Monday, December 21, 2015

Health in All Policies (HiAP) in Malaysia: Now More Than Ever

I refer to the statement made by our Deputy Director-General of Health, Datuk Dr Lokman Hakim in the New Strait Times article ‘Multi-agency Effort Needed to Tackle Diseases’ on 18 December 2015.

In the wake of recent national issues that directly affects health such as that of vape, bauxite mining and leptospirosis, the Deputy Health Director-General's comment on the necessity of multi-agency effort to combat diseases came at fitting time. Although the focus of his comments was on leptospirosis, there is a larger and growing national concerns that commends such effort: non-communicable diseases such as diabetes and hypertension (NCDs) is on the rise, infectious diseases such as dengue and leptospirosis is becoming epidemic across the country, health care costs are spiralling up, inequities are growing. On top of that, we face urgent environmental problems that contributes directly to health hazards: the recent haze, bauxite mining in Kuantan, water contamination to name a few.

Lacking the mandate, authority and organizational capacity, the prevention of these issues that require nation-wide interventions are largely beyond the power of Ministry of Health. We as medical doctors can plead for things like lifestyle changes, tough legislation against vaping, high taxation for tobacco, but we cannot re-engineer social and political environments in ways that puts health at its core.

Many developed nations have long recognized the importance of inter-sectoral efforts in tackling diseases and can be traced back to the 1978 World Health Organization (WHO) Alma-Ata declaration that formally acknowledges of the importance of intersectoral action for health. It was later carried forward in the Ottawa Charter for Health Promotion (adopted in Ottawa in 1986), which discussed “healthy public policies” as a key area for health promotion, and gave rise to the concept of “Health in all Policies” (HiAP) in 2006 during the Finnish Presidency of the EU.

The WHO defines HiAP as “an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity”. An early example is the “North Karelia Project” launched in 1972 aimed to reduce the impact of coronary heart disease in the Finnish region of North Karelia through engaging other sectors such as community organizations, dairy and meat producers, schools to improve community health. The project, which involved the support of the Finnish authorities and the WHO, resulted in significant reductions in cardiovascular disease mortality and has been noted as a successful model for cross-sector collaboration.

Some may argue that we already have elements of HiAP in place, taking an example when the Ministry of Health collaborates with the Ministry of Education to promote health education, dental health and routine immunizations. However, HiAP is more than a collaboration between 2 agencies. HiAP in other countries has moved on to centralize health efforts by establishing councils chaired by the Health Minister, with members from each ministries and agencies that affect health and wellbeing, such as the Ministry of Agriculture, Forestry, Rural and Regional Development, Urban Wellbeing  and Housing, Domestic Trade, and even including the local authorities and city planners to convene at least twice a year to discuss the current national issues that affects health of citizens either directly or indirectly.

Back to our beloved country Malaysia, taking example of issues such as vaping and bauxite mining in which there is still no coherent effort between agencies and ministries to tackle the problem, it is evident that it is high time we adapt HiAP in our approach to become a developed nation by 2020. A developed nation is not only a country that is economically sound, but also a country in which its citizens are physically and mentally healthy, as reflected by its citizens’ life expectancy.

While serving as an intern at the Social Determinants of Health Unit in WHO headquarters in Geneva, I had the chance to be a part of a working group that examines case studies relating to HiAP in developing countries. I have noticed that while HiAP is a new concept to the developing world, many are already approaching the WHO for advise and technical assistance to start implement HiAP in their respective countries. Each countries has their own social, political and economic factors that affects health. What works in one country might not work in another, however I do not see why we shouldn't start by asking for assistance. Health is a core element in people’s well-being and happiness. In the end, policies made in regard of health is not about political, social and economic interests. It is about ensuring that we leave behind a healthier world to live in, for or children and future generations to come.

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