DESIGNING effective public policies in Malaysia is often a thankless job. I spent 10 years in government, intermittently, and one thing I realised pretty early on is that while a lot of effort is made to craft good public policies, it is almost never appreciated.
For one thing, there are many competing interests that policymakers must deal with.
What is good for the goose may not necessarily be good for the gander. In other words, what is good for the government may cause discomfort to the public.
A good example is the goods and services tax (GST). In fact, a study conducted recently made an interesting observation that almost every government that introduced a consumption tax later lost an election.
It's not enough to frame good policies that can be executed successfully: you also need buy-in from the public.
Unfortunately, people are often sceptical even when something is in their interest. This applies to many things, including public health.
Seemingly unrelated issues like morality and theology often get thrown into the mix, distorting the issues at hand. This often makes sensible initiatives unnecessarily complicated, such as harm reduction.
Broadly speaking, harm reduction is a way of preventing disease and promoting health that “meets people where they are” rather than making judgments about where they should be in terms of their personal health and lifestyle.
There is a wide body of scientific literature that supports its place in dealing with public health issues.
A classic example of harm reduction is for drug addiction. Harm reduction, in this case, involves initiatives such as using naltrexone to treat addicts and/or providing outlets for needle exchanges.
Such measures will improve chances of rehabilitation, or at the very least, reduce further negatives, such as HIV/AIDS infections.
Of course, there are critics who claim that such moves are “going soft” or providing tacit approval unhealthy practices, but this is a very short-sighted view.
It’s illogical to say that a society which provides harm reduction for drug users approve of their addiction. It is simply an acknowledgement of human nature and how realistically difficult it often can be to move away from unhealthy practices.
Rather, what harm reduction does is to meet the sufferers halfway, to prevent them from hurting themselves — and society— further.
It is mitigation, not capitulation.
Harm reduction is, in fact, nothing new in Malaysia: methadone clinics and syringe disposal programmes have long been piloted in the country by forward thinking non-governmental organisations and public health authorities to treat the twin issues of illicit drug abuse and HIV/AIDS since 2005.
As for effectiveness, these programmes have helped significantly reduce the prevalence of HIV among drug abusers from 22% in 2009 to 13.4% in 2017.
The cost-effectiveness of these programmes is impressive as well, with long-term benefit projections from 2006-2050 estimating that these programs will save up approximately RM910mil.
In a global first, it was also announced earlier this year that a naltrexone treatment programme is being rolled out for drug users in Malaysia – which will be later subject to a global study.
This latest development is one of many ground-breaking and game-changing intiatives implemented since Malaysia’s hitherto unsuccessful crusade against the scourge of drug addiction of the late 90s.
If anything, drug harm reduction is something all sensible Malaysians should get behind and push for to be expanded.
Yet, I also have a feeling that the harm-reduction approach can be expanded to other areas, including cigarette smoking, for example.
Again, it is something that is bad for people. And it would be better if everyone quit. But ask any smoker: it’s tough.
Harm reduction in this case would be to encourage smokers to switch to less harmful alternatives, like e-cigarettes as authorities in England and New Zealand have done.
Unfortunately, governments in South-East Asia appear to have adopted a completely
different, more punitive, approach: with Singapore and Thailand banning e-cigarettes
This one-size-fits all approach may not work for Malaysia and it would be unfortunate if we tried it.
Decades of “quit-or-die” measures have proven this – the percentage of smokers in Malaysia have remained unchanged since 2011, an almost negligible reduction of around 0.02% according to the latest statistics.
It’s like palm oil: bodies like the World Health Organisation (WHO) have conceded that using it can give indirect health benefits due to its lower cholesterol properties.
Nevertheless, its critics remain intractably opposed to its cultivation and use. The lack of a meeting of minds on this has potentially left the health and livelihoods of many in limbo.
Of course, we should always promote policies that effectively prevent or stop individuals from harmful actions.
But we should also be willing to get creative and adopt an agnostic mindset when it comes to solutions to that can help with these complicated issues. Malaysia cannot afford to embark on more moral crusades: we’ve tried that before and it simply has not worked.
The sufferers of our various public health ills have complicated histories and journeys, and they should have full access to all health care options – I think every Malaysian can certainly get behind that.
Positive and lasting health outcomes will not stem from the "my way or the highway" attitude on the part of authorities and the public.
Rather, what is needed is for Malaysians to rally behind methodical and rational harm-reduction strategies that are given a chance to work.
Ivanpal Singh Grewal is an advocate & solicitor. He was formerly a political secretary to the Minister of Plantation Industries & Commodities.