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Barnama
3 days ago
- Health
- Barnama
Collective Action Needed To Tackle Childhood Obesity
T his is the final instalment of a four-part series exploring the growing prevalence of overweight and obesity among children in Malaysia. Addressing childhood obesity is not merely a matter of making changes to diets and lifestyles but requires a comprehensive, cross-sectoral approach, ranging from public health policies to community-level enforcement and awareness. According to the National Health and Morbidity Survey (NHMS), the obesity rate among children under 18 has shown an alarming upward trend – from 11.9 percent in 2015 to 14.8 percent in 2019. It remained high at 14.3 percent in 2022. The latest NHMS 2024 statistics also reveal that obesity among children and adolescents aged five to 19 remains significantly high at 13.6 percent, proving that this issue has yet to be fully addressed. As the country's lead agency in health-related matters, the Ministry of Health Malaysia (MOH) bears a major responsibility in tackling obesity. However, the issue also calls for the commitment of various parties to share the responsibility and implement coordinated solutions. SET REGULAR MEALTIMES Head of the Dietetics Department at Universiti Malaya Medical Centre (UMMC) Dr Rokiah Ismail emphasised a balanced, nutrient-rich diet to ensure children grow up healthy, active and with optimal energy, adding that children need food that supports growth and brain development and keeps the immune system strong. Admitting that limiting the intake of sugary, oily and other unhealthy food is a big challenge, especially with such food heavily promoted on social media and TV, she said it can, however, be done through several strategies. These include educating children early about the harmful effects of unhealthy food. 'When watching TV with children, parents can explain the pros and cons of (consuming) the advertised foods. 'Set specific mealtimes every day. This helps prevent children from becoming too hungry or reaching for unhealthy snacks between meals,' she said, adding that involving children in meal preparations can make them appreciate healthier home-cooked food. She also said physical activities and exercise play a key role in helping obese children lose weight and achieve a healthy weight. Exercise also improves fitness, muscle strength, heart health and mental well-being. Suitable physical activities for obese children include brisk walking, jogging, cycling, swimming, football, netball, basketball, strength training, outdoor obstacle courses and yoga or pilates. Acknowledging that it is not easy to encourage obese children to participate in sports and lead a healthy lifestyle, Rokiah said it is a process that requires patience and urged parents and schools to create a supportive environment, such as organising various fun-filled activities consistently. '… focus on participation (satisfaction) rather than outcomes (winning) and set a good example for the children,' she told Bernama. ACTION TAKEN BY LOCAL COUNCILS Meanwhile, responding to the issue of vendors selling unhealthy snacks and beverages outside the gates of schools, Seremban City Council (MBS) mayor Datuk Masri Razali said the authority has been monitoring the areas concerned and conducting enforcement actions, in accordance with Section 80 of the Local Government Act 1976, Section 46 of the Street, Drainage and Building Act 1974, and the Hawkers By-Laws 1980. He said enforcement is carried out in response to public nuisance complaints, obstruction of public spaces and unlicensed hawking activities. Actions taken include issuing relocation notices and offence notices, imposing compounds, and seizing goods when necessary. (In the third instalment of its four-part feature on childhood obesity titled 'Obesity's Toll On Children's Mental, Emotional Health', Bernama reported that its survey at several primary schools in Kuala Lumpur and Negeri Sembilan had shown that besides sweets and snacks, fast food like sausages, nuggets and ice cream, and a variety of brightly coloured carbonated drinks were also being sold by vendors outside school gates.) Masri said all business activities within MBS administrative areas, whether on public or private property, must first obtain permission from the local authority. Business licences or permits issued come with conditions, such as only operating in designated zones where hawking is permitted. He added that MBS also acknowledges the Guidelines on the Prohibition of Sale of Unhealthy Food and Beverages issued by the Ministry of Education Malaysia (MOE) and MOH. However, these guidelines have not yet been formally adopted by MBS. 'At present, enforcement against vendors operating outside school premises is carried out solely under the Hawkers By-Laws 1980 and other applicable legal provisions,' he pointed out. PUBLIC COMPLAINTS Masri also said MBS is currently trying to balance law enforcement with the rights of local citizens who earn a living through street vending. For Malaysian citizens engaged in illegal hawking activities, enforcement action begins with a relocation notice, requiring them to move to designated hawker sites provided by MBS. 'However, if their operations pose a risk to public health or safety, we will escalate our enforcement by issuing them a formal notice of offence, and a compound. Seizure (of goods) will be carried out if necessary. 'For non-citizen hawkers, MBS adopts a zero-tolerance approach and will immediately confiscate goods without prior notice, in line with existing enforcement policies and high-risk control requirements,' he said. On the sale of junk food in front of schools, Masri said MBS has received complaints on this matter from the public. To address the issue comprehensively and enhance the effectiveness of their enforcement activities, MBS is collaborating with the Parent-Teacher Associations (PTA) of the schools concerned, he said. 'Previous enforcement actions, such as issuing notices and fines, proved ineffective in stopping illegal vending in these areas. As a result, banners have been put up prohibiting hawking at school gates. This measure serves as a final warning to vendors to trade only in authorised areas, and that strict action will be taken for non-compliance. 'The banners also serve to remind parents and students to follow the rules and raise awareness on the importance of safety and respect for local laws,' he said, adding that complaints, inquiries or suggestions can be submitted to the MBS Public Complaint Management System (SISPAA) at the Respon Rakyat mobile app (available for free download); or by calling 06-7654444. A visit last week to one of the primary schools in Negeri Sembilan that Bernama had surveyed earlier found no more hawkers outside the school gate. MBS has also put up a banner there prohibiting the sale of food and drinks in the area. INITIATIVES IMPLEMENTED BY MOH Expert advice, community engagement and enforcement measures can help curb unhealthy food environments, but long-term solutions require comprehensive interventions driven by national public health policy. In this context, MOH plays a key leadership role in developing a holistic obesity management ecosystem, starting from prevention to clinical treatment. The ministry said it has developed and implemented the 'Guidelines for the Enforcement of the Ban on the Sale of Food and Beverages Outside School Gates', which came into effect on July 13, 2012. 'The implementation of these guidelines banning the sale of unhealthy food outside school areas is an important environmental intervention to support the government's efforts to reduce obesity rates among children in Malaysia. 'These guidelines aim to control students' access to unhealthy food sold outside school premises, which has been identified as one of the contributing factors to the rising problem of childhood obesity,' the ministry said, adding that the implementation is carried out in collaboration with local authorities and monitored by the Ministry of Housing and Local Government. MOH said it has also developed a national obesity management ecosystem, encompassing strategies for obesity prevention and management across the general population, high-risk groups and clinically obese population, aligned with the World Health Organization (WHO) Acceleration Plan to Stop Obesity. 'This approach includes interventions at all levels, from primordial, primary and secondary to tertiary prevention, aimed at fostering healthy environments, preventing new obesity cases, and offering structured treatment and support for those in need. 'At the primordial and primary prevention levels, the focus is on shaping environments that minimise exposure to obesity risk factors,' said the ministry. Key policies and interventions include the implementation of a sugar-sweetened beverage tax in 2019, covering ready-to-drink and pre-mixed drinks. Other efforts include the introduction of the 'Healthier Choice Logo' (in 2017) and the launch of the 'War on Sugar' campaign on June 29 last year by Health Minister Datuk Seri Dr Dzulkefly Ahmad. NATIONAL AGENDA FOR A HEALTHY MALAYSIA The promotion of healthy living was further strengthened through the National Agenda for a Healthy Malaysia (ANMS), launched in 2020. ANMS is a national movement that aims to cultivate healthy lifestyles through communication campaigns and community engagement, and by providing supportive environments. 'Under the second pillar of ANMS, the delivery of health well-being services has been expanded through the establishment of Wellness Hubs. Weight management interventions are among the key services offered across 33 Wellness Hubs nationwide.' MOH said. It reported that from 2020–2024, a total of 14,671 individuals participated in weight management intervention programmes at the Wellness Hubs, with 77 percent (9,075) successfully losing more than one kilogramme, and 16 percent reducing at least 10 percent of their initial weight by the end of the intervention. High-risk individuals are referred to healthcare and community facilities for further management, including lifestyle interventions, weight management and health risk monitoring. The ministry also said that as of 2025, KOSPEN (its Healthy Community, Nation Builders Programme) is being conducted in 793 localities nationwide, with the help of 7,662 volunteers acting as community health agents. 'The programme emphasises early detection of non-communicable diseases (NCDs), and promotes healthy diets and physical activity. Involving the adult community in the programme helps create homes that support healthy habits, which will benefit children as well,' it said. These intervention programmes are essential as recent reports have confirmed that Malaysia continues to rank among the countries with the highest diabetes prevalence in Southeast Asia, with one in six Malaysians having the condition. This is not surprising, given the rising obesity rates, one of the major contributing factors to diabetes. The 2023 NHMS showed a worrying increase in the prevalence of overweight and obesity among Malaysians, from 50.1 percent in 2019 to 54.5 percent in 2023. INTERVENTIONS FOR CHILDHOOD OBESITY Meanwhile, to specifically address childhood obesity, MOH has rolled out targeted programmes within educational institutions. In 2018, the ministry implemented the Health Promotion in Learning Institutions (HePiLI) programme to promote health from preschool to higher education levels. 'The scope of this programme covers healthy eating, physical activity and lifestyle practices to promote a health-oriented culture among students. 'A key component (of the programme) is the Young Doctors Club, established in both primary and secondary schools, where students are trained as peer educators to promote messages on nutrition and physical activity,' MOH said. HePiLI has been implemented in 6,076 kindergartens/preschools through the 'Tunas Doktor Muda' programme; and in 3,530 primary schools and 900 secondary schools nationwide. MOH has also formed a dedicated taskforce committee to address obesity in Malaysia and implemented the 'National Strategic Plan to Combat the Double Burden of Malnutrition among Children (2023–2030)', which involves various parties. Through this plan, the ministry has set a target to reduce the rate of overweight children under the age of five to three percent by the year 2030, compared to the current rate of six percent recorded in NHMS 2022. Meanwhile, for children aged five to 17, the National Plan of Action for Nutrition Malaysia III (2016-2025) has set a target to maintain obesity and overweight rates at the base rates recorded in 2015, with no further increase. The base rates are: for children aged five to nine (obesity 14.8 percent and overweight 12.0 percent); children aged 10 to 14 (obesity 14.4 percent, overweight 16.0 percent); and children aged 15 to 17 (obesity 9.6 percent and overweight 14.4 percent). MOH's key initiatives are being carried out through its 'Policy Options to Combat Obesity in Malaysia' starting in 2016. The initiatives were improved under its 'Reviewed Policy Options to Combat Obesity in Malaysia (2021-2025)', with 60 percent of initiatives targeting child-centric settings such as schools and kindergartens. 'One such initiative is the Healthy Meals in Schools (HiTS) programme, which ensures students are provided only with nutritious meals during recess. Full implementation of HiTS (without the sale of other food items at canteens) helps reduce the risk of overeating and address the sale of unhealthy food in schools,' the ministry added. FIRST 1,000 DAYS OF LIFE MOH has also implemented the 'First 1,000 Days of Life' initiative, which targets pregnant mothers and children up to two years old. It focuses on nutritional care and health as a preventive measure against childhood obesity. 'This period is considered a golden phase in children's development, where optimal nutrition and healthcare can have a long-term impact on their health,' it said. Another initiative is the 'Healthy Eating Responsibility for Women' (HER), which focuses on preventing obesity and anaemia among women in the reproductive age (15–49), ensuring future generations are born healthy. MOH has also appointed lead coaches from among PTA members under its 'Your Best Lifestyle' (C-HAT) programme to promote nutrition and healthy activities in schools. This is complemented by the widespread dissemination of healthy eating information for children, particularly by MOH nutritionists via social media platforms. MOH also conducts school health screenings, including weight monitoring. Children identified as obese are referred to health clinics for treatment and further intervention. RAISE SUGAR TAX MOH said it has also been monitoring food and beverages sold in school canteens since 2012, using MOE's list of prohibited food and beverages as its guide. 'Out of 905 schools inspected by MOH in 2024, 678 (74.9 percent) complied with the ruling. MOE will issue reminders to district education offices and schools found violating the ruling,' MOH said. Meanwhile, the sugar-sweetened beverage (SSB) tax introduced in 2019 has proven to be effective, with consumption of such beverages among teenagers dropping from 36.9 percent (NHMS 2017 findings) to 16.4 percent (2022 Impact Assessment Study on SSB Taxation). The NHMS: Adolescent Health Survey 2022, meanwhile, showed a decline in the prevalence of daily carbonated drink consumption (at least once a day), from 36.9 percent in 2017 to 32.4 percent in 2022. MOH said the current SSB tax of RM0.90 per litre should be raised to further reduce sugary drink consumption, particularly to combat childhood obesity. While current taxation focuses on beverages, MOH has not ruled out the possibility of studying and considering imposing taxes on food in the future if the food industry fails to reformulate their products to contain less sugar, salt and fat, and include more nutrients. According to WHO, health taxes are levied on products that have a negative public health impact, for example, tobacco, alcohol and sugar-sweetened beverages (SSBs). These taxes are considered 'win-win-win' policies because they save lives and prevent disease while advancing health equity and mobilising revenue for the general budget. The aim of health tax policy is to reduce the consumption of products deemed risk factors for noncommunicable diseases by making them less affordable through higher prices. This is achieved with regular tax increases large enough to result in real price increases greater than economic growth. Excise taxes are the most effective tax measures for promoting health because they change the prices of harmful products relative to other goods and can be easily increased over time. ADVERTISING GUIDELINES In October 2024, Health Parliamentary Select Committee chairman Suhaizan Kaiat announced the drafting of a Malaysian Nutrition Act to regulate food nutrition, especially among children. On May 24, Bernama reported that MOH is drafting a Nutrition Bill following Cabinet approval of its proposal on the matter. However, the Bill would not be tabled in Parliament this year. On the issue of fast food advertisements targeting children, MOH said the 'Guidelines for Advertising and Labelling Nutritional Information for Fast Food', introduced in 2008, should serve as a guide to fast food companies, advertising agencies and broadcasters. 'The guidelines prohibit fast food advertisements during children's TV programmes and prevent sponsorship of such programmes by fast food companies. These rules are aimed at raising public awareness and shifting behaviour toward healthier dietary habits. 'MOH is also considering making it mandatory to restrict the advertisement of food and beverages high in fat, salt and sugar on all local and international media platforms, including digital media,' the ministry said. In terms of treatments for obesity, MOH said it has improved clinical obesity management by providing pharmacotherapy and non-pharmacotherapy options, supported by early detection, multidisciplinary interventions and digital tools. 'On the whole, MOH adopts a whole-of-government and whole-of-society approach in addressing obesity,' it added. Ultimately, the fight against childhood obesity is not solely the responsibility of the government, local authorities, parents, schools, teachers or healthcare professionals. It is a collective responsibility, with industry players, in particular, playing an important role in fostering an environment that promotes the health and well-being of the next generation. According to WHO, NCD management interventions are essential for achieving the Sustainable Development Goals (SDGs) target on NCDs The final instalment of this four-part series concludes with a call to action that the future of our children must not be clouded by obesity statistics. Now is the time for all parties to take greater, more serious, and more effective action to tackle childhood obesity in Malaysia. (This story was produced under the 'Communicating Noncommunicable Diseases' Media Fellowship by Probe Media Foundation Inc [PMFI], Reporting ASEAN [RA] and World Health Organization [WHO]. The views and opinions expressed in this piece are not necessarily those of PMFI, RA and WHO.)
Barnama
23-07-2025
- Health
- Barnama
- Brush Up On Your Smile!
23/07/2025 01:00 PM Opinions on topical issues from thought leaders, columnists and editors. By Cheah Chia Wei and Mohd Zamri Hussin A smile is not just a sign of joy – it is a powerful reflection of your overall health and well-being. Yet, many still believe that keeping teeth clean is solely the dentist's job. The truth is, your oral health is in your hands. Plaque – a sticky film of bacteria – constantly forms on your teeth and gums. If left unchecked, it can lead to tooth decay and gum disease, quietly damaging your mouth over time. That is why it is so important to make daily oral care a personal habit, not just something done before a dental visit. And remember, oral hygiene is not one-size-fits-all. If you have crowded teeth, dental bridges, implants, dentures, or wear braces, keeping your mouth clean can be even more challenging. These conditions call for extra care, tailored tools, and proper technique to stay ahead of dental problems. Many of us first learned how to take care of our teeth back in school, thanks to the School Dental Service by the Ministry of Health Malaysia, our teachers, or our parents. But as we grow older, it is easy to forget the right way to keep our mouths clean. A recent study from Universiti Malaya found that just hearing advice from the dentist is not always enough – especially for people wearing braces. Watching videos that show proper oral care techniques can make a big difference in helping them maintain good dental hygiene. These days, with smartphones and the internet, there is a flood of information on apps like TikTok, Instagram, and X (formerly Twitter). While some of it is helpful, a lot of it can be confusing or even wrong! That is why it is important to know how to tell the difference between good advice and bad advice – a skill known as health literacy. Being health literate means knowing where to find trusted information and understanding how to use it to take better care of yourself and your smile. One trustworthy resource we recommend is the Lifelong Smiles Project, available online at This project, led by Prof Dr Mihai Tarce, who is both a gum specialist and software engineer, and his team from the Faculty of Dentistry at the University of Hong Kong, provides valuable information on proper self-care at home. The website is multilingual, including versions in Mainland Chinese, Hong Kong Chinese, and Bahasa Melayu, with plans to translate it into other languages as well. Dental specialists from Universiti Malaya have also contributed to the Bahasa Melayu version of the educational videos. The goal of the Lifelong Smiles Project is simple: to make it easier for everyone to take care of their teeth and gums, using the latest digital tools. This free website offers easy-to-follow guides on how to brush, floss, and use special brushes to clean between teeth. It also has helpful videos that show the right techniques in action. The website is not just useful for the public – it also helps dentists and dental nurses create personalised cleaning plans for their patients. With clear, up-to-date, and trustworthy information, the Lifelong Smiles Project makes sure that people get the best advice to care for their oral health safely and effectively. Five simple habits for a healthy smile Taking care of your teeth and gums does not have to be complicated. Here are some easy tips to keep your mouth healthy every day: 1. Brush twice a day Brush your teeth in the morning and before bed using a fluoride toothpaste. Take your time – spend at least two minutes brushing all surfaces of your teeth. You can use a regular or electric toothbrush. Do not rush it – slow and steady brushing works best! Swap out your toothbrush or toothbrush head every three months, or sooner if the bristles look worn out. 2. Clean between your teeth Once a day, use floss or small interdental brushes to clean between your teeth where your toothbrush cannot reach. If your teeth are close together, floss might work better. Doing this before brushing can help remove plaque more effectively and make fluoride work better in those hard-to-reach spots. Nowadays, floss and interdental brushes are easily available at dental clinics, most pharmacies, and online stores. 3. Use mouthwash (optional) Mouthwash can be a helpful extra step after brushing – it helps reduce plaque and freshens your breath. Choose an antiseptic mouthwash for best results. 4. Visit the dentist regularly Try to see your dentist at least once a year for a check-up and cleaning. Gum disease can start quietly, so it is good to ask your dentist to check both your teeth and gums. They can also recommend the best cleaning techniques for you. 5. Practise a healthy lifestyle A healthy mouth starts with a healthy lifestyle. • Habits like smoking can damage your gums and increase the risk of mouth cancer. • An unbalanced diet can weaken your immune system, making your mouth more prone to inflammation and infection. • Eating too many sugary foods or drinks can lead to tooth decay, so it is important to cut down on sugar where possible. • Regular physical activity helps improve blood flow, including to your gums. High stress levels can also affect gum health. • Make sure to drink enough plain water every day to keep your mouth moist and help wash away food particles and bacteria. A happy mouth, a happy mind Taking care of your mouth is more than just keeping your teeth clean – it is a big part of staying healthy overall. This year's World Oral Health Day campaign reminds us of that with the motto: 'A Happy Mouth Is … A Happy Mind.' Good oral health does not just protect your teeth and gums – it can also boost your confidence and improve your mental well-being. When your mouth feels good, you feel better too. We want to encourage everyone to make oral care a daily habit and understand how important it is to their overall health. Taking simple steps every day – like brushing, flossing, and seeing your dentist regularly – can help prevent problems before they start. And prevention is always cheaper and easier than treatment later on. Your journey to a healthy mouth starts today. Just a little care each day keeps your smile bright and strong for life. So, brush up on your smile – it's worth it! -- BERNAMA Dr Cheah Chia Wei and Dr Mohd Zamri Hussin are from the Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya. (The views expressed in this article are those of the author(s) and do not reflect the official policy or position of BERNAMA)
Borneo Post
16-07-2025
- Health
- Borneo Post
Sabahan OKU doctor inspires nation through her service during Hajj
Dr Sabrina (middle) with the Sabah medical volunteers. On her left is Dr Mira Papoo. KOTA KINABALU (July 16): A remarkable doctor from Sabah has captured the admiration of many through her unwavering dedication and resilience while serving as part of the Malaysian medical team during the 2025 Hajj season in Jeddah, Saudi Arabia. Dr Fatimah Sabrina Moahmmad (sic), a physically disabled (OKU) medical doctor, was among the elite group of health professionals selected to support and care for Malaysian pilgrims performing the Hajj. Despite living with physical limitations, Dr Sabrina fulfilled her duties with unwavering commitment, professionalism and grace under pressure. Her service did not go unnoticed. Fellow officers and pilgrims alike praised her for her empathy, meticulous approach to medical care, and spiritual strength. 'Dr Sabrina's presence reminded us that physical limitations do not define a person's ability to serve. She worked tirelessly alongside others and earned the deep respect of our team and the pilgrims,' said one of her colleagues within the Malaysian Hajj medical mission. Her performance in the field is a shining example of Malaysia's commitment to inclusive representation in national service roles. It also underscores the importance of enabling and empowering Orang Kurang Upaya (OKU) individuals to contribute meaningfully to society, locally and globally. Pilgrims treated by Dr Sabrina also shared their appreciation. 'She was always calm, kind and attentive. I wouldn't have guessed she was OKU unless someone told me. To me, she was just a brilliant doctor who cared deeply,' said one elderly Malaysian pilgrim from Terengganu. A native of Sabah, Dr Sabrina's journey reflects the resilience of East Malaysians and their significant contributions to national development. Her story is not only one of personal triumph but also a powerful symbol of Sabahan pride and national unity in diversity. 'We are incredibly proud of Dr Sabrina. She embodies the spirit of service and shows that no barrier is too great when there is a will to serve,' said a spokesperson from the Ministry of Health Malaysia. This year's Hajj operation saw the deployment of more than 300 medical personnel to assist over 31,000 Malaysian pilgrims, ensuring their health and safety during the physically and spiritually demanding journey. Out of the 79 Malaysian doctors sent there, four were from Sabah. Dr Sabrina's contribution adds a layer of inspiration to the mission, an example of quiet heroism and dedication that will resonate for years to come.
The Star
15-07-2025
- The Star
Worker killed after 17-storey storage rack collapses at glove factory in Kuala Langat
KUALA LANGAT: A worker was killed after being crushed by a 17-storey high storage rack at a glove factory on Jalan Kawasan Perindustrian Olak Lempit here on Tuesday. The Bangladeshi victim, identified as Rahman, 33, was pronounced dead at the scene after being extricated from the debris by rescue teams. Selangor Fire and Rescue Department Assistant Director of Operations, Ahmad Mukhlis Mokhtar, said they received an emergency call at 10.54 am, prompting a response from the KLIA Fire and Rescue Station with nine personnel and two fire engines. "Upon arrival at the location at 11.05am, it was found that six workers were trapped after the 17-storey storage rack collapsed and crushed them. "Five victims were rescued by members of the public before the arrival of the fire brigade, while one victim was still missing at that time," he said in a statement on Tuesday. He added that search and rescue operations continued until the last victim was found buried under the debris at 11.20am. "The victim was confirmed dead by the Ministry of Health Malaysia (KKM) team present at the scene. "All other victims sustained injuries and are receiving further medical treatment," he said. He noted that the case has been handed over to the police for further action.
Daily Express
06-07-2025
- Health
- Daily Express
Costly private or over-burdened govt hosps?
Published on: Sunday, July 06, 2025 Published on: Sun, Jul 06, 2025 By: Lee Ke Yin, Tee Chen Giap Text Size: RECENTLY, Malaysians have been bombarded with headlines about rising medical costs, forcing many to either pay up, or forgo private healthcare, and turn to the 'near-collapsed' public healthcare system. Both are undesirable options. Meanwhile, across the globe, just a few months ago, Luigi Mangione, in a moment of rage and desperation, pulled the trigger on Brian Thompson, the CEO of a major US health insurance company. Advertisement The impact of the gunshots that were fired in New York still continue to ripple throughout the world. To some, it was an act of senseless violence. To others, it was the breaking point for a man who saw himself as a victim of a healthcare system that decides who gets to live and who doesn't. While Malaysia's healthcare system differs significantly from that of the US, we are similarly facing a dire healthcare crisis: Malaysians find themselves trapped between unaffordable private care and an overstretched public system struggling to provide essential services. As our country navigates this two-pronged healthcare crisis, what can be done before it collapses and creates our own Luigi Mangione? Generally, healthcare systems follow either the Bismarck model, developed by Otto von Bismarck, Germany's first chancellor, or the Beveridge model, developed by William Beveridge, a British economist-politician. The Bismarck model was adopted to build healthcare funded by private insurance and employers, as reflected in the US, while the Beveridge model gave birth to the taxpayer-funded National Health Service in the UK, which the Ministry of Health Malaysia (MoH) system is based on. However, as demand for healthcare grew, private hospitals, health insurance schemes and employer-sponsored medical benefits rapidly sprouted in the country. This was how the two-tiered healthcare system started in Malaysia: A taxpayer-funded public healthcare system and a market-driven, predominantly insurance-based private healthcare system. The key difference between the US' and Malaysia's healthcare systems is that while Malaysians can always rely on the 'safety net' of taxpayer-funded public healthcare, Americans do not have this 'privilege'. This prompts a crucial question: Is healthcare a fundamental human right, or is it merely a privilege dictated by power and economic forces? Malaysians know very well that our public healthcare system has long been overstrained. It suffers from overcrowding and extremely long waiting times. In some government hospitals, it is not unknown for patients in emergency departments to experience waiting times of over 24 hours before being admitted. The bed occupancy rate (BOR) in some hospitals has even surpassed 100pc, leading to the use of makeshift beds in corridors. Furthermore, the pressure on doctors and nurses is evident from the newspaper headlines that range from 'Malaysia's medical graduates glut' to 'It's back to a shortage of doctors', the contract doctors' strike (Hartal Doktor Kontrak), and the recent government mandate for longer working hours for government staff nurses. This issue is exacerbated by the low level of public healthcare spending, where the latest regional data in 2021 shows that it amounts to only 4.38pc of Malaysia's gross domestic product — significantly lower than our neighbours (Thailand 5.16pc, the Philippines 5.87pc, Singapore 5.57pc) and well below the spending level seen in developed countries (more than 10pc of GDP). While Malaysians often pride themselves on the 'cost effectiveness' of our healthcare system, it comes at the price of quality healthcare delivery due to a long-standing mismatch between supply and demand. All of this leads to poorer health outcomes for Malaysians, from delays in receiving crucial treatment to constraints in accessing more effective (but costly) treatment options. Till today, discussions among stakeholders have largely focused on public health, and the legal and economic aspects of the healthcare crisis. A crucial, fresh perspective needs to be introduced to the discussion table. As healthcare decisions and policies are enacted that benefit particular stakeholders while depriving others, these should be viewed as active exercises of 'biopower'. The term 'biopower' was popularised by an influential French historian and philosopher, Michel Foucault, in the mid-20th century. It refers to the state and institutions actively regulating lives, health, reproduction and mortality, with the ultimate goal of managing populations. In modern societies, power is no longer limited to traditional sovereign control, as it can manifest in more subtle mechanisms such as policies, health normalisation and surveillance — ultimately deciding who lives and dies within a population. In other words, it has shifted from a 'power to take life [away]' to a 'power over life', or rather, a power to 'help live and let die'. The state actively controls resource allocation and determines the standard of healthcare accessible to the population, shaping health outcomes through policy decisions. It has sadly become 'normal' for Malaysians to suffer complications of diabetes, such as heart disease, cancers, and including amputations, despite these being largely preventable especially when benchmarked against other nations. When diagnosed with diabetes, Malaysians often do not feel an urgency to regain control of their health due to the 'norm' set by current policies, budgets and healthcare standards — a downwards spiralling continuum. The fact that Malaysia is the most obese country in Southeast Asia — due to lifestyle, food and health literacy factors, all of which are influenced by policies through biopower — makes it even less surprising that we have the highest prevalence of diabetes in Asean. This forces us to confront a difficult reality: Who is being left behind or, to use the words of Foucault, 'to let die', in the pursuit of economic efficiency? On the other hand, in private healthcare, healthcare costs are skyrocketing, as seen in University Malaya Medical Centre's medical fees surging by over 200pc, to insurance companies reportedly intending to increase healthcare premiums by up to 70pc this year, until regulators intervened. While the existence of a two-tier system offers more options for Malaysians seeking medical treatment, many such treatments remain out of reach: Only 22pc of Malaysians are insured by personal medical insurance. More worryingly, a stark number of Malaysians are going bankrupt due to healthcare expenditure. Out of 8,321 debt default cases solved by the Credit Counselling and Debt Management Agency (AKPK) in 2015, some 14.3pc was due to high medical costs. The rapid rise in medical inflation will drive more Malaysians away from private healthcare, while further overwhelming the already strained public healthcare. At face value, the decision by faceless bureaucrats to hike medical fees can always be justified through economic reasoning. However, we must critically examine how the decisions of these institutions, even when driven by economic logic, can profoundly shape the lives of Malaysians. The framing of healthcare as a mere commodity — subject to market forces and investor returns — should be challenged, especially when discussions reduce it to a numbers game. Political philosopher Michael J Sandel's words are especially relevant: 'We cannot actually put a monetary value on human life ... to do so is to treat lives as commodities rather than as beings worthy of respect and dignity.' As healthcare costs continue to rise under the guise of economic necessity, we must first recognise this as an expression of biopower, where systemic policies and economic forces end up shaping who gets to live well and who is left behind. Observing the healthcare systems via the lens of biopower offers two major benefits: First, biopower reveals that healthcare is never neutral; it is shaped by policies that can reflect political agenda. Next, acknowledging this fosters crucial discussions surrounding healthcare injustices, and reinforces healthcare as a fundamental human right for all. Recent developments, including stakeholder engagements and public hearings by the Public Accounts Committee, mark a crucial step forward in fostering inclusive polylogue on healthcare costs. These discussions facilitate a comprehensive review of hospital charges and insurance premiums. Bank Negara Malaysia's decision to impose a 10pc cap on insurance premium hikes reflects an institutional willingness to balance economic considerations with public welfare. While efforts are made to evaluate inefficiencies and unjustified pricing distortions, the rakyat must exercise democracy themselves by actively participating in town halls and public hearings. This collective effort helps to hold leaders and policymakers accountable, serving as a counterbalance to the structural power that shapes healthcare outcomes in society. The Malaysian Philosophy Society urges the government to prioritise healthcare budget allocations to bring transformative changes to the public healthcare system. The long-held notion of national pride in a 'low cost and efficient' public healthcare model is no longer sustainable, as the widening cracks in the system make evident. To meet the growing healthcare needs of the population, proactive investments and systemic reforms are imperative. Apart from that, we echo the call for transparent pricing methodologies and ethical costing models used in healthcare to curb the exponential rate of medical inflation due to predatory practices. Ignoring these realities risks abandoning more lives from both fronts of healthcare sectors and recreating our very own Mangione in Malaysia. Lee Ke Yin is a content curator at the Malaysian Philosophy Society and a student at University Malaya. Dr Tee Chen Giap is a medical doctor and co-founder of the Malaysian Philosophy Society. The views expressed here are the views of the writer and do not necessarily reflect those of the Daily Express. If you have something to share, write to us at: [email protected]
