An Expert Discusses What Happened to the Generational Endgame Bill of Malaysia

WORDS MUHAMMAD ZAID ZAINUDDIN

FEATURED EXPERT
MUHAMMAD ZAID ZAINUDDIN
Lecturer (Anatomy)
Centre of Preclinical Science Studies
Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
IN RECENT NEWS

In November 2023, the Dewan Rakyat passed the Control of Smoking Products and Public Health Bill.

The Bill aims to regulate the sale and purchase of tobacco products, smoking materials, tobacco substitute products, and smoking devices, which includes smoking products such as electronic cigarettes or vape.

Though the passing of the bill is a positive step for the country’s public healthcare system and future generations, it has left members of the parliament and public health experts outraged.

WHY THE OUTRAGE?

The passed Control of Smoking Products and Public Health Bill is a watered-down version of the ambitious proposal initiated by our former Minister of Health, Khairy Jamaluddin.

The previous bill, dubbed the “Generational Endgame Bill”, proposed to prohibit persons born on or after 1 January 2007 from purchasing and smoking tobacco products, substitute tobacco products and smoking substances which includes e-cigarettes and vapes.

The bill passed in November 2023 removed this bold clause that would give rise to a smoke-free Malaysian generation in the future.

WHAT WOULD HAPPEN IF THE GENERATIONAL ENDGAME BILL WAS PASSED IN ITS ORIGINAL PROPOSED FORM?

In terms of impact on healthcare, the proposed Generational Endgame policy would ban smoking and vaping for those born in 2007 and onwards for the rest of their lives.

Ideally, this will create a smoke-free generation in the coming decades and save north of RM6 billion ringgit per year in terms of healthcare expenditure in the years to come.

This is stipulated by 2020 data, whereby the country had spent RM6.2 billion to treat three major diseases caused by smoking; lung cancer, heart disease, and chronic obstructive pulmonary disease. This cost was estimated to increase to RM8.8 billion by 2030 and will increase further if smoking had not been curbed.

THEN, WHY WAS THE GENERATIONAL ENDGAME CLAUSE DROPPED?

The Generational Endgame clause was dropped after considering the views from the Attorney-General’s Chambers, who claimed potential constitutional arguments.

The clause is unconstitutional.

In brief, the passing of the bill would create unequal treatment under the law between persons born before 1 January 2007, and individuals born after.

This is contradictory to Article 8 (1) of the Federal Constitution, which states that every person shall be equal under the law and have equal protection of the law.

The proposed bill would be unconstitutional as it would create two sets of laws for two different groups of citizens based on age.

Socio-economic impact on Malaysians.

An assessment of Malaysia’s Generational Endgame Policy by Oxford Economics, published in September 2023, states that the policy would be unlikely to deliver a reduction in healthcare costs. This is because future smokers would switch to illicit products.

This is on the basis that Malaysia has one of the largest illicit tobacco problems globally, with an estimated 57% of all cigarette sales in 2022 occurring through illicit channels.

An argument against the bill claims that a total ban of tobacco products would just expand the illicit tobacco market.

Impact on the economy.

The report also estimates that the legal tobacco industry in Malaysia currently supports a RM983 million contribution to the country’s GDP, RM3.3 billion in tax receipts, and 7,940 jobs.

A total ban of tobacco products would decrease these economic benefits on top of having to sustain an expensive expenditure on policy implementation, public communication, and enforcement programmes in addition to efforts needed to control the expanding of illicit markets.

IS THIS THE END OF THE GENERATIONAL ENDGAME POLICY?

Absolutely not!

The passing of the current bill is a small step forward toward achieving the Generational Endgame policy.

Though not banning the selling of tobacco products in its entirety, the Control of Smoking Products and Public Health Bill protects the younger generation from modern smoking devices, a rampant disease amongst our teenage youths.

The bill prohibits the sale and purchase of tobacco products, smoking materials, or substitute tobacco products as well as the provision of any services for smoking to under 18-year-olds, ultimately curbing the increase of smoking and vaping habit amongst children and teenagers.

IN CONCLUSION

Though our healthcare workers and policy makers are working hard to curb the rise of smoking and vaping, it is of the highest importance to maintain public awareness of the dangers of smoking and vaping. Such public awareness should be promoted and reiterated from generation to generation.


References:

  1. Bernama. (2023, December 7). Experts: Anti-smoking bill first step towards a smoke-free generation. NST Online. https://www.nst.com.my/news/government-public-policy/2023/12/987431/experts-anti-smoking-bill-first-step-towards-smoke-free
  2. Choy, N.Y. (2023, November 23). Health minister pledges to table Generational Endgame bill on tobacco before the end of Parliament sitting. The Edge Malaysia. https://theedgemalaysia.com/node/690959
  3. Harun, H. N. (2023, November 28). GEG dropped due to constitutional arguments – Dr Zaliha. NST Online. https://www.nst.com.my/news/government-public-policy/2023/11/984010/geg-dropped-due-constitutional-arguments-dr-zaliha
  4. Cabello, K. (2023, October 6). An assessment of Malaysia’s ‘Generational Endgame Policy’. Oxford Economics. https://www.oxfordeconomics.com/resource/gegmalaysia/

Can the World Truly Be Free of Fear of Cancer in the Next 25 Years? Experts Believe So

WORDS LIM TECK CHOON

On 5 September 2023, Siemens Healthineers hosted Creating a World Without Fear of Cancer: A Critical Dialogue, a panel discussion for local healthcare experts and leaders to share their thoughts on whether the world can indeed be free of fear of cancer within the next 25 years.

This may seem odd at the surface as cancer cases continue to rise—indeed, the number of cases in Malaysia is projected to double by 2040!

However, we are also seeing a rise in technological innovations that allow for more precise and earlier detection of cancer, as well as more effective forms of treatment through customized therapy that capitalizes on recent breakthroughs in genetics, immunotherapy, and more.

Hence, it is possible that, over the next 2 decades, we will see a shift from cancer as a ‘death sentence’ to a manageable long-term or chronic disease with higher survival rates. In other words, a world without fear of cancer.

We managed to get a front row seat at this panel discussion, and we’re pleased to share the highlights with you.

WHO’S AT THE PANEL DISCUSSION?
  • Fabrice Leguet, Managing Director of Siemens Healthineers Southeast Asia
  • YB Dr Kelvin Yii, Special Advisor to the Health Minister
  • Serena Yong, CEO of Regency Specialist Hospital
  • Professor Ricky Sharma, Global Head of Clinical Affairs at Varian
  • Ranjit Kaur, former President and current board member of Reach to Recovery International (RRI)
HIGHLIGHTS OF THE PANEL DISCUSSION
FEATURED EXPERT
YB DR KELVIN YII LEE WUEN
Special Advisor to the Minister of Health
  • “The National Strategic Plan for Cancer Control aims to make cancer prevention, management, and control accessible and affordable through partnerships with stakeholders,” says YB Dr Kelvin Yii. “The goal is to reduce the cancer burden, promote understanding of cancer, encourage prevention and early diagnosis to alleviate patient fears.”
  • The backbone to this effort is the Public Private Partnerships (PPPs) that involve strategic partnerships between government and private hospitals.
  • Current, most of the medical innovations for cancer diagnosis and management are centred around private hospitals, thus putting them out of reach of many Malaysians, especially those in the B40 group.
  • Through PPP, efforts such as government hospital patients getting follow-up treatments at private hospitals can be made possible while still at a reasonable cost partly funded by the Ministry of Health Malaysia.
  • Dr Kelvin admits that funding is a significant challenge at the moment.
FEATURED EXPERT
PROFESSOR RICKY SHARMA
Global Head of Clinical Affairs
Varian Medical Systems
  • “Cancer is a disease that can evolve and mutate to evade treatments,” Professor Ricky Sharma states. “The importance of patient data cannot be understated, as well as patient experiences of treatment from country to country.”
  • He underscores the importance of using patient data to deliver a personalized patient experience. “It has to be from a holistic point of view,” he elaborates. “We need to be asking important questions from the patients’ perspective: ‘Is treatment accessible? Are patients being treated with the respect they deserve? How and where are clinical decisions being made and the treatments being administered?'”
  • In light of the objectives set by the Ministry of Health Malaysia, such as the digitalization of all their healthcare facilities by 2030, Professor Ricky Sharma believes that this would allow for more accessible healthcare to people of all economic status, regardless of location.
  • For example, he cites the use of a virtual cockpit, which allows a healthcare professional to deploy customized treatment plans, analyze and provide results of imaging tests, etc to multiple hospitals without having to physically travel to those places. This would save time and improve productivity and efficiency.
  • Furthermore, digitalization of the medical workplace would allow for more flexible work hours for the staff, which is an effective way to reduce burnout. He and Ranjit Kaur bring out the fact that the medical profession has one of the highest suicide rates in the world, and this move to digitalization would help reduce the prevalence of burnout and mental issues that could help reduce such tragedy.
FEATURED EXPERT
FABRICE LEGUET
Managing Director
Siemens Healthineers Southeast Asia
  • Fabrice Leguet believes the next step in comprehensive cancer care will be to move beyond today’s fragmented cancer care landscape towards a more integrated approach.
  • He cites the shift of cancer screening from tertiary hospitals to general practitioners’ clinic as an example of such an approach. Having screening services available to clinics, especially at more rural areas of Malaysia, would go a long way in increasing the number of cancer cases detected at an early stage and, hence, the chances of better treatment outcomes and fewer deaths.
  • “By partnering with healthcare providers, we accelerate the transfer of knowledge in oncology across clinical, technical and managerial fields and fast-track the adoption of integrated innovative technologies across the continuum of cancer care,” he says.
  • “While we leverage our access to global best practices and the latest technological innovations, we take a ‘fit for purpose’ approach, where solutions are adapted to the local context in close collaboration with our partners in the region,” he adds.
  • He further says, “Every strategic partnership, every technological innovation, and every collaboration with policy makers will bring us one step closer to creating a world without fear of cancer.”
FEATURED EXPERT
SERENA YONG
Chief Executive Officer
Regency Specialist Hospital
  • Serena Yong shares that the private medical healthcare sector welcomes the partnership with the Ministry of Health via PPP programmes.
  • “By integrating insights from different fields, we can achieve more diverse and effective outcomes,” she states.
  • “Patient well-being at the heart of our mission,” she goes on to add, “so this partnership expedites the integration of connected health solutions, ensuring swifter access to care. Moreover, it facilitates the expansion of teleconsultation services and the implementation of predictive analytics on a broader scale, ultimately contributing significantly to our patients’ journey toward improved health outcomes.”
FEATURED EXPERT
RANJIT KAUR
Former President and Current Board Member
Reach to Recovery International (RRI)
  • In spite of technological advances, Ranjit Kaur reiterates the importance of community support and holistic approaches that emphasizes the patient’s emotional well-being alongside their medical treatments.
  • “In a world where technology drives improvement in various aspects of our lives, we must also prioritize empathy, timely care access and comprehensive support systems for patients, not only in Malaysia but worldwide,” she says. “Each patient journey is often daunting and worrisome, but by paying greater attention to these details, we can help individuals look beyond their diagnosis and find confidence in their ability to overcome cancer.”
  • Given that the oncologists in Malaysia are still concentrated in urban areas such as the Klang Valley, Ranjit highlights the efforts of the Ministry of Women, Family and Community Development to provide very affordable lodging for families that have to travel to these urban areas for a family member’s cancer treatments. She calls for the Malaysian government to look into providing more similar assistance and services to enable Malaysians from outside of urban areas that are traveling long distances for cancer treatments.
  • She and YB Dr Kelvin Yii agree that the government of Malaysia should prioritize the Ministry of Health in the yearly budget. Ideally, the Ministry of Health should be getting the most, if not the lion’s share of, the annual budget to allow PPP programmes to make healthcare treatments, especially for cancer, accessible to all Malaysians regardless of race, gender, and socioeconomic status.

A Health-Centric Wishlist for the Malaysian GE15

WORDS ANWAR ANIS

FEATURED EXPERT
ANWAR ANIS
Executive Director
ALTY Orthopaedic Hospital
FORMATION OF A LONG-TERM PARTNERSHIP BETWEEN PUBLIC & PRIVATE HEALTHCARE

Building upon the successful collaboration between public and private healthcare during the pandemic, a long-term policy on greater partnership will benefit both the government and the private sector, with all Malaysians being the key beneficiary.

There still are waiting lists for procedures in the public hospitals, and these can certainly be reduced if there is a structure long term arrangement for the private hospitals and centres to assist in reducing and maintaining a short wait time, especially for elective procedures which can greatly enhance an individual’s productivity, although it may not be life threatening.

GREATER FOCUS ON AN AGEING SOCIETY

These include the necessary social safety nets, proper care facilities and also post hospitalization care and support.

Here, the government should consider partnering the many physio and home care organizations to ensure patients have good compliance to post hospital care, including physio, wound care and others.

An aging population also typically means reduced mobility due to various issue—for example orthopaedic-related issues, where it can be address with proper intervention, and where needed surgery.

Government subsidy for implants, such as knee and hip implants can reduce the burden for the uninsured (which is a large majority of those who need such care) – and thus ensuring they have good mobility and thus independence even as they age.

INNOVATION IN HEALTHCARE WITH ROBOTICS, 3D PRINTING & OTHER NEW TECHNOLOGIES

The government should consider encouraging the adoption of such technologies especially in healthcare.

Grants or even personal subsidies to access such health technologies where appropriate can propel the adoption and perhaps even development of such tech.

For example, 3D printed casts or prosthesis will improve recovery and long-term quality of life. The regulatory framework also needs to support the faster adoption of such health technologies, to ensure Malaysia is able to maintain its advantage as a healthcare travel destination.

COMPETITIVE & FACILITATIVE IMMIGRATION POLICIES

Competitive and facilitative immigration policies, for healthcare travelers especially, will allow Malaysia to be serve a greater no of patients, which in turn lowers the cost of investment in health-related technologies and equipment, thus enabling more Malaysians to access it as well.

Some of our neighbouring countries continue to attract patients from a number of different countries, despite being less competitive overall than Malaysia, primarily due to the ease of arriving into the country.

Thus, they are able to invest in technology such as proton beam, as fee-paying foreign patients ensure there is a sufficient volume of patients for these advanced and latest modalities.