Non-communicable diseases affect low-income households disproportionately | Multidisciplinary

Non-communicable diseases (NCDs) have the potential to significantly impact B40 households in a negative manner, reveals a local study.

The study, published in the Malaysian Journal of Medical Sciences, noted that a significant portion of B40 households have a high prevalence of NCDs such as hypertension, diabetes mellitus, and hypercholesterolemia. [2024;31(1):124–139] The study suggests a correlation between NCDs and increased likelihood of experiencing poverty and echoes studies carried out in Vietnam and Mongolia. [Asia Pac J Public Health 2017;29(Suppl 5):35S–44S, Trop Med Int Health 2019;24(6):715–726]

NCDs contribute to poverty as comorbidities require expensive medical aid and equipment, on top of regular follow-ups and medicines. In addition, NCDs can potentially impose enormous societal and economic costs, straining the healthcare system and damaging the economy of a nation. Malaysia, with its high prevalence of NCDs, faces a high burden on the healthcare system.

It revealed that B40 households with members diagnosed with at least one NCD face a greater risk of poverty compared to those without NCDs. Those households, should they experience catastrophic payments exceeding 25 percent of their total income, are more likely to fall into poverty than those of higher income groups. Within the B40 group, the elderly individuals, those without formal education, and unpaid workers are particularly vulnerable to poverty due to NCDs. These findings emphasize the necessity of safeguarding B40 households from the financial burden of NCDs by creating more effective financial protection plans for Malaysia’s low-income earners.

The most common NCDs among the B40 households were hypercholesterolemia at 22.89 percent, type 2 diabetes mellitus at 9.9 percent and hypertension at 17.1 percent. To make matters worse, almost half the B40 population (47.6 percent) have at least one undiagnosed NCD.

The authors suggest a few steps to prevent or reduce the impact of NCDs on the B40 group. The first is the establishment of more effective financial protection plans (such as national health insurance or NHI) for low-income earners to protect them from the financial burden of NCDs. A robust NHI system would guarantee that everyone receives the same comprehensive benefits package and that all healthcare providers are compensated at uniform rates, and that access to both private and public healthcare is available. The paper referenced countries such as Taiwan and Thailand, which have successfully managed their health expenditure increases via their NHI systems.

Other recommendations made by the authors were improving healthcare system response (to NCDs), supporting policy development and longitudinal data collection to better understand the causal effects of poverty and contributing factors (as the current study is only an association study).

Note: B40 refers to the bottom 40 percent of the population with a mean monthly household income of less than RM5,250. [Available at https://storage.googleapis.com/dosm-public-publications/multiyear_2022_hies.pdf Accessed on 18 June 2024]. The study also defines any household with an income of less than RM930 per month per individual as being below the poverty line.