NCDs contribute to an estimated 73% of total deaths in 2015, with cardiovascular diseases including heart attacks and strokes represented the most frequent cause of death. An estimated 35% of deaths occurred among individuals aged less than 60 years, who mainly belong to working population. The Second Burden of Disease Study for Malaysia, by the Institute for Public Health in 2012, ranked hypertension, smoking, diabetes, high cholesterol and Body Mass Index (BMI), as the biggest contributors to the increasing disability adjusted life-years (DALY) and total deaths. There is also an increasing double disease burden, where NCDs such as hypertension and diabetes co-exist with CDs such as dengue, tuberculosis (TB) and malaria, which worsen the current health status.
Malaysia has successfully reduced or eradicated many of the CDs due to the various health initiatives such as immunisation and health awareness programmes. However, in recent years the incidence of CDs has been increasing and re-emergence of rare infectious diseases, which have long been eradicated in Malaysia such as lymphatic filariasis and TB, caused by the influx of illegal immigrants. This issue has put a strain on the resources of the healthcare sector.
Despite increasing prosperity, Malaysians are becoming less healthy due to sedentary lifestyle and unhealthy diet choices. There is now a double health burden of malnutrition, with rising rates of childhood obesity as well as stunting amongst under-five children. The prevalence of overweight and obesity among adults and adolescents likewise has increased.
Based on the 2015 National Health and Morbidity Survey (NHMS), the overall prevalence of diabetes mellitus (known and undiagnosed) among adults of 18 years and above has increased to 17.5% in 2015 from 15.2% in 2011. However, the prevalence of hypertension (known and undiagnosed) among adults has fallen to 30.3% in 2015 from 32.7% in 2011. In addition, 30% of adults aged 18 years and above are overweight, with BMI of 25 to 30, and 17.7% as obese with BMI of more than 30. Only 6% of Malaysian adults consume the recommended daily intake of five or more servings of fruits and vegetables.
Smoking and harmful alcohol consumption have also contributed to the rising incidence of NCDs. Approximately 20,000 Malaysians die annually due to smoking habit and the effect to passive smoking, and this is expected to rise further to 30,000 by 2020. On top of the sin tax introduced on alcohol and tobacco, the Government through various agencies has undertaken campaigns and programmes to stop the smoking habit among the rakyat, such as the Tak Nak Merokok campaign. In spite of this initiative, the fall in the prevalence of tobacco use among men has been insignificant, from 43.9% in 2010 to 43% in 2015. Nevertheless, the percentage of binge alcohol drinkers has declined from 11.6% in 2010 to 7.7% in 2015.
The provision of affordable housing has been given emphasised by the Federal Government. Hence, efforts will be intensified to strengthen the management of affordable housing, increasing access to affordable housing for low and middle income households as well as encourage the provision of environmentally-friendly facilities for enhanced liveability. Among the key strategies to be implemented are:
- the establishment of National Affordable Housing Council to oversee the implementation of affordable houses nationwide;
- various public affordable housing initiatives under several ministries and agencies will be rationalised under the Ministry of Housing and Local Government;
- the cooperation of the state government and local authorities will be enhanced to contain the increase in the cost of building affordable houses including Program Perumahan Rakyat projects;
- a review of subsidies for the affordable housing programmes will be undertaken to ensure the sustainability of the programmes as well as to optimise government resources;
- financial institutions will also be encouraged to provide greater accessibility for first-time homebuyers by introducing more flexible and innovative financing schemes; and
- the existing housing financing schemes will be improved to provide sustainable solutions for low- and middle-income households to access affordable homes
The efforts to be taken to empower local authorities are as follows:
- Improving accountability through the local community and non-governmental organizations, enforcement to ensure public and private projects comply with the environmental impact assessment (EIA) and social impact assessment (SIA), ensuring local authorities comply with standard guidelines and operations and local authorities ratings;
- Strengthening the service delivery of local authorities services through through the engagement between the Federal, State and local authorities as well as the private sector, conducting a study to identify other international service standards and best practices and evaluate the efficiency of each local authorities services. Sharing of data will also be improved to ensure data is accessible to the rakyat; and
- Strengthening collobaration for stimulating local economic development by streamlining strategies to attract new and retain existing resident and businesses, intensifying collaboration between local authorities and business communities, improving infrastructure and utilities as well as enhancing transparency and enforcement.