The racialisation of health data

There are other such examples when something becomes a problem when it is Malay and not when it is of another culture. Weddings are another example: Malay weddings are fattening, yet eight course Chinese weddings do not enter the picture. These inconsistencies in understanding should jar our thinking that the problem might not be straightforwardly ‘objective’ in nature. Why is it that fatty foods only become a problem when it is Malay foods? Why are Malay festivals or Malays eating out a problem? This seems to be a reflection of an old prejudice: that Malays are lazy and (by extension) fat.

This prejudice is justified ‘objectively’ as statistically speaking Malays are obese in greater numbers. Statistics however are like a bikini- what they reveal is interesting, but what they hide is fascinating. It is precisely through the use of these statistics that the whole discourse becomes racialized. The National Health Survey 2010 is one major example. If we refer to the executive summary of the survey, we find all manner of problems highlighted by racial categories: Hypertension, high blood pressure, obesity save one: binge drinking. This seems yet another demonstration of cognitive bias; what kind of health problems are highlighted and what are not. However, one may argue against the previous point that binge drinking is much less of a growing problem than obesity. The numbers testify to the problems of an increasingly unhealthy lifestyle: between 2004-2010 alone, the percentage of obesity among men nearly doubled from 6.4% to 12.1%.

Towards the end of the section on obesity, a small blurb suggests that this could be the cause of economic inequality. This is not hard to imagine: people in low paying jobs work longer hours; some like security guards do shift work, which is hardly conducive to exercise. Epidemiologists also suggests other ways economic disparity leads to ill health: for example, being in the lower rungs causes greater stress-inducing cortisol, which causes greater fat storage around the abdominal area. Another side effect of this increased stress could be increased smoking to cope with such stress. Furthermore foods which are ‘high energy density’ are often lower priced and are more affordable and accessible to the poor, in contrast to various health foods and supplements which are more available to the rich. This would mean that the fact we see more Malays as unhealthy could be because of economic situation rather than racial identity.

The absence of the data on class is the fascinating aspect of reality which is obscured. Such a problem is not a technical one, as there are plenty of studies globally which present data based on class. Rather it is ideological as it impacts how the problem of health in Singapore is discussed. With the present racialized framing of data, the discourse becomes about ‘educating’ people on the  consequences or exhortations to change an unhealthy lifestyle/diet/mindset. If a survey based on class divisions revealed great health discrepancies between rich and poor the way which we present and discuss the issues will greatly differ. Issues (mentioned above) of long working hours, high stress and access to quality food will arise. More importantly it would provide an urgent case for a more comprehensive healthcare system, in the light that the poor would be the least insured yet facing more chronic health problems. The way the issue is currently framed severely curtails the discourse on social justice and welfare but merely becomes a tool to confirm deeply held cognitive biases. The problem is without access to data, we cannot compare other possible correlations.

There is a more serious implication to this racialized framing of problems, in that such an approach merely ignores looming problems. The pattern should be self evident now. When there was a housing crisis, many Malays were initially badly affected, becoming homeless and living on beaches. However, we know now the weaknesses of the housing policies and difficulties in providing decent living spaces amidst rising prices and an uncertain economy.  Malays and other minorities were most affected by the influx of migrants many years before a white paper appeared, as the landscape became increasingly unfamiliar and alien. Long before xenophobia became such a compelling cause to rail against, Malays and other minorities have had to struggle with problems of discrimination, stereotyping and prejudice.

We should look at this instance no differently. Over the last few years, there has been an influx of all manner of processed food ranging from desserts to boutique coffee to all kinds of deep fried foods as a result of our open and globalized economy. Partly to accommodate the increase in population, localized town centers have mushroomed to ensure that traffic towards the main city area is reduced. This has inadvertently encouraged consumption and access to the aforementioned processed foods in heartland areas. Encouraged by long working hours and stressful competitive environments, these places constitute a ‘quick fix’, ‘comfort food' or sugar rush which only adds to the problem. With the lack of a comprehensive healthcare system, and rising healthcare costs, this increasingly obesogenic environment is recipe for a catastrophe.

As the problem is defined more broadly, older strategies of facing the problem of health based on race seem archaic and inadequate. Newer, more fundamental solutions need to be explored holistically with reference to real changes on patterns of everyday life, rather than abstract notions and assumptions of culture. The question is whether we let prejudices determine how problems are seen or look beyond these biases for more effective solutions.

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Fadli Fawzi is a blogger who reads, writes and discusses on a wide range of social issues. His writings can be found at daunkesom.wordpress.com.