Social determinant of health Social Epidemiology dan pendekatan sosioekologi

1. Social determinant of healthSocial Epidemiology dan pendekatan sosioekologi Charles Surjadi FK Unika Atmajaya

2. Perkembangan strategi pendekatan kesmas WHO( 1948-2008)

3. Social determinant of health(SDH) Bagian terbesar masalah kesehatan dan kesakitan terjadi karena kondisi sosial pada masyarakat hidup dan bekerja dikemukakan dalam laporan Bridging the gap :1. Kesenjangan yg terjadi kaena keadaan kehidupan sehari hari pada saat kelahirah, pertumbuhan, hidup dan bekerja dan usia tua mngakibatkan kesenjangan kesehatan di dalam negara serta antar negara; 2. Keadaan kehidupan sehari hari itu dipengaruhi oleh keadaan struktural karena kesenjangan keuangan, sumber daya dan kekuasaan. 3. Ada Kebutuhan untuk memperluas dan menyebarkan pengetahuan tentang social determinants of health dan mengevaluasi program dan aksi yang dilakukan secara kritis disamping melakukan pelatihan tentang SDH Ada kebutuhan untuk merumuskan hal itu menjadi agenda kesmas yang pragmatis

4. SDH report 200853 policy recommendationhttp://www.who.int/social_determinants/thecommission/finalreport/en/index.html

5. 6 prinsip pendekatan socioecological • identifikasi phenomena sbg problem social • Melihat masalah dari pelbagai level dengan berbagai cara metode analisi • menggunakan perspektiv teori diversitas • mengenal interaksi lingkungan dan manusia sebagai hal yang dinamis dan aktip • memperhatikan tatanan/konteks social, histories, cultural dan institusional dari interaksi masyarakat dan lingkungan • Mengerti kehidupan masyarakat sehari hari dalam kesederhanaannya • "...most public health challenges...are too complex to be understood adequately from single levels of analysis and, instead, require more comprehensive approaches that integrate psychologic, organizational, cultural, community planning, and regulatory perspectives." • Stokols, D. (1996). "Translating Social Ecological Theory into Guidelines for Community Health Promotion." American Journal of Health Promotion, 10(4), 282-293.

8. But what are they? - The top ten* 1. The social gradient ,- What you do - How much you earn, - Who you are, - Where you live 2. Stress, 3. Early life, 4. Social exclusion 5. Working conditions, 6. Unemployment 7. Social support, 8. Addiction, 9. Healthy food 10. Transport policy

10. MDG interlinkages: action on health determinants as part of a human rights approach to health MDGs 1, 8, 7 & others MDG 1 MDG 1 MDG 7 MDGs 2 and 3 MDGs 4, 5, 6, 8 MDG 1 MDG 7 MDG 3 Influenced by all MDGs Figure source: Rainbow on the social determinants of health, Dahlgren and Whitehead 1991, further elaborated by Theadora Koller, Technical Officer, Social Determinants, WHO Regional Office for Europe, June 2010.

11. Social Epidemiology • Social Epidemiology has been defined as the branch of epidemiology that studies the social distribution and social determinants of health (Berkman and Kawachi 2000).. • Faktor sosioekologi yang berkaitan dengan penyakit dan kesehatan Social and environmental risk factors in the emergence of infectious diseases • Robin A Weiss1 & Anthony J McMichael Nature Medicine 10, S70 - S76 (2004

12. Susser’s Eras in EpidemiologySource: M. Susser. Am J Public Health 1996;86:674-7.

13. Ikatan yg kuat antara epidemiology dan ilmu social menfasilitasi kebutuhan analisa health determinants, dari faktor micro level pada mana keadaan biologis individu bekerja ke faktor macro yang di ekspresikan oleh kondisi sosial pda mana komunitas hidup, pendekatan ini dikenal sebagai “social epidemiology.” • The principal concern is the study of how society and different forms of social organization include structure/policy influence the health and well-being of individuals and populations.. • Social epidemiology di dasarkan atas 3 dasar teori (1) psychosocial, (2) social production of disease and/or political economy of health, and (3) ecosocial theory and related multi-level frameworks. • Epidemiological Bulletin, Vol. 23 No. 1, March 2002 Krieger Theories for social epidemiology in the 21st century: an ecosocial perspective

14. PUBLIC POLICY National, state, local laws COMMUNITY Relationships among organizations ORGANIZATIONAL Organizations, social institutions INTERPERSONAL Family, friends, social networks INDIVIDUAL Attitudes, Knowledge, Skills Social-Ecological Model

15. Levels of Influence in the Social-Ecological Model Behavior change influenced at all levels Structures, Policies, Systems Local, state, federal policies and laws to regulate/support healthy actions Institutions Rules, regulations, policies & informal structures Community Social Networks, Norms, Standards Interpersonal Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs

16. Social-Ecological Model Individuals Social, Family, and Community Networks Living and Working Conditions Broad Conditions and Policies

17. Broad Conditions and Policies Broad social, economic, cultural, health, and environmental conditions and policies at the global, national, state and local levels

18. Broad Conditions and Policies Social conditions include, but are not limited to: economic inequality, urbanization, mobility, cultural values, attitudes and policies related to discrimination and intolerance on the basis of race, gender, and other differences.

19. Broad Conditions and Policies O • Other conditions at the national level might include major sociopolitical shifts, such as recession, war, and governmental collapse. • The built environment includes transportation, water and sanitation, housing, and other dimensions of urban planning.

20. Living and Working Conditions • May include: • Psychosocial factors • Employment status and occupational factors • Socioeconomic status (income, education, occupation, wealth) • The natural and built environments • Public health services • Health care services

21. Social, Family, Community Networks • Social Connectedness: • Social networks • Social support • Social integration • Social engagement

22. Social, Family, Community Networks • Social network pathways of influence on health: • Health behaviors • Health care • Access to material resources – jobs, etc. • Direct physiological responses leading to disease development and prognosis

23. Individuals • Innate biological factors • Health behaviors • Psychological factors • Physiological influences

24. Uraian dari 5 faktor dlm kaitan kes indivdu dan populasi Incl institusi

25. Berkaitan dengan promosi kesehatan dalam praktek kedokteran dan kesmas • ... the health-promotive capacity of an environment must be defined in terms of the multiple health outcomes resulting from people-environment transactions over a specified time interval. Thus, for any environmental context of behavior, it is important to specify key environmental resources or constraints that are likely to influence personal and collective well-being among members of the setting (Stokols, 1992, ). • Daniel Stokols "Establishing and Maintaining Healthy Environments: Toward a Social Ecology of Health Promotion" American Psychologist January 1992, Vol. 47, No. 1, pp. 6-22.)

26. Perubahan interaksi Agent-Host-Environment dan perubahan iklim mengubah siklus hidup vektor penyakit dan keadaan lingkungan dan perilaku manusia Mengakibatkan adanya usul klasifikasi penyakit menjadi empat golongan utama 1,

32. Praktek kedokteran traditional Orientasi individu . Dengan alat penyembuh adalah obat, vaksin dan dukungan lingkungan dan keluargaserta kebijakan pemerintah Penyakit disebabkan karena • Agent , intervensi mengobati penyakit untuk membunuh kuman penyakit • Host Melakukan pencegahan dengan vaksinasi dalam rangka peningkatan kekebalan • Lingkungan , pengadaan lingkungan sehat dan bersih agar kuman penyakit dan penyebab masalah tidak ada di lingkungan kehidupan

33. Keadaan kehidupan • Agent penyakit selalu ada karena keadaan sosial ( hidup di udara tercemar, lingkungan kumuh yang berdempetan ,perilaku tidak sehat/ perokok,air tergenang dengan jentik dll ) • Host acapkali tanpa kebijakan dan legalitas individu dan keluarga tak mampu melakukan tindakan pencegahan dan upaya peningkatan kesehatan • Lingkungan , tak dapat di ubah pasien dan keluarganya karena kedudukan nya di masyarakat dan keluarga

34. Population Health Framework Political Social Cultural Economic Spiritual Ecological Technological Health Outcomes Forces Nation-States Regions (Urban Entities) Neighborhoods / Communities Most Health Care Families / Couples / Households Lifecourse of Individuals Peran dr kesmas ; link individu.keluarga population dan kebijakan Biological Endowment Physical & Social Environmental Exposures Gene-Environment Interactions Most Public Health Interventions 27

35. Tbc control program

36. Berkaitan dengan case study • Bgmn dgn perilaku hidup sehat di padang • Kota sehat di bitung dikaitkan dengan penanggulangan hiv/aids • Pasar sehat dikaitkan dengan flu burung • IPKM dikaitkan dengan health inequity dan partisipasi pimpinan daerah / lokal dan pusat kesehatan dan non kesehatan

37. terima kasih