Non-communicable diseases (NCDs) account for approximately 75% of global deaths, with cardiovascular disease, cancer, diabetes, and chronic respiratory disease being the major contributors. Prevention is more cost-effective than treatment, as NCDs require repeated healthcare visits and long-term management, leading to substantial economic burdens. Economic evaluation tools such as cost-effectiveness analysis, budget impact analysis, and return on investment assessment help policymakers prioritize interventions that maximize health outcomes within limited resources. Effective prevention requires multi-sectoral collaboration, strong primary healthcare systems, and integration of digital health technologies, with nurses playing crucial roles in risk identification, counseling, and follow-up care.
3rd International Conference and Call for Paper Faculty of Health Universitas Ngudi Waluyo 2026Ajouté :
Max.
The only thing I want to touch.
Never knew that it could mean so much.
So much.
You're the fear. I don't care cuz I've never been so high. Follow me through the dark. Let me take you past our slight.
You can see the world you've brought to life.
To life.
So love me like you do. Love me like you do. Love me like you do. Love me like you do.
Touch me like you do. Touch me like you do. What are you waiting for?
Fading in, fading out. On the edge of paradise. Every inch of your skin is a holy grail I've got to find.
Only you can set my heart on fire.
On fire.
I'll let you set the pace cuz I'm not thinking straight.
My head's spinning around. I can't see clear no more.
What are you waiting for?
Love me like you do. Love me like you do. Love me like you do. Love me like you do. Touch me like you do. Touch me like you do.
So what are you waiting for?
Love me like you do. Love me like you do. Love me like you do. Love me like you do. Touch me like you do. Touch me like you do.
So what are you waiting for?
I'll let you set the pace cuz I'm not thinking straight.
My head's spinning around. I can't see clear no more.
What are you waiting for?
Love me like you do. Love me like you do. Love me like you do. Love me like you do. Touch me like you do. Touch me like you do.
So what are you waiting for?
Love me like you do. Love me like you do. Love me like you do. Love me like you do. Touch me like you do. Touch me like you do.
What are you waiting for?
When tomorrow comes, I'll be on my own.
Feeling frightened of the things that I don't know. When tomorrow comes, tomorrow comes. Tomorrow comes.
And though the road is long, I look up to the sky. And in the dark, I find lost hope that I won't fly. And I sing along.
I sing along. And I sing along.
I got me when I got you. Tonight I look around me and see sweet life. I'm stuck in the dark, but you're my flashlight.
You're getting me getting me through the night cuz you're my flashlight. You're shining in my eyes. Can't lie. It's a sweet life. Stuck in the darkness.
You're my flashlight. You're getting me getting me through the night.
Cuz you're the flashlight.
Fish away.
Uh-huh.
Kissy face. Kissy face into your phone.
But I'm trying to kiss your lips for real. Red hearts. Red hearts. That's what I'm on. Yeah. Come give me something I could feel.
Don't you want me like I want you, baby?
Don't you need me like I need you now.
Sleep tomorrow, but tonight go crazy.
All you got to do is just meet me at the Uh-huh. It's whatever. Whatever. It's whatever you like. Turn this pretend to a club. I'm talking drink, dance, smoke, freak. Party all night. Come on. Come back. Come back girl. What's up?
Don't you want me like I want you, baby?
Don't you need me like I need you now.
Sleep tomorrow, but tonight go crazy.
All you got to do is just meet me at the It doesn't make me happy.
Huh? Uh-huh. Hey.
So now you know the game. Are you ready?
Cuz I'm coming. Get you. Get you. Hold on. Hold on. I'm on my way. Yeah.
Yeah. Yeah. I'm on my way.
Hold on. Hold on. I'm on my way. Yeah.
Yeah. Yeah. Yeah. Yeah. I'm on my way.
Don't you want me like I want you, baby?
Don't you need me like I need you now?
See tomorrow, but tonight go crazy. All you got to do is just meet me at the just meet me at the I just meet me at the I just meet me at ah I found a love for me. Darling, just dive right in and follow my lead. I found a girl beautiful and sweet.
I never knew you were the someone waiting for me. Cuz we were just kids when we fell and learn what it was. I will not give you up this time.
Darling, just kiss me slow. Your heart is all I own. And in your eyes, you're holding mine. Baby, I'm dancing in the dark with you between my arms. Barefoot on the grass. Listen to our favorite song. When you said you looked a mess, I whispered underneath my breath, but you heard it. Darling, you look perfect tonight.
I found a woman stronger than anyone I know. She shares my dreams. I hope that someday I'll share her home.
I found love to carry more than just my secrets. To carry love. to carry children of our own.
We are still kids, but we're so in love.
Fighting against all lost. I know we'll be all right this time.
Darling, just hold my hand. Be my girl.
I'll be your man. I see my future in your eyes.
Baby, I'm dancing in the dark with you between my arms, barefoot on the grass, listening to our favorite song. And I saw you in that dress looking so beautiful. I don't deserve this. Darling, you look perfect. I don't deserve this. Darling, you look perfect tonight.
Spend 24 hours anymore hours with you.
Spend the weekend getting even. Ooh.
We spend the whole night making things right between us.
But now it's all good. Babe, roll that back, babe. Play me close.
Cuz girls like you run around with guys like me. So now when I come through, I need a girl like you. Yeah. Yeah. Girls like you, love. Yeah. Me do what I want when I come through. I need a girl like you. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.
I need a girl like you. Yeah. Yeah.
Yeah. Yeah.
I need a girl like you. Yeah. Last night on the last flight to you.
Yeah.
took a whole day up trying to get way up. Ooh, we spent the daylight trying to make things right between us.
Now it's all good, babe. Roll that back, babe. Play me close cuz girls like you run around with guys like me. So now when I come through, I need a girl like you. Yeah. Yeah. Girls like you love fun. Yeah. Me too. What I want when I come through, I need a girl like you. Yeah. Yeah. Yeah.
I need a girl like you. Yeah. Yeah.
I need a girl like you. Yeah.
I need a girl like you. Yeah.
I need a girl like you. Yeah. Yeah.
Maybe it's 6:45. Maybe I'm barely alive.
Maybe you're taking my [ __ ] for the last time.
Maybe I know that I'm drunk. Maybe I know you're the one. Maybe I'm thinking it's better if you drive. Not too long ago, I was dancing. No, it's really crazy. But every other girl you It's I need somebody kind of I'm going in and this time I feel there's no one to save.
this all or nothing really got a way of driving me crazy.
I need somebody to heal, somebody to know, somebody to have just to know how it feels. It's easy to say, but it's never the same.
I guess I kind of like the way you numbed all the pain. Now the day bleeds into nightfall and you're not here to get me through it all. I let my guard down and then you pulled the rope.
I was getting kind of used to being someone you love.
I'm going under and this time I feel there's no one to turn to.
This all way of loving got me sleeping without you.
Now I need somebody to know, somebody to heal, somebody to help just to know how it feels. It's easy to say, but it's never the same.
I guess I kind of like the way you help me escape. Now the day leads into nightfall and you're not here to get me through it all. I let my guard down when you pulled the r. I was getting kind of used to be someone you love.
And I tend to close my eyes where it hurts sometimes. I fall into your love.
I'll be safe in your sound till I come around.
Now the day bleeds and the night fall and you're not here to get me through it all. I let my guard down and then you pulled the rug. I was getting kind of used to being someone you love.
I let my guard down and then you walk the road.
I was getting kind of used to being someone you love.
commitment.
Research for blood.
Faculty computer.
Foreigian professional.
economy professional global International program.
Student program.
Salam International.
Ladies and gentlemen, distinguished guests, researchers and scholars from around the world.
Good morning and welcome to the third virtual international conference of health 2026.
Our event today is the masterpiece of faculty of health collabor with the theme preventive health and chronic disease action from policy to practice.
I am Salsa Vadas and it's my great honor to serve as your master of ceremony today.
This conference is a platform that brings together academic, researchers, healthcare professionals and policy makers who exchange ideas, share meaningful findings and strengthen collaboration in advancing preventive health and chronic disease action, transforming policy into effective practice for better global health outcomes.
Before we begin, let us express our gratitude to God Almighty for his blessing so that we are able here today virtually but clinically.
And now we would like to greet our honorable speakers who is training us in this event virtually through zoo. Dean Pirate speakers as nurse mak dean of faculty of healthy Indonesia associate professor Amria Muhammad Nur MDI PhD from University Brunam Mari BC PhD from grad university Australia city fata from universas clinic fbert Germany ladies and gentlemen today's program will consist of opening ceremony, opening remarks, keynote session, main session, discussion session, and closing.
Let us now proceed to the opening ceremony. We will listen together to the Indonesian national anthem, Indonesia, followed by March of Universas.
Heat. Heat.
Heat. Heat.
Heat. Heat.
Heat.
Heat.
Heat.
Heat.
Morning.
Oh my god.
belong to the one Christmas.
Next, we are honored to invite Lector of Universal to deliver the opening speech. Ladies and gentlemen, please welcome Professor Dr. M. Humman.
Good morning, ladies and gentlemen.
Associate Professor Dr. Abishal Mhammed Nur MT MSC PhD MS PhD Welcome to the third international conference on health faculty. Today we gather under the banner of a crucial time preventive health and chronic DSC action from policy and practice.
Tanlay our global community stand on the shores of a fast turbulent on ocean of health's challenges with the racing tight chronic disase continually crash again our healthc care system for too long we have pulled management like host of health polish radiating brilliant across the global.
Yet the ship of public health still strangle struggle to neiate the teacher house implementation gap failing to find safe habber to actual community level practice.
This conference is our CPR and our pray. We are here not simply to draw more map and discuss what the sum the storm are but to ensure how we shall taught them by bringing together policy architect medical participatories and innovators.
We aim to forget stratlay bridge of tactical recommendation to connect the visionary blueprint on police to the salt crown and everyday operational practice.
etcher inspiral.
Thank you, Professor Dr. Hol for the inspiring opening remarks.
Before I proceed to the case session, I would like to take a moment to capture this special occasion.
Ladies and gentlemen, we will now have our virtual group photo session. May I kindly request all participants to please turn on your cameras and ensure your beautiful smiles are ready.
Our technical team will assist in capturing several screenshots. So, please stay on screen for a few moments.
To our technical team, you may begin.
>> Okay, ladies and gentlemen, I will start the photo captioning for each slide.
There are 11 slides. So please uh stay on cam and give a smile and cheerful.
I'll start for first slide.
One, two, three. Smile.
Okay. Now go on to the second slide.
Okay. Smile.
One, two, three.
Okay, the third slide.
One, two, three.
Then fourth slot.
One, two, three.
Okay, slides.
Please give your best smile, ladies and gentlemen.
One, two, three.
Okay. Next.
On the camera.
Turn on the camera, ladies and gentlemen.
Okay.
One, two, three.
in the next one.
One, two, three.
And then eight slots.
One, 2, 3.
Next slide.
One, 2, 3.
Next.
One, two, three.
And the last one.
One, two, three.
Okay. Thank you for all participation.
And I to the moderator.
>> Thank you. Thank you very much everyone for your wonderful smiles and participation.
This photo still serve as a great memory of our shared commitment to preventive hope and chronic disease action from policy to practice.
Distinguished guests, respected delegates, ladies and gentlemen, it's my great honor and privilege to introduce our keynote speakers for today's event.
We are fortunate to be joined by an outstanding expert whose dedication, achievement and contribution have significantly advanced knowledge through years of academic excellence and research innovation. Our keynote speakers expertise and valuable insight will certainly provide us with a new perspective and meaningful inspiration for today's conference theme and discussion.
Ladies and gentlemen, please join me welcoming our esteemed keynote speakers, Mr. Ek Susilo escapes mop, dean of faculty of health modu. To our not keynote speakers, the time is yours.
Asalam alaikum.
Good morning ladies and gentlemen.
Participant both student and researcher.
Alhamdulillah. Praise be to Allah subhanana wa ta'ala for his blessing.
The faculty of health international conference can be held today with the same preventive health and chronic disease action from policy to practice.
And I would like to press my gratitude for the support from professors M home recctor and Dr. Sigit Amarati Eskim Mus.
the third international conference. This time carries a theme that is relevant to the current situation in health uh in the healthcare sector both in the world and in Indonesian uh namely preventive health and chronic disease action from policy to uh practice.
The current issue of hunter virus has become on international spotlight after report of cluster of cases emergence in several countries in 2026.
But the issue of chronic disease has also received sher's attention.
According to the Indonesian uh Ministry of Health, chronic disease generally refers to non-communicable disease that uh develop slowly last a long time more than six month or uh lifetime and require longterm management.
Major disease uh diabetes uh hypertension cancer uh like a liver lung sher bridge and heart disease and chronic obstructive pulmonary disease.
Uh other chronic disease uh asthma, epilepsy, schizophrenia and chronic kidney disease. We can see uh the biggest case from the difference in the number of this disease. Chronic disease are long-term non-communicable disease that uh develop gradually and uh require continuous management to maintain patient quality of life and prevent uh complication.
Our current attention is from an uncommunicable uh chronic disease account for suffer for present until uh 75% of global deaths major disease uh cardiovascular disease cancer diabetes chronic respiratory disease. the prevalency of uh chronic illness including hypertension, stroke, heart failure, diabetes militus, cancer and chronic kidney disease is resh globally.
The findings indicated that different population have different representation of chronic disase and the that this disease are reflected in the cause of illness.
Indonesia that from the ministry of health show that almost 75% of death in Indonesia are caused by non-communicable disease which can actually be uh prevented with a healthy diet.
Non-communicable disease killed at leant to 75% of non pandemic related that global uh we have let's look at the distribution of uh data from the Indonesian uh ministry of health source Uh the 2023 Indonesian health survey show that almost one in three adult uh 30.8% still suffer from hypertension and only around 18.9% have their hypertension under control.
Uh main risk factor harmful alcohol consumptions uh tobacco use uh physical inactivity or malas legit move. Unhealthy diet like sugar, shots, trans fat, sustainal culture are often associated with eating pattern and tip of food such as central Java uh tends to have sweet foods. West Java tends to have salty taste. And now uh there are many swenit food uh oil pollution and environmental actual and uh evidence-based uh prevention strategies. uh uh use uh scientific uh evidence to design an implementation uh intervention that effectively reduces to disease rise. Public health policy and uh program shall be support by reliable research finding and evaluated regularly.
uh talk various activity include uh number one prevention program so be researchbased and number two monitoring and evaluation improve program effectiveness and number three uh data driven intervention support policy development and four collaboration between researcher and policy maker is important.
Uh example include smoking exercise program, hypertension screening, uh vaccination complex and sugar sweetenment behind according to the uh director of uh prevention and control of non-communicable disase at the ministry of health. Effort to prevent and control non-communicable disease focus on reducing consumey of sugar, salt and fat as part of public health strategy.
R include uh promote balan nutrition education uh promotion of head eating pattern and increase awareness of the risk uh of non uh uh communicable disease to ensure early behavioral change. Ensure regular physical activity and reduce smoking and alcohol use in all a group. Improve sleep quality and stress management. Increase public awareness. talk education and then community and public health uh approach starting from uh commodity based screening program school and workplace wellness initiative public uh compact for healthy living collaborative between uh government and private se sector tele medicine for chronic disease monitoring Variable technology and mobile IB artificial intelligent for early detection and data driven public health uh surveillance and then strategy uh policy and government actions uh about chronic disase policy and control uh have three strategies. is uh number one early detection, number two uh special protection and number three case management chronic disease policy and control in Indonesia method.
Uh the name is check stress regularly health check. Eradicate uh cigarette smoke. Be physical activity.
Eat a healthy balanced diet. get enough rest and management stress.
Rule of health care uh professional uh like uh early screening and diagnosis uh patient center counseling uh that is a role of healthcare uh professional. Yeah. multi-disipline collaborative and uh education communities uh that it support to uh role of healthcare uh professional case example successful preventions program according to article uh 20 of the recala of the minister of health of uh republic Indonesians number uh 71 of 2015 uh concerning the management of non-communicable the community part both individually and in a groups play an active role in the management of non-communicable disease.
This include u implementing community based health efforts uh by establishing and developing integrated non-commodable development ports or postbindu ptm and I challenge in preventions uh number one had inequity and limited access to care. Many people still have an equal access to health care service, education and preventive program especially in a rural and low income communities. Uh number two, urbanization and unhealthy lifestyles, rapid urbanization after lead to unhealthy habits such as poor diet, physical inactivity, smoking and increase stress with raise the risk of disease.
uh uh health future is possible talk preventions collaboration investment and uh global commitment. Uh number one most chronic disase are preventable healthy choice and early action can prefer or delay many chronic disease.
And number two uh prevention requires multi- sector collaboration. Health is influenced by many sector. Working together leads together strong and uh sustainable prevention.
And number three investment in prevention save life and resource.
and uh global commitment to achieve uh SDG's health uh target and the last I hope uh I will give uh something yeah pre today protect tomorrow together we can achieve health and sustainable able communities.
Thank you.
Thank you Mr. Ekosilo as governor and cup for the inspiring presentation and moto. Ladies and gentlemen, this is the very moment that we've waiting been waiting for the polarization for the discussion. We will have Mrs. Indriasari as gazette and gizy as the moderator.
Miss Indry is one of the lecturers of nutrition program in universas.
Right now she is taking her doctoral program in unacetas for moderator. The time is all yours.
Thank you for the wonderful introduction. Mrs. Good morning distinguished speaker, honorable participant, ladies and gentlemen. Good morning. Welcome to the main session of the third international conference and call for paper organized by the faculty of healthially university with the theme preventive health and chronic disease action from policy to practice. My name is Indriasari and I am honored to serve as the moderator for today's session. I would like to thank all speakers and participant who have joined us today from various institution and countries. We hope this conference will provide meaningful academic discussion and strengthen international collaboration in preventive health and chronic disease management.
Ladies and gentlemen, without further ado, let us begin our main session.
Today we are honored to have three distinguished speaker from Hunter Salam, Australia and Germany who will share their expertise and experiences related to preventive health and chronic disease management from policy to practice. Each speaker will have approximately 40 minutes for presentation followed by a discussion and question and answer session. We hope this session will provide valuable insight and broaden our perspective in addressing global health challenge.
Our first speaker in this main session is associate professor Amrial Muhammad Nur MDM Magister of Science PhD from University Pruned Rousam. Pruned Salam.
Are you in our zoom room sir? Yes, >> I'm okay. Alhamdulillah.
>> Thank you.
>> Okay. Before we begin this session, I will briefly read the curriculum fail of our distinguished speaker.
Currently, associate professor Dr. Dr. Amrial Muhammad Nur is a lecturer in health economics, healthcare management and health policy institute of health sciences university bridalam from 1st January 2025 till now.
He has PhD distinction in public health specialization in health economics and financing from national university of Malaysia in 2007. He obtained his MD from Andelas University of Indonesia and master of science health service management from University of Science Malaysia. He is the he is the deputy head of international center for cosmic and clinical coding ITCC from year 2016 until 2019. ITCC is a center of excellent onmic and health economic research in faculty of medicine national university of Malaysia which was established in 2011. He also has worked as a research fellow of United Nation University International Institute for Global Health from 2010 to 2014.
He has been involved in many pundit research project in the field of health economics, health policy, health management and casemic system. He has experience in health economic and cost analysis using various costing methods using cost an including cost analysis, cost effectiveness, cost benefit analysis and budget impact analysis.
Among his research project include cost effectiveness of HPV vaccination against cervical cancer, casmic methology for resources allocation and cost effectiveness of ponoal vaccine.
He has conducted 26 research projects in health economic and health financing mostly funded by local and international donor agencies. He has experience working in a health economic health financing and gasmic project for international agency funded by WH GTZ ADB and AUT in Philippines, Vietnam, Indonesia and Uruguay. He has 17 years experience in teaching and published se uh 73 scientific article books book chapter in and presented more than 65 scientific papers in various conference symposium seminars and workshops. He has supervised more than 23 masters and 15 PhD candidate in the areas of health economics, healthcare management, public health and health policy. What a wonderful CV amal.
>> Today he will present a topic entitled integrating a health n health and nursing perspective and economic evaluation for non-communicable disease prevention from evidence to policy and practice. Before we begin, would you like to share your own material?
>> Yes, I want to share.
>> Oh, you will share your own. Can I >> Can I share my screen?
>> Of course, Mr. Amster, you may share your screen.
>> Okay.
>> Okay. Ladies and gentlemen, please welcome Associate Professor Amrizal Muhammad Nur, MD, Master of Science, PhD. Mr. Amrizal, the screen is yours.
>> Yeah, thank you. uh moderator for introducing myself yeah to the audience.
Uh first of all and very good morning for everyone.
>> Yeah.
>> Um I would like to say thank you very much to the organizing committee. Yeah. To uh organizer to invite me as one of the uh speaker uh today. Yeah. So, I appreciate for the invitation and um uh also um I would like to uh thanks to the dean Yeah. of faculty of heart. Yeah. Uh um Muri Wal is right. Sorry. Yeah. And also for all um deputy dean. Yeah. uh heat department and um uh ladies and gentlemen and uh students. Yeah. Uh all the participant for this session. Yeah.
Okay. Uh uh I got the um uh the topic.
Yeah. The topic integrating Yeah. Health and nursing perspective economic evaluation. Yeah. So um for NCD prevention yeah from evident to policy and practice. Yeah, I think this my outlines. Yeah. Uh just the introduction to the global context a burden of the NCD and impacts and then why uh prevention is very important. Yeah. in uh uh in any country and economic tool for decision making, prevention and economic investment, knows and nursing roles in economic evaluation, policy to practice challenges, regional and globalism and then future direction and recommendation.
This my um uh campus in Brunid Salam. So this uh we call the um institute of health sciences pip. Yeah. Health sciences bronado tala and I'm now uh walking. Yeah. Sorry.
Why cannot move?
I don't know. Oh, okay.
Move.
Okay. So uh the next is about the uh burden yeah global shift toward correct disease.
What are the global context of the NCD right now?
>> Wait a minute this uh to make it yeah uh NCD account for approximately 43 million death annually worldwide. Yeah for the worldwide. So um uh and then this the what we call the quite a lot of uh yeah uh death yeah come from the NCD around 7 75% of the global death yeah caused by the NCD so non-communicable disease is very very what we call uh significant yeah impact to the cost and the economic and and and the health system And um uh from the global deaths the total global deaths 18 million premature deaths come from the NCD and majority is here.
Yeah. Uh you can see here the major contributor what are the major contributor for the premature death for the death in NCD is cardiovascular disease. Yeah. The first the cardiovascular I think it's around 19 million then cancer yeah 10 million cor respiratory around 4 million yeah and diabetes around 2 million and 80% of the all premature death yeah come from the NCD so this one of the disease burden not only disease burden but alo also for the economic burden and as we know that the in low and medium income countries is yeah uh what we call carry the highest burden yeah around 73% of the NCD yeah and till now the NCD still threaten healthcare sustainability for the long term and economic productivity loss of uh productivity loss of income and also um for uh managing yeah managing the complications yeah because the correct disease. Yeah. Uh the patient will come and see the doctors.
Yeah. Repeatedly. Yeah. Repeatedly. So come and come many times. Yeah. To to see the doctors either in clinic or in a hospital.
Okay.
Next. Uh okay. I mentioned it now.
Kadova scholar. Yeah. Uh burden. Yeah.
80% of the premature death because of the LCD death. Yeah. Come from four diseases. Yeah. One is a cardiovascular around 19 million and then uh cancer 10 million and chronic respiratory disease around 4 million and 2 million diabetes and malitis and we can see here we can see here the burden of NCD in selected Asian countries. We compare in terms of uh we have the cardiovascular disease, chronic nervosy diseases, cancer, diabetes and chronic kidney disease and mental disorders. So we compare in terms of the death and disability. Yeah. Can see here the highest uh the highest uh what we call uh death is cardiovascular around 4.2 million. Yeah. 4.2 to million followed by the cancer, chronic diseases, diabet diabetes and mental disorder. But for the disability the highest burden is the mental disorders around 30 million. Yeah. 13 million followed by the chronic respiratory disease, diabetes and then the cardiovascular.
So this disease burden yeah and in the total yeah for only five correct disease around 8 8.6 million suit burden and then for this ability around 65.2 million only for five diseases. Yeah.
Okay. So how much should be spend for help here? How much we spend for the help? Yeah. Okay. So uh if you look at in this uh chart hack spending versus GDP among Asian countries among Asian countries. Yeah. Uh we can see that the highest hacker spending compared to the GDP among Asian countries is the Vietnam 6.4%. Followed by the Vietnam 5.9%.
Yeah. Uh you can see here the Singapore.
Yeah. the rich country here 4.1% only 4.1% yeah below Malaysia Myamma and Philippine and Brunai you can see 2.6% 6% only. Yeah, I think it's because of the uh uh total population here 450 uh,000 only. Okay. So on average we can see on average Yeah. Indi Indonesia 3.1% of the total GDP. So in average we can see yeah in average around 4.27% healthcare spending compared to the GDP among Asian countries. So on average on average so actually Indonesia still below an average in terms of the total health spending you can see here uh you uh globally yeah US still the highest haircut spending compared to the GDP and 60 uh 16.63%.
This report in 2024 I think now increase uh yeah I think almost 17%. Yeah. And then we can see here in what we call uh Asia countries is like for example OECD, Japan and Korea. Japan around 11.5%.
Korea around 9.7%.
So average we can see here 9.9% of the GDP. So the developed country around 9.9%.
Yeah. You can imagine now Asian country only 4.27. to 7% of the total GDP. Yeah.
Uh but in developed country, yeah, they have the highest healthare expenditure.
Yeah. Uh and on average around 9.9%.
Yeah.
Okay. This in front end money this is number number two around 12 around 12 12% of the GDP. Okay. In terms of the econom Yeah. Just now we discussed about the disease burden. Yeah. 19 million for the cardiovascular cancer around 10 million. But how about the in terms of the cost impact the economic impunity.
So globally the cardiovascular disease around 863 billion annually. cancer one point uh what we call the what we call the uh uh cancer around 1.16 trillion annually trillion this billion billion so this trillion chronic disease 2.1 yeah trillion annually diabetes 1.3 trillion annually and then the mental disorder 2.5 trillion annually so the highest economic burden is mental disorders Yeah, mental disorders followed by the chronic respiratory disease and then the uh cancer uh no uh diabetes cancer and then the cardiovascular. Yeah. Okay. So uh projections in 2030 Yeah. for the mental disorders increase the economic burden to uh six trillions by 2030. Why the prevention program is very very important. Yeah. Why? Because you know Yeah. Creative care. Yeah. Creative care in hospital setting. Yeah. Alone is very very what we call very expensive and no longer sustainable depend on the resources that every country has it.
Yeah.
And then uh preventive ech emphasizes early detection and risk reduction. So that we call ely detection and risk reduction. Yeah. So we can uh we call uh costsaving. Yeah. For the long term if we we can uh deliver deliver the pre preventions the promotions on in early.
Yeah. In the beginning. And then the lifestyle there are several medication lifestyle modification and population based intervention reduce health care utilization. Uh so if we can inter intervene yeah lifestyle modification and can reduce healthy utation reduce the patients yeah uh diseases reduce the prevalent of the disease and also uh seeking the doctors in the hospital and health center and prevention also improve the long-term outcome and uh sustainability. Yeah.
All right.
Okay. So what is the health economic actually study on health resource allocation and financing and the core principles of the economic is we have to assess the efficiency. Yeah. To uh um assess the equity of the health services. Yeah. Cover the whole population uh without consider about the income level, education level and etc. uh cost effectiveness. Yeah. Make sure that that interventions that we we implement cost effective and sustainable for the long run not only for five months and then we don't have the enough money. Yeah. To continue our our prevention program and then support evident based policy making. So using the economic tool we can provide the scientific evidence yeah to policy makers to make a decision to change the policy improve the current policy and etc based on the evidence that we uh uh gathered from uh from the uh research and etc help maximize their outcome using the limited uh limited resources as well.
So uh uh talking about the coric diseases. Yeah. Usually uh researchers try to capture three uh uh uh component cost. Direct cost, indirect cost, intangible cost. What is a direct cost?
Direct cost is cost directly related to the patient. For example, hospitalization in the hospital or medication, drug, diagnostic, MRI, CT scan, rehabilitation, physotherapy and etc. And then indirect cost yeah including here the productivity loss disability per mortality absentism and etc. And intangible cost is difficult to to measure actually reduce the quality of life psychological burdens. So not easy to capture but majority in high economics research uh uh business purpose they just uh focus on assessing calculating the direct cost indirect cost global economic loss for the NCD project around 47 trillion US dollar. Yeah. So because of NCD so we can save the money. Yeah.
47 trillion if we can do the prevention.
Yeah. uh properly the health utilation and current disease. Yeah. Uh so this one yeah why the healthare utilization resource consumption. Yeah.
The cost of chronic disease is very very expensive.
Yeah. Compared to the acute disease this chronic disease because repeated Yeah.
chronic disease patient require repeated our outpatient visit. Sometime one patient yeah chronic disease they uh they are what you call seeking the doctors you five times 10 times annually uh okay sometime 20 visit yeah to see the doctors so we can imagine how much does it cost for one visit yeah for everything you for the medication investigation for the doctors whatever and then the long-term monitoring so long-term monitor mentoring. So not in the short term long-term. So we need the cost increase emergency visit and hospital admission. Yeah. Sometime one patient chronic disease they admitted in the what in hospital sometime four time five time this is the cost emergency visit in the cost multiple medication.
So chronic disease not a single diseases they have another diseases. If you have the eskeemic heart disease, elderly people they have hypertension, they have diabetes, malitis, they have rem arthritis whatever. So multiple medication specialist referral increase the cost. So they refer yeah uh to this different type of the specialist speciality. So they increase the cost and then the chronic disease management train. Yeah. The health care system.
Okay. In terms of her economic turn prevention into the crisis. Yeah. The core question here. Yeah. Not will afford the prevention but which prevention give the most value or fail?
This is the question. Okay. So uh in economic yeah we have the several economic evaluation. One of them is we call the CA qual effective analysis.
Yeah. To measure the cost per collective analysis is the uh uh to assess the cost per colle. Yeah. Or daily adverted.
Yeah. Daily adverted. So this we give the pri priority to high impact intervention. Yeah. So if let's say we choose one two intervention. Yeah. Which one? Yeah. Intervention with the cheaper in terms of the cost and then their outcome better. improve the quality of life, increase the length of life. Yeah.
Or yeah. Uh avoid any uh stroke disease for example. Avoid any you stroke disease case detected, case avoided and etc. The second one is by uh BIA BA budget impact analysis. Yeah. This one to assess whether even the cost effective but is this affordable or not over three to five years government have the budget yeah to imple uh to deliver to run the new intervention or not. Uh so in in this another assessment that we have to uh to follow yeah to implement budget impact analysis after cost effective analysis before get decision from yeah from the policy makers and then return of investment. So if let's say uh affordable for five years and then we assess the how much return of investment in terms of the health outcome in terms of the productivity gain and lastly of course equity or they this uh intervention the new intervention cost effective budget impact affordable return of investment is it equity they can we call uh safe for the whole entire population. Yeah, the entire policy not only for the a small group of people get the benefit for the new intervention. Uh so make sure the equity for everybody. So decision of rule is a skill intervention that cost effective affordable. Yeah. We have the budget and implementable Yeah.
and equity. Yeah. For the whole entire population of the economic investments. Yeah. To make a control. Yeah. Let's say what what is the uh uh type of uh prevention program let's say tobacco control uh they can reduce yeah uh reduce the cardiovascular disease but the patient admitted to the what and hospital what yeah they very expensive you can see in uh in our CBGS the tariff very expensive the stroke is hard in very expensive so if we reduce what we When we uh run tobogco control and the prevention in the beginning we can reduce the prevalence of the cardiovascular. Yeah.
We avoid uh patient also for the atmaxization lowers the hospitalization cost.
Diabetes screening also enable early yearly intervention also. Hypertension control prevent expensive complication.
net prevention provide a long-term and return on uh on investment. You can see here the MO updated investment uh case refund the NCD prevention and high return development strategy. They mentioned that uh 12 million yeah live safe by 2030 if we can implement that preventions program. Yeah. Uh what we call uh properly and then 28 million Yeah.
uh prevented heart attack and stroke and also of course in terms of the economic benefits could be generated one trillion plus. Yeah. 1 trillion plus.
So it will take here illustratement investment logic. What are the investment here? You can see tax and regulation. Yeah. Uh what are the tax regulation from the policy makers and then uh screen screening and control program. uh pro promotional health program digitally monitor. Yeah. So we combine all everything. Yeah. For uh uh what we call uh the way Yeah. the type of the prevention. Yeah. Just to get the economic investment for the future five years or 10 years from now and then a particular uh prevention uh portfolio here combined. So when we do yeah a prevention program Yeah. cannot only we deliver to the primary care. No. Yeah.
Only cook. This the responsibility of the smart. Now we have to cover later. For example, population policy.
So the layer policy so to involve population policy policy makers involved in uh created yeah it created the create yeah develop the tobacco control policy site reduction has your food environment active trans transport yeah so this one the economic large read yeah the low cost lower cost. Yeah. Because the policy for the whole population. Yeah.
The cost is lower compared to the patient uh admitted in the world in the hospital or in a health center seeking the doctors in primary care in poker class. For example, the nurse Yeah.
doing uh BP, blood pressure, examination, glucose. Yeah. Blood glucose lipid uh lipid uh screening reservation medication. This what in terms of economic rational what even expensive complication treatment uh if we do the prevention in the beginning so we prevent yeah expensive complication yeah management in hospital and then what else the layer that should involve in prevention community and yeah so uh community and school yeah need involved in prevention also uh by doing yeah doing health literacy workplace awareness school builds nutrition and activity. So we change the no uh yeah we change the habit daily habit with the good wellness habits wellness habits and then health electron health research registry tell health and predictive analytic yeah we need this one we use in prevention program to improve the continuity yeah to monitor monitor uh what we call uh patient that we intervene. Yeah. Whether they have the good outcome after intervention or not.
And then in terms of the nursing rules, yeah, make economical measurable. Nurses are the link between the population risk. Yeah. Better patient behavior care community and real uh would uh outcomes.
So what are the rule of the um what we call nurse and prevention? Okay. risk identification. Yeah. Do the screening blood pressure, glucose, BMI, lifestyle reads, whatever. So they identify which patient yeah have their risk of yeah the risk of yeah certain certain chronic diseases. Okay. And then say identify they have the brief intervention. Uh so they do the intervention. Yeah.
counseling, motivate the patients and personalized prevent prevention because different patients sometime they had the different diseases uh different co-obidity and so we call that personaliz prevent uh prevention. What are the others role is coordination to coordinate referral medication adant and family support to make sure that their patients they are seeking the right doctor the right hospital yeah and etc. And lastly follow up data you know track the coverage control and complication avoid it whatever. So follow up data yeah uh to follow up with intervention that they we we have done yeah to uh what we call patient with the risk with the entity. Okay. What nursing to the economic evolution? What are the the the the important of nursing in economic valation? economic relation improve when nursing activities yeah when nursing activities time outcome equity effect accuracy measure so we have to measure so that's why in tariff in our CBGS yeah we do not we do not include the uh nursing uh workload yeah uh I think we have to improve that one to add the nursing uh nursing what we call cost in in uh in our CBGS because I'm one of the develop in Indonesia. Yeah, in Kangas. So yeah, we have to include what are the component value of nursing here. Yeah, for example, yeah, the time consuming.
Yeah, you can see. So what I cost value, productivity, gain, yeah, avoided complication, digital followup, uh training, supervision and nursing time.
So what are the input on the nursing time counseling session? Uh okay then training that they attended supervision.
Yeah the time consuming for the supervision cost then also nursing outcome. What are the outcome? Risk factors control.
Yeah. And then fewer admission, fewer complication is the outcome of the nursing after they are doing yeah intervention. Yeah. Prevention. So what are the outcome? So we have to measure and then we convert to the cost. Uh then the equity implementation reach among high risk group. Yeah. Continuity satisfaction and acceptability. Uh so in terms of the implementation whether they focus on high-risisk group or moderate risk group so we can assess this one and in practically yeah we have to assess yeah we have to include nursing workload and then nursing outcome in cost effective analysis budget impact analysis and implementation evaluation.
Yeah implementation evaluation. So yeah from evident to policy and practice yeah nursing include prevention strategy. So when the nurse uh nurse uh uh implement yeah the prevention program strategy they need what they need the financing budget they need they uh scoop the coverage they need the data yeah which which one patient with the risk the high risk the moderate risk and low risk they give the priority the high risk versus data need the accountability so from evidence yeah local risk profile file step registry. Yeah. Uh B data, economic test and then they they can involve in quantitative analysis, budget impact.
Yeah. Value for money, service model, nursing lead, screening, counseling, followup and lastly yeah policy level.
So policy makers will uh what we call decide yeah whether this preventions will be fund will fund it yeah uh uh using um we find it including yeah uh for training the scope a indicators so the example coverage uh percentage of the screen control BP HBAC A1C cost avoided admission equity yeah So this how from evidence to policy and practice uh know from policy to practice gap policy often face what are the the challenges yeah our we are facing with the implement implementation changes implementation yeah whether the not proper policy yeah or uh sort of staff yeah and etc. So the common barrier including here funding funding shortages.
Yeah. We need funding. Yeah. We need the staff. Yeah. To deliver. Yeah. To implement the uh uh what we call the preventions. Yeah. Program. Workforce limitation. Uh there the limitation the staff funding not not enough. Yeah.
Staff not enough. Weak and also logistic also weak implementation. Yeah. Reduce policy effectiveness. uh reduce policy effectiveness because not supported by the account level monitoring system remain among the staff and also the patient. So there another policy to practice gap of the implementation. The role of the primary healthcare here primary healthare enable early detection. Yeah.
And prevention community engagement strengthen preventive health program.
Yeah. And then uh primary care is lower cost and more suitable. Yeah. So why preventions is uh suitable in primary care? Because of lower cost. Yeah. lower cost because preventions. Yeah. And health promotion is very yeah uh cost effective compared to the patient treating in hospital level support coverage of course. Yeah.
Using the digital health and big data now AI many AI uh tool right now available in in the markets. Yeah. We can choose what AI uh related to health.
Yeah. So electronic health record. Yeah.
uh based on the many research step that improve the continuity of the care. Yeah. So all the data Yeah. in soft copy. Yeah. Uh documented in the soft copy and then the tele medicine.
Yeah. Uh tele medicine program also one of the expand the healthcare access. So patient in the rural area. Yeah. and Kong can see see the doctors in the health center in Pasmas uh or um uh and also yeah even though they these patients uh stay living in rural area yeah AI and relative analytic of course support detection yeah and then um digital health also improve the efficiency and resource allocation okay so this lesson learned from regional and globaliz Australia the strong health promotion program. Yeah, if you want to uh benchmark Australia is okay. Canada is one of the uh country the quite strong in health promotion. Singapore in preventive financing strategies. Uh so you want to learn about how yeah strategy and financing for preventive Singapore is the one the best in Asia.
Yeah. and globally and Thailand in terms of the community based SUD management.
Yeah. And then Brunai Shalam is strening digital health and primary care. So all in Brunai they use that we call the bruhim. Yeah. Brunai uh health what we call uh informatic management. So every uh citizen they have their own medical record number. Yeah. related to the IC and uh uh uh OO uh uh doctors can assess yeah can assess in terms of the record of the uh uh health of the every uh citizen here. the future direction increase. Yeah. uh investment in prevention because um uh any every country especially in developing country just focus on curative care in hospital you know uh who uh provided um what we call report that 70 to 80% of the total amage expenditure come from yeah for what yeah to be allocated for the hospital corive care yeah small portion of the budget for the prevention. Uh so we have to increase investment in prevention the budget. Yeah. Strengthen primary health system. Yeah. So pukes pandu or whatever we have to strengthen that one because this the what we call the beginning of the prevention. Yeah.
To avoid any complication. Yeah. And also impact on the cost. expand digital exper not only in uh in the town in urban area but also rural area improve health literacy and implementation of design and promote multis sectoral collaboration. The last uh last slide is key measures here. SD are major health e economic trade. Yeah, prevention is more suitable than treatment alone. Treatment in hospital is very expensive. So prevention is more yeah cheaper. Uh okay. Economy improve the healthare prioritization. Yeah. uh help uh uh policy makers to choose which one more cost effective more benefit yeah and uh good quality of outcome strong implementation system are uh essential and prevention require multis sectoral collaboration. So in conclusion, nonicable disease are major global health and economic challenge and prevention is more cost more effective and less costly. Uh sometime we call it cost effective than treating advanced chronic diseases. Yeah. Especially with the multiple complication. Economic health government make better healthcare decision with the limited resources. A strong primary health care and digital uh heart system are important for improving the preventive care and successful chronic disease prevention require good policy, strong implementation and collaboration across the sectors. I think uh that's all for my presentation. Thank you for your um attending and attention. Thank you.
Thank you very much professor Amriza for the insightful presentation. What a number 75% global debts caused by NCTs it cause around 80% parameter debt and it cause economic burden. Yes Mr. unresolved and we have to prevent it to make a program preventive program to make it um uh less cost less cost with effective program like we now have um MBK maybe you know MBK our >> our new program preventive program but we don't have any research or study about the cost effective of the program.
I I think we should do >> we can walk later on if any researchers.
Yeah. From with >> it's really interesting uh topic. Uh Mr. Amria now we will now uh open the discussion session for approximately uh 10 minutes participant who would like to ask question. You may use the raise hand feature in the zoom or you will you you may uh write your question in the chat box. Any question for Mr. Amrial about the economic evaluation in the prevention program.
Oh, I think we have Mrs. >> Yes. You >> Yeah. Hello. Hello.
Mr. >> Okay, first of all, thank you very much to Mrs. Indry that okay for the opportunity that uh uh just now what is the topic from the Mr. Amissa is so interesting uh I do agree that the brand prevention and promotion is uh uh the most effective uh to face the NCD problem. So uh the last the last uh slide uh Mr. Amin uh mentioned in the conclusion that uh NCD is still as the economic economic economic problem in the global in the global.
Okay. But uh it is related with the Brunai Jerusalem because as we know that Brun Jerusalem is rich country right so I think that is not not a big problem uh uh related with the economic problem. So my question is what is the most uh concern of the policy uh of the brunet salam facing NCD problem?
>> Yeah.
Okay. Uh thank you. Yeah. Yeah.
Yeah. Okay. So in Brunai even though this is a rich country here. Yeah. Uh but the NC is still problem here.
>> Okay. The obesity here you can see uh diabetes the di diabetes diab di diabetes malitis prevalent here the third >> the third highest prevalent among the uh ascent countries number one is um Malaysia Malaysia 15 u >> u 15 15% of the >> 15% and then Singapore 14% and then >> Brunai Yeah.
>> Okay. They even able that they have the rich country here but it's still a problem in terms of the chronic diseases the NCD.
>> Okay. So now in Brunai they have the concern now to move yeah the mindset the mindset of the policy makers mindset of the healthare workers doctors nursing yeah >> from give their priority for prevention promotion compared to the corrective >> treating patient in hospital because treating patient in hospital very very expensive for the chronic disease.
Mhm. Patient with the diabetes minister myitis majority not one disease diabetes they have hypertension they have the schemic heart disease they have lung problem uh okay so the concern here still give the priority how the move from corrective yeah uh what we call uh priority to the prevention priority this Now that uh they they are doing here and then they they base here. Yeah.
They use uh what we call bruhel bral or bruhim bral. Yeah. To assess to uh measure the quality of life you know quality of life to measure the uh to identify which uh uh citizen people they have risk of NCD.
Let's say BMI because if you everybody everybody have to log in. Yeah. In the system help.
>> Yeah. And then uh your name your age your uh to BMI your weight and etc. >> Yes.
>> And then from that one uh the government we address which one potential >> Yeah. risk for diabetes.
>> Okay.
>> Yeah. higher risk for cancer, higher risk for eskeemia heart disease and then they do the intervention in primary care in uh something like that. So need what we call the power endorsement from the top level management. Yeah. To the low middle and lower level management.
>> Mhm.
>> Okay. M okay >> I think this thing that yeah endorsement then barrier actually not proper endorsement for the top level yeah and then uh what you call uh we have to yeah every meeting we have to acknowledge we have to announce >> yeah we need to do this we need to do this uh okay I think that's >> okay okay So uh for the second question uh Mr. Amaris so based on that assessment from the government of Brunai so what is the most uh the most highrisisk uh behavior of the citizen of Brunam people? Oh.
>> Oh. Eating pattern.
>> Eating too.
>> Oh, the same.
>> So, obesity is high.
>> Yeah.
>> Obesity. Yeah.
>> Okay. because of they cannot control >> the habits. So that's why very important. Yeah. Uh so uh nara the rich country sometime they the people don't care >> about the welcome they eating habits.
Yeah >> because they have the money so they can free for buy anything. Is it right?
>> Yeah. Then don't consider what happened after that.
any risk of the diseases. Uh so this need intervention of the government, >> intervention of the university of the MO. Yeah. Uh to deliver their proper serious health intervention uh not okay >> okay.
Thank you.
>> Okay.
Thank you, Mr. Sure. Uh, >> by the way, P so can give you around 1,000 kilo calories per need to shift the program from preventive to uh from creative to preventive program. Yes, Mr. Andrea.
>> Yeah. Yes.
>> Okay. Yeah. Our budgeting, >> change our mindset.
>> Okay. Our mindset from the top leader, of course.
Okay.
>> Do we have still time?
>> Do you have time? This one of the question from >> I think we have a question. Yes, you may answer this. Okay.
>> Thank you. I'm Jooko from Center for Healthy >> Administ. Oh, M of Health. Okay. I think you know meh because I I always visited I was visit the ambushes but in a young play medic I would like to ask a few question we are currently developing the ID system. Okay group. At the same time the minister of finance has state that state that uh will be no increase in BPJS contribution rate. Yeah. In addition negation on the new IDRG tariff are quite difficult because some claim tariff are increasing. On the other hand many professional medical association asking for expanded benefit under JKN higher tariff. What your opinion of this issue? We at the ministry of health need to listen to the health care professional but we must also maintain the financial s of the care system. My second uh my second second question about lung cancer screening using low do scan in hospital. Current screening is mainly done at primary care facility.
What is the your view of doing screening in the hospital instead of since would increase health cost also since screening only yearly detection it may be screens.
>> Okay. Uh I answered the the last question said yes. Yeah. Um many research yeah all over the world if you want to save the money yeah do it in primary care. Yeah. Do it in primary care. Yeah. uh if let's say still under the screening program, prevention program, promotion program, do it in primary care permas. Yeah.
Okay. Because now there machine whatever screen. Yeah. We can do it then number one uh this very difficult to answer.
>> Yeah.
>> Because I did this one I developing.
Yeah. I developing I developed the tarif for many times. Yeah. Since to 2006 2006 until 2024.
Uh okay. Okay. You can see here um to me my personal view as the consultant because I'm a consultant not as the government's staff. Yeah. to me. Yeah.
We have to be fair in terms of the cost calculation.
Yeah. We have to inform the methodology.
Yeah. For calculations of the uh what we call inner CBG study. Now we call the ID IDG innovation DRG. We have to be fair.
We have to inform. Yeah. For the ministry of finance this the calculation based on the original real spending. Uh so this that I always tell to the ministry of health, ministry of finance that I did. Yeah. Calculate based on the real spending not based on the budget.
So we get the unit cost the real unit cost.
Yeah. Not estimation based on your spending from real representative hospital. Yeah.
uh hospital they have a representative we choose randomly and we get the unit cost and then we link we get the tariff.
Now after we provide the real unit cost real tariff and then we do the simulation not not my myself but the simulation mo because we are the consultant because I cannot do the simulation. Yeah. Mo yeah with the finance or the minister of finance they do the simulation. Oh the simulation the real Yeah. daily calculation not enough our budget not include our budget so we have to reduce uh something like that okay uh so we have to adjust whatever so that's why some of the DRG yeah t they adjust adjustment because of we don't we don't have the enough yeah enough budget I think that's all yeah from my side any yeah >> okay thank you Mr. result.
I hope it answer your question. We have still have one minute.
>> One minute for the last question maybe.
>> Which one? Question. Okay.
>> Okay. From Margarita from Yes.
Yeah.
>> Okay. Currently developing countries the death rate from non disease are also increasing every year. Yeah. What uh prevention effort are effort? Yeah.
Effort. Effort. I think effort intervention effort. Yeah.
>> Prevention.
>> Intervention effort. Yeah. I already in like the intervention should be come from the top level policy makers. Yeah.
If let's say the prevalence of the NCD still increase every year, they have to change uh uh what we call to to change the policy.
Yeah. Temperature control, sub reduction, healthy food habit, whatever.
So they have to revise the revise or change the policy.
Okay.
The second one involve primary care seriously actively should involve yeah healthcare center actively.
Yeah. Uh not deliver to the uh we call the ministry of health but also in Pukas health center. The third one yeah should involve the health center involve the hospital in the hospital. The third one should involve school.
Yeah school. Yeah. So school. So health literacy. Yeah. Uh what we call uh health promotions in in in in school.
Yeah. And also in community we have the many organ organiz MASA. Is it right? Yeah, we have to another thing.
Okay. So, yeah. And then the other one what use the digital AI. Uh so everyone now using the what we call using the uh uh iPad using using the phone. Is it Android?
>> Yes. Ah now using the uh AI digital tool. Yeah. Everyone uh mandatory watch.
Yeah. Register. So we know that your name, your age. Yeah. And then your wage you told whatever. Yeah. Any previously. So the government they have they every citizen. Yeah, they have their own health profile and and then the screening which one is high risk, moderate and low risk. I give prevent intervention to highrisisk first uh something like that. Yeah. Okay.
>> Okay. Thank you Mr. Amri for the answer.
I hope it answer your question Mrs. Margarita.
you emphasize about uh maximize the primary care and empowerment of the community. Yes, that is that right and the digital health. Yeah, we we are in digital era because we are in digital era.
>> Okay. Thank you for the excellent question and discussion session. Thank you very much uh Mr. Associate Professor Amrial Muhammad Nur MD Mister of Science PhD for the insightful presentation available discussion.
As a token of appreciation for your contribution to this international conference, we would like to proceed with the virtual certificate presentation session.
>> Thank you once again Mr. Amrizal for joining us today and sharing your insightful presentation. is really interesting and I hope we uh can have a better um opportunity in the future for discuss this uh topic.
>> Yeah. Can can discuss how we link the nursing Yeah. preventions uh activity with the uh economics evaluation. Yeah.
>> Thank you Mr. Please give a virtual round of applause to our speaker.
Okay, ladies and gentlemen, our next speaker is Fabi Di Rahadi BS BSC Phis of Science BHP PhD from Gri University Australia.
Mr. Fabby, are you in the Zoom room?
Okay, I saw you. Okay, I would like to briefly introduce your uh curriculum.
PB Di Rahmadi BSD is the course convenor of disaster management and resilience building global health priorities and intervention and health program planning monitoring and evaluation at Grievit School of Medicine. His PhD research focus on a collaborative governance model to link climate change adaptation and disaster risk reduction aiming to build urban community resilience. He also holds the holds the position of program coordinator for Indonesia at the center for environment and population health. He served as the coordinator of the risk communication emergency management and adapting climate change for health consortium.
Dr. Di Rahmedi has a strong understanding uh of collaborative governance, disaster management, community engagement and community based program design theory.
process and application. His field of expertise include global head emergency respond operations, disaster risk reduction, climate change adaptation, health program planning and evaluation as well as community participation and development. You have so many project and funding Mr. Fabby and also publication.
Uh Mr. Uh fab you have approximately 40 minutes to present your material. Would you like to share your own screen?
>> Yes, >> your material.
>> Oh, okay. You may share your own material.
>> Sure.
Hopefully you'll be able. Can you see my screen?
>> Yeah, I can see your screen but it's not the full screen.
>> Full screen.
Uh maybe this one.
>> Okay, it's it's a full screen. Okay, it's a full screen. Okay, Mr. Fid Rahi, please welcome everyone. The screen is yours.
>> Thank you, Vendri. Uh it's a pleasure for me to be here. Thank you so much for the introductions and I learned also quite a lot from Dr. Amrial. I think thank you so much Dr. Amrizal. I think you you really set the scenes especially in relation to the importance of health promotions, health preventions and I think you some somewhere in your slide you did mention as well about the uh strong foundation of health promotions in Australia. I think that's really set the scenes of what I will be sharing today um in the next maybe 354 minutes.
Uh hopefully this is something that uh could help us you know to you know to trigger yeah discussions u mutual discussions between uh between everyone here in in this forum. I think the topic is really important uh and I that's why uh I really thank you so much for inviting me for having me in this um important discussions health promotions health preventions I think this is a very important topic very timely as well especially in relation to um the costs yeah uh that I think ministry of health has already mentioned in relation to um bejs or uh ja and you know u uh financial support that is quite you know lacking you know so this is why I think NCD uh prevention is really important so what I'm going to share today is uh some insights from Australia of course um to some extents we have achieved quite a lot of things so I've been I've been I've been living in Australia since 2011 so I've been here since I've been here for more than I think 15 almost 15 years. So I've I've learned quite a lot in relation to uh you know the differences between health promotion strategies in Indonesia and in Australia. I think uh something that you know like if you still remember what Dr. Amrizal mentioned you know in relation to policy approach. So this is something that I would like to share as well in relation to social uh environmental change that Australia government uh tried to introduce in relation to health promotion strategy. Okay. So for those who don't know where Austral is Australia. So Australia is not too far away from from where you live, right? So only about 7 hours 8 hours by flight. I live in Queensland. I live in Queensland which is somewhere here.
Where's the lesser pointer? So somewhere here. So this is Brisbane. So this is where I live. So Modi Waluyo is in Samarang, right? So it's somewhere here.
So not too far away. Yeah. About 7 7 and a half hours by flight.
Um please welcome to Brisbane. So if you uh if you are uh in Brisbane, please let me know you you all have my contact details through you can you can contact the committee if you need um you know contact details if you visit Australia or especially in Brisbane please do let us know and then we more than welcome to we can have a coffee we can have a chat in relation to potential collaboration.
I guess just to set the scene something that I would like to share uh I think this is somewhat also explained by Dr. Amri Zal as well in his presentations um which is in relation to um if you look at this one here so this is the global average life expectancy.
Okay. So as you can see the glo global average of uh life expectancy has more than doubled since 1 900. So which is actually it's a global global trend. Okay. In Australia life life expectancy is about 81 years old for males and about 85 years old for uh female. In Indonesia uh I just I just got the data here. in Indonesia is about 74 or 73 for uh female and for male is about 69 in Brun because we also have Dr. Angelsa in Brun for female is 77 uh male is about 73 in Germany because I see from from the virtual background we also have speaker from from Germany so in Germany about 83 for women and 78 or 79 for men. So globally both developed country developing country least developed countries they all increasing okay in term of life expectancy the problem is we live longer but necessarily we live better so that's the problem okay so this is actually quite crucial we live longer but necessarily but not necessarily better which means because we also have increased morbidity especially in relation to non-communicable able disease. Okay. So the question is now uh with this life expectancy are we actually promoting health or we are actually delaying death. So these are two different things right. So although at the end of the day it's almost similar you know it's it's all about uh increasing the life expectancy right but the approach is quite different between promoting health and delaying death right so these are two different things in relation to cost of course delaying death is much much more costly than promoting health so this is where I think um this is why health prevent preventions uh health promotion is really important because what we are trying to do is we want to live longer right anybody want to live shorter in this uh zoom of course we all want to live longer but a quality life as well we want a quality life we want a healthy life as well okay um okay I have a this is actually just just a fun no not a funny story but uh this is a real story. We have one Indonesian senior who have been living in Australia since 1962.
Uh his name is Piman. Pimman is 98 years old. Yeah. So he is now 98 years old. So when I visited him in his house, he said to me, "Baby, if you can live longer, don't live too long." That's what he say. Okay. Uh he is currently still healthy. Well, well, he is quite old, so that's why he needs some support, but he he is 98 years old, so it's quite quite um quite old. Okay, so let's go to the next slide here. So if you look at this one here, maybe it's a bit too small for you to have a look, but this is all about metabolic disease and it is actually a global health threats. It is not only related to developed country, it is also developed to it is also related to all countries. Okay, developing countries, less developed countries, we all experience the same thing. Okay. Um here we have issue with uh you know we have uh a cluster of conditions. So we can have a look at here di type two diabetes, we have obesity, hypertensions, dysipidemia uh and also an NLD. So non-alcoholic fatty liver disease. So it's also uh something that we are experiencing as well. Um the common underlying factors if you look at here so it's all about insulin resistance, chronic inflammations and visceral obesity.
Okay. So often all of this related to uh we call it metabolic syndrome. So metabolic syndrome if you look at here uh yeah so if you can hear so obesity is the majority of the delhi okay so and metabolic disease contributes significantly to cardiovascular disease stroke and also premature mortality so when you say premature mortality I I believe everyone know this already where our citizen where people die um before the life expectancy of the particular country. Okay. So if you die uh younger than the life expectancy then you can be considered as premature mortality. Okay.
And majority of majority of this is related to obesity. Okay. And I think Dr. Amir also mentioned I think obesity is is a global global global health uh problem at the moment. So we have um a number of global health issues and I think one of the biggest thing is actually obesity uh including here in Australia as well.
Okay.
And that's why the WH uh if you look at here this is the progress monitor 2025.
So more than 14 million people die each year uh in relation to non-communicable disease. I think this is something that have been explained uh previously by Dr. results. I'm not going to read this in um I'm not going to repeat all of them.
So it's affecting all income groups again not only the wealthy family but also the poor of the poorest. So they also experience non-communicable disease as well. And sometimes even the poor of the poorest so they experience both communicable disease and non-communicable disease. Okay. So the main modifiable behavioral risk factors I think there was a question as well right. So what what is actually the most common unhealthy behavior uh that we often see in our people? So these are actually the four main modifiable behavioral risk factors. Yeah. So we have tobacco use of course in Indonesia still quite prevalent. Yeah. In relation to adult smoking rates, I think more than 30%. Unhealthy diet. Yeah. Um we we discussed earlier about gangan uh a lot of lot of food that is actually processed food. Okay. Junk food, physical and activities as well. So that's why when we are doing this zoom you know uh it is also very important for us to maintain our uh uh physical exercise as well because if we do zoom quite a lot every day I think that is also not good as well and also the last but not least hopefully this is not something that is experienced by Indonesians. So we also have harmful use of alcohol again.
So there are physible and cost effective interventions available to reduce NCD burden. So there are actually a number of options yeah that we can actually uh implement in relation to um reduce all these NCDs.
So this is something that you can download uh yourself later on and have a look at the content.
Um I would like to also provide a little bit of background in relation to uh Australian health. Yeah, Australia is is a developed country but some to some extent we still have number of health issue as well. Okay, as we can expect we have chronic conditions. So if you look at here maybe it's a bit too small as well for you to see. uh but if you look at here um about 47% of Australia living um have one or more chronic health uh issues okay chronic disease okay and in fact 87% of them uh 80% of death are linked to these conditions okay so the burden is really long-term and complex because it is about chronic health conditions so if you look at here as well um I'm not going to read all of them because I don't think we have we do have time to read all of them. I just would like to highlight the things like for instance 23 of adults about 67% are overweight or obese. So this is also quite concerning. Yeah about 67%.
This is in Australian context. Um and this is also just to just to compare in how we actually try to understand our health issue. something that you can also compare here with um you have um maybe in Indonesia, maybe in Timurstee in Brunai. So this is how we actually see our yourself in the context of health uh status. We also have like for instance only 5% of adults meet the recommended fruit and vegetable intake.
So this is actually quite concerning as well, right? 27% of older adults are not physically active each week. Okay, you can imagine Australia it's very easy here in Brisbane it's very easy for you to jog or walk cycle but only 27% of older adults um and about 27 sorry about 27 older adults are not physically active each week so this actually quite good I guess I read quite wrong so 27% older adults are not physically active each week okay so there are quite number of things and if you look at here so overall this report card tells tells us while Australia has made progress in some areas some major challenges now lie in chronic disease lifestyle risk factors we also have mental health issue and also health inequities as well okay health inequities here in relation to the first nation so we call first nation is our aboriginal and tourist rate islander who is the indigenous populations okay um there are still some gaps between Australian and non-abborigian and also the aboriginal community and also the cult community.
Cult community is culturally and linguistically diverse community. Yeah.
So not everyone because Australia is actually a multicultural country. Not only Indonesia but Australia if you come to Australia um nowadays it's very easy for us for us like for Muslim very easy for us to find halal food mosques and etc because it's very multicultural in Australia.
So and what is also uh important for me to highlight here as well most of these issues are preventable. Yeah. And which reinforce why strong coordinated preventive health strategies are so critical going forward. The issue now is we all understand what does it mean by health promotion I believe. Okay. So it's all about enabling individuals and communities to increase control over and improve their health. As you can see, it's all about enabling the community.
So, it's not only about providing them with something. Okay? It also it's also about empowerment. It's also about engagement. Yeah, it's very important.
And this is that's why I highlighted this um important words enabling individuals and the community. And there are two main approaches. Yeah. Uh the first one is also envir environmental approach. The second one is a behavioral change approach. Okay. Which one we actually would like to do or we actually have to do both of them? Okay. Should we target a whole population or should we target only the population at risks?
Okay. There there are a lot of questions. There are a lot of things that we actually try to uh when we want to implement something of course we need to then thinking about should we actually target the whole population or should we target only population at risks okay of course there will be pro and cons in between these options and let's discuss all this together so hopefully we do have times something I would like to I think when I when I look at this picture I think I thought like maybe this is something I would like to So to all of you, so this is disease as you can see this is an iceberg phenomena s. So what we actually see is only this side the small piece of the iceberg which is the lifestyle risk factors. Okay. What is also very important? So lifestyle risk factors is the behavioral change strategy. Okay.
What some something that we cannot see is the one that is submerged. The one that is under the ocean, under the uh it's it's hidden. Yeah. So, daily living conditions, their housings, their employment, have they received social support? What about the crime and safety? What about local, regional, national and global power, wealth distribution, fiscal policy? Is there any gender and class issues? Yeah. Related to those communities. So sometimes when we as as health promoter we only see lifestyle risk factors and sometimes we blame the community right which is actually uh something that we have to avoid. Yeah we um yeah we uh I think last year it was last year so last year we have a group of people from Indonesia.
Uh this is in relation to the establishment of been. Yeah. So they send people to Australia to our university.
Uh this is also in relation to MBG as well right. So and they mention about the issue in East Indonesia for instance they said uh we provide the food but they don't want to eat the food. Okay.
It's nutritious food but they don't want to take it. So what can we do? Okay. So it's something that we actually have to think about a lot of things. Yeah. why the community although it's a free food, free nutritious food but why they didn't take it. Okay. So it's something that we have to really dig you know explore what is the problem. We cannot just blame the community especially as a government.
Yeah. So something that we also need to look at is the upstream downstream approach of health. Okay. We often talk a lot in relation to the health outcomes and also the midstream as well. Yeah.
What is also very important for us is actually for us to climb up to the hill and look at the health determinance the upstream determinance. Okay. So which is the micro level which include uh policies. Yeah. So if you look at the next slides here you can see uh a whole population approaches which is policies, societal factors, educations, food supplies, affordable healthcare. Okay.
Um we talk about people have to put their rubbish into the bin. Okay. But the problem is there is no bin provided.
Okay. The bin is full. So how can the community pro put the bin put the put the rubbish in the bin. Okay. It's very important you know when we say something to the community it has to be in line with all things as well with the policy.
We say for instance smoking is not good for you right but every time you go to Indomar it's I think it's okay for us to mention any names right if you go to circle K if you go to supermarket children can see secret very easy okay before they pay they can see faping faping the the uh uh the advertisement of vaping right at the cashier. All right. So it is not in line you know when the government say smoking is bad for you but why people very easily access cigarette very cheap as well.
Okay. So it's not something that I don't know so what what what do you actually want? Yeah. So in relation to this so so that's why I think what I also would like to share with you as well I think everyone have seen this. This is something that I think everyone has familiar with but I just would like to highlight that we actually influenced by many things. Okay, there are a lot of trust me okay I'm not telling lie there are a lot of Indonesian PhD student who came here as smoker but because they spent 3 years four years in Australia to finish their PhD because smoking is very expensive here in in Brisbane or in Australia about $45 per pack so about 500,000 per pack 100,000 rupia per pack of cigarette. Do you think you want to spend 500,000 just to buy a pack of cigarette in Indonesia?
So that's why they quit smoke. They quit smoke because even though they have money to pay to buy but it is very very difficult for them to smoke. Yeah. But the problem is when they finish their PhD, when they come back to their home country to Indonesia, most of them they will try to smoke again because cigarette is very cheap in Indonesia.
Okay. So lifestyle, community, local economy, activities, built environment, natural environments, we all are influenced by all these factors. Yeah.
So it's very important Yeah. for us to to understand Yeah. all these factors.
If you buy I think it's okay again it's okay for me if you buy Indomi here in Brisbane the taste will be different with Indomin Indonesia because of what?
Because they reduce the MSG.
How can Australia control that? Because Australia protect the people. Okay. They control how much MSG you can put into your food. So if you want to sell food to Australia, you have to follow these regulations. Yeah, that's why in most Indonesian if they go to Indonesia, if they go back to Brisbane or to somewhere in Australia, they always buy a lot of Indomin they put into their uh into their luggage because it's it's um the the taste is um better. That's it.
Right. So, what I'm trying to say is that policy government intervention is really important. Yeah. Okay. So next still about the framework and and then after this I'm going to show you the what what's been implemented here in Australia because it's all about I think um benchmarking right so what we are trying to do is basically we um we try our best to how we can actually also implement this in Indonesia this is what we really want right so if you look at here um just now I saw you the image of a mountain so we have upstream midstream downstream So if you look at here, so help promotion should basically cover all all stages. So upstream, midstream and downstream. And of course the approach will be different in each uh in each uh stream. Okay. So we have upstream. It's all about political um u solutions. So the more upstream you the more upstream you go, the more political the action will be. Okay. The more downstream, the more technical, the more individual, the more personal. All right? So, it is easier to do something that is more personal. Yeah. But it is not that sustainable. It is harder to go political because of course it is something about political decision uh making process. You need to be able to lobby the government. But it is more sustainable. Yeah. If if you can imagine like here in Australia uh just to give you um Australia is a federal country.
Every state might have different uh policy. I'm I live in Queensland uh one of the state in Australia in Western Australia in Perth. So they are thinking about um banning junk food advertisement in public transport. So you won't be able to see McDonald's, KFC, Pizza Hut advertisement in public transport because they will ban uh uh advertisement. Tobacco advertisement has been banned since long time ago. Yeah.
But it is about junk food advertisement.
You can imagine. So in Australia, but as I said, so Australia is federal country, different state might have different policy. So it's about structural factors because people think that especially junk food I think it's one of the biggest issue now energy drinks right so I don't know whether energy drinks also popular in Indonesia but in Australia energy drinks you know um is very popular um because they put a lot of they put cafe in they put sugar they put chemical you know I don't know what what what else they put there but they like it so much especially the young adults the teenager they like it but that is actually the pathway for diabetes okay so it's very important for us to understand all this social health determinist and later I'm going to show you and it is actually written in the national prevention national health prevention strategy in Australia on how Australia try to understand the uh the social health determinance um from from different angles Okay, I'm not going to explain all angles because I'm not going to have enough time. What is also important, I think this is something that we discussed earlier as well earlier as well in in the previous discussions is about the life course approach. When we want to do health promotion, we cannot do it just in one spot only. Okay, especially at adult time. Okay. So that's why when you talk about stunting for instance, how we can address stunting, it is very important for us to basically um intervene from as early as possible.
Yeah. As early as possible. And so because health is not determined at a single point in time. It is shaped by experiences and exposures uh throughout life. Okay. from prenatal, preschool, school training, employment, retirement.
So it is very important for us to have that prevention strategy.
Okay. For example, good nutritions and supportive environment in early childhood can set the foundation of for lifelong health. Okay. While adverse conditions can increase risks of chronic disease later. So um so access safe water, safe drinking water, health and sanitations for instance. So that's why um if you look at you know people who live in slum areas for instance they don't have access to drinking water.
Yeah. How can we expect they have good health conditions if they have no access to water? Very basic water. Okay. So the diagonal line emphasize prevention throughout this life course and this means we need interventions at every stage. Yeah. So it's very important and what I'm trying to say here as well it is a systemic life course approach.
Yeah. Not just treatment in adulthood.
Preventions must start as early as possible throughout our life. So that's why in Australian context. So this is where I'm going to talk about the examples and hopefully um yeah so if you look at here uh this is the the most recent national preventive health strategy 2021 2030 and the aim is to improve the health and wellbeing of all Australian at all stages of life through in uh preventions. So Australia health preventions apply that life course approach. Yeah. Uh intervention and if you look at here the four key strategy um the first one is children grow up in communities that nurture their healthy development providing the best start of to life. So okay so from as early as possible. Okay. So because the benefit of preventions extend beyond reducing chronic conditions and living longer healthy lives only. Okay.
Prevention generates benefits not only by reducing pressure on health budget.
Yeah. It's very important because the government believe that by doing preventions and it not it is not only reduce pressure on the health budget but also increase workforce participations and productivity as well. The healthier the citizens the more productive they will be. Okay. And it is also about improving the health of future generation as well. Especially in the context of uh this era you know uncertainty a lot of disaster a lot of it's climate change era. So it's very important for us to make sure that the community is are healthy. Okay. So the key principles of health promotion of Australia I think some somewhat also uh this was discussed in early um um discussion as well. Uh we have multis sector collaborations. So this is more about coordinated health actions um across health and non-health sectors.
Yeah. uh in Australia for instance uh this is in relation to health in all policy or join up governance or join up governments. It is very difficult for you to buy to to bring meat to Australia for instance or food to Australia. If you want to buy, if you want to bring food from Indonesia, you have to declare because and who control that? It is not health sector. It is the immigration and custom, right? So that's why it is very important for health department to work together with uh with uh custom and immigration as well. What about the importations, food importations?
Okay. Previously they identified some food or salt imported by some countries contains microplastic.
So the trade government the trade sorry the trade department ban this particular country. So Australia no longer import salt from this particular country. Okay.
So it is not health sector it is the uh the the the trading uh department enabling workforce is also very important make sure that our workforce are skilled multi- disciplinary health workforce uh full scope of practice across prevention and care. So I teach health promotion course in my school and we have student from medicine we have student from dentistry as well. So they also learned health promotions uh when they uh when they were doing their uh medical degree as well. It's very important for us to understand prevention strategy as well. So it also have to be a culturally safe evidence-based service delivery. We're talking about community participation as well. It has to be community late uh engage with NOS's uh local government.
Um and now we use also the core design solutions empowering individuals. So later on I'm going to show you some examples of social marketing that aim to empower individuals to enhance their health status as well. Uh we also need to be able to adapt to emerging evidence.
There are a lot of new things that happens. Okay, health is always something you know like for instance now we have 5G. Okay, everyone got mobile phone and leave and 5G. There is a potential that 5G could enhance the risks of cancer especially thyroid cancer. Okay. So we have to adapt to the emerging evidence microlastic. Yeah. So a lot of things right. So equity lens embracing digital innovations. So use of digital hybrid care models and etc. Well, and if you look at on the right hand side here, there's a tree. Okay, so it looks like tree and it is actually a tree, but there's a root. And if you see the root, it's social, environmental, structural, digital, economic, cultural, biomedical and commercial. And these are the social health determinants that will influence the health status of uh of the people in Australia.
Um just a couple more minutes I think I believe. So this is just to give you an example. the social element of it. So we have family situation. So we have we have always so in this health determinance there is always protective and adverse effect. Okay. We all protective effects is family situations.
For instance we have high functioning cohesive and supportive relationship.
Adverse it could be something related to high stress environment. Yeah. uh socioeconomic disadvantage, presence of violence and abuse. Yeah, domestic violence for instance. So it is very important to basically this is actually the one that is available in the document of the national prevention strategy uh in Australia. So we are trying to understand because all these are related to the evidence in Australia uh like for instance just to give you an example of social environmental determinance. So we have also the environmental aspect of it as well. We have element of climate change UV radiation. So UV radiations is important for vitamin D productions but it is also carcinogenic as well. Okay. Um we have biodiversity such as regulate climate filter air and water enables soil formations. However, we also have some adverse effect of biodiversity as well. Okay, built environment. We have low population density because Australia population is only about 27 million and Australia is a very big country in term of geographic uh size, right? So, we have a very low population density but we have issue in term of increased car use. Okay. Um walkability. So we also have neighborhood within walkable very close to one another one one another but we also have some low public transport options non- diverse land use. So this is actually the um analysis um in the context of Australia I'm not going to be able to read this in detail but for them to be able to apply uh their strategy it has to be based on research. Okay this is an example in Brisbane. This is a a bicycle lane. So they separate between bicycle lane and and and the motor vehicle but some area they have to they basically have to share as well depending on where where you where you go and there a lot of public gym as well and this is also part of health promotion as well. Okay. As and providing free access for for the citizen to use this public gym. I think this is something that I think in Indonesia uh I think it is also available as well. So what I'm going to share I think this is very important the framework for action. Okay. How we can actually make sure that Australia has a very strong foundation of health promotion. The first one is mobilizing at prevention system. So it has to be a systemic approach. Right. When I say systemic so it has to be leadership.
Leadership is very important. governance and funding. So these are the three most important thing okay leadership governance and funding and here you have also prevention in the health system okay partnership and community engagement information and health literacy as well. So it's very important for people to also understand what will be their role in relation to health seeking behavior in relation to health promotive strategy. It's very important research and evaluation is very important. So Australian government both federal government and also state government work together with the university as well. So they provide the funding and university will provide the research monitoring and surveillance they also involve the uh NGO they also involve the university as well and also the preparedness um as well because world pandemic um something that we probably will face in the future we don't know when right but we have to be always prepared uh boosting action and focus area so these are the main focus area we have to use and nicotine addiction. So this is still the focus area improving access to the consumption of a healthy diet. Yeah. Uh we actually use the uh principle of um nate approach. I don't know whether you know nate approach uh in our definition but in Australia we call it nanny state approach. NET approach means Australian government control quite strongly. Yeah. So the uh the only the if you think like this like for instance if we only heavily rely on behavioral chains then it won't be that sustainable but if it is the only option is the healthier option. Yeah. So there will be no other choice. Yeah. So the government need to be able to make sure the options the food option is the only the the the is the healthier options that is available. When we say available, it has to be affordable as well. Again, accessible, affordable, it's very important.
Yeah. Uh increase physical activities, increase cancer screening. Yeah. Um bowel cancer is one of the big things as well here. So cancer, breast cancer, um skin cancer, etc. So and also uh so boost action in focus area and also strong continuing strong foundation is also another thing as well. And this is more about the um the foundations. So it's all about mobilizing the system um boosting targeted actions and building on action building on strong foundations. So it's actually it's like a it's like an engine. So it's very important for us to make sure that everything works together so then we can actually produce a strong foundation for health promotion in Australia.
Um the time is almost up so I just would like to show you the uh the framework for action. So this is also another another important things I would like to share as well. Um this is in relation to uh preventive uh health strategy. As you can see all these are partners including schools, including volunteers, including the universities, edge care, so industry. So all these are the uh partner or uh health promotion strategy.
Um these are some examples of um we also provide the threat appeals. I'm not sure whether I think everyone also aware of the threat appeals. So threat appeals especially with the road safety strategy for instance. So in Australia if you forgot to wear your seat belt or maybe if you use your mobile phone and the penalty will be 1,00 $1,100 in Queensland. So it will be about 12 million rupia if they found you use your mobile phone while driving. So it's very costly very costly right. So that's is what we call west threat appeals and it is very effective to reduce road uh injuries road traffic accident.
Slip slop slap is actually uh it's all about skin cancer. to wear shirt uh sunscreen because a lot of Australian they don't wear shirt right so they have to put sunscreen hat this is also very important to reduce to enhance the awareness of sun protections and also to reduce risk of skin cancer HIV preventions and community engagement and folic acid um fortification policy so this is about the um this is more about the pregnancy And um it is mand m m m m m m m m m m m m m m m m m m m m mandatory um poly acid fortifications of bread making flour. So this was introduced back in 2009.
So it is mandatory. So Australia control the bread industry in Austral in in also flour uh to make bread in Australia. So they need to contain uh folic acid. Uh this is basically to um reduce uh pregnancy uh issue. Okay. So because many pregnancies are unplanned in Australia.
So not many women take uh supplement early enough. Yeah. So that's why if they eat bread they will consume the folic acid. Okay. So there this is more about the the whole population approach.
Right. So the whole population approach um okay so this is a quite these are quite um example from Queensland from my state as well and um starting with my health for life so if you look at this is a website and it is very engaging so as a free lifestyle program um people can sign up for free and this will help them to reduce risk of chronic disease is okay. Focus on empowering individuals and provide them with knowledge, support and practical tools.
Deadly choices um is actually for the Aboriginal community and tourist red islander community to make their life uh healthier uh healthier healthier life decision as well. Okay. 1000 step programs uh healthier touchup program.
So this is for school program um eating well staying active. Now in my son's school for instance they also apply the active transport school uh active transport school is they encourage student to uh go to school by bicycle by public transport.
So um it will make them more active. I live very close to my son's school.
Sometimes my son's our son they go back home by just by walk. Okay. So a lot of other things as well. Okay. Can have a look at this later on. Uh don't think I have the time. Just like to show you this one here. So this is about the smoking. Um and it is something that is quite successful as well. Australia tobacco control has been quite successful. uh back in 1989 it was about 25% adult daily smoking uh prevalence and recently it's about 80 sorry 8 about 8.8%.
Okay so it's very big gap between Indonesia Indonesia is about 30%.
So if you look at here it is decades. Yeah.
So not a single not only one single policy it's multiple policies. Yeah. So if you look at here uh tobacco control has evolved in Australia over time and how these efforts has translated into real public health impacts. So stick steady and significant decline in smoking rates and they introduced first of all they introduced the advertising ban. Yeah. So tobacco advertising prohibitions act. Okay. Health warnings on pack first national tobacco campaign.
And in 2003 you are not allowed to smoke at all at the restaurant, at the pub, at the club. It is not possible for you to smoke.
Um and then of course here 1990 1990 uh 1990. So we also have um health warnings on cigarette packs. You also have for instance here um smoking bans in homes and cars with children. So you're not allowed if you smoke at homes if you have children and somebody can call the police. So basically you can get the penalty if you smoke in front of your kids you can get penalty as well.
Okay. Uh it's very important and the plain packaging in 2012 is also very effective as well. So plain packaging if you buy cigarette in Australia uh there will be no advertisement in the package. So it will be it will be a plain packaging. Okay. So that's why now the price is very expensive. In 2024, there's a new tubical legislations and the price is about $45 per pack as well.
Okay. So, of course, in Australia, we have obesity prevention as well. Just jump into another slides. Uh, empowering people. So, promote healthy eating, physical activities because as you know, obesity is one of the biggest problem in Australia as well. And community initiative and local programs as well.
We work together with university with the schools. Um social marketing is being implemented as well and also they introduce the healthstar rating as well.
So it's basically the community when they when they buy something they can choose whether they want to buy the the fivestar rating, the fourstar rating or the three star rating. So it has to be when they buy something it has to be they have to be informed. Okay. So because we cannot force people to buy healthy food all right but we can at least make sure that they understand what will be the consequences. Yeah it's very important.
Uh give you an example uh I also joined this 3,300 push-up challenge. So 3,300 is not just number. Yeah this is about related mental health issue as well. So 3,37 people commit suicide back in 20 2024 in Australia. So that's why they want to do a push-up challenge. 3,300 push-up only within uh 23 uh days in June. Okay. So I joined this challenge as well. Park run is also something that is quite successful in Australia. I think also in Indonesia and some some cities. Uh cycling 100 kilometer cycling. This is to fight uh cancer. So all these are social marketing and all these are health promotion as well to gain funding as well or health promotion research.
Uh we wrote uh a paper as well. So this was a a conversational uh the conversation kind of paper as well. This more about uh sugar tax in Indonesia. Um still very very long to go in Indonesia. How we can make sure that we have sugar tax. Um this is also a paper that we worked together would wrote together with colleagues from Indonesia from Ministry of Health as well and this and also from University of Eranga. This is about the um low sodium potassium rich salt substitutes. Okay. Uh or LSS. Yeah. So because as you know salt consumption is very high in Indonesia and this paper is all about to um replace sodium uh with potassium rich. Okay. And and this can be according to according to this model this could also reduce the risks of uh uh liver disease. Okay. So it's something that we can actually um hopefully we can do as well especially in in reducing blood pressure and also uh at the end of the day it's all about reducing the health um care consumption as well. Maybe that's all from me and hopefully we can have a productive discussion. So for those who have uh maybe if you have any answer to the question so please also help me to answer the questions. uh because maybe you are more familiar than Indonesian context than myself. Okay, thank you so much. This these are my details. So looking forward to collaborate with all of you. So thank you so much for the time. I will return back the microphone to the moderator.
>> Yeah, thank you very much Mr. Frappy for the informative presentation. Um I will conclude uh your material in health promotion program. I noted that uh we have to understand all the risk factor contribute to health problem and make it in line with the policy right and uh we need to uh conduct an environment medic modification I think to support a health uh lifestyle in the community and we have to make a community empowerment and we have to also see from the community perspective if we want our program is more successful I think That's uh the conclusion of your presentation. Next, we will continue with the question and answer session. All the participant you may uh use the right hand feature in the zoom or write your question in the chat box.
Is there any question? Oh, in the chat box. Mr. Faby, I read two question.
First from Laurel Andriani is Karimantan Borneo Indonesia.
Do you think Australia's health promotion strateg strategies can be fully applied in Indonesia? Why or why not? Second question is which Australian health promotion strategy strategy has had the greatest impact so far from Nural Andreani.
The first question Mr. Fabby. Okay. So, thank you so much Bur. I think one of the I think a WH has already acknowledged the turbo control in Australia as quite strong.
Um the something that I think uh hopefully I really hope that this is something that we can apply in Indonesia. this however it is not that easy because there's always what we call by political economy okay political economy what I'm trying to say is that uh it's very easy for Australia to control tobacco because we don't produce tobacco okay there's nothing to do with our economy >> uh if no one smoke in Australia it won't affect our economy at all okay the problem with Indonesia Indonesia we produce tobacco right um so it is much harder than than the implementation in Australia because Australia we don't do we don't produce tobacco so what I'm trying to say but although Australia we don't produce tobacco it took almost 15 years for Australia to for Queensland and Australia especially uh Sorry, Queensland especially to apply the plane packaging. Okay. It took us 15 years because tobacco company always against Yeah. They lobby the policy makers. Same thing in Indonesia as well. the the tobacco industry they got money they got researcher they can hire a lot of PhD they can hire a lot of medical doctor to work with them to counter the evidence to counter or to conduct research and to confirm that look tobacco company provide economy to Indonesian population. So if you uh control tobacco there will be this many people who will lose their income you know. So they always do this you know they always provide very that looks like a very evident based you know recommendations but it is actually not right. So some nural I think something that I really want this to be applied is actually the tobacco control because tobacco is uh especially passive smoker. Yeah. Is very uh I just realized that actually my background is actually the opposite.
Sorry I didn't know that. So um yeah so it's something that we really want to do specifically tobacco strategy but then tobacco in Indonesia they considered especially cretek they considered it's uh it's a cultural heritage of Indonesia so it is against uh cultural preservations because uh cretek is considered as Indonesian culture so again this is actually this statement ment is actually coming from the industry from tobico industry.
So we hope that Indonesia has a very strong government. Okay. In relation to typical control, okay, we have to be able to have the power. Yeah. Because otherwise it is not easy because they got the money. Yeah. Tobacco. If you look at the Indonesian wealthiest people, Yeah. I think most of them they are tobaccoist. they produce tobacco, right?
So yes, so it's it's something that we can implement, but Indonesia need to have a strong government to control the industry. Yeah. Not to mention as well with the uh sachet um you know the sugary drinks or the coffee the cafe coffee sachet um uh that contains a lot of sugar. So this is also not healthy as well. Coffee is healthy. Coffee is good.
But the one that has already in the pack that contains sugar, it is not that healthy. But again, it is also industry.
The industry came and they provide money to the government. So it is not that easy. So we have to control that. Okay.
Hopefully that help. So >> but I hope it answer your question.
Yeah. Because tobacco company also sponsor sport events. But baby in Australia we are struggling with gambling and alcohol.
>> Gambling and alcohol.
>> So alcohol and gambling. So alcohol now is a lot of research is talking about.
So this is almost like back in 1980. So we we have a lot of research talking about preventing alcohol advertisement. Okay. Which is actually a good things but it will take longer time I think.
>> Okay. because a lot of people they drink alcohol >> uh and and Australia produce alcohol as well, right? Produce a lot of alcohol drinks.
>> Okay.
>> So yeah, >> thank you. We move on to the next question. Maybe uh there is a from isakas from Antamua is Nusatangara data shows that up to 60% of Australians have inadequate health literacy even though they are a developed country in your opinion what are the biggest barrier to improving this health literacy and what is the best strategy to empower people to independently make healthy lifestyle choices from eapa Okay.
And let me I thought we also have busy but this is more about >> it's okay.
>> The biggest the biggest bear is to improve uh health literacy.
Um well yeah if you look at if you look at the uh healthy lift model yeah so we have a couple of factors that might enhance the um enhance or influence people's behavior.
So we have uh perceived susceptibility to disease. We also have perceive severity of the disease. Yeah. We also have sufferity. Uh we also have cues to action. Okay. We also have perceived barriers to um to implement the actions. Okay. So multiple factors QC action is where we can actually do lot of things like social marketings right uh advertisement policy. So this is the action. So what you're saying is perceive barriers to take action, right?
>> So, >> oh, >> what I'm trying to say because we are we are actually um in Australia especially at Griffith University um the ideology of our public health because public health also have ideology. So the ideology of public health at Griffith University or most in Australian university is ecological public health. Okay. So ecological public health means we have to make people healthier through the environment.
So I think one of the biggest barriers uh for people to be healthy is the environment. Okay. the environment uh especially in developing countries for instance um not allowing them to be healthy. Okay. Access to nutritious food, access to um proper shelter for instance, access to proper livelihood, right?
Um we just did research with University of Donogoro uh with um faculty of um um engineering. Yeah, we're looking at climate change impact in coastal community in Sarang in the Makpalongan in North Sarang as well and also in North Jakarta and always the issue will be about social environment. Okay. And it is not that easy especially in the context of anthroposine era. So anthroposine era is where the human is the dominant factors across the globe.
Yeah. And everything is influenced by human. Okay.
And we actually create our own problem. So that's the things. So human you can imagine um but yeah we have about 10 billion people across the globe right and how we can make sure that we feed this 10 billion people without destroying the environment it's very it's very difficult >> now we have to produce chemical so then we can make sure that we produce enough food for our people so it is not that easy so social environmental is actually one of the biggest barriers so that's what government has to be there.
Government has to be present to make sure that there is uh proper you know the the environment is proper you know supporting supporting for the for for the citizen to be healthy. It's very important. Yeah.
Hopefully hopefully that's answer is from maybe the last question for this session for from Australia seems to have very strict health regulation and strong penalties for smoking violation including uh high fights in your opinion could this approach by be by effectively implemented in Indonesia considering that even smokef free areas are still frequently violated in Indonesia and people often feel uncomfortably uncomfortable reminding others not to smoke in public places. What strategies would you recommend to improve public compliance and awareness? We have the regulation but the community not follow the regulation.
>> Yeah, it's very important. That's that's a very good questions because uh that's why I think uh we have to be consistent when we when we produce the policy. So we have to law enforcement is >> the next right. So if you remember the the the empower so which is the FCTC framework convention on tobacco control um uh this the uh it is easier for us let's say oh this is we ban tobacco cigarette for instance but the problem is who will control who will monitor the implementation of the policy right so again government has to be there and I What's also important in Australia is we have to remove smoking from the culture. Very important. So back then people believe that smoking is important. So then I can I can have a friend. Okay. Uh if I don't smoke I will lose my friend.
>> Okay.
>> Yeah. It's a social pressure right nowadays.
>> That's right. You have to be alone for you to smoke. You have to you have to uh walk away from the crowd if you want to smoke. So you have to be unsocial if you want to smoke. So it's >> so this is something that we can also apply in Indonesia. So >> uh we have to really remove cigarette from the cultural society. But again a lot of people like influential people they smoke. Yeah.
>> Yeah. They smoke. So it's very important to make sure that it is something that I think in Indonesia it's very easy for you know to go to M O E M M >> M O M UI yes >> instead of cigarette is haram for instance.
>> Yeah >> maybe maybe this is something that can be can be done in Indonesia and maybe more effective >> law enforcement right?
Yeah, >> the government has to be there, law enforcement, but social pressure, social uh what called social pressure, social control, yeah, has to improve. Social has to be >> Yeah. In Indonesia, in the context of Indonesia, religion has to be there. I think >> maybe not in Australia, uh but in Indonesian context, I think religion need to be there. If they can include this as part of the religion and culture, hopefully we can.
Yeah, we hope so, Mr. Baby. Thank you so much, Mr. Fabby. Thank you for all the participant for the active uh participation.
Thank you once again for the excellent presentation. Mr. Fabby, ladies and gentlemen, before we continue to the next session, we will now have to uh we will now have the presentation of a certificate of appreciation as a token of gratitude to our honorable speaker, Mr. Fabi.
>> Thank you. Thank you very much, Mr. Fab.
>> Ladies and gentlemen, please give a virtual round of applause for Mr. Fabby.
>> Thank you so much. Thank you.
>> Thank you so much. You're very welcome, Mr. Fab.
Okay, ladies and gentlemen, we move on to the uh our third speaker. Yeah, Mrs. City Fatona uh from University Clinic Germany. I hope I spell it right. I pronounce this right.
Mrs. City Fatona, are you there?
>> Yeah.
>> Hello.
Hello.
>> Allow me to briefly present the background and your source curriculum.
You are bachelor degree in our university right in 2018 and 2019 you are midwy intern residential home from children and youth in with disability to yan Taiwan 2020 midwife in permatahhati hospital Saratika Indonesia 2021 voluntary at filling in how to read it Germany in 2022 prison midwife university at clinic fra Germany this is city fatona this is uh okay >> you may present your material in approximately 40 minutes the screen is yours please So, can you see?
>> Yeah, I can see clearly.
>> Actually, I don't speak English very well. Please forgive me if my English is broken.
It's okay.
>> Daily and work I use German as a practitioner in Germany hospital speak only Germans. Yeah. So we start optimizing maternal and fatal outcome the important of chronic disease evolution science the first trimester.
So there are many things that can be done to optimizing maternal and fatal outcome because there are great many complication associates with pregnancy uh on childbirth.
Here I will discuss the three minor disease.
So first discussion diabetic militus from mother patenta to fetuses studies on other risk factor of uh DGM or temperature milit um recent meta analysis indicate that vitamin D deficially is also associated with an increased risk of developing DDM.
uh meta analysis involved approach such as two comma 5 million women demonstrates that none woman carrying a fetus higher rights of KDM compared to to carrying a female's fetus in a study mora atal so that saw it that woman with twins pregnancies do not exhibit in increased r of GDM compared to those with single lon pregnancies.
On last two meta analysis involving a less number of patients demonstrated that woman with sleep apnea syndrome had a more than two two three foot increase rise of DDM even after choosing for obesity.
Fiblmia in pregnancy implication for the guilts. Fib insuli, Jettopi, mrosomia, uh organome, liver, heart or sperm, hypoglycemia, postpart respiratory distress syndrome, hyperbilially impactful for bones, not just for the uh pregnant woman on another risk factor of GDM previous pregnancy with gestational diabetes of V of significant white time.
Family history of diabetes act over approximately uh 35 years. Previous birth of a very large baby.
Recoises of steel births.
Poly sister of syndrome.
Excuses. Omniot fluid. Very rapid growth of the baby.
Possible symptoms may include distational diabetes militus. As a midwife we this is extreme important uh num one and usually strong tears frequent urinat records infection.
So in German screening typical performed between the uh 24 until 27 + 4 weeks of pregnancy also cons of following. offers a screening test using a glucose solution followed in the event of a abnormal results by an oral glucose toolance test or UGT.
So uh between the 24 until 27 + 4 in the fasting of uh 92 on after 1 hour 100 I uh greater than 100 I on after 2 hour greater than uh 100 53.
So this is same um for algraphy date. Here is the grand sw uh greater than 20 92.
This is all vermal is uh DDM on patholog is when a one or a two or a vert is the patholog and then hypertens on preclamsy to enable the effective practice internal risk assessment must be controlled as early as the first three measure while risk factor for preeacclamy are leg they are vetted based on insufficient evidence risk factor from the pre-clams and um hypertensy, unfetched maternal eggs, uh high maternal BME or body mass index on ethnics, African, South Asia, who positive family history, mother preclamsy maybe. So premature previous pregnancy with preeacclamy prim uh piggraphy conception essence repro reprotoion practicular frozen embryo transfer multi uh multiple pregnancy chronis hypertensy hypertensy disorders onetus milos tip or tip two systemic lupus modus antihosp antiphospolippid antibbody syndrome and the last nicotinus And then hypertenses. Uh sorry.
Hypertensive clamsy deficion preclamsy no onset of hypertensy and protein or after uh 20 weeks of pregnancy on gistal hypertensy systolic uh 140 and uber uh 90 90 of less to men's uh measure men's space at lasthere or apart measure after the 20 weeks of gistal.
Blood pressure was normal before pregnancy and before the 20 week of gistal and protein in urine. The gold standard is messment in uh 45 44in collection a follow of 300 on 24 is considered pathologies for preclamsy. If no collection orin is available a follow of 30 is considered pathologies false positive follow can be caused by increas of infection signs urin uh mention control party with the actual event of pro protein urin uh deter mention in 24 horsein collection s always report from other hipp uh other hypertensive pregnancy disorders.
induct hypertensy blood pressure first um 130 to 90 of the after the comrade 20 week of gestational on input to further five of case gestin hypertensy different into 9a 6 into severance play clams and chronic superancy on super imposs.
We as we as midwife can do the first screening with blood pressure hypertin and symptoms. If something is compus one must refer to a kinologist or hospital and protein orin them in the Uh on this next blood pressure mess after a 10 minute rest period in the sitting pat on both arm subsequently the arm with the higher val is used for fall objects cause of cough not nor that's part 40% of the upper arm circuling or using a cuff that is too narrow of the not polit coral excess height fellows positioning the calf of heart level to above the influence of hardest pressure if the arm hack excenses Rest pressure low to uh 3 mm haggy.
According to the last of the international sit for the study of hypertenses pregnancy control fas is used to reduce historic blood pressure and control cough pass of five is used to retouch blood pressure.
uh when uh over 130 90 repeats after 10 to 30 minutes.
uh inline graphic factor influencing manal BP main source mean white co hypertension is about 20 uh and 25% high with mid hypertensy daily fans possibly to low first in the in the morning so manifest of severance colus in Preclamsy is facial distensic pine collision distorma protein oran receen and edema.
And next uh help syndrome a caractus a characteristic const of labor finding concourse during pregnancy consils of hemolysi elephant transmis and trombocytoeni facts assol with preeclamsy helps syndrome with inexid null n I na 1 to n comma 5 protein albeit and to 10 p uh 20 protein of al women with preeacclamsy is a selfless comprein occurs with high morbidity and mortality the acutres of life rupta hummorology dissent interfacecoagulation and multiorgan fila. The clinical expression of help syndrome often begins with the upper abdomen predominant of the right sides. This is uh very important for us as midwife in Germany for woman uh with a history race and high score on preeacclampsy screening accordance to F MF oral attributes of low do assistance as or SS acetyl s in early in the pregnancy uh but no later that before v uh 60 of gachion and the last is trombbo emboli pip fen trauma is the of the leg suddenly on's leg swelling on sen aselo and palim storm The pine might be movement dependent favor on a famous comical similos inside of shock.
Thank you.
Please conduct discourse on ask question is Indonesian miss.
>> Yeah.
>> Okay. Okay. Mrs. Mr. >> I conclude that screening is very important in uh pregnancy complication because the impact is really dangerous.
Right. So we move on to the question and answer session. You may ask in Bahasa.
Mrs. City Fatona, you may also answer in Bahasa because you are native in Bahasa, right?
>> Yeah.
>> So, so we can uh communicate in Bahasa.
>> Okay. The participant is there any question about uh prevention or maybe the screening uh in pregnancy complication like preacquamy or diabetes castal.
Is there any question participant all the patron you may use the right hand future in the zoom or you may write your question in the chat box.
Is there any question?
>> You may speak.
Oh, you may ask in Bahasa because she is native in Bahasa.
>> Okay. Hello, Mrs. Cityuna.
Yeah.
>> Okay. Uh I have one question for you. So what is the different challenges uh especially in the maternal uh problem in Indonesia uh comparing with and the German?
What is the difference?
foreign.
Okay.
foreign for Okay. Is it free?
free.
Yeah.
I see.
Okay. Okay. Okay.
That is the problem.
Oh, it's really interesting.
Yeah. Challenging.
>> Challenging. In Indonesia, we face health awareness >> aware on the awareness in the Germany health coverage is more way better than Indonesia. But they face another problem with the refugee from other country.
Yeah.
Yeah, >> yeah, of course. Okay, thank you for the question. Maybe we can next to the other question move on to the other participant.
Is there any question for Mrs. Fatana?
Yeah. Mhm.
Yeah. Yeah. Yeah.
free.
Mhm.
Mhm. Yeah.
Clinic Okay.
Is there any question?
Thank you. city for the nice and wonderful presentation. Thank you for all the participant and we have uh now in this moment we would like to express our sincere appreciation by presenting a certificate of appreciation to our speaker.
Thank you once again B City Fatona for joining us for joining us today.
For all participants, for all participant, please give a virtual round of applause for B City Fatona. Thank you.
Okay, ladies and gentlemen, we have now come to the end of the main session of today's conference. On behalf of the moderator, I would like to express our sincere appreciation to all speakers for their valuable knowledge and inspiring presentations as well as as well as to all participants for the enuistic participation throughout the session.
Hopefully today's discussion will contribute to the advancement of preventive health and chronic disease management practice globally. I sincerely apologize for any mistakes during the session. Thank you very much.
>> I would like to return the session to the master of ceremony.
Thank you Missia as the moderator faculty presents you with a token of appreciation in a form of a certificate.
Thank you very much.
>> Thank you very much. Sorry, ladies and gentlemen.
Please mute your microphone.
Ladies and gentlemen, we would like to inform you that the committer has sent link for the attendance form in the chat box. For participants, please don't forget to complete it and the certificate will be sent to your email address. Make sure that your email address is secure and your name is correctly so that you have don't have to confirm to our committee. As we approach the closing of today's program, allow me to express our deepest appreciation to all speakers, moderator, participants and the organizing comma for the dedication and valuable contribution to the success of this conference. May the discussion and insights shared today continue to inspire us on the importance of strengthening preventive health strategies transforming health policies to future collaboration and concrete action in addressing chronic disease challenge and also promoting sustainable public health system. We hope the insight and experience gained during this conference continue to create positive impacts within our institution, communities and countries.
On behalf of the organizing committee of the third virtual international conference on hold, I would like to express our gratitude in your participation and attention.
Thank you. Stay safe and see you again in the next conference. Good afternoon.
Absolutely.
Dear all the participant do not forget that tomorrow morning is will be our second day of the international conference. So uh please uh turn on your alarm arm to join tomorrow morning at 900 a.m. See you tomorrow.
See you miss.
>> See you miss.
>> Please do not forget to get your uh present playing.
So make sure that you uh submit already your screenshot uh during uh joining on this uh conference.
commitment.
Research Foreign speech. Foreign speech. Foreign speech.
Fore! Foreign! Foreign!
Heat. Heat.
Laboratorium.
Program economy professional global up.
International D program.
Salam International.
Thank you for You should make selfare.
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