PENGANTAR ILMU KEDOKTERAN KOMUNITAS (COMMUNITY MEDICINE/COMMUNITY HEALTH)

YUDHI WIBOWO, MD

OUTLINES
DEFINISI HISTORY DIMENSIONS CONCLUSIONS

DEFINISI
HEALTH:
the one published by the World Health Organization in 1947. That definition states that "health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity."1 However, in more recent times the word has taken on a more holistic approach; Payne and Hahn have defined health as "a reflection of your ability to use the intrinsic and extrinsic resources within each dimension of health in order to participate fully in the activities that contribute to growth and development during each stage of the life cycle. health the blending of all one's personal resources for the enjoyment of a satisfying, productive life

CONT
COMMUNITY
Traditionally, a community has been thought of as a geographic area with specific boundaries-for example, a neighborhood, city, county, or state. However, in the context of community health, community is "a group of people who have common characteristics; communities can be defined by location, race, ethnicity, age, occupation, interest in particular problems or outcomes, or common bonds.3 Examples of communities include the people of the city of San Francisco (location), the Asian community (race), the Hispanic community (ethnicity), seniors (age), the business or the banking communities (occupation), the homeless (specific problem), those on welfare (particular outcome), or church members (common bond). A community may be as small as the group of people who live on a residence hall floor or as large as all of those who make up a nation.

DEFINISI COMMUNITY HEALTH

Public health services emphasizing preventive medicine and epidemiology for members of a given community or region.
The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

a branch of medicine that is concerned with the health of the members of a community, municipality, or region. The emphasis in community medicine is on the early diagnosis of disease, the recognition of environmental and occupational hazards to good health, and the prevention of disease in the community.
Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.

An informal division of general medicine, defined as the care of Pts in the context of their daily lives. See Family practice.
McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies, Inc.

TEXT BOOK OF PH & CM

As a discipline, it is defined as that branch of medicine, which addresses certain selected aspects of health promotion, disease prevention, health restoration (by curative steps) and rehabilitation of the former patients, in the community, usually, from an Institutional Community Base which is usually either an Academic Department in a medical college or through a curative centre.

HISTORY
As a professional movement, in USA, community medicine first appeared when some medical schools began to establish a new department (or rename an existing Dept of Preventive Medicine) to charge it with functions of defining the health problems of a community (in the vicinity of the college, or an adopted community) and to suggest solutions, maintain surveillance and monitor progress.

 Many hospitals also established department of community medicine to bring together responsibility for the professional direction and coordination of a range of ambulatory programs in OPD and emergency, personal health, outreach satellite elements and other services. In UK, community medicine essentially includes Epidemiology and Medical Administration and has been seen as a successor to public health, providing information and advise on the health status and the services to the community and to the local Self Govt / community organizations, as well as performing other planning and management functions. Thus, in UK, the community medicine specialist is trained to function as Medical Officer of Health (MOH).

A Brief History of Community and Public Health

The history of community and public health is almost as long as the history of civilization.
Earliest Civilizations
Tabu, jamu, belum tercatat dengan baik

Ancient Societies (Before 500 B.C.)=masya purba/kuno

Sudah ada bukti perhatian thd public health : drainase, kmr mandi, peresepan obat

Classical Cultures (500 B.C.A.D. 500)

Fitness, suplai air minum, aktif dalam comm sanitasi, regulasi bangunan, RS utk pekerja, public hospital

Middle Ages (A.D. 5001500)

Spiritual era of PH: a time during the Middle Ages when the causation of communicable disease was linked to spiritual dimensions Epidemi CD meningkat

Renaissance and Exploration (A.D. 15001700)

was characterized by a rebirth of thinking about the nature of the world and of humankind was also characterized by exploration and discovery.

 The Eighteenth Century

was characterized by industrial growth Cities were overcrowded, and water supplies were inadequate and often unsanitary, unhealthy environments Diakhiri penemuan vaksin

The Nineteenth Century

Living conditions in Europe and England remained unsanitary, and industrialization led to an even greater concentration of the population in cities. better agricultural methods led to improved nutrition for many. Dr. John Snow studied the epidemic and hypothesized that the disease was being caused by the drinking water from the Broad Street pump. In 1862 Louis Pasteur of France proposed his germ theory of disease Robert Koch who developed the criteria and procedures necessary to establish that a particular microbe This period (18751900) has come to be known as the bacteriological period of public health.

 The Twentieth Century Vitamin deficiency diseases and one of their contributing conditions, poor dental health,
Health Resources Development Period (19001960)
a time of great growth in health care facilities and providers
The Reform Phase (19001920) characterized by social movements to improve health conditions in cities and in the workplace The 1920s a decade of slow growth in public health

Period of Social Engineering (19601975)

Medicare government health insurance for the elderly and disabled Medicaid government health insurance for the poor

Health Promotion Period (19751990)

premature deaths deaths prior to age 65

Community Health in the 1990s and Early 2000s

about health are an individual's responsibility to a significant degree, society has an obligation to provide an environment in which achievement of good health is possible and encouraged.

Health for All by the Year 2000

CH vs PH
Community health includes both private and public (government) efforts of individuals, groups, and organizations to promote, protect, and preserve the health of those in the community. Public health is the sum of all governmental efforts to promote, protect, and preserve the people's health.

Community Health Versus Personal Health

Personal health activities are individual actions and decision making that affect the health of an individual or his or her immediate family members. These activities may be preventive or curative in nature but seldom directly affect the behavior of others. Choosing to eat wisely, to wear a safety belt regularly, and to visit the physician are all examples of personal health activities.

 Community health activities are those that are aimed at protecting or improving the health of a population or community. Maintenance of accurate birth and death records, protection of the food and water supply, and participating in fund drives for voluntary health organizations such as the American Lung Association are examples of community health activities.

Organizations that contribute to community health

How communities measure health, disease, injury, and death Control of communicable and noncommunicable diseases How communities organize to solve health problems Community health in schools Health needs of people at different stages of life Health needs of special populations Community mental health Abuse of alcohol, tobacco, and other drugs The health care delivery system Environmental health problems Intentional and unintentional injuries Occupational safety and health

Factors That Affect the Health of a Community

Physical factors include the influences of geography, the environment, community size, and industrial development. Social factors are those that arise from the interaction of individuals or groups within the community:Beliefs, Traditions, and Prejudices, Economy, Politics, Religion,Social Norms, Socioeconomic Status (SES) Community Organizing "means bringing people together to combat shared problems and to increase their say about decisions that affect their lives."8 It is not a science but an art of building consensus within a democratic process Individual Behavior :herd immunity, the resistance of a population to the spread of an infectious agent based on the immunity of a high proportion of individuals.

4 Dimensions of Community Medicine

Paying attention to sociocultural aspects of patient care Coordinating a communitys health resources in the care of patients Identifying and intervening in a communitys health problem Assimilating into a community and participating in its organizations

DECLARATION of ALMA-ATA (1979)

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can affordble. It forms an integral part of both the country's health system, of which it is the central function and main focus, and the overall social economic development of the community. It is the first level of contact of individuals, the family and the community with the national health system, bringing health care as close as possible to where people live and work and constitutes the first element of a continuing health care process.

Elaborasi
education concerning prevailing health problems and the methods of preventing or controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; provision of essential drugs.

CONCLUSION
Community Medicine
Providing medical services in the community Understanding community resources Health promotion and disease prevention Occupational health Knowledge of communities Care of populations Community participation in health care activities

Declaration of Alma Ata

International Conference on Primary Health Care, 1978 Health is a fundamental human right

DAFTAR PUSTAKA
RajVir Bhalwar. Text Book of Public Health & Community Medicine 1st Ed. 2009. Department of Community Medicine. New Delhi. McKenzie, James F.; Pinger, R. R.; Kotecki, Jerome Edward. An Introduction to Community Health. 1999. Jones & Bartlett Publishers, Inc. Editors: Jones, Roger; Britten, Nicky; Culpepper, Larry; Gass, David A.; Grol, Richard; Mant, David; Silagy, Chris.Oxford Textbook of Primary Medical Care, 1st Edition.Copyright 2004 Oxford University Press The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved
Mosby's Medical Dictionary, 8th edition. 2009, Elsevier. McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies, Inc