DETERMINANTS OF

MORBIDITY AND MORTALITY

IN POPULATION
dr. Ni Luh Putu Ariastuti, MPH
 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).
• Community medicine vs clinical medicine
• Determinants (models) of diseases and
death
• The strengths and weaknesses of
diseases models
 Public Health
• science and art of
– preventing disease,
– prolonging life, and
– promoting health and efficiency,
• through organized community effort for the
sanitation of the environment, control of
communicable infections, education of the
individual in personal hygiene, organization
of medical and nursing services for the
early diagnosis and preventive treatment
 Community Medicine
• A branch of medicine that is concern
with the health of the members of a
community, municipality, or region.
• The emphasis in community medicine is
on
– early diagnosis of disease,
– recognition of environmental and
occupational hazards
– to good health and prevention of disease in
the community
Community Medicine Clinical medicine

Concern to whole population, focuses to individual patients who

either sick or healthy in certain are visit health providers
geographical area.

focuses on prevention of diseases focuses on treating sick individual

in the population patients who come to health
providers.

Understanding of determinants Understanding of pathophysiology

of health problems in the of diseases
community

Treatment at the community Treatment for individual patient:

level: public health program medical treatments, surgery,
such as education program, radiation, physiotherapy, etc
immunization program, nutrition
program, family planning
program, etc
 Clinical practice with community
health perspective

• In health centers, community physicians

not only
– implement disease prevention programs,
– assess community health needs,
– manage healthcare teams and
– advocate for health promoting policies
• but also diagnose and treat diseases.
TYPES OF CAUSAL
RELATIONSHIP
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)
3. 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
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)
 Determinant of health
• Who they are
• What they do
• Condition in which people born, grow, live,
work and age

HEALTH INEQUITIES
SOCIAL DETERMINANTS OF HEALTH
WHO- CSDH conceptual framework
“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