FOR Budget 2022, which will be presented in Parliament on Friday (Oct 29), the Galen Centre for Health & Social Policy calls upon the government to strengthen its commitment towards addressing noncommunicable diseases (NCDs) afflicting millions of Malaysians that are expected to have significantly worsened since the onset of the Covid-19 pandemic.
Before the emergence of Covid-19, Malaysia was already in the firm grip of a national health crisis, which grew larger, required more medical treatment, and claimed more lives each year. Cancer, diabetes, cardiovascular diseases and hypertension combined have already inflicted serious damage over the past decade on individuals, livelihoods and the economy.
For example, Malaysia has one of the worst five-year survival rates for breast cancer in Asia. And 70% of previous health budgets were forced to deal with the consequences of underinvestment in NCD prevention and control.
The Galen Centre has five recommendations for the government's consideration in Budget 2022.
1. A larger allocation for health
The 2022 health budget should be between RM35bil and RM40bil. If we are to deal with existing health issues, ageing equipment, retaining skilled personnel, preparing and ensuring resilience to future pandemics such as Covid-19, much of Malaysia's health infrastructure, including its people, needs additional investments and modernising. This is definitely not the time to underinvest in health.
2. Invest in health promotion, health literacy, NCD treatment and care
New funding should be channelled into preventing and treating cancer, diabetes, and cardiovascular diseases. The incidences of various NCDs have and are expected to worsen and increase as a result of the Covid-19 crisis. We need to invest in improving health literacy, and ensure access and availability of effective treatment and care for those who need it.
3. Establish a sustainable cancer fund
A cancer fund should be established, with RM50mil in seed funding. It could be a form of public-private-patient partnership where the government, private sector and patient co-pay for treatment to increase the availability and quality of existing cancer therapies, particularly those which treat advanced cancers.
As a pilot programme, the government should earmark an initial 5% from the revenue collected from alcohol and tobacco taxes (estimated to total RM5.9bil annually) for health promotion and treatment, focusing initially on diabetes and cancer. This could support the sustainability of a cancer fund, the upscaling of innovative programmes, or fund crucial lifesaving treatment.
4. Invest in improving Sabah and Sarawak’s healthcare infrastructure
The Covid-19 outbreak in Sabah and Sarawak highlighted the state of healthcare in the two states which continue to need urgent attention and investment by the Federal Government. Many long-standing critical issues, such as maternal health service coverage and even primary care, remain woefully inadequate. People are clearly being left behind.
In Budget 2022, the government should identify a clear and separate funded plan for healthcare in these states. It should grant a limited amount of autonomy for Sabah and Sarawak to manage their own health needs, including building of infrastructure and recruitment of skilled personnel.
5. Raise tobacco taxes and impose taxes on e-cigarettes and vaping
Excise duties on tobacco products, especially cigarettes, have been frozen since 2015. It is time for those cigarette taxes to be raised by 61.8% from the existing retail price, to RM24.90 per box. Studies show that this increase in duties could potentially contribute RM3.36bil in tax revenue, a 30% increase to what was collected in 2019.
Since the government is adamant about regulating and not banning e-cigarettes and vaping, it should have the same tax framework for such products as it has for alcohol and tobacco products. The excise duties should cover nicotine and non-nicotine e-liquids and juices.
The statistics reveal that 3.9 million people are living with diabetes now; by 2030 more than 66,000 Malaysians are expected to be newly diagnosed with cancer each year; and a third of the population is currently suffering from hypertension.
The chronic nature of NCDs means patients are sick and suffer longer and require more medical care. The resulting economic costs are high and escalating. According to the Health Ministry and World Health Organisation, in 2020, cardiovascular diseases, diabetes and cancer cost nearly RM9bil in productivity losses annually to the Malaysian economy. We cannot afford to kick the can down the road on NCDs.
AZRUL MOHD KHALIB
Chief executive officer
Galen Centre for Health & Social Policy
The Galen Centre for Health & Social Policy is an independent public policy research and advocacy organisation based in Malaysia.