Making health a higher priority

No health, no wealth: Good public policies are needed to translate scientific solutions into real-world health outcomes.

THIS week, we restart the Vital Signs column, which was previously online only and on hiatus for the last year as this author focused on other projects and priorities in public health.

The last 16 months have been turbulent for Malaysia, with the Covid-19 pandemic and political instability affecting our public health, society and economy.

With the pandemic likely to become endemic and long-term, there are three ways in which this column hopes to contribute to the public discourse.

One, we will further explore the science, politics and economics of public policymaking in Malaysia, focusing on our health system, as well as pandemic exit strategies and the recovery process.

Two, we will elaborate on the position of our health system within the South-East Asian, Asia Pacific and global health arenas, as the pandemic has shown the intricate inter-connectedness of the world.

Three, the column will be co-authored with guest writers, aiming for diversity of voices, ages, genders, geographies and expertise areas.

In today’s column, I would like to share three fundamental realisations for Malaysia’s society in response to the Covid-19 pandemic.

Higher priority

The first realisation is that health should be a higher priority for Malaysia’s national agenda.

That may seem like an obvious statement, but health truly wasn’t always highly prioritised in Malaysia.

That doesn’t mean that health isn’t a priority; it just means that other priorities were deemed more important.

Since 1957, the priorities for Malaysia’s national development and nation-building were always the economy (GDP growth or jobs creation), a stable and secure society (inter-ethnic harmony and racial relations), or development (poverty eradication and education policy).

These are all excellent priorities, which most other countries focus on too.

Growing the economy, ensuring a harmonious society and eradicating poverty are excellent ways to improve the health of Malaysians.

Health helps us gain wealth, and wealth helps us gain health.

But health is still not prioritised as highly as the economic, security or education portfolios.

Here are other proofs: traditionally, health ministers are any party leaders who happen to have a health or science background.

Prime Minister aspirants never consider health as a stepping-stone portfolio, naturally preferring the education, finance, security or rural development portfolios.

And health (other than the standard rhetoric) does not feature heavily in National Malaysia Plans.

This is not being said to be judgmental as it is basically human nature and the fundamental way countries prioritise their issues.

I am not asking for health to be the number one priority.

But it should be higher, and what Covid-19 has done is to elevate health higher as a priority.

Therefore, this is the right timing for policymakers to make the difficult choices to strengthen and reform our health system for the future.

More than healthcare

The second realisation is that health is more than healthcare.

Covid-19 has shown the importance of healthcare in the form of hospitals, ventilators, intensive care units, doctors and nurses. It is encouraging that the government is now investing more in healthcare infrastructure and human capital.

“Healthcare” can be defined as a sick patient coming to a hospital and receiving medical treatment, so an accurate description for healthcare could also be “sick-care” or “disease-care”.

There is a strong medical, scientific and technological angle to healthcare.

However, Covid-19 has shown us that health means more than just healthcare.

As we begin the third nationwide movement control order today, the importance of the social determinants of health become prominent again.

These social determinants are the conditions in which you are born, grow up, live, work, socialise and grow old, and they are arguably more important than more hospitals and medicines.

Health means that you should be born into a family and society that is convinced about the value of childhood vaccinations, and you should study in a secondary school where teachers do not make sexual jokes or discriminate based on gender.

Health also means that you should work in a factory or construction site that prioritises your safety, or in a company that provides adequate health insurance, work-from-home arrangements during pandemics, and generous maternity leave.

Health also means that your home should be spacious and well-ventilated (so that you can quarantine without mental anguish or claustrophobia), and that there should be a well-lit public park within walking distance of your home so that you can exercise safely after putting your children to bed.

And health definitely means no factories polluting your water supply (like in Kelantan, Selangor or Johor), and that you have the financial means to afford healthcare when you grow old or suffer from disease.

Therefore, health is more than just healthcare.

A political choice

And that brings us to the third fundamental realisation: that health is a political choice.

The science of the pandemic is powerful, but we still need good public policies to translate that science into real-world health outcomes.

Covid-19 vaccines are one example of how science is powerful, but how we still need good political choices to realise its potential.

These vaccines were discovered in a short time by brilliant scientists working together and aided by lots of money. But equitable sharing of vaccines around the world still depends on leaders making good policy choices.

Nationwide MCOs are another example of how good science needs good politics to achieve real-world health outcomes.

It requires a leader to understand that epidemiology data will always be imperfect and incomplete, and still be confident enough to say, “Although we’ve achieved success with two nationwide MCOs in the past, I will implement targeted MCOs this time based on best available data”.

The health of Malaysians depends on skilled doctors delivering life-saving care in hospitals.

It also depends on policymakers in the economic, security and planning agencies to support the Health Ministry.

Public health is based on science and evidence, but it is also based on good political choices and good government.

As we resume this fortnightly column with my friends and colleagues, we will look into the health policies of our beloved nation through new lenses, but with the same intentions of the best health outcomes for all Malaysians.

Dr Khor Swee Kheng is a physician specialising in health policies and global health. The views expressed here are entirely his own. For more information, email [e-mail].