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Thursday, October 31, 2013

Malaysia’s health paradox

The lesson is that market forces alone are not enough to address the health problem. Governments and regulators have to step up.
COMMENT
Just like many countries before it, Malaysia’s increase in disposable income and rise in consumption has led to a rise in deterioration in consumption of healthy products which in turn has seen a gradual rise in cardiovascular diseases.
This is a paradox experienced by many countries in transition from middle income to advanced economy status and require a complex society wide-based solution.
Although Malaysia has seen a rise in average lifespan and GDP, non-communicable diseases (NCDs), including diabetes are becoming the country’s top health concerns.
To be sure, this is not a unique problem to Malaysia. Low income to middle income countries regularly experience a change in lifestyle that create new challenges for healthcare sector policy makers.
With the benefit of hindsight though Malaysia has an opportunity to study examples of pitfalls to avoid.
Similar trends can be detected in the United States, where lifestyles have become increasingly sedentary, and high calorie, low nutrient foods are often the cheaper and more convenient choices for consumers influenced by mainstream marketing.
Unhealthy diet, physical inactivity, and tobacco use can be blamed for these trends, which are resulting greater probability of developing diabetes, heart disease, and cancer in adulthood.
The Center for Disease Control (CDC) estimates that one third of American adults are categorised as obese, a condition that comprised an annual medical cost of $147 billion in 2008.
The power of large corporate however has been to some extent curtailed by the rise of consumer awareness groups, regulatory pressure to disclose and display the use of artificial ingredients and preservatives and of course the rise of lucrative organic food and health product industry.
The US, unlike Malaysia, enjoyed large market scale and higher disposable incomes with market forces more than the government able to address a new demand for healthy lifestyle. Nonetheless the US continues to have one of the highest obesity rates in the world.
The lesson is that market forces alone are not enough to address the health problem. Governments and regulators have to step up.
There are some signs that change is afoot. Having successfully reduced the threat of infectious diseases, doctors in Malaysia are turning their attention to NCDs.
Diabetes a real worry
Innovation and research sector in particular as well as the leading institutions such as the National Heart Centre have embraced best international practice in encouraging healthier lifestyle behaviour.
The focus has shifted from preventative medicine with much attention on early detection of cardiovascular diseases.
However statistics continue to show the problem of diabetes at the national level remains acute.
According to the World Health Organization (WHO), Malaysia continues to see a steady increase is the mean body mass index (BMI) and mean total cholesterol for males and females. This is despite a dramatic increase in per capita spending on health care.
It seems overall the health sector is still behind the curve in changing overall population attitudes to healthy lifestyle with high cost to the Treasury.
Processed foods with refined carbohydrates and high fat content are often more affordable and desired than whole foods, such as organic vegetables and natural oils, which can contribute to a balanced diet.
Compounding this issue is pace of life and time spent at work. As these have increased throughout recent decades, time to cook a meal has become a luxury for many and processed foods remain a necessary convenience.
To fight back against NCD, the US has implemented a range of programs – from school lunch nutrition requirements, to free community center exercise programs. Urban community gardens and farmers markets are on the rise, allowing residents of even the most congested cities access to farm-fresh ingredients at a low cost.
It is urban areas that are, perhaps, deserving of the greatest present focus. One expert told OBG that improving preventative care in Malaysia’s cities and towns is vital to improving the nation’s overall health.
Education programs can boost individual knowledge of nutrition and how to choose healthy foods over those that lack nutrients, even with time and finance constraints. More options and incentives for exercise could compensate for increased physical inactivity enabled by escalators and transportation options.
Fiscal incentives
If the family doctor concept is successfully introduced in the public sector, physicians can develop closer relationships with their patients, helping to instill good health practices from childhood through adulthood.
At the end of the day teaching good habits of nutrition and exercise whilst encouraging schools and employers to provide the necessary facilities will be in addressing the structural problem.
The government needs to provide fiscal incentives as well as sanctions on organisations to encourage healthy lifestyle. More need to be done to educate the public about the sugar content in sweets, beverages with an emphasis on balanced diet and benefits of exercise.
This will have both economic and social benefits as a negative perception on unhealthy food intake will spur growth in organic food sector favouring small and medium enterprises (SME) specialising in this segment.
Above all lower health costs will help to release spending for preventative healthcare and ease the pressure on country’s widening fiscal gap.
Paulius Kuncinas is the Regional Editor, Asia at Oxford Business Group.

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