Breaking the Sedentary 9-to-5 Spell of Cardiovascular Concerns

The 76th Session of the World Health Organization (WHO) Regional Committee for South-East Asia (SEARO76) concluded just last week. When I tuned in to the 4-day conference, I noticed one particular concern brought up by all Member States — cardiovascular health. It could not be more apparent from their pre-session morning yoga and Zumba activities to rounds of observations where they shared achievements, challenges, and strategies to address cardiovascular disease (CVD) among their population.

To put into perspective how concerning CVD is, it contributes to 3.9 million deaths in the region every year. Most CVD deaths occur prematurely among individuals between the ages of 30 and 69 years. In Indonesia, more than 470,000 deaths are caused by coronary heart disease (CHD) and stroke annually. Several risk factors of CVDs like hypertension, high blood sugar, smoking, and obesity are placed as the top 5 health burdens in Indonesia. In 2022 alone, catastrophic disease financing increased to USD 1,536 billion (IDR 24.06 trillion). Ischemic heart disease and stroke also burdened the National Health Insurance (JKN) with a financing of USD 981.9 billion (IDR 15.37 trillion).

Such grave numbers had me reflecting on my own lifestyle and those around me who are in the same circumstance — sitting down from 9-to-5 (or more), 5 days a week, in front of our laptops. Many of us stay indoors, sip on (iced) coffee almost every day, order quick lunches and snack on processed foods saturated with sweet or savory flavors. Some also take smoke break(s) in the middle of Jakarta’s bad air quality.

These habits are build-ups of CVD risk factors which could manifest later in our lives, but we usually just brush them off, thinking that a morning run on the weekend or a one-hour body combat class could offset the not-so-wise choices we make and the stress that piles up over the week. It came as no surprise when a 2018 study pointed out that white-collar Indonesian workers are 1.6 times more likely to be diagnosed with CVDs. Another 2020 study also found that CVD risk factors are high and increasing in urban areas, and are associated with those higher in income and education levels.

But the good news is that CVDs are preventable.

A 2022 initiative dubbed SEHEARTS, or the South-East Asia-HEARTS, was first introduced by the WHO SEARO in commemoration of World Heart Day 2022. It emphasized the accelerated implementation of WHO technical packages — WHO HEARTS (for CVD management in primary healthcare), WHO MPOWER (to reduce the demand for tobacco), WHO SHAKE (for salt reduction) and WHO REPLACE (for eliminating industrially-produced trans-fatty acid). A Regional Workshop for implementing the WHO South-East Asia NCD Roadmap 2022–2030 was held on 12-15 June 2023 in Dhaka, Bangladesh, where SEARO Member States produced an outcome titled “Dhaka Call to Action” that represents a set of prioritized actions and interim milestones of the SEAHEARTS initiative for 2025.

So, how do we put these into action, or walk the talk?

During the SEARO76, Indonesia discussed its fair share of commitments with the region’s SEAHEARTS and Dhaka Call to Action agreements, first and foremost through strengthening the national healthcare system to enhance prevention, early detection, and management of CVDs. Integrated healthcare posts (posyandu) across Indonesia provide blood pressure screenings for all people 15 years and up to boost the coverage of NCD screening nationwide, which currently only stands at 16.4%. This is despite the majority of Indonesians having good knowledge regarding CVDs and the risk factors. With the booming food delivery services, we are spoiled with promo codes to buy whatever food our hearts desire. Additionally, smoking culture is very prevalent among Indonesian males, which can be attributed to internalized masculinism.

In light of this, the Indonesian Health Ministry placed a great effort in public awareness campaigns on physical activity, healthy diets, low-on-salt consumption, and tobacco control, dubbed the “CERDIK” campaign, which stands for Check-up on health to find NCD risk factors, Eliminate smoking, Routinely do physical activity, Dieting with balanced nutrition, Incorporate enough rest, and Keep stress levels manageable. Interestingly, 1 out of 5 Indonesians who did not exercise before, started running and doing home workouts during the COVID-19 lockdown, and the habit is here to stay.

It has also become a norm as of late for companies to encourage their employees to participate in after-work exercise and sports or clubs, from yoga, futsal, badminton, tennis, running — all kinds of exercise imaginable. We can also turn to YouTube for free, quality exercise content when we just don't feel like going outside. Content creators also share cheap, healthy, and beginner-friendly recipes that we can all follow and are not just chicken breasts, oatmeal, greens, and black coffee on rotation.

We have all the means. Now it is just a matter of will and realization that we only have this one body to experience the richness of life. If not now, if not us, then who will do it?

P.S. It is okay to indulge in sweet desserts or skip a workout sometimes! Like all things in life, health, too, is a matter of balance; between the body and the mind, discipline and relaxation.