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Level Pencegahan

Penyakit
(health and Prevention )

Dr. H. Agus Widjaja MHA


Overview
• Some argue that prevention is always better than
cure,
– that it alone in the realm of health care is deserving of
greater priority, or
– even that curative care could be dispensed with if
only greater efforts were devoted to prevention
• Others argue that prevention is ineffective,
– that trying to change behavior is futile and elitist, or
– that the sacrifices involved are too great

• To clarify the subject matter that to be addressed, it would be


overviewed what health is , and what prevention is.
What is health?
• Everyone has an idea of what ‘health’ is,
depend on one’s point of view.
• Health is subjective concept, it is
multidimensional, for example, two of many
dimensions of health are pain and immobility.
• The preferred state (of health) will vary
between individuals according to such things
as tolerance of pain or the importance of
mobility in their work and social activities.
What is health,
perfect health and optimum health
Perfect health can be defined ;
• from biological point of view
– as ‘a state in which every cell of the body is functioning at
optimum capacity and in perfect harmony with each other
cell’. (Twaddle, 1974)
• from broader perspective
– as ‘a state of complete physical, mental, and social well-
being’ (WHO 1958).

– From those two perspectives, disease is defined as ‘imperfect


harmony between cell’, while illness is ‘a perceptible state of
physical, mental, or social malfunctioning’.
Perfect health
Arguably, perfect health does not exist. Why ?
• Most people do not concern themselves with
the question of whether or not their current
health state is.
• They would not even choose to try to achieve
perfect health for the simple reason that
improvements in health status are not
costless.
Perfect health does not exist, why?
When the dimensions of time and
uncertainty are introduced, the falsity of the
claim is even more evident …
• Smokers who are aware of the health hazards of
smoking are trading-off the risk of future illness or
death against their present satisfaction and pleasure.
• Similarly with those people who willingly accept the
risk of injury or death by crossing the road at a busy
intersection rather than take the extra minute to walk
to the pedestrian underpass down the road.
Perfect health does not exist, why?
(cont …)

• There are many cases or examples can be


discussed from some point of view. As Cullis and
West point out(1979) point out, ‘Few people, if
any, seek to maximize their health and life
expectancy per se. To do so involves sacrificing
opportunities to eat, drink, play games, drive , etc.
• Thus perfect health is most unlikely to be the most
desirable (rather than the optimum state ).
Optimum health/optimal health
• Optimum health or optimum state is
that where the cost of any further
improvement outweighs the value
attached to that improvement.
• For each individual this optimum
depend on perceptions of both the
desirability of being healthy and the
sacrifices involved in improving health .
Optimum health
• There are many facts that the effort in
producing improvements in health need the
‘cost’ that must not be money/monetary.
• The costs to be sacrificed are, for examples:
– Reducing the consumption of hazardous goods,
such as cigarettes, and alcohol, and eating less
sugar and butter can involve the sacrifice of
pleasure.
– Discuss the other examples.
What is prevention?
• In principle, every individual can be viewed as
being on some current level of health which level
may rise and fall through time and will ultimately
end in death.
• There are four types of intervention through
which the time profile of health status can be
altered:
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
4. Treatment and cure
Primary prevention

• Involves measures taken to prevent the onset


of illness and injury .
• Primary prevention covers efforts to reduce
the probability, severity, and duration of
future illness and injury
Secondary prevention
• Involve measures to detect pre symptomatic
disease where earlier detection will mean
more effective treatment.
• Earlier implies a stage before the individual
would normally seek treatment, and usually
before they would even be aware of disease
Secondary prevention
• Some clinicians go so far to claim that
secondary prevention is a misnomer because
it does not prevent the onset of disease.
• From the individual’s perspective, secondary
prevention prevents the manifestation of
illness so that their health, as they perceive it,
does not deteriorate.
Tertiary prevention
• Involves measure to reduce the disability from
existing illness and prevent it getting worse
• Tertiary prevention seeks to prevent a further
fall in the health status profile after an initial
fall.
• It can therefore be hard, in practice, to
distinguish tertiary prevention from cure.
Treatment and cure
• cover activities to raise current level of health
status from state of illness and injury

• Note :
– Another area that does not fit tidily into the above
taxonomy is health promotion which although
largely concerned with raising current health
status, also promote the message that raising
current health status can reduce the risk of future
illness.
State of health, intervention and health status
Dasar-dasar Pengertian – (untuk
catatan dan pembanding)
Dikenal Tiga Level Pencegahan Penyakit:
• Pencegahan Primer:
– Pencegahan dilakukan sebelum ada gangguan
kesehatan/sakit
– Preventive -promotive
• Pencegahan Sekunder:
– Tindakan yang dilakukan ketika sudah terjadi gangguan
kesehatan/sakit
– Curative
• Pencegahan tertier:
– Tindakan yang dilakukan setelah sakitnya teratasi
– Rehabilitative

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