Dasar KL-2

Perkembangan, Konsep dan

Definisi, & Persoalan Terkini

Abdur Rahman
abd.rahman@ui.ac.id
©2019 CE/1441 AH
 Lingkungan Hidup Kita
 Segala sesuatu yang berada di sekitar kita
dengan kondisi-kondisi fisik, kimiawi, biologis,
sosial, ekonomi, politik dan budaya;
 Total Environment: physical environment +
social environment;
 Total Environment: sistem kesatuan ruang dan
benda, energi, organisme dan perilakunya yang
saling mempengaruhi;
 Isu global lingkungan: penipisan lapisan ozon
(fisika), pemanasan global (kimia), penurunan
biodiversitas (biologi).
 Sifat Lingkungan
 Dinamis (ada daur hidup);
 Rumit (saling bergantung);
 Sistemik (komponennya majemuk)
 Teratur;
 Terkendali.
Siklus Karbon
Siklus Nitrogen
Siklus Belerang
Fotosintesis
Respirasi
Pembakaran
Fotosintesis
Respirasi (Kembali)
 Lingkungan & Kesehatan (1)

 Silent Spring (Rachel Carson, 1963);

 Awal perhatian dunia: 3rd International
Health Promotion Conference, Sundval,
Swedia, 1991, dengan topik supportive
environment for health.
 Konferensi PBB 1992 di Rio de Jenero,
Brazil, 1992 mengenai Environment and
Development, menghasilkan Agenda 21
(UNCED).
The Vernal (Spring) Equinox in the Northern Hemisphere is
the Autumnal (Fall) Equinox in the Southern Hemisphere and vice
versa. The Autumnal (Fall) Equinox in the Northern Hemisphere is the
Spring in the Southern Hemisphere and vice versa.

March Equinox in September Equinox in

Jakarta, Sunday, 20 Jakarta, Friday, 22 Sept
March 2016, 11:30 2017, 13:02 WIB
WIB
 Lingkungan & Kesehatan (2)

 Perhatian dunia: 3rd International Health

Promotion Conference, Sundval, Swedia,
1991, dengan topik supportive
environment for health;
 Konferensi PBB 1992 di Rio de Jenero,
Brazil, 1992 mengenai Environment and
Development, menghasilkan Agenda 21;
 Pengakuan WHO (1997):
 Kesehatan masyarakat tidak dapat dipisahkan
dari kelestarian lingkungan
 Kerusakan lingkungan merupakan faktor
utama rendahnya kesehatan dan buruknya
kualitas hidup
 Kualitas lingkungan bertanggungjawab
langsung atas 25% kejadian sakit yang dapat
dicegah
 Health Promotion dalam Ottawa Charter
(1986) dengan 5 butir pernyataan:
 Development of healthy public policy
 Creation of supportive environment
 Strengthening community action
 Development of personal skill
 Reorientation of health services
 Deklarasi Jakarta (1997) sebagai hasil 4th
International Health Promotion berisi
prioritas:
 Healthy setting (cities, villages, islands,
markets, workplaces)
 Partnership
 Role of private for profit sector
 More environmental health pressing
 New Public Health
dan Lingkungan
 1960-1980:
 Perilaku merupakan fokus utama promosi
kesehatan
 Semua upaya diarahkan untuk mengubah
perilaku tidak sehat dan mengobati yang sakit
 1980an: New Public Health (tesis
McKeown, Black Report, Ottawa Charter)
 Ottawa Charter dianggap sebagai ‘kitab
suci’ New Public Health, didasarkan pada
keyakinan bahwa kesehatan memerlukan
peace, shelter, education, food, income,
stable ecosystem, social justice, dan
equity sebagai prasyarat
 Tesis McKeown:
 Terapi medis tidak berdampak signifikan
menurunkan mortalitas abad 19/awal
abad 20, kecuali vaksinasi cacar
 Faktor-faktor non medis sangat penting
untuk meningkatkan kesmas di negara-
negara industri
 BlackReport (Laporan Partai Buruh
Inggris,1970): Perilaku bukanlah
penyebab utama perbedaan status
kesehatan dalam kelas-kelas masyarakat
Inggris
 New Public Health
 Meminggirkan tindakan medis;
 Memperkenalkan intervensi yang lebih
bersifat sosial, peran serta masyarakat dan
perubahan kebijakan;
 Sebagai kulminasi perdebatan & kritik atas
aplikasi psikologi promosi kesehatan: perilaku
bukanlah determinan utama kesehatan
 Strategi utama WHO untuk New Public
Health: program Healthy City
Tantangan Kesehatan
 Tantangan utama kesehatan:
 Ketidasamaan derajat;
 Dilema perluasan pelayanan kesehatan (private vs
public, BPJS/Askes versus asuransi swasta);
 Kebutuhan, biaya, & keterbatasan sumberdaya;
 Bahaya lingkungan global (pola-pola risiko kesehatan
baru & risiko berkaitan dengan sosioekonomi, politik
& budaya)
 Interdependensi kelestarian pembangunan &
kesehatan melahirkan Ecological Public Health
(Kesmas Ekologi)
Kesmas Ekologi

 Holistik: sosial, kultural, ekonomi yang saling

bergantung (interconnectedness);
 Untuk mencapai pembangunan berkelanjutan
(sustainable development) bidang kesehatan
diperlukan pemahaman tentang:
 What is health?
 What determines human health?
 What approach to make a marked impact on the
determinants of health to achieve greatest health
gain?
 Peran Tenaga Kesehatan
Environmental health professional or
specialist is a practitioner, with
appropriate academic education and
certified training and registered license,
capable to do the following works:

1. Investigate, sample, measure, and assess

hazardous environmental agents in various
environmental exposure media that contact
to human and other living species and
setting;
2. Recommend and apply protective measures
and interventions to manage and control the
environmental hazards;
3. Develop, promote, and enforce guidelines,
standards, policies, laws, and regulations in
environment and health;
4. Develop and provide materials and
techniques of environmental health
communication, publication, and
dissemination;
5. Manage and lead environmental health units
with organization;
6. Apply strategic thinking and develop
strategic planning in environmental health
policies and programs;
7. Perform system analysis and review
environmental health program and planning;
8. Assess and engage community needs and
concerns to understand, address, and
resolve environmental health problems and
relevant issues;
9. Interpret research using science and
evidence to understand the relationship or
influence of health and the environment;
10. Collate, analyze, and interpret data on the
environment relevant to human health,
prepare technical summary, and provide
written report.
 The Quality of Healthy City (1)

A city should strive to provide:

1. a clean, safe, high quality physical
environment;
2. an ecosystem that is stable now and
sustainable in the long term;
3. a strong, mutually supportive and non-
exploitative community;
4. a higher degree of participation and control by
the public over the decisions affecting their
lives, health and well-being;
 The Quality of Healthy City (2)
5. the meeting of basic needs (food, water,
shelter, income, safety, and work) for all the
city’s people;
6. access to wide variety of experiences and
resources, with a chance of wide variety of
contacts, interactions and communication;
7. a diverse, vital and innovative city economy;
 The Quality of Healthy City (3)

8. the encouragement of connectedness with the

past, with cultural and biological heritage of
city dwellers and with other group and
individuals;
9. a form that is compatible with and enhances
the preceding characteristics;
10. an optimum level of appropriate public health
and sick care services accessible to all;
 The Quality of Healthy City (4)

11. High health status (high level of positive health

and low level of diseases).

Source: WHO (1995) Twenty Steps for Developing a

Healthy City Project, Copenhagen, WHO Regional
Office for Europe
 WHO View of Urban Health
 Physical, economic, social & cultural
aspects of city life all have an important
influence on health;
 These aspects exert their effects through
such processes as population movements,
industrialization & changes in the
architectural & physical environment & in
social organization;
 Health is also affected in particular by
climate, terrain, population density,
housing stock, the nature of economic
activity, income distribution, transport
system and opportunities for leisure and
recreation.
 Perubahan iklim: Global warming &
green house effect
 Pemenuhan kebutuhan hidup (dasar &
konsumtif);
 Eksploitasi BBF tidak adil: Penduduk
negara-negara maju hanya 21% dari total
populasi dunia tetapi mengon-sumsi 75%
energi dunia;
 Akhir Pertemuan 2
Tugas (Progress Assignment ): Urairan
singkat mengenai
 Ottawa Charter
 Agenda 21 Indonesia
 Industrialisasi 4.0
 National Environmental Health Action Plan
(NEHAP) Indonesia