Air pollution remains a major public health issue in Indonesia, with annual PM2.5 concentrations exceeding WHO guidelines by 7 to 10 times. This study assesses the potential health and economic benefits of implementing improved fuel quality standards (EURO 4) in Jakarta, Bandung, and Surabaya, three major urban cities in Indonesia that facing severe air pollution primarily from vehicle emissions. Using an ecological time-series approach from 2018 to 2024, the study integrated air quality data, disease incidence, and healthcare cost burdens to evaluate the impact of PM2.5 on respiratory and cardiovascular diseases, and to assess the potential benefits of implementing the EURO 4 fuel standard. The results suggest that an increase in PM2.5 by 15 µg/m3 was associated to higher risks of pneumonia (20–29%), ischemic heart disease (1.2–37%), chronic obstructive pulmonary disease (COPD) (11–27%), and acute respiratory infections (ARI) (10.7–45%). Projections for 2030 under a EURO 4 implementation scenario suggested significant reductions in disease cases: up to 86% in Jakarta, 41% in Bandung, and 33% in Surabaya. Economic analyses revealed substantial healthcare savings by 2030: IDR 609 billion in Jakarta, IDR 29.3 billion in Bandung, and IDR 30 billion in Surabaya, mainly from reduced claims for ischemic heart disease, pneumonia, and ARI. These findings support the adoption of higher fuel quality standards as both a public health and economic imperative. The study emphasizes the importance of multisectoral collaboration for effective data integration and policy-making. To maximize impact, the study recommends nationwide adoption of EURO 4, enforcement of emission regulations, investment in cleaner technologies, and public awareness campaigns. Overall, the transition to cleaner fuel standards represents a cost-effective strategy to reduce disease burden and healthcare costs, while advancing environmental and public health policy in Indonesia.
Haryanto et al. (Thu,) studied this question.