Improving Health Outcomes in Malaysia through Community-Based Noncommunicable Disease Prevention

Noncommunicable diseases (NCDs) such as diabetes and cardiovascular disease pose a threat to well-being and economic development worldwide. Obesity increasingly and disproportionately affects the poor in middle-income countries around the globe, elevating people’s risk of devastating NCD treatment costs, lost productivity, and premature death. An effective response depends on addressing the local social and structural factors that increase NCD risk.

Funded by the United Kingdom Prosperity Fund, the Global Better Health Programme (2019-2022) aimed to cultivate a healthier and more productive workforce by reducing the burden of NCDs in eight middle-income countries. The Better Health Programme Malaysia (BHP Malaysia) was implemented in close partnership with the Ministry of Health, PricewaterhouseCoopers, and with support from the RTI Center for Global Noncommunicable Diseases.

Obesity prevalence has risen sharply in Malaysia in recent decades, and over half of the adult population is considered either overweight or obese. People of low socio-economic status are disproportionately affected. Diabetes is most prevalent among individuals in the bottom 40 percent of the Malaysian population (B40). BHP Malaysia focuses on serving the B40 in recognition of this inequitable disease burden.

BHP Malaysia collaborated with community health volunteers to improve the food and physical activity environment for the urban poor in Kuala Lumpur.  Equipped with digital tools, community health volunteers engaged with local businesses and other community stakeholders to address community priorities, such as the availability of healthier food options or physical activity.  

The program implemented evidence-based interventions for obesity prevention, drawn from global best practice guidelines, and adapted to the local context. During the 9-month pilot phase, BHP Malaysia assessed impact by comparing intervention and control communities. Baseline assessments with community members and community health volunteers helped determine knowledge, attitudes, and practices related to health and NCDs, as well as informed the design of the training curriculum, digital health tools, and program interventions. We also surveyed community health volunteers regarding their access to and use of digital technologies.

Social distancing measures in response to the COVID-19 pandemic accelerated recent trends toward the use of digital tools for health care and health promotion activities. Digital health solutions, such as a mobile phone app, provided eLearning for community health volunteers to support the delivery of program interventions and offered community education opportunities via a gamified community health reward model.

BHP Malaysia worked with community stakeholders to determine which evidenced-based interventions should be prioritized through a discrete choice experiment in each community participating in the pilot, asking community members to make tradeoffs between potential interventions. This approach allowed us to quantify preferences and understand a community’s relative preference for interventions, such as physical activity classes, rewards to make healthier foods more available, or partnerships with local food vendors. This approach enabled us to apply global best practices for evidence-based obesity prevention in a way that was locally relevant and consistent with community priorities.

Using rigorous research methods, the program served to generate evidence to inform NCD policies in Malaysia and beyond.