9/21/2011
Kuliah Pendahuluan Pendekatan Ilmu Sosial dan
Perilaku dalam Kesehatan Masyarakat 2011
Disampaikan oleh:
Yayi Suryo Prabandari
PROGRAM STUDI S2 ILMU KESEHATAN
MASYARAKAT FAKULTAS KEDOKTERAN
UNIVERSITAS GADJAH MADA
1
Tujuan Umum
`
Pada
ada a
akhir mata
ata kuliah
u a karyasiswa
a yas s a
diharapkan dapat memahami tentang teoriteori sosiologi, antropologi dan perilaku,
serta pendekatan sosiologis, antropologis
dan perilaku terhadap problem sosial dunia
kesehatan.
2
1
9/21/2011
Tujuan Khusus :
` Memahami pendekatan sosiologis-antropologis-psikologis
terhadap problem sosial kesehatan (fungsi,
(fungsi konflik dan
interaksi), pencegahan dan pengobatan pasien, (pemberian
pelayanan kesehatan di fasilitas kesehatan, dan
pengambilan keputusan manajemen dan kebijakan
kesehatan.
` Memahami sebab-sebab sosial penyakit dan budaya yang
berkaitan dengan keadaan kesehatan suatu masyarakat
` Meningkatkan pengetahuan karyasiswa terhadap peran
petugas
g kesehatan lainnya
y dalam fungsinya
g y
dokter dan p
sebagai kontrol sosial orang sakit
` Menjelaskan alasan-alasan penduduk untuk mengikuti atau
menolak berperilaku sehat dilihat dari konteks (1) individual,
(2) keluarga, (3) struktur sosial, dan (4) sosial-budaya.
3
4
2
9/21/2011
`
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 5
These determinants include factors such as:
` Income and social status – higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health; ` education ‐ low education levels are linked with poor health, more stress and lower self confidence; dl
lf
fd
` physical environment ‐ safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health; ` employment and working conditions ‐ people in employment are healthier, particularly those who have more control over their working conditions; ` social support networks ‐ greater support from families, friends and communities is linked to better health; 6
3
9/21/2011
These determinants include factors such as:
` culture ‐ customs and traditions, and the beliefs of the family and community all affect health; ` genetics ‐ inheritance plays a part in determining lifespan healthiness and the likelihood of developing
lifespan, healthiness and the likelihood of developing certain illnesses; ` personal behavior and coping skills ‐ balanced eating, keeping active, smoking, drinking and how we deal with life's stresses and challenges all affect health; ` health services ‐
health services ‐ access and use of services that prevent access and use of services that prevent
and treat disease influence
` gender ‐ men and women suffer from different types of diseases at different ages 7
9
9
9
improve the conditions of daily life ‐ the circumstances in which people are born grow live work and age
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
social determinants of health, and raise public awareness about the social determinants of health. 8
4
9/21/2011
In may 2009 the sixty-second World Health
Assembly, after having considered the report of the
WHO Commission, recommended to all Member
States:
`
`
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;
assessment tools;
to develop and implement goals and strategies to improve public health with a focus on health inequities; 9
More recently, In may 2009 the sixty-second World
Health Assembly, after having considered the
report of the WHO Commission, recommended to
all Member States:
`
`
to take into account health equity in all national policies that to
take into account health equity in all national policies that
address social determinants of health, and to consider developing and strengthening universal comprehensive social protection policies, including health promotion, disease prevention and health care, and promoting availability of and access to goods and services essential to health and well‐
being; g;
to ensure dialogue and cooperation among relevant sectors with the aim of integrating consideration of health into relevant public policies and enhancing inter‐sectoral action; 10
5
9/21/2011
`
`
`
to increase awareness among public and private health providers on how to take account of social determinants when delivering care to their patients; to contribute to the improvement of the daily living conditions contributing to health and social well‐being across the lifespan by involving all relevant partners, including civil society and the private sector; , to contribute to he empowerment of individuals and groups, especially those who are marginalized, and take steps to improve the societal conditions that affect their health; 11
`
`
to generate new, or make use of existing, methods and evidence, tailored to national contexts in order to address th
the social determinants and social gradients of health and i ld t
i
t
d
i l
di t f h lth d
health inequities;
to develop, make use of, and if necessary, improve health information systems and research capacity in order to monitor and measure the health of national populations, with disaggregated data such as age, gender, ethnicity, race, caste, occupation, education, income and employment where national law and context permits so that health inequities can be detected and the impact of policies on health equity measured
12
6
9/21/2011
13
Negara berkembang
Negara Maju
Berat badan kurang
Penyakit yang berhubungan dengan penggunaan
tembakau
HIV/AIDS
Penyakit jantung iskemik
Infeksi saluran pernafasan bawah
Depresi unipolar dan penyakit serebrovaskular
Kondisi perinatal dan penyakit diare
Gangguan akibat konsumsi alcohol
Malaria
Kehilangan pendengaran – onset dewasa
Kondisi maternal
PPOK
Depresi unipolar
Kecelakaan lalu lintas
Penyakit jantung iskemik
Kanker paru/tracheal dan bronchial
Campak
Alzheimer dan demensia lainnya
TBC
Cidera yang disebabkan diri sendiri
14
7
9/21/2011
`
`
Evolusi Budaya: perubahan adaptif
budaya untuk menghadapi tekanan
lingkungan
Gaya Hidup: perilaku seseorang,
cara hidup seseorang
Adanya evolusi budaya
menyebabkan perubahan gaya
hidup
15
`
`
`
`
`
`
`
`
`
`
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
16
8
9/21/2011
`
`
Pendidikan rendah
Sosial
Sos
a e
ekonomi
o o
rendah
e da
Banyak
penyakit
Miskin
17
THE HEALTH
HIRARCHY
18
9
9/21/2011
HIRARKI
KESEHATAN
19
HIRARKI
KESEHATAN DAN
SAKIT PADA
MANUSIA
20
10
9/21/2011
HIRARKI KESEHATAN
SERTA DISIPLIN DAN
TEORI DALAM
KESEHATAN
21
HIRARKI
SISTEM
ALAMIAH
22
11
9/21/2011
KAITAN ILMU
SOSIAL DAN
MASALAH
KESEHATAN
SEBUAH CONTOH:
PENYEBAB
KEMATIAN ANAK
23
24
12
9/21/2011
PENJELASAN TENTANG GAMBARAN
ILMU SOSIAL YANG BERKONTRIBUSI
UNTUK MENYELESAIKAN MASALAH
KESEHATAN MASYARAKAT
25
`
`
is a sub-branch of cultural anthropology that
is concerned with the application of
anthropological
h
l i l and
d social
i l science
i
theories
h
i
and methods to questions about health,
illness and healing.
Some medical anthropologists are trained
primarily in anthropology as their main
discipline, while others have studied
anthropology
h
l
after
f
training
i i
and
d working
ki
iin
health or related professions such as
medicine, nursing or psychology.
26
13
9/21/2011
`
`
`
`
Interpretasi dan pengalaman sakit
Budaya
udaya mempengaruhi
e pe ga u pe
pengalaman
ga a a sa
sakitt
Budaya : konteks yang dirujuk pada etnik dan
ras
Disease and illness “as a form of
communication – the language of the organs
– through which nature, society and culture
speack simultaneoursly” (Scheper-Hughes &
Lock, 1987, cit. Lupton, 2003)
27
`
`
`
`
`
Development of systems of medical knowledge and
health care
Patient-practitioner relationships
Integrating alternative medical systems in culturally
diverse environments
The interactions between biological, environmental
and social factors influencing health and illness at
both individual and community levels
The impacts of biomedicine and biomedical
technologies in non-Western settings
28
14
9/21/2011
`
Adanya kepercayaan bahwa:
◦ Ibu hamil tidak boleh makan ikan
◦ Anak yang diare merupakan tanda “anak tersebut
tumbuh besar”
◦ Remaja putri di Jawa Tengah tidak diperbolehkan
makan “rempela, brutu, usus” serta pisang dan
nanas
◦ Partus lama Æ ibunya banyak dosa
29
Etic:
Emic:
` Outsider view of the
` Insider view of the world
world
` Community view
` Researcher view
` Individual view
` Health care worker
view
30
15
9/21/2011
Disease/Penyakit:
` Deskripsi profesional
sebuah
b h penyakit
kit
` Perspektif biomedis
` Fokus pada kontrol dan
pengobatan
Illness/Sakit:
` Menunjuk pengalaman
rasa sakit/distress
` Menggambarkan efek
pada yg menderita dan
bgmn hal tsb
mempengaruhi yg lain
`
Fokus pada:
Apa yg penyebabnya & siapa
yang terpengaruh
Apa yg dilakukan setelah itu
Apa yg terjadi pada saat Anda
menderita karena sakit
31
`
`
`
rural villages
urban
u
ba hospitals
osp ta s
clinics
32
16
9/21/2011
Medical Sociology
33
`
`
The sociological study of illness and medicine
Strauss (1957, cit. Conrad & Kern, 1986):
◦ Sociology “of” medicine
x Focuses on the study of medicine to illuminate some
sociological concern (e.g. patient-practitioner
relationships, the role of professions in society)
◦ Sociology “in” medicine
x Focuses primarily on medical problems (e.g. the
sociological causes of disease and illness
illness, reasons for
delay in seeking medical aid, patient compliance or
non compliance with medical regimens)
34
17
9/21/2011
`
Functionalism:
◦ Views social relations in the health care setting as
products
d
off a consesualist
li society,
i
iin which
hi h social
i l
order and harmony are preserved by people acting
in certain defined roles and performing certain
functions
`
The political economy perspective
◦ Developed as a critical response to functionalism in
the context of larger changes in social thought
occuring in the 1970s – the capitalist economic
system
35
`
Social
Soc
a constructionism
co st uct o s
◦ An approach which questions claims to the
existence of essential truths. What is asserted to be
truth should be considered the product of power
relations, and as such is never neutral but always
acting in the interests of someone
36
18
9/21/2011
` Bila
ingin sehat, jangan menjadi
orang miskin,
miskin betulkah?
37
PSYCHOLOGY:
A STUDY OF HUMAN
BEHAVIOR
38
19
9/21/2011
`
The scientific study of
behavior and mental
processes and
dh
how
they are affected by an
organism’s physical
state, mental state and
external environment
`
39
`
`
The manner in which
one behave
b h
Psychology – the action
or reaction of person or
things in response to
external or internal
stimuli
◦ Synonym: behavior,
conduct, department
40
20
9/21/2011
`
A scientific discipline;
e.g. psychology, in
which the actions and
reaction of human
beings and animals
studied through
observational and
experimental methods
41
`
`
Devoted to understanding psychological
influence on how p
people
p stay
y healthy,
y, why
y
they become ill, and how to respond why do
they do get ill
Health psychologist both study such issues
and promote interventions to help people to
stay well or get over illness
42
21
9/21/2011
`
`
`
`
`
Sistem tubuh manusia
Perilaku
e a u kesehatan
ese ata da
dan p
prevensi
e e s p
primer
e
Stress dan coping
The patient in the treatment setting
Management of chronic and terminal ill
43
`
Pengembangan
P
b
ilmu
il
perilaku
il k
(psikologi), baik pengetahuan maupun
tekniknya yang relevan untuk
memahami kesehatan dan penyakit
serta aplikasinya untuk prevensi,
g
, treatment dan rehabilitasi
diagnosis,
44
22
9/21/2011
`
Bidang iinterdisipliner
Bid
t di i li
yang mempunyaii
perhatian dan kepedulian terhadap
pengembangan serta integrasi teknik dan
pengetahuan ilmu perilaku dan biomedis yang
relevan dengan sehat dan sakit dan aplikasi
pengetahuan
p
ng tahuan sserta
rta teknisnya
t n snya untuk
untu prevensi,
pr
ns ,
diagnosis, treatment dan rehabilitasi
45
`
`
`
Tingginya angka kematian ibu
Mengapa
e gapa ju
jumlah
a pe
perokok
o o d
di Indonesia
do es a beg
begitu
tu
tinggi?
Mengapa seseorang yang telah mengetahui
manfaat olah raga tidak melakukan olah raga
secara teratur dan terukur?
46
23
9/21/2011
EPIDEMIOLOGI SOSIAL
47
`
The study of the distribution and
determinants of states health in populations
p p
(Susser, 1973, cited in Berkman & Kawachi,
2000)
48
24
9/21/2011
`
`
`
Penelitian tentang respon fisik dan stress
pengalaman
g
y
yang
g sangat
g menekan
akibat p
Kemajuan progresif di dalam pembedaan
“sakit psikosomatis” dan “penyakit yang lain)
Pengertian tentang populasi yang berisiko
49
`
The branch of epidemiology as the branch of
epidemiology
p
gy that studies the social
distribution and social determinants of states
of health
50
25
9/21/2011
`
`
`
`
`
`
`
Sosioekonomi
Ketidaksetaraan penghasilan dan kesehatan
Kondisi kerja dan kesehatan
Dampak pengangguran dan pensiun
Integrasi sosial, jaraingan sosial dan
dukungan sosial
Depresi dan sakit medis
Perilaku kesehatan
51
`
`
`
`
`
Dra. Yayi Suryo Prabandari, M.Si., Ph.D
(Koordinator) – psikolog (klinis & kesehatan),
promotor kesehatan
k
h
dr. Mubasysyir Hasanbasri, MA – dokter
(medical sociologist)
Dr. Sumarni DW, M.Kes (Sosiolog – medical
sociologist)
Dra. Retna Siwi Padmawati,, MA ((antropolog
p
g–
medical anthropologist)
Dra. Atik Triratnawati, MA (antropolog –
medical anthropologist)
52
26
9/21/2011
53
27