by Helmy Haja Mydin. A version of this article was published in The Sun 9 December 2011
Throughout history, doctors have been viewed by society with respect. Although partly due to the vocational calling of medicine, this is mainly down to the fact that doctors are viewed as individuals who save lives. While this may be true in the hospital setting, it pains me to say that in the grand scheme of things, doctors do not save as many lives as politicians. Or rather, I think we doctors do not have similar opportunities to make a difference on a large scale.
An individual’s health is influenced by various complex factors i.e. individual behaviour, genetics, environmental exposures, social circumstances, and the healthcare system that they do (or do not) have access to. Governments play a role in all with the exception of genetics but for the purpose of this article, I shall focus on individual behaviour, specifically on tobacco use and physical inactivity.
Tobacco use has been linked with adverse health consequences since the middle of the last century. Over the course of several decades, many countries have introduced regulations and laws that have led to both increased smoke-free public areas and a higher tax on cigarettes; two of the strongest evidence-based tobacco-control measures.
Obesity on the other hand is sometimes incorrectly viewed as a disease of the wealthy. In fact, it is one of the greatest public health challenges of the 21st century. The numbers affected continue to rise and this trend is worryingly replicated in children. This epidemic is not only deleterious to the individual’s physical and psychological well-being, but adds unnecessary weight (no pun intended) to the stress already upon cash-strapped healthcare systems.
Together, tobacco smoking and obesity are the most significant modifiable risk factors in the development of chronic diseases; incurable conditions that progress slowly over time. These include cardiovascular diseases (e.g. heart attacks and strokes), cancer, chronic respiratory diseases and diabetes.
The situation is particularly dire in Malaysia. A World Health Organisation (WHO) report of chronic disease in Malaysia estimated that this group of diseases accounted for 67% of all deaths in Malaysia for the year 2008. In real terms, this equated to an estimated 89,500 deaths or approximately one death every 5 minutes.
It also noted that 41% of men and 1.6% of women in Malaysia smoked tobacco daily. But a rather high 56% of men and 65% of women reported physical inactivity. This divergence is replicated in the proportion of individuals who were reported to be overweight (42% of men, 46% of women) or obese (10% of men, 18% of women), a trend that is on the upward slope. So where does the government come into play? Cigarette smoking is still rife in Malaysia. Media campaigns to raise awareness of the consequences of smoking should be encouraged. One should have total autonomy over one’s behaviour, but one should get sufficient information in order to make an informed choice.
Individuals who smoke should be viewed sympathetically as smoking is an addiction. The tools to help combat this are already in place in the form of psychological therapy, nicotine-replacement therapies and medication e.g. verenicline. The government can play an important role by providing tax breaks or financial incentives to institutions that are able to provide these services.
Obesity needs to be tackled separately but once again, it all boils down to providing sufficient incentives. Health programs that include discounted schemes to attend the gym have proved successful in some countries. So is some basic interventions like ensuring nutritional and calorific contents of processed food are prominently displayed. Tendering school canteens to caterers who provide the healthiest menu would help too.
The government can also influence other aspects of health besides helping modify unhealthy behaviour. We will discuss these in future articles, but key variables include facilitating an insurance scheme that will allow greater healthcare access for all and tackling poverty. Bill Clinton once said “it’s the economy, stupid”. Patients from lower socioeconomic groups have higher rates of premature deaths and are more likely to partake in unhealthy behaviour but they also have less access to healthy food and healthcare services.
These are just a few of the potential roles of the government. However, the biggest responsibility lies with individuals. There is plenty of scope for civil society and individuals without waiting for government. The real responsibility still lie with us. The simple steps of eating less, exercising more and not smoking will go a long way to helping you lead a longer, more fulfilling life. It is our health. Let us take personal responsibility and not be dependent on the government on something so personal.
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Dr Helmy Haja Mydin is a Fellow at the Institute for Democracy and Economic Affairs (www.IDEAS.org.my)
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