Chronic malnutrition carries a two-fold burden: (1) it reduces people’s productivity and (2) it increases risks of non-communicable diseases such as heart disease and diabetes when older. This is the double burden of malnutrition that is referred to in the title of the new World Bank report. Alarmingly, World Bank research indicates that incidences of stunting grew from 35.6 to 37.2 percent in the period between 2015 and 2016. Rising malnutrition implies that Indonesia’s society is becoming less equal.
Research shows that brain (cognitive) development is curtailed by chronic malnutrition and this affects children’s performance at school by reducing IQ scores by five to eleven points. Later on in life when children become adults, reduced cognitive skills translate into lower earnings. The impact of this is not only felt by the individual but also by the economy. The World Bank estimates that losses due to malnutrition are about 2.5 percent of the country’s gross domestic product (GDP). Indonesia has a young population as roughly half of its population is below thirty years of age. This means that the country contains a potentially large workforce and therefore it is often said that the country has a ‘demographic bonus’. However, as the government needs to spend more on costs for national health insurance this demographic bonus can become a demographic burden if people are in an unhealthy condition, and/or cannot work.
The issue of malnutrition in fact already starts during pregnancy when the unborn baby’s body becomes ‘pre-programmed’ to cope with a minimal intake of nutrition. This becomes a medical issue (obesity) when - after birth - the child consumes more food than it was ‘programmed’ for.
The World Bank report highlights four key issues regarding malnutrition for Indonesia:
• Improved life expectancy contributes to a shift in the burden of disease from infectious diseases to non-communicable diseases
• The growth of Indonesia’s national wealth has been accompanied by the growth of food availability, hence doubling the amount of fat that is consumed per capita. Especially in urban regions processed foods are being consumed in higher rates
• Many cities and towns in Indonesia are not pedestrian friendly, do not encourage physical activity, and lack outlets that offer healthy food products, leaving most people with few options other than ready-made foods outside of the home
Indonesia can avoid the double burden of malnutrition by providing health insurance to the poorest 40 percent of the country, by ensuring that adequate health care services are available, by providing services for clean water and sanitation, raise awareness for improved nutrition, sanitation and health and, lastly, expand social safety programs for the poor and near-poor.