KUALA LUMPUR (July 1): The Ministry of Health recently released the 2023 National Health and Morbidity Survey (NHMS) report, revealing alarming statistics about chronic diseases in Malaysia. High cholesterol impacts about 7.5 million adults (33.3%), diabetes affects 3.6 million (15.6%), and 6.7 million (29.2%) suffer from hypertension. Disturbingly, over 80% are unaware of their conditions.

Additionally, the World Obesity Federation’s "2023 Global Obesity Map" predicts that 41% of the population, including 5.3% children, will be obese within the next 11 years.  Poor lifestyle and dietary habits are primary causes, with only 4.9% of adults consuming the recommended five servings of fruits and vegetables daily.

The Ministry of Health is focusing on the increasingly severe issue of chronic diseases. Last year, it introduced Clinical Practice Guidelines for managing obesity. Additionally, the government has increased the sugar-sweetened beverage tax from 40 cents to 50 cents per 100 millilitres starting January 1. Indeed, the chronic disease issue in the country is largely related to poor dietary and lifestyle habits. Further reflection raises the question: What causes these poor dietary and lifestyle habits?

According to a large-scale prospective epidemiological study conducted in both urban and rural areas, dietary habits are correlated with income levels. Specifically, the study found that higher income levels lead to a more diverse diet rich in proteins and fats, with carbohydrates making up only about 50% of daily intake in developed countries. In contrast, in poorer countries, the carbohydrate intake can be as high as 65% as financial constraints limit access to a more varied diet.

According to the World Bank's "The State of Food Security and Nutrition in the World 2023 and Food Prices for Nutrition" report, the global average daily cost of a healthy diet in 2021, adjusted for purchasing power parity, was US$3.66 (RM17.30). This figure significantly exceeds the US$1.12 food poverty line, highlighting a major affordability gap. The report also points out that over three billion people, or 42% of the global population, could not afford a healthy diet in 2021.

Animal-sourced foods were the most expensive category, averaging US$0.87 per day, with the highest regional price in South Asia at US$1.08. Vegetables and fruits were also costly, priced at US$0.79 and US$0.66 respectively on average. In stark contrast, starchy staples - commonly accessible and calorie-dense - were much less expensive. For instance, in Italy, the cost of vegetables was over four times, and fruits were 3.7 times the cost of starchy staples in Maldives, underscoring the economic challenges many face in accessing a balanced diet.

In 2022, the cost of a healthy diet in Malaysia per capita daily was US$3.22. Breaking this down by food category, fruits were the most expensive, costing US$0.93, followed by animal-sourced foods at US$0.83, and vegetables at US$0.65. In contrast, starchy foods were the least expensive, priced at US$0.46.

When comparing these costs relative to starchy staples, the cost of fruits, meat, and vegetables were approximately 2, 1.8, and 1.5 times higher than that of starchy foods respectively. This highlights the economic challenges associated with accessing a balanced diet, as healthier options are significantly more expensive than basic staples.

The stark contrast in the Ipoh market is instructive: an orange costs up to RM3, which barely satisfies hunger for more than 30 minutes, while a loaf of bread is priced similarly and can last for three days. In many countries, including Malaysia, the economic aspects of diet are exacerbated by the need to import many fruits, which incurs additional costs such as tariffs, transportation and storage fees. Fruits are also season-specific, highly perishable and require meticulous handling, all of which contribute to their higher prices. On the other hand, staples like rice, which are significant local products and often subsidised by the government, are priced more affordably.

Indeed, the issue of chronic diseases is intricately linked with economic factors, extending beyond mere public awareness. There exists a complex relationship where unhealthy diets and poverty reinforce each other, creating a vicious cycle. Financial constraints can lead to poorer dietary choices, increasing the risk of chronic diseases such as diabetes, heart disease, and hypertension. These health conditions, in turn, can diminish the economic productivity of individuals, further entrenching the cycle of poverty.

Social determinants of health such as income, education and access to nutritious foods are crucial in shaping dietary habits and health outcomes. To effectively promote healthier eating and reduce chronic diseases, comprehensive policies that address these economic barriers are essential. Having the Ministry of Health declaring a war on sugar isn’t enough.

The Ministry of Education's role in shaping the dietary habits of the nation's youth is pivotal. By integrating nutritional education programmes within the school curriculum, children can learn the importance of healthy eating from an early age. These programmes should not only teach the basics of nutrition but also involve interactive components such as cooking classes and garden-based learning initiatives, which help students understand the source of their food and the benefits of fresh ingredients. By cultivating these habits early, the aim is to instill lifelong preferences for healthier food choices.

The Ministry of Transport has a unique opportunity to influence public health through improved urban planning and infrastructure. By ensuring efficient and reliable transportation to areas with fresh food markets, they can significantly enhance access to nutritious foods, especially in underserved communities. This approach could include developing public transit routes that directly connect residential areas with local farmers' markets or grocery stores that offer fresh produce.

Additionally, the Ministry of Domestic Trade and Cost of Living plays a crucial role by enforcing pricing policies that make healthy foods more affordable. Setting ceiling prices for essential nutritious foods can prevent price gouging and ensure that even low-income families can afford a healthy diet. Local governments can contribute by maintaining and expanding public spaces such as parks, walking trails, and sports facilities, promoting an active lifestyle which complements dietary measures against chronic diseases.

That being said, individuals must take personal responsibility for their health by making informed dietary choices and adopting healthier lifestyles. However, this is only feasible when economic barriers are minimised. Government policies should work synergistically across sectors to create an environment where healthy choices are available, accessible, and affordable for everyone. It is only by addressing both health awareness and economic barriers, Malaysia can tackle the root causes of chronic diseases more effectively leading to a healthier and more productive population.

David Chang is a research officer at BranX-ON Marketing. Sean Thum is a policy officer at the Ministry of Communications and Multimedia.

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