We still have unequal access to healthcare


A woman waits with her children outside an Ipoh clinic in this filepic. Domestic responsibilities often prevent a woman from accessing healthcare in a timely manner.

Paragraph 26 of the United Nations (UN) 2030 Agenda for Sustainable Development states that: “To promote physical and mental health and wellbeing, and to extend life expectancy for all, we must achieve universal health coverage and access to quality health care.

“No one must be left behind”.

In other words, governments across the world must work towards ensuring that their healthcare services are accessible to everyone, including and especially the most vulnerable and disadvantaged of our communities.

The aim, perhaps utopic in nature, is to ensure healthy lives for all and places equity as a central issue in health.

Access to healthcare differs depending on many factors.

It is an open secret that money and power buys you access in many aspects of life, and this includes healthcare.

An individual with access to a private jet and an offshore bank account does not face the same restrictions as one who can’t afford to take a bus out of his village.

Women

But beyond wealth, there are other divisions in terms of access.

For example, equality and rights for women are major determinants of overall health outcomes.

Despite the fact that the health of a woman has been shown to improve the overall health of her family and community, women paradoxically have greater difficulty in accessing healthcare due to issues such as violence against women and the inability to leave home due to domestic responsibilities.

An ageing population also plays a role in preventing adequate access to healthcare, especially as women are expected to stay at home to look after the elderly as per cultural and social norms in Malaysia.

The elderly

Elderly citizens themselves are potential victims of inequality of access.

The factors are manifold and often non-medical.

These include public transportation that does not take into account issues of mobility, the inability of the elderly to wait for long periods of time, and even more prosaic things such as obtaining food and water while waiting.

Without adequate support, it is usually easier for the older person to just stay at home.

This problem is only going to get worse.

According to projections by the UN, the year 2050 will see more Malaysians aged 65 and above than pre-working citizens aged 15 and below.

Two decades after that, the country’s population is expected to decline for the first time.

In fact, Malaysia’s demographic change is of real concern as the ageing process is occurring at a much higher rate than most countries.

By 2045, Malaysia will become an aged nation, with 14% of its population aged 65 and above.

Access to healthcare for the elderly is not only hampered by inadequate infrastructure, but also retirement savings or the lack thereof.

We are likely to see the need for retirement to be forestalled.

According to Belanjawanku, the expenditure guide for different Malaysian households published by the Employees’ Provident Fund (EPF), an elderly couple living in the Klang Valley needs about RM3,090 for monthly living expenses.

Given the fact that the majority of EPF members have savings of less than RM50,000 – and there is now a push to withdraw more before retirement – many Malaysians are at risk of retiring into poverty.

Migrants

Some voices have expressed their concern that finite resources might be shared among all in Malaysia, and not just Malaysian citizens.

These voices have been especially loud in the discussion on vaccinating foreigners in Malaysia against the SARS-CoV-2 virus.

These commentators, who sometimes bear more than a whiff of xenophobia, often forget that microorganisms like viruses do not take note of differences in nationality or skin colour.

There is only the need for one cluster to emerge in order for others to follow suit, and as is often the case, the more vulnerable in society are at higher risk.

Jordan, which hosts almost 700,000 Syrian refugees, has gone as far as opening a coronavirus vaccination centre in the Zaatari camp for the refugees.

It is in the interest of not only the refugees and migrants, but also the governments that host them, that opportunities for outbreaks are kept to a bare minimum.

This has profound public health and economic benefits, alongside the humanitarian aspect.

Rare diseases

We also recently commemorated the annual World Rare Diseases Day on Feb 28.

There are over 6,000 rare diseases affecting up to 6% of the global population.

Approximately three-quarters of these diseases are genetic in nature and start in childhood.

Resources are not always diverted to these conditions because, well, they are rare.

It can also be challenging to diagnose rare diseases because there are a wide range of disorders and symptoms that vary not only from disease to disease, but also from patient to patient suffering from the same disease.

The delay in diagnosis can also occur due to symptoms that are not specific to the underlying condition.

There is also a lack of easy access to a single experienced institution with the ability to perform appropriate tests.

These lead to profound disabilities that can scar a child for life.

Their quality of life will be further hampered by increasing levels of dependence on others.

The lack of effective cures only increases the physical and mental suffering of these patients and their loved ones.

Targeted intervention

Healthcare encompasses more than just treatment of disease.

Protection, prevention, treatment, rehabilitation and palliation are needed by many from cradle to grave.

While Malaysia does have universal health coverage, more can be done to improve access across various demographics by increasing efficiency and putting in place targeted interventions to assist groups that are deemed to be at higher risk of being left behind.

Dr Helmy Haja Mydin is a respiratory physician and chief executive officer of the Social & Economic Research Initiative, a thinktank dedicated to evidence-based policies. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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