The findings are detailed in the 2019 Global Burden of Disease Study (GBD), coordinated by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington, and were published in The Lancet on Oct. 15.

The study analyzed 286 causes of death, 369 diseases and injuries and 87 risk factors in 204 countries and territories, which researchers said could paint a picture of whether populations were prepared for the impacts of COVID-19.

Researchers said the interaction of COVID-19 with rising chronic illnesses and related risk factors, such as obesity and high blood sugar, had created a “perfect storm” that fueled COVID-19 deaths.

 

“In Indonesia, in 1990, noncommunicable diseases contributed about 40 percent to total health loss. That had more than doubled by 2019,” The Lancet editor in chief Richard Horton said during a virtual press briefing on Wednesday evening.

 

“Indonesia, according to the Global Burden of Disease [study] is in the grip – right in the center of the storm.”

Total health loss is a measure of how much healthy life is lost due to early death, illness or disability as a result of certain health conditions and their consequences.

 

The study found that the contribution of NCDs to Indonesia’s total health loss had increased by 82.1 percent over the past three decades, from 39.7 percent in 1990 to 72.3 percent in 2019. The figure is higher than the 2019 global estimate for total health loss at 64 percent, which is also an increase from the 43 percent recorded 30 years ago.

 

The diseases’ contribution to the country’s premature deaths also jumped 114.7 percent over the same period, from 31.2 percent in 1990 to 67 percent in 2019, the study revealed.

Four out of five of Indonesia’s leading causes of health loss in 2019 were NCDs, with the remaining cause being neonatal disorders. In descending order, they are stroke, ischemic heart diseases, diabetes, as well as cirrhosis and other chronic liver diseases.

 

They also made up Indonesia’s leading NCD causes of death, alongside chronic obstructive pulmonary diseases.

“For Southeast Asia […] the progress has been quite considerable on healthy life expectancy in the last two decades, but some of the NCD risks are particularly prominent. For example, tobacco use is a very high-risk factor in the region. This will be familiar to Indonesia, with some of the highest tobacco consumption in the world,” IHME director Christopher Murray said.

 

In a land where nearly 40 percent of the population smokes and tobacco kills about 700 people per day, the COVID-19 pandemic has added another level of precarity.

 

Last month, East Java Governor Khofifah Indah Parawansa and the Health Ministry came under fire after reportedly planning to separate deaths of COVID-19 patients with comorbidity factors from those without pre-existing conditions, which would affect the country’s reported death toll. Both parties later clarified the reports.

 

As of Friday, Indonesia had recorded more than 350,000 confirmed cases, with more than 277,000 recoveries and 12,347 deaths.

 

Authorities have suggested that comorbidity factors have contributed to COVID-19 deaths in the country. Data released by the Health Ministry on Oct. 13 showed that from a sample of 1,057 COVID-19 deaths, 347 patients had pneumonia, 196 had hypertension, 172 had diabetes, and 70 did not have preexisting conditions.

 

But the presence of these risk factors did not necessarily mean a country would have a large epidemic, Murray said, as demonstrated by a number of countries that managed the early phases of the epidemic well through case detection, contact tracing strategies and transmission control to avoid widespread community transmission.

 

“If you look at risk factors like obesity, they are quite high in New Zealand and Australia, but there are almost no deaths there […] It’s the combination of bad control of the virus at the beginning and the presence of those risk factors,” he said.

 

Horton said there was much debate about focusing protection on those who were most at risk while allowing the virus to circulate in communities. He noted that the GBD study showed that the number of people at risk in many countries was far greater that one might imagine.

 

“Once you let the virus into your society and once it's widely prevalent and then if you have a background of poor health in a community, then that community is at risk, which is why it's so important to suppress the prevalence of the virus,” he said.

 

Horton said the world was facing a “syndemic”, a combination of COVID-19 and NCDs, and that it was important for governments to address the underlying social inequalities that shaped them, including poverty, housing, education and race – all of which were important health determinants.

 

Health Ministry NCDs director Cut Putri Ariane said the ministry had carried out various prevention efforts to suppress NCDs, such as by providing risk-factor screening in communities.

 

“The question is, will people change their behavior when their environment isn’t supportive of it? Improving the environment requires a multi-sectoral commitment,” she said.

 

Such a commitment should translate into various efforts, Cut said, including providing pesticide-free food to prevent cancer, increasing the price of and excise on tobacco products and enforcing clear age restrictions, providing green space for the public and persuading the food and beverage industry to not sell products with excessive salt, sugar and fat content.