Pengendalian Faktor Risiko

PTM di masyarakat –
Rekomendasi dan Praktik Baik
Dr. Indah S. Widyahening, MS, MSc-CMFM, PhD
Departemen Ilmu Kedokteran Komunitas
Fakultas Kedokteran Universitas Indonesia
Presentasi pada Rakerkesnas, 13 Februari 2019
Sistematika
• Latar belakang
• Intervensi yang direkomendasi
• Contoh praktik baik
• Kesimpulan
• Saran
LATAR BELAKANG

Angka Harapan Hidup negara-negara anggota ASEAN (2006-2016)

https://www.statista.com/statistics/804453/life-expectancy-at-birth-in-the-asean-countries/
LATAR BELAKANG

10 penyebab kematian terbesar di Indonesia tahun 2017 dan

persentase perubahannya pada periode 2007-2017.

http://www.healthdata.org/indonesia
LATAR BELAKANG

10 Faktor Risiko utama yang mempengaruhi Disability-

Adjusted Life Years (Years) Indonesia, pada semua
golongan usia (2007-2017).

http://www.healthdata.org/indonesia
LATAR BELAKANG

Proyeksi prevalensi obesitas dan diabetes pada tahun 2025 dan

kemungkinan tercapainya target global bagi obesitas dan diabetes

Estimated Prevalence Projection for 2025 Probability of Riskesdas 2018

in 2010 meeting global
target

Women Men Women Men Women Men Women Men

Obesity 6,9% 3,2% 14,8% 10,0% 0% 0% 21,8%
(4,9-9,4) (2,0-4,8) (8,7-22,8) (4,9-17,9)

Diabetes 7,7% 7,0% 9,9% 10,1% 33% 33% 12,7% 9,0%

(5,1-10,8) (4,5- (3,3-23,0) (3,0-23,8)
10,1%)

* Target global WHO bagi obesitas dan diabetes adalah pada tahun 2025 tidak terdapat peningkatan prevalensi
obesitas dan diabetes dibanding tahun 2010.
http://ncdrisc.org/country-profile.html
LATAR BELAKANG

Target global WHO pada tahun 2025

• penurunan angka kematian prematur akibat penyakit tidak
menular sebesar 25% angka tahun 2010,
• penurunan persentase perokok sebesar 30% angka tahun 2010,
• angka obesitas menetap sesuai angka tahun 2010,
• penurunan angka tekanan darah tinggi sebesar 25% angka tahun
2010.

https://www.who.int/nmh/countries/idn_en.pdf?ua=1
LATAR BELAKANG
LATAR BELAKANG

Beban PTM berdasarkan Provinsi Tahun 2017 (DALYs per 100.000)

 Intervensi yang direkomendasikan untuk
pencegahan dan pengendalian PTM
INTERVENSI
 Mengurangi penggunaan tembakau
‘Best buys’: effective
interventions with cost
effectiveness analysis (CEA) ≤
I$100 per DALY averted in
LMICs
INTERVENSI
Effective interventions with
CEA >I$100 per DALY averted
in LMICs
Other recommended
interventions from WHO
guidance (CEA not available)
• Increase excise taxes and prices on tobacco products
• Implement plain/standardized packaging and/or large
graphic health warnings on all tobacco packages
• Enact and enforce comprehensive bans on tobacco
advertising, promotion and sponsorship
• Eliminate exposure to second-hand tobacco smoke in all
indoor workplaces, public places, public transport
• Implement effective mass media campaigns that educate
the public about the harms of smoking/tobacco use and
second hand smoke
Provide cost-covered, effective and population-wide support
(including brief advice, national toll-free quit line services) for
tobacco cessation to all those who want to quit
• Implement measures to minimize illicit trade in tobacco
products
• Ban cross-border advertising, including using modern
means of communication
• Provide mobile phone based tobacco cessation services
for all those who want to quit.
 Mengurangi pola makan tidak sehat
‘Best buys’: effective • Reduce salt intake through the reformulation of
interventions with cost food products to contain less salt and the setting of
effectiveness analysis target levels for the amount of salt in foods and
(CEA) ≤ I$100 per DALY meals
averted in • Reduce salt intake through the establishment of a
INTERVENSI

LMICs supportive environment in public institutions such

as hospitals, schools, workplaces and nursing
homes, to enable lower sodium options to be
provided
• Reduce salt intake through a behaviour change
communication and mass media campaign
• Reduce salt intake through the implementation of
front-of pack labelling
Effective interventions • Eliminate industrial trans-fats through the
with CEA >I$100 per DALY development of legislation to ban their use in the
averted in LMICs food chain
• Reduce sugar consumption through effective
taxation on sugar-sweetened beverages
 Mengurangi pola makan tidak sehat
Other recommended • Promote and support exclusive breastfeeding for
interventions from WHO the first 6 months of life, including promotion of
guidance (CEA not breastfeeding
available) • Implement subsidies to increase the intake of
fruits and vegetables
• Replace trans-fats and saturated fats with
INTERVENSI

unsaturated fats through reformulation, labelling,

fiscal policies or agricultural policies
• Implement nutrition education and counselling in
different settings (for example, in preschools,
schools, workplaces and hospitals) to increase the
intake of fruits and vegetables
• Implement nutrition labelling to reduce total
energy intake (kcal), sugars, sodium and fats
• Implement mass media campaign on healthy diets,
including social marketing to reduce the intake of
total fat, saturated fats, sugars and salt, and
promote the intake of fruits and vegetables
 Mengurangi inaktivitas fisik
‘Best buys’: effective Implement community wide public education
interventions with cost and awareness campaign for physical activity
effectiveness analysis which includes a mass media campaign
(CEA) ≤ I$100 per DALY combined with other community based
averted in education, motivational and environmental
INTERVENSI

LMICs programmes aimed at supporting behavioural

change of physical activity levels

Effective interventions Provide physical activity counselling and referral

with CEA >I$100 per as part of routine primary health care services
DALY averted in LMICs through the use of a brief intervention
 Mengurangi inaktivitas fisik
Other recommended • Ensure that macro-level urban design incorporates
interventions from WHO the core elements of residential density, connected
guidance (CEA not street networks that include sidewalks, easy access
available) to a diversity of destinations and access to public
transport
INTERVENSI

• Implement whole-of-school programme that

includes quality physical education, availability of
adequate facilities and programs to support
physical activity for all children
• Provide convenient and safe access to quality
public open space and adequate infrastructure to
support walking and cycling
• Implement multi-component workplace physical
activity programmes
• Promotion of physical activity through organized
sport groups and clubs, programmes and events
 Menurunkan konsumsi alkohol
‘Best buys’: effective • Increase excise taxes on alcoholic beverages
interventions with cost • Enact and enforce bans or comprehensive
effectiveness analysis restrictions on exposure to alcohol advertising
(CEA) ≤ I$100 per DALY (across multiple types of media)
averted in • Enact and enforce restrictions on the physical
INTERVENSI

LMICs availability of retailed alcohol (via reduced hours of

sale)
Effective interventions • Enact and enforce drink-driving laws and blood
with CEA >I$100 per DALY alcohol concentration limits via sobriety
averted in LMICs checkpoints
• Provide brief psychosocial intervention for persons
with hazardous and harmful alcohol use
 Menurunkan konsumsi alkohol
Other recommended • Carry out regular reviews of prices in relation to
interventions from WHO level of inflation and income
guidance (CEA not • Establish minimum prices for alcohol where
available) applicable
• Enact and enforce an appropriate minimum age for
INTERVENSI

purchase or consumption of alcoholic beverages

and reduce density of retail outlets
• Restrict or ban promotions of alcoholic beverages
in connection with sponsorships and activities
targeting young people
• Provide prevention, treatment and care for alcohol
use disorders and comorbid conditions in health
and social services
• Provide consumer information about, and label,
alcoholic beverages to indicate, the harm related
to alcohol
PRAKTIK BAIK
PRAKTIK BAIK
PRAKTIK BAIK

Pendanaan
 Health Promotion Plan
PRAKTIK BAIK
PRAKTIK BAIK
 Beberapa contoh program
Lokasi Program
Sekolah Penambahan jam pelajaran olah raga di kurikulum dari 1 jam menjadi
2 jam (Kebijakan Kementerian Pendidikan)
Kegiatan aktivitas fisik ekstra kurikular
Program pelatihan berenang bagi anak
Pembatasan penjualan minuman berkarbonasi di sekolah
Komunitas Pembentukan “Holistic health learning center” di pedesaan
Program sukarelawan perawat lansia
Tempat “Healthy Armed Forces”
kerja “Happy workplace”
“Healthy police station”
“Healthy public sector employee”
“Healthy temples” (bersama Kementerian Kebudayaan)
PRAKTIK BAIK
 Beberapa contoh program
Lokasi Program
Provinsi / Penyelenggaraan aktivitas fisik di tempat-tempat umum
kota Promosi aktivitas fisik sebagai bagian dari turism: jalur sepeda dan
tour bersepeda (kota ramah sepeda), water park (Kementerian
Pariwisata dan olah raga)
Kota “aman pangan” (mendorong penggunaan bahan pangan lokal
dan organik)
Provinsi bebas tembakau
Kampanye “Exercise is Magic Medicine” Program
nasional “Thai people without pot-bellies” Program
PRAKTIK BAIK
 Jalur sepeda di Thailand
PRAKTIK BAIK
 Capaian

Percentage of population with

sufficient physical activities
74
72
70
68
66
64
62
2012 2013 2014 2015
Series 1
PRAKTIK BAIK
PRAKTIK BAIK
Kesimpulan
Saran

Aktivitas Fisik Konsumsi sayur dan buah Pemeriksaan kesehatan

berkala
Penyelenggaraan aktivitas Kantin sehat di sekolah dan Pemeriksaan kesehatan
fisik di tempat-tempat tempat kerja pada hari perayaan
umum, hari peringatan Kampanye media massa nasional dan peringatan
kesehatan (Hari Diabetes, mengenai pola makan kesehatan
Hari TB, Hari Lansia, dll) sehat Pemeriksaan kesehatan di
Kota ramah sepeda dan tempat-tempat kerja
pejalan kaki Posbindu
Kampanye media massa
mengenai pencegahan
obesitas
Pembinaan komunitas