Having scored 70.9 on the SDG Index, Malaysia is doing fairly well in terms of overall development and ranks third among ASEAN countries. However, when we compare it to the entire globe, it is ranked 65 out of 165 countries studied, which means it is relatively far from being a completely ‘sustainable’ nation. Primary observation of its overall board of SDG achievement progress suggests it focussed well on infrastructure development and economic growth, but its Gini Coefficient (measured in gross income) was only as low as 0.407 in 2019 (DOSM, 2020), indicating high social inequalities. My particular interest in this country stems from its lack of overall focus that balances growth and wellbeing, especially in the healthcare sector. In this article, the main dissection of Malaysia’s barriers towards sustainability is found within SDG 3, Good Health and Wellbeing, which entails the goal to promote healthy lives and well-being in the country regardless of age. Some of the key points this goal highlights include ending preventable deaths of newborns, ending epidemics, and achieving universal health coverage.
First and foremost, the biggest barrier to achieving sustainability is the life expectancy at birth, which the SDG index reported that significant challenges are present to achieving the target score. Life expectancy at birth means the average number of years which a newborn could expect to live, taking into consideration the sex and age-related death rates at the time of their birth. The World Health Organisation (WHO) set the target score of 83 for Malaysia, but the country had only achieved a score of 76.31 in 2020. However, this does not mean that no growth has been observed. In 1971, the life expectancy at birth was 65.01 years; while in 2019, it was 74.72 years. It is growing at an average of 0.33% every year (KNOEMA, 2021). Yet, this number is not ideal or fast enough, which contributes to the mark recorded by the SDG index as having significant challenges still.
One reason for low life expectancy is the general wealth of a country. In Malaysia, the distribution of mortality indicators by socioeconomic quintiles concluded that poorer districts in the country had higher death rates than more privileged areas (Mariapun, Hairi, Ng, 2016). The study conducted in 2016 showed the disadvantage of poorer areas is due to the lack of or limited access to healthcare facilities (WHO, 2019). The aforementioned limitations of access include the lack of clinics near homes, high costs in commuting and the lack of qualified medical experts available in the region. Despite the overall life expectancy in Malaysia being consistently above 70, more than 50% of the older generation live in poverty (Tey, Siraj, Kamaruzzaman, Chin, Tan, Sinnappan, Müller, 2016). This contradicts Malaysia’s achievement of SDG 1, No Poverty, on the SDG Index. The reported disposable incomes for households from the poverty-affected group could go lower than $5000 annually. Yet, the SDG index estimated that 0% of the Malaysian population lives under the poverty threshold of US$1.90 a day with historical approximates of the income distribution, educational attainment, age and GDP projections. This shows a limitation exists in the SDG Index where income gap discrepancy is not taken into account. In 2018, Khazanah Research Institute (KRI) reported that despite a fall in the official income inequality, the absolute earnings gap between the country’s top 20 percent and bottom 40 percent has doubled. In other words, everyone’s earnings increased but the rich are earning significantly more and quicker, thus putting a larger proportion of people in relative poverty. The poor, especially those living in less accessible areas, would rather spend on food than to commute for medical check ups (Taber, Leyva, Persoskie, 2015). When their medical conditions eventually worsen, their medical conditions are often too late to cure, causing the age of deaths accounting for life expectancy to reduce. Another reason the poor are more likely to have health issues is their limited access to clean water and proper sanitation or hygiene, which is what SDG 6 entails. In a joint report by WHO and UNICEF, about 8% of Malaysians have no access to properly treated water, especially among the indigenous community, while 18% of the entire population lack access to hygienic sanitation services (Thoo, Rhule, 2018). This leads to high rates of deadly parasitic infections among indigenous groups, which can go as high as 90% in some communities, and their infant mortality rate is double of other urban communities (Elmi, 2020). This evidence points to low life expectancy due to low general wealth.
Other than avoiding medical checkups and bad sanitation, a major factor contributing to early deaths in Malaysia is road traffic accidents. This relates much to another target in SDG 3, which is to achieve halving the number of deaths and injuries from road traffic accidents. In Malaysia, the SDG index stated that this target still has major challenges, as the rate of improvement is less than half of the required rate. While the long-term goal of number of fatal road traffic injuries per 100 thousand people is 3.2, it was reported that Malaysia’s indicator stood at 22.48 in 2019 (SDG Index, 2021). This could root from the lack of awareness on road safety and traffic rules (Li, Hsee, Wang, 2021). However, the Malaysian Institute of Road Safety Research (MIROS) argued that improvements are observed across 2020 (Lim, 2020), with evidence of 24.9% reduction in road fatality statistics (Lye, 2021). This statement is backed up with data provided by the Royal Malaysia Police (PDRM) that, in 2019, 6167 deaths were observed in road accidents, but in 2020, only 4634 cases were reported. However, this could be due to the reduction in road use after the Movement Control Order and national lockdown in place due to the curb of the Covid-19 pandemic (Lim, 2020). Despite the fall in statistics, the numbers still remain high, and must be monitored and improved to achieve the index targeted. The unfortunate thing about traffic deaths is that it does not discriminate based on age and gender. Yet, the awareness of road safety could be lower among children, which contributes to lower death ages that, in accumulation of data, lowers the life expectancy level. A blanket awareness-based solution through education since young is what could help prevent it from happening, it aligns with what SDG 4, Quality Education, entails. Furthermore, traffic rules and laws exist to regulate people’s behaviours on the road, which promise safety and prevent accidents. SDG 16, Peace, Justice and Strong Institutions, is to be achieved so that people feel safe when commuting, knowing that laws are obeyed and precaution is taken to protect each other.
Moving on, WHO reported that maternal conditions contribute most to the gap in life expectancy between men and women in Malaysia. The challenge could persist due to Malaysia’s historical conservative and taboo attitudes towards sex education (Khalaf, Low, Kloei, Ghorbani, 2014). The SDG Index shows challenges in achieving SDG 5, Gender Equality, given the slow growth in percentage of women of reproductive age whose demand for family planning has been met with satisfactory modern methods of contraception. The United Nations Departments of Economics and Social Affairs (UNDESA) set a target score of 100 for Malaysia, which translates to meeting 100% the demand for family planning with modern methods. However, the imputed score obtained in 2020 is only 56.1, a clear barrier to achieving SDG 3. As a potential direct result, Reproductive Rights Advocacy Alliance Malaysia (RRAAM) reported that an estimate of 100,000 abortions take place in Malaysia annually, with a high proportion of them being unsafe and illegal. In the country, legal abortion is allowed only if a doctor deems the pregnancy harmful or injurious to the mother´s life or health. Unfortunately, ‘black market’ abortion pills or unlicensed medical procedures still occur within the community, which often leads to unhygienic care, infection and even deaths (RRAAM, 2021). Other than illegal abortions, deaths during delivery occur due to several reasons, including choices of delivery at home with no professional supervision, high rate of infection and postpartum haemorrhage despite having delivered in hospitals. In 2019, it was recorded that the maternal mortality ratio was 21.1 per 100000 live births (Statista, 2020). This value is actually an improved data, given the increase in safe deliveries carried out by trained professionals nationwide, rather than by traditional birth attendants or midwives over the years (Yadav, 2012). Beyond successful deliveries, the discussion extends to satisfactory treatment for infants in ideal postnatal environments, which contributes to ensuring prolonged life expectancy in children. WHO reported that infants who die within the first month after delivery, known as neonatal mortality, often suffer from conditions associated with poor quality care at or after birth. In fact, in 2017, infections, birth asphyxia and preterm birth are the leading cause of neonatal deaths. While the risks of death among young children is higher in low-income countries, WHO found evidence that beyond 50% of premature deaths in Malaysia are in fact preventable and treatable through medical precaution and lifestyle intervention. 1 in 5 premature deaths in Malaysia was caused by cardiovascular disease, diabetes, birth defects, chronic respiratory disease and even cancer (ADB, 2018). The 2015 National Health and Morbidity Survey (NHMS) even found that at least 11.8% of children below 18 years of age are obese, which leads to further health complications including diabetes, obstructive sleep apnea (OSA), hypoventilation syndrome and cardiovascular problems. This evidence shows that lifestyle plays a part in preventing childhood obesity and other aforementioned diseases during childhood, which lower the common ages of death and shorten the life expectancy of a nation. This goes back to the lack of awareness of nutrition, which could be argued as a failure of SDG 4, where awareness through education is one of the essential methods of preventing this situation.
These aspects discussed are reasons why life expectancy at birth is a major barrier to Malaysia in achieving sustainability. There are major challenges in the rate of improving it, which is the prevalent issue in question, despite the positive outlook. These challenges could root from the lack of general awareness in health or its surrounding topics, for example, how road safety can reduce traffic death rates (WHO, 2020) and the overall diet and lifestyle of a family improve life expectancy of a child at birth (CNY, 2021). This extends to the lack of manpower in the healthcare sectors, especially specialist doctors (LabNewsAsia, 2021). The Organisation for Economic Co-operation and Developments (OECD)’s average ratio of clinical specialists is 14.13 per 10 thousand population, but Malaysia only has a disappointing 3.42 per 10 thousand population. Every year, 1000 specialists across more than 30 subspecialities are produced by the Health Ministry, but this means only a handful of oncologists or cardiologists manages to enter the industry annually, which is clearly insufficient for the massive population of 33 million (Badd, 2018). As compared to other countries like the UK, Malaysia’s healthcare landscape is very distinct. Notably, the UK’s high taxation system has promised health coverage for all residents. As a developed nation, the efficient healthcare provided has high quality with little waiting time, and most importantly, it is free of charge. In Malaysia, on the other hand, the government-based public-funded health service charges minimally at the expense of not being available immediately and would require appointments with priority given to only the most serious cases, as only 45% of all registered doctors in the country caters to about 65% of the entire population (MHTC, 2020). This systemic difference is one reason it is difficult to compare advancement in healthcare between Malaysia and other developed countries.
The barrier calls for solutions. First of all, wiser use of public funds with a greater focus on the public healthcare sector could be a long-term investment to improve the healthcare coverage in Malaysia. The introduction of rural health infrastructure and facilities, including clinics, rehab centres and midwife clinics is targeted to provide easier accessibility to primary health care for the general rural community and antenatal care for women. This helped raise the coverage of antenatal care for women to 98% nationwide, back in 2010 (Yadav, 2012). It even increased the frequency of natal check ups per woman across pregnancy to delivery date, from only 6 in 1980 to an average of 12 in 2010. This policy does not only reduce the risks of poor women neglecting their health during pregnancy, it even pushes for the excellent health of their children. Such programmes even spread awareness on family planning, post-natal childcare and importance of good nutrition, which are aimed to increase the general life expectancy. Other than mother and children, Malaysia crafted health policies for the elderly, such as the National Health Policy for Older Persons in 2008 and Plan of Action for Older Persons in 2011. The Ministry of Health and the Ministry of Women, Family & Community Development have joined forces to put focus on provision of healthcare for the elderly. These plans improve the score of life expectancy in Malaysia through social campaigns and legislation that advocates good health, wellbeing, safety and security among the elderly generation (KKM, 2020). Secondly, the government should revise the education system and devise syllabus that could contribute to building a healthier nation, including greater awareness on nutrition, disease prevention and even road safety. This point suggests an inter-goal policy with SDG 4, Quality Education, and ensures the delivery in school instills knowledge of nutrition and health awareness in the younger generation. Thirdly, partnership with medical sources on corporate levels could ensure positive health outcomes for employees and their communities. The best example currently in place is companies organising standardised Covid-19 vaccination centres for employees. Healthcare packages as such could be employed by companies to ensure a blanket treatment to employees, which is not limited to vaccinations but includes health insurance packages and medical checkups.
Conclusion
Life expectancy at birth may be the largest barrier to achieving SDG 3 and sustainability as a whole, but underlying challenges still exist within the framework of other SDGs. Focusing on too many shortcomings at the same time may cause greater problems. However, Malaysia could choose to work with other nations that share similar values to achieve the goals hand-in-hand, which fulfills SDG 17, Partnerships for the Goals. The current rate of achieving this goal is lower than required, and sees many remaining challenges, especially in terms of national spending in healthcare and education, according to reports by the SDG Index. Putting the priority on improving the general healthcare and increasing the life expectancy in the country will aid achieving SDG 8, Decent Work and Economic Growth, in the most efficient way. It is through eliminating causes that prevent the workforce from productively contributing to the economy that will push our country towards sustainable growth.
References
Asian Development Bank (ADB) (2018) Key Indicators for Asia and the Pacific 2018 Available online: https://www.adb.org/publications/key-indicators-asia-and-pacific-2018
Badd (2018) Despite Too Many Medical Graduates, Malaysia Is Seriously Lacking Specialist Doctors… Why? Available online: https://cilisos.my/despite-too-many-medical-graduates-malaysia-is-seriously-lacking-specialist-doctors-why/
Colours New York (CNY) (2021) What are the main reasons that life expectancy has increased? Available online: https://colors-newyork.com/what-are-the-main-reasons-that-life-expectancy-has-increased/#What_increases_life_expectancy
Department of Statistics Malaysia (2020) Household Income & Basic Amenities Survey Report 2019. Available online: https://www.dosm.gov.my/v1/index.php?r=column/cthemeByCat&cat=120&bul_id=TU00TmRhQ1N5TUxHVWN0T2VjbXJYZz09&menu_id=amVoWU54UTl0a21NWmdhMjFMMWcyZz09
Elmi, L. (2020) Improving Water And Sanitation in Malaysia. The Borgen Project. Available online: https://borgenproject.org/water-and-sanitation-in-malaysia/
Goroh, M.M.D., Rajahram, G.S., Avoi, R. et al. (2020) Epidemiology of tuberculosis in Sabah, Malaysia, 2012–2018. Infect Dis Poverty 9, 119. https://doi.org/10.1186/s40249-020-00739-7
Kementerian Kesihatan Malaysia (2020) Available online: https://www.moh.gov.my/
KNOEMA (2021) World Data Atlas: Malaysia - Life expectancy at birth. Available online: https://knoema.com/atlas/Malaysia/topics/Demographics/Age/Life-expectancy-at-birth#:~:text=In%202019%2C%20life%20expectancy%20at%20birth%20for%20Malaysia,description%20is%20composed%20by%20our%20digital%20data%20assistant.
LabNewsAsia (2021) Malaysia needs more specialist doctors, says health minister.
Available online: http://labnewsasia.com/industry-news/1775-malaysia-needs-more-specialist-dhttp://labnewsasia.com/industry-news/1775-malaysia-needs-more-specialist-doctors-says-health-minister/octors-says-health-minister/
Li, XL., Hsee, C., Wang, L. (2021) Incivility awareness could save lives. Behavioral Science & Policy Brookings Institution Press Volume 7, Issue 1, 2021 pp. 1-8 10.1353/bsp.2021.0007
Lim, A (2020) Paultan.org, Covid-19 MCO: Don’t pandu around needlessly lah! Available online: https://paultan.org/2020/03/19/covid-19-mco-dont-pandu-around-needlessly-la/
Lim, A. (2020) Paultan.org, Government to look into “drastic solutions” to reduce the number of road accidents and fatalities – Wee. Available online: https://paultan.org/2020/06/26/government-to-look-into-drastic-solutions-to-reduce-the-number-of-road-accidents-and-fatalities-wee/
Lye, G. (2021) Paultan.org, MIROS reports 4,634 road fatalities in 2020 – down 24.9% from 2019; cases involving injuries up by 14.6%. Available online: https://paultan.org/2021/02/16/miros-road-fatality-report-2020/
Malaysia Travel Healthcare Council (MTCH) (2020) The healthcare system in Malaysia. Available online: https://www.mhtc.org.my/2020/02/02/the-healthcare-system-in-malaysia/
Mariapun, J., Hairi, N. N., & Ng, C. W. (2016). Are the Poor Dying Younger in Malaysia? An Examination of the Socioeconomic Gradient in Mortality. PloS one, 11(6), e0158685. https://doi.org/10.1371/journal.pone.0158685
National Health Service (NHS) (2021) Tuberculosis (TB) Available online: https://www.nhs.uk/conditions/tuberculosis-tb/
Paul, DC., Chew, A., Yau, NL., Hollip, KC., Tangkanggau, F., Lasimin, S., et al. (2012) Multidrug resistant Mycobacterium tuberculosis complex: a laboratory perspective (conference poster abstract). 7th Public Health Colloquium, Sabah State Health Department; Ming Garden Hotel, Kota Kinabalu, Malaysia, 21–22 November 2012.
Reproductive Rights Advocacy Alliance Malaysia (RRAAM) (2021) Abortion. Available online: https://www.rraam.org/abortion/
Rundi, C., Fielding, K., Godfrey-Faussett, P., Rodrigues, LC., Mangtani, P. (2020) Delays in seeking treatment for symptomatic tuberculosis in Sabah, East Malaysia: factors for patient delay. Int J Tuberc Lung Dis. 2011;15(9):1231–8.
Statista (2020) Maternal mortality ratio in Malaysia from 2011 to 2019(per 100,000 live births) Available online: https://www.statista.com/statistics/642032/malaysia-maternal-mortality-ratio/
Taber, J. M., Leyva, B., & Persoskie, A. (2015). Why do people avoid medical care? A qualitative study using national data. Journal of general internal medicine, 30(3), 290–297. https://doi.org/10.1007/s11606-014-3089-1
Tey, N., Siraj, S., Kamaruzzaman, S., Chin, A.,Tan, M., Sinnappan, G., Müller, A. (2016) Aging in Multi-ethnic Malaysia, The Gerontologist, Volume 56, Issue 4, August 2016, Pages 603–609, https://doi.org/10.1093/geront/gnv153
Thoo, A., Ehule, E. (2018) Clean Water for All: A Case Study of Malaysia’s Orang Asli. Our World. Available online: https://ourworld.unu.edu/en/clean-water-for-all-case-study-of-orang-asli
World Health Organisation (2019) Available online: https://www.who.int/gho/publications/world_health_statistics/2019/EN_WHS_2019_Main.pdf
World Health Organisation (WHO) (2020) Fact sheets on sustainable development goals: health targets: Road Safety. Available online: https://www.euro.who.int/__data/assets/pdf_file/0003/351444/3.6-Fact-sheet-SDG-Road-safety-FINAL-10-10-2017.pdf#:~:text=The%20policy%20measures%20that%20are%20most%20efficient%20in,child%20car%20restraints%2C%20seat-belts%20and%20motorcycle%20helmets%20%282%29.
Yadav, H. (2012) A review of maternal mortality in Malaysia. eJSME 2012: 6 (Suppl 1): S142-S151
First and foremost, the biggest barrier to achieving sustainability is the life expectancy at birth, which the SDG index reported that significant challenges are present to achieving the target score. Life expectancy at birth means the average number of years which a newborn could expect to live, taking into consideration the sex and age-related death rates at the time of their birth. The World Health Organisation (WHO) set the target score of 83 for Malaysia, but the country had only achieved a score of 76.31 in 2020. However, this does not mean that no growth has been observed. In 1971, the life expectancy at birth was 65.01 years; while in 2019, it was 74.72 years. It is growing at an average of 0.33% every year (KNOEMA, 2021). Yet, this number is not ideal or fast enough, which contributes to the mark recorded by the SDG index as having significant challenges still.
One reason for low life expectancy is the general wealth of a country. In Malaysia, the distribution of mortality indicators by socioeconomic quintiles concluded that poorer districts in the country had higher death rates than more privileged areas (Mariapun, Hairi, Ng, 2016). The study conducted in 2016 showed the disadvantage of poorer areas is due to the lack of or limited access to healthcare facilities (WHO, 2019). The aforementioned limitations of access include the lack of clinics near homes, high costs in commuting and the lack of qualified medical experts available in the region. Despite the overall life expectancy in Malaysia being consistently above 70, more than 50% of the older generation live in poverty (Tey, Siraj, Kamaruzzaman, Chin, Tan, Sinnappan, Müller, 2016). This contradicts Malaysia’s achievement of SDG 1, No Poverty, on the SDG Index. The reported disposable incomes for households from the poverty-affected group could go lower than $5000 annually. Yet, the SDG index estimated that 0% of the Malaysian population lives under the poverty threshold of US$1.90 a day with historical approximates of the income distribution, educational attainment, age and GDP projections. This shows a limitation exists in the SDG Index where income gap discrepancy is not taken into account. In 2018, Khazanah Research Institute (KRI) reported that despite a fall in the official income inequality, the absolute earnings gap between the country’s top 20 percent and bottom 40 percent has doubled. In other words, everyone’s earnings increased but the rich are earning significantly more and quicker, thus putting a larger proportion of people in relative poverty. The poor, especially those living in less accessible areas, would rather spend on food than to commute for medical check ups (Taber, Leyva, Persoskie, 2015). When their medical conditions eventually worsen, their medical conditions are often too late to cure, causing the age of deaths accounting for life expectancy to reduce. Another reason the poor are more likely to have health issues is their limited access to clean water and proper sanitation or hygiene, which is what SDG 6 entails. In a joint report by WHO and UNICEF, about 8% of Malaysians have no access to properly treated water, especially among the indigenous community, while 18% of the entire population lack access to hygienic sanitation services (Thoo, Rhule, 2018). This leads to high rates of deadly parasitic infections among indigenous groups, which can go as high as 90% in some communities, and their infant mortality rate is double of other urban communities (Elmi, 2020). This evidence points to low life expectancy due to low general wealth.
Other than avoiding medical checkups and bad sanitation, a major factor contributing to early deaths in Malaysia is road traffic accidents. This relates much to another target in SDG 3, which is to achieve halving the number of deaths and injuries from road traffic accidents. In Malaysia, the SDG index stated that this target still has major challenges, as the rate of improvement is less than half of the required rate. While the long-term goal of number of fatal road traffic injuries per 100 thousand people is 3.2, it was reported that Malaysia’s indicator stood at 22.48 in 2019 (SDG Index, 2021). This could root from the lack of awareness on road safety and traffic rules (Li, Hsee, Wang, 2021). However, the Malaysian Institute of Road Safety Research (MIROS) argued that improvements are observed across 2020 (Lim, 2020), with evidence of 24.9% reduction in road fatality statistics (Lye, 2021). This statement is backed up with data provided by the Royal Malaysia Police (PDRM) that, in 2019, 6167 deaths were observed in road accidents, but in 2020, only 4634 cases were reported. However, this could be due to the reduction in road use after the Movement Control Order and national lockdown in place due to the curb of the Covid-19 pandemic (Lim, 2020). Despite the fall in statistics, the numbers still remain high, and must be monitored and improved to achieve the index targeted. The unfortunate thing about traffic deaths is that it does not discriminate based on age and gender. Yet, the awareness of road safety could be lower among children, which contributes to lower death ages that, in accumulation of data, lowers the life expectancy level. A blanket awareness-based solution through education since young is what could help prevent it from happening, it aligns with what SDG 4, Quality Education, entails. Furthermore, traffic rules and laws exist to regulate people’s behaviours on the road, which promise safety and prevent accidents. SDG 16, Peace, Justice and Strong Institutions, is to be achieved so that people feel safe when commuting, knowing that laws are obeyed and precaution is taken to protect each other.
Moving on, WHO reported that maternal conditions contribute most to the gap in life expectancy between men and women in Malaysia. The challenge could persist due to Malaysia’s historical conservative and taboo attitudes towards sex education (Khalaf, Low, Kloei, Ghorbani, 2014). The SDG Index shows challenges in achieving SDG 5, Gender Equality, given the slow growth in percentage of women of reproductive age whose demand for family planning has been met with satisfactory modern methods of contraception. The United Nations Departments of Economics and Social Affairs (UNDESA) set a target score of 100 for Malaysia, which translates to meeting 100% the demand for family planning with modern methods. However, the imputed score obtained in 2020 is only 56.1, a clear barrier to achieving SDG 3. As a potential direct result, Reproductive Rights Advocacy Alliance Malaysia (RRAAM) reported that an estimate of 100,000 abortions take place in Malaysia annually, with a high proportion of them being unsafe and illegal. In the country, legal abortion is allowed only if a doctor deems the pregnancy harmful or injurious to the mother´s life or health. Unfortunately, ‘black market’ abortion pills or unlicensed medical procedures still occur within the community, which often leads to unhygienic care, infection and even deaths (RRAAM, 2021). Other than illegal abortions, deaths during delivery occur due to several reasons, including choices of delivery at home with no professional supervision, high rate of infection and postpartum haemorrhage despite having delivered in hospitals. In 2019, it was recorded that the maternal mortality ratio was 21.1 per 100000 live births (Statista, 2020). This value is actually an improved data, given the increase in safe deliveries carried out by trained professionals nationwide, rather than by traditional birth attendants or midwives over the years (Yadav, 2012). Beyond successful deliveries, the discussion extends to satisfactory treatment for infants in ideal postnatal environments, which contributes to ensuring prolonged life expectancy in children. WHO reported that infants who die within the first month after delivery, known as neonatal mortality, often suffer from conditions associated with poor quality care at or after birth. In fact, in 2017, infections, birth asphyxia and preterm birth are the leading cause of neonatal deaths. While the risks of death among young children is higher in low-income countries, WHO found evidence that beyond 50% of premature deaths in Malaysia are in fact preventable and treatable through medical precaution and lifestyle intervention. 1 in 5 premature deaths in Malaysia was caused by cardiovascular disease, diabetes, birth defects, chronic respiratory disease and even cancer (ADB, 2018). The 2015 National Health and Morbidity Survey (NHMS) even found that at least 11.8% of children below 18 years of age are obese, which leads to further health complications including diabetes, obstructive sleep apnea (OSA), hypoventilation syndrome and cardiovascular problems. This evidence shows that lifestyle plays a part in preventing childhood obesity and other aforementioned diseases during childhood, which lower the common ages of death and shorten the life expectancy of a nation. This goes back to the lack of awareness of nutrition, which could be argued as a failure of SDG 4, where awareness through education is one of the essential methods of preventing this situation.
These aspects discussed are reasons why life expectancy at birth is a major barrier to Malaysia in achieving sustainability. There are major challenges in the rate of improving it, which is the prevalent issue in question, despite the positive outlook. These challenges could root from the lack of general awareness in health or its surrounding topics, for example, how road safety can reduce traffic death rates (WHO, 2020) and the overall diet and lifestyle of a family improve life expectancy of a child at birth (CNY, 2021). This extends to the lack of manpower in the healthcare sectors, especially specialist doctors (LabNewsAsia, 2021). The Organisation for Economic Co-operation and Developments (OECD)’s average ratio of clinical specialists is 14.13 per 10 thousand population, but Malaysia only has a disappointing 3.42 per 10 thousand population. Every year, 1000 specialists across more than 30 subspecialities are produced by the Health Ministry, but this means only a handful of oncologists or cardiologists manages to enter the industry annually, which is clearly insufficient for the massive population of 33 million (Badd, 2018). As compared to other countries like the UK, Malaysia’s healthcare landscape is very distinct. Notably, the UK’s high taxation system has promised health coverage for all residents. As a developed nation, the efficient healthcare provided has high quality with little waiting time, and most importantly, it is free of charge. In Malaysia, on the other hand, the government-based public-funded health service charges minimally at the expense of not being available immediately and would require appointments with priority given to only the most serious cases, as only 45% of all registered doctors in the country caters to about 65% of the entire population (MHTC, 2020). This systemic difference is one reason it is difficult to compare advancement in healthcare between Malaysia and other developed countries.
The barrier calls for solutions. First of all, wiser use of public funds with a greater focus on the public healthcare sector could be a long-term investment to improve the healthcare coverage in Malaysia. The introduction of rural health infrastructure and facilities, including clinics, rehab centres and midwife clinics is targeted to provide easier accessibility to primary health care for the general rural community and antenatal care for women. This helped raise the coverage of antenatal care for women to 98% nationwide, back in 2010 (Yadav, 2012). It even increased the frequency of natal check ups per woman across pregnancy to delivery date, from only 6 in 1980 to an average of 12 in 2010. This policy does not only reduce the risks of poor women neglecting their health during pregnancy, it even pushes for the excellent health of their children. Such programmes even spread awareness on family planning, post-natal childcare and importance of good nutrition, which are aimed to increase the general life expectancy. Other than mother and children, Malaysia crafted health policies for the elderly, such as the National Health Policy for Older Persons in 2008 and Plan of Action for Older Persons in 2011. The Ministry of Health and the Ministry of Women, Family & Community Development have joined forces to put focus on provision of healthcare for the elderly. These plans improve the score of life expectancy in Malaysia through social campaigns and legislation that advocates good health, wellbeing, safety and security among the elderly generation (KKM, 2020). Secondly, the government should revise the education system and devise syllabus that could contribute to building a healthier nation, including greater awareness on nutrition, disease prevention and even road safety. This point suggests an inter-goal policy with SDG 4, Quality Education, and ensures the delivery in school instills knowledge of nutrition and health awareness in the younger generation. Thirdly, partnership with medical sources on corporate levels could ensure positive health outcomes for employees and their communities. The best example currently in place is companies organising standardised Covid-19 vaccination centres for employees. Healthcare packages as such could be employed by companies to ensure a blanket treatment to employees, which is not limited to vaccinations but includes health insurance packages and medical checkups.
Conclusion
Life expectancy at birth may be the largest barrier to achieving SDG 3 and sustainability as a whole, but underlying challenges still exist within the framework of other SDGs. Focusing on too many shortcomings at the same time may cause greater problems. However, Malaysia could choose to work with other nations that share similar values to achieve the goals hand-in-hand, which fulfills SDG 17, Partnerships for the Goals. The current rate of achieving this goal is lower than required, and sees many remaining challenges, especially in terms of national spending in healthcare and education, according to reports by the SDG Index. Putting the priority on improving the general healthcare and increasing the life expectancy in the country will aid achieving SDG 8, Decent Work and Economic Growth, in the most efficient way. It is through eliminating causes that prevent the workforce from productively contributing to the economy that will push our country towards sustainable growth.
References
Asian Development Bank (ADB) (2018) Key Indicators for Asia and the Pacific 2018 Available online: https://www.adb.org/publications/key-indicators-asia-and-pacific-2018
Badd (2018) Despite Too Many Medical Graduates, Malaysia Is Seriously Lacking Specialist Doctors… Why? Available online: https://cilisos.my/despite-too-many-medical-graduates-malaysia-is-seriously-lacking-specialist-doctors-why/
Colours New York (CNY) (2021) What are the main reasons that life expectancy has increased? Available online: https://colors-newyork.com/what-are-the-main-reasons-that-life-expectancy-has-increased/#What_increases_life_expectancy
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