Last month, the government announced the mySalam and PEKA B40 schemes to assist Bantuan Sara Hidup (BSH) recipients with healthcare costs. The mySalam insurance scheme aims to cover recipients aged 18 to 55 by providing a one-off payment of RM8,000 should the policy holder be diagnosed with one of the 36 critical illnesses identified under this plan. It also has provisions for daily allowances for up to 14 days of hospitalisation annually.
The PEKA B40 scheme covers recipients aged 50 and above and provides free health screening, a lifetime coverage for medical devices and rehabilitation equipment up to RM20,000, incentives to complete cancer treatments and transportation allowance.
These targeted assistance schemes aim to provide assistance to encourage health seeking behaviour and improve health outcomes among the B40. However, arguably they emphasise a more curative approach rather than tackling the problems from their root causes.
It is a fact that the B40 do not enjoy a baseline of health compared to most of those in the M40 and T20 group. Studies show that national premature mortality and infant mortality rates are concentrated within the B40 population. The National Health and Morbidity Survey (NHMS) found that they have the highest prevalence of adults with underweight BMIs.
It also found that the B40 have the highest prevalence of abdominal obesity among adults, attributed to childhood malnutrition. An examination of a 15-year trend recorded in the NHMS projected that overweight and obesity rates will continue to increase among the B40, as well as the increased risks of non-communicable diseases (NCDs) that come with it.
These statistics tell us that something must be done to help improve B40 health baselines that invests in preventive measures, particularly improving nutritional intake among this population.
The Ministry of Health and the Department of Social Welfare could pilot a food-purchasing assistance programme to ensure that the B40 receive proper nutrition by incentivising adoption of a balanced diet.
In order to achieve proper nutrition and encourage healthy eating, the government could introduce food stamps for B40 households. These would provide for the purchase of fresh produce such as fruits and vegetables from grocery stores, local markets, hypermarkets and supermarkets. Besides improving nutrition levels and health outcomes, issuing food stamps can also boost local economic activity. Research on the United States’ Supplemental Nutrition Assistance Program determined that every USD 5 spent on food stamps benefits generates USD 9 in local economic activity.
Most adults in B40 households have to work to make ends meet, leaving limited time or the space to prepare healthy meals. As such, the proposed food stamps could also apply to eateries that provide healthy and affordable meals that comply with the Ministry of Health’s Suku Suku Separuh meal portion guidelines.
However, nutritious meals alone may not be enough to prevent NCDs among the B40. The government should also consider expanding the PEKA B40 health screening services to cater to all age groups in the B40 category. NCDs can occur at any stage of life, and it is prudent in the long run to identify those at risk of NCDs and minimise their risk factors.
As such, the primary healthcare physicians and labs engaged under the PEKA scheme could expand their services to include screenings to detect malnutrition and other nutrition related problems. If necessary, they can prescribe or provide dietary supplements to address nutrition gaps and deficiencies for those under the programme. Dietary supplements could also be provided to those identified to be at risk of NCDs such as diabetes, hypertension and heart disease to reduce their risk factors. Nipping these problems by addressing malnutrition could be a cost-effective approach to tackling NCDs.
The proposed programme is an investment that the government should consider making. The output is not just measured in a significant reduction in healthcare cost from the reduced number of patients being treated for NCDs, but also in increased productivity, macroeconomic and societal growth. Cognitive development improves with improved nutrition, especially among children.
Such an approach would increase the chances for upward mobility. It would also be in line with the Ministry of Health’s commitment to focusing on preventive healthcare.
Lifting the standards of living for the B40 must be considered a priority to ensure health parity among the B40 to at least M40 levels. More large-scale studies must be done that focuses on nutrition levels and health parities between the B40, M40 and T20 population groups. Clearly seeing and effectively addressing the disparities of health outcomes between the socioeconomic groups would be a major step towards addressing social inequalities.