More than one in two Malaysians are either overweight or obese. More than a third of the population suffer from high blood pressure and more than half have high cholesterol. 17% of the population has diabetes.

More worrying perhaps is the proportion of undiagnosed patients. “It’s even worse for hypertension (high blood pressure): for every two diagnosed cases, there’s three undiagnosed,” explained Dr Feisul Mustapha, Deputy Director of Non-Communicable Diseases at the Disease Control Division in Malaysia’s Ministry of Health.

The reason for such a worrying trend, he said, is a lack of screening among Malaysians. At the recent Innovation Labs World summit in Singapore, Mustapha shared with the audience why Malaysians don’t get screened, how to influence changes in behaviour, and some solutions already on the ground.

Low priority, high risk

One major challenge is that health is a low priority for Malaysians, said Mustapha. Contributors to the Employee Provident Fund were given free health screening vouchers from the government – but only 20% of them were used. “This is weird. Malaysians love free stuff, if there’s free food Malaysians will go for it – but priority free screening? No one wants to use it,” he added.

The latest National Health and Morbidity Survey in Malaysia shows that health literacy among adults is only at 6.6%. Health literacy, Mustapha expanded, is not just awareness and knowledge, but also how it is understood and applied. “You can be educated, you can have a good job, you can be successful in your career; but that doesn’t necessarily translate to high health literacy,” he said.

At the same time, non-communicable diseases are on the rise in Malaysia. A rapidly urbanising population is leading to an increase in the urban poor who often don’t lead healthy lifestyles. This increases the risk of them getting non-communicable diseases such as diabetes, heart attack and stroke, he said.

Another factor is culture: in the 90’s, Middle Eastern cuisine, for example, was a rarity in the country. Today, there are several shops selling the cuisine even in the smallest of towns. “In a matter of less than 20 years Malaysians have assimilated the diet of another culture, which is unfortunately not so healthy when it comes to NCD risk factors,” Mustapha explained.

Influencing behaviour

A common misconception is that awareness and knowledge of health problems will lead to change, he said. “If that’s the case, then no doctor will smoke, and all doctors will exercise 150 minutes per week, and eat five servings of vegetables,” he mused.

Even with the right policy tools and campaigns, a supportive living environment is essential to influence change in behaviour, he stressed. Mustapha pointed to the example of his children – as a parent, he attempts to regulate what his kids eat. However, he cannot regulate how their grandparents enforce the same rules. “I don’t let them eat sweets, [but] my mom will let them eat sweets,” he said. If people are expected to make healthier choices, they should be widely accessible, he believes.

Digital health solutions can be a catalyst for behavioural change, he continued. “I’m hoping that more people will come up with: an app a day keeps the doctor away,” he quipped.

The health ministry ties up with the private sector to provide apps that encourage healthy behaviour. The first is Naluri, an AI-powered app which works as a motivational coach to encourage healthy habits. The app leverages big data to understand the user’s language, culture and lifestyle challenges, and provide access to professionally-qualified local health coaches, said Mustapha.

BookDoc Activ is another such app which provides tier-based rewards for having a specific average daily step count each month. The Ministry is working with the app developers to expand beyond its step count function, and create more holistic and dynamic interactions.

“I’m biased towards prevention, and to empower individuals in communities. And we need new partners to find new solutions,” Mustapha concluded. It will certainly take a team effort from across government, private sector, and the wider community for Malaysia to push for healthier lifestyles.

Image by Universiti Malaysia Sarawak – CC BY 2.0