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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
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ELA
KA
NG
10 penyebab kematian terbesar di Indonesia tahun 2017 dan persentase perubahannya pada periode 2007-2017.
http://www.healthdata.org/indonesia
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ELA
KA
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10 Faktor Risiko utama yang mempengaruhi Disability-Adjusted Life Years (Years) Indonesia, pada semuagolongan usia (2007-2017).
http://www.healthdata.org/indonesia
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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.
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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
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ELA
KA
NG
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
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
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
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