The current outbreaks of both human and animal cases of avian influenza in various countries are triggering worries that they might coalesce and escalate into a pandemic. — AFP
The year 2023 was annus horribilis (Latin for “horrible year”) for Malaysian healthcare, but 2024 was an improvement.
Some of the important issues for Malaysian healthcare that occurred last year (2024) are discussed below.
Nicotine addiction
The delisting of nicotine from the Poisons List on April 1, 2023, was the primary event that was deleterious to Malaysians’ health.
The Control of Smoking Products for Public Health Act, which was gazetted on Feb 2 last year (2024) was implemented on Oct 1 (2024).
During the 18-month period when nicotine sales were not regulated, there was an opening of the floodgates to advertising, promotion and sales of nicotine products; entry of tobacco companies to the vaping market; and legalised sales of nicotine products to everyone, including minors below 18 years of age.
The Act can now only limit the damage to the health of young Malaysians, many of whom would have become addicted to nicotine during this period.
The effects of nicotine addiction would not be obvious immediately, but it will certainly surface in the medium to long term.
The omission of smoking devices in the Act, with the statement that safety standards of these devices would be regulated by the Domestic Trade and Cost of Living Ministry, and manufacturing by the Investment, Trade and Industry Ministry, will pose a regulatory conundrum.
More infectious diseases
Dengue cases increased markedly in 2024.
Hopefully, the trend will go south in 2025, or at least, not increase further.
Covid-19 infections continue to occur, but in much smaller, manageable numbers.
However, the effects of long Covid in Malaysians are unknown because of the lack of published data.
The virus with pandemic potential that worries many is avian influenza (i.e. bird flu).
It infected 300 bird species and at least 70 mammalian species in 2024.
Multiple human cases of bird flu were reported in the United States, Canada, Australia, China, Cambodia and Vietnam.
Large and continuing outbreaks in birds and mammals increases the likelihood of mutations and the mixing of bird and human influenza genetic materials, which could lead to a new viral strain with pandemic potential.
The reasons for vaccine hesitancy in Malaysians include safety, efficacy, religious incompatibility, misperceptions about alternatives, and conspiracy theories (which have become more rampant after the Covid-19 pandemic).
More effective efforts are needed to educate parents on the benefits of vaccination.
Otherwise, vaccine uptake may decrease, particularly with social media messages from prominent anti-vaxxers, thereby contributing to a continuing resurgence of preventable infectious diseases.
Non-communicable diseases
Non-communicable diseases (NCDs) will continue to rise with increasing undiagnosed and uncontrolled numbers.
This is due to uncoordinated and poor control with impact on the complications of such diseases and long Covid, and will endanger healthcare delivery in the underinvested, overworked, crowded public healthcare system, which may near collapse.
The effects of inadequate or no treatments for NCDs will inevitably lead to premature and excess illness and death, with consequential impact on the country’s economy.
Patient safety and quality of care
Patient safety continued to be an issue in 2024 with several media reports of judicial awards for adverse care events that maimed patients.
It is regrettable that there is no definitive action plan to upgrade the 46 public hospitals that are more than 50 years old, and the more-than-half of equipment that are over 10 years old, all of which are patient safety and quality hazards.
The fundamental principle in medicine, Primum Non Nocere (Latin for “First, do no harm”), appears to have been ignored even in the Health White Paper adopted by Parliament in June 2023.
The public has a right to know how safe care is in the public sector.
Are there any indicators that patient safety and quality of care improved in 2024?
Will patient safety and quality of care continue to be ignored in 2025 and adverse care events classified as inevitable?
Medical workforce
The crucial role of doctors and nurses in healthcare delivery was evident during the Covid-19 pandemic, when some had to play God and decide who was to be ventilated or not – a difference between life or death.
The multiple factors for the chaotic junior doctors’ situation in 2024 included poor coordination and communication between Putrajaya and community healthcare facilities; ignorance of the facilities’ needs and requests; and an insensitivity to the attitudes and needs of junior doctors.
The Parallel Pathway issues exemplified the bigotry infecting the medical profession in which a handful of individuals attempted to restrict speciality training.
Medical unemployment and disgruntlement will continue if the issue of junior doctors is left inadequately addressed.
The best and brightest continue to seek employment abroad as reflected in the sharp decline in registrations with the Malaysian Medical Council (MMC) in recent years.
Medical technologies
New technologies have increasingly impacted on healthcare in 2024 with breakthroughs that included availability of drugs for obstructive sleep apnoea, ulcerative colitis, Alzheimer’s disease, schizophrenia and gene therapy for hereditary deafness.
This will hopefully continue in 2025.
The Health Ministry’s statement that electronic health records (EHRs) will be rolled out throughout Malaysia by 2026 is very unlikely to occur.
If a third or half the country has EHRs by then, it would have already done very well.
Issues of patients’ confidentiality and security, patient safety, and the successes and failures of the new technologies, will continue to be increasingly problematic.
The accountability and framework of the safe and effective use of generative AI (artificial intelligence) to meet the needs of all users has yet to be formulated.
It is vital to always remember that new technologies are just tools.
Discrimination and careful evaluation are critical for humane healthcare, and not technological exuberance.
Increasing healthcare expenditure
Healthcare expenditure and medical inflation will continue to rise due to the ageing population, NCDs, infectious diseases, new technologies, increasing patient demands, and unrestrained insurance and managed care companies, as well as rent seekers, in healthcare.
Increasing out-of-pocket expenditures will lead to more families facing financial ruin if they or their relatives get catastrophic diseases, e.g. cancer, heart attack or stroke, especially if they are made redundant.
It is sad that policymakers, in their so-called attempt to control medical inflation, do not appear to know the difference between diagnosis-related groups (DRGs) and bundled payments.
More private general practitioner (GP) clinics and some private hospitals will close because of financial unsustainability, staff burnout and the bureaucratic maze of regulations.
There will be mergers, acquisitions and closures of some private medical schools and managed care organisations because of financial unsustainability and reducing demand.
Not involving private GPs in the management of NCDs in public sector patients will impact negatively on population health.
Public trust and health policies
Healthcare will be increasingly provided by non-health sectors with technological tools, posing regulatory problems.
The Health Ministry’s increased budgetary allocations cannot assure improved patient safety and quality care unless wastages, inefficiencies and the role of middlemen and rent seekers are reduced markedly, and it has an open and just culture.
If health policies are formulated without genuine consultation with stakeholders, success will be limited or absent.
The Rakan KKM programme is unlikely to succeed without any investment in new facilities and equipment.
Public trust will continue to wane for various reasons, including poor risk communication; non- or poor compliance to standard operating procedures; no meaningful engagement with the private sector, universities and civil society; misuse and abuse of social media; lack of transparency; and poorly considered policies.
There is limited or no available data of improved population health in 2024.
Will the pressure for change in public healthcare delivery come to a head in 2025?
Or will it be another year of reckoning for the public healthcare system?
Stay healthy
Healthcare is avoidable by staying healthy.
A healthy diet, maintaining an appropriate weight, regular exercise, sufficient rest, safe sexual practices, avoiding nicotine exposure, moderate alcohol consumption and keeping vaccinations current are necessary.
This requires effort, smart lifestyle choices and the occasional medical check-up.
NCDs, infectious diseases and other health risks can be minimised by compliance with one’s individual responsibilities and vaccination.
Wishing all readers good health in 2025. Take care of yourself and stay safe.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
