnosa človeštva do sistema Zemlje. Zdravje planeta postane temelj trajnega zdravja človeka. To je več kot le »dodatek k okolju«. Tradicionalna medicina se osredotoča na posameznike in okolje obravnava kot nekaj zunanjega. Planetarna salutogeneza to obrne: osebno dobro počutje je trajnostno le v zdravi biosferi. Zdravje, ločeno od planeta, postane sizifovsko, planetarno zdravje pa kot dinamično stanje prevzema različne oblike, odvisno od kulture, ekologije in institucij.

Skladnost in dobro počutje v afriškem Sahelu, ki je izpostavljen suši, se razlikujeta od strategij v Bangkoku ali Amsterdamu, ki se soočata z naraščajočimi morskimi gladinami, a vse so povezane z obremenjenimi planetarnimi sistemi. Upravljanje, ekonomija in družbene prakse se morajo prilagajati lokalno, hkrati pa upoštevati planetarne realnosti. Ta premik presega univerzalne recepte in se osredotoča na strategije, občutljive na kontekst, pri čemer priznava, da je zdravje skupnosti neločljivo povezano z njenim vodnim in zračnim sistemom, ekosistemi in končno – s celotnim planetom.

Zdravje skozi odpornost

Antonovsky si ni prizadeval razumeti, zakaj ljudje zbolijo (patogeneza), temveč zakaj nekateri kljub skrajnim preizkušnjam ohranijo zdravje. Osredotočil se je na vire namesto na tveganja in oblikoval pojem občutka koherence (SOC) – prepričanja, da je življenje razumljivo, obvladljivo in smiselno.

Opredelil je tri sestavine:

• Razumljivost: dojemanje sveta kot urejenega in predvidljivega, ne kaotičnega.

• Obvladljivost: prepričanje, da so na voljo ustrezni viri, bodisi osebni bodisi zunanji.

• Smiselnost: občutek, da ima življenje namen in da se je vredno spoprijeti z izzivi.

Močan SOC, je trdil, blaži stres, saj pomaga ljudem mobilizirati vire in probleme obravnavati kot obvladljive. V relativno stabilnih socialnih in okoljskih razmerah skladnost oblikujejo vzgoja, socialna podpora in osebne izkušnje. [Preberi več: Obvladovanje stresa: Kako zmanjšati, preprečiti in prenašati stres]

Toda antropocen spodkopava te temelje. Človeštvo je zapleteno v nestanovitne zemeljske sisteme, ki jih je motila industrijska modernost. Podnebni ekstremi, propadajoči ekosistemi in razširjeni toksini naredijo svet težko razumljiv. Povratne zanke in kritične točke ogrozijo predvidljivost, kar zmanjšuje občutek razumljivosti.

Tudi upravljivost je pod pritiskom. Osebni, skupnostni ali celo nacionalni viri se zdijo nezadostni za reševanje kriz na planetarni ravni. Neskladje med globalnimi grožnjami in obstoječim upravljanjem spodbuja tesnobo, paralizo in izginjajoč občutek sposobnosti delovanja.

Najtežje je ohraniti smiselnost. Ob soočanju z destabilizacijo civilizacije mnogi zapadejo v obup, zanikanje ali hedonizem. Če se prihodnost zdi zaprta in posamezna dejanja nesmiselna, smisel zbledi. Nekdaj močna pripoved o stalnem napredku omahuje pred realnostjo planetarnega preseganja zmogljivosti in ekološkega dolga. [Preberi več: Osvoboditev od trpljenja z budizmom (1): Štiri plemenite resnice]

Od patogeneze do planetarne salutogeneze

Te izgube skladnosti ni mogoče razumeti v individualističnem okviru. Človeško zdravje je neločljivo povezano s planetarnimi sistemi. Nismo izolirane biološke enote, ampak holobionti – ekosistemi, prepleteni z mikrobiološkimi, atmosferskimi, oceanskimi in kopenskimi procesi.

Naše notranje in zunanje okolje se medsebojno odražata: tla oblikujejo črevesje, zrak in sončna svetloba vplivata na fiziologijo, biotska raznovrstnost vpliva na imunost in mentalno zdravje. Destabilizacija planeta zato ni zunanji stresor, ampak neposreden napad na našo biološko, psihološko in duhovno celovitost. Okoljski toksini nas prežemajo; podnebne spremembe motijo vzorce prehranjevanja in bolezni; ekološka izguba ogroža naše vire hrane. Zdravje obravnavati le na individualni ravni je kot negovati cvet, pri tem pa ignorirati zastrupljena tla in kisli dež. [Preberi več: Vaše telo je ekosistem, ne stroj] [Preberi več: Jin jang filozofija in duševno zdravje]

Planetarna salutogeneza razširja Antonovskyjevo idejo na planetarno raven in na novo opredeljuje zdravje skozi ključne spremembe:

• Od odpravljanja bolezni k spodbujanju dobrega počutja: ustvarjanje ekoloških, socialnih in kulturnih pogojev, kjer lahko življenje uspeva.

• Od zdravljenja do preprečevanja: obravnavanje vzrokov v ozadju, kot so odvisnost od fosilnih goriv in neenakopravne ekonomije.

• Od egosistema do ekosistema: razumevanje zdravja kot relacijskega in kot rezultat regenerativnih povezav s svetom, ki presega človeka.

• Od genoma dp ekspozoma: priznavanje celoživljenjske izpostavljenosti okolju kot ključnega dejavnika za zdravje.

• Od popravljanja do prilagajanja: razvoj odpornosti v dinamičnih, negotovih sistemih.

• Od trajnosti do bivanjskosti: zagotavljanje, da Zemlja ostane primeren dom za raznoliko življenje.

• Od rasti do ravnovesja: nadomestitev neskončne rasti z ekološko ekonomijo.

• Od antropocentrizma do ekocentrizma: potrjevanje intrinzične vrednosti drugih vrst in ekosistemov.

Zdravje v bolni družbi

Desetletja pred antropocenom je Ivan Illich v delu Medical Nemesis (1975) kritiziral iatrogenske učinke sodobne medicine – njeno nagnjenost k ustvarjanju novih bolezni in odvisnosti, čeprav je iskala zdravila. Izpodbijal je medikalizacijo življenja, nadzor zdravja s strani strokovnih elit in iluzijo, da je zdravje mogoče proizvajati in porabljati kot katero koli drugo blago.

Illich je trdil, da je skrb za osebno zdravje v družbi, ki je v osnovi patogena, pogosto kontraproduktivna. Industrijska proizvodnja, mesta, usmerjena v avtomobile, in potrošniška kultura ustvarjajo pogoje, ki škodujejo dobremu počutju, in povzročajo odvisnost od medicinskih posegov, ki le začasno popravljajo sistemsko škodo.

Za Illicha je bil osrednji problem institucionalen. »Medicinska ustanova je postala velika grožnja zdravju.« Pravo zdravje, je trdil, ni odsotnost bolezni, ampak avtonomna sposobnost posameznikov in skupnosti, da se spopadajo, zdravijo in rastejo v svojem življenju in okolju. Stremljenje k vrhunski telesni pripravljenosti, medtem ko živimo sredi onesnaženja, predelane hrane in razdrobljenih socialnih sistemov, je v osnovi napačno.

Podobno je tudi prizadevanje za dobro počutje, pri čemer se ignorira degradacija sistemov, ki podpirajo življenje na Zemlji, nesmiselno. Planetarna salutogeneza odraža Illichovo spoznanje: tla, zrak, voda in biotska raznovrstnost neposredno vplivajo na naše fizično in duševno zdravje, zaradi česar je človeška odpornost neločljivo povezana z zdravjem planeta. [Preberi več: Krepitev zdravja in dobrega počutja s filozofijo TKM Yang Sheng]

Obnova skladnosti na planetarni ravni

Planetarna salutogeneza predlaga uravnoteženje individualne moči z institucionalnim delovanjem. Da bi v antropocenu ponovno pridobili razumljivost, obvladljivost in smiselnost, moramo sprejeti to širšo, medsebojno povezano perspektivo.

Soočanje z obsegom človeškega vpliva na zemeljske sisteme lahko sčasoma spodbudi sistemsko razumevanje. Spoznavanje biogeokemičnih ciklov, planetarnih meja, ekoloških prelomnih točk in povratnih zank pomaga nadomestiti zmedo z razumevanjem in razkriva vzorce, ki se ponavljajo pri gozdnih požarih, mrtvih conah v oceanih in drugih krizah.

Obnovitev upravljivosti pomeni prehod od individualnega spopadanja s težavami k skupinskemu, sistemskemu ukrepanju. Pravi vpliv izhaja iz preoblikovanja energetskih omrežij, kmetijstva, prometa, finančnih sistemov in potrošniških vzorcev. Strateški ukrepi – regenerativno kmetijstvo, načela krožnega gospodarstva, obnova ekosistemov, odporne skupnosti – omogočajo sodelovanje pri reševanju zapletenih izzivov, pri čemer se opirajo na ekološko znanje, socialno solidarnost, tehnologijo in nastajajoče planetarno upravljanje.

Sprejemanje planetarne usmerjenosti tudi ponovno vzpostavlja smiselnost. Soočanje z antropocenom kot odločilnim kolektivnim prehodom daje smisel dejanjem – od zagovarjanja podnebne pravičnosti do skrbi za lokalne ekosisteme. Pogumno soočanje z našim planetarnim položajem postane osrednja naloga, ki daje smisel, usmerjena ne v utopijo, ampak v soustvarjanje prihodnosti, primerne za življenje. [Preberi več: Iskanje sreče, miru in zdravja: Trije stebri za vsakdanje življenje]

Zdravje kot sodelovanje na planetarni ravni

Planetarna salutogeneza preoblikuje zdravje iz zasebnega dosežka v skupno lastnino vzajemnih odnosov med človeškimi skupnostmi in zemeljskim sistemom. Institucije – zdravstvo, politika, izobraževanje, urbanistično načrtovanje, kultura – morajo vključiti ekološko pismenost, sistemska razmišljanja, domorodno modrost in planetarno odgovornost.

Danes gojenje skladnosti pomeni dojemanje, usmerjanje in sodelovanje z našo turbulentno planetarno realnostjo. Človeško zdravje in planetarno zdravljenje sta neločljiva: prihodnost zdravja bo planetarna, sicer pa prihodnosti zdravja sploh ne bo. [Preberi več: Najboljše zdravilo za vsako bolezen]

Vir: Gilman, N., Kotrba, P., Marashian, A., Seifert, G., Tybbusek, J., & Wallmann, T. (2025, July 10). The future of health on a damaged planet. Noema Magazine. Berggruen Institute. https://www.noemamag.com/the-future-of-health-on-a-damaged-planet 

---

The Future Of Health On A Damaged Planet

The future of health will be planetary or there will be no future health at all.

In the late 1960s, a sociologist named Aaron Antonovsky began working with female Holocaust survivors in a study of menopausal women with the goal of understanding the long-term effects of trauma. Most of the women who had survived the Holocaust, he found, were less healthy than the women who did not experience it. But a third of the survivors appeared no different at all, living as if they had undergone no agony all those years ago.

This led him to ask: What was the miracle? Answering it led him to develop the concept of salutogenesis — the origins (genesis) of health (saluto). At the time, and still today, the foundation of health as a profession and idea is pathogenesis — the origins of suffering or disease. Antonovsky argued that illness itself was not the true cause of breakdown; rather, health depended on adaptability. Salutogenesis shifts attention from treating disease to fostering resilience in a stress-rich environment.

Planetary Salutogenesis

Half a century later, health is still mostly defined at the individual level. We track pathogens, genes, and lifestyle risks. Pathogenesis has advanced medicine but ignores the broader context. As planetary systems buckle under industrial pressures, this lens is insufficient. Anthropocene crises are no longer background noise — they shape human existence and demand a new vision of well-being.

Antonovsky’s salutogenesis gains renewed relevance: health may depend not on the isolated individual but on humanity’s relationship with the Earth system. Planetary health becomes the foundation for lasting human health. This is more than an “environmental add-on.” Traditional medicine focuses on individuals and treats the environment as external. Planetary salutogenesis flips this: personal well-being is sustainable only within a healthy biosphere. Health detached from the planet becomes Sisyphean, and planetary health, as a dynamic condition, takes different forms depending on culture, ecology, and institutions.

Coherence and well-being in Africa’s drought-prone Sahel differ from strategies in Bangkok or Amsterdam facing rising seas, yet all are bound by stressed planetary systems. Governance, economies, and social practices must adapt locally while acknowledging planetary realities. This shift moves beyond universal prescriptions toward context-sensitive strategies, recognizing that community health is inseparable from its watershed, airshed, ecosystems, and ultimately, the planet.

Health Through Resilience

Antonovsky sought to understand not why people became ill (pathogenesis), but why some maintained health despite extreme adversity. He shifted focus from risks to resources and coined the concept of a sense of coherence (SOC) — the confidence that life is comprehensible, manageable, and meaningful.

He defined three components:

• Comprehensibility: perceiving the world as structured and predictable rather than chaotic.

• Manageability: believing adequate resources are available, whether personal or external.

• Meaningfulness: feeling that life has purpose and that challenges are worth engaging.

A strong SOC, he argued, buffers stress by helping people mobilize resources and view problems as manageable. Under relatively stable social and environmental conditions, coherence is shaped by upbringing, social support, and personal experience. [Read more: Stress Management: How to Reduce, Prevent, and Cope with Stress]

But the Anthropocene destabilizes these foundations. Humanity is entangled in volatile Earth systems disrupted by industrial modernity. Climate extremes, collapsing ecosystems, and pervasive toxins make the world feel unintelligible. Feedback loops and tipping points undermine predictability, eroding comprehensibility.

Manageability, too, is strained. Personal, communal, or even national resources appear inadequate against planetary-scale crises. The mismatch between global threats and existing governance fosters anxiety, paralysis, and a fading sense of agency.

Meaningfulness is hardest to sustain. Facing civilizational destabilization, many fall into despair, denial, or hedonism. If the future feels foreclosed and individual actions futile, purpose withers. The once-powerful narrative of perpetual progress falters under the reality of planetary overshoot and ecological debt. [Read more: Ending Suffering with Buddhism (1): The Four Noble Truths]

From Pathogenesis To Planetary Salutogenesis

This erosion of coherence cannot be understood within an individualistic frame. Human health is inseparable from planetary systems. We are not isolated biological units but holobionts — ecosystems entangled with microbial, atmospheric, oceanic, and terrestrial processes.

Our inner and outer environments mirror one another: soil shapes the gut, air and sunlight affect physiology, and biodiversity influences immunity and mental health. Planetary destabilization is therefore not an external stressor but a direct assault on our biological, psychological, and spiritual integrity. Environmental toxins permeate us; climate change disrupts food and disease patterns; ecological loss undermines our sources of nourishment. To treat health only at the individual level is like tending a flower while ignoring poisoned soil and acid rain. [Read more: Your Body as a Garden] [Read more: Yin Yang philosophy and mental health]

Planetary salutogenesis extends Antonovsky’s idea to the planetary scale, reframing health through key shifts:

• From eliminating disease to fostering well-being: building ecological, social, and cultural conditions where life can thrive.

• From treatment to prevention: addressing upstream drivers like fossil fuel dependence and inequitable economies.

• From ego-system to ecosystem: seeing health as relational and emergent from regenerative ties with the more-than-human world.

• From genome to exposome: recognizing lifelong environmental exposures as central to health.

• From fixing to adapting: cultivating resilience in dynamic, uncertain systems.

• From sustainability to habitability: ensuring Earth remains a viable home for diverse life.

• From growth to balance: replacing endless growth with ecological economics.

• From anthropocentric to ecocentric: affirming the intrinsic value of other species and ecosystems.

Health In A Sick Society

Decades before the Anthropocene, Ivan Illich, in Medical Nemesis (1975), critiqued modern medicine’s iatrogenic effects — its tendency to create new illnesses and dependencies even as it sought cures. He challenged the medicalization of life, the control of health by professional elites, and the illusion that health could be produced and consumed like any commodity.

Illich argued that pursuing personal health in a fundamentally pathogenic society is often counterproductive. Industrial production, car-centric cities, and consumerist culture generate conditions harmful to well-being, creating dependence on medical interventions that merely patch systemic damage.

For Illich, the core problem was institutional. “The medical establishment has become a major threat to health.” True health, he claimed, is not disease-free, but the autonomous capacity of individuals and communities to cope, heal, and grow within their lives and environments. Seeking peak fitness while living amid pollution, processed foods, and fragmented social systems is fundamentally flawed.

Similarly, striving for well-being while ignoring the degradation of Earth’s life-support systems is futile. Planetary salutogenesis echoes Illich’s insight: soil, air, water, and biodiversity directly shape our physiological and mental health, making human resilience inseparable from planetary health. [Read more: Cultivating Health and Wellness with TCM Yang Sheng Philosophy]

Rebuilding Coherence On A Planetary Scale

Planetary salutogenesis proposes balancing individual empowerment with institutional action. Regaining comprehensibility, manageability, and meaningfulness in the Anthropocene requires embracing this wider, interconnected perspective.

Confronting the scale of human impact on Earth systems can, over time, foster systemic understanding. Learning about biogeochemical cycles, planetary boundaries, ecological tipping points, and feedback loops helps replace bewilderment with insight, revealing patterns across wildfires, ocean dead zones, and other crises.

Restoring manageability means shifting from individual coping to collective, systemic action. True leverage comes from transforming energy grids, agriculture, transport, financial systems, and consumption patterns. Strategic interventions — regenerative agriculture, circular economy principles, ecosystem restoration, resilient communities — allow participation in navigating complex challenges, drawing on ecological knowledge, social solidarity, technology, and emerging planetary governance.

Embracing a planetary orientation also restores meaningfulness. Confronting the Anthropocene as a defining collective passage imbues actions — from climate justice advocacy to local ecosystem care — with purpose. Engaging courageously with our planetary predicament becomes the central meaning-giving task, oriented not toward utopia but toward co-creating a habitable future. [Read more: Finding Joy, Peace, and Health: Three Pillars for Everyday Life]

Health As Planetary Participation

Planetary salutogenesis reframes health from a private achievement to a shared property of reciprocal relationships between human communities and the Earth system. Institutions — healthcare, policy, education, urban planning, culture — must integrate ecological literacy, systems thinking, Indigenous wisdom, and planetary responsibility.

Cultivating coherence today means perceiving, navigating, and engaging with our turbulent planetary reality. Human health and planetary healing are inseparable: the future of health will be planetary, or there will be no future health at all. [Read more: The Ultimate Cure For Every Disease]

Source: Gilman, N., Kotrba, P., Marashian, A., Seifert, G., Tybbusek, J., & Wallmann, T. (2025, July 10). The future of health on a damaged planet. Noema Magazine. Berggruen Institute. https://www.noemamag.com/the-future-of-health-on-a-damaged-planet