In Creating Regenerative Cities — a book based on Girardet’s work with the World Future Council — he describes the evolution of cities from ‘agropolis’ to today’s ‘petropolis’. To create ‘ecopolis’ as cities that are restorative and regenerative by design, we need to learn from the cascading and circular flows of energy and matter within ecosystems. Applying these patterns to how we organize cities can help us reduce their ecological footprint. The aim is to optimize the urban metabolism by designing for circular resource and energy flows and reliance on renewable energy and resources (Girardet, 2015). Watersheds are a useful starting point for exploring bioregional boundaries and situating cities within the context of their bioregion. Clearly some watersheds of the world’s major rivers are so large that the appropriate scale for bio-regional context for cities within them might require defining sub-regions within one large watershed. Girardet’s book is a great place to start exploring how cities can become Salutogenic processes that support the health of their inhabitants and of people in their bioregion while actively restoring healthy ecosystems functions and regenerating planetary health. We would however do well to pay attention to the crucial role that civic participation, public education and individual and collective capacity building will play in this transformation.
Whether during the many millennia of our Nomadic existence or among the early settled cultures, our patterns of living were closely matched to the uniqueness of the places and regions we inhabited. Bioregional patterns of organizations are not something new. We are invited to combine the wisdom of indigenous cultures with the best of modern (appropriate) technology to rematch our human presence into the bio-physical realities of regions within the limits of planetary boundaries (Rockström et al, 2009).
With more than half of humanity living in urban areas, the creation of bioregionally regenerative cities will be a critical contribution to the redesign of the human impact on Earth from being exploitative and degenerative to being regenerative and healing!
The healing of humanity’s relationship to the rest of the community of life and to the health sustaining cycles of natural process lies at the heart of salutogenesis. The salutogenic model of health and the associated concept of salutogenesis was first discussed by the sociologist of health Aaron Antonovsky1, in his book Health, Stress and Coping (Antonovsky, 1979). Antonovsky distinguished between a “pathological orientation”, which “seeks to explain why people get sick, why they enter a disease category,” and a “salutogenic orientation (which focuses on the origins of health)” (Antonovsky, 1987, p.xii). Antonovsky’s own discussions of the concept do not go into detail regarding the environmental foundations for a healthy society. His focus is mainly on the social and societal dimensions of the phenomenon of health.
Antonovsky hypothesized that “generalized resistance resources” like “money, eco-strength, cultural stability, social supports, and the “like” were providing individuals with the ability to resist against the continuous stressors their environments exert. Variable resistance to omnipresent stressors “ranging from the microbial to the societal-cultural levels” explained why some people are healthy in conditions that lead to the manifestation of disease in others.
Antonovsky proposed the “sense of coherence concept (SOC)”2 to understand all community based processes that improve the “generalized resistance resources” of individuals and their communities. The common element among these processes is that they provide all participants with a way of “making sense out of the countless stressors with which we are constantly bombarded.” Doing so repeatedly over time allows for the emergence of a strong sense of coherence (Antonovsky, 1987, p.xiii). It is this sense of coherence that makes individuals and societies more resilient and healthy.
Antonovsky suggested that one key component of a high sense of coherence is the extent to which a safe and healthy future could reasonably be predicted. The sense of coherence is highest in people who live in highly socially cohesive and place-based communities of human scale, who have an intimate knowledge of their local environment and a long tradition of successfully adapting to environmental changes and of meeting their needs effectively without damaging their local environment. “Salutogenesis,” according to Antonovsky (1987, p.9), “leads us to focus on the overall problem of active adaptation to an inevitably stressor-rich environment.” He described salutogenesis as a strategy that counteracts the universal decay towards greater entropy.
“The key term becomes negative entropy, leading to a search for useful inputs into the social system, the physical environment, the organism and lower-order systems down to the cellular level to counteract the immanent trend toward entropy… [Salutogenesis] opens the way for cooperation between biological and psychosocial scientists… When one searches for effective adaptation of the organism, one can move beyond post-Cartesian dualism and look to imagination, love, play, meaning, will, and the social structures that foster them. Or, as I would prefer to put it, to theories of successful coping.”— Aron Antonovsky (1987)
In the way that Antonovsky described the “salutogenic orientation,” it is derived from “the fundamental postulate that heterostasis, senescence, and increasing entropy are core characteristics of all living organisms.” Based on this postulate Antonovsky described a number of characteristics of a salutogenic orientation.
It keeps us from falling into the trap of focusing solely on the etiology (direct causes) of a given disease rather than always searching for the total story of a human being, including their sickness. Instead of asking, “What caused (or will cause, if one is prevention-oriented) a person to fall prey to a given disease?”—that is, instead of focusing on stressors, we now ask, “What are the factors involved in at least maintaining one’s location on the continuum or moving towards the healthy pole?” That is, we come to focus on coping resources. Stressors come to be seen not as a dirty word, always to be reduced, but as omnipresent. Moreover, the consequences of stressors are viewed not as necessarily pathological but as quite possibly salutary, contingent on the character of the stressor and the successful resolution of tension.
If we go beyond asking “what would a healthy city look like?” or “how can we create sustainable cities?” and understand cities primarily as a process and the physical infrastructure of cities as temporary manifestations or footprints of that underlying process instead, we can begin to explore the potential of cities. In contradistinction to the search for magic-bullet solutions, we are urged to search for all sources of negative entropy that may facilitate active adaptation of the organism to the environment.
For example, the use of pesticides has increased dramatically during the last 50 years. Nitrates and phosphates used as fertilizers cause the eutrophication of rivers and lakes resulting in the death of fish and other aquatic organisms. The run-off from US farms draining into the Mississippi River and on to the Gulf of Mexico is directly linked to the appearance of a 20,000 square kilometre dead zone in the Gulf (Norberg-Hodge et al., 2000, p.18). 22 Many crop pest populations respond to the use of pesticides by developing resistance. There are now more than 500 recorded species of insects, which have developed resistance to at least one type of pesticide. “According to the latest estimates of the World Health Organization, at least three million and perhaps as many as 25 million agricultural workers are poisoned each year. Of these, some 20,000 die” (Pretty, 1998, p.57).
Friedrich Schmidt-Bleek,3 professor of physical chemistry and vice-president of the Wuppertal Institut in Germany, emphasizes that from the scientific viewpoint it is fundamentally impossible to determine, for even a single substance released into the environment, what its possible chemical, physical and biological impacts on ecological systems will ultimately be. He maintains that to investigate, simulate, quantify and give economic or even financial value to these impacts is therefore of limited use (Schmidt-Bleek, 1997, p.88). Such endeavours will mainly reflect how much complexity and context has been included in the particular study. Their effects can be at worst misleading, and at best vaguely indicative.
The awareness of the health damaging effects of chemicals bio-accumulating within the food chain is gradually increasing. The UK government report Local Quality of Life Counts by the Department of Environment, Transport and Regions 4 emphasizes that “chemicals are an integral part of our lives. They provide us with many of the consumer goods we have come to take for granted and the chemical industry is a vital part of the national economy. However, there are risks from the manufacture and use of certain chemicals and it is essential that we identify and manage them sustainably so that the environment is protected” (DETR, 1999, p.110).
The report warns, “pollutants can move between soil, air and water. Dispersed releases are especially important when pollutants build up in the environment, either because they accumulate in plants, animals or people, or because they persist for long periods. We must ensure that we do not store up problems for the future” (DETR, 1999, p.165).
Another example the report highlights are the problems associated with ozone depletion in the upper atmosphere. It states that “man-made emissions of substances containing chlorine and bromine decrease the stratospheric ozone layer, thus increasing the amount of ultraviolet radiation from the sun reaching earth’s surface, which can have consequential effects on both environment and health” (DETR, 1999, p.189).
The long-term effects of the many thousand of new chemical compounds that humanity has released into the environment over the last two hundred years are very difficult to predict with any certainty. It is fair to assume that we already have altered the course of planetary evolution significantly and irreversibly. Yet this insight should not lead to fatalistic complacency but to immediate action.
Another related example for the anthropogenic reduction of ecosystem and planetary health is the erosion of soil, both quantitatively and qualitatively. The Local Quality of Life Counts report emphasizes: “soil is essential for the production of food and other crops, for maintaining biodiversity, for the landscape” (DETR, 1999, p. 209). It adds: “Development can have adverse effects on both the biological and physical properties of soil and can limit its future uses. The sustainable use of soil requires that a sufficient quantity of green field soil is retained for present and future needs: for example, ecosystem support, food and fibre production and the protection of cultural heritage” (DETR, 1999, p.211).
Accelerating erosion is mainly driven by the creation of human infrastructures resulting in the covering over of bioproductive areas and their soils by cities and transport roads. The widespread burying of organic wastes in landfill sites prevents it from replenishing the rapidly depleting soils of the world’s agricultural areas. The UK Department for Environment, Transport and Regions emphasized that “the precise mechanisms by which organic matter maintains soil quality are not completely understood, but it is known that it plays a key role in maintaining soil attributes such as fertility, structural stability, water-holding capacity, and buffering capacity” (DETR, 1999, p.212).
Agricultural intensification 6 causes soil erosion. The removal of field boundaries and hedgerows lead to a loss of 30 to 95 tonnes of soil per hectare (Pretty, 1998, p.69). “Chemical fertilizers and pesticides are destroying the very soils we depend on for our survival. Beneficial soil microbes are being lost, while soil acidification and soil erosion are increasing. In parts of the corn belt of the USA, 20 pounds of topsoil are lost for every pound of harvested grain” (ISEC, 2001). These are all examples of inappropriate, negligent and thoroughly unsustainable design contributing to a decrease in ecosystems’ health. Badly designed food systems based on mass-production, chemical fertilizers and a heavily fossil-fuel intensive global agribusiness are destructive to human and planetary health. Without maintaining healthy and productive soils, the quality of our diet will decrease even further and with it the levels of human health.
Furthermore, by destroying local, ecologically adapted and community based farming practices, we are loosing important indigenous and place-based knowledge and are destroying the social fabric of rural communities. Along with uncontrolled urbanization, the unrestrained release of greenhouse gases, and a rapidly growing human population, these are some of the most damaging impacts on the health of ecosystems and the biosphere. Gretchen Daily, 7 an interdisciplinary research scientist at Stanford University, points out that humans distinguish themselves from all the other estimated 30,000 million species alive today by the impact we have on the planet. Humanity “controls a disproportionate and rapidly growing share of the planet’s resources” (Daily, 2000, p.228). Daily lists a series of crucial environmental effects that this explosive population expansion has had on the Earth’s natural processes. Human activity has massively altered the biogeochemical cycles 8 of major elements such as carbon, nitrogen, and sulphur, with dramatic changes in the chemical composition of the atmosphere, water, and soils. Human technologies have transformed minerals such as coal, oil, and metal ores from the Earth’s crust at rates that rival or exceed geological rates. In particular since the Industrial revolution humans have annually dispersed millions of tons of synthetic chemicals while introducing 1,000 new ones per year to the approximately 100,000 now in the environment. Industrial agriculture has converted tracts of diverse natural forest and grassland to uniform, managed forests, pastures, and food crops, greatly contracting the range of most wild species. Human activity has inadvertently transferred species around the world while blocking (with highways, farm fields, and suburban sprawl) natural processes of dispersal.
This data emphasizes how alarming the current trends actually are and poses an unprecedented challenge to humanity as a whole:
And if so, will we be able to do it in time to halt, and to some extent reverse, the current system trajectories aiming towards accelerating ecological and social disintegration and a drastic decrease in human and planetary health? This is the challenge faced by the salutogenic design approach.
Most of the current crisis of sustainability is to some extent caused by the chain effect initiated through designing a monetary economy 9 along principles that increase competition, division, inequality and greed. We are now facing the results of the piece-meal thinking employed by most economic theory of the last 200 years—a tragically consequential mistake in our society’s guiding meta-design. To anchor the guiding and explanatory story, we tell about ourselves, in an institutionalized individualism and focus on resource scarcity and individual and national competition for these limited resources, was fundamentally the wrong approach. The planet’s resources could be held in responsible stewardship by all of humanity, enabling present and future generations to meet their needs sustainably.
The economists of the 21st century are faced with the salutogenic design challenge to create appropriate economic systems at the appropriate scale. Such economies would nurture the social cohesion and cooperative structures that serve to maintain the health of society as a whole.
“It is important to recognise that through most of human history and prehistory, human societies have made a point of avoiding some of the economic causes of social disharmony and have preferred more egalitarian social systems. The fact that we have had, throughout most of the existence of our species, what is by modern standards a remarkably egalitarian mode of social organization, suggests that we may not be psychologically well adapted to inequality and individualism.” — Richard Wilkinson 10 (1996)
As individuals who are fundamentally interconnected through culture and nature, we are more likely to engage in salutogenic design if we create economic practices that reconnect us to each other, to our communities and to the natural environment. Salutogenic design is design for cooperative structures and social and ecological symbiosis. It is synergistic design.
“A number of studies have shown the beneficial health effects of more, and better quality, social contact between people at home or in the community.” More ecologically and socially appropriate economic systems would improve both social and environmental health, improving quality of life without a need for economic growth or increased resource consumption. Wilkinson also highlights the effect of oppressive or stressful social hierarchies, based on income or power inequalities, on health. He cites physical evidence from autopsies that have shown consistently that individuals from poorer background have been found to have larger adrenal glands at the end of their lives, which indicates a life-long level of stress significantly higher than that of people from richer background who are found to have smaller adrenal glands (Wilkinson, 1996, p.176). This clearly indicates that the basic stress levels throughout their lives were consistently higher. So much so that the gland producing hormones in response to this stress grew larger.
Such results indicate that by re-designing patterns of social organisation—turning dominator into growth hierarchies—with the aim of creating more equitable societies, we are likely to improve health at the societal scale and are therefore engaging in salutogenic design.
In doing so we would make urban development a healing profession. This offers an invitation for urban design professionals to take a form of Hippocratic Oath: 11 Do no harm! I personally believe we do urgently need such an oath for urban development and all forms of design. At the bio-
regional scale we can reintegrate urban development into the bio-physical processes that maintain ecosystems health and stabilize climate patterns. We can do so in place-sourced ways that pay attention to manifesting the potential inherent in the bio-cultural uniqueness of people and place. The bioregional scale is the scale at which we can increase the resilience of communities, cities and their region in the face of the catastrophic climate change we are already committed to. Past emissions will cause continued warming for the coming decades at best. We need to act decisively now to avoid irreversible climate cataclysm and a worsening of the extinction crises driven by cascading ecosystems collapse.
Creating Salutogenic cities that catalyze the improvement of ecosystems and planetary health is grounded in place and participation and focuses on the local and regional scale. Yet, it also needs to be enabled through collaboration, solidarity and open knowledge exchange at the national and international scales, in order to be inclusive and reduce inequality. A Salutogenic City serves its inhabitants by improving their health and as a process of bioregional regeneration contributes to planetary health.
The interconnectedness of human and planetary health demands a holistic approach that redefines how we live, design, and coexist with the natural systems that sustain us. The concept of salutogenesis, as articulated by Antonovsky, provides a powerful lens to understand and address the root causes of health and resilience—both for individuals and ecosystems. Rather than focusing solely on the mitigation of harm or the treatment of symptoms, a salutogenic perspective emphasizes the creation of environments, systems, and processes that actively foster health, coherence, and adaptation in the face of stressors.
The evolution of cities from agrarian agropolis to fossil-fuel dependent petropolis must now shift toward regenerative ecopolis—cities designed not just to sustain but to actively restore ecosystems while enhancing the well-being of their inhabitants. By integrating bioregional principles, cities can operate as part of larger, life-sustaining systems, rooted in the unique characteristics of their watersheds, climates, and cultures. This vision requires a fundamental redesign of urban infrastructure to reflect the circular flows of energy and matter that underpin healthy ecosystems, reducing ecological footprints while fostering local resilience.
Historically, humans have thrived by adapting to and working within the ecological and bioregional realities of their environments. In reclaiming and evolving these bioregional patterns, we have the opportunity to merge indigenous wisdom with modern, appropriate technologies to create systems that are both sustainable and regenerative. This approach is particularly urgent as the ongoing crises of soil erosion, chemical pollution, climate change, biodiversity loss, and the breakdown of social cohesion highlight the unsustainable trajectory of current practices. Cities, as hubs of human activity and innovation, must lead the way in catalyzing this transformation.
Achieving this vision of regenerative, salutogenic cities requires a cultural shift, supported by civic participation, public education, and capacity building at all levels. Civic engagement is critical not only to ensure that solutions are inclusive and equitable but also to foster a sense of collective purpose and agency. By promoting local stewardship and bioregional collaboration, communities can take active roles in restoring ecosystems while enhancing social cohesion and equity.
Economic systems must also be reimagined to align with this regenerative vision. Rather than perpetuating inequality, competition, and ecological exploitation, economies must foster cooperation, social symbiosis, and environmental stewardship. Salutogenic design principles applied to economic systems can help create societies that are not only more equitable but also more adaptive, resilient, and supportive of well-being.
Urban development must rise to the challenge of becoming a healing profession, taking responsibility for fostering ecological and social health. Design professionals should adopt a regenerative ethic akin to a Hippocratic Oath: first, do no harm. This commitment must extend beyond the physical footprint of urban projects to encompass their long-term ecological and social impacts. Cities must be seen not as static entities but as dynamic processes that integrate human activity into the life-supporting cycles of nature.