Politicians: A new threat to public health?

Malaysian politics is in chaos. Issues of legitimacy, political arithmetic and treachery are causing intense grief, anger and frustration.

In the quest for power and money, the Rakyat are betrayed. It’s déjà vu all over again.

In an era where trust is declining in governments and politicians, we need more confidence-building measures, not backdoor machinations.

In a Malaysia with rising inequality, a fractured society, a fraying health system and now, the Covid-2019 outbreak, we need strong public services and cohesive political leadership, not backroom deals.

No matter our resilience, we can’t keep going on like this. We’re now fighting Covid-2019 without a Health Minister – this is not what Malaysia should be famous for.

But in this darkness and uncertainty, what are some timeless truths that we can hold on to when truly rebuilding Malaysia?

Politicking threatens public health

My friends, colleagues and I have spent our entire careers in health, and we can easily list the threats to public health in Malaysia.

I’ve personally worked on these threats as a doctor, refugee worker, researcher, anti-corruption expert, and now, as a health systems practitioner.

The brain drain of doctors, neglected nurses, long queues in public hospitals, rising cost of healthcare, the political economy of health budgets, the importance of preventive care, cigarettes, traffic accidents, Covid-2019 and anti-vaccination parents are some of the endless threats affecting our health.

These threats can be managed, but they require political will, and I’ve often said that health is a political choice.

However, I never imagined the day I’d have to list politicians as a new threat to Malaysia’s public health.

These are the reasons for this bold claim.

One, any Health Minister needs time to build, then implement national health reforms.

Former Minister Datuk Seri Dr Dzulkefly Ahmad now may not see through Sihat Bersama 2030 because we are having musical chairs in Putrajaya that threaten public health.

Two, health is beyond the Health Ministry (MOH). If other ministries are in chaos, the whole of government cannot deliver health and other public services to Malaysians.

Covid-2019 remains a problem, and there are ongoing regular operations from Hospital Arau in Perlis to Klinik Kesihatan Sandakan in Sabah.

Politician-induced chaos threatens public health.

Three, political chaos consumes national attention and the energy of the civil service.

We lose time, energy, resources and momentum that are crucial for reforms to Malaysia’s health system, economy, education, and frankly, every other sector.

Politicking threatens public health by holding back progress.

Be our own leaders

As I write this, nothing is for certain. However, there are some timeless truths.

Politicians will always politick.

Politicians will come and go, but other leaders in the civil service, civil societies, academia and the private sector will remain.

Political leaders may fulfil important roles, but Malaysians cannot rely on them to fix our problems.

From these timeless truths, we can see the sunlight of some solutions.

One, we all have a duty to Malaysia. That duty is active leadership, not just complaining.

My friend Dr Imran Idris says that Malaysia needs all sorts of leaders, not just politicians: “Whatever it is you’re doing, do it better. Aim higher!”

Another friend Prof Mohd Tajuddin Mohd Rasdi has asked that Malaysians “rebuild this country ourselves without expecting too much from elected representatives”.

I agree. Be the best doctor, nurse, paramedic, lawyer, teacher or business leader you can be, then lead your part of Malaysia.

Two, we need some new rules to select leaders.

My friend Nathaniel Tan has written about how “merely swapping politicians” won’t solve our problems.

Politicians want us to believe the fiction that they alone have the solutions and we just need to trust a new set of politicians.

Another friend Dr Wong Chin Huat has written about how malapportionment will see the “bulk of losers being ordinary Malays ‘without cables’ in the urban centres”.

I agree. We must change some of the rules to improve justice for Malaysia and to select better leaders, not just swap politicians and coalitions.

A neutral Health Minister?

The health of Malaysians is the government’s first and biggest priority.

Therefore, we must consider ultra-long-term continuity in our health system.

This continuity has two parts: routine care (e.g. for pregnant women) and non-routine reforms (e.g. in health financing).

These cannot be solved in a five-year term. These are timeless issues that require multi-year planning and implementation.

Therefore, ultra-long-term continuity in our health system must be immune from political chaos, survive political transitions and be protected from irresponsible politicians.

There could be a case for a neutral, apolitical and/or bipartisan Health Minister, capable of working across the political divide and invested with the mandate to implement multi-year reforms.

In essence, we’re ring-fencing and immunising the Health Ministry from the chaos of politics and regime change.

This will ensure continuous delivery of routine care and provide a chance for non-routine reforms.

There could be disadvantages, of course, but the volatile, uncertain, complex and ambiguous (VUCA) status quo is failing us. We’ll examine this idea in future columns.

In all cases, we need unity in the health and health-related professions more than ever, especially given Malaysia’s extreme political uncertainties.

The best, brightest and most well-meaning among us must simply work together.

In the spirit of my role model Zainah Anwar’s words, we can’t afford not to unite.

During these turbulent times, I recall the words of my friend and legal icon Prof Shad Saleem Faruqi to rely on the “wisdom and sagacity of the Yang di-Pertuan Agong [to] guide the nation”.

That is necessary, but we need everyone. In the spirit of my old friend Praba Ganesan’s words, I wish everyone courage as we rebuild our own country, with our own hands and our own skill.

To all my friends and colleagues in the Health Ministry and other ministries, universities, the private sector, professional societies, private sector employers, civil societies, the Employees Provident Fund (EPF), the Social Security Organization (SOCSO), international organisations, and every citizen of Malaysia: we are joint custodians and stewards of our health system, and the fate of our nation depends on our skill.

Dr Khor Swee Kheng has postgraduate degrees in internal medicine and public health, and has worked in five health sectors across three continents. He is currently reading Public Policy at the University of Oxford. The views expressed here are entirely his own.

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