COVID-19 Pandemic and Disaster:Preparing Ageing Societies for Better Future in Indonesia

Sari Seftiani1

1 Researcher, National Research and Innovation Agency (BRIN), Indonesia

インドネシアでも新型コロナウイルスの感染爆発が起き、死亡者の多くは60歳以上の高齢者だった。インドネシアでも今後は高齢化の進展が予想されるので、それにどう備えるべきかを考察した。

Abstract

COVID-19 (Coronavirus Disease-19) pandemic has played a special role in demographers’ work to realize ageing
societies in the future. Many factors might be associated with the risk of people who have been exposed to theCoronavirus. Age becomes one of the prominent factors that increase the probability of infected people getting theworse condition. Increasing age in line with the decreasing of physical condition. It is also increasing the propensity
to have chronic diseases that can make the health condition worse for those who are exposed to the virus. Similar
with many countries, most of death cases due to COVID-19 in Indonesia is dominated by older people. Focusing on
demographic characteristics, this paper aims to understand the lessons learned from the COVID-19 pandemic,
especially for preparedness towards ageing population in Indonesia. Using published data from Statistics Indonesia,
it is shown that Indonesia faces an ageing population, and it comes with a great challenge in many aspects such as
health system and better health protection. Data reveals that COVID-19 patients aged more than 60 years old tend
to have a higher death risk when exposed to the virus. Of the older people who were over 60 and infected by thevirus, almost 50 percent ended in death. Strengthening resilience should be achieved by including older people asa vulnerable group. However, the availability of health workers and hospital beds remains a challenge for Indonesia.
Therefore, preparing a better health system and the environment is highly needed to face pandemic and otherdisasters in regard to face ageing population phenomenon.
Keywords

Pandemic, COVID-19, Disaster, Ageing, Indonesia.

Introduction

Since last year, most countries strive to handle theCoronavirus Disease-19 (COVID-19) pandemic. After
the World Health Organization (WHO) announced that
COVID-19 as a pandemic, the cases remain high in many
countries, including Indonesia. Globally, on March 24,
2021, there were 123,902,242 confirmed cases of
COVID-19, and there were 2,727,837 death cases [1].
Meanwhile, there were 1,476,452 COVID-19 cases inIndonesia, and amount to 39,983 death cases [2].
COVID-19 pandemic is related to demographic
aspects. The prominent variable of demographic

determines the morbidity and mortality of COVID-19
cases is age. Older people tend to have a higher risk thanother age groups, especially when COVID-19 exposes
them. It can be one variable to predict to what extent theconsequences might be faced in a country with anageing population profile when the coronavirus spread
rapidly. Similar to Dowd et al. (2020) that revealed
countries with an ageing population tend to more severe
than others when exposed to the COVID-19 [3].
Perhaps, this COVID-19 pandemic is the first occurrence in our lifetimes, and there are limited knowledge
and experiences on how to deal with this situation.

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Sari Seftiani

However, the experiences and lessons of research on
various aspects of the disaster, including public healthemergencies, are relevant to face the health, social andeconomic crisis in the current situation. Focusing on the
COVID-19 pandemic, several actions to warn and protect that have implemented are pose difficulties forpeople at risk. For example, people within the socially
isolated population or those who lack literacy skills may
not receive and understand detailed information about
the COVID-19 pandemic. Also, the health behaviour tofacing the situation is necessary. Using a mask, physicaldistancing, and often washing your hands becomessomething to be done daily. However, some people
remain to ignore to follow the rules.
Meanwhile, Sendai framework for action 2015-2030
highlight the importance to strengthen building resilience at any level and across different groups [4]. It also
includes the agreement to give more efforts to disasterrisk reduction. Disaster whose risk must be reduced
includes disasters due to epidemics and pandemics. It
can be achieved through understanding better risk andincrease preparedness. At the national level, likeIndonesia, the demographic structure is one of the mostimportant aspects to consider that related to increase
preparedness. In particular, entering the ageing population, the number of vulnerable people based on age will
increase, leading to Indonesia becoming a more vulnerable country on the disaster.
Similar to disaster, the COVID-19 pandemic exposes
the nature of the social fabric and seeks out its weaknesses. This pandemic situation shows the socio-economic gap on a big scale. There are different capacities ofpeople in facing the impacts of the COVID-19 pandemic.
For example, migrants workers tend to more vulnerable
due to the COVID-19 pandemic. The policy regarding
lockdown or physical distancing is affected migrant
workers, especially those who live in urban areas, becauseof the business closure [5]. On the other hands, migrant
workers have limited social safety nets. Research inIndia reveals that the COVID-19 pandemic is affectedby the increase in unemployment [5]. In line with Liem
et al. (2020), migrants are one of the groups vulnerable
to the COVID-19 pandemic due to several factors such128

as health, economic, social, and psychology [6].
Therefore, it is crucial to understand the demographic
characteristics to solve and control the COVID-19 pandemic. By understanding the age structure, we can identify the state or region with high risks facing coronavirus.
World Health Organization mentioned that the risk ofseverity if infected by the coronavirus is higher for older
people. Around 95% of death cases are dominated by
the elderly. Meanwhile, amount to 48.5% of death cases
due to COVID-19 in Indonesia was older people category with total positive cases in older people around
10.7% [2]. Focusing on demographic characteristics,
this paper aims to understand the lesson learned fromthe COVID-19 pandemic especially for preparedness
towards the ageing population in Indonesia.  

Methods

This paper utilized data publication from Statistic
Indonesia, Indonesia COVID-19 task force, Indonesia
Health Ministry and other sources. The descriptive
analysis shows the spreading of COVID-19 cases inIndonesia and provides the characteristics of the population whom COVID-19 exposes. Moreover, Statistics
Indonesia’s publication data also used to see the population projection in the future related to the ageing population phenomenon.

The distribution of COVID-19 Cases

When looking at history, the COVID-19 pandemic is
not the first pandemic that infected human life. Indeed,this pandemic also will not be the last. However, there
were great knowledge and experiences from history thatcan be learned to face this current pandemic. There areseveral pandemics which had occurred in the world,such as the bubonic plague (14th century), Spanish flu(1918), HIV/AIDS (20th century) and SARS (20022003) and MERS (2012) [7-11]. The current pandemic
often related to the Spanish flu that occurred in 1918.
Both diseases are caused by the virus that infects the
respiratory tract. Also, the virus’s character was relatively similar that could spread rapidly through closeinteraction [12].
Figure 1 shows the distribution of COVID-19 cases6th AFC Best Papers

0.4

0.3

0.4

0.3

0.4

0.6

0.4

0.6

0.5

0.7

0.6

0.7

0.6

0.7

0.9

0.8

0.7

1.2

1.1

1.1

1.8

1.7

1.3

2.3

2.1

2.1

2.6

2.4

9.4
4.2

4.1

11.3

16.5

25.3

in Indonesia. Coronavirus can spread rapidly, therefore,
all the provinces in Indonesia have the cases, although
the percentage not as much as the provinces in Java. The
first four provinces which have the highest cases in Javasuch as DKI Jakarta, West Java (Jawa Barat), Central
Java (Jawa Tengah) and East Java (Jawa Timur) [2]. The
proportion of COVID-19 cases for those provinces ismore than ten per cent, except for East Java (9.4%).
Followed by East Kalimantan (Kalimantan Timur),South Sulawesi (Sulawesi Selatan) and Bali which haveless than five percent of the total COVID-19 cases [2].
One of the reasons the provinces in Java become predominantly with COVID-19 cases is the high population
density. More than half (56.10%) of Indonesia’s population live on Java Island [13]. Moreover, the first case isfound in DKI Jakarta, and some regions in West Javaare closed to DKI Jakarta. The high mobility around
DKI Jakarta causes the spread of the coronavirus very
quickly. Although it was a little bit late, the policy ofmobility restriction plays a role to control the spread ofcoronavirus in other provinces.

Fig. 1. COVID-19 cases by Province in Indonesia
Source: Indonesia COVID-19 taskforce. 2021. https://covid19.go.id/

Profiling the COVID-19 Patientsfemale for those who confirmed as COVID-19 patients[2]. However, the proportion of male is dominant for
those who are dying due to the coronavirus. Data reveals
that the amount to 57.1% of males is death due to thecoronavirus and 42.9% for females [2]. The differencesin proportion between male and female are 14.2%. Male
has the higher propensity to death than female if they
have exposed by the coronavirus.
100
80

50.9

52

51.1

49.1

48

48.9

Confirmed cases(positive)

Treatment/Isolated

Recover

42.9

60
40
20
0

Male

57.1

Death

FemaleFig. 2. COVID-19 Cases by Sex in Indonesia (%), 2021.
Source: Indonesia COVID-19 taskforce. 2021. https://covid19.go.id/

Furthermore, one of the prominent aspects in demography to understand the COVID-19 pandemic is age
structure. Age structure also related to other vulnerabilities such as education level, socioeconomic status,
living arrangement and housing [14]. Figure 3 shows the
proportion of COVID-19 cases by age groups. Similar toWHO, older people have a higher risk to more severe
when the coronavirus exposes them. As seen in the
figure, the risk to get worse is increasing by ages. The
highest proportion of the death cases due to COVID-19
is persons aged more than 60 years old (47.9) from thepositive total cases in this category around 10.8%. Thisis followed by people aged 46-59 years old amount to36.6% [2].

In this part, the profile of COVID-19 patients will be
described by sex, age groups, and comorbidities. Figure
2 shows the proportion of COVID-19 cases by sex for
four categories: positive cases, treatment or isolated,recovered, and deaths. In general, there is no significant
difference between male and female in COVID-19
cases. The proportion of male is 49.1% and 50.9 of129

Sari Seftiani

60

Tuberculosis (TBC)
47.9

50

AsthmaAutoimune

40

36.6
29.6

30
25

25.4 25.6

CancerBreathing problems

30.3
28.2

Kidney illness
22.5 21.922.1

20

Obstructive Chronic
Pregnant

9.3

10
2.8 3
0

Liver disease

2.9

0-5

11.6

10.2 9.5

6 - 18

9.6

2.7

0.6

0.6

10.8

11.4

19 - 30

Confirmed cases (positive)

0.3
0.8
0.2
0.8
0.2
1
0.3
1.5
0.5
1.7
0.7
2.5
2.3
4.9
1.6
6.1
0.2

Treatment/Isolated

46 - 59

Diabetes Mellitus

Recover

35.6

9.5
0

> 60 years

17.5

9.3

Hypertension
31 - 4510

5.6Heart disease

50.6

10

20
Death

Death

30

40

50

60

Confirmed cases (positive)

Fig. 3. The proportion of COVID-19 cases by age groups (%)

Fig. 4. Comorbidities of COVID-19 patients (%)

Source: Indonesia COVID-19 taskforce. 2021. https://covid19.go.id/

Source: Indonesia COVID-19 task force. 2021. https://covid19.go.id/

From this data, it is crucial to take seriously for acountry with a high proportion of older people or thosewhich are predicted to face the ageing population. It isbecause a similar pandemic can occur in the future.
Based on the experiences regarding the past pandemics,
also the COVID-19, demography becomes spotlight togive more understanding about this pandemic and supporting as basis policies. By considering the age structures, it can help predict the pandemic curve phaseearlier, critical cases burden and supporting to plan theneeds of bed and medical staff in the hospital [15].
Besides sex and age groups, data from Indonesia
COVID-19 Taskforce also shows the comorbidities of
COVID-19 patients. Health condition regarding chronic
diseases plays an important role which increases the riskof severity due to coronavirus. Indeed, some comorbidities make the condition of COVID-19 patients getting
worst. As shown in Figure 4, several comorbidities suchas hypertension, diabetes mellitus and heart disease
become the three diseases that have a high impact on
COVID-19 patients. Almost 10% of COVID-19 whohave comorbidities hypertension and diabetes mellitus
were death.

Toward ageing population in Indonesia

According to data about the COVID-19 cases by age
groups, it is necessary to pay attention to Indonesia’s
population dynamic for the next few years. Indonesia isfacing an ageing population. The proportion of older
people in 2010 at 7.6% of the total population or amounts
to18,1 million people (Figure 5). It is predicted to increase
to 19.8% in 2045 based on the 2015 Intercensal Population
Survey [23]. In other words, in 2045, one out of fivepeople in Indonesia is an older person. According to
Statistics Indonesia, the life expectancy increased from55.1 years in 1971 to 70.8 years in 2015 [16], and it ispredicted to increase slightly until 72 years in 2035 [17].

19.8%
15.8%
11.8%
8.5%

7.6%
2010

2015

2025

2035

2045

Fig. 5. Proportion of Older Indonesian in 2010 - 2045
Source: Statistic Indonesia, 2010; Bappenas, 2018, BPS, dan UNFPA, 2018130

6th AFC Best Papers

A glimpse of health system in Indonesia

Demographic aspects become essential to include inunderstanding the current pandemic. It can be a basis
for policymakers to do preparedness during the pandemic or other disasters. It helps to address and understand the public health crisis.
Since 2014, the Indonesian government issued apolicy regarding universal health coverages. It is targeted to cover all Indonesian citizens. Until 2016, thetotal of Indonesian citizens who have covered by healthsocial security (Jaminan Sosial Kesehatan-JKN) at
171,939,254 [18]. In 2018, the number of participants
registered in the JKN-KIS program (subsidy by the government) had reached 78.16% of the total Indonesian
population (205,071,003 people) [19]. Moreover, thehealth facilities that collaborate with Health Social
Security Institution (BPJS Kesehatan) amount to 27,105[19]. Of the total population, there is 79.44% have covered by JKN both subsidy and non-subsidy.

156,790,287

171,939,254

133,423,653

2014

2015

2016

Fig. 6. Health Insurance Coverage in Indonesia (BPJS)
Source: BPJS Kesehatan, 2016.

Furthermore, the ratio of total beds to 1,000 inIndonesia has reached the standard minimum of WHO.
Nevertheless, eight provinces did not meet the standardof WHO regarding the bed ratio, namely West Nusa
Tenggara (0.74), East Nusa Tenggara (0.83), Banten(0.87), West Java (0.87), Lampung (0.90), West Sulawesi(0.92), Central Kalimantan (0.94) and Riau (0.98) [20].
In 2019, the proportion of health workers was dominated by nurses. The provinces with the highest numberof specialist doctors were DKI Jakarta, namely 6,174
people and East Java, with 5,156 people. Meanwhile, theprovinces with the least number of specialist doctors
were West Sulawesi (93 people) and Maluku (96 people).
It shows that there is a gap disparity between regions. It
becomes an issue in Indonesia regarding the health carefacilities, especially for those provinces outside Java
Island.

Lessons learned

The COVID-19 pandemic becomes a “wake up call”
regarding the efforts to strengthen the resilience as theagreement in Sendai framework for action 2015-2030. It
is because building resilience is a pretty long time process that needs commitment and sustainable efforts.
There are several points to prepare a better future basedon the experiences and knowledge facing both the previous and current pandemic situations.
Three notes that address in this paper regarding thelesson learned from the pandemic. Firstly, it is importantto pay attention to the ageing population in the future.
Countries with a higher older population tend to increase
the risk of case fatality rates and the problems related to
how older people are treated. Some countries prefer tofocus on healthy and most likely to recover rapidly thanolder patients. When a health crisis occurred, older
people tend to more vulnerable than other groups due toseveral reasons. Living longer does not means living
healthier. Increasing age in line with the decreasing ofphysical condition. It is also increasing the propensity tohave chronic diseases that can make the condition
becomes worse especially in the pandemic situation.
Besides physical condition, region play an importantrole regarding the access to health care facilities.
Looking at the gap disparity of health workers, especially specialist doctors in some regions, it is important
to ensure doctors’ availability. Also, the health system
regarding the bed and medical equipment in the hospitalshould be fulfilled. World Health Organization (WHO)revealed that region is associated with access to healthfacilities [21]. Likewise, Ladusingh and Ngangbam(2016) explained that region could help understand thedifferences in access to health care [22]. Older people131

Sari Seftiani

with disability tend to have difficulties to access thehealth facilities especially for those who are living inrural areas. In some rural areas, health care facilities are
not quite enough to reach due to the geography location.
Besides that, increasing the ageing population comes toa set of challenges in everything, including the healthsystem to provide better health insurance. In fact, there
are older people do not have social protection including
the health insurance.
Secondly, learning from the COVID-19 pandemic,
the age structures become a prominent factor to understand the situation. One of the facts that reveal is the roleof comorbidities on older people. The ageing populationin many countries, including in Indonesia, is facing asituation where the deaths caused by chronic diseases
are increasing, which can interact with the pandemic(COVID-19). Due to this phenomenon, it is necessary tointensify health promotion in Indonesia to promote a
healthy life from the young ages and create new habits
to stay healthy by doing some activities. Therefore, thenumber of people with chronic diseases can be reduced.
Likewise, using a mask, washing hands regularly not
only because of the pandemic, but these activities
become healthy behaviour in daily life. A clean andhealthy lifestyle which one of the programs from the
Ministry of Health should be promoted massively in thecommunities.
The last issue that is highly important to address isabout the availability of demographic data, especiallyfor understanding the pandemic. COVID-19 can beunderstood through population trends and patterns.
This can happen when the data and analysis are available. Moreover, the problem of mortality data due to the
COVID-19 can be resolved when a country has a gooddata registration. The accurate data can support the government to make a precise policy particularly in pandemic and disaster situation.

Conclusion

COVID-19 pandemic addresses plenty of knowledge
and experiences that will be lessons learned for preparedness in the future. The current pandemic should beseen beyond health problems. Demographic aspects

132

play an important role to understand the current pandemic. It will help to support the policymakers to handle
the situation. Several demographic aspects, for instance,
age structures, show the prominent role during this current pandemic. Older people tend to have higher risks
than other age groups, especially when they are exposedto the virus. Health condition of older people, social protection and where they are living become some of reasons. The comorbidities that older people have made thecondition getting worse. Therefore, it is urgent to consider the ageing population that will occur in the future.
Based on data, the proportion of older people inIndonesia will increase over times. Strengthening resilience should be done by seeing vulnerable groups suchas older people. How the health system and the environment prepare to face the pandemic and other disasters ishighly needed.

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