Chronic diseases, mental issues plague Malaysia’s poor more than well-to-do. Here’s why and what can be done

Low income households in Malaysia are more prone to non-communicable diseases (NCDs) and mental health problems than their better-off counterparts as a result of policies that perpetuate class division and wealth inequality, according to a new study by Khazanah Research Institute (KRI).

The study sought to analyse social factors shaping health and suggested that income levels play a significant role in health levels. Researchers from KRI said their conclusion was based on, among others, the prevalence of NCDs between top and bottom earners.

Common NCDs like diabetes, hypertension, and hypercholesterolemia, diseases often caused by an imbalanced diet, were found to be more prevalent among adults in the bottom 20 per cent income bracket, but were lowest among those in the top 20. 

NCDs are also known as chronic diseases.

Researchers also saw disparity in how the diseases spread among the different income quintiles. By looking at reported NCD cases between 2006 to 2015, they found the rates of increase were disproportionately higher for those on the bottom rung. 

“The prevalence of diabetes in the lower quintiles increased much more than the higher quintiles, resulting in a negative socioeconomic gradient in 2015,” KRI said in the third part of its State of the Households 2020 report released yesterday, titled Social Inequalities and Health in Malaysia.

The report is the final part of studies on inequalities and the state of households held throughout the year. In this series, the think tank studied unconventional social factors such as living conditions and work, environments as well as behaviour, to look for signs of inequality in health.

Nazihah Muhamad Noor, Jarud Romadan Khalidi and Puteri Marjan Megat Muzafa were the report’s lead authors.

“For high cholesterol, the prevalence rates depicted an inverted U-shaped curve in 2006, with the bottom and top quintiles having the lowest rates, to a U-shaped curve in 2015, with the bottom and top quintiles having the highest rates instead,” they added.

A similar trend was also found when assessing mental health. 

The KRI study found more adults and children from the low income quintiles, at 33.6 and 13.9 per cent respectively, suffered some form of mental health problem than those in the upper income bracket (26.4 per cent for adults and 8.0 per cent children.)

Such data, KRI said, underscores the impact socioeconomic factors have on health.

“Some health inequalities are unavoidable,” researchers said in the report. 

“For example, differences in health between the elderly and younger populations can be attributed, among others, to biological and physiological variations related to age, factors that are arguably natural and not easily modifiable.

“However, other health inequalities are the result of inequitably distributed health-promoting and compromising conditions” they added.

Income and life expectancy

By using socioeconomic determinants, KRI said it was able to extract a more accurate picture about the state of health in Malaysia. For example, incorporating economic markers allowed them to detect disparities in health between the states by looking at its income levels.

Using state mortality and morbidity data, the study found states with higher GDP per capita, such as Kuala Lumpur, Penang, Sarawak, and Selangor, had higher life expectancies compared to poorer states, data not obtainable with traditional markers alone.

This also allowed KRI’s researchers to use mortality indicators to detect inequality between richer and poorer districts. Among their key findings was the higher risk of dying young among those in the bottom income quintile who live in disadvantaged districts.

Researchers look at potential years of life lost, standardised mortality ratio, infant mortality rate, and the under-five mortality rate as mortality indicators.

Researchers said their findings point to an urgent need to look at public health beyond just life expectancy and access to healthcare, and start to consider other variables that have causal relationship on a household’s health, like income and work.

Life expectancy, or the number of years a person can expect to live, while a key indicator for assessing population health, can obfuscate problems that would otherwise need intervention, like correcting social factors that may have indirect health implications, the KRI researchers stressed.

This would entail addressing socioeconomic gaps that perpetuates health inequities.

What can be done

Health policies must be expanded into areas like physical environments, psychosocial conditions, and culture, which researchers said form structural determinants that have indirect causal effects on a household’s health.

“These structural determinants do not affect health directly but through direct determinants.

“Health inequities are generated when these direct determinants are unevenly distributed, reflecting and perpetuating other social inequalities. In other words, individuals experience differences in exposure and vulnerability based on their respective social status,” KRI said in the report.

So solutions would require a going beyond just universal healthcare and taking an intersectoral approach, such as eliminating barriers to education, scaling up social protection for neglected populations and improving housing conditions, the study suggested.

“Considering the importance of social factors in determining health outcomes, policies must place greater importance on the social mechanisms underlying the inequitable distribution of health,” researchers said.

Researchers recommended that health considerations underline all national policies with society’s well-being as the primary goal.

“In designing national policies to improve the overall well-being of the nation — whether it be urban, educational or industrial planning — policymakers must take into account health considerations across all policies,” they said. — Malay Mail

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