As our country eases lockdown measures from the various stages of movement control order (MCO), it is evident that the people of Malaysia are relaxing perhaps a little too rapidly and too soon in the midst of the ongoing Covid-19 pandemic.
The number of daily new Covid-19 cases in Malaysia reported by the Ministry of Health (MOH) has certainly decreased greatly compared to two months ago when the coronavirus was at its peak in the country, but that does not mean that the pandemic has ended.
Unfortunately, the improvement of the Covid-19 crisis has led many to believe that we have completely beaten the coronavirus, but I fear that with increasing complacency we may soon see another peak of the ruthless coronavirus in the country that is very much preventable.
People’s behaviour that we see with Covid-19 isn’t new and it is a long-time habitual kind of mindset that most Malaysians have, in my opinion. While I am by no means a behavioural scientist or specialist, it is difficult to ignore what is observed in the community.
MOH’s recently released National Health and Morbidity Survey (NHMS) 2019 gave an emphasis on Malaysian adults’ health literacy and revealed that an alarming one in three Malaysian adults have low levels of health literacy, defined as the “ability to find, to understand, and to use health information and services needed for everyday health decision making.”
The data presented by the NHMS 2019 did not disclose the methods used to collect such data on health literacy. For example, what kind of questions were asked to assess the survey participant’s health literacy and how were these questions put together, et cetera. These are some of the undisclosed information that makes it challenging to clinically interpret what is the true significance of the numbers presented.
As deputy director of the non-communicable diseases (NCDs) unit in the Disease Control division in the MOH, Dr Feisul Mustapha, previously mentioned in his letter to CodeBlue, Malaysians’ complacency or the lack of urgency when it comes to health could be explained by an altered or biased risk perception, which is a subjective judgement that people make about the characteristics and severity of a risk.
Such perception or behaviour is not only seen with Covid-19 after the initial urgency when the Covid-19 outbreak was fresh and at its peak, the altered risk perception, as Dr Feisul pointed out, is also seen with the risk of acquiring NCDs such as diabetes and hypertension.
From my personal point of view, I do not believe that Malaysians, being citizens of an upper middle-income country, significantly lack awareness and knowledge of health. Relatively, there is a number of people who refuse to acquire that literacy and it all boils down to behaviour — an anti-science behaviour.
This may sound offensive to some, but from my personal experience, a good number of people blatantly reject the scientific knowledge that is presented to them for reasons that I don’t know and can’t understand, but I believe that there is a cultural aspect to it.
Additionally, we also have health care professionals who knowingly smoke cigarettes or vape as Dr Feisul pointed out, not because they don’t know the risk, but if anyone knows better it would be the health care professionals. It all boils down to perception and ultimately complacency.
On the other hand, we have individuals of lower socio-economic status who do not have the means to change their behaviours due to financial pressures, even if they have a higher level of health literacy. It is the reality of their situations that prevent them from practising better hygiene or other preventive measures.
For example, in the new normal post-Covid-19, how many are able to constantly afford to use the right amount of hand sanitisers, and how many households can afford to buy the appropriate household cleaning products to repeatedly clean their homes and vehicles with the right amount of products without diluting those products to save cost?
Not to mention that these new normal practices take time, and not everyone has the time to carry out these sanitizing procedures repeatedly as advised by professionals, because to many, time is money, and money feeds the family.
This is the reality for many, and survival is their priority even with the risk of contracting an infectious disease like Covid-19, and some of them have no other choice but to take on that risk for survival. So, is this complacency?
Health literacy has many folds, and it is unfair to assume that one has low health literacy because they are not practicing preventive measures when it comes to achieving good health.
The psychology of complacency is commonly linked with depression, as pointed out by US psychologist Dr Michael Hurd in his article titled “The Psychology of Complacency”. He explained that complacent individuals expect things to happen automatically and easily, with little or no effort expanded, and that’s one problem — the complacent person becomes easily disappointed, easily frustrated and then angry that things are not going as smoothly as he or she thinks they should.
Ultimately, this thinking leads to some kind of depression, because such thoughts that has become a habitual thinking leads to a chronic sense of futility and victimisation, and in Dr Hurd’s words — a modern form of fatalism — whereby the person feels as if someone or something else has written the script of his or her life, and there’s nothing that can be done about it.
Of note, the NHMS 2019 also reported that about half a million of Malaysian adults suffer from depression and the majority of them comprise of the Bottom 40 (B40) income group population. In addition to that, nearly half a million Malaysian children were found to have mental health problems in Malaysia with the NHMS citing such findings a “hidden epidemic”.
Culturally speaking, there may be a widespread belief that mental health issues do not exist, at least in my personal experience, that being depressed is seen as being ungrateful for the roof over your head, the food on your table, and the money in your bank.
It is also my personal belief that the numbers reported by the NHMS 2019 could be far less than the actual prevalence of Malaysians suffering from mental health problems such as depression, and the underreporting could be attributed to either denials or social stigma.
Behavioural and mental health specialists are much needed to professionally assess this complacency and depression pattern that is creeping up the scale in the Malaysian population, and such assessment needs to happen soon in order to hit the brakes on this silent epidemic that is growing in the country. Unfortunately, not a lot of public attention is given to such issues in the country at the moment.
Sharon Lee, PharmD
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
