Healthy Indonesia 4.0

KOMPAS/LARASWATI ARIADNE ANWAR

Budi Wiweko

Advances in digital technology, big data, artificial intelligence (AI) and genomics in the last two decades have brought enthusiasm and a flow of change to various fields, including health.

The concept of innovative disruption as a breakthrough leading to changes in society and market structures is very much facilitated and accelerated by the Fourth Industrial Revolution. A 2019 survey by the National Health Service (NHS) states that technological progress supports health services or health workers with the ability to analyze genomics, followed by the use of smart phones, voice recognition technology, artificial intelligence for predicting, and intelligent diagnostic devices.

Health problems in Indonesia

Major problems still haunt the world of health in Indonesia in the Fourth Industrial Revolution era. Data from 2018 show poor indicators for various degenerative diseases, such as obesity, hypertension, chronic kidney disease and diabetes. Almost 22 percent of all Indonesians are obese, while 2 percent have diabetes and 3.8 per million people over the age of 15 suffer from chronic kidney disease.

These figures are high compared to neighboring countries or developed countries in the world. Moreover, increased smoking also has a negative impact on society. Pregnant women often experience anemia, which is an important cause of maternal death.

Tuberculosis and dengue fever are still feared in Indonesia with quite high fatality rates. Worldwide, only India has a higher tuberculosis prevalence than Indonesia.

The increase in life expectancy and the successful Family Planning program will produce a demographic bonus until 2030. However, the elderly accounted for around 15 percent of Indonesia\'s population, or some 45 million people, in 2030. Managing the population trends requires good planning.

Policymakers and health professionals in this country need to be willing and able to adopt and adapt quickly, so that they can produce disruptive innovation to help solve the abovementioned major problems.

“Big data”, bioinformatics and AI as keys

In health, big data, which is a combination of clinical and genomic data, can be used to assess risk factors for individual health quantitatively and biochemically.

Noncontagious diseases typically result from a combination and interaction of genetic factors, living habits and the environment. Changes in DNA acid-base coding, the methylation-demethylation process, and acetylation-deacetylation are factors that cause overexpression or underexpression of a gene that triggers certain degenerative diseases.

Bioinformatics is needed to translate clinical and genomic data into an algorithm to recognize disease risk factors at an early stage, allowing for primary prevention and appropriate treatment.

Of course, we still remember the story of Angelina Jolie, who was willing to have both of her breasts removed on suspicion of having a BRCA-1 gene mutation as a carrier of cancer risk with an accuracy of up to 85 percent. All of this is understandable, because it is easily understood through bioinformatics.

The field of bioinformatics is a combination of computer science, mathematics, genetics and basic science. A bioinformatics expert has the ability to translate millions of gigabytes of DNA base pairs into algorithms that are useful in the early detection or management of certain diseases. This approach is enriched by deep learning and machine learning, which can process large amounts of data through artificial intelligence at exceptional speed and with outstanding sharpness of data analysis in health services.

Malaysia has conducted massive and structured cohort studies on more than 100,000 of its citizens to identify risk factors for various degenerative diseases. The study was led by Malaysia\'s Kebangsaan University and titled "For the Future of Malaysia". Through this study, Malaysia will obtain a pattern and algorithm of risk factors for degenerative diseases in its population, so that they can intervene early to produce a superior future generation and save on health spending.

Singapore has already applied the concept of big data and precision medicine in its national insurance program, for example in the provision of genetic-based antiepileptic drugs that avoid phenytoin ineffectiveness due to resistance. This approach can save Singapore millions of dollars in health expenditure.

The United States, through Harvard University, is keen to educate the public – from students of elementary schools and secondary schools to universities – about genetic science and bioinformatics. Various bioinformatic education modules are prepared by Harvard University to educate laypeople on the concept of disease prevention in the future.

For the sake of the future of Indonesia

To allow for the early detection of degenerative diseases, we need to learn and utilize artificial intelligence in mass screening programs, even involving newborns, so that all clinical and genomic data of the Indonesian population is recorded on the Indonesian Health Card.

Indonesia’s Health Ministry is currently focusing on the Healthy Indonesia-Family Approach Program (PIS-PK), which is oriented toward the life cycle. The concept of primary prevention is very closely related to our efforts to prepare babies in the mother\'s wombs. "The first nine months shape the rest of your life," David Barker popularized this hypothesis in 2002.

With disruptive innovation and the application of bioinformatics to the PIS-PK program approach, we could truly cut the chain of degenerative diseases from the upstream.

We have the Indonesian Medical Education Research Institute (IMERI), the University of Indonesia’s School of Medicine and the Eijkman Institute, which have the latest equipment and technological resources (next-generation sequencing) and human resources ready to support the development of genomic-based primary prevention programs.

The Health Care and Social Security Agency (BPJS) just launched the potential of its data wealth that reaches millions of people and thousands of variables, but until now there is no specific algorithm or pattern derived from the big data to be used for health campaigns or preventive measures in Indonesia. Utilizing this data would definitely be a step forward.

The Healthy Indonesia 4.0 program requires an initial investment that is believed to be able to significantly reduce the BPJS’s financing deficit in the future and, as a bonus, we will get a golden generation to meet Indonesia 2045 as one of the developed countries in the world.

Budi Wiweko, Professor at the School of Medicine at the University of Indonesia, Chairperson of Commission 2 of the Academic Senate, University of Indonesia