This article first appeared in Forum, The Edge Malaysia Weekly on September 10, 2018 - September 16, 2018
According to the World Health Organisation (WHO), non-communicable diseases (NCDs) and mental disorders are currently the biggest threats to health and development globally, particularly in the developing world, directly affecting billions of people.
Here in Malaysia, the main focus of the National Strategic Plan are three NCDs — cardiovascular diseases, diabetes and cancer. These have four shared risk factors — tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.
It is estimated that last year, 73% of the total deaths in Malaysia were due to NCDs and half of those were caused by cardiovascular diseases. As such, the risk factors continue to be a worrying trend for the country. In its effort to combat NCDs, Malaysia is moving ahead with prevention programmes in the health sector, such as promoting more awareness campaigns on their prevention.
Malaysia has the highest obesity rate in Southeast Asia, based on The Economist Intelligence Unit’s report on “Tackling Obesity in Asean”, which covered Malaysia, Singapore, Indonesia, Thailand, the Philippines and Vietnam. The prevalence of obesity in Malaysia is 13.3% of the population, while 38.5% are considered overweight. All the shared risk factors mentioned above have contributed to this. In addressing this, the third National Plan of Action for Nutrition Malaysia (NPANM III, 2016-2025) has identified various programmes and activities to tackle the existing double burden of malnutrition.
To deliberate on a global strategy to “Beat NCDs”, the United Nations is hosting a high-level meeting this month. I participated in a recent interactive hearing held by UN, which was presided over the president of the General Assembly, Miroslav Laják. As a representative of IDEAS, Malaysia, which is now an accredited civil society organisation with the UN, I took part in this hearing, which was attended by more than 300 individuals representing interests from governments, public health lobbies, the private sector, academia and civil society.
Key messages from the hearing were:
- NCDs have become a major threat to quality of life and will become a leading cause of premature death. Inaction will cause 120 million premature deaths by 2030.
- The cost to fight NCDs globally is estimated at an astronomical US$20 trillion by 2030.
- NCDs are rooted in inequality. Almost two-thirds of patients with non-communicable diseases live in developing countries.
- Heavy taxation is the most important measure to curb consumption of products such as tobacco, sugary/salty foods and alcohol. A case study was presented, arguing that this has led to a decrease in the consumption of these items in Colombia without affecting illicit trade.
- NCDs have to be tackled at a political level at the national and supra-national levels. As the World Obesity Foundation warned, “We are four billion voters. You have been warned!”
- Universal healthcare systems at the national level should now include NCDs.
Countries were urged to do one or more of the following actions, as advocated by the co-chair of the WHO Commission on NCDs, Dr Sania Nishtar. These actions should span regulation, taxation, marketing restrictions and trade measures.
I will add innovation to this framework while cautioning on the use of the above four policy measures. Innovation, especially led by the private sector is crucial in this fight, a fact that was also cited by Nishtar, who acknowledges that the private sector is also aligning with the international campaign to end smoking by taking a harm-reduction approach.
Weak governance structures in the least developed countries mean that implementation of many of these ideas — higher taxation and more regulations — remains weak, uncertain and unequal. One example is Malaysia, where higher excise duty on cigarettes has only led to a higher proportion of the illicit trade, which now stands at around 60% — one of the world’s highest. Such fiscal solutions to curb consumption can be simplistic, frustrating and even counter-productive.
The UN hearing clearly proposes a bigger government role in the fight against NCDs but this can lead to increasing the size of the bureaucracy without guaranteed benefits to patients. Health ministries claim to act in the name of patient welfare, whereas alternative approaches can be adopted that capitalise on private-sector participation and voluntary action by citizens.
There are risks to including NCDs in universal healthcare as it socialises the costs. Individuals are responsible for their choices and there is a moral hazard in including NCDs.
It seems that a false dichotomy between health and trade has been created by clubbing together all public health agencies, disease-centred foundations and governments into the “healthy side” and all private sector companies — especially food and beverage, tobacco and pharmaceuticals — into “trade”, implying the latter are “unhealthy”.
By creating this us-versus-them approach, the UN hearing possibly created a greater schism between what can be very loosely termed as “public” and “private”. This is not a helpful approach to address one of the most important challenges humanity faces.
Open trade and public health should not be presented antagonistically, but as symbiotically related. But given the visible politics, this is purposeful and well-planned — and let me say — misleading.
This is even more relevant in the context of the Comprehensive and Progressive Agreement for the Trans-Pacific Partnership. We need to support open trade, public-private partnerships, and innovation — including harm reduction — as part of the solution, something the world body badly needs to be reminded of.
Ali Salman is the CEO of IDEAS Malaysia
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