GE15: Healthcare priorities should be reflected in political manifestos

by Dr Helmy Haja Mydin After more uncertainty than Ross and Rachel’s relationship (in the American TV sitcom Friends ), we finally have a date for the 15th General Election (GE15). As with all general elections, there will be multiple proposals regarding what should be included in each party’s manifesto. Given the increased awareness of the importance of health, the various coalitions will probably have specific healthcare policies too. Health reform The Health Ministry recently announced that a Health White Paper (HWP) will be presented at the next Parliamentary setting. The purpose of the HWP is to put in place long overdue structural reforms for a fair, sustainable and future-proof healthcare system, as well as the establishment of a Health Reform Commission that is answerable to Parliament. As a bare minimum, all parties should pledge their commitment to continuing this process, which includes preparing for the next pandemic, dealing with the challenges of an ageing population, the need for healthcare financing reform, controlling the scourge of non-communicable diseases and mental health disorders, and improving health literacy. There is also very little to argue against increasing the allocation for public health services to at least 5% of GDP (gross domestic product) – health should be viewed as an investment, not a cost. The various parties would do better to highlight their focus areas for the Budget, i.e. how additional revenue will be utilised, as well as the policies that will be introduced to improve governance and transparency in order to improve procurement and reduce leakages. Social determinants of health However, I would argue that a GE15 health manifesto is pointless without a manifesto that prioritises the 3Es of economy, education and the environment. This is particularly pertinent as social determinants of health (SDH) are the factors behind up to 80% of health outcomes. Some of us mistakenly blame the poor for remaining poor, or the unhealthy for being sick. However, it is worth remembering that healthcare and lifestyle choices alone do not determine outcome. Our health is determined by a huge number of non-medical factors, and these start from conception. A mother who can afford to take the appropriate supplements, go for the necessary prenatal check-ups, eat healthier food and live in a spacious environment with easy access to green space and clean air, is likely to give birth to a healthier child than one who is unable to purchase supplements and good food, has to skip medical check-ups for fear of income loss, or lives in a house that is dozens of kilometres away from the nearest health facility, with poor access to clean water and public transport. Ignoring SDH risks not just missing out on disease prevention and maintaining well-being, but will also increase health inequities. It is therefore pertinent that policy proposals identify and address the factors that can improve matters more systematically. Here are some of the factors which may adversely affect SDH: Economy There is the increasing inflation, which in turn will trigger a rise in interest rates, affecting private, corporate and government debts, with the possibility of an increase in non-performing loans and bankruptcies. Then there is currency devaluation, with the ringgit performing poorly against the global benchmark of the US dollar. Meanwhile, increasing oil prices mean an increased subsidy burden for the government, while decreased consumption due to these other factors means less tax revenues, i.e. income, for the government. Job cuts will affect medical coverage for employees, leading to increased congestion at public hospitals as private healthcare is no longer covered for these workers. It will also affect the approximately one-third of Malaysians who use their own money to cover health expenses. We can also expect the high levels of malnourishment and mental health disease to increase. To be even more blunt: less business will mean less taxes, which will mean less subsidies and support for those in need. Challenges to the economy, like increasing inflation, currency devaluation and job cuts, will mean that more and more people will turn to our already-overburdened public healthcare system. — Filepic Education The Covid-19 pandemic affected an entire generation of schoolchildren. Every child had a different experience in remote learning – some were relatively unaffected and had no issues logging on, others had to use their parents’ phone to download WhatsApp messages from school, and be mindful of the data consumed. We do not have clear insight into the short- and long-term impact this long period of remote learning will have on our children’s mental, intellectual and physical well-being. The United States’ Nation’s Report Card found that fourth- and eighth-graders (10 and 14 years of age respectively) fell behind in reading and had the largest ever decline in mathematics. It is not too much of a stretch of imagination to assume that similar issues face our children here in Malaysia. It is pointless talking about improving health literacy, preparing for Big Data and machine-learning without first being brave enough to acknowledge the flaws in our education system, and then introducing specific interventions to address knowledge gaps within our student population. It is only when the foundation is strong that we can hope to compete in the increasingly borderless work space. Environment The World Health Organization (WHO) declared climate change as the single biggest health threat facing humanity. To quote the WHO: “The climate crisis threatens to undo the last 50 years of progress in development, global health and poverty reduction, and to further widen existing health inequalities between and within populations. “It severely jeopardises the realisation of universal health coverage (UHC) in various ways – including by compounding the existing burden of disease and by exacerbating existing barriers to accessing health services, often at the times when they are most needed. “With the poorest people largely uninsured, health shocks and stresses already currently push around 100 million people into poverty every year, with the impacts of climate change worsening this trend.” We see the manifestations of environmental neglect in a myriad of ways, from increased dengue cases due to poorly-maintained construction sites to waterborne illnesses following floods from deforestation. Moving forward The issues listed above are not exhaustive, but it is clear that each can lead to a negative ripple effect elsewhere if not addressed appropriately. The impact will be disproportionately felt by those in the lower socioeconomic segments of society, including the increasingly struggling middle class. The challenge for the incoming government is to have clear policies on stoking sustainable economic growth and preparing adequate social safety nets in the event the economy remains bearish. Our environment should cease to be an afterthought, even though it is literally an existential crisis. And as every parent would agree, a child’s experience in school should prepare him or her for the unceasing challenges of an increasingly complicated adult life. Many of us feel that Malaysia is lagging against our regional and international peers. The next government will have to hit the ground running. As with Rachel and Ross, we have all reached a point where we’re fed up with the games being played and hope that they just get on with it. This article was originally published in The Star Online.