According to the WHO (2014) non-communicable diseases are now the leading causes of mortality in Indonesia, accounting for an estimated ‘71% of total deaths’ (WHO Noncommunicable Diseases Country Profiles, 2014). NCDs, including cardiovascular diseases (35%), maternal, perinatal and nutritional conditions (21%), cancers (12%), chronic respiratory diseases (6%), injuries (6%), and diabetes (6%) account for a considerable share of mortality (WHO, 2018). Mortality due to diabetes was found to have increased by 63 per cent between 2005 and 2016. This represents the largest increase in mortality among NCDs in Indonesia. Furthermore, ‘hypertension and diabetes are primary risk factors for stroke’. The prevalence of strokes between 2007 and 2013 has increased from 8.3 strokes to 12.3 strokes per 1000 population. In 2014, approximately 15 per cent of mortality was related to strokes, which is ‘among the highest proportion’ worldwide (Agustina et al., 2019, p.82).

The cost of care for people with diabetes and stroke are expected to cause substantial burden on the Indonesian health care system. Agustina and colleagues citing data from a 2014 report by the National Institute of Health Research Development report that the cost burden for diabetes (56%), stroke (57%), hypertension (46%), and heart disease (34%) are expected to increase substantially by 2020. The financial implications have been estimated to amount to $5.80 billion for the health care system as well as increasing out-of-pocket costs (Agustina et al., 2019, p.82)

Furthermore, over the last decade, illnesses such as depression and anxiety disorders have been found to increase by 22 per cent and 18 per cent, respectively (Agustina et al., 2019, p.80). This made depressive disorders the ‘seventh largest contributor to years lived with disability in 2016’. It is reported that in 2013 approximately 400,000 people aged 15 and older lived with severe mental disorders. Despite the banning of restraints in 1977, an estimated 57,200 (14.3%) people were subject to this practice (Agustina et al., 2019, p.83; based on National Institute of Health Research and Development. Basic health research 2013).

Overview of significant NCDs

Most data on NCDs are available from the Riset Kesehatan Dasar (Riskesdas)/Basic Health Survey, conducted every five years by the Ministry of Health. Since 2018, in line with Indonesia’s One Data Policy, Riskesdas was integrated into the Survei Sosial Ekonomi Nasional (Susenas)/National Socioeconomic Survey, which is a household survey managed by Statistics Indonesia (Kementrian PPN/BAPPENAS, 2018).

Diabetes Mellitus

The prevalence of diabetes in people aged 15 or above based on previous diagnosis from healthcare professionals increased from 1.1% in 2007 to 2.1% in 2013 and decreased slightly to 2.0% in 2018 (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013; Kementrian Kesehatan Republik Indonesia, 2018). The highest prevalence can be found in the four provinces DKI Jakarta (3.4%), DI Yogyakarta (3.1%), East Kalimantan (3.1%), and North Sulawesi (3.0%) (Kementrian Kesehatan Republik Indonesia, 2018). This is likely linked to stark increase in obesity (10% in 2007 to 21.8% in 2018 and other NCDs) (Agustina et al., 2019, p.75; Kementrian Kesehatan Republik Indonesia, 2018). According to the latest Riskesdas survey, a measurement based of blood glucose level in line with the American Diabetes Association (ADA) and PERKENI 2015 criteria was added to the survey (Kementrian Kesehatan Republik Indonesia, 2018). The national prevalence is much higher (10.9%) when the diagnosis of diabetes is based on this, although this cannot be compared to previous data.

 Hypertension

In 2018, the prevalence of hypertension was 34.11% among the population aged 18 or over (based on blood pressure measurement). This marks as a significant increase from 2013, when prevalence was recorded at 25.8%. However, there had been a 5.9% decrease between the years 2010 to 2013 (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013).

Heart disease

In 2018, the prevalence of all types of heart disease was 1.5%. The four provinces with the highest prevalence of heart disease are North Kalimantan (2.2%), DI Yogyakarta (2.0%), Gorontalo (2.0%), and DKI Jakarta (1.9%) (Kementrian Kesehatan Republik Indonesia, 2018). Previous data in 2013 only reported coronary heart disease (1.5%) and heart failure (0.3%) prevalence in the population (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013)

Stroke

In 2018, the prevalence of stroke in Indonesia confirmed by diagnosis was 10.9 per 1,000 people, which presents a decrease from 12.1 per 1,000 people in 2013 (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013; Kementrian Kesehatan Republik Indonesia, 2018). To aid interpretation of this data, it is important to point out that stroke is reported as the leading cause of death in Indonesia (CDC, 2020; IHME, 2019), (thus prevalence reported here might indicate the number of survivors). However, prevalence of stroke may be underreported as some patients may not have been able to access appropriate healthcare services or were not aware of their diagnosis. Estimates based on diagnosis and interview of symptoms suggest a prevalence rate of 1.21% in 2013  (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013), but results using this method were not reported for 2018 data.

References:

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. (2013). Riset Kesehatan Dasar 2013 (Vol. 6). https://doi.org/1 Desember 2013

CDC. (2020). CDC in Indonesia (Issue Cdc).

IHME. (2019). Indonesia. http://www.healthdata.org/indonesia

Kementrian Kesehatan Republik Indonesia. (2018). Riset Kesehatan Dasar 2018. https://doi.org/1 Desember 2013

Kementrian PPN/BAPPENAS. (2018). Revolusi Kebijakan One Data, Riskesdas 2018 Tampil Beda. Berita Pembangunan. https://www.bappenas.go.id/id/berita-dan-siaran-pers/revolusi-kebijakan-one-data-riskesdas-2018-tampil-beda/

National Institute of Health Research and Development. (2013). Basic health research 2013. Report: Ministry of Health Republic of Indonesia, Jakarta, 2013.

WHO. (2014). Noncommunicable Diseases Country Profiles, 2014. https://apps.who.int/iris/bitstream/handle/10665/128038/9789241507509_eng.pdf;jsessionid=26014D4B19896037A6A9EE830F4A33C4?sequence=1

WHO. (2018). NCDs Country Profiles 2018 WHO. 224. https://www.who.int/nmh/publications/ncd-profiles-2018/en/