Abstract
INTRODUCTION: Occupational ergonomic risk factors are a major contributor to musculoskeletal disorders and productivity loss, yet their welfare implications remain underexplored in low- and middle-income settings. This study aimed to quantify the health and economic burden of ergonomic risks across Indonesian provinces using the Value of Lost Welfare (VLW) framework. METHODS: Disability-adjusted life years (DALYs) attributable to ergonomic risks were obtained from the Global Burden of Disease 2019-2021 estimates. VLW was calculated by multiplying DALYs with the Value of a Statistical Life Year (VSLY), derived from GDP per capita and adjusted for purchasing power parity. Both absolute VLW (International Dollar, Int$) and the VLW-to-GDP ratio were computed at national and provincial levels. Socioeconomic inequality was assessed using the slope index of inequality (SII) and relative index of inequality (RII). RESULTS: National VLW increased from Int$ 44.6 billion in 2019 to Int$ 48.5 billion in 2021, with the largest contributions observed in East Java (Int$ 7.3 billion) and West Java (Int$ 6.1 billion), while smaller provinces such as Gorontalo and North Maluku contributed less than Int$ 200 million. Despite a steady rise in DALYs, the VLW-to-GDP ratio followed the economic cycle, increasing during the 2020 downturn (1.47%) and declining to 1.36% in 2021 as GDP rebounded. Socioeconomic inequality in the VLW-to-GDP ratio was statistically significant, with SII of -0.00165 (95% CI: -0.00255 to -0.00074) and RII of -0.118 (95% CI: -0.183 to -0.053). DISCUSSION: Occupational ergonomics imposes a substantial and persistent health-economic burden in Indonesia, amounting to nearly Int$ 50 billion annually. The observed socioeconomic gradient indicates that lower-GDP provinces experience disproportionately greater welfare losses relative to their economic capacity, underscoring the need for sustained workplace interventions and targeted regional policies, particularly in lower-GDP regions.