MKDU - Ilmu Sosial dan Perilaku dalam Kesehatan Masyarakat (ISP)

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1 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 PROGRAM STUDI S2 ILMU KESEHATAN MASYARAKAT FAKULTAS KEDOKTERAN UNIVERSITAS GADJAH MADA

2 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

3 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

4 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)

5 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

6 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

7 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 health in particular issues-occupational and environment health

8 LATAR BELAKANG PERLUNYA KOMPETENSI SOSIAL PERILAKU: SOCIAL DETERMINANTS OF HEALTH

9 SDG Sustainable Development Goals

10 10 Kondisi dasar Kesehatan (WHO) Pendidikan Ekosistem yg stabil Penghasilan Perumahan Sumber yang berkelanjutan Kedamaian keadilan sosial dan kesetaraan

11 Penentu Sosial Kesehatan Penghasilan Status sosial Pendidikan STATUS SEHAT

12 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

13 * 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.

14 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.

15 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;

16 What is socioeconomic of illness? Social determinant of health Economic and macro situation in a country Socioeconomic Illness Communicable disease Non communicable disease Burden of illness to the sites (district/city, province, nation) Social impact of illness to the family Socioeconomic

17 Fakta * Beberapa slide diambil dari presentasi Promkes Dinkes Propinsi Yogyakarta

18 Laporan WHO 2011 Perbandingan Penyebab kematian

19 Penyebab Kematian Terbanyak berdasarkan Penghasilan Negara

20 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.

21 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 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

22 Pergeseran Beban Penyakit 2000 vs 2010 Sehat (85%*) Sehat (70%**) Mengeluh Sakit (15%*) Mengeluh Sakit (30%**) * mber :Susenas2000* Susenas 2010**

23 * PERUBAHAN BEBAN PENYAKIT DAN 2015

24 PENYEBAB KEMATIAN UTAMA UNTUK SEMUA UMUR DI INDONESIA Penyebab kematian utama di Indonesia 2015 SRS adalah Stroke, Kardiovaskulair, DM Komplikasi (6,7), TB, * Sumber: Litbangkes 24

25 Leading Causes Of Death In Indonesia This page was published on August 30, 2016 Rank Cause Of Death % Of Total Deaths, 2012 Number Of Deaths (in thousands) 1 Stroke 21.2% Ischemic Heart Disease 8.9% Diabetes 6.5% Lower Respiratory Infections 5.2% Tubeculosis 4.3% Cirrhosis 3.2% Chronic Obstructive Pulmonary Disease 3.1% Road Injury 2.9% Hypertensive Heart Disease 2.7% Kidney Diseases 2.6% 41

26 Risk factors of NCD in Indonesia

27 Societal policies and processes influencing the population prevalence of obesity INTERNATIONAL FACTORS NATIONAL/ REGIONAL COMMUNITY LOCALITY WORK/ SCHOOL/ HOME INDIVIDUALPOPULATION Transport Public Transport Leisure Activity/ Facilities Globalization of markets Development Media programs & advertising Media Urbanization Health Social security Media & Culture Education Public Safety Health Care Sanitation System Manufactured/ Imported Food Labor Infections Worksite Food & Activity Family & Home Energy Expenditure Food intake : Nutrient density S IT Y O % P R EV OBESE A LE N E OR UNDER WT National perspective Food & Nutrition Agriculture/ Gardens/ Local markets School Food & Activity Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999:

28 FAKTOR RISIKO PTM 2007 (%) 2013 (%) PROPORSI PENDUDUK DENGAN FAKTOR RISIKO PTM DI INDONESIA 1 Merokok (usia 15 th) 34,7 36,3 2 3 Aktifitas fisik kurang (usia 10 th) Kurang konsumsi sayur & buah (usia 10 th) 48,2 26,1 93,6 93,5 Mengubah perilaku merupakan tantangan utama dalam pencegahan dan pengendalian PTM * Konsumsi minuman beralkohol Konsumsi minuman beralkohol berbahaya Obesitas sentral (usia 18 th) Obesitas (usia >15 th, IMT >25) 4,6 n.a 0,3 n.a 18,8 26,6 19,1 15,4 Sumber: Riskesdas 2007; Riskesdas 2013

29 Determinan penyebab remaja menjadi perokok* *Prabandari, YS, 2012

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31 Riskesdas 2013 Kurang makan buah dan sayur 93,5 Indonesia Perokok di Indonesia dari tahun ke tahun Merokok 64,9 29,3 Kurang aktifitas fisik 26,1 Kurang makan buah dan sayur 85,0 DIY Merokok 26,9 Year Male Female Total 1995* * * ** ^ # (+) Kurang aktifitas fisik 20,8 *Kosen, Aryastami, Usman, Karyana, Konas Presentation IAKMI XI, 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)

32 Prevalensi Perokok di Yogyakarta RISKESDAS 2007, 2010, 2013 Status Merokok 2007 (10 th ke atas) Perokok saat ini Tidak merokok 2010 (15 th ke atas) 2013 (10 th ke atas) Setiap hari 23,8 25,3 21,2 Kadangkadang 6 6,3 5,7 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: 1-10 batang/hari = 66.3% batang/hari = 30,2% batang/hari = 3,0% >30 batang/hari = 0.6%

33 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

34 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 budaya untuk menghadapi tekanan lingkungan Gaya Hidup: perilaku seseorang, cara hidup seseorang Adanya evolusi budaya menyebabkan perubahan gaya hidup 35

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 36

37 Siapakah yang menderita akibat perubahan sosial? Pendidikan rendah Sosial ekonomi rendah Banyak penyakit Miskin 37

38 THE HEALTH HIRARCHY

39 HIRARKI KESEHATAN

40 HIRARKI KESEHATAN DAN SAKIT PADA MANUSIA

41 HIRARKI KESEHATAN SERTA DISIPLIN DAN TEORI DALAM KESEHATAN

42 HIRARKI SISTEM ALAMIAH

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

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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 Demand side Death Supply side 45

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

47 Social Sciences Anthropology (and archaeology) Demography Economics Geography History Law Education Linguistics Political science Psychology Sociology

48 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.

49 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 #

50 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 #

51 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 #

52 Pengajar 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

53 PENUGASAN INDIVIDU DAN KELOMPOK

54 Penugasan Individu Penugasan 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.

55 Penugasan Individu Penugasan 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.

56 Penugasan Individu Penugasan 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.

57 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, masingmasing 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

58 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)

59 Penugasan Kelompok ke 3 Tugas: 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)

60 Reminding GROUP WORK AND SMALL DISCUSSION (3 ASSIGNMENT) Session 2 Session 3 Session 4 Mini Quiz diadakan 5 menit sebelum kuliah dimulai berdasar Main Reference INDIVIDUAL ASSIGNMENT (3) Session 5 Session 6 Session 7

61 Penilaian MINI QUIZ 15% Group assignment.. 25% Individual assignment. 25% Final exam.. 35%

62 Satuan Acara Pengajaran ISP 2017 NO TOPIK BAHASAN PENGAJAR 1 Session 1 Social behavioral approach in public health, trans-disciplinary YSP perspective and the complexity of social behavioral science 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 YSP selected theories on tobacco control 10 Session 7 New paradigm on Health Promotion and the use of Technology for FST promoting health 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 MBS workforces 13 Session 10 Society action and the application of ecological theory in particular FST public health issues: a case of Community empowerment and local policy application for tackling NCD 14 Session 11 Social behavior related to public health in particular issues RSP International and Global Health case of communicable disease AIDS and TB, including stigma 15 Session 12 Social behavior related to public health in particular issues (delivered on each department) departemen terkait FINAL EXAMINATION (TAKE HOME)

63 Terima kasih