including the prevalence of hypertension. In terms of measures of health outcomes, while some trends seem upwards, specifically the movement out of undernutrition and communicable diseases, there seems at the same time to have been a movement toward more risk factors that are likely to lead to future chronic problems, but not universally so. Related to this, other symptoms, such as low levels of HDL cholesterol, are very high, especially for men, and the extremely high rate of current male smoking does not yet show a downward trend (Witoelar, Strauss, and Sikoki, 2009).
The backdrop of these important health and nutrition transitions is a country where the formal social safety system is still in its infancy and policies and programs that are designed to address specific challenges brought about by an aging population are still lacking.2,3 As in many developing countries in the region, elderly in Indonesia mostly rely on children and family networks for old-age support, either through co-residency or transfers (Cameron and Cobb-Clark, 2008). With the elderly population becoming more exposed to risk of chronic and noncommunicable diseases, the issues of elderly care are becoming increasingly important.4 Understanding the socioeconomic status (SES) correlates of elderly health outcomes will help to improve knowledge that could be useful in designing health as well as social programs to improve the well-being of the elderly in Indonesia.
In this chapter, we document the health and nutrition transition that the elderly population in Indonesia has undergone in the 15 years between 1993 and 2008, using the four full waves of the Indonesia Family Life Survey (IFLS).5 This period spans a period of rapid economic growth from 1993 to 1997, a major financial crisis starting at the end of 1997 going through 1998 and 1999, and a major economic expansion starting in 2000, continuing through early 2008. IFLS is uniquely suited to look at changes over time, both for age groups and for birth cohorts in Indonesia, as it is a panel survey covering most of the country. Indonesia, like other developing countries in Asia and Latin America, has been aging rapidly. In 1980, only 3.4% of the population was aged 65 and older; by 2010, it was projected to be 6.1%, and by 2040, 14.7% (Kinsella and He, 2009). The population aged 65 and older is projected to double between 2000 and 2020 and again by 2040. We examine the IFLS sample 45 years and older
2 An important bill on social safety nets was passed in October 2004 (Law no 40/2004). It includes a number of provisions that are important for elderly such as pensions, old-age savings, and health coverage, but has yet to be implemented.
3 See Abikusno (2009) for a review of past and recent laws and government policies related to elderly in Indonesia.
4 Van Eeuwijk (2006) argues that the epidemiological health transition has necessitated a shift from a “cure” to “care” paradigm in healthcare delivery in urban areas in Indonesia.
5 IFLS1 was fielded in 1993, IFLS2 in 1997, IFLS3 in 2000, and IFLS4 in 2007-2008