Healthy Ageing in a Salutogenic Way: Building the HP 2.0 Framework

Health and Social Care in the Community (2011) 19(1), 43–51 doi: 10.1111/j.1365-2524.2010.00947.x

Healthy ageing in a salutogenic way: building the HP 2.0 framework

1,2 2 2 Jeanette Lezwijn MSc , Lenneke Vaandrager PhD , Jenneken Naaldenberg MSc , 2 3 3 Annemarie Wagemakers PhD , Maria Koelen PhD and Cees van Woerkum PhD 1GGD Gelre-IJssel (Community Health Service), AGORA Academic Collaborative Centre, Apeldoorn, The Netherlands, 2Wageningen UR, Department of Social Sciences, Health and Society Group, Wageningen, The Netherlands and 3Wageningen UR, Department of Social Sciences, Division Communication and Innovation Studies, Wageningen, The Netherlands

Accepted for publication 4 June 2010

Correspondence Abstract Jeanette Lezwijn Healthy ageing is inﬂuenced by a variety of interacting GGD Gelre-IJssel determinants. Because no one agency can tackle all these AGORA Academic Collaborative Centre determinants, the promotion of healthy ageing requires an Deventerstraat 43 intersectoral approach. The aim of this article is to 7311 LV Apeldoorn describe a theoretical basis, the development and possible The Netherlands E-mail: [email protected] applications of a framework within a municipality in the Netherlands. This framework supports intersectoral collaboration by guiding and stimulating the development, What is known about this topic implementation and evaluation of health promotion activities for healthy ageing. It is based on the principles of d Healthy ageing is inﬂuenced by a variety of health promotion and on the theory of salutogenesis and interacting determinants within and outside built upon three interrelated central concepts: (1) sense of the health sector coherence, (2) resources for health, and (3) health. The d An important determinant of healthy ageing is framework visualises the interrelationships of the three the ability to maintain autonomy and indepen- concepts within health promotion and salutogenesis. This dence visualisation makes explicit the value and the contribution d Salutogenesis offers a theoretical basis for with respect to content of intersectoral collaboration and development, implementation and evaluation the participation of older people in health promotion. The of healthy ageing strategies relationships between the concepts of the framework also What this paper adds indicate the need to undertake different types of research and gather different kinds of data to develop, implement d A framework which facilitates stakeholders creating actionable knowledge for a community and evaluate healthy ageing strategies. programme Keywords: health promotion, healthy ageing, intersectoral d Provides evidence of the utility of the saluto- collaboration, salutogenesis, sense of coherence genic resources for health d A framework which facilitates adaptation of resources to promote the wellbeing of older people in their context

Introduction Generally, health promotion for older people stresses the problems and limitations that occur due to ageing. As people grow older, biological changes caused by However, in today’s health promotion, ageing can also ageing inﬂuence their mental, physical and social state, be approached in a more positive way. Positive including their social networks (Nygren et al. 2005, approaches to healthy ageing are illustrated by concepts Borglin et al. 2006, Ciairano et al. 2008). These develop- such as active ageing and healthy ageing (Minkler et al. ments can have a large impact on the quality of life of 2000, Hansen-Kyle 2005). The World Health Organisation older people, which is largely determined by their ability deﬁnes active ageing as a process of optimising oppor- to maintain autonomy and independence (WHO 2002). tunities for health, participation and security to enhance

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quality of life as people age (WHO, 2002). Healthy such as: (1) empowerment of individuals and the com- ageing has several definitions, from different perspec- munity, (2) participation of individuals and other tives, i.e. medical ⁄gerontological, psychological and stakeholders in the community, (3) holistic view of sociological. Hansen-Kyle (2005:52) has summarised health, (4) intersectoral collaboration between the differ- these different definitions and defines healthy ageing ent sectors influencing health, (5) equity in health, (6) as: ‘the process of slowing down, physically and cogni- sustainability of effects of health promotion actions, and tively, while resiliently adapting and compensating in (7) use of multistrategies (WHO 1986, 2005, Rootman order to optimally function and participate in all areas et al. 2001). These principles support AGORA and the of one’s life (physical, cognitive, social and spiritual)’. collaborating partners in the action and research to pro- To function optimally means for older people to mote healthy ageing on the individual, organisational perceive control over the decisions that affect their lives and ⁄or political level. Working in a way that is guided (Forbes 2001). This can also mean, when necessary and by the principles of health promotion also improves the in accordance with the older person, that family chance of making sustainable changes in both the physi- caregivers are also involved in these decisions cal and social environment of older people in order to (Hansen-Kyle 2005). Thus, perception of control is an promote healthy ageing and contribute to the improve- essential element of healthy ageing. ment of the quality of their life in the municipality Just like health and well-being in general, healthy (IUHPE & CCHPR 2007). ageing is influenced by different determinants (WHO Within health promotion and thus within AGORA, 1998). According to Dahlgren & Whitehead (2006), these intersectoral collaboration is one of the core principles determinants are: individual lifestyle factors, social and because it creates opportunities for linking and sharing community networks, living and working conditions, information, activities, expertise, skills and resources and general socioeconomic, cultural and environmental between the sectors. So that actioninrelationtohealth factors. These different determinants interact with each can be more effective, efficient and sustainable than other. For example, lifestyle factors are influenced by might be achieved by the health sector alone (Koelen social norms, but also by living conditions, and vice et al. 2008). Intersectoral collaboration, however, is versa. Because of the variety of these determinants and not easy. The different sectors who are involved have the interactions between them, health and healthy ageing different formal structures, and different organisational are subject to complex processes (Saan & De Haes 2005) cultures and values, which are based on professional atti- in which different sectors (Koelen & Van den Ban 2004) tudes, knowledge domains, interests, perceptions and have a responsibility. Examples of these sectors for behaviours (Naaldenberg et al. 2009b). It is therefore a healthy ageing are: health, welfare, housing, transport challenge to achieve and sustain intersectoral collabora- and infrastructure. tion. To manage intersectoral collaboration successfully, In the Netherlands, although many activities, facilities a stable team which is able to provide a broad range of or services for older people in municipalities have been services is essential (Axelsson & Bihari Axelsson 2006, developed and implemented, the reach is sometimes Koelen et al. 2008). AGORA put a lot of effort into creat- low. Consequently, outcome evaluation of these strate- ing such stable teams in the municipalities and found gies shows minor effects on the objective health of older that in practice it was rather difficult to achieve and people (GGD Gelre-IJssel 2006); but this does not neces- sustain such teams. One of the reasons was that the sarily mean that this strategy in itself cannot be effective. participating stakeholders all not only had different In a region in the eastern part of the Netherlands, to views on healthy ageing, but also had different questions promote healthy ageing, in which the development, on the development, implementation and evaluation of implementation and evaluation of a strategy take place at strategies for older people in the municipality. To be able the local level, different disciplines, including health pro- to reach consensus in the teams, common ground was motion professionals, epidemiologists, policy-makers and needed. Therefore, a policy framework was developed researchers, participate in a consortium called AGORA. to support the team working with the principles of health promotion to improve healthy ageing. This framework was named the HP 2.0 framework. AGORA This article describes its development and the theoret- AGORA is a collaboration between the Wageningen ical concepts on which the framework is built. First, the University and Research Centre, a regional community salutogenic perspective and the different concepts of this health service and several municipalities, and aims to theory are described. Second, the development of the develop, implement and evaluate methods and tools to HP 2.0 framework is outlined.Third,thesupportive promote healthy ageing. AGORA works in each munici- framework, the concepts of the framework and the rela- pality according to the principles of health promotion, tionships between the concepts are elaborated upon.

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One example of an application of the HP 2.0 framework 1996, Lindstro¨m & Eriksson 2005). Thus, SOC reflects the is described. This is followed by the discussion with interaction between the individual and the environment some provisos about using concepts like sense of coher- (Eriksson & Lindstro¨m 2008). Recently, a scale to mea- ence (SOC) and healthy ageing in health promotion prac- sure SOC, the Life Orientation Questionnaire, has been tice. Consequences for professionals when using the HP validated (Antonovsky 1996, Lindstro¨m & Eriksson 2005, 2.0 framework are also discussed. Finally, the usability of Eriksson 2007, Hakanen et al. 2007). the framework and how it can contribute to the develop- To develop, implement and evaluate strategies for ment, implementation and evaluation of healthy ageing healthy ageing in practice, the salutogenic approach strategies concludes this article. offers concepts which facilitate working with the principles of health promotion. The next section elab- orates on conceptualising the salutogenic perspective Salutogenesis and the principles of health promotion into a Whereas in the past the emphasis was on disease and supportive framework for healthy ageing: the HP 2.0 disease prevention (Hansen-Kyle 2005, Nygren et al. framework. 2005, Lindstro¨m & Eriksson 2006), nowadays, health promotion is oriented more often to more positive processes, Development of the HP 2.0 framework like for example healthy ageing (Eriksson & Lindstro¨m 2008). Such a positive approach is based on the theory of As already stated, the practice of healthy ageing should salutogenesis, in which the focus is on the causes of be created by participants from different sectors, and by health, instead of on the causes of disease (pathogenesis). the interactions between these participants. Without the It aims to explain why people, despite stressful situa- variety of inputs from their knowledge and visions and tions, stay well (Antonovsky 1996). Applying this theory discussions among, for example, professionals, older to healthy ageing is justified, because the salutogenic people, family and informal caregivers, policy-makers, approach searches for those determinants or factors and researchers, the arena of healthy ageing remains whichstrengthenolderpeopletoadapttoandcompen- empty. A need was felt for the development of a frame- sate the negative consequences of ageing. work to guide and facilitate these participants to To overcome these negative consequences, general- establish what the content should include. Creating ised resistance resources (GRRs) and SOC play an content together is a principle which is also found and important role in this perspective. The GRRs are, successfully applied on the internet. These internet appli- according to the salutogenic theory, resources possessed cations are referred to as web 2.0 applications and by people to deal with stressors in life. These GRRs can examples include Facebook, Wikipedia, Link’d In and be biological, like for example genes, intelligence and Twitter. The main attribute of web 2.0 applications is that immune functioning; material, like money and the content is created in a participative way and thus these house in which people live; and psychosocial, like applications facilitate participative processes (Chui et al. knowledge, capacities, traditions, upbringing, life expe- 2009), much like AGORA tries to facilitate participative riences, social network and marital status (Antonovsky processes in the municipalities. That is why it was 1996, Lindstro¨m & Eriksson 2005, Read et al. 2005, decided to call this framework the HP 2.0 framework, Wiesmann & Hannich 2008). To use GRRs in a health the development of which is now outlined. promoting way, SOC plays an important role. SOC is In the course of AGORA’s search for methods to pro- defined as a global orientation that expresses the extent mote healthy ageing in the municipality, together with to which one has a feeling of confidence that (1) the other stakeholders, at bilateral meetings, interviews and stimuli from one’s internal and external environment in group meetings, three items were repeatedly discussed the course of living are structured, predictable, and (Lezwijn et al. 2011). These discussions revolved around explicable; (2) the GRR’s are available to meet the issues such as (1) why older people in one municipality, demands posed by these stimuli; and (3) these demands which has more activities, facilities and services for older are challenges, worthy of investment and engagement people compared to other municipalities, are not health- (Antonovsky 1987, cited in Lindstro¨m & Eriksson ier than those older people in other municipalities (GGD 2005:441). Gelre-IJssel 2006), (2) according to Dutch law, the There are three dimensions to SOC, namely: (1) municipality is now responsible for creating supportive comprehensibility – that is the ability to assess and environments for all older people to participate in society understand the situation; (2) meaningfulness – that is the (Tjalma-van den Oudsten et al. 2006). The municipality extent to which an individual possesses the motivation still wants to appeal to the sense of responsibility of the and desire to cope with encountered situations; and (3) older persons themselves, and their family members, to manageability–thatisthecapacitytodoso(Antonovsky actually participate. How can the municipality support

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these people to participate in society? and (3) there are ability, comprehensibility and meaningfulness.Theresources already so many activities, facilities and services for for health are resources which older people can use in older people in the municipality, do new ones to order to be in control of situations affecting their lives promote healthy ageing need to be developed or is it (Forbes 2001). The resources for health concept are possible to build upon existing ones? partially similar to the GRRs from the theory of saluto- Following these discussions, AGORA developed a genesis (Antonovsky 1996) but additionally include conceptual framework to support the municipality and potential resources in the physical and social environment other stakeholders to deal with these themes for discus- which can be used for better health in the future. These sion. As already stated, the HP 2.0 framework is based resources for health are available, but may not be famil- on a salutogenic approach and the principles of health iar to everyone. Examples of these potential resources in promotion. The first draft of the framework and the cen- the social and physical environment are public transport, tral concepts within the framework were outlined and thehealthcaresystem,thepubliclibraryandwelfareor- explained in three pilot municipalities at bilateral ganisations’ activities geared to meeting other people. meetings with policy-makers, and at interactive group The concept of health in this framework includes physi- sessions with stakeholders, including the older people. cal, mental, social and spiritual well-being, like for exam- The feedback received from those meetings is that the ple self-reported health status and subjective mental framework could support healthy ageing at a local level, health. Because of these different dimensions within because it integrates different sectors such as welfare health, health is considered as an asset and as the result and health. During those different feedback sessions, of a series of complex processes in which an individual older participants explicitly recommended that a great interacts with the social and physical environment (Naal- effort should be made to reach those older people who denberg et al. 2009b). The three central concepts of the are more or less vulnerable and more or less reluctant to HP 2.0 framework are interrelated. Each of the relation- avail of the opportunities offered by a municipality to ships is now described in more detail along with some participate in society (Lezwijn et al. 2011). This recom- examples in the area of ageing. mendation supports incorporating SOC in the HP 2.0 framework, because SOC gives an explicit value to the Resources for health–SOC differences in cognitions (comprehensibility), motiva- tions (meaningfulness) and capacities (manageability) of The relationship between resources for health and SOC older people in society. In addition to SOC, the frame- in the model is also seen as the salutogenic relationship. work has two other central concepts: resources for health This relationship is about the interaction of the individ- and health (see Figure 1). ual with the resources for health in the physical and social environment (Lindstro¨m & Eriksson 2005, Eriksson &Lindstro¨m 2007). This means that the environment is HP 2.0 framework supportive because of the existence of resources for In the HP 2.0 framework, SOC refers to the way in which health which enable older people to live their lives older people feel able to use the resources for health despite their possible limitations. The resources for and is similar to the SOC in the theory of salutogenesis health in the social and physical environment aim to (Antonovsky 1996, Lindstro¨m & Eriksson 2005). The improve health, but can also aim to strengthen one or SOC in this framework includes the dimensions manage- more of the three differentdimensionsofSOC,i.e. comprehensibility, manageability and meaningfulness (Antonovsky 1996, Lindstro¨m&Eriksson2005);for Sense of Coherence example, when an older person experiences difficulties Manageability Comprehensibility in walking and needs a walking frame. The availability Meaningfulness of such a frame can enhance his ⁄her feeling of confidence and this in turn can strengthen the older person’s manageability of SOC. Another older person who is provided with the same walking frame may feel more fragile, perhaps because the very fact of needing Resources for health the walking frame underlines the person’s physical dif- Individual Health ficulties due to ageing (Naaldenberg et al. 2009a). Thus, Physical environment Social environment the walking frame in this example breaks down self- confidence and influences meaningfulness of SOC. This example shows that different people give different Figure 1 The HP 2.0 framework. meaningstothesameresourceforhealth.Another

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example of a resource for health which positively influ- the resources in the physical and social environment. ences SOC is having a spouse or partner with whom When older people have no physical limitations, it is the older person can share his ⁄her normal daily activi- easierforthemtogocycling,togotothelibraryortouse ties.Theseolderpeopleperceivelifeasmoremeaning- public transport. Health can also have a negative influ- ful and are more motivated to face life’s challenges ence on SOC (Lundberg & Nystro¨mPeck1994,Read (Ciairano et al. 2008). et al. 2005). Anxiety and depression (mental health) are Sense of coherence is an important concept in the HP found to have a high negative impact on SOC (Olsson 2.0 framework. People with a high SOC are more capable et al. 2006). of identifying, using and re-using the resources for In line with the HP 2.0 framework, the items SOC, health to promote healthy ageing (Lindstro¨m & Eriksson resources for health, and the interrelationships between 2005, 2006, Eriksson & Lindstro¨m 2007). These people them, deserve equal attention when healthy ageing strat- are more confident about having control over their own egies are being developed, implemented and evaluated. choices and their situation by using their resources To be able to address them, the involvement of older for health, but probably are also more open to other people is necessary, including information about their potential resources for health. An example of this motives, about what they find important, what they can relationship is that older people with a high SOC more understand and what they can manage. Information is often make healthy lifestyle choices. To make these needed about the specific contexts in which these older choices, one needs to use personal resources for health people live, since the salutogenic relationship is about and respond to health-related advice (Wainwright et al. the interaction of the individual with the physical and 2007). social environment (Lindstro¨m & Eriksson 2005, Eriksson &Lindstro¨m 2007). Information about contexts and about motives also provides insight into how to facili- Resources for health–health tate and stimulate older people to use the resources The relationship between resources for health and health for health available in the environment, so that they is unidirectional and visualises the more biomedical rela- can improve their health and strengthen their SOC. tionship on the individual level. Some examples of the Information about contexts and motives provides influence of resources for health on health are: exercise insight into important concepts to consider for evalua- classes for older people, courses which help people to tion. This in turn gives insight into what is needed to deal with the death of a partner and courses about adapt the resources for health to the SOC of older peo- making new friends. These resources contribute to the ple in a specific municipality or neighbourhood. When different dimensions, i.e. social, physical, mental and an intersectoral health promotion team focuses and spiritual, of health. Resources in the physical environ- works together with older people and their family and ment, for example parks, can also contribute to health. In caregivers, on the interactions between the individual research by Wendel-Vos et al. (2004), it was found that or groups with the environment, the so-called saluto- when more green space was available, more time was genic relationship, what is at stake is improving indi- spent on a bicycle. The influence of the social environ- vidual or community empowerment (Koelen & Van ment on health is also widely recognised (Dahlgren & den Ban 2004, Koelen & Lindstro¨m 2005). In the next Whitehead 2006). Examples of resources for health in the section, an example of a possible application of the HP social environment are: neighbours and social networks. 2.0 framework within an intersectoral team for healthy ageing is described. SOC–health The HP 2.0 framework in practice A strong SOC is found to have a positive influence on perceived health (Geyer 1997, Nesbitt & Heidrich 2000, The HP 2.0 framework explicitly stresses the need to So¨derhamn & Holmgren 2004, Read et al. 2005, Olsson gather information and to incorporate knowledge from et al. 2006, Eriksson 2007, Hakanen et al. 2007, Langeland different stakeholders, including the older people them- et al. 2007). People with a higher SOC often feel more selves. It reveals which relationships require emphasis in confident about their lives and this influences health and practice. For example, in one municipality the team quality of life positively. People with a higher SOC often organised evidence-based courses for improving experience a higher quality of life (Borglin et al. 2006). well-being of older people (Bohlmeijer et al. 2005). Using Conversely, health has an influence on SOC as well. the HP 2.0 framework (see Figure 1) means that the rela- Health is one of the factors responsible for the mainte- tionship between resources for health and health is nance of an individual’s level of SOC (Read et al. 2005). evident. Still, the practitioners in that municipality expe- People in good health often find it easier to make use of rienced difficulties attracting participants for these

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courses. The HP 2.0 framework shows that possibly the Therefore, SOC can be a possible indicator of the effect of preconditions of the course, such as the communication a resource for health. There is still a lot of discussion about this course, the location and the recruitment, insuf- about the stability of SOC. Although it is a relatively sta- ficiently met the SOC of potential participants. So, more ble concept (Antonovsky 1996), it is possible to change insight was needed about how these older people per- SOC and ⁄or the dimensions within it (Eriksson & ceived these courses: whether they met their needs, and Lindstro¨m 2008, Lindstro¨m & Eriksson 2009). Some whether they felt able to attend and follow the course. studies show that SOC is more stable among those To gain insight into the three relationships of the people who have initially a high SOC (Nilsson et al. framework, different kinds of research and different 2003, Hakanen et al. 2007) and is less stable among those kinds of data are needed. To gather information about people with a low SOC. Reasons for this could be that the concept of health, an extensive questionnaire can people with a higher SOC probably have a greater vari- gather quantitative data to get insight into the main ety of GRRs at their disposal and know better how to health problems. Open interviews can be used to get use them. In that case, there is an interaction between the more insight into how older people experience these GRRs and SOC and therefore they can better deal with health problems, their own health and healthy ageing. stressful events in life (Hakanen et al. 2007). Within Such interviews can supply qualitative data which pro- health promotion for healthy ageing, special attention vide an explanation about the health concept in the HP should then be given to those older people who have a 2.0 framework. To gather insight into the resources for low SOC, because they have more difficulty in making health, possible research strategies can include: a use of the resources for health in the physical and social document analysis of annual reports of different organi- environment than older people with a high SOC. It is sations, interviews with family and informal caregivers known that a supportive social environment influences about the support and the care they give to the older per- health (Dahlgren & Whitehead 2006), and that creating son, interviews with different organisations about their supportive environments for these older people is facilities for older people, interactive sessions with these important for supporting and strengthening SOC. organisations in which they discuss facilities for older Within the HP 2.0 framework, the resources for people, and interviews or focus groups with older peo- health should be identified by older people as meaning- ple about these facilities. These different methods of ful, comprehensive and manageable resources to use enquiry can also provide useful information and under- and re-use to promote healthy ageing. However, standing of older people’s motives in their choices with nowadays municipalities, welfare workers and other regard to, for example, facilities for older people. Older professionals often decide which resources for health are people’s SOC can be measured by the validated Life important for older people. The ideas of these profession- Orientation Questionnaire (Antonovsky 1996, Lindstro¨m als about healthy ageing often do not match those of the & Eriksson 2005, Eriksson 2007, Hakanen et al. 2007). elderly people themselves. Therefore, the role of munici- This questionnaire provides quantitative data on SOC. palities, welfare workers and other professionals should Another research method to elaborate more on the con- become more facilitating, so that older people can have a cept of SOC is interviews and group sessions with older role as well in the development, implementation and people about the three different dimensions within the evaluation of resources for health. In this way, the HP 2.0 SOC, i.e. manageability, comprehensibility and meaning- framework also has the ability to support intersectoral fulness. These qualitative data provide more insight into, collaboration (including older people) for healthy ageing. according to the older people, desirable preconditions of This is a topic for further research. resources for health. The HP 2.0 framework is a promising policy model to This example shows that different kinds of research, improve healthy ageing in a municipality; however, which provide different kinds of data from a variety of some provisos are needed. First, the HP 2.0 framework stakeholders, are needed to develop resources for health relies heavily on the cognitive and judgemental ability of whichwillhaveacertainreachamong,orwillbeused the older person. When older people are not capable of by, older people in the municipality. Furthermore, these expressing their perceptions and their needs, then it is data are also needed to build knowledge together with the responsibility of professionals to do research and to the stakeholders about methods to strengthen SOC and assess the situation of these older people, so that they the health of older people in the municipality. can adapt the resource, as well as possible, to the understanding, the motives and the capabilities of older people with cognitive impairment. Then, there is still a focus on Discussion the salutogenic relationship between resources for health The HP 2.0 framework suggests that a resource for and the SOC of the older people: this relates closely to health can have an effect on the SOC of older people. the next proviso.

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Within the HP 2.0 framework, the meaning of healthy consequence of a focus on the salutogenic relationship is ageing is determined by the ageing individuals that a variety of research methods and qualitative and themselves (Hansen-Kyle 2005). This runs the risk of pro- quantitative data are needed to gather information and voking victim-blaming by others (Angus & Reeve 2006). to gain insight into the motives and the contexts of older Others can hold, according to their interpretation of people and into desirable preconditions of resources for healthy ageing, the older person responsible for ageing health. This information and these insights are used as healthily. It can shift attention away from the responsibil- input for the development and implementation of the ity of the government and other stakeholders, who are resources for health for older people. This information responsible for building and sustaining resources, such can also serve as input for the evaluation of a resource as living facilities for older people and accessible health- for health. The third consequence is that, within the HP care. For older people with a certain degree of cognitive 2.0 framework, all the relationships between the concepts frailty, these resources are particularly essential. should be evaluated, including the salutogenic rela- These provisos show that the ideal situation for tionship.Often,inpublichealthmuchevaluationis organisations and policy-makers – that older people conducted solely on the more traditional relationship actively participate in the development, implementation between resources for health and health. Consequently, and evaluation of resources – is not always realistic. This there is little information about the processes that lead to means that awareness of possible negative consequences, health and the reasons why a resource does or does not such as victim-blaming and the difﬁculty of involving show any effect on subjective health. If the salutogenic older people with cognitive frailty, of using the HP 2.0 relationship is incorporated into the evaluation, informa- framework is essential in health promotion practice. tion about the inﬂuences of the resource for health on the processes towards health and on SOC will give a deeper understanding of the possible effects on health. There- Conclusion fore, the HP 2.0 framework has the ability to guide and This article describes the HP 2.0 framework and how this facilitate processes that an intersectoral team in practice framework can be applied. The HP 2.0 framework is may undertake to develop, implement and evaluate based on the principles of health promotion and on the resources for health with a view to promoting healthy theory of salutogenesis. The framework is intended to ageing. support an intersectoral team to create a knowledge base which can support the processes and the content of the Acknowledgements development, implementation and evaluation of healthy ageing strategies. This study is part of the healthy ageing project of ThemaincontributionoftheHP2.0frameworkto Academic Collaborative Centre AGORA, funded by health promotion practice for healthy ageing is the visu- The Netherlands Organization for Health Research alisation of the relationships between three important and Development (ZonMW) (project number concepts within health promotion and salutogenesis. By 50-50400-98-008). The authors wish to thank all visualising these relationships, the framework highlights members of AGORA and the different stakeholders the importance of the participation of different sectors in the municipalities of Berkelland, Epe and Zutphen and older people in health promotion. The salutogenic for their contribution to the development of the relationship between resources for health and SOC also framework. becomes more explicit. The consequences of the HP 2.0 framework for the References development, implementation and evaluation of healthy ageing strategies are threefold. Because of the focus on Angus J. & Reeve P. (2006) Ageism: a threat to ‘aging well’ the salutogenic relationship, the active input of older in the 21st century. Journal of Applied Gerontology 25 (2), people and of other stakeholders is essential (WHO 137–152. Antonovsky A. (1996) The salutogenic model as theory to 2005). Within the theory of salutogenesis, to improve or guide health promotion. 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