Eating our way to non-communicable diseases — Dharrnesha Inbah Rajah

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APRIL 7 — According to the World Health Organisation (WHO), non-communicable diseases (NCDs) kill 41 million people, accounting for 71 per cent of deaths annually. 

In Malaysia, NCDs accounted for 74 per cent of all mortalities in 2016. Typically manifesting as four disease clusters, i.e. cardiovascular diseases (CVDs), cancer, chronic respiratory diseases and diabetes, they are compounded by behavioural risk factors such as unhealthy diets, tobacco use, physical inactivity and harmful use of alcohol. This piece focuses on diet.

Changing consumption patterns from traditional diets towards high-salt, high-sugar, high-fat Western diets has led to an epidemiological transition in Malaysia. 

Mortality causes are rapidly shifting from communicable diseases to NCDs. CVDs have been the leading cause of mortality in Malaysia since 2005 while 30 per cent of Malaysians now have hypertension — one of CVDs’ major risk factors which is exacerbated by high-salt intake. 

Alarmingly, the average Malaysian’s daily salt intake, mostly consumed through cooked processed food, is 7.9 grams or 2.9 grams above the WHO’s recommendation. We are essentially eating our way to NCDs.

While the prevention and control of diet-related incidence of NCDs has gained attention in Malaysia since 2006, continued worrying trends compel policymakers to undertake multifaceted whole-of-society approaches in addressing this health epidemic. 

Historically the disease of the rich, the disproportionate burden of NCDs in low- and middle-income countries (LMICs) accounting for more than three-quarters of global NCDs deaths is a distressing concern. 

Neoliberal economic reforms such as globalisation and trade liberalisation are bringing about harmful nutrition transitions in LMICs. 

The removal of trade barriers is causing the displacement of LMICs’ indigenous crops by cheaper imports or genetically modified high-yield crops requiring imported fertilisers and seeds. 

Concurrently, foreign direct inflows particularly in food processing and retail, and increased digital connectivity allowing for aggressive global food advertising in domestic markets are snowballing the popularity and convenience of more “Westernised” diets.

To safeguard against further diet-related risks contributing to NCDs, we need broader and bolder strategies. First, a higher standard for food safety regulation is needed. 

This includes implementing mandatory front-of-pack labelling of sodium and salt contents in processed food products. 

Front-of-pack labelling of sodium and salt contents in processed food products should be made mandatory.  — AFP pic
Front-of-pack labelling of sodium and salt contents in processed food products should be made mandatory. — AFP pic

With this, community exposure to high-salt diets can also be reduced by drawing attention to the high sodium and salt content in processed food. 

Further, the banning of partially hydrogenated oil (PHO) or artificial trans-fat is long overdue. While this industrial source of trans-fat is not prohibited in Malaysia, neighbouring countries such as Singapore and Thailand have successfully heeded WHO’s call to eliminate it in our diets by 2023. 

Second, increasing data accessibility for research and development (R&D), public awareness, and international peer benchmarking is crucial. 

While national data on the incidence of NCDs and risk factors are available, those on NCD mortalities are not available while data on economic and productivity costs are only updated sporadically when there are collaborations with international agencies such as the WHO to conduct ad-hoc assessments. 

With increased data availability, NGOs including the National Cancer Society Malaysia and Diabetes Malaysia can disseminate accurate and timely information on preventive measures on their digital platforms and community outreach programmes particularly among the low-income groups. 

In addition, policymakers must be accountable in ensuring that national policies are articulated in a clear and measurable manner, and outline implementation details targeting each behavioural risk factor alongside national commitment statements and overarching policy strategies. 

Finally, domestic food security needs to be prioritised. While agriculture remains an important component of Malaysia’s economy, with a 7.4 per cent share of the 2020 GDP, most resources are allocated to industrial crops such as oil palm, as one of the world’s largest palm oil exporters. 

This has led to disparities in terms of optimal utilisation of resources and supply of food. Prohibitive production costs and land scarcity for agro-food is constraining production, increasing prices, and restricting supply of selected produce to the more affluent demography. 

Implementing a land-use policy through the carving out of agricultural land is one way to address land scarcity. Policymakers also need to work with corporations to diversify their oil palm plantations to agro-food productions through investments; and with smallholder farmers to increase technical skills and supplement the high transition costs associated with the country’s changing whole-food consumption. 

As we approach World Health Day 2021, policymakers must acknowledge and heed the call to undertake concrete and actionable steps towards ensuring a healthier and more secured Malaysia, learning from crucial and unfortunate lessons imparted by the Covid-19 pandemic. 

Among others, addressing health and food security inequalities particularly among the marginalised communities; and utilising reliable data to advance innovative solutions can no longer be delayed. 

Perhaps then, we will be eating to beat NCDs.

Dharrnesha Inbah Rajah is a public policy strategist, with experience in social policy and regional financial co-operation. She is currently a master’s candidate at the University of Chicago’s Harris School of Public Policy.

**This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.

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