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How education, income and occupation relate to health (Education)

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How education, income and occupation relate to health (Education)

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Education helps a person hone their communication skills by learning how to read, write, speak and listen.

Education helps eradicate poverty and hunger, giving people the chance at better lives.

Enhance people's knowledge, people with higher education will have better knowledge about health practices (e.g., diet, exercise, preventive care)

Education helps an individual meet basic job qualifications and makes them more likely to secure better jobs.

People who attended school and attained a higher level of education are considered more employable and likely to earn more.

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Socioeconomic status (SES) describes an individual's or group's position in society based on income, education, occupation, family and social support, wealth, access to good nutrition. Income, like how much they earn. Education, the level of schooling or achievement. Occupation, the kind of job and how stable it is. Wealth, the total assets a person owns, and neighbourhood or environment. In short, it’s a measure of both economic and social advantages or disadvantages that shape people's lives and opportunities.

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How education, income and occupation relate to health (Income & Occupation)

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How education, income and occupation relate to health (Income & Occupation)

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Higher-income people are more likely to have better living conditions, like stable housing and nutritious food and clean water. These factors greatly contribute to physical and mental well-being.

Financial stability helps reduce chronic stress, which is a known contributor to various health issues such as cardiovascular diseases, hypertension, and mental health disorders like anxiety and depression.

Lower-income jobs are often more physically demanding and expose workers to dangerous conditions.

Unstable or temporary jobs can cause financial uncertainty, leading to psychological stress and poor mental health outcomes. Job insecurity is associated with higher levels of depression, anxiety, and sleep problems.

Occupations that provide health insurance, paid sick leave, and access to mental health resources promote better overall health.

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The tier’s of Malaysia’s income and the economy classification

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The tier’s of Malaysia’s income and the economy classification

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Malaysia is classifies its population into three main income tiers based on the household income distribution, which are widely used in government policies and economic analysis.

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B40

This represent the lowest 40% income earners in Malaysia. This household earn up to around RM5,249 per month as of 2022 data. The B40 also is further divided into smaller bracket, with median incomes ranging roughly from RM1,929 to RM 4,387.

This low-income families that qualifies for various government assitance program.

M40

The middle-income group covers the next 40% of households, with monthly incomes between approximately RM5,250 and RM11, 819. Median incomes in this group range from about RM5,336 to RM9,695 depending on the subcategory.

The M40 group is considered the middle class and is a key focus for policies aimed at economic growth and stability.

T20

The top 20% of households that earn above RM11,819 monthly. This group includes the highest income earners in Malaysia, with median incomes around RM15, 867 and mean incomes even higher. The T20 group is often the target for wealth tax discussions and luxury tax policies.

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It can affect access to resources like healthcare, education, and job opportunities. It’s closely linked to health outcomes, life expectancy, and quality of life. SES can also influence how people experience and respond to stress, discrimination, or systemic barriers.

Puan ST reluctant to receive her test may be due to these SES factors like no high income, insufficient for the clinical test, and her husband and she didn't realized the severity of her disease.

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These tiers is depending on total income of all members living together and sharing expenses, not individual income.

The income threshold also differs between region due to differences in the cost of living. For example, in Kuala Lumpur, the T20 threshold is higher (above RM 16, 780) compared to rural areas reflecting the higher living costs in urban centres.

These classification helps the government to tailor those financial aid, tax relied and social welfare programs to ensure equitable resource distribution and to address poverty and inequality.

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The differences of SES, and how it affects the different symptoms? 

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The differences of SES, and how it affects the different symptoms? 

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1. High SES (higher income, advanced education, professional jobs, better living condition)

2. Middle SES (moderate income and education, skilled or semi-professional jobs)

3. Low SES (lower income, limited education, manual labor or unstable jobs, often poorer living conditions)

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How SES status can affect the access to the healthcare ( hospital, clinics ) 

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How SES status can affect the access to the healthcare ( hospital, clinics ) 

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Factor

How it Affects Symptoms

🥗 Poor nutrition

May lead to fatigue, poor growth, and chronic diseases (e.g., diabetes, heart disease)

🧠 Stress

Chronic stress from financial instability may cause headaches, insomnia, anxiety, depression

🏠 Living conditions

Overcrowded or unsanitary housing can increase exposure to infections or pollutants

📚 Health literacy

Lack of health knowledge may delay recognition of symptoms or lead to misuse of medication

SES Level

High SES

Easier access to private hospitals, specialists, faster treatment, and preventive care

Middle SES

Moderate access—may rely on public clinics but can afford some private services

Low SES

Often face barriers such as:

🚫 Long wait times at public facilities

💸 Can't afford private care or transport

🏥 Live far from clinics/hospitals

📖 Limited health knowledge—may not seek care early

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1. Mental Health Symptoms

Low SES

Higher rates of depression, anxiety, PTSD, and chronic stress

Limited access to therapy or psychiatric medication

More stigma around seeking mental health help

High SES:

More access to preventive care and support

Stress still present (work pressure), but more resources to cope

2. Physical Health Symptoms

Low SES:

Higher risk of chronic diseases like obesity, diabetes, hypertension

Limited access to nutritious food, clean environments, and healthcare

More likely to experience fatigue, pain, infections.

High SES:

Healthier lifestyle due to resources, time, education

Less exposure to environmental hazards

3. Developmental and Cognitive Symptoms (especially in children)

Low SES in childhood can cause:

- Delays in language, memory, and emotional regulation

- May increased behavioral issues

High SES children:

More access to books, stimulating environments, and quality education

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Advantages & Disadvantages of SES Influence on Healthcare Access

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Advantages & Disadvantages of SES Influence on Healthcare Access

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Advantages (for middle- and high-income groups):

Better Access to Healthcare Services

Individuals in higher SES brackets can afford private health insurance, out-of-pocket treatments, and preventive care.

This results in timely interventions, fewer complications, and better long-term health outcomes.

Shorter Waiting Times

Private hospitals, which are more accessible to the wealthy, often offer appointment-based consultations, efficient service, and minimal delays.

Unlike government hospitals, where one might wait hours or even days for tests and treatment, private care is faster and more responsive.

Advanced Medical Technology and Facilities

Higher SES groups benefit from facilities that have modern diagnostic tools, cutting-edge surgical equipment, and specialized professionals.

This improves both accuracy of diagnosis and success rate of treatments.

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Disadvantages (for lower-income groups):

Limited Financial Access

Many low-income individuals cannot afford private care and rely solely on government hospitals.

Even basic services can be delayed due to underfunded facilities and outdated equipment.

Overcrowding in Public Hospitals

Government hospitals are often overwhelmed by the sheer number of patients.

Limited staff and resources lead to longer waiting times, increasing the risk of disease progression before treatment begins.

Outdated Equipment and Infrastructure

Public hospitals in many areas continue to use old diagnostic machines, non-functional tools, or lack certain essential services.

This results in delayed test results, ineffective treatment, and poor patient experience.

Time Constraints and Opportunity Costs

Many low-income workers cannot afford to take time off to wait in long lines at government hospitals.

The loss of daily wages or caregiving responsibilities forces them to either skip treatment or seek expensive private alternatives, often at great financial strain.

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In Malaysia, the population is divided into three income groups: T20 (Top 20%), M40 (Middle 40%), and B40 (Bottom 40%).

B40 households earn less than RM4,850 per month, often relying on low-paying, manual jobs such as cleaners or labourers.

Members of the B40 group typically face:

Limited access to quality healthcare

Poor nutrition due to financial constraints

Inadequate living conditions

Greater risk of chronic diseases due to lifestyle and environmental factors

In this case, Puan ST, as a B40 member, is unable to afford nutritious food and finds medical tests financially and logistically challenging.

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Pregnancy brings physiological changes that increase nutritional and oxygen demands.

Pregnant women are at a higher risk of developing anaemia, especially if they are not receiving adequate prenatal care.

Antenatal care aims to:

Monitor maternal and fetal well-being

Detect and manage complications early

Provide health education, including nutrition and supplementation

Puan ST is pregnant but finds it difficult to follow medical advice due to her financial situation and personal choices.

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Anaemia is defined by low haemoglobin levels, which reduces the oxygen-carrying capacity of blood.

Common symptoms include:

Easy fatigability

Breathlessness

Paleness

Dizziness

Causes of anaemia in pregnancy include:

Iron deficiency (most common)

Vitamin B12 or folate deficiency

Chronic illness or blood disorders

Untreated anaemia in pregnancy can lead to:

Preterm labour

Low birth weight

Maternal complications

Puan ST was diagnosed with anaemia during screening but is reluctant to undergo further investigation

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Multiparous women have had two or more prior pregnancies; Puan ST is on her 5th pregnancy, making her a grand multipara.

This group is at increased risk for:

Nutritional depletion

Iron deficiency anaemia

Pregnancy complications (e.g. uterine atony, placenta previa, etc.)

Repeated pregnancies without adequate spacing or recovery time worsen maternal health.

Grand multiparas may require closer antenatal surveillance and stronger social support systems.

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Low Socioeconomics Status ( SES ) Families 

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Low Socioeconomics Status ( SES ) Families 

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SES includes income, education, employment, and living environment.

Low SES families like Puan ST’s often:

Have limited health literacy

Delay or avoid medical care due to cost

Experience poor nutrition and overcrowded living conditions

Face transportation barriers to healthcare access

These families might prioritize daily survival over health needs, leading to a cycle of poor health outcomes.

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These are individuals who avoid or delay seeking medical care, even when it's needed.

Reasons include:

Fear of costs or inability to afford recommended treatment

Cultural beliefs or mistrust of medical systems

Lack of awareness or understanding of medical advice

Influence of family members (in this case, her husband supports her decision)

This behaviour increases the risk of complications, as early detection and treatment are delayed.

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Even with better facilities and medical technologies, there is a limit to how many patients can be admitted.

Patients in the A&E department may wait for a long time to be admitted or even get to see a doctor

This is also applicable to ICU units, especially during a pandemic

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Most hospitals are located in city centres, so those living in rural areas or other parts of the country may have difficulty visiting

Even if they manage to travel to the hospital, there are extra expenses that can be a burden to the less fortunate

May also face transportation challenges; minimal public buses/vans to travel to the city, leading to longer travel times without a car

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As of 2024, doctor-to-patient ratio is 1:412 in Malaysia. Their working hour have reduced from 24 to 33 straight hours from on-call duties to 18 consecutive on-call hours according to the WBB system (Waktu Bekerja Berlainan) made by the MOH

The WBB system does not qualify Weekday shifts (5pm-9am) for the Elaun Tugas Atas Panggilan (ETAP) allowance

Only weekend/public holiday work qualifies as on-call under WBB, and even then, some shifts only get passive ETAP instead of the higher active ETAP

New ETAP rates under WBB:

Weekends/public holidays: RM275 (MO) and RM315 (specialists) per active call shift.

Non-WBB active calls: RM220 (MO) / RM250 (specialists).

Weekday on-call: RM200 / RM230 respectively.

Weekend/public holiday WBB shifts are split into two groups:

Group 1: 7am–10pm (active call).

Group 2: 6pm–9am (active call eligible if over 15 hours).

If the following day is a weekday, Group 2 does passive call (8pm–12am) and then works 12am–9am without extra pay.

Replacements for emergency leave follow current system allowances.

33-hour shifts can qualify for active ETAP, but only passive ETAP if ending at 9am.

In summary, doctors still working after 5pm are not compensated. This may lead to overworked staff and demoralisation of future doctors.

May also lead to burnout and turnover due to the low pay

Patients will also suffer, leading to a decrease in satisfaction levels, as understaffed hospitals may have an indefinite delay in surgeries and diffulty in receiving emergency care.

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Breakthroughs in nanomedicine, gene therapy, mRNA research and more are happening at an exponential rate.

Though hospitals are unable to keep up with the latest breakthroughs as it takes time for the treatments and technologies to be widely implemented.

The cost of the treatment may be expensive and limited to a few hospitals so only those who can afford to have access to potential treatment plans.

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What can governments do to help B40 communities ?

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What can governments do to help B40 communities ?

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1. Free / Heavily Subsidized Medical Services

Expand free healthcare services in public hospitals and Klinik Kesihatan.

Ensure low / zero charges for outpatient treatment, maternity care, surgeries, and medications.

2. Deploying mobile clinics to rural and underserved areas to reach B40 communities.

Provide vaccinations, screenings, and basic checkups directly in their neighborhoods.

3. Expand insurance coverage under schemes like mySalam which offers financial support for critical illnesses and hospitalisation.

4. Improve Public Healthcare Facilities

Shorten waiting times since not everyone can spend their time in clinics waiting and increase staff in government hospitals and clinics where B40 families go for treatment.

5. Provide essential medications at minimal or no cost, especially for chronic conditions.

6. Provide free nutrition programs for B40 children and pregnant mothers by offering subsidies or food baskets to prevent malnutrition and anemia.

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1. Anaemia (Most Likely)

Primary cause suggested by the scenario.

Anaemia reduces the oxygen-carrying capacity of blood due to low haemoglobin.

In pregnancy, the blood volume increases (hemodilution), which can worsen or unmask underlying anaemia.

Common symptoms: fatigue, breathlessness on exertion, palpitations, pale skin.

2. Nutritional Deficiency

Likely due to low income and inability to afford iron-rich or nutrient-dense foods.

Deficiencies in iron, folate, vitamin B12, and protein can contribute to anaemia and fatigue.

Her status as part of the B40 group makes this a significant risk factor.

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3. Physiological Changes of Pregnancy

Even in healthy pregnancies, fatigue and breathlessness can occur

Increased cardiac output

Enlarged uterus pressing on the diaphragm

Increased oxygen demand

These changes are exacerbated by anaemia or poor nutrition.

4. Underlying Medical Conditions (Needs to be ruled out)

Although not stated, differential diagnoses could include:

Cardiac issues (e.g., peripartum cardiomyopathy)

Respiratory issues (e.g., asthma, infections)

Thyroid dysfunction

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5. Psychological and Social Stress

Chronic stress, poverty, and physical labor (as a cleaner) can contribute to fatigue, poor sleep, and low energy.

Her reluctance to follow up may be linked to health literacy, financial concerns, or emotional burden.

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Immediate Steps:

Iron & folate supplementation: Start oral supplements immediately, even without waiting for full anaemia profiling (especially in resource-limited settings).

Dietary counselling within her means:

Focus on affordable iron-rich foods like: Sardines, anchovies, liver, green leafy vegetables (e.g., bayam, sawi)....Legumes (e.g., lentils, dhal)....Fortified cereals, eggs….Pair iron-rich foods with Vitamin C sources (e.g., guava, oranges) to enhance absorption.

Diagnostic Follow-up:

Subsidised testing via government clinics or NGOs.

Consider home visits or mobile clinics if access is a barrier.

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2. Social & Support Strategies

Counselling for both Puan ST and her husband:

Educate on the importance of anaemia treatment for both maternal and fetal outcomes.

Emphasize free or subsidized options (if available) and long-term benefits.

Peer support groups:

Link her to other pregnant women or community groups where experiences and low-cost tips can be shared.

Social work referral:

Assess for possible inclusion in welfare aid, zakat, or food voucher programs (if in Malaysia or similar settings).

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3. Health System & Policy-Level Solutions

Improve accessibility:

Bring services closer to B40 communities (e.g., Klinik Desa, mobile clinics).

Integrate anaemia screening into routine antenatal care, with same-day testing and treatment.

Targeted health promotion:

Create culturally appropriate, language-accessible materials about pregnancy nutrition and anaemia.

Partnerships with NGOs:

NGOs and community groups can help supply free food baskets, nutritional supplements, or transport vouchers.

Task shifting:

Empower nurses, midwives, and community health volunteers to follow up and provide basic education and supplements.