A holistic approach to ageing needed in Malaysia

  • Focus
  • Sunday, 15 Sep 2019

TODAY Malaysia appears to be a victim of its own success.

When we gained independence in 1957, the average life expectancy was 57 years, by 1976 it was 68.8 years and now it is 72.7 years for males and 77.4 years for females.

This increase in life expectancy has been brought about by major improvements in the delivery of healthcare, and today, Malaysia can say to a great extent we have provided Universal Health Coverage for the population.

Apart from this, the living conditions of Malaysians have met remarkable targets: 96% of households have clean water, 96% have sanitation, 66% have sullage disposal and 70% have sewage disposal.

However, we have now come to a situation of diminishing returns – the Government will need to spend a great deal more in healthcare to see similarly impressive increase in life expectancy.

Economic success has brought about an increased prevalence of Non-Communicable Diseases (NCDs) such as diabetes, obesity, hypertension and heart disease and with increasing age, more cancers.

Worse, we are the most obese in Asean!

Existing health data shows that many adult Malaysian are not only unfit but also have low levels of awareness of NCDs, including if they are suffering from one.

As such we now have an ageing population which is unhealthy – statistics show 61.3% of Malaysian adults suffer from one NCD, 26.3% from two NCDs and 7.2% from three NCDs and with time, the number will rise.

It is no surprise that NCDs account for an estimated 73% of deaths in the country.

Changing demography

The WHO definition of an ageing nation is when more than 7% are above 65 years of age and we are classified as an aged nation when we have more than 14% above the age of 65.

In 2017, Malaysia had 6.3% above the age of 65, compared to below 3% in 1970; in 2020 we are projected to have 7.2% above the age of 65. We are expected to cross the barrier in 2040 when we will have 14.5% above the age of 65 years.

Data shows there is also a steady and progressive decrease in the below-14 age group – it is predicted that by 2030-2035 the number of Malaysians below the age of 14 years will be less than those above the age of 65 years.

This is worrying because this means that there may not be sufficient people to provide care for our ageing population or provide an adequate workforce in the future.

With a smaller number of working adults, a smaller amount of tax revenue will be collected and this reduced revenue has to be used to look after the elderly. All of this will put strains on the national economy.

Price of ageing

Although for statistical purposes we have clear definitions of an ageing and aged nation, for an individual, ageing is a process that creeps up upon us in a very slow and subtle manner.

One does not get up one morning and say I am now 65 years old and so I am an aged person. We all know of friends and relatives whose chronological ages are

the same but in terms of physical and mental capacities are grossly different. This inequality in ageing is because of their genetics, lifestyles and the level at which they have taken care of their health.

The OECD nations and the US took an average of between 120– 150 years to see the increase in the life expectancy of their population from the mid 50s to the mid 70s of age, but most Asian nations have achieved similar increases of life expectancy within the last 60 years – almost half the time!

This has resulted in a variety of challenges for Asian nations, from insufficient infrastructure, inadequate healthcare personnel to insufficient funds or strains on existing pension funds to keep paying for the longer than envisaged periods.

This needs to be addressed, because in Malaysia for those who reach the age of 65 years in 2017, the males can expect to live another 15 years and the females another 17.1 years.

How many of today’s Malaysians have sufficient funds to see to their basic needs in the coming years let alone to deal with any critical illness? These are major challenges not only for the individual but also for the nation as a whole.

As can be seen from the table above there is a wide disparity between the healthcare cost in the developed and developing nations and in the developing Asean nations the CAGR is significantly higher than the more developed Asean countries.

As such in nations without a comprehensive healthcare system a large part of healthcare will be an out-of-pocket expenditure (OPE) which will rapidly erode any saving that an individual has accumulated during his/her working life.

In Malaysia healthcare seeking behaviour shows that for minor illness almost 75% of the population will seek treatment from private doctors, but when it involves hospitalisation, it is reversed, only 25% use private hospitals, primarily due to cost and insufficient insurance coverage.

As such most of the OPE in Malaysia is for primary care or for over the counter medications and supplements.

Financial sustainability

The reality is that with increasing life expectancy, many will live as long if not longer in their retirement phase of life than their working life. This will put a massive strain on what little saving that they had accumulated.

In Malaysia studies have shown that on an average most retirees who have a lump sum payment on retirement run out of savings within a period of five to six years.

Those who are fortunate to have a regular pension also face the challenge of the shrinking ringgit due to inflation. It is hence crucial that we explore various methods of wealth preservation and wealth growth to face the longer life span.

To address the needs of the B40 in our nation, the Government has started as a pilot project the PeKa 40 health scheme which aims to provide a safety net for citizens within this bracket when they fall ill or when they need certain forms of medical equipment and also mySalam which is an insurance scheme.

Several years ago, the Selangor State government started Peduli Sihat which is a scheme for the B40 in the state to have access to private primary care doctors for common minor ailments, the scheme has caps on payment per visit and total annual payment, this is a win-win situation where both the public and the private doctors are both satisfied.

The possibility of extending such schemes to cover management of NCDs should be studied for cost efficiency and health outcomes.

Faced with the prospects of longer life expectancy, young Malaysian must seriously consider some form of pension or retirement saving.

The World Bank has suggested the five pillars of retirement income which are: state pension funds, mandatory saving (EPF/CPF), voluntary saving, family support and community support. One must try and have at least one or more of these retirement incomes, it recommends.

On the other hand, those who are already in the 50s and 60s have to look at their current saving and see how best to make it last at least another 15 to 25 years.

Ageing gracefully

Anti-ageing is a myth, but graceful aging is a reality which is within the reach of everyone. As one ages, one passes through the various stages of ageing:

* active ageing (55- 70 years) or the process of ageing by optimising opportunities for health, participation and security in order to enhance quality of life as a person ages.

* passive ageing (65-80 years) where a person goes into a semi-retirement phase of life.

Irrespective of our age, remaining healthy by exercising, optimising weight and ensuring optimal control of any NCD will ensure that one will have an opportunity to age gracefully.

The WHO Brasilia Declaration on Ageing and Health in 1996, stated that a healthy older person remains a resource to their families, communities and the economy.

A good example is seen in many countries which have reached the status of an aged nation, where the elderly is actively and gainfully employed in a variety of jobs suitable to their physical capacities.

If we have been fortunate to have saved enough or are lucky to have a regular pension, then it is likely that we will age with grace and dignity.

For the young, they must take active steps of looking seriously at both health and wealth preservation, so that when they reach the stages of ageing they are able to age comfortably.

The real challenge is for those who don’t have the financial means to have an adequate disposable income as they age. It is a social issue which needs to be addressed not only by the Government but also by

society at large, this where homes for the aged run by charities and religious bodies, fill the need.

Today in Malaysia, many of these homes for the elderly are registered under Act 506, the Care Center Act (1993), which is under the purview of the Social Welfare Department, and not under Act 586, the Private Healthcare Services and Facilities Act (2006).

As Malaysia moves to achieve the status of a developed nation, these facilities for the aged will be regulated under Act 802 the Private Aged Healthcare Facilities and Services Act (2018), which will address the many issues and challenges of caring for an ageing society in a developed nation.

However, these Acts don’t address the issue of “ageing in place” that many of the elderly want, which is staying in their homes for as long as they can, as they want to age in familiar surroundings.

In a neighbouring country, for a nominal fee, the Government makes the home aged-friendly.

Ageing is inevitable, but it is possible to age healthy. Apart from a healthy lifestyle, healthy eating habits and the right nutrition is essential. It is heartening to note that many Malaysians are already taking proactive steps towards healthy ageing: In a 2018 Asia Pacific Healthy ageing survey which interviewed 5,500 individuals aged 40 and above, including 500 Malaysians, it showed that 94% agreed that they can take steps to age healthily while 59% of those between the ages of 40-45 years felt that was the right age for them to start taking steps towards ageing healthily.

Still, we need to address the issue of ageing in a holistic manner – covering the current immediate, intermediate and long term needs of the Malaysian population.

Not only must one age healthy but also with grace and dignity, for which one has to have adequate finances.

For those who are not so fortunate, then it should be the responsibility of the Government to find cost-efficient and practical solutions to address this looming challenge.

This is one of the last articles written by the late Datuk Seri Dr Jeyaindran Sinnadurai.

The views expressed here were solely the writer’s own, and do not necessarily reflect those of The Star.
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