ASEAN
09 November 2018
Indonesia's diabetes challenge
Indonesia is increasingly afflicted with first-world problems like diabetes, long before it could ever become a first world country, writes John West.
The health and lives of Indonesian citizens have improved dramatically these past decades. For example, life expectancy has increased from 48 years in 1964 to 69 years today. At the same time, Indonesians are increasingly afflicted with noncommunicable diseases like cardiovascular and respiratory diseases, and diabetes, according McKinsey&Co.
McKinsey reports that in 2014 more than 9 million adult Indonesians suffered from diabetes, making the country’s diabetes population the fifth largest in the world. And this figure could rise to more than 14 million Indonesians by 2035.
In 2014, diabetes was estimated to have caused nearly 176,000 deaths in Indonesia, costing the health system $1.6 billion a year. Without effective interventions, between 2014 and 2020 there could be 1.2 million new diabetes cases, and a consequent $66 billion loss in GDP.
How did Indonesia's diabetes crisis occur?
Physical inactivity -- about 24% of Indonesians older than 18 are physically inactive as they spend their lives in front of a computer or television screen. This rate is much higher than countries like Thailand (15%), India (13%), and the Philippines (16%).
Obesity -- the percentage of overweight Indonesians rose from 21.2% in 2010 to 24.5% in 2014 -- an additional 10.9 million overweight Indonesians!
Smoking -- more than three-quarters of Indonesian males 15 years old and above smoke, compared with 20% in India.
Salt -- average salt intake per person per day is 15 grams, three times higher than the World Health Organization’s recommended daily consumption.
Indonesia also lacks comprehensive diabetes-education programs. Only 47% of diabetes patients are diagnosed in Indonesia.
Ineffective treatment of diabetes. Recommended diabetes-treatment targets are achieved by only 30 to 35% of diabetes patients in Indonesia.
Inadequate healthcare resources. Indonesia has only 2 doctors per 10,000 people, compared with 7 in India and 19 in China. In addition, the distribution of physicians is geographically uneven: for example, Jakarta has more than 15 general practitioners per 10,000 people, while West Sulawesi has less than 1 per 10,000 people.
McKinsey has elaborated a list of measures, based on the experiences of other countries, that Indonesia could undertake.
These are: (i) developing a national diabetes strategy; (ii) establishing data systems and performance-management processes; (iii) upgrading primary-care networks; (iv) using innovative healthcare models to increase screening and diagnosis, particularly in remote areas; (v) upgrading the skills of and providing incentives to healthcare-delivery professionals; (vi) empowering patients to improve adherence to therapy; (vii) increasing awareness of healthy living and encouraging lifestyle changes; and (viii) developing policies to promote and enforce healthier lifestyles.
This list is of course both wonderful and sensible. And we could only hope that the Indonesian government and society are up to the task of implementing this programme.
But our hopes will likely be in vain. Many health programmes are now implemented by local governments, which are notoriously inefficient. Indonesia invests very little in its national health. There is little likelihood of increasing numbers of health professionals any time soon. And growing numbers of Indonesians are still moving from the countryside to the city, and adopting the unhealthy lifestyle that results in diabetes and other noncommunicable diseases.
https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/tackling-indonesias-diabetes-challenge-eight-approaches-from-around-the-world
McKinsey reports that in 2014 more than 9 million adult Indonesians suffered from diabetes, making the country’s diabetes population the fifth largest in the world. And this figure could rise to more than 14 million Indonesians by 2035.
In 2014, diabetes was estimated to have caused nearly 176,000 deaths in Indonesia, costing the health system $1.6 billion a year. Without effective interventions, between 2014 and 2020 there could be 1.2 million new diabetes cases, and a consequent $66 billion loss in GDP.
How did Indonesia's diabetes crisis occur?
Physical inactivity -- about 24% of Indonesians older than 18 are physically inactive as they spend their lives in front of a computer or television screen. This rate is much higher than countries like Thailand (15%), India (13%), and the Philippines (16%).
Obesity -- the percentage of overweight Indonesians rose from 21.2% in 2010 to 24.5% in 2014 -- an additional 10.9 million overweight Indonesians!
Smoking -- more than three-quarters of Indonesian males 15 years old and above smoke, compared with 20% in India.
Salt -- average salt intake per person per day is 15 grams, three times higher than the World Health Organization’s recommended daily consumption.
Indonesia also lacks comprehensive diabetes-education programs. Only 47% of diabetes patients are diagnosed in Indonesia.
Ineffective treatment of diabetes. Recommended diabetes-treatment targets are achieved by only 30 to 35% of diabetes patients in Indonesia.
Inadequate healthcare resources. Indonesia has only 2 doctors per 10,000 people, compared with 7 in India and 19 in China. In addition, the distribution of physicians is geographically uneven: for example, Jakarta has more than 15 general practitioners per 10,000 people, while West Sulawesi has less than 1 per 10,000 people.
McKinsey has elaborated a list of measures, based on the experiences of other countries, that Indonesia could undertake.
These are: (i) developing a national diabetes strategy; (ii) establishing data systems and performance-management processes; (iii) upgrading primary-care networks; (iv) using innovative healthcare models to increase screening and diagnosis, particularly in remote areas; (v) upgrading the skills of and providing incentives to healthcare-delivery professionals; (vi) empowering patients to improve adherence to therapy; (vii) increasing awareness of healthy living and encouraging lifestyle changes; and (viii) developing policies to promote and enforce healthier lifestyles.
This list is of course both wonderful and sensible. And we could only hope that the Indonesian government and society are up to the task of implementing this programme.
But our hopes will likely be in vain. Many health programmes are now implemented by local governments, which are notoriously inefficient. Indonesia invests very little in its national health. There is little likelihood of increasing numbers of health professionals any time soon. And growing numbers of Indonesians are still moving from the countryside to the city, and adopting the unhealthy lifestyle that results in diabetes and other noncommunicable diseases.
References
McKinsey&Co (2016). Tackling Indonesia’s diabetes challenge: Eight approaches from around the world.https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/tackling-indonesias-diabetes-challenge-eight-approaches-from-around-the-world