Pengendalian Faktor RisikoPTM 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

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

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

LATA

R B

ELA

KA

NG

10 penyebab kematian terbesar di Indonesia tahun 2017 dan persentase perubahannya pada periode 2007-2017.

http://www.healthdata.org/indonesia

LATA

R B

ELA

KA

NG

10 Faktor Risiko utama yang mempengaruhi Disability-Adjusted Life Years (Years) Indonesia, pada semuagolongan usia (2007-2017).

http://www.healthdata.org/indonesia

LATA

R B

ELA

KA

NG

Proyeksi prevalensi obesitas dan diabetes pada tahun 2025 dan kemungkinan tercapainya target global bagi obesitas dan diabetes

Estimated Prevalence

in 2010

Projection for 2025 Probability of

meeting global

target

Riskesdas 2018

Women Men Women Men Women Men Women Men

Obesity 6,9%

(4,9-9,4)

3,2%

(2,0-4,8)

14,8%

(8,7-22,8)

10,0%

(4,9-17,9)

0% 0% 21,8%

Diabetes 7,7%

(5,1-10,8)

7,0%

(4,5-

10,1%)

9,9%

(3,3-23,0)

10,1%

(3,0-23,8)

33% 33% 12,7% 9,0%

http://ncdrisc.org/country-profile.html

* Target global WHO bagi obesitas dan diabetes adalah pada tahun 2025 tidak terdapat peningkatan prevalensiobesitas dan diabetes dibanding tahun 2010.

LATA

R B

ELA

KA

NG

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

LATA

R B

ELA

KA

NG

LATA

R B

ELA

KA

NG

Beban PTM berdasarkan Provinsi Tahun 2017 (DALYs per 100.000)

LATA

R B

ELA

KA

NG

Intervensi yang direkomendasikan untukpencegahan dan pengendalian PTM

INTE

RV

ENSI

Mengurangi penggunaan tembakau‘Best buys’: effective interventions with cost effectiveness analysis (CEA) ≤ I$100 per DALY averted inLMICs

• 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

Effective interventions with CEA >I$100 per DALY averted in LMICs

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

Other recommended interventions from WHO guidance (CEA not available)

• 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.

INTE

RV

ENSI

Mengurangi pola makan tidak sehat‘Best buys’: effective interventions with cost effectiveness analysis (CEA) ≤ I$100 per DALY averted inLMICs

• Reduce salt intake through the reformulation of food products to contain less salt and the setting of target levels for the amount of salt in foods and meals

• Reduce salt intake through the establishment of a 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 with CEA >I$100 per DALY averted in LMICs

• Eliminate industrial trans-fats through the development of legislation to ban their use in the food chain

• Reduce sugar consumption through effective taxation on sugar-sweetened beverages

INTE

RV

ENSI

Mengurangi pola makan tidak sehatOther recommended interventions from WHO guidance (CEA not available)

• Promote and support exclusive breastfeeding for the first 6 months of life, including promotion of breastfeeding

• Implement subsidies to increase the intake of fruits and vegetables

• Replace trans-fats and saturated fats with 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

INTE

RV

ENSI

Mengurangi inaktivitas fisik‘Best buys’: effective interventions with cost effectiveness analysis (CEA) ≤ I$100 per DALY averted inLMICs

Implement community wide public education and awareness campaign for physical activity which includes a mass media campaign combined with other community based education, motivational and environmental programmes aimed at supporting behavioural change of physical activity levels

Effective interventions with CEA >I$100 per DALY averted in LMICs

Provide physical activity counselling and referral as part of routine primary health care services through the use of a brief intervention

INTE

RV

ENSI

Mengurangi inaktivitas fisikOther recommended interventions from WHO guidance (CEA not available)

• Ensure that macro-level urban design incorporates the core elements of residential density, connected street networks that include sidewalks, easy access to a diversity of destinations and access to public transport

• 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

INTE

RV

ENSI

Menurunkan konsumsi alkohol

‘Best buys’: effective interventions with cost effectiveness analysis (CEA) ≤ I$100 per DALY averted inLMICs

• Increase excise taxes on alcoholic beverages• Enact and enforce bans or comprehensive

restrictions on exposure to alcohol advertising (across multiple types of media)

• Enact and enforce restrictions on the physical availability of retailed alcohol (via reduced hours of sale)

Effective interventions with CEA >I$100 per DALY averted in LMICs

• Enact and enforce drink-driving laws and blood alcohol concentration limits via sobriety checkpoints

• Provide brief psychosocial intervention for persons with hazardous and harmful alcohol use

INTE

RV

ENSI

Menurunkan konsumsi alkohol

Other recommended interventions from WHO guidance (CEA not available)

• Carry out regular reviews of prices in relation to level of inflation and income

• Establish minimum prices for alcohol where applicable

• Enact and enforce an appropriate minimum age for 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

INTE

RV

ENSI

PR

AK

TIK

BA

IK

PR

AK

TIK

BA

IK

Pendanaan

PR

AK

TIK

BA

IK

Health Promotion Plan

PR

AK

TIK

BA

IK

PR

AK

TIK

BA

IK

Beberapa contoh program

Lokasi Program

Sekolah Penambahan jam pelajaran olah raga di kurikulum dari 1 jam menjadi2 jam (Kebijakan Kementerian Pendidikan)Kegiatan aktivitas fisik ekstra kurikularProgram pelatihan berenang bagi anakPembatasan penjualan minuman berkarbonasi di sekolah

Komunitas Pembentukan “Holistic health learning center” di pedesaanProgram sukarelawan perawat lansia

Tempatkerja

“Healthy Armed Forces”“Happy workplace” “Healthy police station”“Healthy public sector employee”“Healthy temples” (bersama Kementerian Kebudayaan)

PR

AK

TIK

BA

IK

Beberapa contoh program

Lokasi Program

Provinsi / kota

Penyelenggaraan aktivitas fisik di tempat-tempat umumPromosi 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 lokaldan organik)Provinsi bebas tembakau

Kampanyenasional

“Exercise is Magic Medicine” Program“Thai people without pot-bellies” Program

PR

AK

TIK

BA

IK

Jalur sepeda di ThailandP

RA

KTI

K B

AIK

Capaian

62

64

66

68

70

72

74

2012 2013 2014 2015

Percentage of population with sufficient physical activities

Series 1

PR

AK

TIK

BA

IK

PR

AK

TIK

BA

IK

Kesimpulan

Saran

Aktivitas Fisik Konsumsi sayur dan buah Pemeriksaan kesehatanberkala

Penyelenggaraan aktivitasfisik di tempat-tempatumum, hari peringatankesehatan (Hari Diabetes, Hari TB, Hari Lansia, dll)Kota ramah sepeda dan pejalan kakiKampanye media massamengenai pencegahanobesitasPembinaan komunitas

Kantin sehat di sekolah dan tempat kerjaKampanye media massamengenai pola makansehat

Pemeriksaan kesehatanpada hari perayaannasional dan peringatankesehatanPemeriksaan kesehatan di tempat-tempat kerjaPosbindu