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/

How Technology Can Grow & Improve Our Healthcare Ecosystem

WORDS IRIS CHIN

FEATURED EXPERT
IRIS CHIN
Sales Director
Wistron Medical Technology Malaysia

Malaysia’s healthcare system is underinvested, overburdened, and has faced increasingly urgent calls for improvements to our national healthcare policies and strategies.

While public concern surrounding COVID-19 has largely fizzled out, the pandemic has brought to light the fractures in our public healthcare system.

This includes specialist shortages, chronic under-funding, and the need to future-proof our health infrastructure to alleviate the burden borne by hospitals.

BUDGET 2023 YET TO ADDRESS POLICY FOCUS IMBALANCE

Budget 2023 has allocated RM36 billion to strengthen the capacity of public health services. However, this has yet to address the imbalance in policy focus between hospital care and primary care. Primary care involves extending beyond healthcare facilities to continue serving a patient’s medical needs, such as through treatment and rehabilitation.

With the proper investment and development, primary care has the potential to reduce the overall cost of care and to make positive health outcomes more accessible to all Malaysians — which is why more needs to be urgently done to grow the local rehabilitation industry.

WHY GROW THE LOCAL REHABILITATION INDUSTRY?

Based on my experience in expanding primary care, rehabilitation departments tend to have the smallest budget allocation or be the most neglected in the eyes of hospital management. Some hospitals may not even be equipped with a proper setup for patient rehabilitation treatment.

But in truth, rehabilitation is—and this cannot be stressed enough —an incredibly crucial step in the recovery process.

I would go so far as to say rehabilitation can do something that traditional medicine or operational procedures would not be able to: empowering patients to live with a changed body and independently manage their health condition while recovering.

This is especially important in cases such as brain injuries (where rehabilitation can come in the form of speech and language therapy), impaired movement and flexibility, patients of advanced age, or cancer and stroke survivors.

CHALLENGES TO THE GROWTH OF THE REHABILITATION INDUSTRY

The main issue currently plaguing the industry is accessibility.

Rehabilitation services are often provided only at high-cost specialist centres in urban areas, often with long waiting lists and long waiting times too. This also indirectly means that there are fewer trained rehabilitation professionals compared to other types of medical caregiving.

Even when rehabilitation services are available, patients face high out-of-pocket expenses as they are billed on specialist hours. Rehabilitation programmes are also less commonly covered by medical financial support such as insurance plans. Referral pathways to rehabilitation services are affected by this, preventing the industry as is from growing and patients from accessing the support they need.

Taking into account the country’s ageing population, there is a greater need now than ever for rehabilitation to share a greater burden of care with healthcare facilities at large.

To fill these gaps and drive primary care growth more quickly, I believe we need to look at a game-changer that can help lower barriers to rehabilitation and make it more easily accessible — a role that technology and robotics has already started to play.

INTEGRATING ROBOTICS INTO REHABILITATION

Contrary to the name, robotic rehabilitation doesn’t mean that it removes the quintessential human element of care. Instead, it comes in the form of robotic devices that patients can wear or use during rehabilitation programmes, complementing the instructions and advice of trained physiotherapy professionals.

This technical support, so to speak, is a game-changer for rehabilitation for a number of reasons.

Not only does this open up opportunities for more treatment options, it is also easier to make global technology more readily available to a larger number of people—as compared to a mad rush to train rehabilitation specialists or accommodate geographical restrictions.

At the same time, it is a cost-effective way to offload partial tasks from physical therapists. They would have more time to meet or assist particularly complex cases, applying their knowledge to specific rehabilitation programmes that may need more specialised input.

In sum, advanced technology-assisted rehabilitation has the potential to more quickly shift the focus to growing primary care within Malaysia.

With robotics, we are now able to bring global rehabilitative technology directly to the people who need it most—with portable devices that are not only available in specialist centres but also community clinics in non-urban areas.

With increased access also comes increased awareness among the general population, which can play a significant role in improving overall health literacy and the everyday Malaysian’s perception of physical therapy.

We already have the demand for rehabilitation. A little nourishment with the right talent, policies, and funding could be all it takes to lead a new and improved rehabilitation industry within Malaysia’s medical ecosystem. It is high time we harness that potential.

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.

Empowering Pharmacists to Better Serve The Nation

WORDS LIM EN NI

FEATURED EXPERT
LIM EN NI
Chief Pharmacist
Alpro Pharmacy

For the longest time, the role of a pharmacist has been seen by many, even among those in the profession, as retailer of supplements and other healthcare products. However, due to the COVID-19 pandemic, the general public have come to recognize the values community pharmacists bring.

MEDICATION SAFETY

Very often, patients with multiple non-communicable diseases (NCDs) were prescribed with medications by different doctors, they might not be aware of possible medical contradictions. They brought these medications to community pharmacists like me, and we helped them review and explain the dosage and possible side effects of each medicine. Most importantly, pharmacists ensure the safety of patients from medication errors.

ACCESSIBILITY

Pharmacies are usually open for long hours and pharmacists offer informal, appointment-free consultation. At the height of the pandemic when clinics and hospitals required COVID-19 screening prior to consultation with doctors and patients avoided going to high-risk places, community pharmacists filled the gap by offering advice on COVID-19 and other health related matters including basic health screening and re-filling much needed chronic prescriptions through collaboration with telemedicine providers.

SOLUTION-BASED SERVICES

In recent years, many product-based retail pharmacists have transited to community pharmacists with solution-based services, such as wound-care, smoking cessation service, and diabetic-care.

THUS, COMMUNITY PHARMACIES INFLUENCE NATIONAL HEALTH CARE PROGRESSION IN POSITIVE WAYS

It is high time for the Government to endorse community pharmacists as an integral part of community health and wellness by allocating funding for programmes in support of the Government’s efforts in creating a smoke-free generation, battling against NCDs and providing preventive care for the ageing population.

The inclusion of community pharmacists in the Government’s outreach plan will benefit the country as a whole, as it will ultimately reduce medical costs, improve population health, increase the quality of healthcare in Malaysia and contribute to the country’s GDP.

This year, The International Pharmaceutical Federation announced the theme of World Pharmacist Day 2022 as “Pharmacy United in Action for a Healthier World”. This theme invites comrades from all sectors of the pharmacy profession to take part in the campaign. Regardless of culture or point of view, the core duty of every pharmacist remains—to safeguard medication safety for everyone.

Reflections of a Pharmacist on Solidarity, Price Wars & Public Service

WORDS LIM KELVIN

FEATURED EXPERT
LIM KELVIN
Pharmacist

The views and opinions expressed in this article are the author’s own. They do not reflect the opinions of his colleagues, associates, employer, and organizations he is affiliated with.

THE 25TH OF SEPTEMBER IS WORLD PHARMACISTS DAY

The official theme of the year is ‘Pharmacy united in action for a healthier world’.

The aim of this theme is to showcase the positive impact of pharmacists on health around the world and to further strengthen solidarity among the profession.

The keywords here are ‘united’ and ‘positive impact’.

THE POSITIVE IMPACT OF PHARMACISTS

In today’s healthcare landscape, pharmacists find themselves playing a new role, bestowed upon them by the public: they are the fact checkers and encyclopaedia for members of the public when it comes to everything and anything related to health. In other words, pharmacists are the new Alexa or Siri whenever someone has a question about health!

Pharmacists didn’t necessarily ask for or want this role, but it is one thrust upon us by a public that not only view us as the most accessible healthcare professionals in our society—members of the public also develop a trust in our knowledge after forming a rapport with us.

Our clients usually just walk into our outlet and obtain valuable health advice easily, with low or no cost at all.

With the advent of social media, we tend to become THE go-to person they talk to whenever they want to verify a health claim or ask about the latest health fad.

How pharmacists can step up for this role

To perform this role well, pharmacists need to be competent in their core field of pharmacotherapy, as well as to know a bit of everything in the realm of healthcare.

This is not a small feat to achieve, but it’s one that we need, to be able to guide our clients, or at least point them to the correct direction when there is no direct answer to their queries.

Having good research and analytical skills and keeping up with current updates are the 2 main paths for a pharmacist to become a good source of information.

Apart from pharmacists taking the initiative to do the necessary, our universities play a big role in instilling these skills in our pharmacy undergraduates, to enable them to cope with this new demand. So perhaps our fellow academicians can put more emphasis in this aspect.

Does it make a difference though, if we play this new role well?

Yes. Immensely.

In this world of information overload (or rather the age of misinformation), any Tom, Dick, and Harry can broadcast ‘health advice’ on social media.

As a result, members of the public are bombarded with equal amounts of information and misinformation.

Not everyone will be able to separate fact from fiction, even after googling for the answers, perhaps due to a lack of understanding of the information they found or to use the information to make an informed conclusion.

Pharmacists with years of training and experience will be in a better position to help members of the public digest complex terms and ideas into simple statements that they can more readily absorb. Even more so for the elderly and uneducated.

So, being a trusted point of reference is of utmost importance for our society right now. Apart from carrying out our core duties of being the custodians of medications, this new role positions us to impact the health of the world most significantly, positively.

PHARMACISTS IN SOLIDARITY

Then we arrive at the other key aspect of this year’s theme: unity.

Unity is not something we commonly see among retail or community pharmacies. The supposed fellowship and camaraderie had eroded more substantially in the recent years, mainly due to the intense competition between big pharmacy chains as well as price wars.

Competition was originally thought to be a positive force in keeping market prices low for the benefit of the consumer. However, when competition goes too far, it becomes unhealthy to both the profession and the consumer.

‘Tribal war’ among pharmacists?

Pharmacists have become more and more hostile to their counterparts from another ‘tribe’, due to the aforementioned competition.

They view each other as adversaries or even enemies, instead of colleagues.

This hinders cooperation between pharmacy groups. Even in times of medication shortage, a pharmacist is less likely to seek cooperation/help from other ‘tribes’, which in turn negatively impacts their clients’ welfare and the image of our profession.

Furthermore, smaller pharmacies not belonging to any big ‘tribes’ sometimes face unnecessary hostility from bigger tribes when these tribes migrate and open next to them en masse.

Almost in every town you can see 4 to 5 different pharmacies opening in the same stretch of shop-houses, and price wars inevitably make it near impossible for a stand-alone pharmacists to practice their trade professionally.

Still, price wars are good for the consumer… right?

Unfortunately, this is not always true.

With drug prices being sold at cost or below cost, businesses have to to obtain profits through alternate channels. These channels can be additional sales of legitimate products or from some other less-ideal methods.

Either way, the interest of the client is not going to be the main focus anymore. Instead, sales, incentives, and targets take precedence over the client’s genuine needs.

This is NOT what most pharmacists want, but the nature of the industry is forcing more and more of them to sing to this tune. Furthermore, the end game for many price wars is monopolistic in nature, where absurd profits are to be reaped after a dominant force appears.

But what can pharmacists do about this? How do we unite?

Needless to say, it is going to be a gargantuan task, but we have to start somewhere.

Stay professional. Always be a pharmacist first, retailer or businessman second. I’m not asking you to go on strike or forego profits. Just be sure to put our client’s needs first in our every consideration.

From here, build bonds with your fellow pharmacists. Meet more pharmacists outside your workplace, so that you can find solutions to each other’s weaknesses. Cooperation not only benefits our customers in the long run; it also changes our views on competition.

Maintain mutual respect and keep competition healthy. Compete with each other to be the better pharmacist, to see who elevates our healthcare to a higher level. Don’t just compete in terms of profit and loss.

It’s up to us to create the future we want to live in. I always say I don’t want to grow old one day and have to doubt the advice given by my pharmacist for the fear of being ripped off or being coerced into buying something.

Talk to your management. Voice out what you feel is right or wrong whenever you have the opportunity. This doesn’t have to be confrontational, if we do it the right way. Only when there are enough voices saying the same thing, will things start to change.

Lastly, do actively support our professional body.With enough support and the right mindset, our profession can be more united to under this body, and we can all serve the public better.

A LAST NOTE: TO OUR CLIENTS

Cherish and support any pharmacist that gives you more value for your health rather than your wallet.

Granted, price is a big deciding factor when making any purchase, but as long as the difference is not too big, always support the one that truly cares for your health.

Hopefully with changes in the mindsets of both pharmacists and clients, the big divide caused by price and competition will slowly narrow and allow pharmacists can be more united in serving the public positively.