Taki Taki Sewaka

Guna Widya

Kebudayaan Rumah Sakit dan Interaksi

antar profesi di Rumah Sakit
Dinar Lubis
MK Sosiologi Kesehatan
Kelas A dan B
2021

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Inequity dan kemiskinan sebagai akar

permasalahan kesehatan global
Dinar Lubis
MK Kesehatan Global dan PHC
5-10-2021

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Tujuan
• Mahasiswa mampu menganalisis permasalahan kesehatan
masyarakat di tingkat global dan upaya mengatasi permasalahan
tersebut

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Sistematika
• Pengertian Equity dan Equality
• Perubahan Profil Kesehatan
• Pola Ketimpangan yang Terjadi di Indonesia (dampak
dari sosioekonomi kasus, gender dan Kesehatan,
lokasi dan Kesehatan)
• Ketimpangan sosial determinant of health
• Beberapa Contoh Kerangka teori yang menggunakan
Sosial determinan of Health

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Pengantar :
Disparitas sosial ekonomi dan status kesehatan
• Salah satu dampak globalisasi adalah disparitas kesehatan baik antar negara maupun didalam
sebuah negara
• Perkembangan Globalisasi hanya akan memberikan dampak positif pada orang yang siap
menghadapi globalisasi
• Kelompok yang mempunyai akses informasi terhadap kebutuhan global akan dapat merespon
perubahan namun yang tidak punya akses akan tertinggal dibelakang
• Penguasaan informasi akan mempengaruhi kualitas hidup dan kesehatan kita. Dengan informasi
kita tahu bagaimana menjaga kesehatan dan fasilitas kesehatan yang tersedia
• Namun, ada sekelompok masyarakat yang tidak memilki akses terhadap informasi seperti orang
yang tingkat pendidikan rendah, sosial ekonomi rendah, resiko kesehatan tinggi biasanya tidak
mendapat akses terhadap informasi.
• Disparitas dalam akses terhadap informasi, ekonomi termasuk akses terhadap internet
merupakan salah satu ukuran dalam kualitas hidup
• Mengurangi disparitas kesehatan/sosial biasanya dilakukan dengan prinsip pemerataan
pembangunan. Ada dua prinsip yang digunakan dalam pemerataan yaitu prinsip Equality
(Kesamaan) dan Equity (Keadilan).

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Definisi Equality dan Equity

• Equality merupakan upaya untuk menyamaratakan tingkat dan jenis sumber daya
yang akan didistribusikan pada seluruh anggota masyarakat, tanpa melihat latar
belakang sosial ekonomi nya
• Equality (pemerataan) adalah pendistribusian kebutuhan sosial primer secara
berkeadilan, terutama diprioritaskan bagi rakyat kecil.
• Dengan bahasa awam, equality bisa didefinisikan sebagai keadilan prorakyat kecil,
yang merupakan anggota masyarakat yang paling tidak beruntung.
• Misalnya: kebijakan perumahan untuk masyarakat berharga sewa rendah seperti
rusunawa untuk memenuhi kebutuhan rumah rakyat kecil. Dalam kebijakan ini
misalnya, pemerintah menetapkan peraturan dan persyaratan mulai dari kelompok
sasaran dan tipe bangunan yang paling cost-effective dan tepat guna.

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Equality VS Equity Guna Widya

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2. Perubahan Profil Kesehatan

World Health report 2021

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Indikator Kesehatan
• Life expectancy (LE) & Health Life expectancy (HALE)
• Penyebab Kematian
• Under Five and Neonatal Mortality rate
• Maternal mortality ratio

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Life expectancy (LE) and healthy life expectancy (HALE), by sex, global and WHO
region, 2000–2019

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• The African Region still had the lowest LE and HALE among WHO regions in
2019, at only 64.5 and 56.0 years, respectively, despite experiencing the
largest gains
• over the past two decades. The Region of the Americas had the highest LE
(74.1 years) in 2000 but dropped to third place (77.2 years) in 2019 as the
European Region and Western Pacific Region made accelerated gains,
reaching 78.2 and 77.7 years, respectively. The latter two regions also had
the highest HALE in 2019, at 68.3 and 68.6 years, respectively.
• A metric to assess the health of older adults, LE at 60 years of age, has also
improved globally from 18.8 in 2000 to 21.1 in 2019. However, HALE at 60
years has only risen from 14.1 to 15.8 in the same period.

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Inequality
pada HALE
DAN LE

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• Globally, LE and HALE for males were consistently around 5 years and 2.4 years
lower than females, and there has been very little change in the gaps between
women and men in the past 20 years. Across country income groups, however,
there are different patterns of sex-related inequality in HALE.
• HALE is lowest in LICs for both men and women and has been improving the
fastest of all income groups. However, the situation has been improving slightly
faster for women than men, and the gap in HALE has consequently widened.
Conversely, in HICs the gap between women and men is narrowing, as HALE
among men has improved at a faster pace.

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Penyebab
Kematian

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Under Five and Neonatal Mortality

• Remarkable declines were seen for child mortality, yet disparities remain. In
2019, an estimated 5.2 million children (90% UI 5.0 to 5.6) died before reaching 5
years of age, with 2.4 million (90% UI 2.3 to 2.7) (47%) dying within the first 28
days of life (the neonatal period). Under-five and neonatal mortality rates have
declined considerably over the past 30 years. In 2019, the underfive mortality
rate was 38 per 1000 live births (90% UI 36 to 41), which is a 59% reduction from
the 93 per 1000 live births (90% UI 92 to 95) seen in 1990. Neonatal deaths
reached 17 per 1000 live births (90% UI 17 to 19) in 2019, which is a 52%
reduction from 37 in 1990 (90% UI 36 to 38). Most of the under-five deaths were
concentrated in two SDG regions: sub-Saharan Africa and Central and Southern
Asia, which together accounted for more than 80% of deaths in 2019 yet only
52% of the under-five population.

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UnderFive and
Neonatal
Mortality

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Maternal Mortality Ratio

• Maternal mortality has shown uneven burden and progress. In 2017, an
estimated 295 000 women (80% UI 279 000 to 340 000) died globally from
causes related to or aggravated by pregnancy and childbirth, with a
maternal mortality ratio (MMR) of 211 maternal deaths per 100 000 live
births (80% UI 199 to 243). This represents a 35% reduction from the 451
000 (80% UI 431 000 to 485 000) maternal deaths, and a 38% reduction
from the MMR of 342 (80% UI 327 to 368), estimated in 2000. LICs and
LMICs accounted for 94% of the global maternal deaths in 2017 with an
MMR of 462 (80% UI 437 to 540) and 254 (80% UI 226 to 307), respectively.
Examining SDG regions, the burden was highest in sub-Saharan Africa with
196 000 (80% UI 180 000 to 235 000) maternal deaths and an MMR of 542
(80% UI 498 to 649) followed by Central and Southern Asia with 58 000
(80% UI 50 000 to 69 000) maternal deaths and an MMR of 151 (80% UI
131 to 181)

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Maternal
Mortality Ratio

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Disparity cakupan
immunisasi, di
Indonesia (Riskesdas
2013)

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2. Sosial determinant of health

Aspek sosial yang menyebabkan

disparitas status kesehatan masyakat.
Social determinan model bisa berubah
tergantung pada kelompok masyarakat
yang disasar

https://nacchocommunique.com/tag/social-determinants-of-
health/
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https://www.ncbi.nlm.nih.gov/books/NBK221225/figure/mm
m00005/?report=objectonly
BEBERAPA CONTOH APLIKASI TEORI SOSIAL DETERMINAN DALAM BIDANG KESEHATAN
FRAMEWORK FOR ACTIONS TO ACHIEVE OPTIMUM FETAL AND
CHILD NUTRITION AND DEVELOPMEN
SOCIAL DETERMINAN HIV PADA LSL MUDA
Risk and
vulnerable
to HIV
Poor
Indonesian Access to
responce to universal
HIV health
coverage

Social
determinan
ts of HIV
among
Migration YMSM Sexual
and norms
Tourism

Stigma Poor
and Access to
discrimina sexual
tion health
services Lubis, D, 20018
KERANGKA KONSEP
 Taki Taki Sewaka
Guna Widya

Diskusi
• COVID-19 dan Equity:

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Dinar SM Lubis
Thank you Staff Pengajar Promosi Kesehatan
Dinar_lubis@unud.ac.id
Whatsapps: 082145678776
Google scholar: Dinar Lubis
Orchid: https://orcid.org/0000-0002-8288-3892
Scopus ID: 57209213279

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