Reflection

2. Necessary but not Sufficient

Factor A
+
Factor B Disease
+
Factor C

Multiple factors required: initiator & promoter (cancer,

TB)
2. Necessary but not Sufficient
Example:

Aflatoxin
+
Alcohol Liver Cancer
+
Drugs

Multiple factors required: initiator & promoter (cancer,

TB)
4. Neither sufficient nor necessary
(contributory causes)

Factor A + Factor B
or
Factor C + Factor D Disease
or
Factor E + Factor F

Most accurately represents causal relationships in most

chronic diseases
4. Neither sufficient nor necessary
(contributory causes); Example:

Aflatoxin + Alkohol
or
Hepatitis B + Drugs Disease
or
Hepatitis C + low physical activities

Most accurately represents causal relationships in most

chronic diseases
Learning Outcomes:
a) Describe several determinants (models)
of diseases and death occurring in the
population
b) Explain the applications of
understanding diseases and death
determinants (models)
c) Identify the strengths and weaknesses of
diseases models
 Model Segitiga (The Epidemiologic Triad/
Triangle)
HOST (intrinsic)
(age, sex, genotype, behaviour,
Traffic accidents nutritional status)
TB

AGENT ENVIRONMENT
(biologic, physic, mechanical, chemical,
(Physical, Biological, Social)
nutrient)
Model Roda (Wheel Model)
INTERNAL
(intrinsic)

Social
Biological HOST • politic,
Environment • economic
Genetic
• culture

Physical Environment

EXTERNAL (extrinsic)
 Not a single factor, always
multifactors , not black ad white
only
 BLUM MODEL
Genetic

Morbidity and
Behavior Health
mortality in
services
a population

Environmental factors
(biological, physical, social, economical, politic)