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DETERMINAN
PROMKESMUH. SYAFAR
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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 whichmeasures 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)
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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 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)
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Health is the capacity to cope with on
adapt to discruptions among the organic,
social, and personal components atindividuals 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)
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Health as quality of life, involving social,
mental and biological fitness on the partof 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)
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Multidimensional and includes
vocational health as well as the moretraditional health components (Eberst,
1985)
Social health, mental health, emotional
health, spiritual health and physical
health, (Dintiman and Greenberg, 1992),(Linda Ewels,2000)
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SOCIAL DETERMINANTS OF
HEALTH
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Determinants of health
Proximal determinants of health
Distal determinants of health
Disability adjusted life years (DALYs)
Ecological fallacy
Social capital
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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
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Disability-Adjusted Life Year
(DALY)
Daly adalah ukuran beban penyakit secarakeseluruhan, yang dinyatakan sebagai
jumlah tahun yang hilang akibat sakit, cacat
atau kematian dini.
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Kerugian Ekonomi penderita HIV dan
AIDS di Indonesia Tahun 2010
Jumlah Penderita tahun 2010 =
21.770 orang
Hasil perhitungan
Biaya Perawatan per hari Rp. 1.000.000Biaya perawatan per orang
dalam 1 tahun 12 X Rp.
30.000.000,-
Rp.30.000.000,-
Total biaya perawatanpenderita di Indonesia dalam
setahun = 21.770 x Rp.
360.000.000,-
Rp. 7.837.200.000.000,-
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Pengeluaran Biaya Merokok Penduduk di
Indonesia Tahun 2007
Jumlah Penduduk :225.000.000 penduduk Hasil Perhitungan
Jumlah Perokok : 28 x 225.000.000 = 65.000.000
Harga rokok per batang rerata diisap 10
batang/hari
Total konsumsi perhari : 65.000.000 x 10
btg
650.000.000 batang
Total Harga : 650.000.000 x Rp.1.000,- Rp.650.000.000 batang
Dalam 1 bulan 30 X 650 milyar Rp.19,5 Trilyun/bulan
Dalam setahun 19,5 Trilyun x 12 bulan Rp. 234 Trilyun/tahun
Cukai rokok (April 2010) Rp. 28,3 Trilyun
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Pengeluaran Biaya Merokok
Penduduk di Makassar
Jumlah Penduduk : 1.300.000
penduduk
Hasil Hitungan
Jumlah Perokok : 22,1 % x
1.300.000 =
287.300 Orang
Harga rokok perbatang Rp.1.000,-
/batang rerata diisap 10-12
batang/hari
Total harga 287.300 x Rp. 1.000,- Rp. 3 milyar/hari
Dalam 1 bulan 30 hari x Rp. 3
milyar
Rp. 90 milyar/bulan
Dalam setahun Rp.90 milyar x 12
bulan
Rp. 1,08 Trilyun
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Ecological Fallacy
About the relationship
between individual wealth
and individual health.
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Social Capital
Social Capital is a term that became of interest
to many health researchers looking at socialdeterminants of health
Trust and Reciprocity
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ENVIRONMENTAL
DETERMINANTS OF HEALTH
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Environmental health
Ecologically sustainable development
Equaity and environmental healthjustice
Physical settings
Life support systems
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Mandala of health: a model of the human
ecosystem
Spirit
Body Mind
Family Psycho-
economic
environment
Personal
behaviour
Physicalenvironment
Humanbiology
Work
Sick-
care
system
Human-care environment
Community
Lifestyle
Cultur
Biosphere
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Local effects of loss of global sustainability
GLOBAL CHANGE AUSTRALIAN LOCAL EFFECTS
Air
OzoneGlobal warming
Melanomas (worlds highestlevel,) TasmaniaFloods, droughts, changed pollination patterns
Water
Imigration
Forest clearances
Salting, acidification of soils
Increased erotion, drop in rainfall
LandProductive land Reduced by 10 per cent every year,
60 per cent degraded
Life
Biodiversity More mammals extinct than any other continent
PeoplePopulation Waste production per head second in Organization for
Economic Cooperation and Development
Energy
Energy Life Geenhouse gases increasing by 16 per cent
(8 per cent allowed by 2008 in the Kyoto Agreement
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Physical Settings
Urban Environments
Rural and Remote Environments
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Life Support Systems
Air Pollution
Water Pollution
Contaminated Food
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BIOLOGICAL DETERMINANTS
OF HEALTH
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Biological determinants of health and
disease
Models of disease causality
The role of genes
Race and ethnicity as determinants ofhealth and disease
Morbidity and mortality in relation to age
Gender differences in health and diseaseUnderstanding biological markers of risk
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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
Biological determinants of
health and disease
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Gene-environment interation
pattents an example of :
1. Single gene disease-sickle cell
anaemia
2. Multi-gene diseases
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Gender Differences in risk Factors and protective facvtors for
cardiovascular diseases (prevalence rates except for saturated fats)
DETERMINANTS MALES (%) FEMALES (%)
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)
18
31
50
6727
8
13
13
27
42
5234
7
13
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
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Case study
Ama, a small, tree-year-old child, was playing with hersiblings 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.