The findings from the National Health and Morbidity Survey 2023 report recently announced by the health minister unfortunately confirms that Malaysians are currently living amidst a non-communicable diseases (NCD) crisis.
More than two million people are living with three types of NCDs such as diabetes, hypertension, and high cholesterol. Half a million are living with four NCDs, including obesity.
Malaysia now has the highest rate of diabetes in the Western Pacific region, and one of the highest in the world, costing around RM 3.1 billion annually. It is expected that seven million Malaysian adults aged 18 and older will be either prediabetic or diabetic by next year. Many of them will be undiagnosed and unaware of their status.
The Galen Centre makes three recommendations for urgent action in light of these worrying findings.
Firstly, we welcome the health minister’s call for urgent action on sugar consumption to reduce diabetes among the population. However, rather than introduce a grading system for sugar content, we believe that the government would see better and immediate results by removing sugar as a gazetted item under the Price Control and Anti-Profiteering Act 2011.
Price controls on sugar are a key factor of excessive sugar consumption in our food. The price of sugar is currently being kept artificially low and under the ceiling price due to incentive payments made by the government to the sugar industry, resulting in Malaysia, a non-sugar producing country, to have among the lowest sugar prices in the world.
Cheap sugar is driving higher uptake. These tax-funded subsidies work against any War on Sugar, and are expected to cost the government between RM500 million to RM600 million annually.
It does not make sense to go to war against sugar, but at the same time, subsidising it. These incentive payments should be stopped. With diabetes costing more than RM3 billion annually and other cardio-renal-metabolic diseases such as kidney disease, we cannot afford half measures.
Secondly, a recent proposal to ban 24 hour eateries was met with furious opposition. However, it is a fact that the food culture in this country is actually harmful, especially nighttime consumption of high calorie food such as nasi kandar, mee goreng, and burgers.
Studies have shown that eating at night leads to twice as much weight gain, or 500 more calories per day than those who limited their eating to daytime hours.
When combined with sedentary lifestyles, it is not a surprise that at least half of the population are either obese or heading there. The costs of treating the resulting medical conditions such as cardiovascular disease is already costing billions each year.
While it seems impossible to ban 24-hour eateries or limit a person’s freedom to choose when and what to eat, we propose that the government impose a 10 per cent midnight surcharge for all food and beverages sold in licensed food establishments between 12.00 am and 6.00 am.
The funds collected can be channelled and earmarked for treatment of NCDs, including diabetes, cardiovascular disease, kidney disease, hypertension, and cancer.
It is estimated that the amount collected from such surcharges could exceed the RM5 billion in sin taxes currently collected from cigarettes and alcohol. It would also help deter nighttime eating while increasing the coffers needed to treat NCDs.
Finally, with the coming operationalisation of the Control of Smoking Products for Public Health Act 2024 (Act 852), the government must consider increasing the existing excise duties on cigarettes and tobacco products which have remained unchanged since 2015, and limiting nicotine vape to 2 per cent.
The suggested excise tax rate is RM0.77 per stick, equivalent to 61 per cent excise tax of the retail price. This can generate additional tax revenue of RM771.8 million. Together with the expected tax collected from nicotine vape, this will bring in at least RM 1.2 billion.
Vapes with 5 per cent nicotine content are commonly found in Malaysia. The maximum nicotine concentration in countries which regulate vape is 2 per cent.
The government must place a hard ceiling on nicotine vape at 2 per cent to manage addiction and in line with the practice of other nations. This is not an area where we want to be outstanding.
It is sobering to note that Malaysia spends an estimated RM16 billion annually treating smoking-related illnesses such as cardiovascular disease and lung cancer. How will we continue to pay for the treatment of these chronic diseases which will last for years and cost billions?
The money must come from somewhere. With 70 per cent of the population dependent on the public health care system, this expenditure will come out from the public purse.”
Azrul Mohd Khalib is the chief executive of the Galen Centre for Health and Social Policy.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
