Health Research 2014-2018

There is nothing more vital to the sustainable growth and development of a society than the health and wellbeing of its people, particularly its young people. Investing in that wellbeing will be the key to Indonesia’s success in this century; it will be just as important for Australia.

The great challenge facing both countries will be preventing illness, disability and premature death from non-communicable diseases (NCDs). The World Health Organisation estimates such diseases are responsible for 71 per cent of worldwide deaths each year, and has declared them second greatest threat to global health, behind only pollution and climate change.

Non-communicable diseases, including mental health conditions, are the leading cause of illness and premature death in Indonesia, Australia and around the world

The focus on NCDs has traditionally been the burden of heart disease, diabetes, chronic lung disease, cancer and obesity. Mental health conditions, however, are increasingly understood to be highly significant diseases that have historically received less research and policy attention, especially in low- and middle-income countries.

Non-communicable diseases, including mental health conditions, are the leading cause of illness and premature death in Indonesia, Australia and around the world. They also come at a significant economic cost, with estimates that US$7 trillion will be lost in low and middle-income countries alone between 2011 and 2025. In Indonesia, the majority of the public health insurance scheme is spent on NCDs. Compounding these costs are the prolonged social impacts of preventable early deaths, disability and illness.

To combat this rising epidemic, the Health Cluster concentrated its research on innovative approaches to primary prevention in children and adolescents. The themes of our projects were:

• Primary prevention: We have invested our efforts here because prevention is better than cure – and far more cost effective than the screening, diagnosis, or management of NCDs.
• Improving risk factors: Eliminating one risky behaviour can reduce the rates of multiple conditions – for example, smoking is linked to heart disease, chronic lung disease and cancer. Risk factors such as smoking, poor nutrition choices, harmful use of alcohol and physical inactivity are also largely preventable.
• Early intervention: The most cost-effective investment is in early-life health. Interventions in childhood and adolescence can improve nutrition, increase physical activity, and help people avoid harmful substances in later life. Quality education is critical to future health and wellbeing, as are safe and engaging physical and social environments.
• Compounding benefits: We have helped build understanding that the benefits of early intervention extend beyond the current generation, with payoffs in adulthood and in ensuring that the next generation gets the healthiest start to life.
• Improving the quality of research and training: We have used new research methods, brought together new interdisciplinary teams, focused on knowledge transfer and helped build research management capabilities.
• Empowering young people: We have worked hard to engage young people as active participants in the research process, and to elevate their voices in research translation activities.
• Boosting capacity: We have worked to maximise policy opportunities for effective actions on NCDs where children and young people live and learn.

Key achievements

• Learning from young people about the barriers to fresh nutritious food, about the need for spaces for them to be physically active and about the increasing pressures that negatively impact their mental wellbeing.
• Following training, general practitioners became more confident in forming partnership with students around health promotion in local Yogyakarta schools.
• Evaluation of the advertising tactics of Big Formula showed Indonesian and Australia mothers and health professionals were influenced away from exclusive breastfeeding towards purchasing their less healthy products.
• Geospatial mapping demonstrated the saturation of Big Tobacco advertising targeting children and adolescents around schools (places that are intended to be healthy and safe spaces for children and young people).
• In October 2017, the Indonesian delegates to the International Association for Adolescent Health Congress committed to form a national adolescent health association. This has led to the establishment of the Indonesian Association for Adolescent Health (AKAR), a resource for influencing Indonesian policy agendas, research, education and training, and clinical practice.
• Bringing attention to the ‘double burden’ of nutrition in children and adolescents, with the need to reduce stunting and obesity.
• Supporting the development of empowered, bilateral collaborative research partnerships.
• Providing opportunities for experiencing research engagement, consultation and learning practices through divergent thinking, appreciative inquiry and participant ownership.

This is an edited version of Christianne O’Donnell and Professor Susan Sawyer’s summary of the Health Cluster’s work.