From plate to policy: an overview of the nutrition and health landscape in Brunei Darussalam

Authors: Helena Trigueiro, Halima Jama, Haiza Ahmad, Sarah Dalzell, Sumantra Ray 

Reviewer and Editor: Ramya Rajaram 

Copyeditor: Veronica Funk 

Key Acknowledgements: Shailaja Fennel, Siti Rohaiza Binti Ahmad and Anne Cunningham; Support from the University of Cambridge, ASEAN Secretariat and Universiti Brunei Darussalam 

Special Acknowledgement for Funding in Part: Mary Lim (NNEdPro Southeast Asia)   

Brunei, like many nations, faces the challenge of meeting the nutritional needs of its population while navigating complex food systems. The nation presently heavily relies on imported food, necessitating the formulation of a comprehensive strategy. Aligned with this imperative is the government's Wawasan 2035 plan, which endeavours to not only diversify the economy but also to channel investments into the realms of agriculture and the agri-food sector. A judicious exploration of global research, notably delving into the scholarly contributions of Thompson and Scoones (2009), may furnish a nuanced roadmap for comprehending the intricate dynamics of Brunei's agri-food systems. 

Upon scrutinising available data, discerning patterns come to light, particularly in the realm of adolescent nutrition, which evoke a sense of concern. The prevalence of gender disparities, coupled with an absence of critical data pertaining to micronutrients, accentuates the imperative for precisely targeted interventions. The resolution of these challenges necessitates a thoughtfully nuanced approach, one that considers the multifaceted nature of the issues at hand. 

Figure 1 World Health Organization - Noncommunicable Diseases (NCD) Brunei Country Profiles, 2019. (World Health Organization 2019)  

Interventions encompass a spectrum of strategies aimed at addressing population health challenges. This includes low agency/nudge interventions, exemplified by initiatives like salt reduction programs, which reformulate foods to reduce salt intake or employ mass media campaigns to encourage behavioral changes. While these interventions may be perceived as limiting free choice, there exists potential synergy in combining approaches, especially in addressing complex issues such as childhood obesity (Adams, Mytton et al., 2016). In response to the prevalence of ultra-processed food and beverages, Adams, Hofman et al. (2020) emphasize the necessity of simultaneously altering supply and demand at all levels of the food system, alongside structural interventions to enhance access to convenient, palatable, and affordable minimally processed foods. Positioned as a wealthier nation within the ASEAN region, Brunei has the opportunity to pioneer the integration of these public health approaches, effectively combating the double burden of malnutrition it confronts. 

Another pivotal intervention involves enhancing nutrition education for healthcare practitioners. Despite doctors having limited influence over the diverse causes of diet-related diseases, an inadequately trained medical workforce is recognized as a structural contributor to diet-related diseases (Morris, 2014). Nutrition care, defined as health professionals' practices aimed at improving patients' nutritional behaviour and subsequent health (Ball et al., 2010), directly aligns with health care and population health systems (Willet et al., 2019). However, medical students and, subsequently, physicians are often trained to prioritize scientific evidence in pharmaceutical decision-making and clinical guidelines, overlooking the significance of nutritional interventions and guidelines in clinical nutrition (Womersley & Ripullone, 2017). In Brunei, where aspiring medical students first complete a Bachelor of Health Science Medicine (BHSc) degree at the University Brunei Darussalam before refining their clinical skills at partner universities globally (Rajam et al., 2021), the initial years of the BHSc program present a unique opportunity to enhance nutrition education for future physicians. This is especially relevant given their heightened exposure to their own cultural culinary habits. 

Moreover, by establishing academic partnerships with medical faculties worldwide, Brunei can adopt and showcase global models, positioning itself as a noteworthy example within the ASEAN region for teaching nutrition to medical students. Nutrition education for trained professionals is indispensable, warranting targeted interventions at both regional and national levels. 

In the broader context of public health, a systems framework is imperative for comprehending and addressing malnutrition. The three-tiered approach of primary, secondary, and tertiary prevention requires a well-coordinated effort. Regular surveys, robust screening mechanisms, and a clear delineation of responsibilities for risk assessment and management are crucial components in this holistic endeavour. 

Vision for the Future  

The Sustainable Development Goals (SDGs) serve as a guiding beacon for integrated thinking and sustainability. Aligning Vision 2035 with environmental dimensions is crucial, especially concerning Brunei's goal to enhance food security and regional cooperation. Recognizing the untapped potential of Brunei's biodiversity can further this goal.  

Trends of rising obesity and unhealthy diets across the life-course are concerning. In particular, dietary habits of Brunei’s children and adolescents characterized by high intakes of SSBs, salty, fried snacks and low intakes of nutritious foods (e.g. fruits, vegetables, legumes, and nuts) are contributing to the nation’s current and future burden of malnutrition and NCDs. Knowledge and awareness are not sufficient to improve diets, as globalisation and the desire for convenient, fast food continues to promote obesogenic food environments and consumption of unhealthy diets.  The approaching demographic shift to an ageing population is also a reminder that the future costs of NCDs are likely to continue to rise.   

Emphasis on earlier prevention of malnutrition is essential. Requiring a better, more integrated understanding of socio-ecological determinants of food, nutrition and health, as well as the underpinning biological mechanisms that may increase risk in Brunei across all its varied contexts, ethnicities and age groups. If prioritised, developing food, health and social welfare systems that work together to identify and address nutrition inequities will ensure the realisation of Vision 2035 for all in Brunei Darussalam. 

Key Takeaways for a Healthy Future 

I. National Diet and Nutrition Surveillance for Comprehensive Risk Assessment and Progress Monitoring 

a. Implement a dynamic programme for ongoing assessment of dietary intakes and nutritional status. 

b. Ensure the regular availability of nationally representative estimates every three years to facilitate tracking. 

c. Enhance the utilisation of nutritional biomarkers for more thorough and nuanced assessments. 

II. Interdisciplinary Research for Evaluating Agri-food Systems and Food Environments 

a. Encourage interdisciplinary research spanning agriculture, nutrition, health, and social sciences. 

b. Update national dietary guidelines to incorporate considerations of ecological sustainability. 

III. Emphasis on Child and Adolescent Health: 

a. Integrate food and nutrition components into existing health initiatives targeted at adolescents. 

b. Conduct research to comprehend the factors driving obesity, particularly among boys. 

c. Introduce sustainability-focused food and health initiatives within schools and universities. 

IV. Monitoring and Evaluation: 

a. Designate clear responsibilities for the assessment and management of risks. 

b. Scrutinise policies through a double-duty action lens, addressing the challenges posed by the double burden of malnutrition. 

In conclusion, this article underscores the critical role of education, emphasising the need for nutrition-focused training for healthcare practitioners and medical students. By weaving together local cultural nuances and global best practices, Brunei has the potential to shape a healthcare landscape that goes beyond treating diseases to preventing malnutrition and fostering long-term well-being. 

Looking ahead, the vision extends beyond immediate interventions. Aligning with the Sustainable Development Goals and Vision 2035, the emphasis shifts towards sustainable practices, biodiversity utilisation, and an integrated approach to address the rising challenges of obesity and unhealthy diets. The concluding call is for a collective commitment to earlier prevention, socio-ecological understanding, and integrated systems that dismantle nutrition inequities. 

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