GROUP 1

Agnes Butet Hanis – 1706040416

Gavin Andre Irhandy – 1706045783
Liana Oktavia – 1706040460
Made Bayu Hari Utama – 1706045455
Pelegia Samira Pattdiana Sitompul – 1706040454
Tirza Amadea Nugroho – 1706040473
Vena Adrianti Ningrum – 1706045770

Answers for Block 3

1. After you have read and gathered information about the above determinants, please draw a mind map/diagram
on determinants that play roles in global health, make it complete and the mind map must be followed by
narrative at length.
Answer:

Determinant of Health is conditions that affect a person's opportunity to obtain health. Factors such as poverty,
food shortages, social inequality and discrimination, unhealthy childhood conditions, and low employment status are
important determinants of illness, death and health imbalances between and within a country.

There are 7 first individual determinants of global health, Individuals are divided into 3 namely Genetic, Gender,
and Age. The first is genetic, genetic has a determinant that is inheritance plays a role in determining age, health, and the
possibility of developing certain diseases. Personal behavior and coping skills - balanced eating, staying active, smoking,
drinking, and how we face life's stresses and challenges, all affect health. The second is Gender, men and women suffer
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from various types of diseases at different ages. The third is age, the healthier people eat, the age will be longer, and vice
versa. Third is the Physical Environment, the physical environment includes clean water, clean air, good sanitation, good
workplaces as well as safe houses, communities and roads all contribute to good health. Next is Culture, as already known
that culture is still very attached to everyone and difficult to escape such as customs and traditions, and family and
community beliefs all affect health. Next is Government and Regulation, everyone has the right to get good health services
from the government, the government must provide health services without doing discrimination, timely, acceptable to
the community, and access to health services is easily accessible.
The next is social status, higher social status and social status related to better health. The greater the gap
between the rich and the poor, the greater the difference in health. Next is Education, with education being held to the
community we can teach about the ability to prevent and also overcome disease, educate about how good and right
health practices can also increase income due to good work. The last is the Economic Status with increasing human
productivity automatically will also increase the income generated and certainly it will be easy to get adequate health care
facilities in terms of costs.

2. As country develop economically, what changes will occur in the health determinants, what changes will occur in
their burden of disease?
Answer:
Income rises with improving health, and the improvement of health serves multiple goals other than simply
income growth. As the country’s economic sector evolving, changes will occur in health determinant. There are 4 health
determinants according to H. L. Bloom:

 Life style
Community behavior in maintaining health plays an important role in creating a healthy society. The more
prosperous the economy of a country, the more health behavior education is understood. But in another case,
many people in developing economy country does not aware about healthy lifestyle especially in physical activity.
It causes the prevalence of people suffering from non-communicable disease is increasing.
 Environment (Social, economy, culture, politic)
Political policy is important in improving health. In a number of low income countries, the lack of political stability
has been a major impediment to progress in achieving the MDGs
 Health Service
High income also affects the health services provided by a country and the health services provided will be more
comprehensive.
 Genetic Factors
Epidemic transition theory by Omran (1971), Olshansky and Ault (1986) divide the epidemiological transition into
5:
 The age of pestilence and famine, manifested by high mortality and fluctuations and life expectancy of less than
30 years
 The age of receding pandemics, era where life expectancy begins to increase between 30-50 year
 The age of degenerative and man-made disease, the phase where infectious diseases is decreasing but
degenerative diseases is increasing
 The age of declining CVD mortality, ageing, lifestyle modification, emerging and resurgent diseases; pronounced
by life expectancies reaching 80-85, very low fertility rates, as well as cardiovascular disease and cancer
 The age of aspired quality of life with paradoxical longevity and persistent inequalities which describes the hopes
in the future, with life expectancies reaching 90 years old and encouraging efforts to improve quality of life.

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 3. How does education of a mother play in promoting health of her children. Go back to the issue on global health
that your group has chosen (say your group choose the issue of Cancer as a NCD disease), take that issue and
make a story/case study on this relationship in one poor country and one rich country scenario.
Answer:
Essentially, health and education are connected in three ways, one of them is that there are intergenerational
links: the health and education of parents affect the health and education of their children (Skolnik, 2016). A study even
shows that the mortality rate of children under 5 years of age was almost 60 percent lower for the children of mothers
with at least 7 years of schooling, compared to the children of mothers with no schooling. Therefore, can be concluded
that the mothers’ education or knowledge has a great impact on their children’s health.
The issue our group has chosen is about mother and child’s health, focusing primarily on the issue of lack of
knowledge and access to healthcare services. This issue is of course very related to the relationship between parents’
education and their role in promoting health to their children. Mothers in rich country may not encounter any problem in
terms of lack of knowledge and education of their children’s health as they have sufficient knowledge and also easy access
to health care services (also their knowledge makes them more aware of their children’s health and healthcare services
available around them, so that they will make use of the services available to check their children’s health frequently).
On the other hand, mothers in poor countries will encounter many difficulties on keeping their pregnancies’
health. The lack of knowledge (because of lack of education), lack of access to healthcare services, and even sometimes
added with unhealthy superstitions and behavior would worsen their (and also their children’s) health. They also don’t
have sufficient knowledge in preventing and managing illness, thus keeping the country’s children mortality rate high. This
wouldn’t end unless the parents and children (who will be parents in the future) are provided with education and
knowledge on the importance of maintaining their health.

4. How does culture affect health? Why might the health of some culture groups be different from the health of
other groups? Go back to the issue on global health that your group has chosen, take that issue and develop an
illustration on the cultural factors in 2 different countries.
Answer:
Culture is pattern of ideas and behavior in people or society. Culture is shared among people who agree and
understand. Culture usually is learned through generations. Culture is integrated into all aspect in individual’s life,
including health. It is because individual’s ideas and behavior affect their way of living. Their way of living affects their
health.
Health of some culture groups might be different from health of other groups because each group has their way
of living differently, such as their behavior of diet, their ideas of living healthy life, and other more. For example in Maternal
and Child Health topics:

 Instruction of breast milk for newborn babies in modern culture

Colostrum (the first drops from breast milk) is good for increasing the baby’s immunity. So colostrum is given to
the newborn babies.

 Instruction of breast milk for newborn babies in traditional culture

Colostrum is look like a damaged milk, its color is yellowish. Colostrum is not good for the babies’ health. It can
cause diarrhea, throw up, and many more.
Mothers in modern culture tend to improve their knowledge about food for babies from the expert like
nutritionist, doctor, or nurse. So their ideas of breast milk are valid. Meanwhile mothers in traditional culture tend to

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believe in what they see and their ancestors beliefs. So their ideas of breast milk are only based on their perspective,
without any opinion from expert.
Health of baby who is given colostrum and not given colostrum might be different. Baby who is given colostrum
may have a better immunity than the one who is not. It approved that health of some culture groups might be different
from health of other groups.

5. Does “health make wealth” or does “wealth make health “, explain at length with your own wordings.

Answer:

It goes in both directions! First, health makes wealth. About this if you are healthy, you have physical abilities that
allow you to do work in making money. And of course it will increase the amount of your wealth. But if you are not healthy,
of course physical abilities will not be able to do work that makes money. And of course it will not increase the amount of
your wealth.

Second, for wealth makes health. I want to say that rich people find it easier to get good health services. Unlike
the poor, they find it difficult to get good health services because their wealth is not enough to do health care. So, the way
that there is no gap between wealth and health. We must be healthy in order to be productive in doing work and of course
increasing the amount of our wealth. But when we already have enough wealth, we must be willing to do health care so
that we stay healthy and stay productive.

References
1. https://www.kidsnewtocanada.ca/culture/influence
2. https://www.euromedinfo.eu/how-culture-influences-health-beliefs.html/
3. Maas, Linda T. Kesehatan Ibu dan Anak: Persepsi Budaya dan Dampak Kesehatannya. [online] Available at:
https://www.academia.edu/9337995/KESEHATAN_IBU_DAN_ANAK_PERSEPSI_BUDAYA_DAN_DAMPAK_KESEH
ATANNYA. Accessed on 12 March 2019.
4. Michael Marmot, Sharon Friel, Ruth Bell, Tanja A J Houweling, Sebastian Taylor. Closing the gap in a generation:
health equity through action on the social determinants of health.
5. US National Library of Medicine, National Institute of Health.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924476/
6. Skolnik, Richard L. Global Health 101 2nd edition. 2017.
7. Skolnik, Chapter 2:Health Determinants, Measurements and Trends
8. https://www.who.int/hia/evidence/doh/en/

Synopsis Reading and Video

Human rights and health - WHO | World Health Organization, Fact sheets, WHO fact sheet on health and human rights
with key facts, introduction, disadvantaged populations and the right to health , violations of human rights and WHO
response. WHO (2017). Human rights and health [online] Ghjournal.org. Available at: https://www.who.int/news-
room/fact-sheets/detail/human-rights-and-health [Accessed 12 mar. 2019].

Human Rights in a Global Health Perspective: A Major Challenge by Philippe Chastonay. Available at:
https://www.coursera.org/lecture/global-health-overview/human-rights-in-a-global-health-perspective-a-major-
challenge-by-philippe-0Jmyz [Accessed on 12 Mar. 2019].

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 The WHO constitution (1946) imagine “the highest attainable standard of health as a fundamental right of every
human being.” Therefore, creates a legal obligation on states to ensure access to timely, acceptable, and affordable health
care of appropriate quality as well as to providing for the underlying determinants of health, such as safe and potable
water, sanitation, food, housing, health-related information and education, and gender equality. And do periodic review,
or the committee on economic, social and cultural rights. Also, the participation of non-governmental organizations - are
meaningfully involved in all phases. So, The right to health must be enjoyed without discrimination on the grounds of race,
age, ethnicity or any other status. The right of health, includes both freedoms and entitlements:

 Freedoms include the right to control one’s health and body and to be free from interference
 Entitlements include the right to a system of health protection that gives everyone an equal opportunity to enjoy
the highest attainable level of health
In 1948, the Declaration of Human Rights says that everyone has right to a standard of living adequate. This
definition is quite different from the WHO (1946) definition. The important breakthrough in notion of health as being a
human rights and the rights to health is the International Covenant on Economic, Social, and Cultural Rights in 1996. The
Definition from the International Covenant on Economic, Social, and Cultural Rights in 1996 clearly takes over from the
WHO. In article 12.2, it does say that the states has participation to recognize the right of everyone to the enjoyment of
the highest attainable standard of physical and mental health. The importance of the states to implement health and to
implement the right to health in their country.
General Comments14 to the CESCR 2000 says there are 4 components of the right to health that states have the
obligation to provide public health prorams and health-care facilities. First component is availability, can be measured
through the analysis of disaggregated data to different and multiple stratifiers including by age, sex, location and socio-
economic status and qualitative surveys to understand coverage gaps and health workforce coverage. Second component
is accessibility, there are 4 aspects in accessbility namely non-discrimination, physical accessibility, economical accessibility
(information accessibility). Third component is acceptability, requires that health facilities, goods, services and
programmes are people-centred and relates to respect for medical ethics, culturally appropriate, and sensitivity to gender.
Fourth component is quality, Quality is a key component of Universal Health Coverage, and includes the experience as
well as the perception of health care. Safe, Effective, Timely, Equitable, Integrated, and Efficient Safe, Effective, Timely,
Equitable, Integrated, and Efficient are important components of quality health services.
There is 3 points why health and human rights are connected. The first thing because human rights violations
affecting health such as hamrful/inapproriate medical practice, torture, slavery, and violence in women and children. The
second is because protection of health trough human rights, right to information, right to education, right to water, adn
right to food and nutrition. The last thing because public health policies affecting human rights, right to participation,
freedom from discrimintaion, right to pregnancy, right to privacy, and freedom of movement.
Malaria, HIV/AIDS, And TBC is three of the world’s fatal communicable disease. usually this disease occurs in low-
income countries and is compounded by inequality and other inequalities including gender, age, sexual orientation or
gender identity and migration status. And conversely, the burden of non-communicable diseases - often thought to affect
high-income countries. non-communicable diseases such as cancer, cardiovascular disease, and chronic illness and
mortality have higher mortality and morbidity rates, this is because it is difficult to get accessible healthcare prevention,
treatment, rehabilitation and care services.
Minimum attention to attention to human rights can have serious health consequences, violations of human rights
not only contribute to and exacerbate poor health, but for many, including people with disabilities, indigenous populations,
women living with HIV, sex workers, people who use drugs, transgender and intersex people, the health care setting
presents a risk. Therefore, more attention needs to be paid to a human rights-based approach for setting and evaluating
health policy and service delivery, targeting discriminatory practices and unjust power relations. Accountability, Equality
and non-discrimination, and Participation are aspects of the core principles of human rights.
WHO have commitment to mainstream human rights into healthcare programmes and policies on national and
regional levels, and WHO strengthening the capacity of WHO and its Member States to integrate a human rights-based
approach to health. WHO in approaching health inequities, namely prioritizing gender equality aspects, and equity in other
5
aspects. As such, WHO promotes a concise and unifying framework that builds on existing approaches in gender, equity,
and human rights generation solutions to health inequities. This approach is considered capable of creating a cohesive and
efficient approach to promote health and well-being for all.

References
- WHO (2017). Human rights and health [online] Ghjournal.org. Available at: https://www.who.int/news-room/fact-
sheets/detail/human-rights-and-health [Accessed on March 12nd 2019].
- Unversity of Gueneva. Nd. Human Rights in a Global Health Perpetive: A Major Challenge by Phillippe Chastonay.
[Online] Available at: https://www.coursera.org/lecture/global-health-overview/human-rights-in-a-global-health-
perspective-a-major-challenge-by-philippe-0Jmyz [Accessed on March 12nd 2019]