IPP in the health and welfare domain is one of the key indicators that reflects the quality of life of youth in a region. In Yogyakarta, although overall it has relatively high IPPs compared to other provinces, the value in the health and welfare domain tends to be lower than the national average. This low score indicates significant challenges in the physical, mental, and social welfare aspects of youth in Yogyakarta.
Indicators such as youth morbidity, the percentage of youth victims of crime, the prevalence of youth smoking, and the percentage of adolescent girls who are pregnant show a worrying picture of the health and welfare conditions of youth in the region. These figures not only indicate individual problems, but also reflect deficiencies in various sectors, such as health services, reproductive health education, the social environment, and behavioral patterns influenced by local culture. The following will discuss the factors underlying the low value of IPP in DIY in the domain of health and welfare based on the data and literacy obtained by the researcher.
The pain rate is the percentage of youth whose daily activities have been disrupted in the past month as a result of the health complaints they have experienced (Badan Pusat Statistik, 2022). A health complaint is a person who has a health or psychiatric disorder, either due to an acute illness, chronic illness, due to an accident, criminality, or other health complaint (Sekretariat DPRD DIY, 2023). This disease rate indicates an overall level of health among youth, where a
low value indicates a high prevalence of the disease in this population. Youth health cases in Yogyakarta show serious challenges, including significant suicide cases, especially among students. Until October 2024, the Yogyakarta Health Office (Dinkes) recorded 52 suicide cases. Gunungkidul Regency is the area with the most cases, followed by Sleman Regency and Bantul Regency. In Gunungkidul, economic factors are the main cause, while some individuals also suffer from diseases that do not recover. In Sleman Regency, the causes of suicide are dominated by economic factors and conflicts, and there are also problems with being entangled in loans (Pangaribowo & Hardiyanto, 2024). In some cases, there are also students who face social isolation or heavy mental burdens related to academic and work expectations after graduation (Dinkes DIY, 2023). Regarding the cause of suicide among students, the former Director of Grhasia Hospital in Pakem said that it was due to socio-economic problems. From several cases detected, it was found that the student victims did not come from the wealthy, but were only limited to being affluent, and then entangled in the demands of lifestyle (Bramantyo & Tirtana, 2024).
The high mental health problems in Yogyakarta are the main challenge in maintaining the welfare of youth. These mental disorders are often not handled properly, mostly caused by several structural and social factors that exist in society. One of the main causes is the lack of access to affordable mental health services. Although there are health facilities that offer mental health services, many youth find it difficult to access them due to high costs, long distances, or even the inability to reach such services in rural areas. In addition, the social stigma that considers mental health problems as something embarrassing or "unreal" also contributes to this condition. Many young people in DIY are reluctant to seek help for fear of being perceived as weak or unable to overcome their problems. As a result, they often choose to address the problem on their own, which can worsen the situation and lead to further disruptions, such as an increased risk of suicide. The lack of awareness among adolescents and youth about the importance of maintaining mental health is also a significant factor. Many of them still view mental health as a less important issue compared to physical health. As a result, they tend to ignore the symptoms of mental disorders that begin to appear, such as excessive feelings of anxiety or drastic mood swings. One of the main keys to maintaining mental health is strengthening social support. Support from family, friends, and community plays a vital role and is key in helping youth/youth cope with various pressures and stresses.(Rusdiana, 2024).
Social conditions in modern society, including in Yogyakarta, have undergone significant changes influenced by the rapid development of science and technology. A social environment that is not accompanied by the development of ethical values and social development often creates inequality that triggers conflicts, both internal and external. This conflict arises as a result of the clash of traditional values with the new culture brought about by
globalization, such as individualism, hedonism, or the influence of a technology- oriented lifestyle.
The lack of balance between modernization and social development can lead to various negative impacts, including actions that deviate from the norm, such as violence, criminality, to conflicts between individuals or groups. Street crime, cyberbullying, and rising irresponsible consumptive behavior are some of the tangible forms of these challenges. This phenomenon is in the spotlight in DIY because despite its reputation as a city of students and culture, the region also faces social complexities arising from migration, urbanization, and socioeconomic pressures. The mindset of the community that is sometimes unrealistic in revealing and understanding ethics in the social life order so that it leads people to carry out an action that is considered to violate the norms that apply in their living environment, such as committing crime and violence (Santoso & Zulfa, 2001).
Violence is generally aimed at groups that are considered weak,
youth, especially women and children are one of the groups that
are vulnerable to such violent behavior. Violence against youth is
all forms/acts of physically or emotionally painful treatment,
sexual abuse,
(Sugiyanto, 2020)
Figure 1 Number of Cases and Perpetrators of Crime in DIY in 2020-2021 Source: (Pahlevi, 2022)
Based on the image above, in 2020 the Yogyakarta Regional Police recorded 52 cases of criminal prosecution with 91 perpetrators being prosecuted.
Then throughout 2021 the number increased to 58 cases with 102 perpetrators being prosecuted. The Yogyakarta Regional Police also said that most or 80 perpetrators of the crime in 2021 were students (Pahlevi, 2022). Youth are often the target of random attacks by groups involved in criminal acts. These attacks usually occur at night and use sharp weapons such as celurites or iron chains, which cause serious injuries to death. Victims of crime are generally individuals who happen to be at the scene without direct contact with the perpetrator. As victims, youth face severe physical, psychological, and social impacts. Physically, these attacks often result in severe injuries that require intensive medical treatment. Psychologically, victims can experience trauma, anxiety, and fear of doing activities outside the home at night. Socially, the victim's family also often feels insecure, which creates an environment full of uncertainty. One of the main factors for youth to become victims is the increase in nighttime activities, especially among students or college students who often travel home late. The lack of street lighting, lack of security patrols, and a culture of hanging out at night in certain areas also increase their risk of being targeted. In some cases, victims are randomly selected by the perpetrator to build an image as a "strong" group or to meet challenges within their group (Saputro & Nashrullah, 2024).
Smoking behavior has become one of the main burdens for Indonesia, not only in terms of public health but also economically. Smoking is one of the main risk factors for Non-Communicable Diseases (NCDs) such as heart disease, stroke, diabetes, and cancer, the percentage of which continues to increase from year to year. This condition aggravates the national health service system because NCDs require long-term treatment at high costs. According to the Social Security Administration Agency (BPJS), most of the health financing in Indonesia is used for the treatment of NCDs, with cigarettes being one of the main causes.
In DIY, the trend of smokers has not improved, even among teenagers. Smokers who start their habit in adolescence have a tendency to become smokers until adulthood. Intrapersonal, interpersonal, and environmental factors affect the occurrence of adolescent smoking (Wibowo & Trisnowati, 2024). Intrapersonal factors, such as low awareness of the health risks of smoking, poor self-control, and lack of understanding of the long-term consequences, are one of the main reasons adolescents start this habit (Swatan et al., 2020). In addition, interpersonal influences, such as relationships with peers, also play a significant role. In a strong social environment, adolescents tend to follow group habits to build a sense of acceptance and social identity.
Research shows that social norms related to smoking are changing in various communities. In societies with contexts that "denormalize" smoking, as is increasingly the case in some regions, smoking is more often considered a negative behavior. In contrast, in communities that "normalize" smoking, this behavior tends to be seen as a symbol of courage or maturity, which attracts the attention of adolescents to try it (Littlecott et al., 2023). This social factor is exacerbated by the appeal of cigarette advertising that is still widespread in
various media and stores, provoking the desire of teenagers to try cigarettes as a new experience.
Education in the family plays an important role. Families who actively educate their children about the dangers of smoking can prevent this behavior. Parents who have better knowledge of the health consequences of secondhand smoke tend to be more effective in protecting their children from smoking habits (Ehsani-Chimeh et al., 2020). In DIY, this factor is becoming increasingly relevant given the high student population that is vulnerable to peer influence and social pressure.
The percentage of adolescent girls who are pregnant in Yogyakarta reaches 23.33%, which is quite high compared to the national average. This phenomenon is influenced by various interrelated factors. One of the main factors is the lack of reproductive health education among adolescents. Adolescent girls' understanding of the reproductive aspects, contraception, and consequences of premarital sexual activity is still low. This is largely due to the lack of comprehensive reproductive education materials in the school curriculum as well as the inherent taboos in discussing this topic in the family and community environment (BKKBN, 2023).
In addition, the practice of early marriage is a significant factor that also contributes. Based on data from the Office of Women's Empowerment, Child Protection and Population Control (DP3AP2) of Yogyakarta, cases of early marriage in 2022 reached 632 cases. Of these, 84% of cases are due to pregnancy out of wedlock or Unwanted Pregnancy (KTD). The increase in the number of early marriages is a serious concern, especially in the city of Yogyakarta which is considered an educational destination for students and students from outside the region, especially Central Java (Kemen PPA, 2023).
Yogyakarta, which despite having a policy aimed at reducing the rate of early marriage, apart from being caused by pregnancy out of wedlock, this practice of early marriage still occurs, especially in rural or suburban areas. In societies with low economic levels, early/early marriage is often seen as an economic solution or to avoid social stigma against extramarital relationships. Early marriage is directly linked to the high rate of teenage pregnancy due to lack of access to information on reproductive health and contraceptive services (Hidayat, 2024).
Cultural norms and social pressures are also important aspects. Some communities in DIY have permissive norms against out-of-wedlock pregnancies, but the stigma against teenage pregnant women remains high. This creates a dilemma for adolescent girls, who struggle to get adequate support, both from their families and from public health services. Studies show that social pressures, including the inability to overcome social stigma in society, can hinder adolescent girls from seeking adequate help from health care professionals (Latifah et al., 2023).
The evaluation of policies and programs implemented in Yogyakarta related to youth health and welfare includes various initiatives aimed at improving the quality of life, but still faces a number of challenges.
The Yogyakarta Government conducts the Healthy Indonesia with a Family Approach Program (PIS-PK). This program is an important step in increasing public access to health services. One of its main focuses is to increase the availability of accurate health data to support the planning and implementation of public health programs. The approach involving health center officers shows the importance of the role of health workers at the local level as the spearhead in obtaining valid health data. Puskesmas officers not only function as data collectors, but also as implementers of health programs that can provide direct feedback to local governments regarding conditions in the field. While this measure is quite effective, limited human resources and lack of training for data collection remain a challenge.
Evaluation of program implementation in the field shows that coordination between related agencies is also a crucial factor that needs to be improved. Limitations in cross-sectoral coordination often hamper efforts to improve health service coverage. For example, the synergy between the health office, health centers, and community in solving health problems is still not optimal. This shows the need for more integrated policies and a collaborative approach between local governments, health facilities, and communities to ensure that health services can reach all levels of society. The availability of adequate resources, capacity building of health workers, and better coordination between agencies must be priorities. With improvements in these aspects, the program can be more effective in achieving its main goal, which is to improve the degree of public health evenly in Yogyakarta (Rusdianah & Widiarini, 2020).
Mental health services are also of particular concern due to the high rates of mental health problems among youth, including anxiety disorders and depression. The Yogyakarta government has implemented various initiatives, such as psychological consultation services in health facilities and anti-stigma campaigns, but access to adequate and affordable mental health services remains an obstacle. In addition, social stigma against individuals with mental problems also hinders the effectiveness of these programs (Kusuma, 2013).
Yogyakarta faces serious challenges related to crime or street crime, which involves many youth, both as perpetrators and victims. Problems often occur due to social factors such as peer pressure, lack of positive activities, and weak family supervision. These young people who are victims of street crime often experience physical and psychological trauma that requires special attention. In addition, without adequate rehabilitation, youth who have been perpetrators or victims have the potential to repeat this negative behavior.
Children's Correctional Institutions (Prisons) have an important role in dealing with youth who commit crimes. In DIY, children's prisons have been designed to provide guidance through educational approaches, skills training, and psychosocial counseling. However, evaluations show that prison capacity is
often limited in providing holistic services, especially in relation to comprehensive rehabilitation programs. Many young inmates do not receive enough training to help them return to society as productive individuals. In addition, the societal stigma against former child inmates is a major obstacle to their reintegration.
Post-criminal rehabilitation is one of the efforts of the Yogyakarta government to deal with the long-term impact of street crime on youth, both perpetrators and victims. The Yogyakarta government has made efforts to establish community-based rehabilitation centers for youth involved in street crime. This place is designed to provide counseling services, skills training, and psychosocial assistance. However, its implementation faces several challenges, such as budget limitations, lack of experts, and low community participation.
Yogyakarta has made various efforts to reduce the rate of early marriage and increase awareness about reproductive health among youth through socialization and training programs involving schools, communities, and government institutions. These measures aim to educate youth about the risks of early marriage, reproductive rights, and the importance of family planning for the future. Some programs also collaborate with non-governmental organizations to educate adolescents in rural areas who are more vulnerable to early marriage practices due to cultural norms and limited access to information. This effort is an integral part of realizing youth development goals that focus on the overall quality of life of youth, including reproductive health aspects (Rusdianah & Widiarini, 2020).
However, the implementation of this policy in Yogyakarta still faces various challenges that limit its success. One of the main obstacles is the strong influence of social and cultural norms that support early marriage in some regions. In addition, the lack of active involvement of parents and the community in supporting youth behavior change is a significant obstacle in this program. Education provided at school is often not accompanied by support at home, so the messages conveyed are not implemented effectively. Addressing this issue requires a more integrated strategy, such as involving religious leaders, community leaders, and family empowerment to create an environment that supports early marriage delay and strengthening reproductive health awareness among youth.
The Yogyakarta government continues to strive to reduce the prevalence of smoking behavior among youth through various policies. Some of the strategic steps that have been taken include restrictions on cigarette advertising, the implementation of no-smoking zones (KTR), and campaigns on the dangers of smoking targeting teenagers and youth. This program is designed to increase public awareness about the negative impacts of smoking, both in terms of health and socio-economy. In addition, the government also involves educational institutions and local communities to strengthen education about the risks of smoking at a young age, in the hope of preventing the emergence of a new generation of smokers (Putri, 2021).
The implementation of this policy cannot be separated from major challenges. One of the main factors is peer influence, where teens are often
exposed to social pressure to smoke as a form of solidarity or to gain recognition in their group. The availability of easily accessible tobacco products, even in the environment around the school, also exacerbates the situation. In addition, aggressive marketing strategies from the cigarette industry, such as sponsoring sports or music events that involve a lot of youth, remain a significant obstacle in reducing the number of novice smokers. Studies have shown that advertising, promotions, and sponsorships of cigarettes induce adolescent desire to start smoking, encourage adolescent smokers to continue smoking and encourage adolescents who have quit smoking to return to smoking (Fadhila et al., 2021).
To address these challenges, stronger collaboration between governments, communities, and the private sector is needed. The government needs to strengthen regulations related to the distribution of tobacco products and increase supervision of violations of the no-smoking zone policy. On the other hand, local communities can take a role in overseeing the implementation of these policies, for example by reporting violations or organizing community- based campaigns that are relevant to local values. In addition, a family-based approach that involves parents in smoking risk education is also important, given the large role the family plays in shaping youth behaviors (Ahmad & Zainuddin, 2020). This comprehensive approach is expected to help DIY achieve the target of significantly reducing the number of young smokers.