This article is also published in Indonesia’s English daily newspaper The Jakarta Post on Oct 9, 2014. (Link at the end of this article.)
As the nation welcomes a new leader, the future of Indonesian health policy becomes a hotly-debated topic among medical professionals and the general public alike. The upcoming administration will have to tackle numerous obstacles in implementing the promised universal healthcare coverage as a way to improve the health status of Indonesians.
However, the government must not lose sight of the bigger picture about health.
So far, most of the conversations about health policies are constrained to the provision of medical care: how to develop adequate facilities, allocate resources, deploy medical professionals, and certainly, how to finance the whole operation. While they are real problems facing our healthcare system right now, at the same time our policymakers must take into account other determinants that also has real and measurable impact on health. These determinants of health include socioeconomic environment, physical environment, and individual characteristics and behaviors.
For example, experiencing unbearable psychological stress at work may lead to troublesome physical symptoms. Lack of open green spaces means children spend more time indoors, deprived of healthy physical activities. Smokers feel free to puff in public spaces thanks to weak law enforcement . Neglecting to manage these determinants will put a heavy burden on even the most developed healthcare system, let alone our fledgling system.
One important determinant of health is education. A growing body of research findings show that better education brings better health outcomes. More years of schooling translates into lower mortality rate, better physical health conditions, and higher life expectancy. Education exerts its effects through many channels: the better educated are less likely to engage in unhealthy behaviors, are more likely to adopt preventive healthcare, and utilize available healthcare more optimally. In short, educated people have better health literacy, or “the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”.
Furthermore, those with higher education lands better-paying jobs — and income still plays a huge role in one’s health status.
Implementing a high-quality education system, therefore, is a requirement to achieve the goals of Indonesia Sehat (Healthy Indonesia). Sadly, several recent examples show the inadequacy of our schools in educating the masses, especially in health literacy.
Example 1. Quack healers are still attracting clients all over the country, including those selling dubious ‘natural remedies’, even though there is simply no physiological or pharmacological basis for the therapy. People are spending exorbitant amount of money to pay for placebo effect at best, or even worse, potentially harmful treatment.
Example 2. Indonesian children are being increasingly victimized by the anti-vaccination movement that sprang up in recent years, an unwelcome import from misguided Western cultures as well as conspiracy-loving religious extremists. These anti-vaxxers rely on pseudo-science and mass hysteria, instead of sound medical evidence affirming the safety and benefits of immunization. Two examples of their evil handiwork are the 2005 polio outbreak in Sukabumi and 2011 diphtheria outbreak in East Java; not to mention the steady rise of previously-rare vaccine-preventable diseases.
Example 3. The use of long-term contraception methods such as the intra-uterine device, praised for its effectiveness and convenience, is hampered by myths about its side effects. Many women still reject the IUD in fear of exaggerated risk of uterine damage or the baseless rumor that it causes congenital defects in the baby should it fail in preventing pregnancy. Couple this trend with the fact that less-educated women tend to have more child, we still have a long way to go in reducing maternal mortality rate that disproportionately affects those with high number of children.
Thus, investing in quality education and health literacy is as pressing an issue as building hospitals and training new physicians. Education is more than a job requirement; it serves a higher purpose as the key to leading fruitful life by opening up precious opportunities. By providing quality education, we are giving the next generations of Indonesians an opportunity to grow up and live healthy.
Additionally, educated persons make empowered patients, who realize that their health is their responsibility and are ready to collaborate with the medical system to achieve good health. Patient and community empowerment to maintain their health is vital because physicians and other health professionals can only influence the health of their patients up to a certain degree.
As health itself depends on various factors, there are many parts of the curriculum that contributes to improve health literacy. The education system in general should properly equip students with critical thinking skills so that they will be able to navigate the flood of information in the digital era. Successful science education like biology and chemistry will build a strong foundation of health knowledge. Reading is crucial, as many health information sources are written. Oral language skills are as influential to allow people to describe their health condition more accurately to the doctor, a starting point to better care. Basic math will always come in handy, whether to calculate one’s BMI or to take the correct drug dosage. Finally, students must develop analytical thinking to select relevant informations and apply them in health-related decision making.
A chain is only as strong as its weakest link; building the medical system alone will not suffice in achieving Indonesia Sehat. An understanding of the close connection between education and health should serve as yet another wake-up call for stakeholders to evaluate, and to redesign if necessary, the national education system.
The fresh air president-elect Jokowi brought into politics should also make its way into our education policies. The government must not hesitate in overhauling our school system and curricula and give the national education system a fresh restart. Nevertheless, these changes must be carefully thought out in enough time, unlike the last decade’s rushed curriculum changes that have become more like knee-jerk reflex reactions instead of deliberately planned actions.
If the government is serious about improving the health of the nation, the quality of our education must also take center stage, considering that its success or failure will affect the health of generations of Indonesians to come.