DASAR-DASAR KES MASY

Hema dewi A.
Fk unimus-2017
CONCEPT OF MEDICINE AND HEALTH

 MEDICINE :
 (1) The Arts and Science of healths Care through
diagnosis, treating and prevention of diseases.
 (2) The Arts and Science dealing with the
diagnosis, cause, prevention and Cure of
diseases.
 HEALTH :
 A Complete state of physical, mental and Social
well being and not merely the absence of diseases
or infirmity.
 OPTIMAL SEVERE
HEALTH ILLNESS

Healthy status of health Illness

Promotive Preventive Curative Rehabilitative

Figure : Relationships between functional and status of illness

 Masyarakat Sehat
(healthy people)

Masyarakat dalam risiko

(Risk People)

Masyarakat sakit
(sick people)

Figure : Condition of health in community

 Beberapa faktor yang mendorong perlunya
pemikiran konsep Paradigma Sehat
(1) Pelayanan kes. berfokus pada orang sakit tidak efektif.
(2) Konsep sehat berubah, termasuk unsur produktif sosial dan ekonomis (tak
hanya kelainan fisik saja)
(3) Transisi epidemiologik dari peny infeksi ke peny. kronik (perubahan perilaku).
(4) Transisi demografik, lansia jumlah makin meningkat.
(5) Konsep faktor yang berpengaruh terhadap kesehatan penduduk juga makin
bervariasi.
 PARADIGMA SEHAT : MEMBINA PENDUDUK/SDM YANG SEHAT

PENCEGAHAN PENYAKIT

Pencegahan dari ancaman penyakit &

Lingkungan Pencegahan khusus, skrining,
penyuluhan masyarakat immunisasi masal,
PERLINDUNGAN perilaku : Tenaga Kesehatan
KESELAMATAN
• Pendudk yang
SDKI. 1992
“tidak sakit”
15-21% PENGO
Perlindungan masyarakat • Tidak sedang Penduduk
Mencari Sakit BATAN
terhadap pencemaran, Mencari
pengobatan
kekerasa, rudapaksa, pengobatan
penyalah gunaan, • Tidak mengeluh
kecelakaan, sanitasi air
minum, makanan,
pengendalian bahaya
alam potensial PROMOSI
KESEHATAN
Tenaga Kesehatan dan
sektor lain • Meningkatkan, pemeliharaan kesehatan penduduk, olah raga
kebugaran, UKS, Gizi Masyarakat
• Pengaturan perundangan
• Tenaga : Kesehatan kerja sama dengan sektor lain
 RELATIONS AMONG DEMOGRAPIC,
EPIDEMIOLOGY AND HEALTH TRANSITIONS
HEALTH TRANSITIONS

DEMOGRAPHIC EPIDEMIOLOGIC
TRANSITION TRANSITION

URBANIZATION INFECTIOUS FERTILITY POPULATION CHRONIC &

DISEASE DECLINES AGES NON COM-
INDUSTRIALIZA MORTALITY MINICABLE
TION DECLINES DISEASE
RISING IN COMES EMERGE
EXPANSION OF
EDUCATION ECONOMIC PERSISTENCE
IMPROVED MEDICAL RECESSION OR RE EMER-
AND PUBLIC HEALTH AND IN GENCE OF COM
CREASING DISEASE

PROTRACTED POLARIZED
EPIDEMIOLOGIC TRANSITION
 LINGKUP ILMU
KEDOKTERAN
•

Ilmu Kedokteran mencakup ilmu alam

dasar kedokteran/ilmu biomedik, ilmu
kedokteran komunitas, ilmu kedokteran
klinik, disertai strategi yg memberikan
arahan dan mendasari pendekatan
teoritik, metodologis dan aplikatif yang
tekanannya bersifat individual.
 BIDANG GARAPAN UTAMA
I.KEDOKTERAN
• Bidang garapan utama dan fenomena yg
menjadi obyek studi I.Kedokteran adalah
perubahan, penyimpangan atau tidak optimal
berfungsinya sistem organ secara
terintegrasi pada tingkat individu sebagai
anggota komunitas, sampai dengan tingkat
subseluler, sebagai akibat interaksi dengan
lingkungan, dan adanya pengaruh faktor
genetik.
 ILMU KESEHATAN
MASYARAKAT

Mencakup ilmu-ilmu dasar (alam,

sosial, perilaku), ilmu biomedik, ilmu
dasar kesehatan masyarakat (terapan),
dengan menggunakan metode utama
yaitu epidemiologi & biostatistik, pada
aplikasinya menggunakan pendekatan
dan metode memecahkan masalah
secara saintifik.
BIDANG GARAPAN UTAMA ILMU
KESEHATAN MASYARAKAT
Bidang garapan utama & fenomena yang
menjadi obyek studi I.Kes.Masy. adalah keadaan
tidak normal atau penyimpangan tingkat ‘sehat’
dan ‘kesehatan’, yg teridentifikasi melalui
berbagai faktor yg berpengaruh thd. tingkat
kesehatan, baik pada tingkat individu, keluarga,
komunitas, atau masyarakat, sebagai akibat
interaksi dgn lingkungan/ketidak-mampuan dan
ketidak-tahuan masyarakat.
 PUBLIC HEALTH (Winslow,
Public Health is the1920)
science and art of (1)
preventing disease, (2) prolonging of life, and (3)
promoting of health and efficiency through
organized community effort for (a) the sanitation of
the environment (b) the control of communicable
infections © the education of the individual in
personal hygiene (d) the organization of medical
and nursing service for the early diagnosis and
preventive treatment of disease (e) the development
of the social of living adequate for the maintenance
of health, so organizing these benefits and enable
every citizen to realize his birthright of health and
longevity.
 USES OF EPIDEMIOLOGY
GENETIC FACTORS
1. Causation

GOOD HEALTH HEALTH

ENVIRONMENTAL FACTORS Death

(incluiding lifestyle)
2. Natural history Subclinical Clinical
Good health changes disease

3. Description of health status Recovery

of populations
Good health
Propotion with III health,
change over time, change III
with age, etc. health Time

Treatment medical care

4. Evaluation of Good health III health

Intervention
Health promotion
Preventive measures
Public health services
 SPECTRUM OF DISEASE

Exposure DEATH
Etiologic Sympton
Pathologic Diagnosis
Agent Changes Time

Subclinical Clinical
RECOVERY
Manifestation Manifestation
 CONCEPT OF HEALTH STATUS

•(1) THE TRADITIONAL (ECOLOGICAL) MODEL :

(a) Agent (b) Host © Environment
• (2) THE HEALTH FIELD CONCEPT (HL
Lamframboise, 1973) : (a) Environment (b) Life style ©
Biological (d) System of health service.
• (3) THE ENVIRONMENT OF HEALTH (H.L.Blum,
1974; The Force field and wellbeing paradigms of
health) : (a) Environment (b) Behaviour (Life style) ©
Health service and (d) Heridity.
 Konsep sehat
Optimal feeling and Suboptimal function,
function optimal feeling

Suboptimal feeling, DISEASE

optimal function
Suboptimal feeling and
function
 Epidemiologic Triad

Disease is the
result of forces
within a dynamic
system consisting
of:
Agent
Host
Environment
 Epidemiological TRIAD

Host
Intrinsic factors that influence host susceptibi

Agent
Environment
Extrinsic factors Biological characteristic of
Opportunity for infection to occur
Triad Cont’d - Determinants
 Agent factors: pathogenicity; virulence

 Host factors: age, gender; education;

behaviors; culture.

 Environmental: climate; geography;

biological; socioeconomic, political, and
cultural
 AGENT OF HOST
DISEASE
FULCRUM

ENVIRONMET OF
LIFE

BIOLOGY PHYSIC SOCIAL ECONOMIC

Leavell’s diagram of balanced of gondition

Little agent More Agent Weaknes of

(not more) Healthy of and very
host host
virulent

Good Bad
Environment Environment

DIAGRAM : Balance of Health DIAGRAM : Imbalance of Health

BIOLOGICAL INTERACTION
 MODEL ECOLOGY

1 2
H A
A

E E
In crease in the ability of The pproportion of
an agent to infect and susceptiibles in the
cause in men human host population
is increased
A H

E
At equliibrium 4
3
H A
A I
H
E
Environmental change Enviromental change
facilities agent spruad afters host susceptibility
 THREE ASPECT OF
EPIDEMIOLOGY
•
Agent : Substantial or power for essensial to
disaese event.
•Human Host : Human factor for contribute
of disease event (imunnity, biological,
immunological, behavior etc)
•Environment : consist of physical, biological,
social, economical, cultural.
Classic Epidemiologic Theory
 Agents
 Living organisms
 Exogenous chemicals
 Genetic traits
 Psychological factors and stress
 Nutritive elements
 Endogenous chemicals
 Physical forces
 ETIOLOGIC FACTORS FOR HUMAN
DISEASES & INJURIES
•Biologic Agent : Certain bacteria; viruses;
ricketsia, parasit, fungi, exposure including in utero
exposure.
•Chemical agents : Lead; mercury; certain
pesticide; hydrogen cyanide; certain medications,
arsenic, florine gas.
•Physical agents : Asbestos; trauma including
burns; ioninizing/non radiation; high voltage electricity.
 ETIOLOGIC FACTORS FOR HUMAN
DISEASES & INJURIES

• Nutritional factors : Overly high/low caloric

intake; low protein; vitamin deficiency;
calcium intake; sodium intake; saturated fat
intake.
•Life-style choices : Exercise level; tobacco use;
alcoholic beverage intake; dietary preference;
seat belt use; bicycle helmet use.
Classic Epidemiologic Theory
 Agents have characteristics such as infectivity,
pathogenicity and virulence (ability to cause
serious disease)
 They may be transmitted to hosts via
vectors
 ETIOLOGIC FACTORS FOR HUMAN
DISEASES & INJURIES

•Host characteristics : Genetic factors; immune

status (immunity and immunity response);
gender; concurent disease; level and type of
natural and suplemented estrogens, social
support; economical support, cultural support,
response of stress, host behavior.
 Environment

•Climate
•Vector
•Ecology
•Penyedia makanan
 POPULATION
Size distributin, growth rate
gene pool
H
E
R
NATURAL E CULTURAL
D
RESOURCES I SYSTEMS
T
Y

ENVIRONMENT PSYCHO-
physical and
man made, SOCIO- HEALTH CARE SERVICES
socio-cultural, prevention, cure,
SOMATIC rehabilitation
economic, education,
employment HEALTH
(well being)

B
E
H MENTAL HEALTH
A
V Emotional satisfaction
I Intelectual efficiency
ECOLOGICAL O
R adaptability
BALANCE
 Teori HL Bloom
4 faktor yang mempengaruhi status kesehatan
seseorang :
 lingkungan

 Perilaku  gaya hidup, pola makan

 keturunan

 pelayanan kesehatan
Terima kasih