Malaysia needs innovative fiscal measures for sustainable health financing

15 May 2020

Author: Yen Lian Tan, Southeast Asia Tobacco Control Alliance

Non-communicable diseases (NCDs) accounted for 73 per cent of total deaths in Malaysia in 2015, with half of these being due to cardiovascular diseases. This health burden is growing as the prevalence of NCD risk factors continue to rise among Malaysians.

The now abolished Malaysian Health Promotion Board (MySihat) complemented the Ministry of Health’s (MOH) role in the prevention and control of NCDs by promoting healthy lifestyles. Its work was in line with the priority areas of the Malaysia–WHO Country Cooperation Strategy 2016–2020.

MySihat, established as a statutory body by the Malaysian Health Promotion Board Act (Act 651), was a semi-autonomous entity within the MOH. Since its inception in 2006, it has promoted healthy lifestyles and chronic disease prevention programs. MySihat initially proposed to secure stable financing by imposing an earmarked tax on tobacco, alcohol and other harmful products. But a lack of political commitment changed the funding sources. MySihat was offered funding through the treasury budget’s allocation for health. But the MOH makes the final decision on the distribution of funds.

This funding mechanism is often limited and varies yearly depending on the availability of funds. Allocation is determined by the past year’s performance and competition with other programs. MySihat received an annual allocation of RM36 million (US$8.2 million) in 2007 but it dwindled to RM5.5 million (US$1.3 million) in 2016 and was maintained that amount until 2018.

MySihat spent 42 per cent of its budget between 2008–2018 to support the implementation of various health promotion programs at the community level. It collaborated with more than 1000 groups and organisations over that period and supported cross-sector partnerships between government, non-governmental organisations (NGOs) and the community. Such partnerships build the capacity to strengthen health promotion knowledge and skills among health-related and community-based organisations, benefitting millions nationwide.

In June 2018, Health Minister Dr Dzulkefly Ahmad announced a cabinet decision to abolish MySihat as part of the government’s rationalisation plan. Health advocates and NGOs have expressed their concerns.

MySihat’s responsibilities were transferred to other MOH departments without addressing the funding source problems for the annual health promotion programs. Most of the health budget is allocated to curative (acute) health care over preventive health promotion initiatives. The 2020 budget allocated the health sector RM30.6 billion (US$7 billion). But the allocation for prevention and control programs was unclear, and the country’s NCD burden remains unabated.

Health promotion needs multi-sectoral collaboration and a new sustainable financing mechanism for innovative health promotion programs. Additional fiscal resources are needed to achieve the 17 Sustainable Development Goals in the United Nations’ 2030 Agenda.

One way is to impose a surcharge tax on health-harming products, like tobacco, to generate a secure funding stream for health promotion. Its consumption contributes to all four major NCDs. This is in line with recommendations from the Article 6 Guidelines and Article 26 of the World Health Organization Framework Convention on Tobacco Control. Earmarking tobacco tax revenue would strengthen the effectiveness and sustainability of current health literacy and NCD prevention programs. This has been successful in 30 other countries.

Adopting and adapting experiences from the Thai Health Promotion Foundation (ThaiHealth) and other health promotion foundations worldwide would help to shape a new health promotion foundation in Malaysia. Thailand is the first ASEAN country to establish an autonomous health promotion agency. Since ThaiHealth’s establishment in 2001, it has received funding through a 2 per cent surcharge levied on alcohol and tobacco excise tax.

The ThaiHealth funding mechanism has been effective in securing a reliable source of funding for health promotion. The funding for Thai Health has increased from 3.1 million baht (US$95,500) in 2010 to 4.4 million baht (US$135,500) in 2017, enabling it to implement short-, medium- and long-term health promotion programs across the country. In 2017, a 2.9 million baht (US$89,300) fund was allocated for some major NCD risk reduction programs such as tobacco and alcohol control, and traffic accident prevention.

Such an allocation is a small investment compared to the economic cost of 280 billion baht (US$8.6 billion) — or 2 per cent of GDP — attributed to NCDs due to premature deaths and loss of productivity in the workforce in 2013. Many countries regard ThaiHealth as the gold standard for health promotion models.

To address the problems faced by MySihat, the Malaysian government should replace MySihat with an autonomous agency, using surcharge tax to secure a predictable and stable budget for health promotion programs. It will be a win-win policy for health as well as the budget.

Yen Lian Tan is the Knowledge and Information Manager at the Southeast Asia Tobacco Control Alliance (SEATCA).

Courtesy:East Asia Forum

First Person: Humankind’s ‘modern mentality to tame’ the environment: A volcanologist’s view

    

31 March 2020

SDGs

The 17 goals agreed by the global community to reduce poverty and create a sustainable planet are the responsibility of all people, wherever they are in the world, according to the United Nations. The Sustainable Development Goals or SDGs represent a boundary-pushing blueprint for the future of the Earth and it’s anticipated they will be realized by 2030. UN News joined the International Labour Organization on a visit to Hawaii where many people are already living or studying aspects of the goals in their everyday work.

Ken Rubin is a professor of volcanology and geochemistry specializing in volcanoes and sea level change. Based in the Department of Earth Sciences at the University of Hawaii, he travels the world to observe active and dormant volcanoes, both on the land and beneath the sea.

“In my work, I look at specifically at how volcanic eruptions impact populations. It doesn't have to be human populations; it could be marine communities that live in and around the submarine volcanoes. 

When I'm studying volcanoes on land, I focus mostly on understanding how frequently events happen and what hazards people face. Up until maybe a thousand years ago, humans were much more tuned into their environment and tended to stay away from the most dangerous places like volcanic areas, but it's our modern mentality that we can tame anything. So, we encroach much more closely on very dangerous environments.

This whole area that we're standing in was inundated in the 1940s by a tsunami created by a big earthquake in Alaska. It's part of the reason why this coastline is now protected and there are no buildings. A tsunami event like that only happens every several decades; the last one was in 1964 and we haven't had a big one since.  

Treating the water like a trash can

Living and working on an island, you understand quickly that there's a lot of reliance on the nearshore environment as a resource for marine life and the protection of the coastlines. A healthy coral ecosystem, for example, helps to protect coastlines from events like tsunamis. 

There's a legacy of people treating everything below the waterline with less direct regard than what is above water; for instance, the dumping of all types of trash. I do a fair amount of work in the submarine environment in manned submersibles and there are places around Hawaii that we can't go because of thousands of unexploded bombs and strings of bullets. 

The damaging effects of human activity

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.@kenhrubin is a volcanologist at Hawaii's @UH_EarthScience. He spoke to @UN News about the impact of #climatechange on volcanic activity. Full story here: https://news.un.org/en/story/2020/03/1060342 … CC: @ilo4USA

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The way I like to think about climate change is to recognize that the planet has been changing ever since it formed and that the climate fluctuates over different time scales. So, there's a long-term time scale, which has to do with the what we call the rock cycle, the forming of materials on the land and their subsequent breakdown which affects the carbon dioxide (CO2) in the atmosphere. So, over the course of Earth history, CO2 levels have naturally been slowly going down. 

Then we have factors like how the Earth orbits the sun which affects the cycles of ice ages and warm periods such as the warm period that we're in now. 

And there's of course the shorter-term damaging human-produced or anthropogenic effects resulting from human activity which picked up pace following the industrial revolution.

Volcanic eruptions and global cooling

There's always been a certain amount of volcanism. It waxes and wanes and affects climate in both positive and negative ways in terms of temperatures. Volcanoes can inject aerosols into the upper atmosphere which reflect light and can cause planetary cooling, rather than warming. But, it's really only the very big eruptions, the sort which occur once or twice a century, that have any kind of measurable impact on climate.

Mount Pinatubo in the Philippines erupted in 1991 and caused a couple years of cooling afterwards which gave a lot of fuel to the anthropogenic climate naysayer types because they said, “look it's getting cool.” In Hawaii, our eruptions aren't so violent and don’t cause the same effect. But when volcanoes erupt in a big way, they affect climate in one place or another for a brief period of time.

What volcano eruptions mean collectively is the outgassing of the interior of the Earth which brings a lot of CO2 and water to the surface; those are the two things that modulate our atmosphere and temperature patterns. If we didn't have water vapour and CO2 in our atmosphere, if we didn't have the greenhouse effect, we wouldn't be able to live here. That atmosphere is provided by volcanism.

Climate change and increased volcanic activity

I'm looking specifically at the period after the last ice age, when we had a 140-metre sea level rise over about ten thousand years. It was the last period in our history where we had sea-level change of the magnitude we predict for the next several hundred years.

Climate change can also have an impact on volcanic activity, although we have to look at this from a geologists’ timeframe. In Iceland after the ice age, when the glaciers started to retreat, the amount of volcanism increased dramatically, but it didn't happen right away. It took several thousand years.

So, I wouldn't want to go out on a limb and say there's going to be more volcanism in a hundred or a thousand years as the full effects of anthropogenic climate change are felt, but that's what we would predict based on our observations from the past.

I would say that in all the myriad ways that anthropogenic climate change is going to affect us, volcanism is pretty far down the list of things we need to worry about. But it is one of the reasons why we like to study volcanic cycles.”
 

Courtesy:UN News