One of the silver linings of the Covid-19 pandemic is that it has brought healthcare to the forefront of our consciousness.
One can argue that we are now more aware of the importance of a robust public health system, alongside a healthcare service that is able to serve current and future needs.
As we troubleshoot one Covid-19 issue to the next, it is difficult to pause and scan the horizon.
Identifying potential future scenarios that may challenge our healthcare system is essential, alongside coming up with realistic strategies that can be implemented in a timely fashion.
The first step is to identify core issues, of which there are many.
Infectious diseases
The pandemic brought about by the SARS-CoV-2 virus is not the first of its kind, nor will it be the last.
However, it still took the world by surprise and many countries were ill-prepared to handle the situation, ranging from not having enough personal protective equipment (PPE) to difficulties in rapidly manufacturing new vaccines.
The nation has to be better equipped for future pandemics.
Alongside novel viruses, we are also facing increasing levels of antimicrobial resistance (AMR), i.e. infections caused by microorganisms like bacteria, viruses, fungi and parasites, that do not respond to conventional antimicrobials.
According to a study in The Lancet journal, in 2019, bacterial AMR alone played a part in almost five million deaths and was directly responsible for an estimated 1.3 million deaths worldwide.
One in five of the deaths occurred in children under the age of five, with low- and middle-income countries bearing the highest burden.
Nutrition and lifestyle
The 2021 Global Nutrition Report stated that the number of stunted children under the age of five in Malaysia increased from 20.7% in 2016 to 21.8% in 2019.
In other words, one in five Malaysian children below the age of five are being given inadequate nutrition.
Permatang Pauh Member of Parliament Nurul Izzah Anwar recently pointed out that the situation is likely to have worsened with acute poverty among children arising from the pandemic, with ripple effects on the children’s education, social mobility and future prospects.
On the other side of the spectrum, more than half of Malaysia’s population is overweight or obese.
This is closely linked with the increasing prevalence of diabetes – the 2019 National Health and Morbidity Survey (NHMS) estimated that 18.3% or almost four million Malaysians have diabetes.
More worryingly, only half of them knew that they had diabetes.
This has profound implications, as diabetes is the main cause of blindness and kidney failure requiring dialysis.
Smoking is another well-known risk factor for the increasing prevalence of non-communicable diseases (NCDs) such as kidney disease, heart disease, emphysema and cancer.
As it kills half of its users, and even those around smokers who inhale harmful secondhand and thirdhand smoke, a lot more can and should be done to reduce its impact on not only our health, but also the associated escalating healthcare costs.
Ageing
The increasing prevalence of NCDs is all the more worrying when combined with the fact that Malaysia is an increasingly ageing nation.
According to the World Bank, we became an ageing society (defined as 7% of the population being 65 years of age and over) in 2020.
We are scheduled to become an aged society in 2044 (where 14% of the population is aged 65 and over), and a super-aged society in 2056 (where one in five people are aged 65 and over).
There are economic implications not only in terms of the nation’s growth, but also in terms of healthcare costs.
Preventative measures are needed to ensure that people not only live longer, but also live longer healthily.
These issues are closely linked to the availability of social support nets.
The Employees’ Provident Fund (EPF) withdrawals that were made during the Covid-19 pandemic have placed increased pressure on not only the future cost of healthcare, but also post-retirement income security.
As of now, more than six million members have less than RM10,000 in their EPF accounts, with 3.6 million members having less than RM1,000.
Mental health
Frailty in the elderly is a cause for anxiety and low mood.
And according to the Global Health Data Exchange, one in seven children between the ages of 10 to 19 suffer from mental health conditions.
But the mental health situation across all age groups has worsened with the pandemic.
This is a consequence of job losses and economic hardship, as well as isolation from social networks and support.
The rise of domestic abuse, higher rates of divorce and increased cases of suicide are all emblematic of the increasing strain our society is facing.
Any effort to improve our healthcare service will need to include policies that ensure better access to mental health support.
Patient safety and quality of care
Anyone who sees a doctor or goes to a hospital will rightfully expect to not get worse as a consequence of getting treated or admitted.
However, adverse events due to unsafe care are one of the 10 leading causes of death and illness in the world.
More than 130 million adverse events occur in hospitals in low- and middle-income countries due to unsafe care, resulting in 2.6 million deaths.
In more advanced countries, 15% of total hospital activity and expenditure is a consequence of adverse events.
More importantly, it is estimated that up to half of these adverse events are preventable, highlighting the fact that consistent use of proper policies and guidelines will alleviate such dire outcomes.
Capacity
Alongside developing healthcare worker skills and specialisations, there is a need to invest in not only more healthcare services (hospitals and home care), but also to do so in a manner that incorporates green technology and digital technology advances.
The availability of sufficient connectivity and access to cloud technology will allow us to dip into the opportunities afforded by the Internet of Things, big data and analytics.
The potential benefits are legion: better communication between healthcare professionals and with patients, predictive analytics, better access to medical information, improved patient safety, electronic health records, telehealth and wearables that can be used alongside health apps that can both nudge and warn patients regarding their current health status.
Such advancements will inevitably have a cost, not only financially, but also in terms of the increasing need for cybersecurity and a more robust framework for personal data protection.
Health reform commission
The above issues are just the tip of the iceberg.
There are other issues such as air pollution and climate change, coordination between government ministries and agencies, improving access to expensive personalised care, etc.
Health Minister Khairy Jamaluddin recently mooted the idea of creating a Health Reform Commission to address these issues.
There are many difficult choices ahead of us, from increasing the GDP (gross domestic product) spent on healthcare to potentially introducing new health insurance schemes that can make healthcare not only affordable, but also accessible to all.
An independent commission can deep dive into these challenges and come up with recommendations to implement them.
The Commission should be answerable to Parliament and be created in such a fashion that the necessary reform is implemented irrespective of the political party in power.
Although healthcare is inherently political, we can all agree that it should be above the petty distractions of partisan politics.
It is only through such a platform that we will be able to drive through the necessary reform to ensure that the health of our current and future citizens are properly catered for.
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.
Already a subscriber? Log in
Get 20% OFF The Star Digital Access
Cancel anytime. Ad-free. Unlimited access with perks.
