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)

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 = 21.770
orang

Hasil perhitungan

Biaya Perawatan per

hari

Rp. 1.000.000

Biaya perawatan per

orang dalam 1 tahun
12 X Rp. 30.000.000,-

Rp.30.000.000,-

Total biaya perawatan Rp.

penderita di Indonesia 7.837.200.000.000,
dalam setahun =
21.770 x Rp.

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

Rp. 234

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. Rp. 90 milyar/bulan

3 milyar
Dalam setahun Rp.90
milyar x 12 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
Cult
ur
Commun
ity
Lifestyle

Personal
behaviou
r
Sickcare
syste
m

Psychoeconomic
environme
nt

Family
Spirit

Body

Mind

Wor
k
Physical
environme
nt

Human
biology
Human-care
environment
Biosph
ere

Local effects of loss of global

sustainability
GLOBAL
AUSTRALIAN LOCAL EFFECTS
CHANGE
Air
Ozone
Global warming
Water
Imigration
Forest clearances
Land
Productive land
Life
Biodiversity
People
Population

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

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
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)

MALES
(%)

FEMALES
(%)

18
31
50
67
27
8
13

13
27
42
52
34
7
13

56
67
39

44
62
47

Protective factors
Psysically active (>150 minutes/week)
Alcohol intake (low risk pattern in 60+
age group)

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