May 10 -- One of the most vivid memories of my father was him asking my mother for a blue plastic bowl to piss into because he was too weak to walk from the living room to the bathroom, his body ravaged by cancer.
I remember the smell of his leather jacket when he used to take me around on his Kawasaki motorbike, before cancer took over and killed him when I was 16.
Cancer is quite prosaic now, as Klang MP Charles Santiago himself notes that so many people around him are getting the disease. But death is never banal. The permanence of death demands that we do everything in our power to prevent it.
Yet, for some reason, health care is not political in Malaysia -- through the Barisan Nasional (BN) and now year-old Pakatan Harapan (PH) administrations -- in that Malaysians rarely hold the government of the day to account for health care problems that lead to disease and death.
We don’t have a Bernie Sanders in Malaysia. Malaysian politicians across various parties don’t run on health care issues either, unlike Democratic candidates who campaigned in the United States’ 2018 midterm elections on giving all Americans access to government-run health care. Democrats later seized the House of Representatives in the election.
Democrat lawmakers and think tanks have even proposed nine different plans to push for universal health care in the US.
Aside from a few outspoken MPs on health care like Charles and his party colleague Dr Kelvin Yii (Bandar Kuching), Malaysians are curiously blasé about health, spending more time and political capital instead on issues like race and religion.
You cannot march rain or shine to defend your faith if you are sick. You cannot climb the corporate ladder and make more money either if you are sick. You must be healthy, first and foremost.
That requires better access to quality health care so you don’t die from something that could have been prevented with good medical care.
Malaysia only ranked 84th with a score of 68 on the Healthcare Access and Quality (HAQ) Index that measures personal health care access and quality from 1990 to 2016 based on 32 causes that should not result in death if effective medical care is present, also known as “amenable mortality”. The HAQ Index score is scaled from 0-100, with 0 reflecting highest death rates.
The 32 causes considered amenable to health care comprise vaccine-preventable diseases; infectious diseases and maternal and child health; non-communicable diseases (NCDs), including cancers, cardiovascular diseases, and other NCDs like diabetes and chronic kidney disease; and gastrointestinal conditions from which surgery can easily avert death, like appendicitis.
Singapore ranked 22nd with a HAQ Index score of 91, while neighbouring countries like Brunei and Thailand ranked higher than Malaysia at 53rd and 76th respectively with scores of 76 and 69. Sri Lanka also beat Malaysia’s 84th rank by coming in at 71st.
How can countries that are supposedly less developed than Malaysia have better health care than us?
Malaysia scored among the worst on non-melanoma skin cancer and lower respiratory infections, besides featuring in the third-lowest or eighth decile on ischemic heart disease and stroke.
Malaysia also has terrible survival rates for breast cancer, the most common cancer here, as only slightly more than six out of 10 women are living five years after diagnosis. In Australia and the US, however, breast cancer five-year survival rates are 89.5 per cent and 90.2 per cent respectively.
Health Minister Dzulkefly Ahmad himself admitted recently that Malaysia’s average life expectancy has plateaued since 1990 at 75 years. Vietnam has overtaken us with a life expectancy of 76 years, while Thailand has matched us. Singapore’s average life expectancy is almost 83 years.
All of this is not acceptable.
Why aren’t Malaysians speaking up more? Advocating our rights and making health care “political”, so to speak, is necessary because politicians often act only upon public pressure.
If there are louder voices demanding for, say, more religious enforcement officers to curb personal sins, then limited public resources will be diverted there instead of going to health care, for example, if patients, caregivers, and other stakeholders remain silent.
Change does not happen behind closed doors. In a democracy, citizens must demand loudly and publicly for what they want, or risk being placed on the backburner as lawmakers prioritise more vociferous voices.
It is also perfectly reasonable to ask for better access to quality health care so that we live longer lives. If people can ask for places of worship, why not medicine? You can’t pray when you’re dead.
The previous health ministers under BN may have sat on their butts doing nothing for the past few decades. But as PH promised a “New Malaysia”, the way we do health care must change.
What are BN’s and PAS’ plans to fix the ailing health care system in the country that is becoming increasingly unsustainable, as Malaysians get sicker and die preventable deaths? Create a social health insurance scheme with contributions from employees, employers, and government?
Or reduce the government budget for less essential items like religion and increase the Health Ministry’s allocation instead so that Malaysia’s health care spending reaches 6 per cent of the GDP from the current 4.5 per cent?
As it is, BN doesn’t even have a shadow health minister, since both Mersing MP Abdul Latif Ahmad and Hulu Terengganu MP Rosol Wahid, who were on the coalition’s health shadow committee, defected from Umno to Bersatu.
It is also unfortunate that Parliament is not setting up a parliament select committee (PSC) to monitor the Health Ministry alone, as the Speaker plans to merge it with education, community and social development. The huge Education Ministry should be monitored by its own PSC too.
A PSC to monitor health issues alone would be able to hold the government to account on issues like mySalam’s pathetic approval rates of less than 0.2 per cent for its RM8,000 cash benefit for critical illness. The bipartisan parliament committee can even summon pharmaceutical executives to testify in public hearings about drug prices, like in the US, even as the Health Ministry plans to impose price ceilings on medicine.
All lawmakers and policymakers -- not just in the Health Ministry but also in the Women, Family and Community Development Ministry, Finance Ministry, and other ministries -- must be open to criticism on health care and resist responding in a petty or churlish manner.
More importantly, Malaysians who have ever fallen sick -- which is pretty much everyone -- must be brave enough to speak up for their right to health care.