The Orang Asli Health Survey: Advancing Evidence for Indigenous Health Equity in Malaysia

Indigenous populations worldwide continue to experience significant health disparities compared with non-Indigenous populations. These inequities are often rooted in historical marginalization, socioeconomic disadvantage, geographical isolation, and limited access to health services. ¹ In Malaysia, the Orang Asli, the Indigenous peoples of Peninsular Malaysia, represent one of the most vulnerable populations in terms of health outcomes, social development, and economic opportunities. ² Despite national progress in health care and socioeconomic development, gaps remain in understanding the health needs and determinants affecting this community. Comprehensive, nationally representative data are essential to inform policies and targeted interventions aimed at improving health equity among the Orang Asli. ³

The Orang Asli Health Survey 2022 (OAHS) was undertaken to address this evidence gap. Conducted across multiple states in Peninsular Malaysia, the survey represents one of the most comprehensive nationwide assessments of health and well-being among Orang Asli communities to date. Using a stratified random sampling design across 68 villages, the survey collected extensive data on demographic characteristics, socioeconomic conditions, lifestyle behaviors, and major health indicators. Importantly, the survey achieved a high response rate and included diverse tribal groups, including the Senoi, Proto-Malay, and Negrito communities, ensuring broad representation of Orang Asli populations across rural, fringe, and remote settings. ³

Globally, Indigenous health research has emphasized the need for culturally sensitive and community-engaged approaches in both research and intervention design. Evidence consistently demonstrates that Indigenous communities experience higher burdens of infectious diseases, malnutrition, non-communicable diseases (NCDs), and behavioral risk factors compared with general populations.^1,4 These patterns are similarly observed in Malaysia, where Orang Asli communities face persistent challenges related to poverty, limited education, and restricted access to health care services.^2,5 Previous studies have reported high rates of childhood malnutrition, infectious diseases, and emerging NCD risk factors among Orang Asli populations.^5,6 However, these studies were often limited to specific regions or tribes, highlighting the importance of a nationwide survey such as the OAHS.

The OAHS provides a holistic view of the health status of Orang Asli communities and highlights several important patterns. Many Orang Asli continue to live in remote or fringe areas with limited infrastructure and socioeconomic opportunities. Educational attainment remains low, and income levels are substantially below national averages. These structural determinants of health contribute to increased vulnerability to both communicable and NCDs. At the same time, ongoing social and economic transitions are influencing lifestyle behaviors, leading to the coexistence of undernutrition and increasing NCD risks within the same communities.

This special issue of the Asia Pacific Journal of Public Health brings together 11 articles derived from the OAHS, providing important insights into the health profile, risk factors, and social determinants affecting Orang Asli populations. Collectively, these studies contribute to a more comprehensive understanding of Indigenous health in Malaysia and offer valuable evidence for policy development and public health practice.

The first article in this issue presents the methodology and general findings of the OAHS, describing the survey design, sampling framework, and key health indicators observed across Orang Asli communities. The study highlights important demographic characteristics, socioeconomic conditions, and health outcomes, including the coexistence of communicable diseases, malnutrition, and NCD risks within the population.

Several articles focus on maternal and child health, which remains a critical priority for Indigenous health equity. One study examines childhood stunting among Orang Asli children under 5, reporting a high prevalence and identifying key associated factors such as low birth weight and tribal differences. These findings emphasize the need for culturally appropriate nutritional interventions and strengthened maternal and child health programs in Indigenous communities. ⁷

Another article investigates vaccination coverage among Orang Asli children aged 12 to 59 months. While the study reports relatively high overall vaccination coverage, it identifies disparities among specific tribal groups and geographical locations. These findings highlight the importance of targeted outreach programs and culturally sensitive engagement with community leaders to ensure equitable immunization coverage. ⁸

In addition to child health, reproductive health is explored through a study examining modern contraceptive use among married Orang Asli women. Interestingly, the prevalence of contraceptive use among Orang Asli women was found to exceed the national average in Malaysia. The study identifies several demographic and reproductive factors influencing contraceptive use, underscoring the importance of improving access to reproductive health services, particularly for women living in urban or transitional areas.

Communicable diseases remain an ongoing concern, particularly tuberculosis (TB), which disproportionately affects minority Indigenous populations in Southeast Asia and the Western Pacific. ⁴ Indigenous populations. One study examines tuberculosis (TB) prevalence among Orang Asli communities, revealing a notable burden of disease and highlighting the need for improved early detection, treatment adherence, and community-based TB control strategies. Given the association between tuberculosis and socioeconomic disadvantage, these findings underscore the importance of addressing broader social determinants of health.

Alongside infectious diseases, several articles address the growing burden of NCDs. One study investigates the association between body mass index and hypercholesterolemia, demonstrating the increasing influence of obesity and metabolic risk factors among Orang Asli adults. Another study explores the prevalence and determinants of undiagnosed diabetes, hypertension, and hypercholesterolemia, revealing substantial proportions of individuals with previously unrecognized conditions. ⁹ These findings highlight the need for enhanced screening programs and improved access to primary health care services in Indigenous communities.

Lifestyle and behavioral risk factors are also examined in several studies. Tobacco use remains highly prevalent among Orang Asli adults, particularly among men and individuals with lower socioeconomic status. The findings emphasize the need for culturally tailored tobacco control and cessation programs. ¹⁰ Similarly, another study explores alcohol consumption patterns, identifying risky drinking behaviors among certain demographic groups. These behaviors may further contribute to health risks and underscore the importance of community-based prevention strategies.

Cultural practices also play a role in shaping health behaviors among Indigenous populations. One study examines betel quid chewing, a traditional practice that remains common among Orang Asli communities. While culturally significant, this habit is associated with several adverse health outcomes, including oral cancer and cardiovascular diseases. ¹¹ The findings highlight the challenge of balancing respect for cultural traditions with efforts to reduce health risks through education and prevention programs.

Finally, this special issue includes a study examining self-rated health among Orang Asli adults, an important indicator of perceived health status and well-being. The study identifies several factors associated with poor self-rated health, including acute illness, hospitalization, unemployment, and lifestyle behaviors. These findings emphasize the complex interplay between health conditions, socioeconomic factors, and perceptions of well-being among Indigenous populations. ¹²

Taken together, the articles in this special issue demonstrate the multifaceted nature of health challenges faced by Orang Asli communities. The coexistence of infectious diseases, nutritional problems, and rising NCD risks reflects ongoing epidemiological transitions within these populations. Addressing these challenges requires a comprehensive and culturally sensitive approach that integrates health care delivery, health promotion, community engagement, and social policy interventions.

Importantly, the OAHS also highlights the need for sustained investment in Indigenous health research in Malaysia. Continued monitoring and longitudinal studies are necessary to track health trends, evaluate interventions, and ensure that policies effectively address the needs of Orang Asli communities. Collaborative partnerships between researchers, policymakers, health care providers, and Indigenous communities will be critical to achieving meaningful and sustainable improvements in health outcomes.

This special issue represents an important step toward strengthening the evidence base for Orang Asli health in Malaysia. By presenting findings from the nationwide OAHS, the articles provide valuable insights that can guide future research, policy development, and public health interventions. Ultimately, improving the health and well-being of Orang Asli communities is not only a public health priority but also a matter of social justice and equity.