DETERMINAN KESEHATAN

Determinan
Lingkungan

Nunuk Nugrohowati, drg. MS

Dept. of Public Health
 Learning Objective:
Menjelaskan ttg ekosistem dan
lingkungan
Menjelaskan hub antara lingkungan-
kesehatan dalam tatanan determinan
kesehatan (Teori Blum)
Menjelaskan lingk biologi, kimia,
fisika
Menjelaskan ttg lingkungan sosial
Menjelaskan ttg kesehatan
lingkungan
Menjelaskan tentang sustainable
development
Ecosystem
Beberapa unit organisasi atau spatial dimana
termasuk organisme hidup & substansi mati
yang berinteraksi untuk memproduksi
pertukaran materi antara bagian yang hidup
dan mati
Basic components:
substansi abiotik
organisme producer
organisme consumer
organisme decomposer
 Basic components of an
ecosystem
PRODUCERS
Green plants
Bacteria

PRIMARY CONSUMERS
Basic plant Herbivores
nutrients Plant parasites

SECONDARY CONSUMERS
DECOMPOSERS Omnivores
Saprophytic bacteria Carnivores
Fungi Animal parasites
Scavengers
Simplified illustration of integration within the
comparatively simple pine forest ecosystem
 What is environment?
(Semua) yang ada diluar / external dari
individu manusia. (Semua) dapat
digolongkan kedalam fisik, biologi, sosial,
kultural, dimana sebagian atau
seluruhnya dapat mempengaruhi status
kesehatan di populasi (Last, 1995)
 Semua penyebab penyakit karena
lingkungan yang bukan genetik
Nature vs nurture
Faktor lingkungan termasuk yang
mempengaruhi organisme melalui
kondisi sosial atau media lingkungan
 Lingkungan Sosial
Slide lain
Manusia memp kemamp ekstra
beradaptasi dan terlibat dgn lingk mrk
utk memenuhi kebutuhan nya
Banyak cara utk membuat lingk lebih
Gangguan kesehatan lingkungan yang
sehat
dapat mencemari individu misalnya;
Pencemaran industri
Persediaan air bersih & sanitasi yg
buruk
Perumahan & tata kota yang buruk
Kurangnya kontrol persediaan
makanan dan industri makanan
Kualitas jalan yang buruk
Kondisi yang buruk ditempat kerja
 Tipe penyebab gangguan
kesehatan
Klasifikasi :
nature
natural vs anthropogenic
traditional vs modern
route of exposure
 Tipe2 gangguan kesehatan
Biological hazards
e.g. bacteria, viruses, parasites
Chemical hazards
e.g. toxic metals, air pollutants, solvents, pesticides
Physical hazards
e.g. radiation, temperature, noise
Mechanical hazards
e.g. motor vehicle, sports, home, agriculture, & workplace
injury hazards
Psychosocial hazards
e.g. stress, lifestyle disruption, workplace discrimination,
effects of social change, marginalization, unemployment
Gangguan dari sistem Gangg sistem
Traditional Modern
Disease vectors
Tobacco smoking
Infectious agents
Transport hazards
Inadequate housing &
shelter Pollution from
Poor-quality drinking sewage & industry
water & sanitation Outdoor air
Indoor air pollution pollution from
from cooking industry &
Dietary deficiencies motorcars
Hazards of child birth Overuse or misuse
Wildlife & domestic of chemicals
animals
Industrial
Injury hazards in
agriculture machinery
Unbalanced diet
 Jalan Masuk Pajanan
Route of exposures
Sumber:
Kejadian alam
man-made: industrial, agricultural, commercial,
domestic, manufacturing wastes
Pajanan
- inhalation - breastfeeding
- oral ingestion - placental transfer
- absorption via the skin - inoculation & direct penetration
- absorption via the eyes
 Biological, chemical & physical hazards
by routes of exposure
Biological Chemical Physical
AIR
Agent/source Microorganisms Fumes, dust, particles Radiation, heat, noise

Vectorial factors Coughing, exhalations Contaminated air Climate, unguarded

exposures
Routes Inhalation, contact Inhalation, contact Inhalation, direct
penetration
WATER
Agent/source Microorganisms, Discharges, teaching, Radiation, heat in power
decayed organic dumping station cooling water
material
Vectorial factors Insects, rodents, snails, Contaminated food & Accidents,
animal excreta, food water contaminated food &
chain water
Routes Bites, ingestion, contact Ingestion, contact Ingestion, contact
 The scale & nature of human activities
(agricultural, industrial, & energy production, the use &
management of water & wastes; urbanization; the
distribution of income & assets within & between countries;
the quality of health services; & the extent of protection of
the living, working, & natural environment

HEALTH

Physical & chemical environment

Biological environment
(air, water, food & soil chemical composition
(type & distribution of pathogens & vectors, as
including radiation; climate including temperature,
well as their habitats)
humidity, precipitation, & seasonal changes)

Source: Yassi et al., 2001 (adapted from WHO 1992)

 Persyaratan dasar suatu
lingkungan yang sehat
Udara bersih
Air yang aman & mencukupi
Makanan yang aman & adequate
Tempat tinggal yang aman & damai
Lingkungan global yang stabil
Kesehatan Lingkungan
Terdiri dari aspek2 pada kesehatan
manusia termasuk kualitas hidup, yang
diukur dari faktor2 fisik, biologis, sosial
dan psikososial dalam lingkungan
Merujuk pada teori & praktik mengukur,
memperbaiki, kontrol & mencegah
faktor2 dalam lingkungan yang secara
potensial memperburuk kesehatan
generasi sekarang dan masa depan
(WHO, 1993)
 Gangguan/paparan/hazard dalam lingkungan,
dampaknya pada kesehatan/risk & variasi
sensitivitas utk mencemari/mengexpose populasi
suatu kondisi atau keadaan lingkungan yg optimum
shg berpengaruh positif thd terwujudnya status
kesehatan yang optimum pula
Usaha efektif memperbaiki/mengoptimumkan lingk
hidup manusia agar merup media yg baik utk
terwujudnya kesehatan optimum bg manusia yg
hidup didalamnya
 Sustainable Development
development that meets the needs of the present
without compromising the ability of future
generations to meet their own needs
(WCED, 1987)
Human beings are at the center of concerns for
sustainable development. They are entitled to a
healthy & productive life in harmony with nature
(UN, 1993)
UN:
1st Order Principle:
Ensuring human survival should be taken as
a first-order principle
Universal Declaration of Human Rights (UN, 1948)
all people have the right to a standard of living adequate
for the health and well-being of themselves & their family,
including food, clothing, housing, health care, and the
necessary social services

2nd Order Principle:

Respect for nature & control of environmental
degradation
 References
Last.J, M. Public Health and Human Ecology.
Chapter 4: Environmental Health. McGrawHill.
Medical Publishing division. 1998
Notoatmojo, Soekidjo. Ilmu Kesehatan
Masyarakat, Prinsip Prinsip dasar, 2003
Yassi A, Kjellstrm T, de Kok T, Guidotti TL.
Basic environmental health. Chapter 1:
Introduction. New York: Oxford University
Press, 2001
Smith KR, Corvaln CF, Kjellstrm T. How much
global ill health is attributable to environmental
factors? Epidemiology, September 1999, Vol.
10(5):573-84
Thank you .