Unit 12

A. Reading Comprehension

PROXIMAL AND DISTAL DETERMINANTS

OF HEALTH AND DISEASE

In epidemiology and public health the word ‘determinant’ is used to refer to any
factor, whether an event, characteristic, or other definable entity, that brings about, or
contributes to, a change in health. It is common to refer to proximal and distal
determinants. A distal determinant is one that is remote, either in position, time or
resemblance to the outcome of concern, and a proximal determinant is one that is much
closer to the outcome of concern. For example, in the case of Jason’s cut and infected
leg, the proximal determinants include the fact that he fell on some dirty, sharp, jagged
steel. The more distal determinants include the fact that there was nowhere else to play in
that neighbourhood, and he lives in that neighbourhood because his parents are too poor
to live elsewhere.

Figure 7.1 illustrates the different levels and types of determinants of health and disease,
with the more distal determinants on the outside, working in towards more proximal
determinants. (based on a figure from the Public Health Agency of Canada).
 One of the strongest and most pervasive distal determinants of health is socio-
Economic circumstances. It is estimated that around one-sixth of the world’s 6.2 billion
population live in extreme poverty, on less than the equivalent of $1 a day, and for them
it is a daily struggle to meet the basic necessities of life. It is hardly surprising therefore
that overall people in this situation have the worst health experience in the world.
What perhaps is more surprising is that even in the world’s richest countries,
such as those of North America and Western Europe, people who are less well off have
substantially shorter life expectancies and more illnesses that the richer members of those
countries. In fact the differences by socio-economic circumstances are finely graded,
there is no threshold: life expectancy increases, and rates of illness decline across the
spectrum from the poorest to the richest members of society. Work through Exercise 7.2,
which shows the differences in life expectancy at birth across occupational class groups
in England and Wales.
 It is likely that a number of factors related to socio-economic circumstances
contribute to these differences in life expectancy by occupational and social class shown
in Exercise 7.2. They include: absolute and relative material deprivation, differences in
education and behaviours related to health, such as smoking and aspects of diet and long-
term psychological stress. These factors do not operate at one point in time, and it is
increasingly clear that the risk of many adverse health outcomes is related to exposures
that have occurred throughout life, even during growth in the womb.

Vocabulary
Determinant : faktor penentu
Distal determinant : faktor penentu jauh
Proximal determinant : faktor penentu dekat
Pervasive : tersebar luas
Finely graded : sangat samar
Threshold : ambang batas
Material deprivation : kekurangan secara materi
Adverse : hal yang merugikan
Exercise 1 : Answer the following questions based on the texts above.
1. What is meant by determinant?
2. There are two determinants of health, what are they?
3. If someone has a throat cancer, what could possibly be the distal dan proximal
determinants? ( 3 each)
4. Why do socioeconomic circumstances become the strongest and most pervasive distal
determinants of health?
5. From table in exercise 7.2, give example of jobs that give longer and shorter life
expectancy? (3 each)

Exercise 2 : State T if the sentence is True and F if the sentence is False

1. T/F The proximal determinant for someone with lung cancer is smoking habit.
2. T/F The distal determinant for someone with stomach ache is eating dirty food.
3. T/F Poverty is the only factor for people life expectancy.
4. T/F Women have longer life expectancy than men in general.
5. T/F A male construction worker can reach the age of 70.
6. T/F A baby cannot be affected by the health determinant.
7. T/F Psychological stress can affect someone’s life expectancy.

Exercise 3 : Translate the following sentences into good Indonesian

1. In epidemiology and public health the word ‘determinant’ is used to refer to any
factor, whether an event, characteristic, or other definable entity, that brings about, or
contributes to, a change in health.
2. It is estimated that around one-sixth of the world’s 6.2 billion population live in
extreme poverty, on less than the equivalent of $1 a day, and for them it is a daily
struggle to meet the basic necessities of life.
 B. Grammar : Two Part Verbs
B. 1 Verb + preposition

Ask ( somebody ) for …………………. A man stopped me and asked for money.

Belong to …… Does this book belong to you?

Happen to I can’t find my pen. What happened to it?

Listen to ……. Listen to this music. It’s beautiful.

Speak/talk to somebody about Did you talk to Paul about the problem?
Something.(on the phone) Can I speak to Chris ?

Thank somebody for …. Thank you very much for your help.

Think about … or think of ……. He never thinks about (or of) other people

Wait for……….. Don’t go yet. Wait for me.

Write to somebody ( no prep) I must write to my parents

B. 2 Look at / look for / look after

Look at …. She’s looking at her watch

Look at these flowers! They’re beautiful.
Why are you looking at me like that?

Look for …… (= try to find) He’s lost his key. He’s looking for it.
I’m looking for Sarah. Have you seen her?

Look after…. When Barbara is work, her friend looks after her son.
( = take care of, keep safe) Don’t lose this book. Look after it. (= keep it safe).

B. 3 Depend

We say depend on ……………

 A : Do you like eating in restaurants?
 B : Sometimes. It depends on the restaurant.

You can say it depends what /where/how (etc) with or without on :

 A : Do you want to come out with us?
 B : It depends where you’re going. Or It depends on where…
B.I.1 Look at the pictures and complete the sentences with a preposition.

1. She’s looking … at …. her watch. 4. Paul is talking ………to……… Jane.

2. He’s listening ………to……… the radio. 5. They’re looking ……at…. a picture.
3. They’re waiting ……for…….. a taxi. 6. Sue is looking ………for…….. Tom.

B.I. 2 Complete the sentences with a preposition (to/for/about etc.) If

necessary.

1. Thank you very much ….. for …. Your help.

2. This is not my umbrella. It belongs ……to……… a friend of mine.
3. ( on the phone) Can I speak ………to…………. Mr. Davis, please?
4. ( on the phone) Thank you ………for……… phoning. Goodbye.
5. What happened ……to….. Mary last night? Why didn’t she come to the party?
6. We’re thinking……about……… going to Australia next year.
7. We asked the waiter ……for….. coffee but he brought us tea.
8. Do you like reading books? It depends ……on……… the book.
9. John was talking but nobody was listening ……to…….. what he was saying.
10.we waited …for………. Karen until 2 o’clock but she didn’t come.

B.I. 3 Complete these sentences with at/ for/after.

1. I looked ……at……… the newspaper but I didn’t read it carefully.
2. When you are ill, you need somebody to ………look after……. You.
3. Excuse me, I’m looking ……for…….. Hill Street. Can you tell me where it is?
4. Goodbye! Have a nice holiday and look ……after……… yourself.
 5. I’m going to take a photograph of you. Please look ……at…….. the camera and smile.
6. Barry is looking ………for…… a job. He wants to work in a hotel.

B.I. 4 Answer these questions with it depends ………..

1. Do you want to go out with us?
2. Do you like eating in restaurants?
3. Do you enjoy watching TV?
4. Can you do something for me?
5. Are you going away
It depends where you’re going
It depends on the restaurant
It depends on the TV
It depends on what I can do for you
It depends on where you’re going away

B.2.1 Phrasal verbs 1

A phrasal verb is a verb ( go/look/be etc. ) + in/ out/up/down etc.
B.2.2 Look at the pictures and complete the sentences. Use the verbs in the list+
in/out/up etc.

1. I went to the window and …..looked out…....

2. The door was open, so we…………got in…………………
3. He heard a plane, so he…………looked up…………………….
4. She got on her bike and ……………rode on………………..
5. I said hello and he …………………looked around…………………..
6. The bus stopped and she ……………got out………………
7. There was a free seat, so she………sat on………………
8. A car stopped and two men…………went out……………..

B.2.3 Complete the sentences. Use out/ away/back /up etc.

1. What happened to the picture on the wall? It fell …down...
2. Please don’t go ………out…………! Stay here with me.
3. She heard a noise behind her, so she looked ………around………
4. I’m going ……away……. now to do some shopping. I’ll be …back……. at 5 o’clock.
5. I’m feeling very tired. I’m going to lie ……down….. on the sofa.
6. When you have read this page, turn………over……… and read the other side.
7. Jim is from Canada. He lives in London now but he wants to go …away.. to Canada.
8. We haven’t got a key to the house, so we can’t get ……in…………….
9. I was very tired this morning. I couldn’t get …………up…………………..
10. Ann is going on holiday next month. She’s going …away…,, on the 5th and coming
……back…. on the 24th.
B.2.4 Complete the sentences. Use a verb from the box + on/off/up etc. If necessary; put
the verb into the correct form. All these phrasal verbs ( wake up etc )
Break fall give slow take
Carry get hold speak wake

1. I went to sleep at 10 o’clock and …woke up…. At eight o’clock the next morning.
2. A : It’s time to go.
B : ………hold on………. A minute. I’m not ready yet.
3. The train …………slow off………….. and finally stopped.
4. I like flying but I’m always nervous when the plane………take off……..
5. How was your exam? How did you ………………get on………………….?
6. It’s difficult to hear you. Can you ……………speak up…………… a little?
7. This car isn’t very good. It has…………broke out………….. many times.
8. When babies try to walk, they sometimes……………fall off……………..
9. I told him to stop but he doesn’t ……………carry out…… Perhaps he didn’t hear me.
10. I tried to find a job but I ………………give up…………… It was impossible.

B.3.1 Phrasal Verbs 2

Sometimes a phrasal verb ( put on/ take off etc. ) has an object.
Some more phrasal verbs + object :

B.3.2 Look at the pictures. What did these people do?

1. He turned on the light or turned the light on.

2. She ………took off hers hat……………………………………………….
3. He ………………put down his bag………………………………………..
4. She ……………………pick up the magazine………………………………….
5. He ………………………put on his glasses…………………………………
6. She…………………………took off the water gag…………………………….
B.3.3 Complete the sentences Use one of the verbs in the list + it/them.

Bring pick switch take turn (+ on/off/up/back)

1. I wanted to watch something on television, so I… turned it on.
2. I bought a lamp but it doesn’t work. I’m going to …switch it……. to the shop.
3. There were some gloves on the floor, so I ………pick up them……… and put them
on the table.
4. When I finished working on the computer, I ……turned it off……………
5. Thank you for lending me these books. I won’t forget to ………bring back it……..

Embeded question questions in a question

Can you tell me where it is, Not where is it
Can you tell me...
1. What is your name? Can you tell me what your name is
2. Where is your address? Can you tell me where your address is
3. How old are you? Can you tell me how old you are
4. How much is it? Can you tell me how much it is
5. Who is this person? Can you tell me who this person is
6. What do you think? Can you tell me what you think
7. What did you say? Can you tell me what you said
8. What have you done? Can you tell me what you done
9. How can you open the box? Can you tell me how can you open the box
10. Is it right? Can you tell me whether it is right or not
11. Are you sick? Can you tell me whether you’re sick or not
12. Can you swim? Can you tell me whether you can swim or not
If Can you tell me what your name is, jadinya embeded question
Can you tell me whether it is right or not (khusus yes no question)