Overview presented to group of undergraduate and postgraduate students from UPM on 9 December 2013 in Putrajaya

1. Ministry of Health
Malaysia
NCDs in Malaysia:
Issues & Challenges
Feisul Idzwan Mustapha
MBBS, MPH, AM(M)
Public Health Specialist
Disease Control Division
Ministry of Health, Malaysia
9 December 2013
dr.feisul@moh.gov.my

2. Non-Communicable Diseases
Section
• Headed by a Deputy Director
• Consists of three main sectors:
• NCD-Cancer-FCTC
• Occupational & Environmental Health
• Mental health, Substance Abuse, Violence and Injury Program
(MESVIP)
• Two main functions:
• Policy and Program Development for the prevention and control
of NCD in Malaysia
• Monitoring and Evaluation
2

3. There are Four Major Groups of NonCommunicable Diseases;
Four major lifestyles related risk factors
Modifiable causative risk factors
Noncommunicable diseases
Tobacco use
Unhealthy
diets
Physical
inactivity
Harmful
use of
alcohol
Heart disease
and stroke




Diabetes




Cancers




Chronic lung
disease

3

4. Prevalence of Diabetes,
≥30 years (1996, 2006 & 2011)
25
20.8
Prevalence (%)
20
14.9
Total diabetes
15
8.3
10
5
0
10.7
9.5
6.5
4.3
4.7
5.4
NHMS III (2006) NHMS 2011
Prevalence of Hypercholesterolaemia,
≥18 years (2006 & 2011)
40
32.7
35.1
35
25
19.8
20
Total HPT
15
Known
10
Undiagnosed
12.8
Prevalence (%)
30
Prevalence (%)
IFG
5.3
Prevalence of Hypertension,
≥18 years (2006 & 2011)
32.2
Undiagnosed
1.8
NHMS II (1996)
35
Known
10.1
26.6
30
25
20.6
Total HChol
20
Known
15
Undiagnosed
10
5
5
0
0
NHMS III (2006)
NHMS 2011
Source: National Health & Morbidity Surveys (NHMS)
8.4
4
NHMS III (2006)
NHMS 2011

5. Prevalence of Overweight & Obesity,
≥18 years (1996, 2006 & 2011)
35
Prevalence of Abdominal Obesity, ≥18 years
(2006 & 2011)
MALES
29.4
29.1
60
54.1
16.6
20
15.1
14.0
15
Overweight
Obesity
10
4.4
5
PREVALENCE (%)
25
47.1
50
37.1
40
30.1
30
0
NHMS II (1996)
NHMS III (2006)NHMS 2011
20
NHMS 2006
70
63.2
62.8
50
44.7
40
33.6
28.6
30
48.0
61.4
NHMS 2011
63.2
56.2
55.7
60
PREVALENCE (%)
Prevalence (%)
30
FEMALES
51.0
50.4
Prevalence of Abdominal
Obesity by age groups
(NHMS 2011)
19.6
20
5
10
18-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
AGE GROUPS (years)

6. Overweight in adults, ASEAN
Region, 2010
50.0
45.0
40.0
Prevalence %
35.0
30.0
25.0
20.0
15.0
Male
Female
10.0
5.0
0.0
6

7. Obesity in adults, ASEAN
Region, 2010
18.0
16.0
14.0
Prevalence %
12.0
10.0
8.0
Male
6.0
Female
4.0
2.0
0.0
7

8. High Blood Sugars in
Adults, ASEAN Region, 2010
12.0
10.0
Prevalence %
8.0
6.0
Male
4.0
Female
2.0
0.0
8

9. Burden of Diabetes in Malaysia:
Trends & Projections by 2020
(Adults age 18 years and above)
25
5,000,000
Current
projection
4,500,000
4,000,000
Prevalence (%)
3,500,000
15
3,000,000
2,500,000
10
2,000,000
1,500,000
5
Estimated population
20
1,000,000
500,000
0
0
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Year
Est. population, 2006
Est. population, 2011
Prevalence projection, 2006
Prevalence projection, 2011
9

10. UN Secretary-General:
NCDs in developing countries are
hidden, misunderstood and underrecorded
A rapidly rising epidemic in developed and
developing countries…
… with serious socio-economic
impacts, particularly in developing countries.
Workable solutions exist to prevent most
premature deaths from NCDs and mitigate the
negative impact on development.
The way forward: These solutions need to be
mainstreamed into socio-economic development
programmes and poverty alleviation strategies.
10

11. 11

12. 65th World Health
Assembly (May 2012):
Decided to adopt a global target of
a 25% reduction in premature
mortality from NCD by 2025.
66th World Health Assembly
(May 2013):
Adoption of the Global Action plan for
the Prevention and Control of NCDs
(2013-2020), including 25 NCD
indicators with 9 voluntary global
targets.
12

13. Global Monitoring Framework for NCDs
Indicator
Targets
1.
Premature mortality from NCD
25% relative reduction in risk of dying
2.
Harmful use of alcohol
10% relative reduction
3.
Physical inactivity
10% relative reduction
4.
Salt intake
30% relative reduction in mean population
intake
5.
Tobacco use
30% relative reduction
6.
Hypertension
Contain the prevalence
7.
Diabetes & obesity
Contain the prevalence
8.
Drug therapy to prevent heart
attacks & strokes
At least 50% of eligible people receive
therapy
9.
Essential NCD medicines & basic
technologies to treat major NCDs
Availability & affordability
13
Note: Targets for year 2025, against baseline of year 2010. Reporting to the
United Nations every five years (next will be in 2015)

14. Overarching principles &
approaches in the GAP for NCD
14

15. Seven Strategies:
1.
2.
3.
National Strategic Plan for
Non-Communicable Diseases
(NSP-NCD) 2010-2014
•
•
•
4.
5.
6.
7.
Presented and approved by the Cabinet on 17
December 2010
Provides the framework for strengthening NCD
prevention & control program in Malaysia
Adopts the “whole-of-government” and “whole-ofsociety approach”
Prevention and Promotion
Clinical Management
Increasing Patient
Compliance
Action with
NGOs, Professional Bodies
& Other Stakeholders
Monitoring, Research and
Surveillance
Capacity Building
Policy and Regulatory
interventions
15

16. Multi-Sectoral Approach:
What & Why?
• Working together across sectors to improve health and
influence its determinant
• Forging new collaborations and partnerships are critical in
making progress in addressing the NCD epidemic.
• Partnership occurs at different levels:
• Individuals, families and communities.
• Government, communities and NGOs.
• Government, development partners (within countries), civil
society and, as appropriate, the private sector.
16

17. ‘Whole-of-Government’ and
‘Whole- of-Society’ approach
• ‘Whole-of-Government’ denotes
public service agencies working
across portfolio boundaries to
achieve a shared goal and an
integrated government response
to particular issues.
• Responsibility for health and its
social determinants rests with
the whole society, and health is
produced in new ways between
society and government.
17

18. Social Determinants of Health
18

19. Cost effective interventions to
address NCDs
Populationbased
interventions
addressing
NCD
risk factors
-
Excise tax increases
Smoke-free indoor workplaces and public places
Health information and warnings about tobacco
Bans on advertising and promotion
Harmful use
of alcohol
-
Excise tax increases on alcoholic beverages
Comprehensive restrictions and bans on alcohol marketing
Restrictions on the availability of retailed alcohol
Unhealthy
diet and
physical
inactivity
Individualbased
interventions
addressing
NCDs in
primary care
Tobacco use
-
Salt reduction through mass media campaigns and reduced salt
content in processed foods
Replacement of trans-fats with polyunsaturated fats
Public awareness programme about diet and physical activity
Cancer
-
Prevention of liver cancer through hepatitis B immunization
Prevention of cervical cancer through screening (visual
inspection with acetic acid [VIA]) and treatment of precancerous lesions
CVD and
diabetes
-
Multi-drug therapy (including glycaemic control for diabetes
mellitus) for individuals who have had a heart attack or stroke,
and to persons at high risk (> 30%) of a cardiovascular event
within 10 years
Providing aspirin to people having an acute heart attack
-
-
19

20. Interventions & Multi-Sectoral Action
ADVOCACY, HEALTH IMPACT ASSESSMENT  HEALTH IN ALL POLICIES
Tobacco
use
Harmful
use of
alcohol
• Excise tax increases on alcoholic beverages
• Comprehensive restrictions and bans on alcohol
marketing
• Restrictions on the availability of retailed alcohol
Unhealthy
diet and
physical
inactivity
MINISTRIES
Excise tax increases
Smoke-free indoor workplaces and public places
Health warnings
Bans on advertising and promotion
•
•
•
•
• Salt reduction through mass media campaigns and
reduced salt content in processed foods
• Replacement of trans-fats with polyunsaturated
fats
• Public awareness programme about diet and
physical activity
MSA
 Health,
Ministries including
Agriculture,
• Health
• Agriculture
Finance,
• Finance
Transport,
•Transport
 Trade and Industry
• Trade and Industry
Education,
• Education
• Labour
Labour,
• Urban planning
Urban planning,
• Justice
Justice
OTHER STAKEHOLDERS
 Other stakeholders including
Civil society,
• Industry
• Civil society
NGOs,
• NGOs
Academia,
• Academiasector,
Private
 Donor, development
partners
20
“Healthy” Settings such as Cities, Towns, Schools, Workplaces etc.

21. MSA-Entry Points
National National multi-ministerial forum
• Effective only with commitment at the highest
level, need a good driver, Health in All Policies
Inter
ministerial
Subnational City/District/Village level
• More feasible, leverage local government, collective
voice of community, government closer to the
community, local ordinances
Local
Government
Risk factor Tobacco/Alcohol/Physical Activity
• Facilitators-activism, pressure
groups, champions, international agreements
(FCTC), global reporting, more palpable
interventions, common good /common enemy
Cross sector
working groups 21

22. Current inter-sectoral mechanisms:
MOH participation
• Cabinet Committee for a Health-Promoting Environment.
• Established under NSP-NCD.
• Chaired by the Deputy Prime Minister, members consist of 10
Ministers
• National Council on Food Safety and Nutrition
• Established under the National Plan of Action for Nutrition.
• MOH is also a permanent member of various interministerial committees under several ministries e.g.
•
•
•
•
Ministry of Education;
Ministry of Youth and Sports;
Ministry of Housing & Local Governments;
Ministry of Women, Family and Social Affair.
22

23. Current inter-sectoral mechanisms
Cabinet Committee for A Health Promoting Environment
Chaired by the Deputy Prime Minister
1. Minister of Health
2. Minister of Education
3. Minister of Information, Communications, Arts & Culture
4. Minister of Rural & Regional Development
5. Minister of Agriculture and Agro-based Industry
6. Minister of Youth & Sports
7. Minister of Human Resource
8. Minister of Domestic Trade, Co-operatives and
Consumerism
9. Minister of Housing and Local Governments
10. Minister of Women, Family and Social Affairs
Main TOR: To determine policies that creates a living
environment which supports positive behavioural changes
of the population towards healthy eating and active living
23

24. Strategy 7 NSP-NCD:
Policy & Regulatory Interventions
• Main thrust of NSP-NCD
• Health promotion and education will increase awareness and
knowledge
• However changes in behaviour is strongly influenced by our
living environment
Awareness
Knowledge
Health promotion & educations
Behavioural
Change
Supportive living
environment
24
Policies & regulations

25. 25

26. Strategy 7: Policy & Regulatory
Interventions, Progress thus far…
• Guideline on marketing of foods and non-alcoholic beverages
to children (Self-regulatory, August 2013).
• Strengthening implementation of the Framework Convention
for Tobacco Control (FCTC).
• Guideline on food and beverages sold in school canteens
(revised guideline, January 2012).
• Banning of sale of food & beverages by mobile vendors
outside of school perimeters (2012)
• Health-promoting workplaces in the public sector
• Healthy menus during meetings
• Healthy vending machines
• Healthy cafeterias
There is still much that needs to be done….
26

27. Lessons learned from the past and current
attempts to work with other sectors
• Go for the path of least resistance.
• Perhaps less impact, but at least establish the link and develop
trust.
• Compromise, find the “middle path”
• You cannot force the other sectors to go 100% your way.
• Be creative – think “out-of-the-box”
• Use other existing mechanisms not previously used to move the
NCD prevention agenda forward.
• Be sensitive to current global/national trends.
• Use any opportunity to move the NCD prevention agenda
forward.
27

28. Meet their primary interestNCD prevention can be a Co-Benefit
Education
Improved
scholastic
outcome
Improved
health of
children
Agriculture
Improved
production of
fruits and
vegetables
Improved
consumption of
f&v in
population
Industries
Urban
planning
Improved
productivity
Less expenses
on sickness of
employees
Beautiful
city, more
tourists, more
money
Healthier
people
More physical
activity
28

29. Strategy 5, Research
• What’s new?
• Currently developing a research framework for developing and
evaluating behaviour change interventions in combating
obesity among Malaysians.
• JOM MAMA – a pre-pregnancy intervention for the future
prevention of obesity, diabetes and CVD.
• SEACO Demographic Surveillance Site.
• HOPE-4: Hypertension Outcomes Prevention and Evaluation 4;
cluster randomised trial of a model hypertension and CVD risk
assessment, detection, treatment and control programme.
29

30. Challenges for Malaysia
• The main challenge in policy and regulatory interventions
remain that they are mostly under the responsibilities of
ministries and departments other than Ministry of
Health
• Ministry of Health needs to take leadership role.
• Need to find a win-win solution – “mutuality of interest”.
• Economic and “political” consideration remains paramount and
needs to be acknowledged.
• The health sector needs to play a strong advocacy role.
30

31. Summary
• Preventing and controlling NCD is an urgent priority for
all countries.
• Most of the drivers of NCDs and their risk factors lie
outside the control of the health sector.
• Specific for NCDs:
• MSA is required to create enabling environments, so that healthy
choices are the easy choices.
• MSA is also required to break the cycle of poverty and NCDs.
• The prevention and control of NCDs and their risk factors have a
positive impact not only on health, but also on productivity and
economic and social development.
31

32. Health promotion champions
• Public health personnel are most
suited to become health promotion
champions
• Health knowledge
• Clinical skills
• Communication skills
• Right attitude
• Confidence among people
• Friendly
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33. Thank you
dr.feisul@moh.gov.my
Facebook: Feisul Mustapha
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