Putting nutrition at forefront of healthcare

THE Health White Paper to be tabled in Parliament at the end of this year outlines a clear shift from the current system of treating the sick to one that promotes healthcare and wellness.

But does this mean nutrition, already a long neglected issue, will be given greater emphasis? While the ambition to tackle malnutrition is strong, on-the-ground actions have been inadequate possibly due to lack of political commitment and ineffective integration of nutrition into national policies.

Nutrition is a core component of primary healthcare. It promotes health through healthy eating, and concerns not only the quantity and quality of the food we eat but also eating patterns and lifestyle factors. In fact, nutrition is a significant determinant of various health issues across generations.

Malaysia’s health report card is far from satisfactory. Half of Malaysian adults and around 30% of children aged five to 17 are overweight or obese. Three of 10 women of reproductive age (15 to 49 years old) suffer from anaemia, which is commonly caused by lack of iron, a mineral naturally present in food. Stunting remains a public health concern, affecting one in five children under five years of age.

In spite of the rising disease burden, healthy behaviours among Malaysians are lacking, possibly due to limited awareness or knowledge of health issues and a supportive environment. One in four Malaysian adults is not physically active enough while 95% do not eat enough fruits and vegetables.

Unhealthy diets and lifestyles do not just increase the risk of many diseases but can also affect one's quality of life, even mental health, negatively.

Most public health nutrition interventions are cost-effective, considering their immediate, long-term and inter-generational impacts. For example, initiatives to improve the nutrition of women of reproductive age also improve their children's health.

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.

A 2019 KRI (Khazanah Research Institute) report showed the 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 amounts of 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.

According to a Health Ministry report 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% of total health spending was on public services, including health promotion and prevention, with most spent on curative services (67.7%).

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.

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 who are 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 is making our food less safe to eat. Climate change is also making food such as rice, corn and wheat less nutritious.

There are existing policies and guidelines that can promote healthy food environments, for example 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 drawing up strategies to ensure that nutrition policies and guidelines are easily understood and can be implemented by multiple stakeholders.

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 to enhance universal health coverage, making health a reality for all Malaysians.


Research Associate

Khazanah Research Institute

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