Improving the production of Indonesian non-sugarcane alternatives as a public health intervention: Challenges and opportunities
Indonesia ranks among the top 10 countries with the highest prevalence of type 2 diabetes, experiencing one of the steepest increases globally. Could improving the production of non-sugarcane alternatives provide a viable solution?
In 2021, the global prevalence of diabetes among individuals aged 20-79 was estimated at 10.5% (536.6 million people) and is projected to rise to 12.2% (783.2 million) by 2045. As of 2023, Indonesia had a total of 14.9 million cases of all types of diabetes, a figure expected to grow to 28.6 million by 2045.
Diabetes is a chronic condition that occurs when the pancreas produces insufficient insulin or the body becomes resistant to insulin, leading to impaired blood sugar regulation. This imbalance can result in short- and long-term complications, including neuropathy, peripheral vascular disease, kidney disease, and cardiovascular disease.
Diabetes and the role of food environments
According to the 2023 Survei Kesehatan Indonesia report, diabetes is more prevalent in urban areas than in rural areas, with prevalence rates of 12.1 and 11.2, respectively. This disparity is partly attributed to food environments in urban settings, which often promote the consumption of unhealthy foods. The availability, accessibility, and affordability of specific types of foods within communities significantly influence dietary behaviors and health outcomes.
A study examining the relationships between retail food environments, obesity, diabetes, and community income found that individuals living near a high density of fast-food restaurants and convenience stores–commonly known as“food swamps”–have a significantly higher prevalence of obesity and diabetes compared to those living near grocery stores or fresh produce vendors.
Fast-food dining is associated with higher caloric intake, lower consumption of fruits and vegetables, and increased intake of sugary beverages, all of which elevate the risk of obesity and diabetes. Similarly, convenience stores primarily sell ultra-processed foods (UPFs) of low nutritional value, further exacerbating these health challenges.
In addition to the prevalence of UPFs, unsupportive food environments in Indonesia increase the availability, accessibility, and affordability of cane sugar. Current agrifood policies prioritize monoculture production of a limited number of strategic commodities, including rice, corn, soybeans, shallots, garlic, chili peppers, beef or buffalo meat, chicken meat, chicken eggs, fish, oil, and sugarcane, due to their economic significance and influence on inflation. Despite being prioritized as a strategic commodity, Indonesia faces a sugarcane production shortfall of 6 million tons, placing additional pressure on natural resources and increasing economic vulnerabilities.
Cane sugar, heavily supported by government subsidies and imports, is significantly cheaper at Rp18,450.00 per kilogram than alternatives like aren and coconut sugar, which range between Rp25,000.00 and Rp45,000.00 per kilogram, respectively.
While these policies ensure the affordability of cane sugar, they overlook critical aspects of sustainable food systems, such as resource management, nutrient diversity, and public health–factors essential for climate resilience, equitable access to nutritious food, and reducing diabetes prevalence.
The potential for non-sugarcane alternatives
Can reshaping food environments help lower diabetes prevalence and provide safe options for individuals with diabetes?
Diversifying sugar sources beyond sugarcane offers a promising pathway, and this begins with prioritizing the production of non-sugarcane alternatives.
Monoculture sugarcane farming in Indonesia carries significant environmental costs, as its dependence on chemical inputs like imported pesticides and synthetic fertilizers is associated with depleted soil health and genetic diversity. This leaves ecosystems vulnerable to disease outbreaks and environmental stressors, exacerbating long-term sustainability challenges in Indonesian agriculture.
Indonesia has a rich tradition of producing sugar from various palm tree species, including arenga (Arenga pinnata), coconut (Cocos nucifera), lontar (Borassus flabellifer), and nipa palm (Nypa fruticans). Palm sap sugar, or neera, is a natural sweetener derived from these palms, which offers a potential alternative to cane sugar.
Regarding the climate, these palms contribute to carbon absorption and support land and water conservation, sequestering an average of 0.478 tons of carbon per tree. When managed sustainably, palm sugar production can be both economically and environmentally viable. However, the extraction and processing stages, particularly sugar recovery, can be resource-intensive and require considerable energy inputs.
Palm sugars, such as those from arenga and coconut palms, have health benefits compared to cane sugar. For instance, coconut palm sugar has a glycemic index (GI) of 35, significantly lower than cane sugar at 60. Additionally, palm sugars retain essential nutrients, including antioxidants (phenolic compounds and flavonoids), vitamin C, and minerals (potassium and sodium) due to minimal processing. These properties make palm sugars slightly nutritionally superior, as they offer more than just empty calories.
However, evidence on the full environmental impacts and the health benefits of palm sugars remains limited and inconclusive, suggesting that more research is needed to fully understand the long-term impacts of palm sugars on climate and health, particularly for individuals with diabetes.
Improving the Indonesian sugar ecosystem for climate and health
Indonesia’s national food production strategy prioritizes staple commodities, especially rice for carbohydrates and sugarcane for sweeteners. This focus on sugarcane production leaves consumers with few affordable alternatives, perpetuating high cane sugar consumption. A lack of public awareness about non-cane sugar alternatives further reinforces the dominance of sugarcane in the market, limiting healthier and more sustainable choices.
While research on the environmental and health impacts of palm sugar production is still emerging, growing evidence suggests that diversifying the sugar ecosystem in Indonesia could align environmental conservation with socioeconomic and cultural interests.
The Indonesian B2SA (Diversification of Food Sources) initiative provides an opportunity to promote non-sugarcane sweeteners, such as arenga, coconut, lontar, and nipa. Scaling up production to meet rising consumer demand ensures these alternatives are viable and accessible. A balanced approach is necessary–one that simultaneously creates demand for alternative sweeteners while ensuring their reliable supply–to avoid unmet expectations and market inefficiencies.
Building a solid evidence base on the environmental and health impacts of non-sugarcane alternatives–especially in the context of diabetes and food environments–can play a pivotal role in shaping public health policies and influencing consumer behavior. By systematically evaluating the effects of different sweeteners on blood sugar regulation, insulin sensitivity, and resource use, researchers can provide actionable insights for prevention and management strategies.
References:
Sun, H. et al. (2022) ‘IDF diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045’, Diabetes Research and Clinical Practice, 183, p. 109119. doi:10.1016/j.diabres.2021.109119.
Survei Kesehatan Indonesia (ski) 2023 - Badan Kebijakan Pembangunan Kesehatan: BKPK Kemenkes (2024) Badan Kebijakan Pembangunan Kesehatan | BKPK Kemenkes. Available at: https://www.badankebijakan.kemkes.go.id/hasil-ski-2023/ (Accessed: 14 November 2024).
Diabetes (2024) World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes (Accessed: 14 November 2024).
Naseri, M.W., Esmat, H.A. and Bahee, M.D. (2022) ‘Prevalence of hypertension in type-2 diabetes mellitus’, Annals of Medicine & Surgery, 78. doi:10.1016/j.amsu.2022.103758.
Feldman, E.L. et al. (2019) ‘Diabetic neuropathy’, Nature Reviews Disease Primers, 5(1). doi:10.1038/s41572-019-0092-1.
Spampinato, S.F. et al. (2020) ‘The treatment of impaired wound healing in diabetes: Looking among old drugs’, Pharmaceuticals, 13(4), p. 60. doi:10.3390/ph13040060.
Babey, S. et al. (2008) UCLA Center for Health Policy Research. Available at: https://escholarship.org/content/qt7sf9t5wx/qt7sf9t5wx.pdf?t=lnq48w&v=lg.
Cooksey-Stowers, K., Schwartz, M. and Brownell, K. (2017) ‘Food swamps predict obesity rates better than food deserts in the United States’, International Journal of Environmental Research and Public Health, 14(11), p. 1366. doi:10.3390/ijerph14111366.
Kementan Jaga Produksi, Pastikan Stok Gula Aman Selama Bulan Ramadhan hingga Lebaran (2024) KEMENTERIAN PERTANIAN DIREKTORAT JENDERAL PERKEBUNAN. Available at: https://ditjenbun.pertanian.go.id/kementan-jaga-produksi-pastikan-stok-gula-aman-selama-bulan-ramadhan-hingga-lebaran/#:~:text=Selain%20memberikan%20pupuk%20bersubsidi%2C%20di,dan%20kemudahan%20dalam%20kredit%20perbankan.
Green, A. et al. (2020) ‘Assessing nutritional, health, and environmental sustainability dimensions of Agri-Food Production’, Global Food Security, 26, p. 100406. doi:10.1016/j.gfs.2020.100406.
Finley, J.W. et al. (2017) ‘Nutritional sustainability: Aligning priorities in nutrition and Public Health with agricultural production’, Advances in Nutrition, 8(5), pp. 780–788. doi:10.3945/an.116.013995.
Roberts, D.P. and Mattoo, A.K. (2019) ‘Sustainable crop production systems and human nutrition’, Frontiers in Sustainable Food Systems, 3. doi:10.3389/fsufs.2019.00072.
Weiler, A.M. et al. (2014) ‘Food sovereignty, food security and health equity: a meta-narrative mapping exercise’, Health Policy and Planning, 30(8), pp. 1078–1092. doi:10.1093/heapol/czu109.
Kurniawan, T. et al. (2018) ‘Palm Sap sources, characteristics, and utilization in Indonesia’, Journal of Food and Nutrition Research, 6(9), pp. 590–596. doi:10.12691/jfnr-6-9-8.
Rianse, I. et al. (2016) ‘Financial, Economic And Environmental Feasibility Analysis Of Palm Sugar Domestic Industry In Kolaka Indonesia ’, International Journal of Economics and Management Systems, 11.
Yusof, S.J. et al. (2018) ‘Environmental performance of bioethanol production from oil palm frond petiole sugars in an integrated palm biomass biorefinery’, IOP Conference Series: Materials Science and Engineering, 368, p. 012004. doi:10.1088/1757-899x/368/1/012004.
Srikaeo, K., Sangkhiaw, J. and Likittrakulwong, W. (2018) ‘Productions and functional properties of Palm Sugars’, Walailak Journal of Science and Technology (WJST), 16(11), pp. 897–907. doi:10.48048/wjst.2019.5323.
Maryani, Y. et al. (2021) ‘Identification of macro elements (sucrose, glucose and fructose) and micro elements (metal minerals) in the products of palm sugar, coconut sugar and sugar cane’, Advances in Biological Sciences Research [Preprint]. doi:10.2991/absr.k.210304.051.
Asghar, M.T. et al. (2021) ‘A Review of Nutritional Facts, Production, Availability and Future Aspects of Coconut Palm Sugar’, Journal of Nutrition and Food Sciences, 11(3).
Putri Intan Suri, Faradina Zevaya and Helen Parkhurst (2024) ‘Potensi Dan Prospek Industri gula aren di Indonesia’, Journal of Islamic Economics and Finance, 2(2), pp. 251–264. doi:10.59841/jureksi.v2i2.1462.
Sulasno, S., Wahyuddin and Agustin, F. (2020) ‘Kearifan Lokal Petani gula aren Kecamatan Cijaku (Antara Tradisi Dan Tuntutan Ekonomi)’, LITERATUS, 2(1), pp. 1–7. doi:10.37010/lit.v2i1.25.
Pathirana, H.P. et al. (2022) ‘Comparison of blood glucose responses by cane sugar (saccharum officinarum) versus coconut jaggery (Cocos nucifera) in type 2 diabetes patients’, Journal of Future Foods, 2(3), pp. 261–265. doi:10.1016/j.jfutfo.2022.06.007.