Authors: Helena Trigueiro, Jørgen Torgerstuen Johnsen, Sucheta Mitra, Halima Jama, Mei Yen Chan and 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)
Introduction
The pervasive issue of malnutrition remains a global challenge, Impacting nations worldwide and posing a significant obstacle to the attainment of the 2025 global nutrition targets, despite notable progress captured by certain indicators. The establishment of the ASEAN Community has facilitated the implementation of comprehensive health initiatives by the ASEAN Health Sector, specifically aimed at ensuring food and nutrition security on both national and regional scales. Given the widespread implications of malnutrition and diet-related non-communicable diseases stemming from unhealthy dietary practices, the promotion of a healthy diet coupled with the effective implementation of nutrition-sensitive interventions emerges as instrumental in advancing towards these objectives. Within the realm of international and national pursuits aligned with the UN 2030 Agenda for Sustainable Development, Universal Health Coverage stands as a paramount focus for the World Health Organization. In this blog post, we delve into the evolving landscape of nutrition-related policies among Member States of the Association of Southeast Asian Nations (ASEAN), underscoring the urgency for concerted action and offering recommendations to combat malnutrition within the broader framework of achieving universal health coverage.
Malnutrition in the ASEAN Region
Malnutrition, encompassing both undernutrition and overnutrition, poses a substantial human capital and economic development challenge across most ASEAN Member States. Undernutrition, prevalent in lower-income countries, heightens the risks of infant morbidity, mortality, and healthcare expenditures. It undermines educational investments, reduces income-earning potential, and impacts labour force productivity, potentially perpetuating across generations. Some ASEAN states experience annual GDP losses ranging from 2.4% to 4.4% due to undernutrition. Concurrently, overnutrition, evidenced by rising obesity rates, compounds these challenges. Over the past 35 years, obesity prevalence in ASEAN has surged over sevenfold, with Cambodia, Indonesia, and Lao PDR experiencing over tenfold increases. Childhood overweight, exceeding 25% prevalence in Brunei, Malaysia, and Thailand, incurs direct costs, such as 16% in Brunei, and is expected to escalate indirect costs through labour productivity loss.
The coexistence of undernutrition and overnutrition within households and individuals, termed the double burden, varies across ASEAN countries. Poverty is a fundamental cause of undernutrition, driven by poor infant feeding practices, insufficient access to nutritious foods, and limited healthcare. Conversely, overnutrition is primarily linked to changing lifestyles and urbanisation, with urban areas fostering environments conducive to the consumption of processed and unhealthy foods. Addressing malnutrition demands region-specific policy responses, acknowledging the diverse determinants involved, such as maternal and childcaring practices, food security, and women's social status. This emphasizes the critical need for targeted interventions to address both undernutrition and overnutrition within the ASEAN region.
Harnessing Global Initiatives – Universal Health Coverage (UHC) and nutrition in tackling malnutrition in ASEAN Member States The World Health Organization (WHO) defines UHC as ensuring that all individuals and communities receive necessary health services without facing financial hardship. This approach facilitates universal access to services addressing major health concerns. This approach requires not only accessibility but also a commitment to delivering high-quality services to enhance overall health.
Tackling malnutrition in its various forms demands breaking down silos and addressing nutritional needs throughout the entire life-course, especially during key stages of life like pregnancy, infancy, and early childhood. Adopting a life-course approach necessitates a deeper understanding of nutritionally sensitive life stages while concurrently addressing multiple forms of malnutrition. The complexity of deconstructing health systems is evident, particularly when dealing with a cross-cutting and multi-sectoral issue like nutrition, where actions naturally overlap.
Current UHC status data for ASEAN member states reveal lagging overall progress. While some data points are outdated, assessing country contexts and gaps is crucial before implementing cost-effective solutions outlined in the 2020 Global Nutrition Report and WHO's Mobilising Ambitious and Impactful Commitments for Mainstreaming Nutrition in Health Systems – Nutrition in Universal Health Coverage brief. Despite having tools and knowledge, there's a shortfall in implementation expertise.
To tailor strategies to each country and region's contexts, meticulous planning and assessment of ideal nutrition and health interventions are necessary to maximise health outcomes. Recognising the difficulties posed by diversity and political differences among ASEAN member states, effective healthcare systems can only be established through collective efforts. We believe that by transcending national boundaries and fostering a united approach, ASEAN member states can overcome existing fragmentation, addressing health policies and programs through enhanced and sustained regional mechanisms and a broader model of cooperation within this significant multilateral group.
Recommendations
Challenges have impeded progress in achieving Universal Health Coverage (UHC) in certain Member States due to a lack of clear nutrition action and the implementation of essential nutrition measures. In response, we advocate for:
Regional cooperation structure between ASEAN and WHO regional offices along with high level political commitment: WHO regional office in the South-East Asia region has been instrumental in designing regional flagship programs achieving key SDGs for Health. Some of the areas WHO is working on includeaccelerating maternal and child health, achieving progress towards universal health coverage, enhancing capacity development in managing other health emergencies, etc.
Inclusive framework for cooperation on health: an inclusive framework for cooperation would adhere to an all-encompassing regional, national, and global entity to ensure major health improvements in the ASEAN region. Therefore, in this complex setting, one system cannot solve the problem. There is a need for the involvement of all major actors such as state actors, private actors, civil-society organisations, healthcare professionals, healthcare workers, international development agencies, UN bodies, multilateral organisations and others. This will give momentum to the efforts towards advancing and sustaining universal health coverage.
Integrated Health Information System – A Way to Equal Access to Healthcare: As ASEAN experiences demographic disparities, an integrated health system will be key to providing equal access to healthcare to different strata of society. For the benefit of everyone in this region, an integrated, reliable, and well-monitored National Health Information System needs to be put in place. This would monitor population movements and provide healthcare facilities by the health providers in various localities and residential areas.
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