Chitchat Playing the race card even for serious health issues.

https://mothership.sg/2017/08/today...eating-habits-sporeans-call-it-out-as-racist/
TODAY article on diabetes targets Malay & Indian eating habits, S’poreans call it out as racist
Nasi Lemak did nothing wrong.

By Guan Zhen Tan | August 28, 2017 979

On Friday, August 25, the TODAY newspaper put out an article amplifying this message.

Titled “War on diabetes: Changing eating habits of Malay, Indian communities an uphill task”, it ventured guesses as to why statistically, Singapore’s Malay and Indian communities have a higher incidence rate of diabetes (For Singaporeans above age 60, 6 in 10 Indians and 5 in 10 Malays) compared to the Chinese (2.5 out of every 10).

It’s understandable they’re trying to tackle an issue that’s affecting some communities more than others.

But here are some of the points raised:
1. Only Chinese dishes can be modified with healthier ingredients
For one, the article suggests, very early on, that only Chinese dishes can be made in a healthier manner or with healthier ingredients — which, of course, is not true.

For them, unlike Chinese dishes, one cannot produce a healthier, yet still tasty ayam penyet or roti prata by simply using less oil, salt or sauce.

2. Indians and Malays only eat unhealthy ethnic food all the time
For this part of the article, they interviewed an Indian restaurant owner, a nasi lemak stall owner and a diabetic who struggles to change his eating habits.

One area that needs to be addressed is their eating habits, even though those interviewed acknowledged that it will be an uphill task.

Mr Rathinasamy Murugesan, owner of Greenleaf Cafe, an Indian restaurant in Little India, pointed out that many Indians eat a lot at one go, three times a day. They also tend to prefer 9pm dinners, which are close to bedtime, and need to round off their meals with a satisfying, sugar-rich dessert.

“My Chinese friends would take the Indian sweet, and (throw up) because it is too sweet for them, but we Indians can take four or five of those,” said the 44-year-old.

Taxi driver Hartono, 56, is one of those who find it difficult to change his eating habits even though he is a diabetic.

He loves the rendang that is chock-full of coconut milk, and believes that Malay food should be all about “the colour and spice”. He finds such Malay dishes much more attractive than the “bland” soups, steamed food and stir-fries common in Chinese cooking.

While his wife, a nurse, and his doctor often chide Mr Hartono for his food choices, the man himself finds it just too hard to give up his beloved buffets and nasi briyani. After losing weight during the fasting month by eating mainly cereal, it was “back to square one” after the Hari Raya season, no thanks to all the feasting during festive gatherings and wedding banquets.

For Madam Mizrea Abu Nazir, 45, “nasi lemak would not be nasi lemak” without coconut milk, and her stall usually uses two litres of coconut milk to cook a large pot of the rice.

Her family owns the popular Mizzy Corner Nasi Lemak at Changi Village.

While she does not mind cutting down on coconut milk on request at special events, the reality is that people often ask for “more”, rather than less.

“In our lontong, ayam lemak, most of the cooking is about using a lot of coconut milk and oil. At the moment, I don’t (see the need to change) because everyone is still enjoying what they eat… That’s how it is,” Mdm Mizrea said.

3. Chinese people live healthier lifestyles than Malays
The article included just one interview that brings up this point, without expanding on or bothering to add any disclaimers.

While the quotes below do clearly come from the interviewee, a diabetic, it certainly can’t be sufficient to back up the argument they’re making:

“The doctor talks like it’s very easy (to change), but our lifestyle is not like the Chinese lifestyle. For them, they go qigong, they go exercise …”

“Our culture is different, we like to gather and cook, go picnic, go makan… You see (the Malays) carrying their pots to Changi Village to go there to eat, sleep, swim (all day),” he said.

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Although healthcare and its affordability have dominated the headlines in Singapore, issues of general health, fitness and well-being are becoming of increasing concern. The Ministry of Health’s 2010 National Health Survey (NHS) indicated that Singapore’s obesity rate has increased to 10.8% from 6.9% in 2004. This is worrying as obesity can lead to other associated diseases such as diabetes, high blood pressure, and stroke. A growing epidemic of obesity can pose a serious challenge to policymakers, since it can place a greater strain on the country’s health infrastructure.

And this pressing problem is not only confined to Singapore. Obesity is a global epidemic that is occupying the attention of developed countries such as the United States as well. However, what is particular to Singapore is how ethnic frames predominate our approach to health issues. Take, for instance, the construction of obesity as a “Malay problem”. Such narratives localize obesity as a “community problem” and blame Malay cultural practices or habits for the community’s high incidence of obesity. This approach is not only insensitive but also too simplistic and reductionist to truly resolve the issue.

Obesity as a 'Malay Problem'

On 21st December 2014, the Straits Times (ST) featured an article identifying the Malays as the unhealthiest group in Singapore, based on the findings of a longitudinal study conducted by the newspaper. The study found that “a disproportionate number of diabetics and patients with kidney failure, heart attacks and strokes come from this group.” This was similar in tenor to an ST article in 2010 entitled “Malay and Obesity: Big trouble” which castigated the Malays for being “too fat, getting fatter too fast and succumbing to chronic diseases in the process”.

Parsing obesity through ethnic frames feeds into the tendency to seek “culturalist” explanations to account for these health issues. These culturalist explanations try to explain away any social malaise such as obesity as a cultural deficit or failing of the affected ethnic group. For example, the 2010 ST article blamed Malay cuisine and dietary habits, with its “glistening with coconut saturated rice” and “delightfully rich, sinfuly sweet melt in the mouth kueh”, for engendering Malay obesity. Even Malay gatherings such as weddings were faulted. Such celebrations were seen to promote the consumption of richer and fatty food, ignoring the fact that the occasional festive indulgence is common throughout many cultures.

Furthermore, even the daily behavior of the Malays came under scrutiny. In a 2011 commentary in the Berita Harian, it was claimed that that Malay women were now becoming fat because they tend over-eat while doing little work, in contrast to the past where they kept themselves busy with housework.

It should be noted that in countries such as the United States, the groups who suffer disproportionately from obesity are generally the low-income ethnic minorities. Given that these ethnic minorities tend to populate the lower end of the society’s income distribution, researchers and policymakers have recognized that obesity is a causally-complex phenomenon that is affected by other socio-economic factors such as income levels.

The health issues that plague ethnic minorities such as the Malays should thus not be reduced into a local problem endemic only to the community. Rather, it should be seen as the “canary in the coal mine” – an early warning to greater underlying structural issues undergirding the country’s healthscape.

Moving beyond health problems as 'Malay issues'

The seminal Whitehall Studies (also known as the Stress and Health Study) provide a useful contrast to the approach adopted by local health surveys. First conducted in the 1960s by the University College London, the first Whitehall study surveyed some 18,000 male civil servants. Set up as a longitudinal study to look at individual risk factors for cardiorespiratory diseases and diabetes, it helped to debunk certain myths about health and inequality. The received opinion then was that the poor were affected by diseases relating to material deprivation, while the rich people suffered from illnesses such as heart disease and peptic ulcers. The study instead showed that there exists a social gradient where men in the lower-employment grades were much more likely to die prematurely from both coronary heart disease (CHD) and non-coronary causes than those in the higher grades.

A second Whitehall study was conducted in the 1980s to understand why such a social gradient should exist. In this study, a total of 10,308 civil servants participated in the baseline survey – this time, two thirds were men and one third women. The findings revealed that there was a correlation between the grade of employment and the health behaviour of the respondents. Those at the lower employment grades (particularly women) not only exercised less, but were more likely to smoke and be obese.

Furthermore, the second Whitehall study showed that stress resulting from poor working conditions or precarious employment conditions can adversely affect health. Factors such as workplace organization, control over working life, and workplace support were the main reasons for the social gradient in health. People on the lower rungs of the organizational hierarchy were more likely to face more difficult working conditions. Not only is that innately detrimental to one’s physical and mental health, such a stressful environment may affect a person’s mood and ability to maintain a healthy lifestyle beyond work, resulting in the preponderance of smoking, lack of exercise, and obesity. This reflects the idea of a “bandwidth tax” on the poor, where being poor poses a significant cognitive burden that leaves them with less energy and attention for other activities beyond eking a living for themselves. Routine activities (to the rest of us) such as exercising or eating healthy home-cooked meals present themselves as an additional exertion for an already-stretched individual. For instance, for a security guard making ends meet with shift work, getting the requisite hours of exercise or conforming to a healthy diet can be a luxury.

Prescription: better data and framing

Ethnic frames, while convenient, are thus severely limited and inadequate in understanding complex social issues. An ethnic frame not only relies on, reproduces, and reinforces inaccurate cultural stereotypes, but also prevents us from having a constructive discussion about policy and structural shortcomings. The challenge now is to transcend these ethnic frames and instead engage issues of health on a deeper level.

This can be done if more raw data can be collected and made available to all. Statistical data that is presented to the public should be more varied and comprehensive. By releasing only one set of statistical data (i.e. data grouped by ethnic sets), it inadvertently gives a veneer of objectivity to the framing of obesity as a Malay problem. The collection and publication of more data points will allow policymakers, academics, and civic-conscious citizens an opportunity to re-interpret and re-think social issues from a different perspective. For instance, presenting health data in terms of income might introduce a fresh dimension to our understanding of health issues in Singapore.

This is however not to say that all ethnic demographic data should be abandoned. Policy governance in Singapore has a strong tradition of encouraging ethnic group-focused solution, preferring to allow ethnic communities to help themselves out of respect to the sensitivities of each group. Ethnic group-focused solutions are not necessarily detrimental. In certain cases, it may render policy implementation and outreach more effective.

The fundamental flaw however lies in diagnosing every social issue through an ethnic frame and presuming that all social malaise can be solved only through group-focused solutions. More often that not, such ethnic frames lead us astray from uncovering the genuine socio-economic or structural roots of a problem.

Hence, while data presented across ethnic lines might be relevant, it is definitely not sufficient. This is true of obesity, and is even clearer for issues such as education. It is second-nature for the government and media to release statistical breakdowns of academic performances on ethnic lines, which diverts our attention away from any structural or socio-economic causes of academic underperformance. If we are able to avoid relying on ethnic frames as a crutch to interpret and diagnose social problems, political and policy discourse in Singapore can only mature.

Fadli Bin Fawzi, 34
Law student at Singapore Management University

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