Youth Well-being and NCD Preventions in Indonesia: A ‘Healthy’ Wake-Up Call in the Middle of Pandemic

Across the globe, we have a larger generation of youth than ever before. Half of the world’s population is now under the age of 30. This significant number hugely affects what the future holds. As they grow into adults, they make decisions that affect not only their wellbeing, but also their families, communities, and countries. Therefore, there is a big concern for youth well-being in the world.

There are few studies to measure youth well-being. The International Youth Foundation (IYF) and the CSIS, for instance, joined forces to develop the youth wellbeing index 2014. The index encompasses a set of 40 indicators across six connected domains of young people’s lives: citizen participation, economic opportunity, education, health, and ICT (information and communication technology). Based on the index, Indonesia ranks 19th among 30 countries. The health domain consists of eight indicators: water source, life expectancy at birth, people living with HIV/AIDs, fertility, causes of mortality, self-harm, stress level, and youth’s prioritization of healthy eating and living. 

Additionally, according to the youth well-being index 2017, Indonesia ranks 10th overall in youth well-being. Seven domains that are used consist of gender equality, economic opportunity, education, health, safe & security, citizen participation, and ICT (information and communication technology). Each domain has its indicators. The health domain, for instance, has five indicators (youth stress, tobacco use, adolescent fertility, youth health perceptions, and youth self-harm). Indonesia’s young health ranks 13th driven by the low rate of suicide. However, tobacco use is still heightened and adolescent fertility is exceeding the index average of 43 per 1,000.

Indonesia now has 17% of young people (age 10-19) which is 46 million. 10.8% of them live below the poverty line. While the mortality rate of young people has gradually declined over the years, several NCD and NCD risk factors are becoming the top cause of DALYs (Disability-Adjusted Life Years). NCD risk factors include tobacco use, nutrition, air pollution, mental health, and the COVID-19 pandemic. According to the WHO, non-communicable diseases (NCDs) account for 73% of all death in Indonesia. Cardiovascular disease and cancer are the leading cause of death, accounting for 35% and 12% respectively. 

There are considerable ways to prevent and control NCDs. One way is reducing the risk factors associated with these diseases. There are traditional risk factors and non-traditional risk factors. Traditional risk factors included sedentary lifestyles, obesity, high-calorie diets, smoking, and a history of family diseases. While the non-traditional risk factor is inflammation which plays a role in atherosclerosis and causes ischemic vascular diseases such as stroke, coronary heart disease, and peripheral artery disease. 

There are at least four general prevention and control approaches to NCD risk factors, namely: (1) advocacy, partnership, leadership, and management of NCD, (2) promotion and prevention of NCD risk factors reduction through community empowerment, (3) strengthening of health services capacity, collaborate with private sectors and professionals, and (4) strengthening NCD surveillance and research.

A 2018 study found that intersectoral and fiscal policies are convincing ways to reduce NCD risk in Indonesia. For tobacco use, the interventions to reduce monthly smoking prevalence among adolescents are (1) an increase in excise tax to 75% of the final retail price of tobacco products and (2) point-of-sale advertising bans. For obesity, there are also two interventions: (1) the addition of a 20% excise tax on sugar-sweetened beverages and (2) a school-based nutrition and physical activity program to reduce obesity or overweight.  

Related to the promotional approach, a study from The National Center for Biotechnology found peer education is an effective tool for promoting healthy behaviors among adolescents. However, it also depends on the social settings, context, values, and expectations of the participants. Thus, conducting such programs requires proper preparation, training, supervision, and evaluation.

A program called Young Health Programme (YHP) AstraZeneca aimed to implement prevention and control on non-communicable diseases to children and young people in Indonesia. Children and young people, through YHP, are actively involved in health intervention by peer education. Peer education means an informal learning approach that provides empowerment, confidence, and independence to young people whatever their background. Meanwhile, peer educator occurs when young people carry out non-formal or organize d activities with their peers, over a while, to develop their knowledge, skills, beliefs, and attitudes. 

The objectives of YHP are to improve the health and well-being of young people by increasing their knowledge on NCD prevention, increasing their capacity to make informed decisions about their health, improving health services, and advocating for a supportive policy environment for young people. Through YHP, there will be 91,840 young people and over 3,080 teachers, parents, health professionals, government, and civil society stakeholders from the four targeted city districts in Jakarta receiving the direct beneficiaries of the program.

In the middle of the pandemic, people with NCDs are facing dangerous circumstances due to their comorbidities. Staying at home may seem safe, but they mostly need medications. It is also worsening for them as there are a lack of physical activities at home and intense fear of the potential impact of COVID-19 on their well-being. In tackling those issues, there have been some options, from telemedicine for virtual medical consultation to door-step delivery of prescribed drugs. However, another cliche issue is rising, namely the readiness of infrastructure. In the end, the government must be aware of and handle these issues properly, or a wave of worsening non-communicable diseases will haunt us down.