Non-Communica Diseases in Malaysia Ministry of Health, Malaysia Non-Communica Diseases in Malaysia Feisul Idzwan Mustapha MBBS, MPH, AM(M) Disease Control Division Ministry of Health, Malaysia Email: dr.feisul@moh.gov.my

MALAYSIA Total Population: ~28 million (2008) Life expectancy at birth (years) Male 71.7 Female 76.5

Who are Malaysians? Malay Chinese Indian Malaysia's largest ethnic group, accounting for over 60% With the oldest indigenous people, they form a group called bumiputera, which translates as "sons" or "princes of the soil" Chinese About 26% of the population Indian About 8% of the population

Malaysian Health Care System at a glance Health care provided at nominal charge for all Malaysians (& even non-citizens) Total MOH Budget (RM 12.9 billion); 7.29% of total National Budget Total expenditure on health (% of GDP) 4.70% MOH Health Clinics: 802 Private Medical Clinics: 6,371 MOH Hospitals: 130 (33,004 beds) Private Hospitals: 209 (11,689 beds) Source: Health Informatics Centre, MOH (all figures for 2008, except % of GDP 2007)

Burden of NCD in Malaysia Currently about 60-70% of total health clinic attendances are related to NCD Excluding normal deliveries, NCD contributes to over 20% of total hospitalisation in MOH Hospitals NCD is also in the top five most common cause of death in MOH Hospitals in the past five years Most common cause of premature death (below 60 years of age) in Malaysia are due to cardiovascular diseases, followed by road traffic accidents Sources: Health Informatics Centre, MOH Malaysian Burden of Disease & Injury Study 2004

Prevalence of NCD Risk Factors in Malaysia (1996-2006) NHMS II (1996) NHMS III (2006) Age group ≥18 years Smoking 24.8% 21.5% Physically Inactive 88.4% 43.7% Overweight (BMI ≥25 & <30 kg/m2) 16.6% 29.1% Obesity (BMI ≥30 kg/m2) 4.4% 14.0% Hypercholesterolaemia N.A. 20.6% In 2006, there is an estimated 2.8 million Malaysians age 18 years and above are current smokers, 5.5 million physically inactive, 3.6 million overweight and 1.7 million obese Malaysians. The increase in diabetes and hypertension can be linked to the increase in NCD risk factors. These factors has been shown by scientific studies to be strongly correlated to NCD. Obesity is strongly correlated with diabetes. The increase in prevalence in overweight and obesity certainly explains the increase in prevalence of diabetes in Malaysia. Increase of over 200% 6

Prevalence of Diabetes & Hypertension in Malaysia (1986-2006) NHMS I (1986) NHMS II (1996) NHMS III (2006) Age group ≥25 years ≥30 years Prevalence of HPT 14.4% 32.9% 42.6% ≥35 years Prevalence of Diabetes 6.3% 8.3% 14.9% In 2006, there is an estimated 4.8 million Malaysians age 18 years and above living with hypertension and 1.5 million Malaysians living with diabetes The number of people with hypertension has also increased since 1986. Hypertension also causes numerous complications. Increase of over 80% 7

Mapping of current health system activities of NCD in Malaysia Malaysia have fulfilled most indicators of the building blocks However current activities disjointed, not well coordinated, restricted to ‘health sector’ & not truly multi-sectoral Lack of strong civil society The Disease Control Division had mapped the current health system activities in Malaysia related to NCD, using the “Health System Building Blocks”, developed by WHO, to enable inter-country comparisons. The “Health System Building Blocks” contain six main criteria (1) Stewardship; (2) Health financing; (3) Health workforce; (4) Information & Evidence; (5) Medicines & Technology; (6) Health services; each with its own specific indicators. Malaysia fulfilled most of the indicators – however it was noted that current activities are disjointed and not truly inter-sectoral. Stewardship: Government mandate for NCD policies Health financing: Government pays for bulk of primary care Heath workforce: Information & skills in NCD part of basic training Info & evidence: Availability of nationwide risk factor data Medicines & technology: First & second line drugs available Health services: Risk factor screening & intervention

NSP-NCD: Seven Action Areas for Malaysia Prevention and Promotion Clinical Management Increasing Patient Compliance Action with NGOs, Professional Bodies & Other Stakeholders Monitoring, Research and Surveillance Capacity Building Policy and Regulatory interventions The general objective of the NSP for NCD is to prevent or delay the onset of CVD and diabetes and their related complications, and to improve their management, thus enhancing quality of life of our population, leading to longer and more productive lives. The specific objectives are: To raise the priority accorded to NCDs in development work at global and national levels, and to integrate prevention and control of such diseases into policies across all government departments; To establish and strengthen national policies and plans for the prevention and control of NCDs; To promote interventions to reduce the main shared modifiable risk factors for NCDs: unhealthy diets & physical inactivity; To promote research for the prevention and control of NCDs; To promote partnerships for the prevention and control of NCDs; To monitor NCDs and their determinants, and evaluate progress at the national, regional and global level. The Malaysian NSP-NCD are in line with WHO resolutions & recommendations: Resolution WHA55.23 “Global Strategy on Diet, Physical Activity and Health”. Resolution WHA60.23 yang bertajuk “Prevention and Control of Noncommunicable Diseases: Implementation of the Global Strategy”. Resolution WPR/RC59.6 “Western Pacific Regional Action Plan for Non-Communicable Diseases”. Diabetes & obesity were selected as the entry points for the NCD and NCD risk factor respectively. NSP-NCD provides the framework for NCD prevention & control at the National level Diabetes & Obesity selected as entry points Action Areas in line with WHO recommendations

Perception of the Public Emotions Perception of the Public versus Reality

Politics

Work in Progress… Creation of a cabinet-level committee, chaired by the Deputy Primer Minister. Members from 9 other key ministries: Education Information & Communication Rural Development Agriculture Youth & Sports Human Resource Domestic Trade & Consumerism Housing & Local Government Women, Family & Community

Work in Progress (2) Whole-of-government approach Policy & regulatory interventions Regulation of salt & sugar in food/drinks Regulation on advertising Expansion of workplace-based, school-based, & community-based interventions

Lessons learned Put the right people at the right place Have all of the materials and tools prepared – seize the chance when the opportunities come Seek out the “right” partners in other ministries & civil societies Facts may not actually work well in getting buy-in. Need to become a salesman

My Grand Challenge Raise the political priority of NCD Provide committed and effective leadership in NCD

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