Consequences of Urbanization in Malaysia
How it works
- 1 Introduction
- 2 General State of Healthcare
- 3 Health Study
- 4 Conclusion
- 5 References
A country profile is a brief overview on the factors that affect and shape the health and wellbeing of its citizens relating to its demographics, economy, government, healthcare system, and environment. I chose the country of Malaysia simply because my husband was stationed there in the military and received care while in combat.
Malaysia is the 66th largest country in Southeast Asia separated by the South China Sea and divided into two regions known as Peninsular Malaysia and East Malaysia.
Its population in 2010 was noted to be well over 28 million making it the 42nd most populated country, with the population increasing by 1.54% each year. Twenty out of the twenty-eight million of the population reside in Peninsular Malaysia. Within this twenty-eight million, people within the 15–64 age group amount to 69.5 percent of the total population (Wikipedia, 2019). Malaysia is located near the equator making the climate hot and humid year round. The average annual rainfall is about 98 inches. Climate change is likely to affect sea levels and rainfall, increasing flood risks and leading to droughts (Wikipedia, 2019). Malaysia is a federal constitutional monarchy which closely resembles the Westminister parliamentary system. The head of the state is the Yang di-Pertuan Agong also known as the King who’s elected to a five year term by the nine hereditary rulers of the Malay states. Race plays a major role in politics. Under the affirmative action policies like, New Economic Policy and the National Development
Policy the bumiputera, sons of the soil, consist of Malays and indigenous tribes who are considered the original inhabitants of Malaysia have privileged treatments when it comes to employment, education, scholarships, business, housing, and so on (Wikipedia, 2019).
General State of Healthcare
Urbanization has become a rapid trend around the world improving economic growth and development, but it has also created some negative effects when it comes to health. Statistics from 2011 show that 72.8% of Malaysian people live in urban areas (Mansor & Harun, 2014). This urbanization has caused residents to obtain a sedentary lifestyle leading to diseases that have caused morbidity and mortality rates to increase in Malaysia. This lifestyle has lead to health problems like obesity and overweight leading to health issues such as diabetes, coronary disease, cancer, and mental illness. The National Health and Morbidity Survey reported that in 2006, 29% of Malaysian adults were overweight, and 14% obese (Mansor & Harun, 2014).
In 2008, the World Health Organization Global Status Report 2010 recorded that 36.1 million deaths around the world were caused by non-communicable diseases (NCDs) like heart diseases, chronic lung diseases, cancers, and diabetes while heart attacks and strokes were among the main death causes in Malaysia (Mansor & Harun, 2014).
It is noted that living an active lifestyle, performing thirty minutes of physical activity for 5-6 days per week, will reduce the risk factors for NCDs. There has been an increase in government funding on health campaigns carried out by the Department of Health Malaysia such as the ’10,000 steps challenge’ to promote a more active lifestyle (Mansor & Harun, 2014). The initiatives carried out by the government to improve public awareness of living a healthy lifestyle were foreseen as a great contribution but the number of NCDs continued to increase. The reasoning behind this ineffective approach was solely due to lack of participation on the part of healthcare professionals, lack of support from surrounding agencies, ministries, and leaders in the communities.
Healthcare in Malaysia is two tiered comprising of a private and public sector; with the public provision being rather basic. According to the World Health Organization (WHO, 2018), Malaysia attained government funded universal health coverage for their citizens that exist in the private sector. They placed 5% of the government’s budget into public health care which is an increase of more than 47% over the previous figure (Wikipedia, 2018).
The burden of non-communicable diseases requires a transformation in how health services are organized, financed and delivered. In doing so, the 11th Malaysia Plan intends to “accelerate efforts to achieve universal access to quality healthcare by targeting underserved areas, increasing capacity of both healthcare facilities and personnel, and promoting community engagement to ensure shared responsibility for health” (WHO, 2018). With the commitments and partnerships of various health programs and community engagements they have been more proactive in directing health and health care needs. The country must now build on its successes and reinforce its health services to be able to cope with the challenges looming from its changing demographics and burden of non-communicable diseases (WHO, 2018).
Currently non-communicable diseases (NCDs) represent 63% of the global burden of disease and is expected to be responsible for 73% of all deaths in 2020 (Norris et al., 2014).
According to the World Health Organization (WHO, 2019), in adults 18 years and older, the prevalence of known hypertension in 2015 was 13.1% and previously undiagnosed hypertension 17.2% (total 30.3%); hypercholesterolemia prevalence in adults (18 years and over) is 47.7%; diabetes prevalence (adults 18 years and over) is 17.5% (including undiagnosed 9.2%). Additionally, 30% of adults are overweight, with a body mass index (BMI) of 25–29.99, and 17.7% as obese (WHO, 2019).
Urbanization has become a trend among the population of Malaysia causing residents to become sedentary and inactive leading to diseases that have been noted to cause morbidity and mortality.
The World Health Organization (WHO) reports that NCDs are by far the leading cause of death globally, representing over 60% of all deaths. Every year it is estimated that 2.8 million people die from being overweight. High cholesterol accounts for 2.6 million deaths and 7.5 million people die due to high blood pressure. Risk factors such as a person’s background, lifestyle and environment are known to increase the likelihood of certain NCDs (Mansor & Harun, 2014).
In order to attack the prevalence of non-communicable diseases (NCDs) it is recommended by the Malaysian Board of Health Promotion, that in order to maintain an active lifestyle you must become physically active, like brisk walking for thirty minutes five to six days a week, participating in activities that increase strength and endurance of muscles and flexibility for two or three times a week, practicing good eating habits, getting enough sleep and allowing the body to rest will facilitate in maintaining the overall health of this urbanized population thereby preventing chronic diseases (Mansor & Harun, 2014).
According to the World Health Organization (WHO, 2002) Malaysia spent an estimated 3.9% of the Gross National Product (GNP) on health in 1996. Per capita spending was estimated at US$ 263 in 1995 and in 2000, the government allocated 7.7% of the national budget to health, up from 7.4% in 1999 (WHO, 2002). The health budget was increased in order to support the economic slump during the South Asian financial crisis. Health is essential in the development process and influential to socioeconomic advancement (WHO, 2002).
To spread awareness and prevention against NCDs, the Ministry of Health embarked on the first phase of ‘healthy lifestyle campaign’ in 1991. This campaign continued for six years introducing a new theme each year like diabetes, cardiovascular disease, cancer, food safety and so on. It aimed to encourage a healthy dietary, physically active lifestyle in order to combat these diseases. With the support of the National Plan of Action on Nutrition (NPAN) the campaign began its second segment from 1997 to 2002 by concentrating on behavioral changes. From then on with efforts from the government and other organizations emerged more campaigns for a healthier lifestyle for Malaysians which included ‘My Healthy Body,’ ‘Happy Healthy Family,’ ‘Eat Healthy During Chinese New Year,’ ‘Jacobs Walk of Life 2008,’ ‘Obesity and our Environment,’ ‘Less Salt Please,’ and the list goes on. The intent of the campaigns were to empower and encourage the citizens of Malaysia to practice a healthy lifestyle by maintaining a healthier diet, exercising, overcoming stress, and avoiding smoking (Mansor & Harun, 2014).
It is noted that the environment plays a significant role in promoting a healthier lifestyle among these urbanized sedentary citizens of Malaysia. Green spacing and health have become interchangeable in terms of promoting a healthier lifestyle. Green spacing provides a serene outdoor environment creating efforts to improve general health through encouraging outdoor physical activities like walking, outdoor sports, recreational activities, cycling, gardening, and so much more. “Mitigating and adapting to these human-induced activities by promoting greener public infrastructure may benefit citizens, government and the environment in efforts to reduce morbidity and mortality linked to the sedentary lifestyle” (Mansor & Harun, 2014). Research completed by Peninsula College of Medicine and Dentistry (2011) found that outdoor physical activity “melt away tension, anger, and depression,” people prefer exercising outdoors more than indoors which increases the likelihood of the continuation of physical activity (Mansor & Harun, 2014). As of yet Malaysia doesn’t attain an acceptable degree of green space to aid in this type of environment.
The campaigns brought forth by the government and various organizations contributed to the awareness of the Malaysian citizens in acquiring a healthy lifestyle but issues regarding the effectiveness of these efforts still remain. According to the National Health and Morbidity Survey (2011) between 2006 and 2011 the number of patients with diabetes, hypertension, and hypercholesterolemia increased; not only that but the increment prevalence of obesity went from 4.4% in 1996 to 15.1% in 2011 which equals to 2.5 million obese Malaysians (Mansor & Harun, 2014). The logic behind these failed efforts were the lack of collaboration and cooperation among agencies, leaders, media, and the community as a whole. To improve these efforts more aggressive approaches by the government and other organizations to bring about awareness of healthy lifestyles should be continued. Allowing the Malaysian citizens to become more involved in this approach could bring about more positive outcomes. These various organizations and healthcare professionals should pole the citizens of Malaysia and allow their voices to be heard in regards to what they feel would be a more feasible approach in promoting a healthier lifestyle that best fits their everyday lives.
According to Mansor & Harun (2014), Malaysia has been labeled as a country that has the highest obesity problem in South East Asia and the sixth in Asia (Mansor & Harun, 2014). The occurrence of obesity and overweight, if not controlled, causes health issues like coronary heart disease, diabetes, hypertension, and hypercholesterolemia.
With the increment of obese and overweight adults in Malaysia nowadays, the prevalence of having these types of diseases are high. The consumption of unhealthy foods and living a sedentary lifestyle has undeniably led to steep rises of NCDs among Malaysians. In 2010, over 3.4 million Malaysians were a diabetes sufferer with 4 out of 5 patients dying of heart disease…. Studies have shown that 45% of adults, especially urban residents, live a sedentary lifestyle and consume unhealthy diets compared to rural people due to lack of physical activity and high consumption of calorie rich diets (Mansor & Harun, 2014).
This urbanized population has become extremely inactive and sedentary, causing major health issues. Environmental factors play a key role in creating a more serene active outdoor experience in promoting a healthier lifestyle through what is known as green spacing but Malaysia doesn’t attain this type of environment. Therefore it is up to the government, local leaders, communities, organizations, and healthcare professionals to collaborate with one another in hopes of creating an alternative yet effective means of providing an active lifestyle for the citizens of Malaysia. According to Jaabi (2018), “there are at least four major factors that hinder Malaysians from eating healthily, such as time constraints, inconvenience of healthy food availability, low purchasing power and low level of awareness.” Malaysians make up 70 percent of the urban population; providing awareness to this group of individuals could be a start in changing the mindset of this urbanized group as it pertains to a healthier more active lifestyle. To aid in promoting this healthier lifestyle, healthier food choices must be made available, increased awareness of healthier food options that are accessible locally, levy tax on sugar-based goods to improve healthcare delivery systems.
Ideally, taxes discourage consumption of targeted items and increase consumption of the alternatives. Malaysia plans to levy taxes on unhealthy food by 2020. Further, Malaysia also targets a minimum number of 15 formulated or reformulated less-sugary food products per year. This is essential to control sugar consumption as it contributes to obesity in children (Jaabi, 2018).
By levying taxes on unhealthy food Malaysia can improve healthcare delivery systems with added revenue which can reduce public health per capita spending, particularly in purchasing medicine to cure NCDs. It would allow Malaysia to increase its allocation of gross domestic products (GDP) on healthcare, providing improved health outcomes like lowering infant mortality rate and increasing life expectancy. Right now, Malaysia spends 4.3 percent of its GDP on healthcare, which is lower compared to developed countries, which stands at 17.2 percent (Jaabi, 2018).
- Jaabi, A., (2018 January, 23). Choosing to eat healthy. New Straits Times. Retrieved from https://www.nst.com.my/opinion/columnists/2018/01/327860/choosing-eat-healthy