Abstract

Life expectancy is widely recognized as a fundamental indicator of population health, and its improvement is often linked to government health spending, particularly in decentralized health systems. This study aimed to investigate the relationship between local government health expenditures and life expectancy in decentralized Indonesia. Data from 492 cities and districts, spanning from 2015 to 2019, were analyzed using a two-way fixed effects regression model to control for time-invariant district characteristics and common temporal shocks. The findings indicated that a 10% increase per capita in government health expenditure was associated with a 0.01% increase in life expectancy. This association was established after adjusting for key health system and contextual variables, including physician density, sanitation coverage, poverty rates, and proportion of fiscal transfers from the central government. The association remained strong and statistically significant across all model parameters. The results demonstrated that increased local health expenditure improves population health outcomes.

References

1. Liberty IA, Septadina IS, Rizqie MQ, et al. Community childhood obesity assessment in elementary school, anthropometric indices as screening tools: A community cross-sectional study in Indonesia. BMJ Public Health. 2024; 2 (1): e000751. DOI: 10.1136/bmjph-2023-000751.

2. Hanandita W, Tampubolon G. The double burden of malnutrition in Indonesia: Social determinants and geographical variations. SSM Popul Heal. 2015; 1: 16–25. DOI: 10.1016/j.ssmph.2015.10.002.

3. Pulungan AB, Puteri HA, Ratnasari AF, et al. Childhood Obesity as a Global Problem: A Cross-sectional Survey on Global Awareness and National Program Implementation. J Clin Res Pediatr Endocrinol. 2024; 16 (1): 31-40. DOI: 10.4274/jcrpe.galenos.2023.2023-7-5.

4. Nurwanti E, Hadi H, Chang JS, et al. Rural–urban differences in dietary behavior and obesity: Results of the riskesdas study in 10–18-year-old Indonesian children and adolescents. Nutr. 2019; 11 (11): 2813. DOI: 10.3390/nu11112813.

5. Ahmad A, Zulaily N, Shahril MR, et al. Association between socioeconomic status and obesity among 12-year-old Malaysian adolescents. PLoS One. 2018; 13 (7): e0200577. DOI: 10.1371/journal.pone.0200577.

6. Sarintohe E, Larsen JK, Burk WJ, et al. The Prevalence of Overweight Status Among Early Adolescents From Private Schools in Indonesia: Sex-Specific Patterns Determined by School Urbanization Level. Nutr. 2022; 14 (5): 1001. DOI: 10.3390/nu14051001.

7. Putri R, Asniar, Tahlil T. Relationship of Social Determinants and Physical Activity among Adolescents with Risk of Obesity in Rural Areas of Indonesia. Int J Nurs Educ. 2023; 15 (1): 5–11. DOI: 10.37506/ijone.v15i1.18997.

8. Di Cesare M, Sorić M, Bovet P, et al. The epidemiological burden of obesity in childhood: A worldwide epidemic requiring urgent action. BMC Med. 2019; 17: 212. DOI: 10.1186/s12916-019-1449-8.

9. Chen Z, Chen P, Zhu L. Associations of sleep, sedentary behavior, and physical activity during out-of-school time and the risk of overweight and obesity in children and adolescents: A dose-response and isotemporal substitution analysis. BMC Public Health. 2025; 25: 1877. DOI: 10.1186/s12889-025-23011-9.

10. Atmaja ARD, Hidayat R, Rokhman S, et al. Factors influencing adolescent BMI a study between rural and urban areas in Mamuju Regency. Dialnet. 2025; 68: 234–248.

11. Daradkeh G, Al Muhannadi A, P Chandra, et al. Dietary Habits and Intakes Associated with Obesity and Overweight Among Adolescents in the State of Qatar. J Nutr Disord Ther. 2015; (S1): 005. DOI: 10.4172/2161- 0509.S1-005.

12. Murni IK, Sulistyoningrum DC, Susilowati R, et al. The Association Between Dietary Intake and Cardiometabolic Risk Factors Among Obese Adolescents in Indonesia. BMC Pediatr. 2022; 22: 273. DOI: 10.1186/s12887-022-03341-y.

13. Ford ND, Patel SA, Narayan KMV. Obesity in Low- and Middle-Income Countries: Burden, Drivers, and Emerging Challenges. Annu Rev Public Health. 2017; 38: 145–164. DOI: 10.1146/annurev-publhealth-031816-044604.

14. Noonan RJ. Poverty, Weight Status, and Dietary Intake Among UK Adolescents. Int J Environ Res Public Health. 2018; 15 (6): 1224. DOI: 10.3390/ijerph15061224.

15. Iyun OB, Okobi OE, Nwachukwu EU, et al. Analyzing Obesity Trends in American Children and Adolescents: Comprehensive Examination Using the National Center for Health Statistics (NCHS) Database. Cureus. 2024; 16 (6): e61825. DOI: 10.7759/cureus.61825.

16. Gallego A, Olivares‐Arancibia J, Yañéz‐Sepúlveda R, et al. Socioeconomic Status and Rate of Poverty in Overweight and Obesity Among Spanish Children and Adolescents. Children. 2024; 11 (8): 1020. DOI: 10.3390/children11081020.

17. Nugroho PS, Tianingrum NA, Sunarti S, et al. Predictor risk of diabetes mellitus in Indonesia, based on national health survey. Malaysian J Med Heal Sci. 2020; 16 (1): 126–30.

18. Ruiz LD, Zuelch ML, Dimitratos SM, et al. Adolescent Obesity: Diet Quality, Psychosocial Health, and Cardiometabolic Risk Factors. Nutr. 2019; 12 (1): 43. DOI: 10.3390/nu12010043.

19. Bakhtiar S, Famelia R, Goodway JD. Developing a Motor Skill-Based Curriculum for Preschools and Kindergartens as a Preventive Plan of Children Obesity in Indonesia. Adv Heal Sci Res; 2020. DOI: 10.2991/ahsr.k.200214.030.

20. Fauzi FA, Mohd Zulkefli NA. Biosocial background in the development of child overweight and obesity among preschoolers in Putrajaya: An observational study. Malaysian J Med Heal Sci. 2017; 13 (3): 11–20.

21. Rachmi CN, Li M, Alison Baur L. Overweight and obesity in Indonesia: Prevalence and risk factors—a literature review. Public Health. 2017; 147: 20–29. DOI: 10.1016/j.puhe.2017.02.002.

22. Ramesh N, Kumar P, Sweta S, et al. Correlation of anthropometric measurements with body mass index and estimation of the proportion of metabolic syndrome among overweight and obese children: A hospital-based cross-sectional study. BMJ Paediatr Open. 2024; 8: e002354. DOI: 10.1136/bmjpo-2023-002354.

23. Kachi Y, Otsuka T, Kawada T. Socioeconomic status and overweight: A population-based cross-sectional study of Japanese children and adolescents. J Epidemiol. 2015; 25 (7): 463–469. DOI: 10.2188/jea.JE20140108.

24. Iqhrammullah M, Abshori NF, Rampengan DDCH, et al. Does urban living contribute to better nutrition? An ecological study on urban–rural disparities in Indonesia. Res Square; 2025. DOI: 10.21203/rs.3.rs-7177814/v1.

25. Wibowo A, Cholid S, Annisah, et al. Effects of Peers on Obesogenic Behavior in Indonesia’s Adolescents: A Case Study of Adolescents in the Provinces of DI Yogyakarta, South Kalimantan, and Bali. Adv Soc Sci Educ Humanit Res; 2021. DOI: 10.2991/assehr.k.210531.007.

26. Widjaja NA, Prihaningtyas RA. Determinants of Food Choice in Obesity. Indones J Public Heal. 2020; 15 (1): 122–132. DOI: 10.20473/ijph.v15i1.2020.122-132.

27. Rachmi CN, Li M, Baur LA. Overweight and Obesity in Indonesia: Prevalence and Risk Factors—a Literature Review. Public Health. 2017; 147: 20–29. DOI: 10.1016/j.puhe.2017.02.002.

28. Rachmi CN, Jusril H, Ariawan I, et al. Eating Behaviour of Indonesian Adolescents: A Systematic Review of the Literature. Public Health Nutr. 2020; 24 (S2): s84–s97. DOI: 10.1017/S1368980020002876.

29. Eker HH, Taşdemir M, Mercan S, et al. Obesity in adolescents and the risk factors. Turkish J Phys Med Rehabil. 2018; 64 (1): 37–45. DOI: 10.5606/tftrd.2018.1402.

30. Liu H, Bi C, Lin H, et al. Compared with dietary behavior and physical activity risk, sedentary behavior risk is an important factor in overweight and obesity: Evidence from a study of children and adolescents aged 13–18 years in Xinjiang. BMC Pediatr. 2022; 22: 582. DOI: 10.1186/s12887-022-03646-y.

31. Liang Y, Zhu X, Yang JH, et al. Associations of different types of physical activity and sedentary behavior with self‑rated health in children and adolescents: A systematic review of research from 2010 to 2024. Int J Behav Nutr Phys Act. 2025; 22: 48. DOI: 10.1186/s12966-025-01747-2.

32. Andrade A, Mara K, Oliveira AD, et al. Physical activity as a protective factor in the mood of children and adolescents: Association with overweight and obesity. Front Pediatr. 2025; 13: 1494998. DOI: 10.3389/fped.2025.1494998.

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