Processed Food, Poverty And The Price People Pay For Cheaper Food Options

A food desert is a region where people have limited access to healthy and affordable food, usually because of low incomes or having to travel farther to find healthier food options^[1]. Often, it would lead to people resorting to processed foods due to their availability or cheapness, a diet that leads to health problems later in life. 

And unfortunately for Malaysia’s Bottom 40% (B40, categorised as people earning an average monthly household income of below RM4,849^[2]), many of them are living smack-dab in the middle of such situations.

The poor are categorised as those with a household income of RM2,208, so can you imagine living in Kuala Lumpur with the high prices of food and transport? – Datuk Dr Madeline Berma, Academy of Science Malaysia^[3]

Indeed, according to the National Poverty Data Bank System (eKasih), in the Federal Territories, at least 6,100 households are considered poor (earns less than RM2,208 a month), and, 4,500 are hardcore poor (earns less than RM1,169 a month)^[4]. All struggle with balancing their available budget to afford necessities to survive. With rising living costs and inflation, it is a worsening struggle. 

We shall look more closely at why B40 households sometimes have to sacrifice their nutrition and how this sacrifice can lead to health problems later on in life.

Rising Costs Make Eating Healthily Expensive

We used to have meat at least once every one or two weeks when both of us were working. But now, we only have it on special occasions like Deepavali. Even chicken or fish is once in a while. – Sushila M., housewife and babysitter^[4]

For many individuals and families in the B40 group, food is a priority. According to Academy of Sciences Malaysia fellow Datuk Dr Madeline Berma, B40 families spend more than 40% of their income on food, with transportation being the second highest expenditure^[3].

A 2019 household expenditure report by the Department of Statistics shows that food and non-alcoholic beverages made up the highest expenditure group (24.4%, approximately RM763 per household) in rural households^[5].

All of this makes lower-income households more vulnerable to food insecurity as prices go up, something that has already happened during and following the Covid-19 pandemic. Even basic foods and beverages such as roti canai and teh tarik have seen price hikes of between 20-30%^[4].

Eating outside is also more expensive, with a plate of ‘nasi campur’ increasing [from] 50 sen to RM2, even if there isn’t any meat and very few ‘lauk’ (dishes). The price of roti (canai) has also increased. Drinks such as coffee or tea at a food stall have also increased by 50 sen. It might not seem like much to someone who is wealthy, but to those who are just surviving, it often means just drinking plain water (from the factory water dispenser). – S. Krishnan, a factory worker^[4]

Cheaper Substitutes

Madeline states that most B40 households rely on stores that offer low prices and bulk purchases or donations for their food supply^[7]. And most of the foodstuffs that they can afford or receive are largely comprised of starches (e.g. rice), cooking oils, processed and ultra-processed foods (e.g. instant noodles, fast food, packaged bread, soft drinks etc.) or canned foods (e.g. sardines, luncheon meat, salted vegetables, etc.).

Such foodstuffs are filling, high-energy and long-lasting but are also high-calorie and lacking in essential nutrients and dietary fibres. Processed and ultra-processed foods are especially unhealthy as they contain added sugars, salt or chemicals (e.g. artificial colours, flavours or stabilisers) that make them addictive.

Adding to the problem is that when they find themselves strapped for cash, B40 households will drop fresh foods such as fruits and vegetables from their expenditures and replace them with cheaper substitutes such as canned foods to fill their stomachs quickly while also sustaining them through the price hikes^[7].

Whether they live in cities or rural areas, parents in the B40 group are bound to focus on their survival rather than the nutritional quality of the food they eat. Their main source of carbohydrates is rice while they get their protein from chicken. Consuming vegetables and fruits, the prices of which have gone up is not a priority for them. – Prof Dr Ruzita Abd Talib, Universiti Kebangsaan Malaysia^[6]

And if they are desperate, some families will skip meals altogether, with dinner being the only mealtime they will have in a day^[8].

Covid-19 has affected my family’s life tremendously. Since I only work once a week, we have to really cut back on our food to save costs. Most of the time we only eat kampung fried rice or onion fried rice. As long as it can fill our stomachs, that’s enough. – Mohammad Mahhadir, a lorry driver^[7]

The Hidden Health Costs For Children

After school, I don’t have lunch, but my mother will bring some food from her workplace, like chicken curry. So I eat after she returns from work after 5pm. After Isha prayers (around 8:30 pm), I will eat again. – Nur Hayati Elia, student^[8]

By sacrificing freshness for affordability, lower-income households will put themselves and their families at risk of suffering more severe health problems later in life.

Even before the pandemic struck, Malaysia was already suffering from malnutrition problems such as obesity, wasting and anaemia. These health issues are especially prevalent among children; data from the Institute for Public Health (IPH) shows that stunting among under five years was higher than the average rate in other upper-middle-income countries, and it continued to increase from 17.7% in 2015 to 21.8% in 2019)^[9].

Rising food costs greatly impact the urban poor and their quality of life (physically and mentally) as it leads to stress or even depression. Aiming for a balanced diet will be quite hard, and another concern is stunting among children. So one major issue is the long-term effect of the lack of nutrition and how it will affect their physical and mental development. – Prof Dr Mohamad Fazli Sabri, Universiti Putra Malaysia^[3]

The National Health and Morbidity Survey (NHMS) 2019 showed that the obesity and overweight prevalence rates among children from B40 families stood at 15.6% and 15.4% respectively, roughly equivalent to the rates among urban children which stood at 15.3% and 15.4% respectively^[5].

And more critically, children from low-income households like Nur Hayati Elia are either unaware of basic nutrition, such as the dangers of sugar and the importance of nutritious food, or if they are, are constrained by their circumstances^[8].

Childhood is a critical time when food preferences and eating habits are formed with long-lasting effects on health. We know that if children have an unhealthy weight early in life, this tends to trace into adolescence and then adulthood. We also know that excessive consumption of ultra-processed foods is linked to a number of health issues including being overweight or obese, high blood pressure, cardiovascular disease, type two diabetes and cancer later in life, so the implications are enormous. – Dr Eszter Vamos, Senior Clinical Lecturer in Public Health Medicine at Imperial College London^[10]

The Long-Term Repercussions Of An Unhealthy Diet

It is not just children who are at risk of suffering health problems from this diet.

A staggering 89.5% of B40 adults were found to not consume adequate daily amounts of fruits and vegetables. In addition, 68.1% reported consuming sugar-sweetened beverages at least once per week, including commercially packed ready-to-drink beverages, sugar-added self-prepared drinks, and premixed drinks and another 52.9% consumed bread and other commercially-baked goods at least once per week^[11].

And moderate consumption of ultra-processed foods and beverages can regularly increase one’s chances of becoming obese, leading to worsening health conditions later down the line. Indeed, many non-communicable diseases such as diabetes, cardiovascular disease (i.e. heart attacks), stroke and cancer have been linked to high obesity rates and diets lacking in essential nutrients^[12].

This observation has been confirmed in multiple studies, which [have] shown that people who consumed a higher proportion of ultra-processed foods have higher obesity rates, poorer nutritional quality in their diet, higher intake of sodium and sugar, lower intakes of fibres, whole grains, fruits, and vegetables. This then leads to a higher risk of developing Type 2 diabetes. – Dr Teoh Wei Leng, consultant endocrinologist, Sunway Medical Centre^[12]

And sad to say, Malaysia has earned the title of the fattest nation in Asia, with about half of its population being obese for 30 years^[13].

Fast food or processed food can most definitely be detrimental to our health in the long run especially when taken too frequently. As they are generally higher in calories, taking too much can result in weight gain. In addition to that, they are also usually high in saturated fats, refined carbohydrates and sodium, which can typically cause other non-communicable diseases such as hypercholesterolemia, diabetes and hypertension. – Darsheka Wanithasan, nutritionist^[14]

A diet of processed and ultra-processed meals has even been linked to mental ailments such as depression. It was found that people who ate large amounts of ultra-processed foods were more likely to report symptoms of poor mental health compared with those who ate less^[15].

We found that individuals who consume higher amounts of ultra-processed food also report more undesirable mental health symptoms such as anxiety and symptoms associated with mild depression. For example, diets high in ultra-processed foods often lack essential nutrients and are high in added sugars, both of which have been found to be associated with adverse mental health symptoms. – Dr Eric M Hecht et al., researchers at Florida Atlantic University^[15]

Now that we better understand the circumstances that force B40 households into poorer diets and how said diets affect their health, the question is, are we doing anything to help?

Providing For The B40

For the most part, the government has been sensitive to the plight of the B40 communities and has responded quickly^[3]. Many government initiatives aimed towards empowering and providing for B40 communities such as Bantuan Keluarga Malaysia.

Many corporations have also set up programmes dedicated to providing for B40 families; Sunway for example has its #SunwayforGood Food Bank initiative which distributed more than 25,000 kilograms of food or grocery items to aid some 2,100 B40 families across Selangor, Kuala Lumpur, Perak, Penang and Johor between the National Day and Malaysia Day period^[16]. And Air Selangor has its Box of Hope initiative which as of now has distributed a total of 2,455 boxes to B40 communities and selected charities around Selangor and Kuala Lumpur, alleviating the burdens of low-income earners^[17].

And then of course there are NGOs such as the Lost Food Project which is dedicated to ‘rescuing’ food from landfills and distributing them to the B40 communities, ensuring that quality, nutritious food and other surplus goods do not go to waste and are given to those who need them.

As admirable as these groups and programs are, Dr Mohamad Fazli does note that it is difficult to truly determine their effectiveness.

But it is hard to comment on the effectiveness of all these initiatives because there is not one scientific or empirical study that has been done. That is what is lacking. There are many programmes but do they reach the target group? We need to do simple research or survey into the effectiveness of all these programmes. Sometimes one community may receive more than is needed if there is a lack of coordination. – Prof Dr Mohamad Fazli Sabri, Universiti Putra Malaysia^[3]

Aid That Extends To More Than Just Handouts

Perhaps the best way to truly help the B40 communities with their food problems is to find a way for them to become self-sufficient.

Madeline notes that improving food security amongst the B40 is key to empowering and providing for them during price hikes. One of the projects she suggests is establishing urban farming communes or neighbourhood gardens to provide B40 households with an affordable, reliable and sustainable means of obtaining fresh fruits and vegetables^[3].

Urban farming projects here need to be further developed to make it accessible and affordable for the B40 to start and manage them so they can be more self-sufficient. For the poor, the government has to provide the initial costs of setting up vertical farming projects in PPR flats for example. The government can also allocate small plots of land near the PPRs to grow food. – Datuk Dr Madeline Berma, Academy of Science Malaysia^[3]

She also suggested setting up food banks at PPR flats which should be managed by the residents themselves^[3].

For example, each flat has a space with food items given by the government to start with, such as rice, sugar, flour, milk and basic necessities. Residents may ‘borrow’ what they need but the items must be returned eventually in cash or kind. And they can restock the items later by getting them from a wholesaler, so it’s cheaper. The project will build trust among the community and give them a sense of ownership of the project. If it’s not managed well, they will be the ones affected. – Datuk Dr Madeline Berma, Academy of Science Malaysia^[3]

Prof Mohamad Fazli, meanwhile, stresses that B40 households must learn new skills to improve their job prospects and thus become less reliant on aid for their survival^[3].

Therefore, we need to reskill, upskill or cross-skill the B40 group, which is important because the urban poor population is capable of it. At the same time, in our 12th Malaysia Plan, there is a focus on the gig economy. So employers and corporations should also give priority to the B40 group and help equip them with the skills necessary for job placements. – Prof Dr Mohamad Fazli Sabri, Universiti Putra Malaysia^[3]

He also highlighted the importance of long-term financial planning^[3].

Malaysians sometimes I feel are too focused on current consumption, but they neglect future consumption like children’s education, which will be more expensive, or aspects like health, insurance and emergency savings. So I feel that for those who receive aid, they should use the funds carefully on necessary items for the family, and then save the rest. Whatever amount you can save, just be consistent in saving, be it RM10 or RM50, so financial literacy is also important. –  Prof Dr Mohamad Fazli Sabri, Universiti Putra Malaysia faculty of human ecology dean^[3]

Ultimately, while we must provide whatever aid we can to the B40 households that have been badly affected by the recent price hikes, as Prof Mohamad Fazli pointed out, the B40 cannot rely on aid for too long.

Providing education in not just skills and financial planning but also health and diet are equally necessary for helping the B40 with eating healthily whilst still having enough in their budget for other necessities.

Explore our sources:

1. What are food deserts, and how do they impact health? (2020) Medical News Today. Link.
2. H.L. Lim (2020) B40 Nutrition and Watermelons. Abundant Ventures. Link.
3. W. Li Za (2022) Rising food costs: Equip and empower B40 group, say Malaysian experts. The Star. Link.
4. W. Li Za & M. Teoh (2022) Urban poor Malaysians forced to skip meals, sacrifice nutrition due to rising food costs. The Star. Link.
5. Household Expenditure Survey Report 2019. Department of Stastics Malaysia. Link.
6. Bernama (2022) Food inflation may expose children to obesity risk, say experts. The Malaysian Reserve. Link.
7. S. Chua (2021) Daily meals a struggle for B40 families after job loss, pay cuts. FMT. Link.
8. The Malaysian Insight (2018) Plump but malnourished, health of urban poor Malaysian children a ticking time bomb. today. Link.
9. Addressing Malaysia’s nutrition crisis post-COVID-19: Time for nutrition-focused social protection. Unicef. Link.
10. Urgent Need To Reduce Childrens’ Ultra-Processed Food Consumption (2021) Technology Networks. Original story from Imperial College London. Link.
11. C.W. Eng et al. (2022) Dietary practices, food purchasing, and perceptions about healthy food availability and affordability: a cross-sectional study of low-income Malaysian adults. BMC Public Health. Link.
12. Does Consuming Ultra-Processed Food Increase Your Risk Of Obesity, Diabetes And Cancer? (2022) CodeBlue. Link.
13. M. Chalil (2021) Cling on to traditional food culture to address fattest nation reputation, UK expert advises Malaysians. Malaymail. Link.
14. J. Tan (2022) Deliciously Dangerous. The Sun Daily. Link.
15. N. Schimelpfening (2022) Your Favorite Snacks May Be Causing You to Feel Anxious or Depressed. Healthline. Link.
16. Sunway Commits National Day Advertising Funds to Help B40 Community (2021) Sunway Stories. Link.
17. M. Murugesan (2022) #HEALTH: Ensuring good food for B40 families. New Straits Times. Link.