THE prevalence of diabetes among Malaysians has become a hot topic. It was reported that up to five million Malaysians are projected to have the disease by the end of the year.

The debate over 24-hour restaurants surfaces each time the sorry state of public health is mentioned.

For some, limiting their opening hours to prevent late-night bingeing is only one way to address the issue of chronic illnesses. But let’s look at the problem objectively.

We close the 24-hour mamak to deny football fans their customary Milo ais (320 calories) and two roti canai (600 calories).

Now the fan watches it at home – with a bag of chips (530 calories) and a can of soda (130 calories).

Similarly, if the mamak stalls were closed, shift workers could head to a 24-hour convenience store and make themselves some instant noodles and a soft drink.

So isn’t the real problem unhealthy food choices?

What if the bag of chips or sugary drink were to be taxed on its salt and sugar content? And the prices of vegetables and healthy meats were subsidised?

This is a paradigm shift, a very difficult one, to change the mindset of people from one of survival (filling foods) to one of health (nutrition).  It could be one we may not yet afford but we should not let our finances force us to further delay addressing the problem.

We need to hold people accountable for their health choices; it is as simple as that.

If we are wise enough to impose a sugar tax and consider a generational tobacco ban, we certainly should be looking into this.

The present overcrowding at government healthcare facilities is largely due to hundreds of thousands of Malaysians collecting heavily subsidised medicines to control their sugar and blood pressure levels.

This bill, growing heavier by the year, is hindering us from improving our education system, healthcare delivery system, national security, and defence .

When our national healthcare was set up in 1957, the average life expectancy of Malaysians was much lower at 57.1 years. Today it is 76.6 years. That’s a 25% increase.

The cost of medicines has gone up and our understanding of health has improved tremendously. Chronic illness was not a common diagnosis in the past, nor was social and mental health as much discussed as it is today.

We need to alleviate the healthcare pressure on the government. This can be achieved by pushing back the responsibility to the local and state governments, who have limited access to funds but stronger ties to the community.

Perhaps we could also look at decentralising the healthcare system, like it has been done in Britain or Canada.

Perhaps we should look at joint contributions. Singapore quickly identified and solved the problem in the 1970s. Norway, which has the best healthcare system in the world, spends 6.6 times more on health per capita than we do, but still requires its citizens aged above 16 to cough up RM1,000 per year on medical insurance.

Norwegians live longer than us, have a lower prevalence rate of virtually all medical conditions and have a much higher doctor- and specialist-to-patient ratio in nearly all medical specialisations.

The overhaul of public healthcare is long overdue, and so is the injection of personal responsibility.

Perhaps a starting step could be mandatory counselling and monitoring for stubborn patients and penalties in the form of subsidy reduction for them.

This has been studied and implemented in various forms for insurance subscribers and private sector employees who get medical coverage from their companies.

It is time to implement personal responsibility for the public who burden the healthcare system.. – April 25, 2024.

* Emmanuel Joseph firmly believes that Klang is the best place on Earth, and that motivated people can do far more good than any leader with motive.