Perkembangan Profesi dan

Ilmu Kesehatan
Masyarakat
Agustin Kusumayati
Dosen FKM Universitas Indonesia

Disajikan pada Kuliah Umum Mata Kuliah

Kesehatan Masyarakat Intermediet, Fakultas
Kesehatan Masyarakat Universitas Indonesia,
pada tanggal 4 September 2021 secara daring
● University Secretary – Universitas Indonesia
● Chairperson – Indonesian Public Health
Schools Association
● President Elect – Asia-Pacific Academic
Consortium for Public Health
● International Committee Member – Global
Partnership on MCH Handbook
● Advisory Board Member – AUN Health
Promotion Network
● Advisory Board Member – Indonesian Public
Health Association
● Dean – Faculty of Public Health Universitas
Indonesia (2013-2017, 2017-2019)
 Apa penyebab
perubahan Praktik/
Layanan Kesehatan
Masyarakat…?
Disajikan pada Kuliah Umum Mata Kuliah Kesehatan Masyarakat Intermediet,
Fakultas Kesehatan Masyarakat Universitas Indonesia, pada tanggal 4 September 2021 secara daring
Alasan Untuk Berubah

1. Revolusi Industri 4.0

2. Perubahan masalah
kesehatan masyarakat
3. Perubahan gaya dan
cara hidup manusia
akibat terjadinya
pandemi Covid-19
4. Perkembangan Ilmu
Kesehatan Masyarakat
Revolusi Industri 4.0
4th

IR
 Industrial
Revolution 4.0
requires ADAPT
Public Health
Professionals
and
to be able to CHANGE
Critical Skills Needed Emotional intelligence
Critical thinking
Cognitive flexibility
Influence curriculum Creativity
Communication & negotiating
Collaboration and teamwork
Influence approaches to Complex problem solving
teaching & learning Judgement & decision making
Service orientation
Computational thinking
New skills and Global awareness
Financial, economic, business and
competencies required entrepreneurial literacy
Civic literacy
Health literacy
Environmental literacy
Perubahan Masalah
Kesehatan Masyarakat
New Normal is

A new lifestyle and standard of living

that is triggered by Covid-19 pandemic, that
enables humans to live healthy lives, carry out
their social roles and functions,
and be productive, as to create a
noble and prosperous life
 The health system
capacities are in place to
The transmission is
detect, test, isolate, and
controlled
treat every case and trace
every contact
The outbreak risks are
minimized in special
settings like health
facilities and nursing
homes

The preventive measures

The communities are fully
are in place in workplaces,
The importation risks can educated, engaged, and
schools, and other places
be managed empowered to adjust to
where it’s essential for
the new norms
people to go

6 Criteria for Countries to Consider Lifting Restrictions

Five Level of
Tertiary
Prevention Rehabilitation
Prevention
Happy Disability Limitation
people Secondary
Prevention
Excellent Early Diagnosis
Prompt Treatment
Young
Generation Specific Protection
Disease Prevention
High quality Primary
of life Prevention
Health Promotion
Reduce morbidity
and mortality
+
Comprehensive Arrangement
of a New Normal Life
Health Specific Protection Early Diagnosis
Promotion Disease Prevention Prompt Treatment
Transmission control √ √
Strengthen health system: Detect, Test,
Isolate, Treat, Trace √ √

Outbreak prevention at special settings √ √

Preventive measures at places where it’s
essential for people to go √ √

Control of imported risks/cases √ √

Communication, Information, and
Education √ √
essential health care based on
practical, scientifically sound
and socially acceptable
methods and technology,
made universally accessible to
individuals and families in the
community through their full
participation and at a cost
that the community and the
country can afford to
maintain at every stage of
their development in the
spirit of self-reliance and self-
determination.

Alma Ata Declaration on Primary

Health Care, WHO-UNICEF, 1978
 Primary Health Care
 is a basic health care and is a whole of society approach to healthy well-being,
focused on needs and priorities of individuals, families and communities;
 addresses the expansive determining factor of health and ensures whole person care
for health demands during the course of the natural life  includes physical, mental
and social well-being;
 is an approach to health care which integrates at the community level all the factors
required for improving the health status of the population, includes health promotion,
disease prevention, diagnosis and treatment, rehabilitation and palliative care;
 is people-centered rather than disease-centered;
 is available to all the people at the first level of health care;
 is developed with the concept that the people of the country receive at least the basic
minimum health services that are essential for their good health and care.
Community Intersectoral
Participation Coordination The Four
Primary Pillars of
Health Primary
Care Health
Support Appropriate Care
Mechanism Technology
+

Di mana Ahli Kesehatan Masyarakat harus

hadir pada masa Kenormalan Baru ini…?
+
Di Berbagai Tatanan Khusus yang
berisiko tinggi mengalami wabah
● Kompleks perumahan, RT, RW, desa/kelurahan
● Dinas Kesehatan Provinsi dan Kabupaten
● Fasilitas pelayanan kesehatan: Puskesmas, klinik, RS
● Laboratorium
● Asrama  sekolah, universitas, militer, pekerja
● Pesantren, biara, vihara
● Panti Asuhan
● Panti Werda
● Lembaga Pemasyarakatan, Rumah Tahanan
+
Di Tempat-tempat Umum
● Transportasi umum  pesawat terbang, kapal laut,
kereta, bus, angkot, taksi, ojeg
● Bandar udara, pelabuhan laut, stasiun, terminal, halte
● Kampus, sekolah, day care
● Tempat kerja  kantor, pabrik, pertambangan, perkebunan
● Pasar, supermarket, minimarket, mall
● Hotel, motel, home stay, penginapan, resort
● Restoran, kantin, warung makan
● Tempat hiburan  bioskop, pub, bar
● Tempat olah raga dan rekreasi
● Objek wisata
+
Di Perbatasan dan
Pintu-pintu Masuk Negara
 Perbatasan darat, stasiun dan terminal antar negara
 Pelabuhan laut
 Pelabuhan udara
Perkembangan Ilmu
Kesehatan Masyarakat
 Public Health is a combination of
science and art, knowledge and skill,
ethics and morality, that mean to
Definition of improve health status and prolong the
Public Health life of all people through organized
collective efforts to prevent diseases and
fulfill all health needs by empowering
communities to live healthy life.
 Graphical Model of Public Health

Biostatistics

Interdicciplinary/Cross-cutting
Competencies
Environmental
Epidemiology
Health Sciences Communication and Informatics

Diversity and Culture

Leadership

Professionalism

Program Planning

Public Health Biology

Systems Thinking
Health Policy Social and
and Behavioral
Management Sciences
 Evolution of Public Health
Public Health 1.0
Public Health 2.0
Comprehensive PH
protection, from primary Public Health 3.0
Tremendously uneven PH
prevention to treatment capacity at the local levels
Social determinants of
Development of PH Department strained to health are the conditions
astonishing array of address new infectious in which people are born,
health-protecting tools diseases challenges as live, work and age
and capacity with well as the growing
increasingly - Economic opportunity
challenge of chronic non- - Housing
sophisticated techniques communicable disease
to ensure sanitation and - Environment
prevention/preparedness
food safety - Education
Governmental PH came of - Food
age - Safe neighborhoods
- Transportation
Public Health 3.0

ADDRESSING
BEYOND-HEALTH
DETERMINANTS
+
Socio-Ecological Model of Health promotion
 Modifikasi dari:
Whitehead and Dahlgren
THE FUTURE ... Public Health
genomics
Public Health Genomics is the use of
genomics information to benefit Public
Health. This is visualized as more
effective preventive care and disease
treatments with better specificity,
tailored to the genetic makeup of each
individual. Public Health genomics is an
emerging field of study that assesses the
impact of genes and their interaction
with behavior, diet and the environment
on the population health.
Modifikasi dari: Dorman, U
 10 Essential Public Health Services
1. Assess and monitor population health status, factors that influence health, and
community needs and assets
2. Investigate, diagnose, and address health problems & hazards affecting the
population
3. Communicate effectively to inform and educate people about health, factors that
influence it, and how to improve it
4. Strengthen, support, and mobilize communities and partnerships to improve health
5. Create, champion, and implement policies, plans, and laws that impact health
6. Utilize legal and regulatory actions designed to improve and protect the public’s
health
7. Assure an effective system that enables equitable access to the individual services
and care needed to be healthy
8. Build and support a diverse and skilled public health workforce
9. Improve and innovate public health functions through ongoing evaluation, research,
and continuous quality improvement
10. Build and maintain a strong organizational infrastructure for public health
WHO Regional Office for Europe 2020
Essential Public Health Operations
Intelligence EPHOs
EPHO 1 Surveillance of population health and wellbeing
EPHO 2 Monitoring and response to health hazards and emergencies
Core Services Delivery EPHOs
EPHO 3 Health protection, including environmental, occupational, food safety, and
others
EPHO 4 Health promotion including action to address social determinants and
health inequity
EPHO 5 Disease prevention, including early detection of illness
Enabler EPHOs
EPHO 6 Assuring governance for health
EPHO 7 Assuring a competent public health workforce
EPHO 8 Assuring organizational structures and financing
EPHO 9 Information, communication and social mobilization for health
EPHO 10 Advancing Public Health research to inform policy and practice
 Apa Kompetensi
Kesehatan Masyarakat
yang Dibutuhkan … ?

Disajikan pada Kuliah Umum Mata Kuliah Kesehatan Masyarakat Intermediet,

Fakultas Kesehatan Masyarakat Universitas Indonesia, pada tanggal 4 September 2021 secara daring
Council on Education for Public Health 2016 Accreditation Criteria
Foundational Competencies
1. Evidence-based Approaches to Public Health
1. Apply epidemiological methods to the breadth of settings and situations in public
health practice
2. Select quantitative and qualitative data collection methods appropriate for a given
public health context
3. Analyze quantitative and qualitative data using biostatistics, informatics,
computer-based programming and software, as appropriate
4. Interpret results of data analysis for public health research, policy or practice
2. Public Health and Health Care Systems
5. Compare the organization, structure and function of health care, public health and
regulatory systems across national and international settings
6. Discuss the means by which structural bias, social inequities and racism
undermine health and create challenges to achieving health equity at
organizational, community and societal levels
Council on Education for Public Health 2016 Accreditation Criteria
Foundational Competencies
3. Planning and Management to Promote Health
7. Assess population needs, assets and capacities that affect communities’ health
8. Apply awareness of cultural values and practices to the design or implementation
of public health policies or programs
9. Design a population-based policy, program, project or intervention
10. Explain basic principles and tools of budget and resource management
11. Select methods to evaluate public health programs
4. Policy in Public Health
12. Discuss multiple dimensions of the policy-making process, including the roles of
ethics and evidence
13. Propose strategies to identify stakeholders and build coalitions and partnerships
for influencing public health outcomes
14. Advocate for political, social or economic policies and programs that will improve
health in diverse populations
15. Evaluate policies for their impact on public health and health equity
Council on Education for Public Health 2016 Accreditation Criteria
Foundational Competencies
5. Leadership
16. Apply principles of leadership, governance and management, which include
creating a vision, empowering others, fostering collaboration and guiding
decision making
17. Apply negotiation and mediation skills to address organizational or community
challenges
6. Communication
18. Select communication strategies for different audiences and sectors
19. Communicate audience-appropriate public health content, both in writing and
through oral presentation
20. Describe the importance of cultural competence in communicating public health
content
7. Interprofessional Practice
21. Perform effectively on interprofessional teams
8. Systems Thinking
22. Apply systems thinking tools to a public health issue
Association of Schools of Public Health in the European Region 2018
European List of Core Competences

A. Methods in public health

B. Population health and its social and economic determinants
C. Population health and its material - physical, radiological,
chemical and biological - environmental determinants
D. Health policy; economics; organizational theory, leadership and
management
E. Health promotion, health protection and disease prevention
F. Ethics
 WHO Europe-ASPHER Competency Framework for Public
Health in the European Region 2020

Content and Context

1. Science and practice
Epidemiology of communicable and noncommunicable diseases; demography;
biostatistics; qualitative and quantitative research methods; assessment,
analysis and evaluation; evidence-based research; measurement, monitoring
and reporting; health indicators; health systems; population health; health
inequalities.
2. Promoting health
Education and promotion through social participation; health literacy at the
community, organization and individual levels; citizen empowerment; health
needs assessment; screening and secondary prevention; evaluation of health
promotion interventions and programs.
 WHO Europe-ASPHER Competency Framework for Public
Health in the European Region 2020

Content and Context

3. Law, policies and ethics
International and European laws and regulations; European public health law;
strategies and strategic approach (international, national and local levels);
policy development and planning; program and policy assessment and
implementation; priority setting; ethics, ethical frameworks, ethical practice and
decision-making.
4. One Health and health security
Human health; health protection; occupational health; food safety; animal
health; cross-border health; international health; global risks and threats;
preparedness and response; pandemics; environmental health; climate
change.
 WHO Europe-ASPHER Competency Framework for Public
Health in the European Region 2020
Relations and Interactions
5. Leadership and systems thinking
Vision, mission and strategy; individual task-team work; leading change and
innovation; understanding and applying the theories of complex systems in
practice; organizational learning and development; people development;
emotional intelligence.
6. Collaboration and partnerships
Effective collaboration; building alliances and partnerships; networking and
connecting; working with and building interdisciplinary and intersectoral
networks; dealing with and managing stakeholders
7. Communication, culture and advocacy
Effective written and verbal communication, including communication with the
media; scientific communication; presentation, respect for diversity and
inclusiveness; historical and cultural context; advocacy and diplomacy.
WHO Europe-ASPHER Competency Framework for Public
Health in the European Region 2020
Performance and Achievement
8. Governance and resource management
Human resource management; organization, administration and
governance of resources; financial planning; quality assurance;
technical expertise and logistics; basics of health economics;
economic evaluation and analysis.
9. Professional development and reflective ethical practice
Professional and reflective practice; continuing professional
development; lifelong learning; values; ethical professional conduct.
10. Organizational literacy and adaptability
Use of technology; data management; entrepreneurship;
fundraising; creativity, analysis and synthesis; digital health and
social media; understanding of public health services and
operations.
Public Health
Ethics
Disajikan pada Kuliah Umum Mata Kuliah Kesehatan Masyarakat Intermediet,
Fakultas Kesehatan Masyarakat Universitas Indonesia, pada tanggal 4 September 2021 secara daring
 BIOMEDICAL NORMS

CORE MORAL NORMS CORE BEHAVIORAL NORMS

1. Autonomy 1. Veracity
2. Beneficence 2. Privacy
3. Non-Maleficence 3. Confidentiality
4. Justice 4. Fidelity
 PUBLIC HEALTH MORAL NORMS
 Producing benefits, often but not exclusively health benefits, and often
interpreted in health policy as a utilitarian commitment to maximizing
aggregate health benefits
 Preventing harms, often health harms, such as preventable morbidity
and premature death
 Distributing health benefits fairly, or distributive justice (fair distribution
of social goods)
 Procedural justice (fair process), participation, and transparency
 Respecting individual autonomy and liberty of action
 Respecting and fulfilling universal human rights
 Respecting privacy and confidentiality
 Protecting non-dominant subgroups from marginalization and
stigmatization
 Building and maintaining trust
ETHICAL QUESTIONS IN PUBLIC HEALTH

1. How does public health balance the interests of individuals with the interests
of the broader public?  social justice
2. What is paternalism and who is responsible for health?  behavioral change
health education
3. What constitutes a fair distribution of health?  social justice
4. What is participation in health?  social justice
5. When should communicable diseases be reported to public health
authorities?  vs. autonomy (confidentiality)
6. Can medical treatment ever be provided against a patient’s will?  vs.
autonomy (informed consent)
7. Can patients refuse to undergo routine preventive health measures?  vs.
autonomy (informed consent)
 ETHICS

 Ethics are moral principles that govern a person’s behavior.

 Ethics define and systemize what is right versus wrong, and
are used to guide society to make good, moral choices.
 In the field of public health, ethics are used to steer public
health actions.
 According to the Center of Disease Control, “Public health
ethics is the application of relevant principles and values to
public health decision making.”
 PUBLIC HEALTH CORE VALUES

1. Professionalism and Trust. The effectiveness of public health policies,

practices, and actions depends upon public trust gained through
decisions based on the highest ethical, scientific, and professional
standards. Public health gains public trust in part because its practices
are informed by evidence.
2. Health and Safety. Health and safety are essential conditions for
human flourishing. Public health practitioners and organizations have
an ethical responsibility to prevent, minimize, and mitigate health
harms and to promote and protect public safety, health, and well-being.
 PUBLIC HEALTH CORE VALUES
3. Health Justice and Equity. Human flourishing requires the resources and social
conditions necessary to secure equal opportunities for the realization of health and
other capabilities by individuals and communities. Public health practitioners and
organizations have an ethical obligation to use their knowledge, skills, experience,
and influence to promote equitable distribution of burdens, benefits, and
opportunities for health, regardless of an individual’s or a group’s relative position
in social hierarchies.
4. Interdependence and Solidarity. The health of every individual is linked to the
health of every other individual within the human community, to other living
creatures, and to the integrity and functioning of environmental ecosystems. Public
health practitioners and organizations have an ethical obligation to foster positive
—and mitigate negative—relationships among individuals, societies, and
environments in ways that protect and promote the flourishing of humans,
communities, nonhuman animals, and the ecologies in which they live.
 PUBLIC HEALTH CORE VALUES

5. Human Rights and Civil Liberties. While coercive legal measures

limiting behavior can be ethically justified in certain circumstances,
overall the effective and ethical practice of public health depends upon
social and cultural conditions of respect for personal autonomy, self-
determination, privacy, and the absence of domination in its many
interpersonal and institutional forms.
6. Inclusivity and Engagement. Preventing adverse health outcomes and
protecting and promoting the flourishing of individuals, societies, and
ecosystems require informed public decision-making processes that
engage affected individuals and communities. Public health
practitioners and organizations have an ethical responsibility to be
transparent, to be accountable to the public at large, and to include
and engage diverse publics, communities, or stakeholders in their
decision making.
A Code of Ethics for Public Health
Principles of the Ethical Practice of Public Health
1. Public health should address principally the fundamental causes of disease and
requirements for health, aiming to prevent adverse health outcomes.
2. Public health should achieve community health in a way that respects the rights of
individuals in the community.
3. Public health policies, programs, and priorities should be developed and evaluated
through processes that ensure an opportunity for input from community members.
4. Public health should advocate for, or work for the empowerment of, disenfranchised
community members, ensuring that the basic resources and conditions necessary for
health are accessible to all people in the community.
5. Public health should seek the information needed to implement effective policies and
programs that protect and promote health.
6. Public health institutions should provide communities with the information they have
that is needed for decisions on policies or programs and should obtain the
community's consent for their implementation.
A Code of Ethics for Public Health

Principles of the Ethical Practice of Public Health

7. Public health institutions should act in a timely manner on the information they have
within the resources and the mandate given to them by the public.
8. Public health programs and policies should incorporate a variety of approaches that
anticipate and respect diverse values, beliefs, and cultures in the community.
9. Public health programs and policies should be implemented in a manner that most
enhances the physical and social environment.
10. Public health institutions should protect the confidentiality of information that can
bring harm to an individual or community if made public. Exceptions must be justified
on the basis of the high likelihood of significant harm to the individual or others.
11. Public health institutions should ensure the professional competence of their
employees.
12. Public health institutions and their employees should engage in collaborations and
affiliations in ways that build the public's trust and the institution's effectiveness.
Public Health for a Better
Future

Stay Safe and Healthy

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