Welcoming the age of disease prevention
While Indonesia’s socioeconomic status is improving, more people in the country are suffering from degenerative diseases such as cardiovascular problems that are becoming the number one killer.
Most degenerative diseases are related to unhealthy lifestyles such as a sedentary life, smoking, junk food consumption, a high intake of salt and carbohydrates and a lack of exercise.
Those lifestyles are modifiable risk factors for degenerative disease and the government can directly intervene through preventive health actions.
The government should further act by issuing regulations, building infrastructure and promoting healthy lifestyles. The positive impact of these initiatives is not only for society’s sake but also for the government itself as it will curb the curative health budget.
In terms of regulation, Indonesia can emulate Denmark which has introduced a regulation that promotes low consumption of sugar, salt and refined carbohydrates.
Denmark has also just introduced the first fat-food tax in the world by imposing a surcharge on foods that contain more than 2.3 percent saturated fat.
Many similar taxes on fat, soda, calories, sugar, salt, fast foods and processed foods have been proposed in a bid to combat obesity and the many health problems associated with excess weight such as heart disease and diabetes.
Such taxes have managed to reduce tobacco use and change alcohol consumption in many countries.
Why not put a tax on fat, calories or sugar? Such a tax is justified in changing people’s food choices and eating patterns with the funds from the tax used to help cover the huge cost of excess weight to the health budget.
The taxes are expected to raise about 2.2 billion Danish Krone (US$220 million) and reduce consumption of saturated fats by about 10 percent.
Another European country, Hungary, has recently imposed a tax on packaged foods that contain unhealthy concentrations, such as beverages containing more than 20 mg of caffeine per 100 ml. The government, however, is afraid of restricting cigarette consumption due to its contribution to state revenues.
For Indonesia, the good news is the government will raise cigarette excise in 2012. The bad news is the government is reluctant to ban cigarette advertising.
Indonesia can learn from Australia which prohibits the cigarette industry from advertising. The tobacco industry is forced to use plain, logo-free packaging for its products in a bid to make them less attractive to smokers under legislation that will take effect on July 1, 2012.
A government health warning will be prominently displayed on cigarette packs instead, with the brand name relegated to a small, generic font at the bottom. The government also announced it would raise cigarette excise by 25 percent.
Besides the regulation on tax and advertisement restrictions, the regulation on smoking in public areas should be made stricter. The government should also educate society and promote the hazards of smoking especially among the younger generation.
In infrastructure, the government could build a comfortable pedestrian and city park for people to walk, jog and bike in. With good promotion of healthy lifestyles from our leaders, we hope Indonesians can implement healthy lifestyles.
Government can also revitalize the role of Puskesmas (Community Health Centers) as the backbone of health promotion and preventive action. The usage of health cards, immunization, promotion of environmental health and food supplement programs in Puskesmas should be repackaged to suit community needs.
In health prevention, it is not only the government who can play an important part; we also need a big contribution from society. The government should make regulations on the prohibition of food with dangerous coloring and preservatives and restrict licensing of fast food restaurants.
Society, especially schools, can make healthy canteens without junk food and food with coloring and
preservative agents. Schools can also promote exercise and other health promotion through school health units.
Society should also support the no-smoking regulation in public places. The family is another promoter of healthy lifestyles because through the family we can teach non-smoking, how to choose healthy foods and other healthy lifestyles to the children.
There is considerable research to show that it would work. Research has shown that taxing pizza and soft drinks can reduce the amount of calories that are consumed from these foods.
A study of more than 5,000 young adults aged 18-30, found that a 10 percent tax on soda drinks resulted in a 7 percent reduction in calorie intake and 10 percent on pizza produced a 12 percent reduction in calories eaten through pizzas.
The researchers in this study suggested that an 18 percent tax on soda drinks and pizza could cut daily calorie intake by about 60 calories for each person in the population, and could lead to an average weight loss of about 5 lb (2 kg) for every person per year.
Another study tested whether providing calorie information to 178 University students and imposing taxes on the total number of calories bought affected food choices. Increasing prices of high-calorie foods reduces the total calories chosen for lunch meals.
Too many people in Indonesia are not reaching their full health potential because of preventable diseases. The government and the House of Representatives must respond to this need by enacting a preventive health policy.
We believe that the policy will increase the health status of every Indonesian. Preventing is always better than a cure, isn’t it?
The writer is a general physician, who lives in Jakarta.
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