DETERMINAN PROMKES

MUH. SYAFAR

THE MEANING OF HEALTH
Health is state of complete physical, mental, and social well-being and not merely the absence at disease or infirmity (WHO, 1947) Health is the condition of organism which measures the degree to which its aggregate powers are able to function (Obertenffer, 1960)

Health can be regarded as an expression of fines to the environment, as a state at adaptation (Dubos, 1965)

mental. 1974) . and social activity taking age into account (Lalonde.Health the quality at life involving dynamic interaction and interdependence among the individuals main train a continuum at balance and purposeful direction with environment where be is functioning (Dunn. 1967) Healt is a state at well-being sufficient to parform at adequate level of physical.

and personal components at individual’s health system (Bates and Winders. 1984) Health can be defined as the quality of people’s physical. social. and sociological functioning that enables the to deal adequately with the self and others in a variety of personal and social situations (Redwonth. psychological.Health is the capacity to cope with on adapt to discruptions among the organic. 1992) .

positive self-concept. cognition. which result from adaption to the environmen (Shirreffs. 1982) Component of health but also includes skill development values awareness. other variables (Horowitz. 1985) . involving social. mental and biological fitness on the part of the individual.Health as quality of life.

emotional health. (Dintiman and Greenberg. spiritual health and physical health. (Linda Ewel’s. 1992). 1985) Social health.Multidimensional and includes vocational health as well as the more traditional health components (Eberst. mental health. 2000) .

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SOCIAL DETERMINANTS OF HEALTH .

• • • • • • Determinants of health Proximal determinants of health Distal determinants of health Disability adjusted life years (DALYs) Ecological fallacy Social capital .

Proximal determinants or downstream factors 2.Determinats of health : 1. Distal determinants or upstream factors The entanglement of the social determinants of health Gender Ethnicity Wealth Education .

Disability-Adjusted Life Year (DALY) Daly adalah ukuran beban penyakit secara keseluruhan. . cacat atau kematian dini. yang dinyatakan sebagai jumlah tahun yang hilang akibat sakit.

000 Rp.200.770 x Rp.Kerugian Ekonomi penderita HIV dan AIDS di Indonesia Tahun 2010 Jumlah Penderita tahun 2010 = Hasil perhitungan 21.Rp.000. 1. 360.Total biaya perawatan penderita di Indonesia dalam setahun = 21. 7.000.770 orang Biaya Perawatan per hari Biaya perawatan per orang dalam 1 tahun 12 X Rp.000.000.000.000.000.837. 30.- Rp.30.000.000.- .

1.000.000.5 Trilyun x 12 bulan Cukai rokok (April 2010) Rp.000.000. 234 Trilyun/tahun Rp.000.Dalam 1 bulan 30 X 650 milyar 650.000 x Rp.19.3 Trilyun .000 batang Rp.000 Dalam setahun 19.000.650.000 x 10 btg Total Harga : 650.000 = Harga rokok per batang rerata diisap 10 batang/hari Total konsumsi perhari : 65.000. 28.000 penduduk Hasil Perhitungan Jumlah Perokok : 28 x 225.000.5 Trilyun/bulan 65.000 batang Rp.Pengeluaran Biaya Merokok Penduduk di Indonesia Tahun 2007 Jumlah Penduduk :225.

000 = Harga rokok perbatang Rp. 3 milyar Dalam setahun Rp.1 % x 1.000.08 Trilyun .1.000 penduduk Jumlah Perokok : 22.300.Pengeluaran Biaya Merokok Penduduk di Makassar Jumlah Penduduk : 1. 90 milyar/bulan Rp.300.300 Orang ± Rp. 1.90 milyar x 12 bulan Hasil Hitungan 287. 1.300 x Rp. 3 milyar/hari Rp./batang rerata diisap 10-12 batang/hari Total harga 287.000.Dalam 1 bulan 30 hari x Rp.

Ecological Fallacy About the relationship between individual wealth and individual health. .

Social Capital • Social Capital is a term that became of interest to many health researchers looking at social determinants of health • “ Trust ” and “ Reciprocity “ .

ENVIRONMENTAL DETERMINANTS OF HEALTH .

• Environmental health • Ecologically sustainable development • Equaity and environmental health justice • Physical settings • Life support systems .

Mandala of health: a model of the human ecosystem Cultur Community Lifestyle Personal behaviour Sickcare system Human biology Family Spirit Psychoeconomic environment Work Body Mind Physical environment Human-care environment Biosphere .

60 per cent degraded More mammals extinct than any other continent Waste production per head second in Organization for Economic Cooperation and Development Geenhouse gases increasing by 16 per cent (8 per cent allowed by 2008 in the Kyoto Agreement . acidification of soils Increased erotion. drop in rainfall Reduced by 10 per cent every year. droughts.Local effects of loss of global sustainability GLOBAL CHANGE Air Ozone Global warming Water Imigration Forest clearances Land Productive land Life Biodiversity People Population Energy Energy Life AUSTRALIAN LOCAL EFFECTS Melanomas (world’s highest level.) Tasmania Floods. changed pollination patterns Salting.

Physical Settings • Urban Environments • Rural and Remote Environments .

Life Support Systems • Air Pollution • Water Pollution • Contaminated Food .

BIOLOGICAL DETERMINANTS OF HEALTH .

Biological determinants of health and disease Models of disease causality The role of genes Race and ethnicity as determinants of health and disease Morbidity and mortality in relation to age Gender differences in health and disease Understanding biological markers of risk .

or moderate the pathways towards health or disease Interactions between genes.Biological determinants of health and disease Disease refer to a wide range of heterogeneous. intra-individual factors that drive. mediate. behaviours and environments .

Single gene disease-sickle cell anaemia 2.Gene-environment interation pattents an example of : 1. Multi-gene diseases .

f>88cm) Diabetes Saturated fat intake (% of energy) Protective factors Psysically active (>150 minutes/week) Alcohol intake (low risk pattern in 60+ age group) Vegetable and fruit consumption (>five serves/day) Adequate HDL (‘good’) cholesterol (>1.Gender Differences in risk Factors and protective facvtors for cardiovascular diseases (prevalence rates except for saturated fats) DETERMINANTS MALES (%) FEMALES (%) 18 31 50 67 27 8 13 13 27 42 52 34 7 13 Risk factors Smoking (current smokers) High blood pressure (>140/90) High LDL (‘bad’) cholesterol (>3.5 mmol/I) Overweight + obesity (body mass index >25 kg/m2) High abdominal girth (m>102cm.0 mmol/I) 56 67 39 81 44 62 47 95 .

with flaring up the leg. Her mother washed the wound and bandaged it. was playing with her siblings outside her home in a smal. Over a week the wound did not heal. Ama began to complain that she had pain in her groin. a small. tree-year-old child. . The wound remained red and ‘angry’. she became weak and febrile. While chasing her older brothers she trod on a nail. semi-urban. the area remained red and ‘angry’. slum area. Ama was taken to hospital when her mother could not control her fever and she died within a few days of a few days of admission.Case study Ama.

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