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After Covid – Cardiovascular Disease?

NEWS | 22 October 2021



Based on research by The George Institute for Global Health

As we start to see the decline in Covid cases and look toward a new era of health and productivity, it would be timely to take a moment to see what other non-transmittable, non-infectious, but equally dangerous health challenges Indonesia faces. We are all (probably) aware that diabetes is rampant here, but heart disease is a widespread and after stroke is the biggest killer of indonesians. It’s time to step forward and take a close look at what we face, says publisher Alistair Speirs.

Dense Population

Indonesia is the most populated nation in South-East Asia and home to 260 million people. Half (54%) of the population live in urban areas, with the area around West Java the most populated region of Indonesia with over 1,200 people per square kilometre.

Socioeconomic Status

Although Indonesia’s poverty levels are steadily declining in 2016 approximately 28 million people were still living in poverty and an additional 68 million were classified as near poor, using an international poverty line of $2USD a day. Poverty is more prevalent in rural areas compared to urban areas (7.8%). The greatest poverty is observed on the islands of Java and Sumatra. This has been greatly exacerbated by the pandemic and the statistics will probably have worsened over the last two years.

Life Expectancy

In 2015, the average life expectancy for males was 67.2 years and for females 71.4 years. In addition, it was estimated that on average males would enjoy 60.7 (90.3%) of these years in good health and 6.5 of these years in poor health; for females this was 63.7 years (89.2%) and 7.7 years of poor health. Again this has probably been mad worse by the pandemic but new statistics are not yet available.

Age Distribution and Future Aging Population

The Indonesian population is predominantly young The 2010 census shows 28.9% of the population is younger than 15 years and 7.6% of the population was aged 60 years and over. The Economic and Social Commission for Asia and the Pacific (ESCAP) estimates that 8.5% of the population are currently aged 60 years and older.(1) In the coming decades there will be a transition to approximately one-fifth of the population being aged over 60 years in 2050. We are in need of a new census now to bring all our data up to date.

The Critical Factors

Indonesia has a population of 260 million and over 10% of the population live in poverty. Cardiovascular disease (CVD) is responsible for 37% of deaths in Indonesia. Stroke is the leading cause, followed by coronary heart disease, and diabetes. There are considerably more years of life lost due to premature mortality from stroke, coronary heart disease, and diabetes in Indonesia when compared with neighbouring regions.

Modifiable risk factors (high blood pressure, high cholesterol, diabetes, obesity, and tobacco) are the main contributing factors to the burden of cardiovascular disease in Indonesia. The trend of increasing levels of risk factors over time indicates CVD health burden in Indonesia is likely to increase further.

Population health surveys found:

  •  65% of males smoke
  • Over a quarter of the population have high blood pressure
  • A third have high cholesterol and a third are overweightØ 
  • 8% of females have diabetes

Universal healthcare coverage will provide a comprehensive level of cardiovascular disease care for all Indonesians however, healthcare personnel and services for CVD are currently inadequate. In 2015-16 there was an estimated 3.8 neurologists, 0.4 endocrinologists and 1.5 cardiologists per 1,000,000 and there were only 30 stroke units across Indonesia, with the majority of specialists and specialist services provided in Jakarta. That may have improved since these figures were recorded – but may have slipped again due to the pandemic…

However, primary care has insufficient capacity to diagnose, monitor or manage cardiovascular diseases including diabetes. Strengthening primary care to manage CVDs through existing established community health centre networks is a potential way of addressing this and should be undertaken without delay.

Medications for primary and secondary prevention of CVD are made available under the Jaminan Kesehatan Nasional (JKN) however, issues with coordination between levels of government and inadequate staffing have led to inequalities with regards to availability and access to medicines across Indonesia.

Some studies have identified poor awareness, treatment and control of cardiovascular risk factors. Addressing these gaps could reduce and prevent cardiovascular disease. Over half of participants with high blood pressure were unaware of their diagnosis and untreated and over half of patients with diabetes were untreated.

There is evidence to suggest that patients present late in their disease course. A large percentage of the population are estimated to have undiagnosed diabetes and a first presentation with established diabetes, with secondary complications, is common.

Studies revealed that patients with ST elevation myocardial infarction (STEMI) presented late to hospital and many (~60%) did not receive reperfusion therapies with high (~13%) in-hospital mortality among these patients.

Focusing on prevention and treatment of risk factors in primary care and implementing protocols for acute stroke and heart attack management could be some practical strategies to address the burden of CVDs. Improving data collection for health service utilisation and deaths will help monitor strategies for reducing the cardiovascular disease burden and assist in directing resources where they are most needed.

In plain language – it’s time for us all to put aside our fear of going to the hospital because of covid transmission and go and get a comprehensive check up to see exactly where our bodies are after 2 years of reduced mobility, working form home, closed gyms, and the rest of the restrictions.