Climate change is not a distant threat — it is a present and pressing reality, shaping the health and wellbeing of individuals and communities worldwide.1,2 General practice, central to the UK healthcare system, has a critical role to play in addressing this challenge.3–6 To effectively contribute to a net zero future,7,8 general practice must move beyond traditional models of disease management and embrace a transformative vision — one that aligns health promotion, public health, and long-term sustainability.
From pathogenesis to salutogenesis: rethinking the paradigm
Healthcare systems worldwide have historically emphasised pathogenesis: the origins, mechanisms, and treatment of disease.9 Yet, such a model, while central to clinical care, insufficiently addresses the upstream drivers of health. Salutogenesis, first introduced by Antonovsky, shifts this focus towards understanding the factors that support human health and wellbeing.9 Rather than viewing health as merely the absence of disease, salutogenesis and its construct of ‘sense of coherence’ asks what enables individuals and communities to maintain and improve health, even amid adversity.9
While some may argue that the determinants of poor health identified by pathogenesis overlap with those highlighted by salutogenesis, the paradigms differ fundamentally in intent. Pathogenesis is reactive, responding to deficits, while salutogenesis is proactive and systemic, prioritising capacity-building and environmental coherence, highlighting the importance of coherent living environments (for example, environments that foster predictability, manageability, and meaningfulness), strong social networks, and individual resilience in maintaining health and wellbeing.9
Clarifying the role of general practice
General practice is uniquely positioned to implement salutogenic and sustainable approaches. Unlike secondary care, general practices are embedded in local communities, maintain ongoing patient relationships, and operate across clinical and social domains. This …
