Saturday, October 29, 2011

What makes Indonesian (not) healthy ? [part one]

Do you know if you were born in Japan you will probably live 40 years longer than somebody who were born in Afghanistan?*
*Life expectancy for Countries

And the fact that Indonesian people have life expectancy 12 years shorter compared to their neighboring country, Singapore !
This intriguing fact is something that I learned during my core course in Amsterdam about health determinant**.
**What determines health?

It has haunted my mind and spirit as medical doctor and public health practitioner.

Epidemiology and statistics, branch of study that talked about important numbers/indicators on population, used to be unpopular class when I was a student in medical school.

I remember how bored it was and demotivated most of us to really learn something from it, or put it into practice.

Few years after I finished my medical school, I realized how important it could be.

It does tell whether we're moving from one point to another (or not), make any good or bad progress as nation in terms of managing health.

Maternal mortality rate (MMR) in Indonesia is one of the highest in Southeast Asia, but if you stratified by region- some more developed region (West Java) has lower MMR (lower than Southeast Asia rate in average) while another region, Papua has MMR 3 times higher than national average!

Back to my main question, as a title: ' What makes Indonesian (not) healthy ?'

I would use the framework borrowed from Canadians :: Population Health.

This is actually looks like my assignment as master student in International Health program-
but in the name of knowledge, science, humanity and nationalism- I write this for you all who interested in this subject (as much as I do).

1. Income and social status

Pretty much makes sense for all of us, people who are poor would more likely have worse health status than those who are richer.

Specifically in countries like Indonesia whereas most of the health expenditure come from out-of pocket (user fees) expenses.

Those who are poor assumed would spend less money on health care (they would prioritize on something that are considered basic needs e.g. foods).

And this group would likely to come late (if they happen to be sick) to the doctors, they would collect money first, seek out alternative treatment etc- in this out-of-pocket systems.

Because here doctors/health care institutions are considered as something 'expensive' or luxurious need for the poor.

It's likely this could be the case: they (the poor) couldn't afford money to go to the doctors, they become even sicker. When they go to the doctor, their worsened conditions would make them pay ever more (more treatment, more medication) compare if they seek treatment earlier.

next on health determinants . . . .

2. Social support networks

3. Education and literacy

4. Employment / Working condition

5. Social environment

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