Fakultas Kedokteran

Universitas Sriwijaya

The Scope of Public Health

Public Health: Combination of science,

practical skills and beliefs directed to the

maintenance and improvement of the
health of the people.
Goals of Public Health determined by:
Values of Society (child abuse, violence on

women)
Knowledge (tele-medicine, water purification,
vaccination)
Ability to resolve perceived public health
problems.

Ilmu kesehatan
masyarakat
: mencegah
Ilmu & Seni yang bertujuan

timbulnya penyakit , memperpanjang usia

hidup & mempertinggi usia kesehatan dengan
usaha masyarakat yg terorganisir untuk
sanitasi ling, pengendalian peny. Menular,
pendidikan hygiene perorangan,
mengorganisir pelayanan medis & perawatan
agar dapat dilakukan diagnosa dini,
pengobatan & pencegahan, Membangun
mekanisme sosial, shga setiap insan dpt
menikmati standar kehidupan yg cukup baik
untuk dpt memelihara kesehatan.

The basic six :

APHA

Pencatatan dan analisa data

Pendidikan kesehatan & diseminasi informasi
Pengawasan, pengaturan, pelayanan kes.ling
Adm & Yankes
Yankes
Koordinasi Sumber daya Kesehatan

EMERSON & LUGINBUHL

Statistik Vital
Pendidikan kesehatan
kesling
Pemberantasan peny. Menular
Kesejahteraan Ibu & Anak
Pengendalian Peny. Kronis
Laboratorium Kesehatan

WHO
Pemeliharaan dokumen Kesehatan
Pendidikan kesehatan
Kesling
Pemberantasan peny. Menular
Kesejahteraan Ibu & Anak
Yanmed & perawatan kesehatan.

Ways to promote good

health:
Safe environment (physical, chemical, biological)
Enhance immunity to infection (vaccination,

nutrition, physical fitness)

Behave sensibly (drugs and alcohol, exercise,
safe sex, stress management);
Satisfactory nutrition (well balance diet)
Well born children (KIA)
Prudent health care (cautious in adopting new
technology)

Env. and. Occ Health

defined
Occupational and Environmental Health is the
multidiciplinary approach to the recognition,
diagnosis, treatment and prevention and control of
diseases, injuries, and other adverse health
conditions resulting from hazardous expsoures in the
workplace, the home, or the community. (Levy and
Wegman, et al 2006).
Ilmu Kesehatan Kerja adl : Bagian dari ilmu Kesmasy
yg mengkaji secara multidisiplinear pengenalan,
diagnosis, pengobatan, dan pengendalian penyakit
terkait pekerjaan, kecelakaan & berbagai keadaan
lainnya yg terkait pekerjaan.

Examples of Hazardous
Exposures
Contamination of air, water and soil, by a

factory where workers are also exssed.

Agriculture workers application of pesticides
that may contaminate surface and ground
water.
Workers bringing asbestos, lead and other
hazardous materials home on their work cloth,
skin and hair.
Exposure of workers and community residents
to hazardous wastes that have been
inapproppriately disposed of by industries.

Environmental and
Occupational Health
Natural and anthropogenic sources.
Hazards

Biological (bacteria, viruses, parasites,

BBP etc.).
Chemical hazards: heavy metals, solvents,
pesticides, carcinogens.
Physical hazards: noise, vibration, thermal,
radiation, illumination.
Mechanical (motor vehicles, workplace
injury)
Ergonomics: repetitive, awkward positions.
Psycho-social: stress, lifestyles.

HEALTH and ENVIRONMENT

Ecosystem: a system of dynamic interdependent

relationship among living organisms and their physical

environment.
It is a bounded entity that has self-stabilizing mechanism
(Gaia Hypothesis: earth has global homeostatic
mechanism).
Stable and balance ecosystem will survive longest
(Watershed and water supply);
Ecosystem capacity is not unlimited (carrying capacity)
waste (water, soil, air);
Material and energy consumption;
Availability of arable land, fresh water;
Collapse of ecosystem (e.g. traffic);
The law of minimum (Justus von Liebig).

HEALTH and
ENVIRONMENT
F (human health)= G (DNA) + E (P,C,B)
Impediments to health: Poverty, Poor living

and working condition, lack of education

Social and Economic condition.
Health is only possible where resources
available to meet human needs and where
living and working environment is protected
from life-threatening and health-threatening
pollutants, pathogens and physical hazards.
Message: Health professional have a special
role in the environmental health but they
need to work with all groups.

Scale and Nature of Human

Activities (agricultural,
industrial, energy production,
urbanization)

HEALTH

Physical and
Chemical
Environment (air,
water, soil, food)

Biological Environment:
pathogens, vectors and
Habitats.

Interaction of Human Activities and Environment

Top Risk Factors Leading to

Disease, Disability, or Death
Developed Countries
Developing
(behavior)
Countries

Tobacco

Underweight

High blood pressure

Unsafe sex

Alcohol

Unsafe water,

High cholestrol

sanitation and
hygiene
Indoor smoke
Deficiency vit and min
High blood pressure
Tobacco
High cholestrol.

High body mass index

Low fruit and

vegetable intake
Physical inactivity
Illicit drugs
Unsafe sex
Fe Deficiency

Ref. Murphy, E.M (2005). Promoting Healthy Behavior. Population

Reference Bureau. Washington DC, USA.

Biological Hazards
Plants, insects, rodents, fungi, bacteria, viruses,

toxins, allergens.
Prion (disease producing protein particle) mad cow.
Five major killers: respiratory infection, diarrhea, TB,
Malaria, Measles.
Water pollution by human excreta is the main
pathway of cholera, dysentery, typhoid, hepatitis-A
and Schistosomiasis.
Environmental changes: ebola, malaria, Avian Flu,
etc.
HIV/Aids and re-emerged of TB.

Chemical Hazards
10 millions chemicals synthesized, 1 % used

commercially;
3000 chemicals enter the market annually,
1% hazards known.
Most chemicals not adequately tested on
their toxicity;
Inorganic: corrosive materials, metals;
Organics: Hydrocarbons (aliphatic and
aromatic), Halogenated Hc, Alcohols, Glycols
and derivates, Organic solvents (benzene,
trichlorethylene).
Pesticides (organo-chlorine, organophosphorous, Carbamate)

Media: Water, Air, Soil, Drugs

Skin

Respirator
y

GI. Tract

Tract
Other
Organs

BLOOD

Liver

Kidney
Sweat

Hair

Urine

Feces

Physical Hazards
Noise:
Occupational Exposure: Noise Induced Hearing loss;
Ambient Noise: Nuisance;

Vibration:
Hand arm vibration syndrome;
Whole body;

Thermal: Heat related disorders: Stroke, exhaustion,

cramps, syncope; Frostbite.

Barometric pressure: Hyperbaric, aerospace
medicine.
Radiation:
Ionizing: Alpha, Beta, Gammas, Neutron, X-rays
Non Ionizing: UV, IR, Lasers, Microwave, Radio

Mechanical and Ergonomics

Hazards
Physical Injury:
Traffic;
Workplace.
Home and recreation.

Ergonomics
Designing workplace that can be modified or

adapted to the needs of individual workers.

Cumulative Trauma Disorders (eg. Carpal Tunnel
Syndrome)
Frequency, Strength, position.

Psycho Social
Stress:
Depression;
Suicide;
Substance abuse;
Violence
Psycho somatic

diseases.

Stressors:
Family related;
Work related:

Interpersonal,
Organizational.

Batasan Risk Assesment

Pemeriksaan yang teliti dari apa yang dapat

mengancam kesehatan atau keselamatan

manusia untuk menilai apakah upaya
pencegahan sudah memadai atau harus lebih
ditingkatkan.
Karakteristik yg sistematik dan ilmiah dari
berbagai bahaya kesehatan potensial yang
memberi paparan terhadap manusia.

Prevention and Control Of

Exposure
Risk assessment:
Hazards identification
Exposure assessment
Risk characterization

Risk Management
Risk evaluation
Control of exposure
Monitoring

Prevention and control of

exposure
Control at the source:

Substitution eg. Solvent

based to water based;

Engineering control;
Exhaust ventilation.
Control along the path:
General ventilation;
Protective barrier.
Control at the person:
Personal Protective
Equipment
Training
Administrative control
(eg. Working time)
Secondary Prevention
(early detection)

Healthy People 2010, USA

Environmental Health
Outdoor Air Quality
Water Quality
Toxics and Wastes
Healthy Homes and Healty Communities
Infrastructure and Surveillance
Global Env Health.

Additional Challenges for

Developing Countries
Export of Hazards
Infrastructures and Human Resources
Trans-national Problem

Relationships between Workplace and

Home Environment
Economic Development - rapid
industrialization, urbanization.
OH/EH Services and Primary Health Care.

Topik Diskusi ttg.

Quality Air, ambient and indoor.
Keslingker

Domestic Waste Management;

Excreta Disposals;
Water Supply Sanitation;
Housing and Health
Food Sanitation;
Vector Control;
Environmental Pollution and Health
Workers Health Surveillance
Emergency Response Plan
Public Health Risk Assessment.

Student Projects
Domestic Waste Management;
Excreta Disposals;
Liquid Industrial waste;
Air quality (ambient);
Noise quality (ambient);
Water quality (stream);
Water Quality (surface non stream);
Work related diseases;
Industrial Noise;
Canteen Hygiene;
Food Safety;
Vector Control: mosquitoes.
Housing and health
Indoor Air Quality
Chemcal managemet in the work place.