OPINION
“根據醫學期刊《柳葉刀》于2014年的一份報告指出，大馬有49%女性和44%男性，擁有超重或
肥胖的問題。超過400萬國民，以及每7個兒童便有1人，被列為胖子。”
Azrul Mohd Khalib
CEO – 28 Aug 2017
DM Analytics智囊機構的首席經濟學者兼Khazanah Research Institute智囊機構的前研究總
監莫哈末阿都卡立博士最近提到，馬來西亞在未來會面對醫療系統不勝負荷的問題。
問題的成因，乃是社會面的醫療問題惡化，例如高血壓和糖尿病患者人數增加。莫哈末阿都卡
立在他的暢銷書《不平等的顏色》中提到，邁向2050年的馬來西亞，會面對老化、貧窮化、多
病、無子化及無居所化的問題。
他說得對，馬來西亞人的確不健康；但我卻不同意他說的，醫療系統在未來會出現問題。
因為根據數字，醫療系統在今天就已經出問題了！
東南亞肥胖率最高
根據醫學期刊《柳葉刀》于2014年的一份報告指出，大馬有49%女性和44%男性，擁有超重或
肥胖的問題。超過400萬國民，以及每7個兒童便有1人，被列為胖子。
在東南亞國家中，大馬的肥胖率最高；2015年全國衛生和患病調查也顯示出現同結果。
糖尿病是非傳染病如中風、心疾、失明和腎衰褐的主要導因。今天，全國3200萬人口中，估計
有300萬成人患糖尿病，大約每5個大馬人就有1人是患者。患有乙型糖尿病的大馬成人佔了成
人人口的22.6%；2006年的數字只不過是14.9%。如今，小至7歲的兒童也會患上乙型糖尿
病。不久前，我們還以為，年過45者才會患上糖尿病。
馬來西亞人的毛病是食用很多高卡路量和高碳水化合物的水物，而且也貪吃，在半夜也吃。
是不是馬來西亞人太不注重身體健康？看起來好像是這樣。然而，醫療危機的成因可不是單一
的。
其實，健康的食物如水果和蔬菜，價格越來越貴，令到低收入階層人士難以負擔。反之，加工
食物如面條和快餐食品越來越便宜。一個家庭的經濟能力，決定了他們能選擇甚么食物。健康
食品因此成了奢侈品，有多餘錢的人才消費得起。
有一個在南非實行並奏效的解決方案值得參考，就是政府提供補貼。當地的蔬果等健康食物獲
得政府補貼，價格折扣25%。如此一來，人們便會受鼓勵多食用健康食品並養成習慣。馬來西
亞可以仿而效之。補貼金何來？我們有煙草稅金。
不過，再怎么提高煙草稅，也都有個限度。我們也到了那個限度。根據估計，大約有500萬國
民，相等于人口的22.8%是煙民。目前的香煙價格已是17令吉，再調高，就會逼使煙民轉而購
買價格低至4令吉的走私煙了。
改變人民生活習慣
目前的香煙市場，有7成是走私煙。政府要減少香煙害處，應該由改變人民的生活習慣和態度下
手，這比採取強硬和懲戒性手段，例如加稅來得好。在英國、加拿大和澳洲等先進國家，如此
處理方式證實奏效。
馬來西亞的醫療體系相對的不昂貴、大眾化、得到政府補貼，國人應感慶幸。不過，很多人會
因此誤以為，我們不論患上甚么疾病，都可以得到照護和治療。
慢性疾病例如癌症很折騰人，可以讓人山窮水盡。馬來西亞人的醫療準備，普遍上做得不足。
再加上非傳染性疾病如糖尿病患者人數增加，我們的醫療系統可以說是不勝負荷了。很多先進
國家前車可鑑，如果沒有及時處理，醫療系統問題就會惡化下去。
The healthcare crisis is now
China Press (28 August 2017)
A recent statement by Dr. Muhammed Abdul Khalid, chief economist for DM Analytics and former research director at Khazanah Research Institute indicated that Malaysians in the future would face an inadequate and overburdened healthcare system.
This would be as a result of a society increasingly afflicted by health problems due to ailments such as high blood pressure, hypertension and diabetes. In his bestselling book, The Colour of Inequality, has put forward a projection that by 2050 more Malaysians will be older, poorer, sickly, childless and homeless.
I agree with the points raised by Dr. Muhammed on the fact that the current generation of Malaysians not being healthy. But I disagree with him that this is a problem for the healthcare system in the future.
Looking at the data, the health crisis is already happening in Malaysia today.
According to a study published in The Lancet in 2014, 49 per cent of women and 44 per cent of men in Malaysia were found to be overweight or obese. More than four million people in this country and one in seven children are classified as obese.
When placed against regional data in comparison to neighbouring countries, it is sobering to realise that this country has the highest obesity rates in Southeast Asia. The 2015 National Health and Morbidity Survey reported similar findings in its nationwide review of the Malaysian population.
Diabetes is the leading cause of non-communicable diseases such as stroke, heart disease, blindness, and kidney failure. Today, an estimated three million adults out of a population of 32 million have diabetes. Around one in five Malaysians. The prevalence of Type 2 diabetes among Malaysian adults has risen to 22.6 per cent today compared to 14.9 per cent in 2006. Children as young as seven are developing Type 2. Not too long ago, this type of diabetes used to be seen only in adults over 45.
Malaysians are also not only eating more high-calorie and high carbohydrate food, they are also eating around the clock, including late at night.
The question has been asked whether Malaysians are not taking their healthcare seriously. But it is too easy and simplistic to generalise and say that this is the case. There is no one thing that is driving this healthcare crisis.
The reality is that healthy food such as fruits and vegetables is becoming increasingly expensive and inaccessible to those with lower incomes. Processed foods such as noodles and fast food on the other hand are getting increasingly cheaper. When food choices are increasingly determined by how much money a household earns and what that shrinking purchasing power can provide, eating healthy is seen as a luxury affordable only by those with more disposable income.
This is not an issue of food scarcity. There is an abundance of food today but there is currently no incentive for people to eat healthier and more nutritious food options when they are expensive. Most households, particularly those of lower and middle income families, make food and dietary choices based on their disposable income.
One method which has been shown to work in South Africa is subsidisation, where healthy foods such as vegetables and fruits were subsidised and available at a 25% discount. This led to an uptick in healthier food habits and dietary intake within the population. We could do the same and fund it using the income gathered from tobacco taxation.
Some people have supported further taxation of cigarettes as a way to reduce the number of smokers and promote a healthier lifestyle.
However, there is a limit to taxation what can do and I think we have reached that limit. An estimated five million Malaysians, or 22.8 per cent of the population, are smokers. Increasing taxes on legal tobacco products making them more expensive beyond the current RM 17 per packet will just make them choose the cheaper and illicit options which cost around RM 4.00.
With more than 70 percent of the tobacco market currently dominated by illicit cigarettes (7 out of 10 cigarettes sold in Malaysia is illicit), the approach to deal with smoking today must be within the context of changing people’s behaviour and social attitudes towards consciously making healthier lifestyle choices rather than a brute force and punitive action such as taxation. That is what has produced sustainable and long term results in more developed societies such as in the United Kingdom, Canada and Australia.
Malaysians are fortunate to have a relatively inexpensive, accessible publicly subsidised healthcare system. This may have lulled us into complacency and apathy, mistakenly thinking that care and treatment for whatever disease will always be available when we need it. Disease or chronic illness such as cancer can often be debilitating and quickly exhaust healthcare options and resources. Malaysians are generally unprepared when it comes to healthcare issues.
The reality is that with the increasing burden of non-communicable diseases such as diabetes, our healthcare system is currently overburdened, overstretched and underfunded.
As experienced by other more developed countries, the healthcare crisis is only going to worsen if no steps are taken to address it.
A national health insurance scheme is increasingly being seen as a possible option to help provide sufficient financing and funding for healthcare services for every person who needs it. People must take responsibility for looking after their own health with as many choices and healthcare options available for those who can afford them. Social safety nets must be established and be accessible for those in need of assistance and unable to afford adequate healthcare.