2017 ISP Sesi 1 YSP Ilmu Sosial Perilaku dalam Kesehatan Masyarakat

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MKDU - Ilmu Sosial dan

Perilaku dalam

Kesehatan Masyarakat

(ISP)

Kuliah Pendahuluan Pendekatan Ilmu Sosial dan Perilaku dalam Kesehatan Masyarakat 2017 Disampaikan oleh: Yayi Suryo Prabandari

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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.

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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.

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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

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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

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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)

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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 of

community 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

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LATAR BELAKANG PERLUNYA

KOMPETENSI SOSIAL PERILAKU

:

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Kondisi dasar Kesehatan (WHO)

Pendidikan

Penghasilan Perumahan

Kedamaian keadilan sosial dan kesetaraan

Sumber yang berkelanjutan Ekosistem

yg stabil

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Penentu Sosial Kesehatan

Penghasilan

Status sosial Pendidikan

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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 co text of people’s lives deter i es their

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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.

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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

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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

'closi g the gap i a ge eratio ’ as a atio al co cer , 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;

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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

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Fakta

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Laporan

WHO 2011

Perbandingan Penyebab

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Impact of Non-Communicable

Diseases on Productivity

• Countries throughout the world are expected to lose significant a ou ts of atio al i co e as a result of chro ic 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

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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 .8 times as important as absenteeism. The science of understanding metrics and costs of presenteeism are still being developed, however

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

Pergeseran Beban Penyakit 2000 vs 2010

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

mber :Susenas2000* Susenas 2010**

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PERUBAHAN BEBAN PENYAKIT

1990

–

2010 DAN 2015

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PENYEBAB KEMATIAN

UTAMA

UNTUK SEMUA UMUR

DI INDONESIA

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Penyebab kematian utama di Indonesia 2015 SRS adalah

Stroke, Kardiovaskulair, DM

Komplikasi (6,7), TB,

Sumber: Litbangkes

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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

7 Chronic Obstructive

Pulmonary Disease 3.1% 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 Indonesia

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FACTORS

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

POPULATION

Societal policies and processes influencing the

population prevalence

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PROPORSI PENDUDUK DENGAN

FAKTOR RISIKO PTM DI INDONESIA

FAKTOR RISIKO PTM 2007

(%)

2013

(%)

1 Merokok (usia ≥ 15 th) 34,7 36,3

2 Aktifitas fisik kurang

(usia ≥ th) 48,2 26,1

3 Kurang konsumsi sayur &

buah (usia ≥ 10 th) 93,6 93,5

4 Konsumsi minuman

beralkohol 4,6 n.a 5 Konsumsi minuman beralkohol

berbahaya 0,3 n.a

6 Obesitas sentral

(usia ≥ 18 th) 18,8 26,6 7 Obesitas (usia >15 th,

IMT >25) 19,1 15,4

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Determinan

penyebab remaja menjadi perokok*

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Riskesdas 2013

Kurang makan buah

dan sayur

93,5

Merokok

64,9

29,3

Kurang aktifitas

fisik

26,1

Kurang makan buah

dan sayur

85,0

Merokok

26,9

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

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Prevalensi

Perokok

di Yogyakarta

RISKESDAS 2007, 2010, 2013

Status Merokok ₂₀₀₇

(10 th ke

Setiap hari 23,8 25,3 21,2

Kadang-kadang

6 6,3 5,7 Tidak

merokok

Mantan 5,9 10,4 9,1 Bukan

perokok

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:

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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

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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

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Gaya Hidup dan Kesehatan

• Evolusi Budaya: perubahan adaptif budaya

untuk menghadapi tekanan lingkungan

• Gaya Hidup: perilaku seseorang, cara

hidup seseorang

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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

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Siapakah yang

e derita

akibat

perubahan sosial?

• Pendidikan rendah

• Sosial ekonomi rendah

Miskin

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HIRARKI

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HIRARKI KESEHATAN DAN SAKIT PADA

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HIRARKI KESEHATAN SERTA DISIPLIN DAN TEORI DALAM

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KAITAN ILMU SOSIAL DAN MASALAH

KESEHATAN

SEBUAH CONTOH:

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Maternal death determinant:

Indonesian case

Education Economy Gender Social Culture P

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

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BEHAVIORAL AND SOCIAL SCIENCES :

DEFINITIONS, DOMAINS,

(47)

Social Sciences

• Anthropology (and archaeology)

• Demography

• Economics

• Geography

• History

• Law

• Education

• Linguistics

• Political science

• Psychology

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The social and behavioral

sciences provide tools for:

• Analyzing health and illness

• Developing greater competencies (especially cultural competence)

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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

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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

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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

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• 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, antropolog kesehatan dan kebijakan

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

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

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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.

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Penugasan Individu

Penu-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

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Penugasan Individu

Penu-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).

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PENUGASAN KELOMPOK 1

Tugas:

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,

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Penugasan Kelompok ke 2 Penugasan:

Kelas dibagi kelompok dan lanjutkan dengan kelompok yang sama pada penugasan sebelumnya (penugasan 1).

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.

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Penugasan Kelompok ke 3 Tugas:

Penugasan dan diskusi kelompok (Kelas dibagi beberapa kelompok, satu kelompok terdiri dari 4 atau 5 mahasiswa)

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,

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Reminding

G

ROUP WORK AND

S

MALL DISCUSSION

(3

ASSIGNMENT

)

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Penilaian

• MINI QUIZ ……… 15%

• Group assig e t ……….. 25%

• Individual assignment ……….……… 25%

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NO TOPIK BAHASAN PENGAJAR 1 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 Fasilitator 4 Session 3 –The main principle of anthropological approach to understand health RSP 5 Diskusi kelompok 2 Fasilitator

6 Session 4 –Sociological theories and perspective in understanding health SP 7 Diskusi kelompok 3 Fasilitator 8 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)

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