DETERMINANTS

OF HEALTH
EKA NURHAYATI
PUBLIC HEALTH DEPARTMENT
2016

BLUMS THEORY (1974)

THE EPIDEMIOLOGIC TRIAD

OF A DISEASE
Host

Vector

Agent

Environment
Source: adapted from Gordis (1996)

Beagleholes Model of Health

Determinants (2002)
Global & ecological
perspectives
Genes

Gender
perspective

Disease
experience

Life course

Health & well-being of

populations

Public health
perspective

Health system
influences

Social, cultural, &

environmental
determinants

Institute for the Future/IFTF

(2003)
Access to Care
(10%)

Genetics
(20%)
Environmen
t(20%)

HealthBehaviors
(50%)

Factors that may be associated with

increased risk of human disease
HOST

Age
Sex
Race
Religion
Customs
Occupation
Genetic profile
Marital status
Family background
Previous disease
Immune status

AGENTS

Biologic (e.g. bacteria)

Chemical (e.g. poison)
Physical (e.g. trauma)
Nutritional (e.g. deficiency)

ENVIRONMENT

Temperature
Humidity
Altitude
Crowding
Housing
Neighborhood
Water
Milk
Food
Radiation
Air pollution
Noise

PRIMARY PREVENTION
Health Promotion

Health education (edukasi kesehatan

Good standard of nutrition adjusted
to developmental phases of life
(standar nutrisi yang baik)
Attention to personality
development (memperhatikan
pengembangan kepribadian
Provision of adequate housing,
recreation & agreeable working
conditions
Marriage counseling & sex
education
Genetics
Periodic selective examination

Specific Protection
Use of specific immunization
Attention to personal hygiene
Use of environmental sanitation
Protection against occupational

hazards
Protection from accidents
Use of specific nutrients
Protection from carcinogens
Avoidance of allergens

SECONDARY PREVENTION
Early Diagnosis & Prompt Treatment

Case-finding measures, individual & mass

Screening surveys
Selective examinations

Objectives:
- to cure & prevent disease processes (untuk menyembuhkan
dan mencegah proses penyakit)
- to prevent the spread of communicable disease (untuk
mencegah penyebaran penyakit menular)
- to prevent complications & sequelae (untuk mencegah
komplikasi dan sekuele)
- to shorten period of disability (untuk memperpendek
periode dan kecacatan)

TERTIARY
PREVENTION
Disability limitation

Rehabilitation

Adequate treatment to

Provision of hospital &

arrest the disease process

& to prevent further
complications & sequelae
( perawatan yang memadai
untuk menangkap proses
penyakit dan mencegah
komplikasi lebih lanjut dan
sequele
Provision of facilities to
limit disability & to prevent
death
( penyediaan fasilitas untuk
membatasi kecacatan dan

community facilities for

retraining & education for
maximum use of remaining
capacities
Education of the public &
industry to utilize the
rehabilitated
As full employment as
possible
Selective placement
Work therapy in hospitals
Use of sheltered colony

Family Assessment Tools

Family Genogram
Family Circle
Family APGAR
FACES (Family Adaptability and Cohesion
Evaluation Scale)
FES (Family Environment Scale)
Clinical Biography and Life Events
SCREEM
DRAFT (Draw A Family Test)
Family Mapping

GENOGRAM
Family Pedigree/Family Tree/Genealogic Chart
Def : versatile clinical tool that can help family
physicians integrate a patients family
information into the medical problem-solving
process for better patient care (Waters et al,
1994)
Include: family hereditary background, major
medical, social and interactional influences.

GENOGRAM
Is a biopsychosocial family tree. It records the
family in its life cycle, family illnesses and
relationship
A genogram can be drawn in sceletal form during
one of the first few visits, ideally the first visit and
then it can elaborated during subsequent visits as
FK known
UNPAD about the family
more is

COMPONENTS OF GENOGRAM

Three or more generations

The name of all family members
Age or year of birth of all family members
Any death, including age and cause of death
Significant diseases or problems of family members
Indication of members living together in the same
household
Dates of marriages or divorce
A listing of the first born of each family to the left, with
siblings listed sequentially to the right
A key depicting all symbols used
Symbols selected for simplicity and maximum visibility

1989

married and year

Close
relationship
Family living together

1990

1992

Separation and
year

Divorce and year

1989

Unmarried
relationship
Conflictual relationship

1989
1992

Symbols of diseases or situation

Obesity

Allergy
xxx

xxx

Alcoholism

Asthma

Hypertension

Heart disease
Stroke

Depression

War Casualty

Commonly used
Abbreviations
ALC
ALL

Alcoholic

GI

GI tract disease

Allergy

HT

Hypertension

ARTH Arthritis

MI

Myocard Infarction

CAD

Coronary Artery
Disease

MVP Mitral Valve Prolapse

CVA

Cerebrovascular
Accident

PUD Peptic Ulcer Disease

CA
DEP

Cancer

DM

Diabetes mellitus

Depression

SLE Systemic Lupus

Erythematosis

TB

Tuberculosis

THANK YOU