Salutogenesis for thriving nations: Sense of coherence and longevity across income strata

Abstract

Traditional salutogenesis literature and theories in health and development have emphasized the role of sense of coherence dimensions-comprehensibility, manageability, and meaningfulness-in shaping population health. However, their relevance at a macro scale, across varying contexts, has been overlooked. What is the relationship between these dimensions and population health at the national level? Do they exert a uniform effect across countries with varying income levels? Using the sense of coherence framework dimensions at the macro-level, we argue that comprehensibility, manageability, and meaningfulness are related to national life-expectancy. We examine their relationship across various economic contexts to refine the boundaries of their links with population health and provide a nuanced understanding of their interplay. Drawing on a panel dataset of 135 countries from 2017 to 2020 from the Quality of Government institute, International Telecommunications Union, and World Bank, we test our hypotheses using a high-dimensional fixed effects model. We find support for two dimensions, manageability, and meaningfulness, in improving life expectancy. We unpack these findings to understand whether they exert a uniform effect or vary across different levels of income. Our findings show that the effectiveness of each dimension on longevity varies by income level, suggesting their relevance is context specific. Through an ecological approach, this study extends Antonovsky's theory of salutogenesis to demonstrate how structural factors at the population level contribute to maintaining health.

Keywords: Economic stratification; Longevity; Salutogenesis model of health; Sense of coherence.

Fig. 1

The Salutogenesis Model of Health. A conceptual framework depicting the salutogenesis model of health and the hypothesized relationships between its key components, with income level moderating these relationships.

Fig. 2

Life expectancy mean around the world (2017–2020). Source: created by Stata thematic mapping using Quality of Governance Institute data.

Fig. 3

Income classification around the world. Source: created by Stata thematic mapping using World Bank data.

Fig. 4

Coefficient plot illustrating the interaction between meaningfulness and income level on life expectancy.The upper-middle-, lower-middle-, and lower-income group lie near the zero line, reflecting their statistical significance. Notes: Interaction terms compare each income group relative to the baseline category high income, with a 95 % confidence interval.

Fig. 5

Coefficient plot illustrating the interaction between manageability and income level on life expectancy. The upper-middle income group lies near the zero line, reflecting its marginal statistical significance (p = 0.048). Notes: Interaction terms compare each income group relative to the baseline category high income, with a 95 % confidence interval.