Environmental change and health risks in coastal Semarang, Indonesia: importance of local indigenous knowledge for strengthening adaptation policies

ABSTRACT

Climate and environmental change are currently in the forefront as global development issues due to their economic, societal and health impacts, and the complex ways these interact. Experience and perception play an important role regarding the overall nature and severity of the environmental change, as these shape coping behaviour. Therefore, more insight is needed into local health-related risk perception, knowledge and coping mechanisms. In Semarang, a low-lying coastal city in Indonesia, a concurrent mixed-methods study design was applied using a cross-sectional survey supplemented by six focus group discussions and eight semi-structured key informant interviews with village officers and health-care workers. Respondents exhibited high awareness of environmental change and impact on health, housing and livelihood, and acknowledged the role of human activity, yet insight in underlying disease mechanisms was low. Most coping mechanisms were mainly short-term due to financial limitations and the frequency and intensity of environmental events. Existing health educational programs should be expanded and incorporate local perception and knowledge, to optimise coping behaviour and strengthen population resilience to environmental change. Further research needs to focus on differences regarding perception and desired coping strategies between household members and individual vulnerability to environmental change.

KEYWORDS:

• Environmental change
• health
• risk perception
• coping mechanism
• Indonesia

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Author contributions

JvdH and ES designed the study, analyzed the data and wrote the paper. All authors were involved in the development of the questionnaire. JvdH, BB and YHD conducted focus group discussions and key informant interviews. BB and YHD translated the focus group discussions and key informant interviews. All reviewed drafts of the paper and approved the final article.

Acknowledgments

The authors want to thank dr. Hanifa M. Denny, BSPH, MPH, PhD (former Dean of the Faculty of Public Health, Diponegoro University) for support and facilitation, and mrs. Toeti Rahajoe and the students of the Faculty of Public Health, Diponegoro University Semarang, for assistance in conducting the surveys and data entry. We also express our gratitude to dr. Hans Groenewoud and dr. Rogier Donders of the Department for Health Evidence, Radboud University Medical Centre for their advice regarding the statistical analyses and to Dr. Leon Bijlmakers for comments on an earlier draft. Lastly, we would like to thank dr. Ton van Naerssen, associate member of the Nijmegen Centre for Border Research (NCBR) at Radboud University Nijmegen, the Netherlands for proof reading the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

Commission on Health Research Ethics of the Faculty of Public Health at Diponegoro University Semarang, Indonesia.

Supplemental data

Supplemental data for this article can be accessed here.

Notes

1. Students received training, including introducing study concepts, safeguarding confidentiality, reporting, dealing with interferences and contingencies, through group discussions and survey field-testing.

2. Assets included education and employment security of head of household, savings, possession of land and goods (radio, computer, mobile phone, refrigerator, air conditioner, television, bicycle, motorcycle, car/truck, generator, boat, sewing machine and stove), and housing quality (type of toilet, building materials and number of rooms). Non-discriminating variables were excluded from the analysis.

3. All focus group discussions and key informant interviews were audio recorded with approval of the participants, transcribed verbatim, translated by a native speaker for thematic analysis and cross-checked by two researchers. Results were categorised as subtopics per theme (knowledge, risk perception, coping mechanisms) and compared to findings of the survey.

4. Twenty-two variables were included to calculate wealth scores and strong indicators of wealth were possession of refrigerator(s), mobile phone(s) and motorcycle(s), and a number of rooms. Possession of a boat was negatively related to wealth, similar to the wealth index of the Indonesian Demographic Health survey of 2012 (Statistics Indonesia (BPS) et al., 2013). This is likely caused by the relation between owning a boat and being a fisherman by profession, an occupation with unreliable income in our research area due to the negative effect of environmental pollution on growth and harvest of fish. Two households, each including one head of household, showed outlying wealth scores due to a combination of high income through primary occupation, receiving remittances from family members, and possession of more goods, land or fish ponds. Outliers did not distort results and were thus included (Table 2).

Additional information

Funding

This study is a side-project of the New Regional Formations (NRF) project, supported by the Volkswagen Foundation. We are grateful for support received for this side-project from Radboud University Medical Centre, Nijmegen, the Netherlands, and Diponegoro University, Semarang, Indonesia.

Notes on contributors

Julie van de Haterd

Julie van de Haterd, Msc, is currently a final-year medical student at the Radboud University in Nijmegen, the Netherlands. She received a master’s degree in Biomedical Sciences at the Radboud University with a specialisation in Health Technology Assessment, consultancy and international public health. She is interested in interfaces between health care and social issues.

Budiyono Budiyono

Dr Budiyono Budiyono is currently associate professor and Dean of the Faculty of Public Health, Diponegoro University Semarang, Indonesia. He is a researcher in the field of public health, focussing on disease and health problems related to environmental risk factors. He has published several articles related health and environmental factors based on research supported by national and foreign grants, and received professional training supported by WHO, UNICEF, Diponegoro University and the Ministry of Health and the Ministry of Research, Technology and Higher Education Republic of Indonesia.

Yusniar Hanani Darundiati

Dr Yusniar Hanani Darundiati is a lecturer and researcher in Faculty of Public Health, Diponegoro University, Indonesia, specialized in environmental health. Her research focusses on heavy metal and pesticide effects on children development and childbearing mothers. Her dissertation was about mercury misuse in artisanal gold mining in Wonogiri, Indonesia and the effect on children development in order to develop a model to prevent this impact.

Ernst Spaan

Ernst Spaan MA, PhD, is Assistant Professor International Public Health at the Radboud Institute for Health Sciences (RIHS), Radboud University Nijmegen, the Netherlands. His research interests concern population and development issues, labour migration, environmental change impacts on health and livelihoods, and health systems reform in developing countries.