KUALA LUMPUR, Jan 13 — Alarm bells have been ringing because of the worry that Malaysia will be unable to deal with its ageing population.
The number of seniors aged 65 years old and above is forecast to make up 15.3 per cent of the country’s population or 5.8 million people by the year 2030.
That, according to experts, is a rapid rate of ageing.
In addition to that, statistics have shown that more Malaysians are developing chronic illnesses such as heart disease and diabetes at a younger age.
And let’s not forget that we are the fattest country in Asia.
As Malaysia is expected to face significant challenges to meet the needs of an ageing nation, it is evident that much thought has to be given to grapple with the problems that can arise.
These include straining the healthcare system and the social and economic implications of an ageing population.
Here in Malaysia, relevant associations, healthcare specialists and policymakers have raised the alarm about several issues, including increased healthcare costs, unsustainable pensions and lack of elderly-friendly infrastructure in the country.
Highlighting the forthcoming challenges, the National Council of Senior Citizens Organisations Malaysia president (Nacscom) Datuk Soon Ting Kueh said there were four main areas that needed to be looked at when addressing the needs of an ageing population.
These were associated with older people having financial security, health and long-term care system, social well-being and suitable environment as well as elderly-friendly housing and transportation.
Soon also urged the government and civil society to develop and provide an enabling environment for senior citizens to live a comfortable and a meaningful life.
“We currently lack necessary public amenities and infrastructure, including suitable housing and transportation for the elderly,” he said.
“Nacscom has been pushing the government to look into various issues and challenges of the ageing population, but unfortunately no decisions or any actions have yet to be taken on the matter."
Established in 1990, Nacscom is a not-for-profit federation of senior citizens organisations in Malaysia with 40 affiliates and a total membership of close to 20,000 nationwide.
In order to have an active and productive ageing population, Soon said the government should improve the socio-economic life of the senior citizens by providing financial security for the elderly poor, enhance health and long-term care as well as engaging the seniors in social and economic matters.
“Senior citizens should remain in society and contribute to both social and economic development,” he added.
What’s Health Ministry’s take on the matter?
Health Ministry’s disease control division (non-communicable disease section) deputy director Dr Feisul Idzwan Mustapha also doubted if Malaysia was ready to face the challenges of an ageing population as the numbers are rising at a much faster pace.
“The rate of ageing is too fast when compared to the ageing rate of developed nations, which happened over 50 to 70 years," he said.
“There are also many dimensions of healthy ageing — not just health, but more importantly the social dimensions."
According to him, the elderly population are at risk of developing morbidity and complications of those morbidities.
“These complex medical issues will require a higher level of care and more resources to be allocated to them, often at a higher operational cost,” he added.
Based on the National Health and Morbidity Survey 2018 for Elderly Health, 51.1 per cent of elderly reported themselves as having been told to have hypertension by a medical professional.
Among other NCDs that they were reported to be living with were hypercholesterolemia (41.8 per cent) and diabetes (27.7 per cent).
Dr Feisul also agreed that poverty was still a major determinant of health and said the lower socioeconomic class in Malaysia were likely to be more vulnerable to the negative health and social impacts of ageing in the coming years.
Apart from healthcare and socioeconomic challenges, Dr Feisul said the built living environment here was another wider determinant of health, which is also linked with poverty.
“An elderly-friendly infrastructure takes into account the physical, mental and social needs of the elder population – and again, this goes beyond the health sector.
“Infrastructure for me goes beyond the physical built environment, but also includes the attitudes of the community towards the elderly which includes the acceptance, civility and caring towards the ageing population."
To transform the infrastructure into one that was more elderly-friendly, Dr Feisul said they (authorities) first needed to take into account the needs of the population as a whole, look at the public health aspects to cultivate a more active population, create green and open spaces, promote public transport, and institute policies to limit personal transport.
“This will need a whole-of-government approach as multiple government ministries and agencies have to be actively involved.
“We need to invest more in the health of our population in general, while addressing the specific needs of a vulnerable population, including the elderly.”
He also said there also needed to be more focus on disease prevention and health-related efforts despite the fact that awareness and knowledge were not enough to change people’s behaviour.
“You would need a supportive living environment as well, address various wider determinants of health, and expand beyond the Health Ministry and the health sector,” he added.
Alternative healthcare financing policy
As the ageing population grows, Dr Feisul said there would be increasing pressure to deliver quality care at public healthcare facilities.
“NCDs are chronic and require life-long treatment and management, which is often very costly.
“The issue of sustainability of the current healthcare system is something that the government needs to make some difficult decisions."
In Malaysia, he said, an alternative healthcare financing system should be the first step to address the issues of sustainability.
“This alternative health financing policy must take into account the health needs across the population, especially of the poor and across all spectrum of healthcare, including promotive, preventive, curative and rehabilitative," he said.
“As most of our healthcare budget is pumped into curative care, there is a dire need to expand the financial capacity to preventive care to address the shifting demographics and disease burden while effectively manage chronic diseases at a population level, and thus reduce overall healthcare expenditures.”
Moving forward, Dr Feisul said the ministry’s aim was to develop a healthy ageing population.
“Healthy ageing is the development and maintenance of optimal mental, social and physical well-being and function in older adults.
“This is most likely to be achieved when communities are safe, promote health and well-being, and use health services and community programmes to prevent or minimise diseases,” he said.
Dr Feisul also noted that other government ministries and agencies should come together to address the wider determinants of healthy ageing beyond the health sector.
A need for measurable plans and actions
Commenting on the government’s plans and ongoing initiatives, obstetrics and gynaecologist Dr Milton Lum said plans and actions meant nothing unless they were measured, monitored and modified.
“The government has to ask itself whether it is prepared and preparing for the health needs of the ageing population," he said.
“Healthcare involves not only care in clinics and hospitals but also community, home and social care."
Dr Lum who was forme president of both the Federation of Private Medical Practitioners Associations Malaysia and Malaysian Medical Association, said non-governmental organisations who were active in the community, home and social care had little or no governmental support.
“It is time that the government, in particular, the Health Ministry change the know-it-all mindset to one that is open, transparent and accountable.”
To promote healthy ageing, Dr Lum said there was a need for sustained commitment and action to formulate evidence-based policies that would enhance the abilities of senior citizens.
Apart from that, he noted that the health system should be aligned with the needs of senior citizens and include adherence to the principle of Universal Health Care, focus on senior citizens’ needs as well as preferences and enhancement of their abilities.