JAKARTA - Indonesia has made advances in health since 1990, increasing life expectancy by eight years and decreasing rates of health burden from communicable diseases like diarrheal disease and tuberculosis. But the country is facing a growing and expensive wave of health threats from heart disease, diabetes, and other non-communicable diseases, according to a new study.
"Indonesia is wrestling with a 'double burden.' We must remain vigilant in driving down rates of communicable diseases and ailments that affect mothers and infants. At the same time, we need to prevent and treat non-communicable diseases, which is an expensive endeavor," said Dr. Nafsiah Mboi, former Indonesian health minister and lead author of the study. "This gets even more complicated as Indonesians live longer and wrestle with more complex combinations of diseases."
The study, published today in The Lancet, covers 1990 to 2016; it is part of the Global Burden of Disease (GBD) study, a comprehensive effort to quantify health internationally. For this study, Mboi and IHME researchers worked with a diverse team of Indonesians including officials of the Ministry of Health, the National Institute of Health Research and Development, the National Planning Board, the Central Bureau of Statistics, the Eijkman Oxford Institute, University of Indonesia, and the National Social Health Insurance Scheme. Researchers reviewed 333 causes of death and disability in Indonesia and seven comparison countries. It is the largest systemic effort ever to examine Indonesian health trends and their causes.
Indonesians today live longer than ever before: 71.7 years in 2016 compared to 63.6 years in 1990. Women live slightly longer than men. This increase in life expectancy is largely the result of Indonesia's successful efforts against communicable, maternal, neonatal, and nutritional diseases. In 1990, diarrheal diseases, lower respiratory infections (LRI), and tuberculosis (TB) were the top three causes of death and disease. More than 25 years later, TB was the #4 cause of health loss, diarrheal diseases were #10, and LRI dropped from the top 10.
Despite substantial gains, these diseases are still major health challenges, Mboi said.
At the same time, the health loss from non-communicable diseases has dramatically increased. Rates of cardiovascular diseases and diabetes have ballooned in the past 25-plus years. These increases have been fueled by poor diet, high blood pressure, high blood sugar, and tobacco use - now the top risk factors in Indonesia. Diabetes has shown a particularly marked rise. Death and disability from diabetes increased 38.5% since 2006, promising to strain the country's health system for years to come.
Injuries from traffic accidents and non-deadly ailments such as low back and neck pain, along with vision and hearing loss, are also taking an increasing toll on Indonesians' health.
The study comes at a critical time for Indonesia. More than 180 million people - nearly 70% of the population - are enrolled in Jaminan Kesehatan Nasional, the country's national insurance program. This program was launched in 2014 and aims to provide health coverage for all Indonesians, with the government paying premiums of people living in poverty. The government has set the ambitious goal of enrolling 95% of the population by 2019, effectively achieving universal health coverage.
This rapid expansion of health care will require intensified and strategic investments, according to Mboi.
"This study will help the government make more informed health investments and policies in the coming years. We need continued research efforts to increase our understanding of health trends, especially in different provinces of our very large and diverse country," she said.
"The Global Burden of Disease study allows policymakers in Indonesia and beyond to better understand the diseases, injuries, and risk factors that impact health - and how these are changing over time. This information empowers people to make more effective health decisions," said Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, whose organization coordinated the study.
The study, "On the road to universal health care in Indonesia, 1990-2016: a systemic analysis for the Global Burden of Disease Study 2016," was published today in The Lancet. The study is part of a special issue exploring different aspects of health in Indonesia.
Top 10 causes of disease burden in 2016:
- 1 - Ischemic heart disease
2 - Stroke
3 - Diabetes
4 - Tuberculosis
5 - Low back and neck pain
6 - Neonatal preterm birth complications
7 - Sense organ diseases
8 - Road injuries
9 - Skin diseases
10 - Diarrheal diseases
Top 10 risk factors contributing to disease burden in 2016:
- 1 - Dietary risks
2 - High systolic blood pressure
3 - High fasting plasma glucose
4 - Tobacco use
5 - Child and maternal malnutrition
6 - High body mass index
7 - Occupational risks
8 - Air pollution
9 - High total cholesterol
10 - Impaired kidney function
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About the Institute for Health Metrics and Evaluation
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to improve population health.