Who is responsible for your health?

The question seems like a no-brainer. Under normal circumstances, the answer is most likely ‘our own good self’.  But in reality, some people do not take care of their health as well as we would like to think. The common wisdom is ‘Prevention is better than cure’; if every Malaysian took this axiom seriously, it would surely ease the task of the government in terms of public health and financing.

The reality is stark. The National Health and Morbidity Survey 2015 recently showed that 30% of the Malaysian population is overweight, while a further 17.7% are obese. In other words, nearly half of the Malaysian population was found to have an unhealthy body size based on the World Health Organisation’s (1998) Body Mass Index (BMI) guidelines. The percentage goes even higher, at 64%, if we are to use the Malaysian Clinical Practice Guidelines).

Based on the definition given by the International Physical Activity Questionnaire (IPAQ), 33.5% of the population is identified as ‘inactive’. This is unsurprising news, given that one third of the Malaysian population do not practise moderate intensity level of physical activity such as walking for more than 30 minutes per day for minimally five days a week.

Unhealthy dietary practice is correlated with a higher risk of non-communicable diseases (NCDs). A study found that 64.1% Malaysian individuals eat at least one meal per day outside of the home daily, while 31.9% habitually eat a heavy meal after dinner.

As a natural defence, many Malaysians would be quick to claim that Malaysia has too much irresistable good food. But contrary to popular belief, there is no correlation between good food and obesity. If that were true, then countries such as the United States and Britain, two countries that currently top the obesity rankings, should also top the world for the best food, instead of countries renowned for their culinary fare such as Italy and France! On a more regional note, Thailand and Indonesia, countries which have equally tempting food choices as Malaysia, are in fact ranked lower than our country in the obesity rankings.

Society cannot afford to ignore the serious consequence of lack of exercise and bad eating habits to public health. NCDs are responsible for 73% of deaths among Malaysians. In 2012, at least 70% of Malaysians were diagnosed with NCDs. As of 2015, NCDs in respiratory, circulatory, digestive and genitourinary systems as well as neoplasms (cancer) made it to the top 10 principal causes of hospitalisation, totalling 1.2 million cases. The cost of treatment for diabetes alone is estimated to account for 16% of the national Malaysian healthcare budget, while the combined direct and indirect per-patient costs for diabetes was found to be RM3,750 in 2014.

Yet, is it right to place the blame solely on the individual, and claim that the government plays no role in attaining good health outcomes in the communities? I do not think so.

The Malaysian government has many tools at their disposal to coordinate effective health promotion, including TV and radio channels as well as newspaper press. These are effective channels through which the government can encourage active lifestyle and good dietary habits among society. These days, we are constantly bombarded by various fast food advertisements on TV, radio, newspaper and billboards. Perhaps the government should emulate the US Food and Drug Agency (USFDA) in regulating food providers, especially fast food outlets, to have compulsory nutritional list on their standard menus.

The government could also come up with creative ways to encourage healthy eating habits using commercial activities. For example, the use of popular animation series such as “Sesame Street” or the locally produced “Upin dan Ipin” to promote good eating habits and encouraging physical exercise could potentially lead to a shift in lifestyle habits among minors, and further reduction in NCDs.

School-based nutrition plays a great role in altering social norms and behaviours. It is not helpful if some school canteen operators could get away with selling foods which are either too oily or too sweet. Current programmes involving poor students such as “Rancangan Makanan Tambahan untuk Pelajar Miskin” are a good platform to educate canteen and cafeteria providers on the importance of including more nutritious food items in their menu. The sale of junk food should be banned if they follow the guidelines set by the government.

In terms of physical education in primary and secondary schools, the government allocates just 80 minutes per week. We are lagging behind other countries in the region – Singapore and South Korea both allocate 120 minutes, China, 105-135 minutes, and Japan, 125-130 minutes. In Malaysia, physical education is seldom prioritised because it is perceived as less important than studying and passing for examinations.

While there has been an increase in the number of running and cycling events in the Klang Valley, such events should be encouraged in other states in the country and younger participants should be encouraged to participate. Parents need to lead by example, by teaching their children to love physical activities . This could be done through enrolling them in running clubs, frequently enjoying indoor or outdoor sports as a family, and limiting screen or internet time so as to encourage outdoor activities.

Finally, from an urban planning perspective, the government must provide sufficient parks and recreational spaces per population density, especially in the urban areas. Local governments can encourage higher activity levels by improving the connectivity of pedestrian walkways and cycling paths, and encouraging the use of public transportation over that of private cars.

In conclusion, there is plenty that the government can do to shape desirable social behaviours towards better public health outcomes. But society, too, must do its part by responding to these calls. If both play their roles right, Malaysia will surely be on the right track to reducing public health issues and living up to the mantra of “prevention is better than cure”. 

Published at The Malaysian Insight, Voices, July 9, 2017.