INTRODUCTION:

Health is one of the main priorities of the World Health Organization (WHO) and the Government of Indonesia in achieving the Sustainable Development Goals (SDGs), particularly Goal 3, which aims to ensure healthy lives and promote well-being for all at all ages¹.

This goal encompasses nine key targets to be achieved by 2030, including reducing the maternal mortality ratio to fewer than 70 per 100,000 live births, decreasing preventable neonatal and under-five mortality, and lowering deaths caused by communicable and non-communicable diseases².

Healthy Life Expectancy (HLE) has emerged as a critical indicator for assessing population health quality. HLE reflects the number of years an individual is expected to live in good health, free from serious illness or significant disability³. According to United Nations (UN) and WHO data, global life expectancy in 2023 was 70.8 years for men and 76.0 years for women, with an overall average of 73.4 years⁴. Meanwhile, Statistics Indonesia (BPS) reported that in 2019 and 2023, Indonesia’s life expectancy reached 73.93 years for women and 69.4 years for men, showing a steady increase compared to only 59.4 years in 2000⁵.

Population well-being is influenced by the overall health status, which can be improved through comprehensive health development programs⁶. The Indonesian government has initiated the Indonesia Sehat Program, designed to promote health-oriented national development, enhance community self-reliance in maintaining health, and improve the quality of healthcare services. In addition, access to affordable education and healthcare facilities remains a crucial factor in increasing productivity and socio-economic welfare⁷. According to the World Health Organization (2025), population health status is shaped by multiple determinants, including behavior, environment, healthcare services, genetic factors, and broader social determinants such as economic conditions, education, and equity⁸. These determinants interact dynamically in shaping individual and population health outcomes.

MATERIALS AND METHODS:

This study employed a descriptive-analytic design with a field research approach, aiming to explore the determinants of Healthy Life Expectancy (HLE) among the population in Kutai Kartanegara Regency. Data were comprehensively collected through both qualitative and quantitative analyses, focusing on dietary habits, lifestyle, environmental risk factors, healthcare services, as well as genetic or disease history. The research was conducted in Kutai Kartanegara Regency, East Kalimantan, covering various institutional and community settings, including district-level government agencies (Organisasi Perangkat Daerah/OPD), primary healthcare centers (Puskesmas), and neighborhood units (Rukun Tetangga/RT) across 20 sub-districts: Anggana, Kembang Janggut, Kenohan, Kota Bangun, Kota Bangun Darat, Loa Janan, Loa Kulu, Marangkayu, Muara Badak, Muara Jawa, Muara Kaman, Muara Muntai, Muara Wis, Samboja, Samboja Barat, Sanga-Sanga, Sebulu, Tabang, Tenggarong, and Tenggarong Seberang. The fieldwork was carried out over six months, from February 26, 2024, to August 24, 2024.

Data Sources:

The study utilized both primary and secondary data. Primary data were obtained through interviews and surveys with officials at the district-level government agencies (Organisasi Perangkat Daerah/OPD), sub-district authorities, primary healthcare centers (Puskesmas), and community members across 20 sub-districts. Data collection at the OPD level involved various relevant institutions, including the District Health Office, Regional General Hospital, Environmental Agency, Food Security Agency, Public Works and Housing Office, Regional Water Utility (PDAM), Village Community Empowerment Office, Regional Research and Innovation Agency (BRIDA), Regional Development Planning Agency (Bappeda), Women’s Empowerment Office, and the Education Office. Secondary data were collected from multiple sources, including official reports from Statistics Indonesia (BPS), the Health Profile published by the District Health Office, as well as scientific journals and books relevant to the research topic.

Data Collection and Processing Techniques:

Data collection in this study involved interviews, observations, and documentation. Interviews and observations were conducted using structured questionnaires distributed to government officials (OPD), healthcare workers, and community members to obtain relevant information. Documentation was carried out by compiling data from official reports, scientific journals, and books related to public health in Kutai Kartanegara Regency. The collected data were then processed and analyzed using descriptive methods, with the findings presented in the form of tables and narrative explanations. The results of the analysis were used to support the discussion on dietary behavior, lifestyle, environmental conditions, healthcare services, and genetic factors influencing the Healthy Life Expectancy (HLE) of the population.

Population and Sample:

The study population consisted of female residents eligible for identity cards (wajib KTP) in Kutai Kartanegara Regency in 2023, totaling 556,526 individuals according to data from the Department of Population and Civil Registration of Kutai Kartanegara Regency (2024)⁹. The sample size was calculated using the Lemeshow formula for a known population, resulting in 384 respondents. To ensure a representative distribution across sub-districts, a proportional stratified random sampling technique was applied based on the number of female residents in each sub-district. Subsequently, the number of respondents in each neighborhood unit (Rukun Tetangga/RT) was determined proportionally according to the sub-district sample allocation. Respondents were selected using purposive and accidental sampling methods with the following criteria: residents of Kutai Kartanegara Regency, aged 17 years and above, and willing to participate in the interview.

RESULT:

Respondent Characteristics:

The study involved a total of 410 respondents, with a slightly higher proportion of women (52.2%) compared to men (48.8%). In terms of educational background, the majority had completed secondary education (senior high school/vocational school/Islamic senior high school) at 45.4%, followed by junior secondary school (21.5%) and primary school (22.4%). Only 7.6% had attained higher education (diploma, undergraduate, or postgraduate), while 3.2% had never received formal education. Regarding occupational status, the largest groups were housewives (26.6%) and entrepreneurs/traders (20.7%), followed by private employees (14.9%). Meanwhile, 7.8% of respondents were unemployed. This distribution indicates variation in access to and utilization of healthcare services.

From a health perspective, more than half of respondents (52.9%) reported experiencing recurrent health complaints, while 38.8% reported new health issues. Non-communicable diseases (NCDs) were predominant, with the highest prevalence being hypertension (28.5%), hypercholesterolemia (20.0%), gout (15.6%), and diabetes (11.2%). Other chronic conditions were also identified, including stroke (9.5%), heart disease (4.9%), and cancer (1.7%), albeit with lower proportions. Family morbidity levels were also considerable, with 41.5% of respondents reporting family members who had died due to chronic illnesses. The leading causes of death included diabetes (5.1%), aging (3.7%), hypertension (2.4%), and disease complications (2.4%).

Interestingly, in relation to local cultural beliefs, one respondent (0.2%) attributed the cause of death to supernatural factors (santet). While statistically insignificant (0.2% or 1 out of 410 respondents), this finding is socioculturally notable. It suggests that certain segments of the community continue to interpret mortality through a combined natural and supernatural framework, reflecting the persistent influence of socio-cultural and religious beliefs, particularly in the context of significant life events such as death (mortality salience)^10,11.

Table 1. Sociodemographic and Health Characteristics of Respondents (n = 410)

Characteristics	n	%
Sex
Male	200	48.8
Female	210	52.2
Educational Level
No formal education	13	3.2
Primary (SD/MI)	92	22.4
Junior secondary (SMP/MTs)	88	21.5
Senior secondary (SMA/SMK/MA)	186	45.4
Diploma/Undergraduate (D1–S1)	29	7.1
Postgraduate (S2)	2	0.5
Occupation
Unemployed	32	7.8
Housewife	109	26.6
Farmer	25	6.1
Private employee	61	14.9
Trader/Entrepreneur	85	20.7
Others	98	23.9
Recurrent Health Complaints
Yes	217	52.9
No	193	47.1
New Health Complaints
Yes	159	38.8
No	251	61.2
Types of Health Problems
Diabetes	46	11.2
Hypertension	117	28.5
Heart disease	20	4.9
Stroke	39	9.5
Hypercholesterolemia	82	20.0
Cancer	7	1.7
Gout	64	15.6
Allergy	40	9.8
Family Morbidity (Deaths from Chronic Illnesses)
Yes	170	41.5
No	240	58.5
Causes of Family Deaths
Aging	15	3.7
Diabetes	21	5.1
Hypertension	10	2.4
Complications	10	2.4
Heart disease	7	1.7
Gastritis/Ulcer	7	1.7
Suspected supernatural cause (santet)	1	0.2

Analysis Based on the Host, Agent, and Environment (HAE) Approach:

From the host perspective, which refers to individual characteristics, the findings highlight that individuals themselves function as risk factors contributing to disease occurrence. The low proportion of respondents with higher education (only 7.6%) indicates limited understanding of healthy lifestyles and disease prevention. Previous studies have emphasized that health literacy is strongly correlated with education, culture, and language (Nutbeam¹²; Bohlman¹³). In addition, the predominance of informal or non-productive occupations (e.g., housewives and the unemployed) suggests potential limitations in access to preventive healthcare services and social security. The high prevalence of non-communicable diseases (NCDs) such as hypertension, hypercholesterolemia, and diabetes reflects an ongoing epidemiological transition—from infectious disease-related mortality toward degenerative diseases—driven by urbanization, lifestyle changes, and modernization^14,15.

From the agent perspective, the analysis shows that the agents of disease in this context are not biological pathogens such as bacteria or viruses, but rather lifestyle and metabolic risk factors. Hypertension, high cholesterol, and obesity emerge as the main agents that cluster and significantly increase the risk of NCDs. These risks are largely associated with unhealthy diets high in fat, sugar, and salt (FSS), stress, tobacco use, alcohol consumption, sedentary lifestyles, poor sleep patterns, and lack of exercise. Such factors have been identified as the primary drivers of NCDs globally, including in developing countries^16,17.

From the environment perspective, both physical and social environments play a crucial role, encompassing living conditions, access to healthcare, family support, and broader social systems. East Kalimantan, as a migration hub and the site of Indonesia’s new capital city (IKN) development, is undergoing rapid urbanization, which may accelerate lifestyle shifts and social pressures, thereby exacerbating the epidemiological transition toward NCDs. In such contexts, healthcare access may remain uneven or of limited quality, particularly for vulnerable groups lacking social security or adequate health education^18,19.

From the behavioral perspective, the findings align with the Health Belief Model (HBM), which posits that individuals tend to neglect preventive behaviors unless they perceive themselves to be at direct risk (perceived susceptibility). When medical causes are unclear or poorly understood, individuals may resort to alternative explanations, including supernatural beliefs. This indicates that disease perception and prevention are influenced by personal and cultural beliefs, particularly in communities with low education levels that contribute to misperceptions of risk. From a socio-cultural standpoint, the results are also consistent with the Social Determinants of Health framework (WHO, 2008), which highlights that education, decent employment, supportive living environments, and social services strongly shape health outcomes, life expectancy, and access to medical care^20,21,22.

Determinants of Healthy Life Expectancy in Kutai Kartanegara Regency:

The findings presented in Table 2 highlight the key determinants influencing Healthy Life Expectancy (HLE) among the population in Kutai Kartanegara Regency, which include dietary behavior, access to healthy lifestyle information within families, preventive health behavior, and environmental factors.

In terms of dietary behavior, the majority of respondents were categorized as adequate (53.2%) or good (34.1%), while 12.7% remained in the poor category. This indicates that, overall, nutritional intake among the population is relatively sufficient, though its distribution remains uneven.

Conversely, family-level healthy lifestyle information showed notable limitations. Most respondents were in the moderate category (65.9%), with 19.3% categorized as low and only 14.9% as high. This finding suggests that health literacy within households has not yet reached an optimal level.

With regard to preventive health behavior, results varied considerably. At the individual level, 45.6% of respondents demonstrated high preventive practices, though 42.9% were still classified as low. At the family level, most fell into the moderate category (47.1%), followed by low (39.8%) and high (13.1%). These findings indicate that preventive awareness has begun to emerge but remains inconsistent both individually and collectively.

The most prominent determinant was the supportive environment for health. A total of 84.1% of respondents rated their environment as highly supportive, reinforced by field observations showing that 60% of neighborhoods were categorized as good, 31.5% as moderate, and only 8.5% as poor. These results underscore that environmental conditions play a primary and positive role in enhancing Healthy Life Expectancy in Kutai Kartanegara Regency.

Table 2. Determinants Influencing Healthy Life Expectancy in Kutai Kartanegara Regency (n = 410)

Characteristics	n	%
Dietary Behavior
Poor	52	12,7
Adequate	218	53,2
Good	140	34,1
Family Healthy Lifestyle Information
Low	79	19,3
Moderate	270	65,9
High	61	14,9
Individual Preventive Health Behavior
Low	176	42,9
Moderate	47	11,5
High	187	45,6
Family Preventive Health Behavior
Low	163	39,8
Moderate	193	47,1
High	54	13,1
Supportive Health Environment (Self-Reported)
Low	9	2,20
Moderate	56	13,66
High	345	84,14
Environmental Observation
Poor	35	8.5
Moderate	129	31.5
Good	246	60.0

DISCUSSION:

Sociodemographic characteristics of respondents indicate a relatively balanced gender distribution between males (48.8%) and females (52.2%), suggesting that the study population adequately represents the community in terms of sex composition. Educational attainment was dominated by senior high school graduates (45.4%) and elementary graduates (22.4%), whereas only 7.6% of respondents had higher education. The limited proportion of higher education implies restricted health literacy, which is strongly associated with the capacity to understand and apply healthy lifestyle practices²³. This is reflected in the findings where the majority of respondents reported only “adequate” dietary behavior (53.2%), followed by “good” (34.1%), while 12.7% remained in the “poor” category.

Regarding occupational status, most respondents were engaged in the informal sector, such as trade/self-employment (20.7%), private employees (14.9%), farmers (6.1%), and housewives (26.6%). Employment in the informal sector is frequently associated with limited access to healthcare services and irregular lifestyle patterns²⁴. This explains why, despite relatively high individual preventive health behavior (45.6%), the overall quality of healthy lifestyle practices remains low. Hence, occupational status emerges as a significant determinant of health disparities.

The burden of non-communicable diseases (NCDs) among respondents was considerable, particularly hypertension (28.5%), hypercholesterolemia (20.0%), gout (15.6%), and diabetes mellitus (11.2%). These figures are consistent with the National Health Survey (Riskesdas) report highlighting the increasing prevalence of NCDs in Indonesia²⁵. Healthy dietary practices are closely linked to the prevention of hypertension and diabetes²⁶, while dietary improvements without access to nutritious food sources provide limited impact²⁷. Accordingly, the high prevalence of NCDs observed in this study can be understood as a consequence of suboptimal dietary behavior.

At the family level, most respondents reported that healthy lifestyle information within households was at a moderate level (65.9%), while preventive health behavior in families also clustered predominantly at the moderate category (47.1%). This indicates a weak intergenerational transfer of health values. Families play a central role as health change agents²⁸, and higher family health literacy has been shown to significantly reduce NCD risks²⁹. Strengthening the family’s role in health promotion therefore becomes an essential strategy.

Environmental factors were generally supportive, with 84.1% of respondents perceiving their neighborhood as healthy, and 60% categorizing it as “good.” However, the discrepancy between a supportive environment and the persistently high NCD prevalence highlights a behavioral gap. Similar findings in Malaysia suggest that a healthy environment only translates into better outcomes when accompanied by consistent healthy behaviors^30,31.

Taken together, the findings reveal a public health paradox: while individual preventive behavior is relatively high and the physical environment is supportive, overall healthy lifestyle practices remain low, and NCD prevalence continues to rise. This underscores the need for multi-level interventions, including strengthening health literacy from early education, reinforcing the family’s role as a health promotion agent, and optimizing healthy environments through sustained behavioral change strategies. An integrative approach of this nature is expected to sustainably enhance healthy life expectancy in alignment with national health development agendas and the Sustainable Development Goals (SDGs).

CONCLUSION:

This study highlights that public health in Kutai Kartanegara Regency remains burdened by the high prevalence of non-communicable diseases, particularly hypertension, hypercholesterolemia, gout, and diabetes mellitus. Although preventive behaviors and environmental support were relatively adequate, limited family health literacy and suboptimal healthy lifestyle practices emerged as the primary barriers to improving healthy life expectancy. These findings underscore the need for integrated interventions that are culturally sensitive, strengthen the role of families, engage community leaders, and promote behavioral changes alongside trust-building in the health system. Such strategies are essential to achieve sustainable improvements in healthy life expectancy and align with broader public health and development goals.

CONFLICT OF INTEREST:

All authors declared no conflict of interest within this study.

ACKNOWLEDGMENTS:

This research was fully supported by the Research and Innovation Agency of Kutai Kartanegara Region, Kutai Kartanegara Regency, East Kalimantan.

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Received on 25.09.2025 Revised on 23.10.2025

Accepted on 14.11.2025 Published on 07.03.2026

Available online from March 10, 2026

Res. J. of Humanities and Social Sciences. 2026;17(1):27-32.

DOI: 10.52711/2321-5828.2026.00005

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.