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
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.