Joko Mulyanto CHEM 2 – 2012

• The underlying social, economic, cultural and environmental factors that are responsible for health and disease, most of which are outside the health sector. • Not direct cause of the disease • Proximal cause (Enabling, Reinforcing Factors)

• Universal medical access is not sufficient. • The concept of multiple determinants of health. • Limited contribution of medical care in health status of population. .SIGNIFICANCE OF HEALTH DETERMINANTS • The biomedical model of health. • Growing recognition of other underlying determinant of health status.

Lalonde) • Health field Model (Evans & Stoddard) .MODEL OF HEALTH DETERMINANTS • Force-field health paradigm (Blum.

FORCE – FIELD HEALTH PARADIGM • • • • Heredity Environment Behavior Healthcare services .


MAJOR HEALTH DETERMINANTS • • • • • Social environment Genetic endowment Physical environment Behavior Healthcare .

SOCIAL ENVIRONMENT • • • • • • Family structure Education Social network Social class Work setting Level of prosperity .

Family Structure • Two-parents family is better than single – parent family • Nuclear family is better than extended family .

• Young age education influence health behavior • Mother education influence maternal and child health status .Education • Independent effect on health status regardless the income • Higher level education better health status.

Social Network • An individual’s integration into a self-defined community and the degree of connectedness to other individuals and to institutions. • There is a strong inverse correlation between the number and frequency of close contacts and mortality from all causes. 1979) . with odds ratios of 2:1 or higher and a clear “dose–response” relationship (Berkman and Syme.

Social Class • A clear relationship between social class (based on job classification) and mortality. • The relationship persists throughout the social hierarchy and is unchanged after adjusting for income and smoking. .

Work Setting • Autonomy in job • Involuntary unemployment .

Level of Prosperity • Level of income independently and consistently correlated with mortality rate .

GENETIC ENDOWMENT • • • • Significant influence on health Risk predictor rather than certain cause. affective disorder Interaction with social and physical environment • Susceptibility of the host . Schizophrenia.

PHYSICAL ENVIRONMENT • • • • • Various way Exposure of hazardous material Safety at work and home Poor housing Overcrowding .

BEHAVIOR • Individual response to external stimulus specially from environment • Free-choice behavior • Lifestyle: Pattern of behavior. economically constrained . and consistently endure for certain period. culturally embedded. • Socially influenced.

HEALTH CARE • Limited but not neglected • Preventive and curative care .

CONCLUDING COMMENT • Health is broad and determine by multiple factors. • Healthcare it self will not sufficient to improve health of population .

THANK YOU 2012 .