Tackling The Double Disease Burden: A Nationwide Push for Healthier Behaviors

Meet Bunga—a 10-year-old girl from Tegal, Central Java. On the surface, her life looks ordinary. She lives with her parents and two older siblings; her father works in construction, and her mother manages the household. Nothing about her story seems unusual—until you look closer.

A Double Burden of Silent Threats

Her first risk is easy to overlook. She spends most of her time indoors, often on her mother’s phone, preferring screens to play. Her diet is high in sugar from snacks and street food, with little room for fruits and vegetables. At age nine, she was found to have elevated blood sugar—but no follow-up test was done. No diagnosis. No intervention. Just a quiet warning, left unanswered.

Her second risk is more visible, yet just as normalized. Every one to two months, Bunga suffers from diarrhea—severe enough to cause dehydration and loss of appetite. Her family relies on untreated well water. Handwashing is inconsistent. These are not extraordinary conditions; they are common, everyday realities for many families. And that is precisely the problem.

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Bunga is not just a patient; she is a reflection of a system where risk accumulates silently, and prevention arrives too late.

What makes Bunga’s story unsettling is not the severity of her symptoms—it is their familiarity. Each behavior, in isolation, seems harmless. A sugary snack. A skipped handwash. Untreated water. A missed health check. But together, they form a pattern—one that quietly pushes a child toward both chronic disease and recurrent infection.

The National Paradox

11.7%of Indonesian adults are living with diabetes, often undiagnosed

5.2%of children aged 1–4 are impacted by diarrhea

The Indonesian Health Survey (2024) reveals the depth of this paradox. One in nine adults is living with diabetes, often silently and undiagnosed. Meanwhile, preventable infectious diseases continue to affect the most vulnerable: diarrhea impacts 5.2% of children aged 1–4, more than three times the rate seen in young adults. These are not isolated statistics; they expose a deeper issue—missed opportunities for prevention.

Two out of three adults have never checked their blood sugar.
Nearly half the population does not practice proper hand hygiene.

KEY INSIGHT

The question is no longer whether we have the tools to prevent disease, but why they are not being used.

GERMAS at a Crossroad: From Awareness Campaign to Behavior Change Engine

Indonesia has not been passive in the face of its growing health crisis. Through Gerakan Masyarakat Hidup Sehat (GERMAS), the government has attempted something ambitious: to shift an entire nation’s behavior. It is a bold idea—one that recognizes a hard truth. Policies can build hospitals, but only behavior can prevent people from needing them.

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Because awareness alone does not save lives—behavior does.

At its foundation, GERMAS is thoughtfully positioned. It is not confined to the health sector; rather, it is designed as a multisector movement that aligns ministries, agencies, and local governments around shared goals and KPIs. In theory, this creates a powerful engine for collective action.

But a movement without a clear pathway risks becoming a slogan. GERMAS still lacks a fully articulated theory of change that connects its inputs to long-term outcomes. Without this, activities may be implemented and targets reported, yet the deeper question remains unanswered: are behaviors truly changing?

73.93%of districts and cities reported implementing GERMAS policies in 2023

Recommendation: The ABC Approach

Apply Segmentation & Targeting: Tailor messages and interventions to specific population segments and direct greater support to high-burden areas.
Bridge Awareness to Action: Shift from one-off campaigns toward consistent efforts that embed healthier behaviors into everyday life.
Control of Conflicting Messages: Align health messages across policies and platforms to reduce public confusion.

Taken together, these shifts are less about changing direction and more about deepening impact—ensuring that awareness translates into action, and action into lasting change.

— NADI Analysis

FINAL QUESTION

If we begin to make these changes today, how different could Bunga’s life look ten years from now?