MKDU - Ilmu Sosial danPerilaku dalam

Kesehatan Masyarakat(ISP)

Kuliah Pendahuluan Pendekatan Ilmu Sosial danPerilaku dalam Kesehatan Masyarakat 2017

Disampaikan oleh:Yayi Suryo Prabandari

PROGRAM STUDI S2 ILMU KESEHATAN MASYARAKAT FAKULTAS KEDOKTERAN

UNIVERSITAS GADJAH MADA

Tujuan Umum mata kuliah

• Formulate socio-anthro-psychological theories and approach in understanding health social problem comprissing how to function, conflict and interaction, promotion, prevention and curative delivery in health services, management and policy decision making process.

• Evaluate the social, behavioral and cultural aspects related to community health status and the role of health workforce function in controlling community health

Tujuan Umum mata kuliah

• Analyze the reasons and causes of people in accepting or refusing healthy behavior in perspective and context of individual, family, social structure and culture.

• Debate global and international health issues related to social determinant of health

Tujuan khusus

• Explain rationale to learn about social behavioral approach in public health, trans-disciplinary perspective and the complexity of social behavioral science

• Debate main behavioral theories to learn about healthy and unhealthy behavior (Group assignment and discussion)

• Appraise the main principle of anthropological approach to understand health

• Debate main anthropological principles to sharp human approach in public health (Group assignment and discussion)

Tujuan khusus

• Review sociological theories and perspective in understanding health

• Debate main sociological theories in public health (Group assignment and discussion)

• Analyze social determinant of health, equity and public health program

• Review new paradigm health promotion and the application of social behavioral theories for promoting health

Tujuan khusus• Appraise behavior change theories and its

application of selected theories on tobacco control

• Analyze dimension of social culture on health and illness including gender perspective

• Debate the health seeking behavior of the community in relation to health and illness (Group assignment and discussion)

• Appraise the shift of health organization, services, and health workforces, in relation to social change

Tujuan khusus• Debate the shift of health organization and services –

observation from the field (group assignment and discussion)

• Appraise society action and the application of ecological theory in particular public health issues: a case ofcommunity empowerment and local policy application for tackling NCD

• Appraise social anthropological perspective related to public health in particular issues – International and Global Health – case of communicable disease AIDS and TB (including stigma)

• Appraise social behavior approach related to public health in particular issues-occupational and environment health

LATAR BELAKANG PERLUNYA KOMPETENSI SOSIAL PERILAKU:

SOCIAL DETERMINANTS OF HEALTH

SDG – Sustainable Development Goals

Kondisi dasar Kesehatan (WHO)

Pendidikan

PenghasilanPerumahan

Kedamaian

keadilansosial dankesetaraan

Sumber yang berkelanjutan

Ekosistemyg stabil

10

Penentu Sosial Kesehatan

Penghasilan

Status sosialPendidikan

STATUS

SEHAT

WHO Commission on Social Determinants of Health (2008)

• The determinants of health include the social, physical and economic environments, as well as individual characteristics and behaviors.

• The context of people’s lives determines their health, not less than their genetic inheritance and their personal choices and way of life thus, health is inappropriate

KEY DEFINITIONS

• Social determinants of health These refer to the social, economic, and political situations that affect the health of individuals, communities, and populations.

• Inequity in health and health care

• Inequity in health is a normative concept and refers to those inequalities that are judged to be unjust or unfair because they result from socially derived processes.

• Equity in health care requires active engagement in planning, implementation, and regulation of health systems to make unbiased and accountable arrangements that address the needs of all members of society.

*

WHO’s Commission on Social Determinants of Health (2008) established the following overarching recommendations:

improve the conditions of daily life - the circumstances in which people are born, grow, live work and age

tackle the inequitable distribution of power, money and resources - the structural drivers of those conditions of daily life – globally, nationally and locally;

measure the problem, evaluate action, expand the knowledge base, develop a workforce , that is trained in the social determinants of health, and raise public awareness about the social determinants of health.

WHO’s Commission on Social Determinants of Health (2008) established the following overarching recommendations:

• to tackle the health inequities within and across countries

through political commitment on the main principles of 'closing the gap in a generation’ as a national concern,

as is appropriate, and to coordinate and manage intersectoral action for health in order to mainstream health equity in all policies, where appropriate, by using health and health equity impact assessment tools;

• to develop and implement goals and strategies to improve public

health with a focus on health inequities;

What is socioeconomic of illness?

• Social determinant of health

• Economic and macro situation in a country

Socioeconomic

• Communicable disease

• Non communicable disease

Illness• Burden of illness to

the sites (district/city, province, nation)

• Social impact of illness to the family

Socioeconomic

Fakta

* Beberapa slide diambil dari presentasi Promkes DinkesPropinsi Yogyakarta

Laporan WHO 2011

Perbandingan Penyebab kematian 2000-2011

PenyebabKematianTerbanyakberdasarkanPenghasilanNegara

Impact of Non-Communicable Diseases on Productivity

• Countries throughout the world are expected to lose significant amounts of national income as a result of chronic disease’s negative impact on labor supplies and a reduction in GDP.

• Labor supplies are reduced as a result of premature death or illness causing inability to work.

• In 2005, heart disease, stroke and diabetes caused an estimated loss in national income of 18 billion international dollars in China, 9 billion in India and 3 billion in Brazil These losses accrue over time because more people die each year so estimates for 2015 are three to six times that of 2005 for the same countries.

Costs of Absenteeism and Presenteeism

• Absenteeism is defined as absence from work due to illness while presenteeism is defined as productivity lost from ill employees coming to work and performing below the normal standard.

• In 2006, the United Kingdom had a working population of 37.7 million individuals. There were 175 million days lost in 2006 to absence from illness.

This amounts to 4.64 days lost due to illness per person. In the UK, the estimated cost – both direct and indirect – of absences due to illness was 20.2 billion pounds in 2006.

• It is widely accepted that presenteeism has a larger effect than absenteeism, causing some to state that presenteeism is “1.8 times as important as absenteeism.” The science of understanding

metrics and costs of presenteeism are still being developed, however controlling presenteeism and absenteeism is an area that will save employers money and also will contribute to the national economy

Sehat (85%*) Sehat (70%**)

Pergeseran Beban Penyakit 2000 vs 2010

Mengeluh Sakit (30%**)Mengeluh Sakit (15%*)

mber :Susenas2000* Susenas 2010***

PERUBAHAN BEBAN PENYAKIT

1990 –2010 DAN 2015

*

PENYEBAB KEMATIAN UTAMA UNTUK SEMUA UMUR DI INDONESIA

24

Penyebab kematian utama di Indonesia 2015 SRS adalahStroke, Kardiovaskulair, DM Komplikasi (6,7), TB,

Sumber: Litbangkes*

Rank Cause Of Death% Of Total

Deaths, 2012

Number Of

Deaths (in

thousands)

1 Stroke 21.2% 328.5

2 Ischemic Heart Disease 8.9% 138.4

3 Diabetes 6.5% 100.4

4 Lower Respiratory Infections 5.2% 81.1

5 Tubeculosis 4.3% 66.7

6 Cirrhosis 3.2% 48.9

7Chronic Obstructive

Pulmonary Disease3.1% 48.1

8 Road Injury 2.9% 44.6

9 Hypertensive Heart Disease 2.7% 42.2

10 Kidney Diseases 2.6% 41

Leading Causes Of Death In IndonesiaThis page was published on August 30, 2016

Risk factors of NCD in Indonesia

FACTORSINTERNATIONAL

Development

Globalization

of

markets

School

Food &

Activity

WORK/SCHOOL/

HOME

Infections

Labor

Worksite

Food &

Activity

Leisure

Activity/

Facilities

Agriculture/

Gardens/

Local markets

COMMUNITY

LOCALITY

Health

Care

System

Public

Safety

Public

Transport

Manufactured/

Imported

Food

Sanitation

NATIONAL/REGIONAL

Food &

Nutrition

Urbanization

Education

HealthO

SITY

PREVALEN

E

INDIVIDUAL

Energy

Expenditure

Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999: http://www.iotf.org

POPULATION

%

OBESE

OR

UNDER

WT

Social security

Media

Transport

Family &

Home

National

perspective

Media &

Culture

Food

intake :

Nutrient

density

Media

programs

& advertising

Societal policies and processes influencing the

population prevalence

of obesity

PROPORSI PENDUDUK DENGANFAKTOR RISIKO PTM DI INDONESIA

FAKTOR RISIKO PTM 2007(%)

2013(%)

1 Merokok (usia ≥ 15 th) 34,7 36,3

2Aktifitas fisik kurang

(usia ≥ 10 th)48,2 26,1

3Kurang konsumsi sayur &

buah (usia ≥ 10 th)93,6 93,5

4Konsumsi minuman

beralkohol4,6 n.a

5Konsumsi minuman beralkohol

berbahaya0,3 n.a

6Obesitas sentral

(usia ≥ 18 th)18,8 26,6

7Obesitas (usia >15 th,

IMT >25)19,1 15,4

Sumber: Riskesdas 2007; Riskesdas 2013

Mengubah perilakumerupakantantangan utamadalam pencegahandan pengendalianPTM

*

Determinan

penyebab remaja

menjadi perokok*

*Prabandari, YS, 2012

Riskesdas 2013Kurang

makan buahdan sayur

93,5

Merokok 64,9 29,3Kurangaktifitas

fisik26,1

Kurangmakan buah

dan sayur85,0

Merokok 26,9Kurangaktifitas

fisik20,8

Indonesia

DIY

Perokok di Indonesia dari tahun ke tahun

*Kosen, Aryastami, Usman, Karyana, Konas Presentation IAKMI XI, 2010 @Ministry of Health, Basic Health Research, 2007 ( prevalence of > 10 years old)#Ministry of Health, Basic Health Research, 2010 (prevalence of > 15 years old)

^WHO, 2012 Global Adult Tobacco Survey: Indonesia Report 2012

(+) Ministry of Health, Basic Health Research, 2013 (prevalence of > 15 years old)

Year Male Female Total

1995* 53.9 1.7 27.2

2001* 62.9 1.4 31.8

2004* 63.0 5.0 35.0

2007** 65.3 5.6 35.4

2010^ 65.9 4.2 34.7

2011# 67.0 2.7 34.8

2013(+) 64.9 2.1 29.3

Prevalensi Perokok di Yogyakarta

RISKESDAS 2007, 2010, 2013

Status Merokok 2007(10 th ke

atas)

2010(15 th ke atas)

2013(10 th ke

atas)

Perokok saatini

Setiap hari 23,8 25,3 21,2

Kadang-kadang

6 6,3 5,7

Tidakmerokok

Mantan 5,9 10,4 9,1

Bukanperokok

64,4 58,1 64,1

Jumlah rokok yang dihisap 9,8 **** 9,9

****Dalam RISKESDAS 2010 jumlah rokok yang dihisap

dihitung secara dengan cara:

1- 10 batang/hari = 66.3%

11-20 batang/hari = 30,2%

21-30 batang/hari = 3,0%

>30 batang/hari = 0.6%

RISKESDAS 2010

ASI eksklusif 15,3 – 39,8

Akses terhadap air minum yang baik 67,5

Kepemilikan fasilitas BAB pribadi 69,7

Buang sampah sembarangan 9,0;

dibuang di laut/sungai/parit 10,2

Gizi buruk 4,9; Gizi kurang 13,0; Gizi lebih 5,8

RISKESDAS 2013

ASI eksklusif 38,0%, Inisiasi menyusui dini 34,5%

Akses terhadap air minum yang improved 66,8%

BAB dengan benar 82,6%

Buang sampah sembarangan 9,0;

dibuang di laut/sungai/parit 10,2

Kurus 8,7%; Gizi lebih 13,5%; Obes 15,4%

35

Gaya Hidup dan Kesehatan

• Evolusi Budaya: perubahan adaptif budayauntuk menghadapi tekanan lingkungan

• Gaya Hidup: perilaku seseorang, carahidup seseorang

Adanya evolusi budaya menyebabkanperubahan gaya hidup

36

Global trends• Demografi dan tekanan sosial• Kondisi ekologi• Pertumbuhan dan perkembangan ekonomi• Kesenjangan kemiskinan• Social fabric• Perkembangan teknologi• Perkembangan, konflik dan perdamaian• Beban ganda penyakit• Pekerjaan• Kecenderungan sistem kesehatan yg spesifik

37

Siapakah yang “menderita”akibatperubahan sosial?

• Pendidikan rendah

• Sosial ekonomi rendah

Miskin

Banyak penyakit

THE HEALTH HIRARCHY

HIRARKI

KESEHATAN

HIRARKI KESEHATAN DAN SAKIT PADA MANUSIA

HIRARKI KESEHATAN SERTA DISIPLIN DAN TEORI DALAM KESEHATAN

HIRARKI SISTEM ALAMIAH

KAITAN ILMU SOSIAL DAN MASALAH KESEHATAN SEBUAH CONTOH:PENYEBAB KEMATIAN ANAK

45

Maternal death determinant:Indonesian case

Education Economy Gender Social Culture

P

r

e

g

n

a

n

t

w

o

m

e

n

Nutrition

Infectious

disease

4 T’s

Behavior

C

o

m

p

l

i

c

a

t

i

o

n

Late to identify of

red flag and make

decision

Late in reach health

facilities

Late in get

services in health

facilities

Human resources Facilities Medication

Death

Demand side

Supply side

BEHAVIORAL AND SOCIAL SCIENCES : DEFINITIONS, DOMAINS, CONTRIBUTION AND INTERVENTION

Social Sciences• Anthropology (and archaeology)

• Demography

• Economics

• Geography

• History

• Law

• Education

• Linguistics

• Political science

• Psychology

• Sociology

The social and behavioral sciences provide tools for:

• Analyzing health and illness

• Developing greater competencies (especially cultural competence)

• Developing a more critical and discerning science.

WORKING DEFINITION OF THE BEHAVIORAL AND SOCIAL SCIENCES (ADAPTED FROM THE OFFICE OF BEHAVIORAL AND SOCIAL SCIENCE RESEARCH OF THE NIH)

• The Behavioral and Social Sciences are defined as the sciences of behavior, including individual psychological processes and behavioral interactions, and the sciences of social interaction, including familial, cultural, economic, and demographic.

• The core areas focus on the understanding of behavioral or social processes and on the uses of these processes to predict or influence health outcomes or risk factors

#

HEALTH CARE CHALLENGES AMENABLE TO BEHAVIORAL AND SOCIAL SCIENCE INQUIRY

• Behavioral & Social Determinants of Morbidity and Mortality

• Health and Health Care Disparities

• Medical Error Reduction

• Patient Safety

• Primary Care Shortage

• Physician Discontent and Burn-out

• Unequal Access to Care

#

Behavioral and Social Science Domains related to Health and Health Care

• Patient Behavior

• Mind-Body Interaction

• Physician Role & Behavior

• Physician-Patient Interaction

• Health Policy, Economics, and Systems (including Population Health)

• Social and Cultural Context

#

• Dra. Yayi Suryo Prabandari, M.Si., Ph.D (Koordinator) – psikolog (klinis & kesehatan), promotor kesehatan

• Dr. Fatwa Sari Tetra Dewi, MPH., Ph.D – dokter, epidemiolog dan promotor kesehatan

• Dr. Ratna Siwi Padmawati, MA – antropolog, antropologkesehatan dan kebijakan

• Dr. Mubasyisyir Hasan Basri, MA (dokter, kesehatan masyarakat, sosiologi

• Supriyati, S.Sos., M.Kes., Ph.D (can) – sosiolog, promotor kesehatan

Pengajar

PENUGASAN INDIVIDU DAN KELOMPOK

Penugasan Individu

Penu-

gasan

1

Buatlah diagram penentu sosial sebuah penyakit yang dilaporkan tinggi

prevalensi atau insidensinya di daerah asal karyasiswa

Gunakan minimal 3 artikel jurnal terbitan 5 tahun terakhir sebagai dasar

pembahasan selain laporan kasus dari daerahnya. Jurnal minimal terdiri 1

artikel jurnal internasional reputasi (ambil data base yang dilanggan UGM)

dan 2 artikel jurnal nasional terakreditasi.

Jawaban diketik dalam kertas A4 maksimal 3 halaman termasuk judul dan

daftar pustaka, gunakan font times roman, dikumpulkan pada sekretaris

masing-masing minat paling lambat 1 minggu setelah kuliah sesi 5.

Penugasan IndividuPenu-

gasan

2

Pilih salah satu kasus berikut:

- Mengapa orang yang berpendidikan cenderung mengonsumsi

pil/obat tinggi serat daripada makan buah dan sayur segar?

- Mengapa kawasan tanpa rokok tidak efektif di Indonesia?

- Mengapa terdapat 70% penduduk Indonesia yang mengonsumsi mie

instant setiap hari meskipun hal tersebut tidak sehat?

- Mengapa mahasiswa senang makanan ”sampah” (junk food)

Jawaban maksimal 2000 kata dan didasarkan minimal 5 artikel jurnal terbitan

5 tahun terakhir (3 artikel jurnal nasional terakreditasi Ristekdikti atau

Litbangkes dan 2 artikel jurnal internasional bereputasi – gunakan data base

yang dilanggan UGM).

Jawaban diketik dalam kertas A4, gunakan font times

roman/arial/Calibri/cambria, dikumpulkan pada sekretaris masing-masing

minat paling lambat 1 minggu setelah kuliah sesi 6.

Penugasan IndividuPenu-

gasan

3

Pilihlah salah satu pesan kesehatan yang ada di media cetak

atau web/virtual atau media berbasis teknologi lainnya dan

reviulah pesan kesehatan tersebut berdasar teori komunikasi,

perilaku, sosial atau antropologi, serta efektivitas media.

Jawaban maksimal 2000 kata dan didasarkan minimal 5 artikel

jurnal terbitan 5 tahun terakhir (3 artikel jurnal nasional

terakreditasi Ristekdikti atau Litbangkes dan 2 artikel jurnal

internasional bereputasi – gunakan data base yang dilanggan

UGM).

Jawaban diketik dalam kertas A4, gunakan font times

roman/arial/Calibri/cambria, dikumpulkan pada sekretaris

masing-masing minat paling lambat 1 minggu setelah kuliah

sesi 6.

PENUGASAN KELOMPOK 1Tugas:

Penugasan dan diskusi kelompok (Kelas dibagi beberapa kelompok, satu kelompok terdiri

dari 4 atau 5 mahasiswa)

Dalam penugasan kelompok, karyasiswa diharuskan:

1. Melakukan wawancara semi struktur pada temannya di luar Prodi S2 IKM, masing-

masing mahasiswa mewawancara 2 orang tentang perilaku sehat dan tidak sehat

2. Setelah wawancara, hasil dianalisis untuk memahami terbentuknya perilaku berdasar

teori perilaku

3. Melakukan reviu langkah pertama dan kedua dengan referensi yang diwajib dan

anjurkan di kuliah sesi 2

4. Hasil wawancara individu dan analisis digabung dalam satu kelompok, dikomparasi

dan disimpulkan

5. Setiap kelompok presentasi dalam diskusi kelompok yang dipandu fasilitator.

Presentasi disajikan dalam PPT atau lainnya (video pendek dsb). Setiap kelompok wajib

presentasi selama 10 menit dan dilanjutkan 10 menit diskusi.

6. Hasil presentasi kelompok dikumpulkan pada fasilitator masing-masing paling lambat 1

minggu setelah presentasi. Laporan penugasan kelompok diketik pada kertas A4, huruf

arial/times roman/Calibri/Garamond, minimal font 11, spasi 1.5 and maksimum 7

halaman, termasuk cover dan daftar pustaka. Gunakan pustaka artikel jurnal 5 tahun

terakhir, minimal 3 artikel jurnal nasional terakreditasi Ristekdikti atau Litbangkes dan 2

jurnal internasional bereputasi (gunakan data dasar EBSCO, PubMed, Cochrane,

Scopus, dan yang dilanggan oleh UGM

Penugasan Kelompok ke 2

Penugasan:

Kelas dibagi kelompok dan lanjutkan dengan kelompok yang sama pada penugasan

sebelumnya (penugasan 1).

Dalam penugasan kelompok, karyasiswa diharuskan:

Melakukan evaluasi prinsip antropologi yang berkaitan dengan sehat dan sakit

Melakukan debat prinsip antropologi yang berkaitan dengan kesehatan masyarakat

Reviu langkah 1 dan 2 dengan referensi yang wajib dan dianjurkan dalam kuliah sesi 3

Setiap kelompok presentasi dalam diskusi kelompok yang dipandu fasilitator. Presentasi

disajikan dalam PPT atau lainnya (video pendek dsb). Setiap kelompok wajib presentasi

selama 10 menit dan dilanjutkan 10 menit diskusi.

Hasil presentasi kelompok dikumpulkan pada fasilitator masing-masing paling lambat 1

minggu setelah presentasi. Laporan penugasan kelompok diketik pada kertas A4, huruf

arial/times roman/Calibri/Garamond, minimal font 11, spasi 1.5 and maksimum 7 halaman,

termasuk cover dan daftar pustaka. Gunakan pustaka artikel jurnal 5 tahun terakhir, minimal

3 artikel jurnal nasional terakreditasi Ristekdikti atau Litbangkes dan 2 jurnal internasional

bereputasi (gunakan data dasar EBSCO, PubMed, Cochrane, Scopus, dan yang dilanggan

oleh UGM)

Penugasan Kelompok ke 3Tugas:

Penugasan dan diskusi kelompok (Kelas dibagi beberapa kelompok, satu kelompok

terdiri dari 4 atau 5 mahasiswa)

Dalam penugasan kelompok, karyasiswa diharuskan:

Melakukan reviu teori utama sosiologi yang berkaitan dengan kesehatan secara umum

dan kesehatan masyarakat

Melakukan depat perbandingan teori-teori sosiologi

Melakukan reviu langkah pertama dan kedua dengan referensi yang diwajib dan anjurkan

di kuliah sesi 4

Setiap kelompok presentasi dalam diskusi kelompok yang dipandu fasilitator. Presentasi

disajikan dalam PPT atau lainnya (video pendek dsb). Setiap kelompok wajib presentasi

selama 10 menit dan dilanjutkan 10 menit diskusi.

Hasil presentasi kelompok dikumpulkan pada fasilitator masing-masing paling lambat 1

minggu setelah presentasi. Laporan penugasan kelompok diketik pada kertas A4, huruf

arial/times roman/Calibri/Garamond, minimal font 11, spasi 1.5 and maksimum 7

halaman, termasuk cover dan daftar pustaka. Gunakan pustaka artikel jurnal 5 tahun

terakhir, minimal 3 artikel jurnal nasional terakreditasi Ristekdikti atau Litbangkes dan 2

jurnal internasional bereputasi (gunakan data dasar EBSCO, PubMed, Cochrane,

Scopus, dan yang dilanggan oleh UGM)

Reminding

GROUP WORK AND

SMALL DISCUSSION

(3 ASSIGNMENT)

INDIVIDUAL

ASSIGNMENT (3)

Session 2Session 3Session 4

Session 5Session 6Session 7

Mini Quiz diadakan 5 menitsebelum kuliah dimulai –berdasar Main Reference

Penilaian• MINI QUIZ …………………………………………………… 15%

• Group assignment ………………………………………….. 25%

• Individual assignment ……………….……………… 25%

• Final exam ………………………………………………….. 35%

NO TOPIK BAHASAN PENGAJAR1 Session 1 – Social behavioral approach in public health, trans-disciplinary

perspective and the complexity of social behavioral science YSP

2 Session 2 – Behavioral theories underlying healthy and unhealthy behavior YSP

3 Diskusi kelompok 1 Fasilitator4 Session 3 – The main principle of anthropological approach to understand health RSP

5 Diskusi kelompok 2 Fasilitator6 Session 4 – Sociological theories and perspective in understanding health SP

7 Diskusi kelompok 3 Fasilitator8 Session 5 – Social determinant of health, equity and public health program MBS

9 Session 6 – Communication & Behavior change theories and its application of selected theories on tobacco control

YSP

10 Session 7 – New paradigm on Health Promotion and the use of Technology for promoting health

FST

11 Session 8 – Dimension of social culture on health, illness and gender perspective RSP

12 Session 9 – Social change and the shift of health organization, services and workforces

MBS

13 Session 10 – Society action and the application of ecological theory in particular public health issues: a case of Community empowerment and local policy application for tackling NCD

FST

14 Session 11 – Social behavior related to public health in particular issues –International and Global Health – case of communicable disease AIDS and TB, including stigma

RSP

15 Session 12 – Social behavior related to public health in particular issues (delivered on each department)

departemen terkait

FINAL EXAMINATION (TAKE HOME)

Satuan Acara Pengajaran ISP 2017

Terima kasih