Malnutrition is not, as commonly perceived, merely a state of having an insufficient amount of food. For example, a large plate of plain white rice can satisfy hunger and energy needs, but clearly falls short in fulfilling nutritional requirements.
According to the Global Nutrition Outcome report in 2018, different forms of malnutrition coexist in Malaysia.
It is the child who fails to reach her optimal height and potential due to undernutrition. It affects the woman who does not get adequate iron and folate from her diet and is at risk of complications in pregnancy.
It rears its head in nearly half of Malaysian adults who are overweight or obese, and one in 10 children who are obese. It is also a major driver of non-communicable disease (NCD) burden: one in five people globally will suffer from heart disease, type 2 diabetes and some cancers due to dietary risks.
In Malaysia, almost one in three adults is expected to develop diabetes by the year 2025.
Such far-reaching and multiple impact of poor diet quality across the population points to a failure in our food environment and the overall food system.
The national nutritional survey in 2014 found inadequate intake of fruits and vegetables among Malaysian adults. While sugar, soy sauce and condiments were staple household items, whole grains were soundly absent. Only a minority of children and adolescents consumed whole grains, at insufficient levels, in the MyBreakfast study in 2013.Implementing policies where these gaps are identified can reshape food systems to help individuals have healthier diets.
The announcement by the Education Ministry to continue its collaboration with the Health Ministry to provide healthy breakfasts to primary schoolchildren is a step in the right direction.
With the purchasing power of the public sector, this initiative has the potential to shift the focus of industry and research to production of highly nutritious foods, if well managed.
For example, since whole grains are lacking in the average Malaysian diet, the menu could incorporate brown rice, oats or barley instead of only refined grains. Rice being a staple food, fortification initiatives to prevent micronutrient deficiency in the population, especially girls and women, are desirable.
From a health promotion standpoint, schools are in the powerful position of influencing the capacity for healthy eating – not simply reducing hunger – throughout the six years of primary school. The programme will benefit from teachers and parents being champions themselves, which can potentially flow on to their own health status.
Given the national priority on NCD’s, expanding the requirement for minimum nutritional standards in cafeterias of all learning centres and workplaces with a significant number of workers at risk or diagnosed with NCDs, is necessary.
The government is already spending billions of ringgit on managing existing cases in the public healthcare system and the predominantly curative approach cannot be sustained.
The upcoming Budget 2020 is an opportunity to ensure that the problems and programmes mentioned earlier have the necessary resources. We need to invest more in health prevention and promotion programmes.
We need to be bold to introduce innovative measures and incentivise health prevention behaviours, such as making healthier food choices, taking supplements to address nutritional deficiencies and adopting healthy lifestyles, such as sports.
The new excise tax of 40 sen per litre on sugar-sweetened beverages is one example and is also a countermeasure to the NCD epidemic. It pushes manufacturers to reformulate and reduce consumption patterns.
Depending on the impact of this approach, the government should then consider strategies for made-to-order sugary drinks.
Starting with large players like fast food chains and multinational beverage chains which are frequented by young people, display of sugar content per cup and choice of sweetness level should be mandatory. Research has indicated that high sodium and trans fat content are not consistently declared on food labels.
Even if it is declared, less than half of Malaysian adults read nutrition labels anyway.
The British traffic light system and Australian five-star food rating system provide at-a-glance nutritional information and serve as a guide to consumers.
As the consumption of ultra-processed foods rises, diet quality in terms of nutrients drops. Sales and consumption of ultra-processed foods and snacks, which are cheap, palatable and convenient, need to be balanced with information to consumers. Higher than daily recommended content should be highlighted instead of hidden.
Subsidy and food assistance programmes in the upcoming Budget should cover fruits, vegetables and legumes to help the B40 group reduce reliance on ultra-processed food. Wet markets and farmers’ markets are great places to get fresh produce, hence their cleanliness, safety and accessibility should be prioritised.
Nutrition is not only linked to food prices. Long working and commuting hours, lack of childcare support, clean water, perception of health food being less tasty, lack of information and transport options can all impede meal preparation using fresh foods.
Just as easy as it is to access fast food and beverages, weight management and diet counselling for people who are already overweight should be piloted in high traffic areas using sin taxes. Access to nutrition counsellors already exists in some retail pharmacies, where consumers may get advice for dietary supplements if they are unable to fulfil requirements through diet alone.
Tackling malnutrition is not the sole responsibility of the Nutrition Division of the Health Ministry and the end goal is not just the perfectly balanced plate that would make a nutritionist beam. Social and economic outcomes from eating well and living well require shared action through multi-sectoral symbiosis and a focus towards achieving Sustainable Development Goals.
Galen Centre for Health & Social Policy
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