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MANAGING COMMUNITY HEALTH PROBLEMS

IKM-KP 2 - Semester 2
MODULE OUTLINE for STUDENTS

DEPARTMENT OF PUBLIC HEALTH


FACULTY OF MEDICINE UNIVERSITAS BRAWIJAYA

2013

Module Outline

Managing
Community Health
Problems
IKM-KP 2
Semester 2, 2013

Please read this module outline fully and keep it handy for reference throughout the semester.
The module outline (this document) gives you important information about the general aims of the unit,
texts and references, and details about the assessment, including allocation of marks. You are required
to read and understand the expectations outlined in this document. Study it carefully, paying particular
attention to method of instruction, class times, and evaluation.

Coordinator:
Lecturers/Facilitators:

dr. Harun Al Rasyid, MPH


dr. Jack Roebijoso, MSc.OM (KK)
dr. Siswanto, MSPH
dr. Chusnul Chuluq Ar., MPH
drg. Purwani Tirahaningrum, MPd
Dra. Psi. Asmika M., MKes
DR. dr. Sri Andarini, MKes
dr. Nanik Setijowati, MKes
dr. Viera Wardhani, MKes
Lilik Zuhriyah, SKM, MKes
dr. Arief Alamsyah, MARS
dr. Harun Al Rasyid, MPH
dr. Safitri Dwicahyani
dr. Holipah
dr. Alidha Nur Rahma
dr. Nuretha Hevy Purwaningtyas

Module IKM-KP 2 - 2013

Objectives
Module Managing Community Health Problems provides students with a common grounding in the
theory and practice of public health. This module is the continuation of previous course Foundations of
Public Health (IKM-KP 1) in Semester 1. This module contains four topics:
1. Epidemiology
2. Health Promotion
3. Introduction to Family Medicine
4. Principles of Management.
Upon the successful completion of the module the student will be able to:

Understand the use of epidemiology in measuring health and disease

Understand epidemiology study designs

Understand the core competencies and characteristics of family medicine/doctor (WONCA)

Understand the basic concept of holistic and comprehensive approach in family medicine

Distinguish between the principles of health education and health promotion

Explain the framework of health promotion

Recognize health promotion actions in the community

Define management

Decide which principles of management apply in variety of situations

Participate in team-based learning.

Methods
The module will be completed through self-learning process and teaching-learning process, which
combines lectures, group discussion and experiential learning activities (Epidemiology Race, Health
Campaign, and Management games).

Evaluation
There are two types of evaluation: group evaluation and individual evaluation. Group evaluation is the
results of group performance in discussion and activities which will be marked equally among the
member of the group. Individual evaluation will be taken from pre-test/post-test, quiz, UTS and UAS.

Module IKM-KP 2 - 2013

Schedule IKM-KP 2
Date

Time

Class A

Class B

KBI

Monday, 13
May 2013

08.00 - 08.50

Introduction
pre-test

Introduction
pre-test

Introduction
pre-test

Lecture:
Health Promotion

09.00 - 12.00
12.00 - 13.00
13.00 - 16.00
Tuesday, 14
May

Group discussion
Lecture:
Epidemiology

Lecture:
Health Promotion

13.00 - 16.00

Tutorial:
Epidemiology

Group discussion

09.00 - 12.00

Lecture: Health
Promotion

09.00 - 12.00
12.00 -13.00

Wednesday,
15 May

Lecture: Epidemiologi Lecture: Family Medicine

12.00 - 13.00

Thursday, 16
May

13.00 - 15.00

Group discussion

15.00 - 16.00

Pleno

09.00 - 12.00

Lecture:
Family Medicine

Tutorial: Epidemiology

Lecture:
Epidemiologi

12.00 - 13.00
13.00 - 15.00

Friday, 17
May

Lecture:
Family Medicine

Tutorial:
Epidemiology

08.00 - 09.00

Quiz

Quiz

Quiz

09.00 - 11.00

Group discussion

Group discussion

Group discussion

13.00 - 15.00

Pleno

Pleno

Pleno

Monday, 20
May

08.00 - 16.00

Epidemiology Race

Tuesday, 21
May

08.00 - 16.00

Epidemiology Race

Epidemiology Race

11.00 - 13.00

Module IKM-KP 2 - 2013

Date

Time

Class A

Class B

KBI

Wednesday,
22 May

08.00 - 16.00

Health Campaign

Thursday, 23
May

08.00 - 16.00

Friday, 24
May

08.00 - 16.00

Health Campaign

Health Campaign

Monday, 27
May

08.00 - 16.00

Management games

Tuesday, 28
May

08.00 - 16.00

Management games

Management games

Wednesday,
29 May

08.00 - 09.00

Lecture:
Management

Lecture:
Management

09.00 - 10.00

Feedback & Wrap-up

Feedback & wrap-up

Lecture:
Management

Post-test

Post-test

post-test

10.00 - 11.00
11.00 - 12.00

Module IKM-KP 2 - 2013

Overview Topic 1

EPIDEMIOLOGY

Epidemiology is the study of how disease is distributed in populations and the factors that influence
or determine this distribution. Why does a disease develop in some people and not in others? The
premise underlying epidemiology is that disease, illness, and ill health are not randomly distributed
in a population. Rather, each of us has certain characteristics that predispose us to, or protect us
against, a variety of different diseases. These characteristics may be primarily genetic in origin or
may be the results of exposure to certain environmental hazards. Perhaps most often, we are
dealing with an interaction of genetic and environmental factors in the development of disease.
A broader definition of epidemiology than that given above has been widely accepted. It defines
epidemiology as the study of the distribution and determinants of health-related states or events in
specified populations and the application of this study to control of health problems. What is
noteworthy about this definition is that it includes both a description of the content of the discipline
and the purpose or application for which epidemiologic investigations are carried out.
Epidemiology has five specific objectives.
1. To identify the etiology or the cause of a disease and the risk factor that is, factors that
increase a persons risk for a disease.
We want to know how the disease is transmitted from one person to another or from a
nonhuman reservoir to a human population. Our ultimate aim is to intervene to reduce
morbidity and mortality from the disease. We want to develop a rational basis for prevention
programs, if we can identify the etiologic or causal factors for disease and reduce or eliminate
exposures to those factors, we can develop a basis for prevention programs.
2. To determine the extent of disease found in the community.
What is the burden of disease in the community? This question is critical for planning health
services and facilities and for training future health care providers.
3. To study the natural history and prognosis of disease.
Clearly, certain diseases are more severe than others; some may be rapidly lethal, but others
may have longer durations of survival. We want to define the baseline natural history of a
disease in quantitative terms so that as we develop new modes of intervention, either through
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treatments or new ways of preventing complications, we can compare the results of using such
new modalities to the baseline data to determine whether our new approaches have truly been
effective.
4. To evaluate both existing and new preventive and therapeutic measures and modes of health
care delivery.
For example, has the growth of managed care and other new systems of health care delivery
had an impact on the health outcomes of their patients and on their quality of life? Does
screening men for prostate cancer using the prostate-specific antigen (PSA) test improve
survival in patients found to have prostate cancer?
5. To provide the foundation for developing public policy and making regulatory decisions relating
to environmental problems.
For example, is the electromagnetic radiation that is emitted by electric blankets, heating pads,
and other household appliances a hazard to human health? Are high levels of atmospheric
ozone or particulate matter a cause of adverse acute or chronic health effects in human
population? Is radon in homes a significant risk to human beings? Which occupations are
associated with increased risk of disease in workers, and what types of regulation are required?

Taken from: Epidemiology by Leon Gordis, 3rd edition, Elsevier Saunders, Philadelphia, 2004.

Module IKM-KP 2 - 2013

Overview Topic 2

Health Promotion

In the past, prevention has encompassed changes in public health, including simple environment
interventions, such as John Snows removal of the handle of the Broad Street pump in the London
cholera epidemic of 1849. As people began to congregate in towns and cities, health education arose
from a need to transmit information to the public about hygiene and other health-related issues. Now,
because many modern diseases have a social, economic, behavioural, and environmental or lifestyle
aetiology, the emphasis in prevention has shifted to procedures aimed at altering social and physical
environments and individual and community behaviour, a process now called health promotion.
Until recently, health promotion was more commonly known by the term health education. Health
education emphasised the structuring of learning experiences to facilitate voluntary actions conducive
to health. Some writers consider the two terms to be synonymous, but we distinguish the two. Health
education is embedded within the broader field of health promotion. Health promotion has been
defined as the combination of educational and environmental supports of actions and conditions of
living conducive to health.
The WHO sponsored Ottawa Charter in 1986 was a milestone in international recognition of health
promotion. It outlined five specific actions for health promotion under the new public health. These
were:

Developing healthy public policy

Developing personal skills

Strengthening community action

Creating supportive environments, and

Reorienting health services

Since then, the Jakarta Declaration (1997) has added to and refined these original proposals with the
following priorities

Promoting social responsibility for health

Increasing investments for health developments in all sectors

Consolidating and expanding partnerships for health


Module IKM-KP 2 - 2013

Increasing community capacity and empowering the individual

Securing an infrastructure for health promotion

Figure 1 presents a framework on which the structure of this text is based. We have chosen to focus
on individuals, groups or populations to demonstrate the strategies and tools of health promotion
practitioners. The strategies range from educational and motivational approaches and social
marketing techniques to economic, regulatory, technological and organisational interventions. The
first two of these (education and motivation) primarily address intra- and interpersonal factors that
underlie risks for health, whereas the last four are aimed at the socio-political, physical or sociocultural
environments-addressing the risk conditions for health promotion interventions are more likely to be
effective where combinations of strategies are employed.

Illness
or
health
risk

Individuals
Groups
Populations

Educational
Motivational
Operational
Economic
Regulatory
Technological

Behavioural
adaptations
Environmental
adaptations

Better
health
and
wellbeing

Quality
of Life

Figure 1. A framework for health promotion

The Curtin University Staff Health Promotion Program


To illustrate the concept of health promotion an example is taken from the Curtin University Staff
Health Promotion Program. This long running program is the most comprehensive health promotion
intervention of its type in an Australian university and has won several awards. Its objectives include
the creation of a healthy environment and providing opportunity for healthful behaviours such as
those relating to diet, physical activity, alcohol, tobacco and other drug use, and stress reduction. This
example focuses specifically on the objectives to increase the amount of physical activity undertaken
by the 4000 staff employed by the University.
Health education for behavioural change includes providing information to staff related to physical
activity and health via newsletters (electronic and mailed copies), brochures, emails, displays etc.
Health education for structural change includes the provision of information about the benefits of
physical activity to senior management staff who have been responsible for supporting the program
with resources. This education or lobbying of these senior staff ensured that the program became
incorporated as part of the staff employment enterprise bargaining agreement which includes a time
off work policy.

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Organisational actions include allowing staff to take up to two hours per week of work time to
participate in program activities providing the time, is matched by their own time such as before or
after work or lunchtime participation. Another example is that a varied program of physical activities
(e.g. dance, volleyball, wayball, walking, weight training, yoga) is offered at times that best suit staff.
Economic actions include providing physical activities at subsidised cost to staff, and with the
University allowing employees up to two hours per week to participate in program activities. Payment
for activities including gym membership can be undertaken via salary packaging.
The effect of this combination of strategies is to bring about attitudinal and behavioural change (i.e.
increase exercise levels amongst staff), as well as social (eg improved connectedness) and
environmental changes (eg improved facilities and resources for physical activity) conducive to
health (in this case, the health benefits of physical activity).
Finally, based on evidence from other programs, it is expected that these changes will ultimately
result in improved health status (eg less risk of cardiovascular disease; improved mental health) of
the participants. This combination of strategies is an example of creating a supportive environment
for the targeted behaviour (physical activity).
Since its inception in the late 1980s, the program has been designed and run by the staff (i.e.
consumer participation) as an opportunity for them to increase control over their own health. A
fulltime program director coordinates the program, and liaises closely with all sections of the
institution that provide services relevant to promoting health, including physical activity. A program
management committee consists of representatives from all major sections of the University including
the staff unions, and the service providers (e.g. Health and Counselling Services, recreation and
sporting facilities and services, occupational therapy and occupational health and safety services, the
campus Health Promotion Centre, the Department of Health Promotion, Human Resources, etc). In
addition a network of advocates from staff groups is maintained by the program director. A continual
interaction with this large number of consumer representatives along with regular surveys ensures
substantial consumer participation in the design and delivery of the program. This approach has also
ensured sustainability of the program for over a decade.
This whole process is a good example of health promotion in practice. It also illustrates a successful
community development approach, as it was the staff themselves who identified a need for such a
program, and it has been the staff who have had a major role in designing and delivering the program.
Closely related to this has been substantial capacity building of staff to carry out these tasks.
Community development and capacity building are inherent to the definition of health promotion.

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Overview Topic 3

Introduction to
Family Medicine

Family medicine is a division of primary care that provides continuing and comprehensive health care
for the individual and families across all ages, genders, diseases, and parts of the body. It is based on
knowledge of the patient in the context of the family and the community, emphasizing disease
prevention and health promotion. The family physician will also give an advocation to patients by
providing advice whether certain diagnostic procedures or treatments are necessary or not.
The term family medicine is used in many European and Asian countries, including Indonesia, instead
of general medicine or general practice. Doctors who practice family medicine are specially trained
physicians or general practitioners at primary care practice. According to the Association of Indonesian
Family Physician, the main philosophy of the application of family medicine approach is delivering
comprehensive and holistic medical care to patients and families.

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Overview Topic 3

Principles of
Management

Management has been applied since the beginning of civilization and community living; it is not an
invention of the 20th century. Whenever people have worked together in groups - to grow crops,
to buy and sell, to wage war, to build a temple - there has been management.
Although management is so old and universal, it has no agreed definition; there are many
definitions to choose from and readers can select their own to suit their purposes. Perhaps the
shortest is:
Management is: getting things done
The principle underlying this definition is `commitment to achievement', i.e. commitment to
purposeful action, not to action for its own sake. To stress this notion of purpose the definition
may be rewritten as follows: `management is saying what one wants to be done, and then getting
it done'. In other words, management ensures first that objectives are specified (i.e. states
specifically what is to be achieved) and then that they are achieved.
Doctor as manager
Doctor has several responsibilities in collaboration with other parties to maintain the health status of
individual and community. WHO has stated the main functions of doctor in primary care setting as
the five star doctor as follow:

Care provider : Who considers the patients holistically as an individual and as an integral
part of the family and the community, and provides high quality, comprehensive,
continuous, and personalized care within trusting long-term relationship

Decision maker: Who makes scientifically sound judgments about investigation,


treatments and use of technologies that take into account the patients wishes, ethical
values, cost effective considerations and the best possible care for the patient

Community leader: Who, having won the trust of the people among whom he or she
works, can reconcile individual and community health requirements, advise citizen
groups, and initiate action on behalf of the community

Communicator: Who is able to promote healthy lifestyle by effective explanation and


advocacy, thereby empowering individual and groups to enhance and protect their health
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Manager: Who can work harmoniously with individuals and organizations both within and
outside the health system to meet the need of individual patients and communities,
taking appropriate use of available health data

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READING LIST
1. Epidemiology foundations: the science of public health by Peter J Fos, Jossey Bass, San
Francisco, 2011
2. Pengantar metode epidemiologi by Bambang Sutrisa, Dian Rakyat, Jakarta, 2010
3. Foundations for health promotion by Jennie Naidoo & Jane Wills, 3rd edition, Elsevier, UK, 2009.
4. Promosi kesehatan: teori & aplikasi by Soekidjo Notoatmodjo, Rineka Cipta, Jakarta, 2010.
5. The European definition of general practice/family medicine, WONCA Europe, 2011.
<http://woncaeurope.org/content/european-definition-general-practice-family-medicineedition-2011>
6. On being in charge: a guide to management in primary health care by Rosemary McMahon,
Elizabeth Barton & Maurice Piot, WHO, 1992.
<http://whqlibdoc.who.int/publications/9241544260.pdf>

Module IKM-KP 2 - 2013