Fakultas Kedokteran Universitas Sriwijaya

The Scope of Public HealthPublic 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 :Ilmu & Seni yang bertujuan mencegah 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 dataPendidikan kesehatan & diseminasi informasiPengawasan, pengaturan, pelayanan kes.lingAdm & YankesYankesKoordinasi Sumber daya Kesehatan

EMERSON & LUGINBUHLStatistik VitalPendidikan kesehatankeslingPemberantasan peny. MenularKesejahteraan Ibu & AnakPengendalian Peny. KronisLaboratorium KesehatanWHOPemeliharaan dokumen KesehatanPendidikan kesehatanKeslingPemberantasan peny. MenularKesejahteraan Ibu & AnakYanmed & 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 definedOccupational 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 ExposuresContamination 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 HazardsNatural and anthropogenic sources.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 ENVIRONMENTEcosystem: 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 ENVIRONMENTF (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.

HEALTHPhysical and Chemical Environment (air, water, soil, food)Biological Environment: pathogens, vectors and Habitats.Scale and Nature of Human Activities (agricultural, industrial, energy production, urbanization)Interaction of Human Activities and Environment

Top Risk Factors Leading to Disease, Disability, or Death (behavior)Developing CountriesUnderweightUnsafe sexUnsafe water, sanitation and hygieneIndoor smokeDeficiency vit and minHigh blood pressureTobaccoHigh cholestrol.Developed CountriesTobaccoHigh blood pressureAlcoholHigh cholestrolHigh body mass indexLow fruit and vegetable intakePhysical inactivityIllicit drugsUnsafe sexFe DeficiencyRef. Murphy, E.M (2005). Promoting Healthy Behavior. Population Reference Bureau. Washington DC, USA.

Biological HazardsPlants, 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 Hazards10 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, organo-phosphorous, Carbamate)

Media: Water, Air, Soil, DrugsSkinRespiratoryTractGI. TractBLOODOther OrgansLiverKidneyUrineSweatHairFeces

Physical HazardsNoise: 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-raysNon Ionizing: UV, IR, Lasers, Microwave, Radio

Mechanical and Ergonomics HazardsPhysical Injury:Traffic;Workplace.Home and recreation.ErgonomicsDesigning workplace that can be modified or adapted to the needs of individual workers.Cumulative Trauma Disorders (eg. Carpal Tunnel Syndrome)Frequency, Strength, position.

Psycho SocialStress:Depression;Suicide;Substance abuse;ViolencePsycho somatic diseases.Stressors:Family related;Work related: Interpersonal, Organizational.

Batasan Risk AssesmentPemeriksaan 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 ExposureRisk assessment:Hazards identificationExposure assessmentRisk characterizationRisk ManagementRisk evaluationControl of exposureMonitoring

Prevention and control of exposureControl 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 EquipmentTrainingAdministrative control (eg. Working time)Secondary Prevention (early detection)

Healthy People 2010, USAEnvironmental Health Outdoor Air QualityWater QualityToxics and WastesHealthy Homes and Healty CommunitiesInfrastructure and SurveillanceGlobal Env Health.

Additional Challenges forDeveloping CountriesExport of HazardsInfrastructures and Human ResourcesTrans-national ProblemRelationships between Workplace and Home EnvironmentEconomic Development - rapid industrialization, urbanization.OH/EH Services and Primary Health Care.

Topik Diskusi ttg. Keslingker Quality Air, ambient and indoor.Domestic Waste Management; Excreta Disposals;Water Supply Sanitation;Housing and HealthFood Sanitation;Vector Control;Environmental Pollution and HealthWorkers Health SurveillanceEmergency Response PlanPublic Health Risk Assessment.

Student ProjectsDomestic 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 healthIndoor Air QualityChemcal managemet in the work place.

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