Editorial
Successes and challenges for health in Indonesia
OLAGONDRONK/Getty Images
See Review page 75
For the Global Burden of
Disease Study in Indonesia see
Articles Lancet 2018;
392: 581–91
Yusuke Murata/Getty Images
2 www.thelancet.com Vol 393 January 5, 2019
Indonesia is known too often for its natural disasters,
like the tsunami in the Sunda Strait on Dec 22 that
killed 437 people, injured 14 000, and displaced
almost 34 000. A closer study shows a vibrant country
of 262 million people keen to develop. Health is an
example of the country’s success and vision, with
8 years’ increased longevity since 1990. Universal
health coverage was introduced in 2014 with the
Jaminan Kesehatan Nasional (JKN), which now includes
76% of the population, the largest single-payer scheme
in the world.
A Review of the JKN by Rina Agustina and colleagues
was launched in Jakarta on Dec 20, 2018. The Review,
published in today’s issue, charts successes of the JKN
and identifies areas for improvement, such as maternal,
newborn, and child health. There is enthusiasm
to address health challenges through high-quality
research—and an urgency to do so, according to the
Global Burden of Disease Study. However, limited funds
and academic resources constrain the very investigations
Looking ahead to 2019 in The Lancet
What can regular readers of The Lancet expect in 2019?
Our priority is always high-quality research, review, and
comment. But, increasingly, we see value in the organi-
sation of science as a foundation for health advocacy.
January, 2019, sees publication of two complementary
Commissions offering insights into the 21st century chal-
lenge of feeding the world’s growing population. Food in
the Anthropocene: the EAT-Lancet Commission on healthy
diets for sustainable food systems, proposes a new refer-
ence diet that will help to reverse and minimise future
damage to our planetary boundaries while addressing
urgent nutritional requirements. Later in January, The
Global Syndemic of Obesity, Undernutrition and Climate
Change examines how these factors intersect in previous-
ly unseen proportions, and proposes new frameworks for
tackling their multi-layered impact on health.
Other global health projects will include a Commission
on tuberculosis, together with Series on security and
public health and gender equality, norms, and health. The
tenth anniversary of The Lancet Palestinian Health Alliance
will be celebrated in March in Amman, Jordan, showcasing
that Indonesia needs to improve outcomes. Clearly, local
research requires better support.
Indonesia is in transition. Disability-adjusted life-years
are dominated on the one hand by cerebrovascular
diseases and on the other by tuberculosis; malnutrition
is manifest in both stunt­ing and obesity. The range of
health challenges is daunting, spread across almost
18 000 islands, and 730 languages. But complexity is
no excuse for inactivity. Indonesia has a precious, brief
opportunity to realise the potential of the JKN to deliver
health promotion and preventive care in addition to
curative services. Now is the moment to invest more
earnestly in health. Failure to do so will burden the JKN
with chronic diseases that it cannot afford to treat, and the
resulting lost productivity will compromise Indonesia’s
development. Because 65% of men in Indonesia smoke
daily, an imperative first step is to implement the WHO
Framework Convention on Tobacco Control, thereby
aligning government policy more closely to the health
needs of the country. n The Lancet
the energy and potential of future health leaders from
the Palestinian region. Clinical publications in 2019 will
span the life course with a Series on communicating with
children about life-limiting disease and a Series on frailty.
Additionally, we will publish Clinical Series on heart failure,
oral health, and post-operative pain control.
Throughout the year, we will continue to focus our
attention on vulnerable and marginalised populations,
including those living in DR Congo, Syria, and Yemen.
At the country level, we will explore the unique
contributions of health-care systems in Australia,
New Zealand, China, and Myanmar. Highlights of
our partnerships in China will include a review of
10 years of health-care reform in a special issue presented
at the annual Lancet-Chinese Academy of Medical Sciences
meeting in October, and a Commission on Reproductive,
Maternal, Neonatal, Child, and Adolescent Health in China.
A journal’s science depends on a dialogue between
readers and editors. We would like to hear from you about
what you think should be attracting our attention in 2019.
Please write to us at editorial@lancet.com. n The Lancet