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)

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, mental, and social activity taking age into account (Lalonde, 1974)

Health is the capacity to cope with on adapt to discruptions among the organic, social, and personal components at individuals health system (Bates and Winders, 1984)

Health can be defined as the quality of peoples physical, psychological, and sociological functioning that enables the to deal adequately with the self and others in a variety of personal and social situations (Redwonth, 1992)

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

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

SOCIAL DETERMINANTS OF HEALTH

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

Determinats of health : 1. Proximal determinants or downstream factors 2. 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, yang dinyatakan sebagai jumlah tahun yang hilang akibat sakit, cacat atau kematian dini.

Kerugian Ekonomi penderita HIV dan AIDS di Indonesia Tahun 2010

Jumlah Penderita tahun 2010 = Hasil perhitungan 21.770 orang
Biaya Perawatan per hari Biaya perawatan per orang dalam 1 tahun 12 X Rp. 30.000.000,Total biaya perawatan penderita di Indonesia dalam setahun = 21.770 x Rp. 360.000.000,Rp. 1.000.000 Rp.30.000.000,-

Rp. 7.837.200.000.000,-

Pengeluaran Biaya Merokok Penduduk di Indonesia Tahun 2007

Jumlah Penduduk :225.000.000 penduduk Hasil Perhitungan
Jumlah Perokok : 28 x 225.000.000 = Harga rokok per batang rerata diisap 10 batang/hari Total konsumsi perhari : 65.000.000 x 10 btg Total Harga : 650.000.000 x Rp.1.000,Dalam 1 bulan 30 X 650 milyar 650.000.000 batang Rp.650.000.000 batang Rp.19,5 Trilyun/bulan 65.000.000

Dalam setahun 19,5 Trilyun x 12 bulan

Cukai rokok (April 2010)

Rp. 234 Trilyun/tahun

Rp. 28,3 Trilyun

Pengeluaran Biaya Merokok Penduduk di Makassar

Jumlah Penduduk : 1.300.000 penduduk Jumlah Perokok : 22,1 % x 1.300.000 = Harga rokok perbatang Rp.1.000,/batang rerata diisap 10-12 batang/hari Total harga 287.300 x Rp. 1.000,Dalam 1 bulan 30 hari x Rp. 3 milyar Dalam setahun Rp.90 milyar x 12 bulan Hasil Hitungan 287.300 Orang

Rp. 3 milyar/hari Rp. 90 milyar/bulan Rp. 1,08 Trilyun

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

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 (worlds highest level,) Tasmania Floods, droughts, changed pollination patterns Salting, acidification of soils Increased erotion, drop in rainfall

Reduced by 10 per cent every year, 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

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

Biological determinants of health and disease

Disease refer to a wide range of heterogeneous, intra-individual factors that drive, mediate, or moderate the pathways towards health or disease

Interactions between genes, behaviours and environments

Gene-environment interation pattents an example of :

1. Single gene disease-sickle cell anaemia 2. Multi-gene diseases

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, 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 (>1.0 mmol/I)

56 67 39 81

44 62 47 95

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