Speaking at a public lecture on Thursday, Christopher Murray, the director of the Institute for Health Metrics and Evaluation (IHME), an independent global health research center at the University of Washington in the United States, said the major factors that contributed to the increased prevalence of NCDs in Indonesia were blood pressure, diet, blood sugar, obesity, tobacco and air pollution.

“[Indonesia is] in a critical window now as we head toward 2030. By tackling the drivers of these NCDs, you can make a very substantial difference,” Murray told the audience at the 23rd Panglaykim memorial lecture hosted by the Panglaykim Foundation and Centre for Strategic and International Studies (CSIS).

During his presentation, Murray highlighted the enormous shift in the disease burden between 1990 and 2017. While the disability adjusted life year (DALY), a global health measure of overall disease burden, in 1990 was dominated by communicable maternal and neonatal causes, the DALY in 2017 was dominated by NCDs.

“It is a very different set of dominant causes than what we had back in 1990 […] these risk factors [increasing NCDs] are highly correlated with development,” he said.

“Among several factors, such as pollution, unsafe water, smoking and alcohol consumption, a major risk factor that continues to increase is obesity. And perhaps the one [factor] that is most alarming is that obesity is the only risk that is increasing all around the world […] Not one country in the last three decades has seen a decline in obesity,” he said.

In its reference scenario, IHME predicted that the prevalence of communicable diseases would drop significantly, with tuberculosis, as one example, expected to drop from the third biggest cause of premature death in 2016 to fifth by 2040.

Neonatal preterm birth will also drop from fifth place to 13th by 2040.

Meanwhile NCDs such as Ischemic heart disease, stroke and diabetes are predicted to become more predominant causes of premature death by 2040.

Chronic kidney diseases will also rise up to fourth place by 2040 from 11th place in 2016.

The Basic Health Survey (Riskesdas) 2018 shows that the rate of obesity among Indonesian adults has increased from 2007 to 2018.

The survey’s latest figures on obesity, defined as a body mass index (BMI) of more than 27, showed a general increase from 14.8 percent of the population in 2013 to 21.8 percent in 2018.

However, Murray said that while there were many success stories and strategies around the world to tackle other causes of NCDs, such as banning tobacco, there was still no proven policy strategy for reducing sugar consumption and improving people’s diets.

“Unfortunately, for obesity and diet we lack clear strategies that appear to work,” he said.

Murray is a founder of the Global Burden of Disease (GBD) approach, a systematic method for quantifying the comparative magnitude of ill-health due to diseases, injuries and risk factors by age, sex and geography over time.

As a physician and health economist, he has worked for many years on improving public health and improving methods for collecting health data.

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