OCTOBER 6 ― The Health White Paper to be tabled in Parliament at the end of this year sets out a clear goal to shift the current health system from sick care to health care and wellness.
This paradigm shift should position primary healthcare as the system's first line of health resilience, focusing on keeping people healthy, rather than just treating them when they fall sick.
But does that mean nutrition, already long neglected, will be given greater emphasis? While the ambition to tackle malnutrition is strong, on-the-ground actions have been inadequate possibly due to the lack of political commitment and effective integration of nutrition into national policies.
Good nutrition for effective prevention
Nutrition is a core component of primary healthcare, preventing and promoting health through healthy eating. In fact, it is a significant determinant of various health issues across generations.
It concerns not only the quantity and quality of the food we eat, but also eating patterns and lifestyle factors affecting our health and nutrition.
Malaysian nutrition worrying
Malaysia’s health report card is far from satisfactory. Half of Malaysian adults and around 30 per cent of children aged five to 17 are overweight or obese. Three of ten women of reproductive age (15 to 49 years old) suffer from anaemia, which is commonly caused by the lack of iron, a mineral naturally present in food. Stunting remains a public health concern, affecting one in five children under five.
In spite of the rising disease burden, healthy behaviours among Malaysians are lacking, possibly due to the lack of health awareness and knowledge and a supportive environment. One in four Malaysian adults is not physically active enough, while 95 per cent do not eat enough fruits and vegetables.
Poor nutrition causes preventable diseases
All these health issues can be attributed to modifiable and preventable eating behaviour. Unhealthy diets and lifestyles do not just increase the risk of many diseases, but can affect the quality of life, even mental health, negatively.
Most public health nutrition interventions are cost-effective considering their immediate, long-term and intergenerational impacts. For example, initiatives to improve the nutrition of women of reproductive age also improve their children's health.
-Nutrition, a complex public health concern-
Poor nutrition is not a stand-alone issue. Factors like age, gender, culture, education, income, and cooking knowledge and skills also determine food intake. What and how people eat are also influenced by personal preferences, family influences, food environments, social and cultural norms, and advertising.
For example, a 2019 KRI report showed differences in the health behaviours of various households by income. Adults from higher household income quintiles were more likely to have enough fruit and water intake, whereas the frequency of smoking and binge drinking or drinking excessive alcohol is higher among adults from lower household income quintiles.
Hence, there is no one-size-fits-all approach to nutrition. Socioeconomic, environmental, and system-level factors need to be considered when designing and implementing nutrition interventions and policies.
Nutrition not adequately addressed
According to a report by MoH summarising Malaysia’s health expenditure from 1997 to 2019, primary healthcare, which comprises first-contact health services provided in the community, constitutes about one-fifth of total health spending. Only 6.8 per cent of total health spending was on public services, including health promotion and prevention, with most spent on curative services (67.7 per cent).
Despite being effective, nutrition has been underutilized in health promotion and prevention. Existing nutrition-specific strategies that address the direct causes of malnutrition include micronutrient supplementation, breastfeeding promotion and nutrition education. They have been useful in directly improving the nutrition of targeted groups.
On the other hand, nutrition-sensitive strategies that target the underlying causes of malnutrition through policies in healthcare, education, city planning, agriculture and trade, social protection, and labour are underutilised. Combining both nutrition-specific and nutrition-sensitive strategies can accelerate progress towards nutrition goals.
Food environment must support healthy choices
Where processed food is readily available and affordable, healthy eating is no longer an individual choice but also strongly influenced by the food environment.
Rising food inflation typically means higher prices of nutritious food like fruits and vegetables. This has been a growing barrier to healthy eating, especially for those less well off.
Marketing of unhealthy food and drinks, especially via unregulated digital media, can easily influence food choices, especially of children and adolescents.
Toxic food production due to excessive use of antibiotics and pesticides, water pollution and heavy metal contamination are making our food less safe to eat. Climate change is also causing food such as rice, corn and wheat less nutritious.
Malaysians need an environment more conducive to healthy food choices. There are existing policies and guidelines that can promote healthy food environments, eg., in settings such as school canteens, health facilities and workplaces. However, these should be strongly enforced and extended pragmatically to improve people’s health. This will also require strategies to ensure nutrition policies and guidelines are understood and friendly to be implemented by multiple stakeholders.
Nutrition pillar of primary healthcare
The Malaysian Dietary Guidelines and Healthier Choice Logo are among the existing nutrition initiatives. These can be more effective in improving health when supported by an enabling environment.
The National Plan of Action for Nutrition of Malaysia (NPANM) III 2016-2025 and the National Nutrition Policy of Malaysia 2.0 can help better integrate nutrition into national policies and plans.
We must ensure nutrition is central to the health white paper discussion. Mainstreaming nutrition and scaling up nutrition efforts will help enhance universal health coverage, making health a reality for all Malaysians.
* Dr Teoh Ai Ni is a Research Associate at Khazanah Research Institute, a not-for-profit organisation that carries out research on pressing national issues to recommend policies to improve the well-being of Malaysia. The views expressed here represent those of the author.
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
