The Lancet: New study shows lingering health disparities between Indonesia’s provinces
Published October 11, 2022
- The probability of death for ages birth to 20 and 20 to 55 declined in all provinces, but that of ages 55 to 90 increased in six provinces.
- High systolic blood pressure and tobacco use were among the top
five leading risk factors for all provinces.
- Child and maternal malnutrition was the leading risk factor in three provinces
and the second leading risk factor in five provinces.
- High body mass index was the leading risk factor in three provinces
and the second leading risk factor in five provinces.
SEATTLE, Wash. Oct. 11, 2022––A new peer-reviewed systematic study analyzing hundreds of diseases, injuries, and risk factors in Indonesia shows that there were large disparities in health outcomes among provinces. This study was published today in The Lancet Global Health and is a collaboration among a network of researchers and policymakers from governmental agencies and academic institutions in Indonesia, including the Ministry of Development Planning, Ministry of Health, and Statistics Indonesia, and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine. It is the first systematic and comprehensive analysis of burden of disease for all 34 provinces in Indonesia, based on data from the Global Burden of Disease (GBD) Study 2019. GBD, which is now in its 30th year, is the most comprehensive worldwide observational epidemiological study that provides a tool to quantify health challenges in 204 countries and territories.
“We have long been aware of disparities in health status across our large and diverse country,” said Dr. Nafsiah Mboi, former Minister of Health of Indonesia (2012–2014) and board member of IHME. “This analysis gives us a comparable set of data for all 34 provinces to guide policy and program development and to serve as a critical baseline for monitoring progress.”
Life expectancy for both males and females increased across Indonesia. For males, it increased from 62.5 to 69.4 between 1990 and 2019, a positive change of 6.9 years. For women during the same period, life expectancy increased from 65.7 to 73.5, an increase of 7.8 years. Bali had the highest life expectancy in 2019 at 75.4 years, while Papua had the lowest at 65.2, a 10.2-year difference. The probability of death from birth to age 20 and from 20 to 55 declined in all provinces for both sexes, but that of ages 55 to 90 increased in Papua, North Maluku, West Papua, Aceh, East Kalimantan, and Banten.
High systolic blood pressure and tobacco use were among the top five leading risk factors for all provinces. Reflecting the geographical differences and inequalities observed in Indonesia, child and maternal malnutrition was the leading risk factor for North Kalimantan, Gorontalo, and Papua, and the second leading risk factor in East Nusa Tenggara, Southeast Sulawesi, West Sulawesi, Maluku, and North Maluku. High body mass index was the leading risk factor for Riau, Riau Islands, and East Kalimantan, and the second leading risk factor for Bangka-Belitung Islands, North Kalimantan, Jakarta, West Papua, and Papua.
“The findings are crucial to improve health and reduce the burden of disease in Indonesia as they show the leading risk factors and diseases in each province, allowing for designing and implementing programs and policies at the local level to promote health and prevent diseases,” said Prof. Ali Mokdad from IHME. “Such collaboration with colleagues in Indonesia allowed us to provide better data for better health.”
Indonesia’s epidemiological transition continues to unfold, introducing significant new challenges to the health system. Reductions in the communicable disease burden have been slow, while non-communicable diseases continue to affect Indonesian health, albeit in uneven patterns across the provinces. Non-communicable diseases like diabetes are urgent health policy concerns—diabetes is a particularly expensive disease to treat and manage. During the past 30 years, and since the country launched its Universal Health Care program National Social Health Insurance (Jaminan Kesehatan Nasional [JKN]) in 2014, communicable diseases like TB, diarrheal diseases, and lower respiratory infections have remained a main source of disability-adjusted life years (DALYs) in Indonesia, while non-communicable diseases such as ischemic heart disease and diabetes have soared. A DALY is a universal metric for the number of healthy years lost due to specific causes and risk factors. It’s calculated by adding the number of years of life lost to death and the number of years lived with disability due to specific causes and risk factors.
“The findings from the first subnational burden of disease study for Indonesia provide a solid basis for formulating policies that address both communicable and non-communicable diseases and strengthen the health system,” said Pungkas Bahjuri Ali, the Director of Public Health and Nutrition at the Indonesia Ministry of Development Planning.
Continuing to invest in programs that address the high burden of both communicable and non-communicable diseases in Indonesia by utilizing subnational estimates will not only help address provincial and regional health disparities but also lift the overall health profile of the country. The Indonesian government has invested in programs to address communicable diseases, such as the National Tuberculosis Control Program that provides policy guidance and oversight of Indonesia’s goal to eliminate tuberculosis by 2035. Indonesia also invested around US$348 million between 2003 and 2017 to procure drugs, bednets, and rapid tests through the Global Fund to Fight AIDS, Tuberculosis and Malaria. To address the rising burden of non-communicable diseases, the Indonesian government has launched health campaigns and programs, such as the Gerakan Indonesia Lawan Diabetes, which raises awareness about diabetes prevention and treatment. The National Health Social Security Agency (Badan Penyelenggara Jaminan Sosial [BPJS]) initiated the Chronic Disease Management Program (Program Pengelolaan Penyakit Kronis [PROLANIS]) in 2014 to provide a proactive health care service for patients with chronic diseases such as diabetes mellitus.
“The availability of health facilities is the worst in provinces with poor health outcomes. This situation presents tough challenges for the limited government resources available to narrow the large disparities across provinces, said Prof. Laksono Trisnantoro, the Chair of the Gadjah Mada University’s Center for Health Policy and Management Board. “More resources for health should be mobilized by the government and private funding by using innovative measures. It is expected that this report will fuel the commitment of central and local policymakers to invest more in public health activities,”
This analysis provides a comprehensive overview of health conditions in the country immediately prior to the COVID-19 outbreak, shedding light on the efficacy of health policies and programs implemented in Indonesia that might go undetected due to the COVID-19 pandemic.
“The process of carrying out this first subnational burden of disease study was an important learning process for many people in our health system as we worked with the IHME team on designing, carrying out, and analyzing our Indonesia-specific health situation. One of the great benefits of this first subnational burden of disease study was the opportunity for capacity building for this type of data collection and analysis across the country. Looking ahead, we now have the capacity to take up the urgent task of doing more health analysis at the district level,” said Dr. Nafsiah Mboi.
As future iterations of GBD, including the upcoming GBD 2021, will include health loss due to COVID-19, health officials will be able to estimate the performance of health systems at the national and subnational levels before and after the onset of the pandemic.
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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 School of Medicine that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME is committed to transparency and makes this information widely available so that policymakers have the evidence they need to make informed decisions on allocating resources to improve population health.