Malaysia’s overall health outcomes have experienced commendable improvements over the past decades. Malaysians are now living longer with a life expectancy of 75.6 years[1]. As a result of better healthcare facilities and public health policies, there has been a decline in the maternal mortality rate (29 out of 100,000 live births)[2].
However, the picture is rather incomplete as gains in health outcomes are uneven. Adequate healthcare is limited for those living in poverty and in remote areas. The urbanites in Klang Valley tend to have a longer life expectancy (78 years) compared to those living in Sabah (74.3 years) and Terengganu (73.4) [1].
We assembled 10 reasons why health and poverty are interlinked:
Poverty-related diseases and issues among men, women and children
#1: Men suffer from an array of health problems related to their lifestyles. The top two illnesses associated with men are lung cancer and ischemic heart disease subsequently causing economic loss to the nation [3].
- At least 4.8 million Malaysians age 15-years-old and above are smokers. The proportion of smokers is 30 times higher among males compared to females[4].
- A higher prevalence of smokers was recorded in Kedah, Sabah and Terengganu[5]. A study on smoking determinants found that poverty or poorer circumstances resulted in a higher likelihood of tobacco usage[5]. Smoking became their coping mechanism while facing tough life choices.
#2: Women living in poverty are considered one of the most vulnerable groups when it comes to health. They sacrifice their meals for other family members, especially their children. As a result, women in poverty consume lesser necessary micronutrients such as iron and iodine.
- 3 out of 10 women in Malaysia are anaemic[4], this leads to adverse health effect such as a higher risk of miscarriage, premature delivery and possible heart failure[6].
#3: At least 1 in 5 children in Malaysia below the age of 5 are stunted in their growth[4].
- There is an increased chance of children under the age of 5 having a stunted growth from 20.7% in 2016 to 21.8% in 2019 [6].
- The risk doubles if a child is part of a household earning less than RM1000 per month compared to a household earning RM5000 and above[7].
The cost of eating healthy
#4: Food expenditure is highly related to household income. For example:
- A typical B40 household spends approximately RM763 per month on food expenses. It works out to RM25 per day, per household for food only[9].
- An average M40 household spends at least RM44 per day on food expenses, and a T20 household, RM76 per day[10].
- In percentage, the B40 group spent 24.2% of their monthly income on food whilst M40s and T20s only utilised 18% and 12.6% of their income on monthly food expenses[10]. What this indicates is the B40 group is spending a larger chunk of their income to curb their hunger as compared to the M40s and T20s.
#5: With a significantly smaller budget for food expenses, the B40 community have to choose and consume food that will fill them for longer and cost lesser.
- Healthier options such as vegetables, high-quality proteins (meat) and whole grains are removed from their grocery list. As substitutes, their shopping basket would be loaded with low-cost energy-rich starches (rice), added sugars, vegetable fats and processed food[10].
When the poor fall sick:
#6: The average time taken for a rural resident to reach a hospital is 30.65 minutes. It only takes an average of 16.71 minutes for urban residents to arrive at a nearby healthcare provider[11].
- There are 75 remote clinics in Sarawak that can only be reached via the river, with no means of accessing them overland. East Malaysia is notorious for its difficult to navigate terrains, which adds to the challenges of developing proper infrastructure[12].
- The dispatching of COVID-19 vaccination only further emphasised the barriers faced by East Malaysians. Rural folks are limited in their access to healthcare facilities due to poor infrastructure (roads), mobile coverage and expensive or lack of transportation[12].
#7: Malaysia’s public healthcare is arguably affordable where citizens are charged only RM1 at a government clinic or hospital for visits and diagnosis [13]. The cost however could hike up for long-term medical treatment. (eg. hemodialysis for kidney problems and chemotherapy).
- The majority of Malaysians (80%) used their income to pay for medical services. 36% relied on their savings and 11% would have to borrow from family and friends in such cases[4].
- At the same time, 43% of Malaysians cannot afford to purchase personal health insurance[4]. Fortunately, we have changemakers that are assisting the poor when it comes to long term medical care.
- Reportedly, the poor relied on over-the-counter medication (eg. paracetamol) to ease their symptoms. Instead of seeing a doctor, many choose the self-medication route because of the fear of hefty medical fees and the reluctance to sit in long queues at government hospitals or clinics because it will take time off work, which meant lesser income.
- Thus far, the government has launched two initiatives, PeKa B40 and MySalam to ease B40’s healthcare burdens.
#8: There are gaps in the medical facilities provided in hospitals in urban and rural areas.
- 70.7% of the Sarawak’s public health clinics do not provide laboratory services, 39% do not even have pharmacists. 88.9% do not even have x-ray services[14].
- Only basic healthcare services are provided in most medical facilities (Klinik Komuniti/Klinik Kesihatan) in East Malaysia.
- Cases that require complex medical procedures would be referred to state hospitals or district hospitals that would require rural dwellers to travel further.
- This was the scenario during the pandemic. The Intensive Care Unit (ICU) at the Tawau Hospital ran out of space. The medical frontliners had to redirect outpatients to Lahad Datu Hospital; another 2 hours and 30 minutes drive[15].
#9: The shortage in medical doctors have been hot in the headlines recently. The problem was evident in rural areas and poorer parts of Malaysia.
- The World Health Organisation recommendation for doctor-patient ratio is 1:500. Supposedly, Malaysia has exceeded the target in 2020 with a 1:454 ratio [16].
However, the ratio of doctor to population differs in every state in Malaysia, and the latest data in 2016 reflects that not all states are provisioned with medical doctors equally. - Selangor has the highest number of doctors (public and private combined) with 9,483 doctors, given that it is one of the densest states in Malaysia in 2016[17].
- Sabah had only 3,212 doctors (1 doctor for 1,187 populations). Wilayah Persekutuan Labuan had only 81 doctors (1 doctor for 1,207 populations) in 2016[17].
Did mental health issues skip the poor?
#10: The pandemic and its repercussions had hit all of us one way or another. However, the urban B40 mental health state is concerning.
- At the early stages of the pandemic in 2020, 30% of households reported symptoms of depression. In December 2020, 1 in 5 of household heads are depressed. Their two top main concerns had been whether they would have enough to provide for their families and the state of their children’s education[18].
- Children in the B40 household did not escape this pattern, as 1 in 2 parents observed that their children’s mental health was affected during the prolonged Movement Control Order. 1 in 5 reported disruption in their children’s sleep pattern[18].
Explore our sources:
- Department of Statistics Malaysia. (2021). Abridged Life Tables, Malaysia, 2019-2021. Link
- The World Bank Data Indicator. Maternal Mortality Ratio.(modeled estimate, per 100,000 live births). Link
- Ministry Of Health. (2020). The Impact Of Noncommunicable Diseases And Their Risk Factors On Malaysia’s Gross Domestic Product. Link
- Ministry of Health Malaysia (2019). National Health and Morbidity Survey 2019. Link
- R.Abd Rashid., et al.(2019). The Prevalence of Smoking, Determinants and Chance of Psychological Problems among Smokers in an Urban Community Housing Project in Malaysia. Int. J. Environ. Res. Public Health 16, 1762. Link.
- Wiki impact. (2020). The Impact Of Poverty On Women’s Health. Link
- De Onis, M., & Branca, F. (2016). Childhood stunting: A global perspective. Maternal and Child Nutrition, Vol. 12, pp. 12–26. Link
- Kok, D. (2019). STUNTING IN MALAYSIA: Costs, Causes and Courses for Action. Link
- Wiki Impact. (2020).Three Surprising Health Facts About The B40 Community. Link
- Department of Statistics Malaysia. (2019). Household Expenditure Survey Report. Link
- Ministry of Health. (2012). National Health And Morbidity Survey 2011 Volume III Healthcare Demand and Out-of-Pocket Health Expenditure. Link.
- Wiki Impact. (2021). Can Covid-19 Vaccines Reach Rural Areas In Time? Link
- Imoney. (2017). Treatments You Can Get For As Low As RM1 At Malaysian Government Hospitals. Link
- Batumalai, K. (2020). 57 Years Later, Do Sarawak, Sabah Enjoy Equal Health Care To Peninsula? Code Blue. Link.
- Ashswita Ravindran, Code Blue. (2020). Poverty, Sickness, And Death: Why Sabah’s Covid-19 Patients Are Ill. Link.
- The Star. (2020). Doctor-patient ratio exceeds target. Link
- Ministry of Health of Malaysia. (2020). Malaysian Health at a Glance. Link
- UNICEF. (2021). Families on Edge, Issue 4. Link.