HIS ROYAL HIGHNESS
SULTAN NAZRIN MUIZZUDDIN SHAH
OPENING CEREMONY OF THE AUGUST 2017
KUALA LUMPUR CONFERENCE ON QUALITY
AND SAFETY IN HEALTHCARE
DATE: 25 TH AUGUST 2017 (FRIDAY) TIME: 10.00 AM
VENUE: KUALA LUMPUR CONVENTION CENTRE
I am very happy to be here at the opening of this event, and must say that it is very
encouraging to see such an in-depth conference devoted to this topic of Quality and Safety in
Healthcare now occurring on a biannual basis. I am delighted that this event is held in Kuala
Lumpur, and I warmly welcome all the international and local experts and practitioners, here
to share their insights and experience.
2. The fact that such a conference is being hosted here not only reflects the progress
that has been made in this important area. It also reflects the major changes that have been
occurring in recent decades in healthcare provision here in Malaysia, as well as in the South
East Asian region more broadly. The very fact that this topic of quality and safety is now
becoming such a central aspect of our healthcare delivery, is itself testimony to the
modernisation and growing sophistication of our healthcare systems.
Changing healthcare needs in Malaysia and the region
3. In the past, healthcare services in the region were focussed mainly on combatting
infectious and communicable diseases, and on the delivery of basic healthcare services,
especially those concerned with maternal and child health. The success of these efforts can
be seen in the considerable improvements in overall health outcomes across the region.
These include significant reductions in infant and maternal mortality, and equally significant
gains in life expectancy. In Malaysia, these are all now at levels comparable to those of the
4. These major population-wide health improvements are now under threat, however,
from the growing epidemic of chronic non-communicable diseases or NCDs. Rates of NCDs
including heart disease, diabetes, respiratory illnesses and cancers, have increased
considerably across the region in recent decades. South East Asia now has the fastest rising
NCD rates of anywhere in the world. From only around 40% in 1990, they now account for at
least 60 to 70% of the death and disease burden in the region.
5. This regional epidemic forms part of a broader global trend in which developing
countries have become increasingly susceptible to these diseases that used to be much more
closely associated with the developed world. This trend presents major challenges for
economies and for human well-being, for which low and middle-income developing countries,
including those in this region, are particularly ill-equipped. Households and the broader
economies alike are far less able to bear the high costs of NCDs than those of better-off
countries, and the poorest sectors are often among the worst affected.
6. The healthcare needs that are created by the rising incidence of NCDs require very
different and far more complex responses than those of the past. The more traditional
concerns of maternal and child health and the prevention and treatment of infectious
diseases, delivered through community-based health clinics and practitioners, do still remain
important of course. Dengue fever remains a major challenge across the region, as do
potential outbreaks of viruses such as SARs or Zika. But responding more effectively to
NCDs and their risk factors is now the major healthcare challenge for Malaysia and the
7. As the infrastructure and workforces of the countries of the region were not developed
to provide the complex care that is required for the treatment and control of NCD, a major
transition has become necessary. The region's primary health care systems were designed to
administer vaccinations, deliver pre- and post-natal care, and provide dengue prevention
education, through networks of community health clinics. These now have to evolve into the
far better equipped and more sophisticated systems that are required to deliver long-term
acute and palliative care to growing numbers.
8. Despite the limited means available to fund this transformation, there been some
progress towards it across the region. Targeted NCD policies are now common, and
healthcare systems are slowly undergoing modernisation. Here in Malaysia, we have made
considerable investments in our healthcare sector. A national strategy for NCDs was
introduced in 2010, and more recent efforts have focussed on the upgrading and further 2
expansion of our health infrastructure. This includes public and private hospitals, medical
education and manufacturing of pharmaceuticals and equipment. We have also made
significant progress in the area of quality and safety, with the establishment of a Patient
Safety Council and conduct of information campaigns.
The heavy burden of NCDs in Malaysia and the region.
9. Populations across the developing world have become increasingly susceptible to a
number of risk factors for NCDs. For Malaysia, both its relative affluence as an upper middle
income country, and its high level of urbanisation, make it particularly vulnerable. NCD rates
here were responsible for an estimated 73% of deaths and diseases in 2015, up from only
40% in 1990. The only countries in the region with comparable levels are Singapore and 3
Brunei, both high-income countries with NCD rates approaching 80%. These levels are 4
similar to those of other higher income countries, where NCD incidence generally exceeds
the global average of around 70%.
10. Trends in Malaysia also have much in common with its middle-income neighbours in
the region and beyond however. This reflects a wider paradox, in which the marked
improvements in health status experienced in many developing countries due in part to rising
incomes and economic growth, are now being undermined by deteriorating diets and greater
exposure to other NCD risk factors, as part of these same processes of development.
Urbanization is a key aspect, being associated with various risk factors including stress,
pollution, smoking and poor diet.
11. Dietary risks represent the leading cause of the NCD burden in Malaysia, which
reflects the high rates here of both diabetes and obesity. The incidence of deaths associated 6
with diabetes has increased by 20% over the past ten years alone. A similarly high 7
incidence of diabetes is also found in Singapore and Brunei, Malaysia's most affluent
neighbours. Diabetes rates are increasing everywhere, and have risen the most in the past
25 years amongst all the major causes of NCDs. But they are generally still higher in
better-off countries, and among better-off sectors within middle and low-income countries,
due to the particular lifestyle factors involved.
12. This is in contrast to obesity, which is more closely correlated with lower income
levels, whether by population group or country. Obesity and overweight rates have doubled in
Malaysia since the 1990s, and now exceed 40%. High obesity rates are widespread in the 8
region, and found in middle-income countries including Indonesia and Thailand, and in low
income ones including Myanmar and Laos. Smoking rates are also high in these same
countries, with a startling three-quarters of all adult males in Indonesia smokers, and rates of
above 40% in Malaysia, Thailand and Vietnam. Together with air pollution, this trend 10
contributes to a heavy burden of lung and respiratory-related NCDs. Rates of lung cancer
have risen by almost 30% here in Malaysia over the past 10 years.
13. These behavioural trends are closely associated with the large and growing urban
populations in many of these countries. More urbanised populations, with their greater
exposure to processed food, tobacco and alcohol, consume these unhealthy items in
evergrowing quantities. Advertising campaigns influence this behaviour, while the relative
affordability and convenience of many processed foods for low-income families with limited
time is another factor. Only one in ten urban households in Malaysia consumes the
recommended amounts of vegetables and fruits, a good proxy for poor diet. Similar patterns 12
are observed across the region, along with greatly increased consumption of soft drinks and
14. Increased urbanization also contributes to higher levels of stress, due to modern work
patterns, environmental factors such as pollution, and poverty. The impacts of stress are
seen in high rates of hypertension, as well as in rising rates of mental health problems. In
Malaysia these are second only to cardiovascular issues in the overall disease burden.13
Depression makes up half of all mental health problems here, with males and the younger
generation particularly vulnerable. Along with diabetes and obesity, rates of this type of NCD
have also shot up here over the past decades. While only 10% of the population here
reported mental health problems in the 1990s, nearly 30% are doing so today.
15. Increasing rates of chronic disease are also of course associated with rising longevity
as a result of life expectancy gains. This is partly why the overall incidence of NCDs
continues to rise in higher income countries, despite more effective treatment and some
successes in addressing various risk factors. The demographic changes resulting from
increased life expectancy in this region mean that we will also have growing numbers of
people who are living longer, but suffering from a wide range of chronic conditions. Rising
rates of degenerative brain diseases already reflect this trend.
16. This dynamic is expected to be exacerbated further by elevated current levels of youth
obesity, diabetes and smoking in the region, as well as high rates of under-diagnosis. Even
best case future scenarios, based on assumptions of positive policy impacts, suggest that
these trends will only continue and intensify further. This underlines again the importance of
far greater preparedness among the health systems of the region in order to be able to
respond to the complex needs that this epidemic is creating. But it also points to the need to
look more deeply at the underlying dynamics that are driving the risk factors in developing
countries, including those associated with the development process itself.
NCDs as diseases of poverty as much as affluence
Ladies and Gentlemen:
17. NCDs used to be associated with developed rather than developing countries. They
even used to be called diseases of affluence. Many of the risk factors are closely associated
with 'modern' ways of life, from higher disposable incomes, to the unhealthy diets and other
habits that these fund, to pollution and stress. Richer countries do still have larger
proportions of their populations suffering from NCDs, which are also responsible for a greater
proportion of their death and disease burden than elsewhere. But the overall numbers
suffering from NCDs are now higher in developing countries, where many of these same risk
factors are increasingly present.
18. Unlike in the past, these lifestyle factors are now no longer associated only with
affluence, but also with poverty. Exposure to both behavioural and environmental risk factors
seems to be occuring at lower income levels than the past, and at earlier stages of
development. And not only are lower and middle-income countries bearing a growing NCD
burden, but within these countries, the least well-off sections appear to be particularly
vulnerable. They are also of course as mentioned, the ones least able to bear the severe
economic impacts and costs of the epidemic.
19. The lack of comprehensive public healthcare provision in many developing counties
greatly increases the burden that falls directly on households themselves, and
disproportionately on poorer households. Poorer households in high-income countries are
also both more susceptible to certain risk factors, and less able to bear the costs of NCDs.
The negative economic impacts are again far greater where public provision is weaker, and
insurance schemes less effective. In developed and developing countries alike, the effects at
household level are then felt in the broader economy, through reductions in productivity due
to the accumulation of working hours lost. This is in addition to the direct costs associated
with the healthcare response.
20. The major challenges that developing countries face in responding effectively to rising
rates of NCDs, are increasingly being recognised. Recent progress in the development of
more comprehensive and effective global strategies to address NCDs, now being
implemented across the region, is very welcome. This more integrated approach, which 15
includes a greater focus on preventative measures, should gradually contribute to slowing
the spread and lessening the impact of the epidemic.
21. But greater efforts must now also be focussed on addressing other aspects of the
NCD epidemic. These include the substantial vested financial interests in the continued
consumption of unhealthy products such as tobacco, alcohol, processed food and soft drinks.
These economic interests operate at both regional and global level. The manufacture of
various of these consumables constitutes a leading sector in many, if not all, of the region's
economies. This makes it far more difficult for governments even to consider introducing
policies aimed at reducing demand for them.
22. There are also of course considerable global financial interests invested in the
continued consumption of the products that contribute to the NCD epidemic. Multi-national
companies have increasingly targeted developing countries, driven in part by the growing
restrictions in their developed country bases. These same regulatory efforts have, however,
played a key role in reducing rates of smoking and even obesity in some developed
countries. This has generally been in combination with concerted and well-designed public
23. Such an approach must now become part of more fully integrated strategies in this
part of the world as well, including greater regulation as part of prevention. Although these
aspects of the NCD epidemic are perhaps more difficult to address than some of the more
purely health-related ones, and they certainly go beyond the usual purview of the health
sector, they must also be tackled if the trend is to be brought under control.
Ladies and Gentlemen
24. As the NCD epidemic continues to grow and intensify, we must also continue to
strengthen our ability to respond effectively. Events such as this conference contribute to this
process, as we benefit greatly from the exposure to global best practice that they provide.
This helps to deepen our understanding and practice in specific areas such as health and
safety. And this in turn forms part of our broader efforts to build a strong modern healthcare
system in the country. It now gives me great pleasure to declare the conference open.