Politicians should be fit enough to carry out their demanding duties

Sometimes, a politician’s duty includes exercising with the public, as seen here with MCA Bentong candidate Datuk Seri Liow Tiong Lai (right) and former MCA secretary-general Datin Paduka Chew Mei Fun (centre) in this filepic. Chew is currently undergoing treatment for breast cancer, which was diagnosed when she went for a routine health check-up after her sister passed away from colon cancer during the Covid-19 pandemic.

With their packed schedules and multiple duties, elected representatives, whether they be Members of Parliament (MPs) or state assemblymen (Aduns), really need to be in the pink of health.

Before the last two general elections, Barisan Nasional (BN) stated that all its candidates had undergone and cleared a health screening before being approved to run for office.

Then-BN secretary-general Datuk Seri Tengku Adnan Tengku Mansor had said before the 13th General Election (GE) in 2013, that the compulsory health screening was implemented due to the high number of by-elections caused by the incumbents’ deaths since the 12th GE.

Eight Parliamentary seats and 15 state seats lost their representatives during that period, triggering 13 by-elections, with the remaining being held off as they occurred close to the next expected general or state elections.

Of these, 19 representatives had died, with the causes ranging from a heart attack to various types of cancer and accidents.

Tengku Adnan had said that those with illnesses like cancer and heart ailments were excluded from running, although candidates with conditions like high blood pressure and diabetes, which can be well-controlled with medication and lifestyle changes, were considered on a case-by-case basis.

Since GE14, 14 MPs and Aduns have passed away while in office, many of them from heart-related conditions (see graphic below).

Heart disease has long been the number one killer in Malaysia, according to the Statistics Department.

In general, politicians – and elected representatives in particular – tend to be adults of middle age and older.

With increasing age comes an increased risk of non-communicable diseases (NCDs).

ALSO READ: Non-communicable diseases kill three out of four people worldwide

According to the 2019 National Health and Morbidity Survey (NHMS), two in 10 adults has diabetes, three in 10 have high blood pressure, and four in 10 have raised cholesterol levels.

However, half of those with diabetes and high blood pressure respectively were unaware of their conditions, while one in four adults did not know they had elevated blood cholesterol.

Even incumbent Langkawi MP Tun Dr Mahathir Mohamad, who is a prime example of healthy ageing, has had heart issues.

The two-time former Prime Minister had his first heart bypass surgery in 1989.

He underwent a second heart bypass in 2007, following two heart attacks in the preceding two years.

He also had a serious health scare earlier this year when he was hospitalised twice within two months due to a low red blood cell count and an elective procedure to implant a pacemaker, during which he contracted an infection.

Dr Mahathir was also hospitalised on Aug 31 due to Covid-19, but was discharged and allowed to continue his quarantine at home four days later.

He is the oldest political candidate in the world at the age of 97, as he looks to defend his Langkawi seat in the upcoming elections.

Meanwhile, Health Minister Khairy Jamaluddin had suggested in March that all MPs, especially those aged 40 and above, undergo regular health check-ups.

This proposal was welcomed by Dewan Negara president Tan Sri Rais Yatim, who opined that all senators and MPs should undergo such health screenings to ensure that they are both physically and mentally healthy.

Basic health check

Consultant endocrinologist Dr Mohd Saiful Bahari Mohd Kassim shares that half of those who come for health screening turn out to have diabetes, while more than half are found to have high cholesterol or high blood pressure.

He notes that if a person has all three conditions, his or her risk of a stroke or heart attack increases by two to four times.

Early diagnosis allows for early treatment and management of medical conditions, allowing for improved outcomes and reduced risk of severe consequences, including disability and death.

Dr Saiful explains: “The idea of a full health screening is to look at the kidney function, liver function, full blood picture, cholesterol, sugar and gout.

“An ultrasound to scan the tummy, to look at the liver or any other organs that are enlarged or missing, and to look for any fatty liver.

“Then a chest X-ray to make sure there are no sort of lesions in the chest, and a baseline ECG (electrocardiogram) to make sure there is no evidence of any heart damage.”

He thinks that it is important for politicians to have a full body health check.

“Blood is only the tip of the iceberg.

“When we are shown the result of a blood test, it only helps us to navigate the surface, but sometimes, we miss out on what is happening underneath the water with the rest of the iceberg,” he says.

That is why he adds that: “What I tend to do for all my patients is a test called ankle-branchial pressure index (ABPI), where we assess their heart attack risk and their artery disease risk, and we measure the percentage of body fat, muscle mass and visceral active fat.”

Such a full body health assessment allows doctors to see what the body composition is so that they can get a clearer picture of the person’s overall health.

“This is at least the baseline that these politicians can do,” he opines.

With cancer being one of the main causes of death among MPs, blood tests for tumour markers are an important screening for them to undergo as well.

Female MPs should also do a mammogram to check for any signs of breast cancer, especially if they are aged 40 and above.

ALSO READ: Be aware about your breasts to catch cancer early

However, Dr Saiful notes that while tumour markers are very good for monitoring cancer, they are not the main tool for a diagnosis.

Therefore, if the results are suspicious, further investigations need to be done.

While nonagenarian Mahathir is still going strong and defending his Langkawi seat, he has had his share of heart problems and currently has a pacemaker. — IZZRAFIQ ALIAS/The Star

Overweight and smoking

Dr Saiful, who subspecialises in diabetes and obesity, notes that the risk of a heart attack is two to four times higher in the overweight and obese population, compared to those of normal weight.

The former are also at higher risk for developing diabetes and high blood pressure, which are themselves additional risk factors for heart disease.

Malaysia is the most obese nation in South-East Asia, with one in two adults being overweight or obese.

In addition, around one in four adults in Malaysia are not physically active.

He says: “This is amplified with people who eat and have meetings all day long; they are only sitting down and not really moving.”

Politicians are at greater risk of being overweight if they are unable to control what they eat and practise a healthier lifestyle.

“Every time you eat within four hours of your sleep, your body cannot process the food.

“All that sugar and carbohydrates goes to your stomach, stored as visceral fat (active fat), which is the worst fat in your body.

“If you have too much of fat in your tummy, it increases the risk of heart attack.

“In terms of an exercise regiment, I encourage my patients to do 10,000 steps a day,” he says.

Many politicians also smoke.

This not only increases their risk of lung cancer, but can also lead to heart disease and stroke.

“When you smoke, your inner blood vessel wall gets damaged and it fills up with yellow gunk (plaque).

“This causes the blood vessel to become blocked.

“While some smokers think exercising is good enough to be physically active, smoking after exercising makes everything worse.

“Exercising makes the blood vessel become narrower; there is a higher risk of it being completely occluded.

“Therefore, it does not make sense for anyone to smoke after exercising,” he says.

Dr Saiful shares that his friend Datuk Dr Mohamed Farid Md Rafik, who was then Deputy Minister in the Prime Minister’s Department, passed away in 2019 due to a heart attack.

“He was a good friend of mine,” he says.

“He was a smoker and slightly overweight.

“He also had a family history of heart disease.

“All those factors can result in heart disease.”

He adds that if your family has a history of any health condition – not just heart disease – then you are at higher risk for those conditions.

Be a good example

An unhealthy lifestyle can not only lead to an unhealthy physique, but also an unhealthy mind.

As politicians tend to be on the go all the time, it can be quite stressful for them.

Depression and anxiety are both associated with a higher risk of strokes and heart disease.

Stress itself also leads to an increased risk of such cardio- and cerebrovascular events.

ALSO READ: What stress does to your body and mind

Unfortunately, Dr Saiful believes that most politicians are reluctant to get checked for physical problems, much less mental ones, because they do not want people to know that they are unhealthy.

“My late father was in politics.

“He was a chronic smoker and passed away in 1990 when he was only 60 years old.

“He never wanted to see a doctor.

“He said that if he went to the doctor, people would know and they would not vote for him,” he shares.

His father was the late Machang MP Mohd Kassim@Yahya Ahmad, who had also previously held the posts of Parliamentary Secretary to the Minster of Foreign Affairs and the Minister of Agriculture respectively.

Dr Saiful says: “Health issues can hurt a campaign.

“A candidate’s popularity can drop if they do not manage to stay fit.

“That is a stigma that we have to break down for all these politicians in terms of the health risk, because they are representing the people.

“They are not only looking at their own health, but are also an example for thousands of other people.”

He concludes: “Anybody above the age of 40 should (do a health check-up), and anybody above the age of 50 must.”