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Lecture 1 CBP Topik 1

The document discusses different approaches and models for understanding the determinants of morbidity and mortality in a population. It describes how community medicine focuses on prevention by understanding the determinants of health problems in a population, while clinical medicine focuses on treating individual patients. Several models are presented for understanding the various factors that influence disease occurrence, including the epidemiologic triad model, wheel model, web model, and Blum model. The social determinants of health framework is also briefly discussed.

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44 views22 pages

Lecture 1 CBP Topik 1

The document discusses different approaches and models for understanding the determinants of morbidity and mortality in a population. It describes how community medicine focuses on prevention by understanding the determinants of health problems in a population, while clinical medicine focuses on treating individual patients. Several models are presented for understanding the various factors that influence disease occurrence, including the epidemiologic triad model, wheel model, web model, and Blum model. The social determinants of health framework is also briefly discussed.

Uploaded by

citra sucipta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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DETERMINANTS OF MORBIDITY

AND MORTALITY IN POPULATION


LEARNING OUTCOMES
• Describe the difference approach of
community medicine and clinical medicine
• Describe several determinants (models) of
diseases and death occurring in the
population.
• Explain the applications of understanding
diseases and death determinants (models).
• Identify the strengths and weaknesses of
diseases models
• Community medicine vs clinical medicine
• Determinants (models) of diseases and death
• The strengths and weaknesses of diseases
models
Community Medicine Clinical medicine

Concern to whole population, either focuses to individual patients who are


sick or healthy in certain geographical visit health providers
area.

focuses on prevention of diseases in focuses on treating sick individual


the population patients who come to health
providers.

Understanding of determinants of Understanding of pathophysiology of


health problems in the community diseases

Treatment at the community level: Treatment for individual patient:


public health program such as medical treatments, surgery,
education program, immunization radiation, physiotherapy, etc
program, nutrition program, family
planning program, etc
• Epidemiology is the study of the distribution
and determinants of health-related states or
events in specified populations, and the
application of this study to the control of
health problems
illness does not occur randomly in a population,
but happens only when the right accumulation
of risk factors or determinants exists in an
individual.
Epidemiological models or theories of
diseases causation

• The Epidemiologic Triad/ Triangle


• Wheel Model
• Web Model
• Model Blum
(The Epidemiologic Triad/ Triangle)

HOST (intrinsic)

AGENT ENVIRONMENT
(biologic, physic, mechanical, (Physical, Biological, Social)
chemical, nutrient)
Model Roda (Wheel Model)
INTERNAL
(intrinsic)

Social
Biological HOST • politic,
Environ- Genetic • economic
ment • culture

Physical Environment

EXTERNAL (extrinsic)
Contoh
WEB MODEL Kasus Kematian
(SARANG Ibu
LABA-LABA)

Modifikasi dari: FA Moeloek, 2010


BLUM MODEL
Genetic

Morbidity and
Behavior Health
mortality in
services
a population

Environmental factors
(biological, physical, social, economical, politic)
SOCIAL DETERMINANTS OF HEALTH
WHO- CSDH conceptual framework
Four types of Causal relationships
1. Necessary and Sufficient
2. Necessary but not Sufficient
3. Sufficient but not Necessary
4. Neither Sufficient nor Necessary

Necessary = without that factor disease never develops


Sufficient = in the presence of that factor disease always
develops
1. Necessary and Sufficient

Direct:
Factor A Disease

Indirect:
Factor A Step1 Step2 Disease

 rarely happens
2. Necessary but not Sufficient

Factor A
+
Factor B Disease
+
Factor C

Multiple factors required: initiator & promoter


(cancer, TB)
2. Sufficient but not Necessary

Factor A
or
Factor B Disease
or
Factor C

Leukemia = Exposure to radiation OR benzene


4. Neither sufficient nor necessary
(contributory causes)

Factor A + Factor B
or
Factor C + Factor D Disease
or
Factor E + Factor F

Most accurately represents causal relationships in most


chronic diseases
“Some of the people need health care
some of the time
BUT
All of the people need public health all
of the time."

C. Everett Koop, MD
former U.S. Surgeon General
Thank you

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