Health can be defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1946). In more recent years, this statement has been modified to include the ability to lead a “socially and economically productive life.” Health is a social and cultural concept in addition to its fundamental biological characteristics. There are three basic sources of differences in the health of populations: hereditary determinants, socio-economic circumstances, and lifestyles and other behavioral factors. Gender differences span all three domains and cultural and political factors also play important parts in determining the health of populations (Detels, et. al., 2004). Those differences in the health of population can be categorized into macro, meso, and micro level as the determinant of health. Socio-economic circumstances plays role at macro level; social capital, community norms and organizations can be considered as meso level; while hereditary-genetic factors, lifestyle and other behavioral factors can be considered as micro level. These determinants of health influence the health condition and health problems of the population in a particular community which always correlates one with the others.
People in developing countries are still not only exposed to traditional environmental health hazards, such as poor water supply and sanitation and inadequate food hygiene, but are also at high risk of the hazards of uncontrolled industrialization. Mismanagement of natural resources and poor living conditions in rural areas and urban slums have also led to higher risk of diseases from degraded environmental conditions. In addition to the higher prevalence of new, emerging, and re-emerging communicable diseases, the prevalence of non-communicable diseases like cancer, cardiovascular diseases, and other chronic degenerative diseases and conditions is also increasing (Detels, et. al., 2004).
Particularly in Indonesia, due to demographic and epidemiological transition, the Indonesian health care system faces what is known as the “double burden” of diseases. On the one hand, it still has to deal with major health problem of infectious diseases-which have been reduced but not eliminated, such as tuberculosis and malaria. On the other hand, already the country has had to contend with the growing number of chronic ailments such as cardiovascular diseases, metabolic disorders and cancer, whose treatment and prevention are even more costly (World Bank, 1999; WHO, 2000). This condition also made it difficult for health policy-makers and administrators to decide on equitable allocation of scarce resources.
Therefore, based on the particular situation, the ultimate goals of public health have always been and remain the prevention of disease and the promotion of health in communities. In developing countries, reduction of infectious diseases and malnutrition still must take priority, but increasingly, reduction of chronic diseases, accidents and trauma, and environmental threats to health are becoming goals there as well. Achieving that goal requires assurance that public health advances reach those groups of people still suffering heavily from morbidity and mortality that can be avoided using current knowledge and technology (Detels, et. al., 2004).
Saiful Hamsyah, SKM