• Nafsiah Mboi, Indra Murty Surbakti, Indang Trihandini, Iqbal Elyazar, Karen Houston Smith, Pungkas Bahjuri Ali, Soewarta Kosen, Kristin Flemons, Sarah E Ray, Jackie Cao, Scott D Glenn, Molly K Miller-Petrie, Meghan D Mooney, Jeffrey L Ried, Nur Anggraini NingrumDinaDDepartment of Public Health, Universitas Negeri Semarang, Semarang City, Indonesia; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei City, Taiwan., Fachmi Idris, Kemal N Siregar, Pandu Harimurti, Robert S Bernstein, Tikki Pangestu, Yuwono Sidharta, Mohsen Naghavi, MurrayChristopher J LCJLInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., and Simon I Hay.
• Centre for Strategic and International Studies, Jakarta, Indonesia; National Commission for Tobacco Control, Jakarta, Indonesia.
• Lancet. 2018 Aug 18; 392 (10147): 581591581-591.

BackgroundAs Indonesia moves to provide health coverage for all citizens, understanding patterns of morbidity and mortality is important to allocate resources and address inequality. The Global Burden of Disease 2016 study (GBD 2016) estimates sources of early death and disability, which can inform policies to improve health care.MethodsWe used GBD 2016 results for cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 333 causes in Indonesia and in seven comparator countries. Estimates were produced by location, year, age, and sex using methods outlined in GBD 2016. Using the Socio-demographic Index, we generated expected values for each metric and compared these against observed results.FindingsIn Indonesia between 1990 and 2016, life expectancy increased by 8·0 years (95% uncertainty interval [UI] 7·3-8·8) to 71·7 years (71·0-72·3): the increase was 7·4 years (6·4-8·6) for males and 8·7 years (7·8-9·5) for females. Total DALYs due to communicable, maternal, neonatal, and nutritional causes decreased by 58·6% (95% UI 55·6-61·6), from 43·8 million (95% UI 41·4-46·5) to 18·1 million (16·8-19·6), whereas total DALYs from non-communicable diseases rose. DALYs due to injuries decreased, both in crude rates and in age-standardised rates. The three leading causes of DALYs in 2016 were ischaemic heart disease, cerebrovascular disease, and diabetes. Dietary risks were a leading contributor to the DALY burden, accounting for 13·6% (11·8-15·4) of DALYs in 2016.InterpretationOver the past 27 years, health across many indicators has improved in Indonesia. Improvements are partly offset by rising deaths and a growing burden of non-communicable diseases. To maintain and increase health gains, further work is needed to identify successful interventions and improve health equity.FundingThe Bill & Melinda Gates Foundation.Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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