Family and Community Aspects

in Growth and Development

Nuri Purwito Adi
Community Medicine
Department
FMUI

Health is a state of complete physical,

mental and social well-being, not merely
absence of disease or infirmity

WHO definition of health, 1948

UU RI, No.23 tahun 1992

Being Healthy means well physical, mental
and social function so that everyone can
live socio-economic productively

Periods of development
Late adulthood

Middle adulthood

Early adulthood

Biological
processes

Adolescence

Middle & Late

childhood

Cognitive
processes

Socioemotional
processes

Early childhood

Infancy

Prenatal period

Factors influence growth & development

Intrinsic - genetic
Extrinsic
Environment
Diseases from other people
Mothers condition (prenatal period)

The Mandala of Health

A model of human ecosystem

culture
community
lifestyle
family

Personal
behavior
Sick
care
system

spirit

body

Human
biology

Psycho-socioEconomic
Environment

mind

work

Physical
environment

Human-Made Environment
biosphere

The concept of Bloom

environment

genetics

Health status

Health services

behavior

AGENTS:
-physics
-chemistry
-biologic
-physiologic
-psychologic

HOST

DISEASE

ENVIRONMENT

Gordon & Le Richt

Ecological Theory of Development

Santrock JW, Life-span development. 7th ed. p. 42

Macrosystem
Attitudes & ideologies of the culture
Exosystem
Extended family
Mesosystem
Microsystem

Friends
of family

Family

School
The individual
Sex
Age
Health
etc

Health
services

Neighbors

Church
group
Mass
media

Peers
Neighborhood
play area
Legal
services

Chronosystem
Patterning of environmental
events & transitions over the
life course; sociohistorical

Time

Social welfare
services

ry
a
et
i
D

Nutrition

ha

t
bi

FAMILY
&
ENVIRONMENT

Child Upbringing
Relationship
Friends
PUBERTY :
Physical, Social,
Emotional,
Behavior

Activities
&
Lifestyle

Energy
&
Metabolism

Ethnic
St
res
s

GENE

Hormones
&
Biochemical

The Influence of Family on

Health & Disease
Genetic influences
The family is crucial in child development
Some families are more vulnerable to illness
than others
Infectious disease spreads in families
The family is important in recovery from
illness
Family factors affect morbidity & mortality
of family member itself.

Prenatal period
Maternal characteristics
Mothers age
Nutrition
Emotional states & stress

Maternal diseases & conditions

Rubella, Syphilis, Herpes, HIV

Drugs (incl. tobacco & alcohol)

Prenatal period
Environmental hazards

Radiation
Pesticides
Pollutants and wastes (CO, mercury & lead)
Toxoplasmosis
Heat

Familys influence
Parenting styles
Cultural, ethnic & social class variations
in families
Sibling relationships & birth order

Interaction between children & their parents:

Marital relationship

Child behavior &

development

Parenting

Santrock JW, Life-span development.

7th ed. p. 172

The family life cycle

Source: Duvall 1977

8. Family in
later years

1. Newly married couple

2.Newborn children
2
3. The family with
2.5
young children
3.5
10-15
7
7

15
7. Middle age parents
to retire time

4. The family
with school-age
children
5. Family with
adolescent

8
6. Launching family

The changing family in a changing society

Working mothers
Divorce
Depressed parents

Other factors
Peer relations

Provide source of information and comparison

about the world outside the family

Play

Increases affiliation with peers

Releases tension
Advances cognitive development
Increases exploration
Provides a safe environment

Television

Television
Positive influence

Presenting motivation and education programs

Increase information about the world beyond
the child environment
Providing models of positive social behavior

Negative influence

Taking children away from homework

Making them passive learning
Teaching stereotypes (repeated negative
/information behavior
Provide violent models of aggression
Presenting unrealistic views of the world

Health problems of children

in Indonesia

Causes of death in under-five children (developing countries)

Infant Mortality Rate (IMR) and Under-five Mortality Rate (U5MR)

SDKI 1991, 1994 and 1997
100.0

Kematian/1000 LH

80.0
60.0

SDKI-91
SDKI-94

97.4
40.0

81.3
67.8

57.0

20.0

58.2

45.7

0.0
IMR

Source: Sumantri, et.al 2000

SDKI-97

U5MR

Low birth-weight Infant Proportion from various sources: 1990-2000

18
16.1

16

15.0
14

12
Proporsi BBLR (%)

WSC Goal

12.6

10.4

10

9.9
9.2

7.3

8.4
7.7

7.3
7.1

Repelita Goal

11.4

6.8

10
9.4

7.9

6.6

4
2

0
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Source: End Decade Goal Report, 2000

Studi di Jakarta
Studi di Sulsel
Studi di U. Pandang
Studi di Jabar
SKRT
Studi Long. Ciawi
Studi Long, Indramayu
SDKI
SDKI,Kota
SDKI,Desa

Severe and Moderate Mal-nutrition in Under-five Children, Susenas 1989-2000

Source: Direktorat Gizi Masyarakat, 2001

Children Rights

To be born after conception

To get adequate food and health care
To be loved and protected
To get education
To have opportunities to play and recreation
For those who are disabled; rights to get
special care
To become functional individual

The efforts of government to enhance

child welfare
1.

Targeting and providing health care,

especially for poor families with certain
indicators.
2. Providing special services such as
extra/suplement food for under-weight
under-five children and pregnant mothers.
3. Providing maternity care for pregnant
women through enforcement of village
midwives
4. Revitalization of posyandu to maintain its
activities in growth monitoring of babies and
under-five children

The efforts of government to enhance

child welfare
5. Advocate local governments to always target
adequate allocation to area which were high
risk in nutrition and health problems
6. Promoting to increase education and basic
health services
7. Develop health maintenance program for
communities
8. Develop and strengthen monitoring and
evaluation system (surveillance) based on
the local demands, mostly to improve local
policy of health services and nutrition

Thank you