How Malaysia is tackling rising obesity

Interview with Dr Feisul Mustapha, Public Health Consultant, Ministry of Health.

Malaysia’s Ministry of Health wants to take a hard stance on reducing obesity. In a country where nearly half of the citizens are overweight or obese, the Ministry is “aware of the increasing burden” and is now “looking at more ‘hard’ policies as opposed to ‘soft’ policies”, says Dr Feisul Mustapha, Consultant in Public Health (Non-Communicable Diseases) at the Ministry. ‘Soft’ policies refer to “raising awareness and knowledge”, whereas ‘hard’ policies refer to “changing laws and regulations and the environment to promote healthy living and healthy eating”, he explains. Dr Mustapha, who develops policies and programmes for preventing and controlling diabetes, cardiovascular disease and other non-communicable diseases, shares with GovInsider how Malaysia is making strides towards healthier living and behaviour for its citizens. Soda tax Minister of Health Datuk Seri Dr S. Subramaniam noted last June that obesity is an “increasing trend” in Malaysia. Based on the National Health and Morbidity Survey 2015, about 3.3 million adults aged 18 years and above - or 17.7% of the population - are obese, and about one out of three are overweight. “Most of the non-communicable disease risk factors among the adult population in Malaysia are on the increasing trends compared to the previous survey,” the minister said. To address this worrying health trend, the Health Ministry recently announced that it was considering a sugar-sweetened beverage (SSB) tax. “That means you increase the price of products which are unhealthy, with the hope that you make it less accessible,” explains Dr Mustapha, adding that Brunei has already implemented a similar tax. [blockquote]“You increase the price of products which are unhealthy, with the hope that you make it less accessible.”[/blockquote] Meanwhile, Mexico introduced a sugar tax back in 2014, which appears to be producing some results. There was a 5.5% drop in sugar-sweetened beverage purchases the first year after the tax was introduced, the report said, followed by a 9.7% decline in the second year. More than 70% of the population is overweight or obese, reported The Guardian. Malaysia is now learning from Mexico's efforts. “They have done a lot of evaluation research in Mexico, [and] it has been helpful in providing us with the scientific basis to support our recommendation,” says Dr Mustapha. A healthy Malaysia The Government needs to take a whole-of-government approach to tackle obesity, as it cuts across ministerial responsibilities. “The Ministry of Health have to work with other agencies and ministries because the acts and regulations for healthy eating and active living fall under their responsibilities,” Dr Mustapha says. For instance, the Customs Department will take the lead in implementing the sugar tax. The Ministry of Finance and Ministry of Youth and Sports will also be involved in improving health. “The implementor for introducing the SSB tax will be the Customs Department, similar to the ‘sin’ tax for tobacco and alcohol in Malaysia,” he explains. The Ministry of Transport can also step up, he says. Prime Minister Najib Razak has just announced the new phase of the rail system in Greater Klang Valley, according to Dr Mustapha. Public transport can be a factor in helping citizens to adopt healthy behaviour, as “[when] you use public transport, the number of daily steps that you take automatically goes up,” he says. But the Minister of Transport is “talking still on the economy point of view” and not taking the advantages to health into account, Dr Mustapha points out, adding that this can culminate in “a war” between health and economic considerations. After all, Malaysia has a “very big” soft drink industry that will be affected by the SSB tax, and the introduction of the tax would be “working against the industry interest,” he says. Involving local government Local authorities also play a role, Dr Mustapha continues, as they can declare certain areas to be smoke-free, come up with prohibitions, and “provide spaces for active living”. For instance, the former mayor of Kuala Lumpur, Datuk Seri Ahmad Phesal Talib, introduced Car Free Mornings, which sees the closure of certain sections of the city on some Sundays for people to cycle and run. “He can take full credit for creating a health-promoting KL.” [blockquote]“He can take full credit for creating a health-promoting KL.”[/blockquote] Mayors and ministers “can take a leadership role”, and ‘own’ it, he adds. The Ministry of Health can “provide the evidence, technical knowledge, and training, but you’re in the driver’s seat and you can call it your own”, he believes. “That feeling of ownership is still one of our challenges,” he notes. Obesity is an economic challenge as much as it is a health one. Malaysia needs concerted efforts from civil servants across ministries to tackle this issue. Healthcare leaders will be in Singapore at Innovation Labs World on 26 September 2017 to share how they are transforming healthcare systems with technology. Register today. Image from the Car Free Morning Facebook Page