Source: grist.org
In recent decades, we have seen a dramatic shift in public health nutrition perception and policies. This is in tandem with the evolving of the healthcare industry which is currently experiencing a period of unprecedented change to address the many challenges that are associated with this new healthcare. There is a new paradigm shift in the healthcare industry — from “sickness care” to “wellness care”. With the changing paradigm of health care from “sickness care” to “wellness care”, we have to grapple with health threats and crises every day.
Recent changing trends in the health scenario in Malaysia are likely to be continued into the future. Over the years, Malaysia has progressed tremendously with socio-economic development that has led to improvement in the quality of life. However, it has also induced lifestyle changes that are not always favourable to health with changes towards unhealthy diet and sedentary lifestyle. Globalisation, urbanisation and economic pressure have also changed our eating culture and behaviour unfortunately towards unhealthy eating behaviours. The burden of NCDs continues to rise in Malaysia and although the causes are complex, unhealthy diet is a major risk factor for NCD. Therefore, the successful health implementation by the various health professionals and disciplines including the public health nutrition is crucial to support the provision of an equitable, affordable and efficient health system that forms the thrust of our Vision For Health.
The public health nutrition plays a very important role in public health especially in preventive medicine. All of you: public health doctors, nurses, nutritionists and other allied health or healthcare personnel are the main front liners of public health workforce. Indeed, to ensure competence practice of public health nutrition, Malaysia’s framework to strengthen the healthcare system is based on a multidisciplinary care team approach, well-trained human resource, evidence-based decision support tools and effective health information systems. Currently, under the purview of the proposed Allied Health Professional Act, which is currently underway, it will hopefully protect the practice of nutritionists and other allied health professional especially in the public health sectors.
The role of nutrition in public health today is more complex than during its early development. Within the framework of ‘public health nutrition’, nutritional considerations are traditionally guided by public health issues. In recent decades, the public health discipline has evolved to include wide range of issues. In developed countries where over nutrition surpasses under nutrition, public health concerns are about food and nutrition policies for chronic diseases and prevention or health longevity. In communities where poverty remains a considerable concerns, poor nutrition continues to bring about malnutrition and micronutrient deficiencies.
At the 66th World Health Assembly in Geneva last year, intense discussions took place in finalising and adopting the Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) 2013-2020, which also contains the Global Monitoring Framework of 25 indicators and 9 voluntary global targets. A global target of 25% reduction in premature deaths due to NCDs by the year 2025 was decided upon. In terms of the nation’s response, the Ministry of Health has strengthened the NCD prevention and control program in Malaysia by developing and implementing the National Strategic Plan for Non-Communicable Diseases (or NSP-NCD) 2010-2014.
When it comes to the adoption of healthy behaviours, who is responsible? Is it the government or is it individuals? In my mind, here lies the great prevention debate: “Personal choice versus public or societal responsibility”. Some may argue that if you want people to make healthy choices we have to make healthy choices available, accessible and affordable. On the flip side of the coin however, even when healthy choices are available, accessible and affordable, some individuals may still choose not to make healthy choices. Therefore, prevention is BOTH a personal and public or societal responsibility.
Human behaviour is hard to be comprehended. Have all the health initiatives made a difference to the health of Malaysians? I believe this is not a simple question to answer. More importantly, to find what strategies work better in reducing risk factors in the population particularly with regards to changing the unhealthy eating habits or practices among Malaysian across the age groups. All health professionals, including nutritionists, working in the field of public health nutrition must work synergistically and showcase their utmost commitments to achieve the country’s health mission and in line with the conference’s theme “New Paradigm in Public Health Nutrition: Towards Competent Policy and Practice.”
We also need to be aware that policies in other sectors have potential impacts on exposure to NCD risk factors. In particular, bilateral or regional trade agreements pose risks and opportunities for public health nutrition. In general, the recent trade agreements have brought about three important changes to food systems i.e.
• opening of domestic markets towards international food trade and foreign direct investment;
• subsequent increased entry of transnational food companies and their global market (integration); and
• global food advertising (or cultural hybridisation).
These three changes affect population diets and raise concerns about under-nutrition, obesity and NCDs, by altering the local availability, nutritional quality, price and desirability of foods. Recent trade agreements also encroach on policy space, protecting the investor at the cost of public health (e.g. affecting fiscal measures or taxes on unhealthy foods, food labelling and advertising restrictions on unhealthy foods). Food industry influence on public policy development is already a significant problem in many countries. Therefore, we need strong evidence to inform trade policy that embeds principles of health, nutrition and equity, and implementation strategies that mitigate the negative health consequence of trade agreements.
Considering multiple linkages and threats of malnutrition, following the 1992 International Congress of Nutrition (ICN) in Rome, many countries, including Malaysia, have formulated and implemented the National Plans of Action on Nutrition (NPANs) to address malnutrition, unhealthy diets, obesity and/or nutrition-related NCDs. Malaysia has implemented the National Nutrition Policy of Malaysia that endeavours to achieve and maintain optimal nutritional well-being of Malaysians. The policy aims at providing access to adequate, nutritious, safe and quality food for all. It promotes and supports strategies for the practice of healthy eating. The policy integrates and synergises the efforts of relevant stakeholders in planning, implementing and evaluating food and nutrition programmes that are effective and sustainable.
The National Plan of Action for Nutrition of Malaysia (NPANM) has been framed and implemented since 1996 following the call from the World Declaration on Nutrition and Plan of Action adopted by the International Conference on Nutrition (ICN) in Rome, 1992. The plan focuses on multi-sectoral efforts and commitments of all nations, non-government organisations and the international community to enhance the nutritional status of the population as well as to prevent and control diet-related non-communicable diseases. Thus, there are currently established and strong collaborations in nutrition and health sectors between Ministry of Health Malaysia and various ministries and agencies.
With the upcoming Framework for Action (FFA) which is guided by the upcoming Rome Declaration on Nutrition 2014, a collective commitment made at ICN2 will ensure that development in improving people’s nutrition including the global food system in the region is carried out in a sustainable way. This will strengthen the implementation of the country specific NPAN covering all spectrums of nutrition issues including governance, environmental, social and health aspects. This FFA is designed to provide key priorities that would guide member states a Decade of Action on Nutrition, endorsed and led by the United Nations General Assembly.
To align further our efforts to harness towards better health through public health nutrition, I hope that the presentations and sharing of knowledge and experiences from various fields would challenge and encourage participants in this conference to enhance our policy formulation and evaluation, and improvement in our practices, in the fields of public health nutrition, where relevant.
Datuk Dr Noor Hisham Abdullah
Director General of Health Malaysia