Letter to the editor from the Deputy Director General of Health (Public Health), in response to the article titled ” Unfit at work”, The Star, 27 February 2015 

Cardiovascular disease, cancer, respiratory disease and diabetes together account for over 80% of the 38m deaths from NCDs; 16m of these people die prematurely (under the age of 70)

We refer to the report “Unfit at work” and related series of reports by Hemananthani Sivanandam (The Star, Feb 27).

The Ministry of Health is also extremely concerned with the increasing burden of Non-Communicable Diseases (NCDs) in Malaysia, not only among the working population, but also the general population at large.

Unfortunately Malaysia now has a “sick population”. Data from our National and Health Morbidity Survey (NHMS) has demonstrated that at least 63% of adults age 18 years and above have at least one NCD risk factor (overweight/obesity, high blood pressure, high blood sugar or high blood cholesterol). The report from SOCSO provides further evidence to this fact.

Now we need to ask the right questions:

Question 1: Why are Malaysians not getting themselves screened?

As this report showed, only about 16% (308,039 out of 1.9 million SOCSO members) have used their vouchers. Definitely it is not an issue of availability and accessibility of screening facilities. After all, they are many private clinics throughout Malaysia, and most have extended working hours.

Question 2: Maybe Malaysians and SOCSO members do not know that annual health screening is important?

Over the years MOH has continuously promoted the importance of annual health screening. To answer this question, we need to better understand the health-related behaviour of Malaysians, and our sociologists can assist in contributing to this knowledge.

Question 3: Do Malaysians believe “ignorance is bliss”?

NCD is a silent disease and again MOH has continuously advocated this message as well. However NHMS has also shown that a large proportion of Malaysians remains undiagnosed with NCD risk factors because they never underwent regular health screenings. When symptoms developed, they are likely to be in an advanced stage of the disease, more difficult and more costly to manage, with irreversible health consequences.

Question 4: How high do Malaysians value their health?

Unfortunately we don’t have a clear answer on that question as well. A previous healthy lifestyle survey had showed that Malaysians placed high importance on health. But when asked whether they have taken action to improve their health, the answer is disappointing. In other words there is a mismatch between aspiration and action.

When in comes to addressing NCD risk factors, let’s take obesity as an example, there is a constant debate on the role of government in addressing the obesogenic environment versus individual choice. This debate is both polarised and unhelpful. We need to reframe obesity as a consequence of the “reciprocal nature of the interaction between the environment and the individual”[1]. This is where a bottoms-up approach is just as important as a top-down approach.

We need a strong civil society to achieve an effective bottoms-up approach. We urge that Malaysians must place a high value in their personal health and environmental health for us to move forward on this issue.

For an organisation – employees are human capital. Employers must invest to get the best value from their human capital. Without this investment on health, employers will continue to face the double burden of loss of productivity and increased medical costs. Even SOCSO we believe will soon reach a point where current premium rates will be unable to sustain the claims made due to NCD-related complications.

Click here for link to MOH’s NCD-related publications

MOH has developed many workplace-based NCD risk factor interventions, a combination of both soft- and hard-policies. Admittedly, implementation even within MOH headquarters in Putrajaya is fraught with challenges. Changing human behaviour and organisational behaviour is not easy and that is why we need everyone on board. The main issue is not that we do not know what needs to be done, but we do not know how best to implement.

As we head towards a developed-nation status by year 2020 – unless we address this dichotomy of how low Malaysians value health – that achievement will ring hollow. NCD is one of the most important challenges that must be tackled collectively by all Malaysians.

DATUK DR LOKMAN HAKIM SULAIMAN, Deputy Director General of Health (Public Health) 

DR FEISUL IDZWAN MUSTAPHA, Public Health Physician (NCD)

Ministry of Health Malaysia

All slides are courtesy of Dr Feisul Idzwan Mustapha

[1] Roberto CA, Swinburn BA, Hawkes C, et al. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet 2015; published online Feb 18. http://dx.doi.org/10.1016/S0140- 6736(14)61744-X.