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Knowledge Centre: for Healthier Living

Malaysian Society of Hypertension 9th Annual Scientific Meeting Official Opening Speech
Contributed by
Dato' Sri Dr. Hasan bin Abdul Rahman
15 Feb 2012 10:37AM
15 Knowledge articles

Hypertension is the world’s number one risk factor for cardiovascular diseases, which includes strokes and heart attacks; contributing to 17.5 million premature deaths worldwide. Scientific research has shown that 54% of strokes and 47% of coronary heart diseases were attributable to hypertension.

The rising epidemic of non-communicable diseases or NCD is a global phenomenon. In September 2011, world leaders have met at the United Nations in New York. All Member States have unanimously adopted the United Nations Political Declaration on the prevention and control of NCD. This was only the second time a health issue was discussed at the highest global forum, the first being HIV/AIDS in 2001.

Malaysia is not spared from this rising epidemic of NCD and NCD risk factors, including hypertension. An analysis conducted using the Third National Health and Morbidity Survey 2006 data has shown that 63% of Malaysians had at least one cardiovascular risk factor, 33% had two risk factors and 14% had three or more risk factors. Hypertension remains the number one risk factor with a prevalence rate of 43% in adults above 30 years of age, followed by central obesity (37%), hypercholesterolaemia (24%) and hyperglycaemia (15%).

The results of the latest population-based survey, the 2011 National Health and Morbidity Survey on NCD were recently announced by the Honourable Minister of Health in December 2011. In general, the prevalence of NCD risk factors in Malaysia continues to rise. Now we have about 2.6 million adult Malaysians who have diabetes, 5.8 million Malaysians with hypertension, 6.2 million with hypercholesterolaemia and 2.5 million with obesity.

What is even more worrying, the proportion of those undiagnosed continues to increase further. So now, for every one person diagnosed with diabetes, there’s another one who is undiagnosed; for every two known hypertensive, three is undiagnosed; and for every one person with diagnosed hypercholesterolaemia, another three has high cholesterol but undiagnosed. As healthcare professionals, you already know the consequences of late diagnosis in terms of disease control and risk of developing complications.

It has been said that in the management of patients with chronic NCDs, the best doctor is the individual himself. If you look at current literature examining the factors that influences achievement of treatment targets, we can group them into three main categories. (i) Firstly, healthcare provider factors; (ii) secondly, patient factors; and lastly (iii) health systems or delivery of care factors. A lot of efforts are concentrated on the first and last factors, perhaps because these factors are directly under our control and therefore easier to modify. Patient-related factors are sometimes dismissed because they are more difficult to modify, and being thought of as “beyond our control”.

But, I would like to challenge all of you here this morning. If it is not our responsibility as the healthcare provider to modify the patient-related factors, then whose responsibility is it? Do we continually hope that the patient would have a change of heart somehow and suddenly becomes compliant to treatment?

I firmly believe that appropriate management of NCD patients is beyond prescribing the best and latest drugs. Even then, we can never be assured to their compliance in taking their medications. Of course, during our clinic consultations we do conduct patient education, however one-way communication, with us dictating to the patients on what they should and should not do, may not be the best approach in changing people’s behaviour.

There is a saying, “Only a fool does the same thing over and over again, expecting different results”. We have to move beyond our “business as usual” way of delivering health education to our patients. In the developed countries, there is already a shift from “patient education” to “patient empowerment”.

 As a developing country, we have to move forward as well. We need to develop a better approach to empower our patients to change their behaviour. This is however not easy to develop as a lot of factors influences behaviour, including ethnicity and socio-cultural factors. While we can learn from the overseas model for patient empowerment, substantial work must be done to adopt and adapt these models to work in each of your distinct working and community environment. Empowering patients also requires a team effort. Everyone must work together, doctors, nurses, assistant medical officers, dieticians, nutritionists and other health care providers working within a healthcare facility.

Nurse and PatientIn addition, it is not just about quantity, but more importantly, quality. We need healthcare providers who are not only competent technically with the necessary knowledge and skills, but who are also creative and innovative. At a recent Conference for Public Health Specialists in 2011, I have shared with the audience of the expectation of our government to improve service delivery. The government expects us to (i) firstly, practice a creative and innovative work culture; (ii) secondly, be responsive; (iii) thirdly, consider value-for-money, or cost-effectiveness; and (iv) lastly, always practice professional integrity. I would like to continue echoing the same expectations to all of you today.

Prevention of NCD goes beyond the health sector, both public and private. The factors influencing our behaviour relating to healthy living lies under the responsibility of many other ministries and sectors other than health. Therefore to effectively prevent NCD in Malaysia, we need to engage not only the healthcare sector and the public, but even the other government agencies and the other private sector besides health. Under the National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2011-2015, several initiatives have been undertaken under Strategy 7: Policy and Regulatory Interventions.

To improve school health, the Ministry of Education has already agreed on 18 January 2012 to implement the new healthy eating guideline in schools, which consists of three components (i) measurement of students BMI twice a year and reporting the results to parents. Students found to be obese will be referred to a healthcare professional; (ii) healthy menu in school canteens; and (iii) depiction of calorie contents of food sold in school canteens.

The Ministry of Health is also currently in discussion with the Department of Local Governments to standardise the by-laws on prohibition of sale of unhealthy food and drink outside of school perimeters. The working paper is currently awaiting presentation to the Majlis Negara Kerajaan Tempatan (or National Local Government Council) chaired by the Deputy Prime Minister.

Following the National Food Safety and Nutrition Council Meeting on 8 December 2011, the Ministry of Health was given the mandate to develop a guideline to control marketing of food and beverages to children in Malaysia by 2012. This was further reiterated by the Health Minister during a dialogue with food and drinks industries, held on 16 December 2011. During this meeting, the food and drink industries have made several commitments to increase the production and promotion of healthy food choices, including those with reduced sodium, and adopt an active role in multi-sectoral partnerships with the MOH.

In October 2011, I mooted the idea for Malaysia to have an Anti-Obesity Law by year 2020. The exact details of this proposed law is still being developed by the relevant divisions within the Ministry. I envisioned that the implementation will be developed in stages, looking at different settings along the life-course i.e. from childhood, adolescent and adults. In principle, such a law would not be discriminative in nature against those who are obese, but will ensure that Malaysians value their health and becomes a strong motivator to adopt a healthy lifestyle.

And lastly, the Ministry is also currently in the process of formalising the Salt Reduction Strategy for Malaysia. A Technical Working Group has been formed, and in line with UN Political Declaration on NCD, I hope that this initiative can be completed this year.

Just to share with you: Singapore conducted a 24-hour urine sodium analyses in 2010, and found that the individual’s daily salt intake was at 8.3 gm, more than 60% above the recommended level. The latest data for Malaysia is from the 2003 Malaysian Adult Nutrition Survey, which showed 6.4 gm; however data obtained through dietary surveys then to underestimate sodium intake. Since Singaporeans and Malaysians share the same love for salty food, and looking at our higher prevalence of hypertension compared to Singapore at 23%, means that our sodium intake must surely be more than Singaporeans. The Ministry has just completed a 24-hour urine survey amongst MOH staff throughout Malaysia, which I hope the results will be published soon. So for 2012, we will have an estimate of the true intake of sodium amongst Malaysians.

Lastly, intellectual gatherings, such as this conference, provide an excellent platform for sharing innovative and creative ideas and initiatives in improving the quality of care to patients with hypertension and cardiovascular diseases. I hope that the Malaysian Society of Hypertension continues to promote public education on hypertension, as well as provide a strong voice in supporting the policy and regulatory interventions introduced by the Ministry of Health and the government.


Additional photos from public domain have been added solely for illustration purpose.

Photo Credit to:       
First Photo by Leo Reynolds l
Second Photo by HelpAge l

tags: Kementerian Kesihatan Malaysia