Malaysia Quality of Life

HEALTH

Vision for Health

“Malaysia is to be a nation of healthy individuals, families and communities, through a health system that is equitable, affordable, efficient, technologically appropriate, environmentally adaptable and consumer-friendly, with emphasis on quality, innovation, health promotion and respect for human dignity, and which promotes individual responsibility and community participation towards an enhanced quality of life. The mission of the Ministry of Health towards the achievement of the Vision for Health is to build partnerships for health, to facilitate and support the people to attain fully their potential in health, to appreciate health as a valuable asset and take positive action to improve further and sustain the health status of individuals, families and communities through health promotion, prevention, curative and rehabilitative services so as to enable all to lead a socially and economically productive life, and enjoy a better quality of life”.

Source: Ministry of Health, Malaysia

Considerable improvements were achieved in the health status of the nation. This was the direct result of the Government’s commitment and advocacy of health as a social responsibility. This commitment is based on the recognition that health is an integral part of the development process and instrumental to effect socio-economic change and hence, the quality of life. Malaysian health care is a mixed public-private system, which operates in parallel with heavy involvement of the public-sector in the provision of health services. Malaysia’s health status is comparable to that of developed countries especially in terms of life expectancy at birth and infant mortality rate.

The health status of the population, measured by the Health Index in the MQLI, mirrors the achievement of the health sector. During the period 1990-2002, significant improvements were made in the standard of health as reflected by the increase in the health index. The health index, as measured by the infant mortality rate, life expectancy at birth and the doctor population ratio, increased by 15.8 points. This was mainly due to the implementation of programs for the improvement of the quality of health services.

The infant mortality rate, one of the most significant indicators of the overall health and nutritional status of the nation, improved from 13.3 per thousand live births in 1990 to an impressive 5.7 in 2002, indicating the country’s achievement comparable to that of developed countries. Rural and public health programs such as immunization, maternal and child-care, nutrition, water sanitation and health education contributed to this improvement.

Life expectancy at birth for both male and female improved from 68.9 to 70.4 years and from 73.5 to 75.3 years, respectively from 1990 to 2002. This is largely attributed to significant improvements in access to health and medical services as well as the increased emphasis on promotive and preventive services.

The doctor-population ratio also improved from one doctor per 2,582 in 1990 to 1,406 in 2002. The increase in the number of doctors was due to concerted efforts that were taken during the period, including the expansion in the intake of medical students into local institutions of higher learning, recruitment of foreign doctors and specialists as well as the re-employment of retired doctors and specialists on a contract basis.

Major Measures Undertaken to Improve Health, 1990-2002

Promotive and Preventive Health Services

• Healthy lifestyle campaigns focusing on healthy behavior, healthy eating, exercise and fitness, good mental health and abstinence from smoking and dadah emphasized Promotion of Healthy Families in 2001 and promotion of Healthy Environment in 2002.
• In 2001 CERAH or Cegah Rokok, Alkohol dan Dadah was introduced to encourage youth to adopt a healthy lifestyle.
• Health education programmes were intensified to provide knowledge and information towards ensuring a healthy lifestyle. These include programmes on Cardiovascular Disease (1991), Acquired Immunodeficiency Syndrome (AIDS)(1992), Food Hygiene (1993), Promotion of Child Health (1994) and Prevention of Cancer(1995).
• An expanded program of immunization was continued for the prevention of diphtheria, prussic, tetanus, poliomyelitis and tuberculosis.
• Nutritional programs were incorporated into the Program Pembangunan Rakyat Termiskin (PPRT).
• The food quality control program was continued to ensure that the public consumed safe and nutritious food.
• The environmental health and sanitation program continued to ensure safe water to rural communities.
• The National Institute of Occupational Safety and Health was established in 1992 to provide training in occupational safety and health, disseminate information on preventive measures, promote healthy and safe practices at work and conduct research as well as provide consultancy services.

Curative Health Services

• Curative health care facilities such as hospitals and polyclinics improved significantly through the provision of upgraded services and modern diagnostic equipment which included Magnetic Resonance Imaging (MRI), Computerized Tomography (CT) Scan, mammography equipment as well as echo cardiography and stress test equipment.
• Specialist facilities and services were improved
• General outpatient and pharmaceutical services were expanded

Medical Research and Development

• Medical research and development activities were aimed at improving the diagnosis, management and prevention of infectious diseases with emphasis given to biomedical, clinical, epidemiological and behavioral research.

HEALTH as indicator of QOL

Definition of Quality of Life

The degree to which a person enjoys the important possibilities of his/her life. Possibilities result from the opportunities and limitations each person has in his/her life and reflect the interaction of personal and environmental factors. Enjoyment has two components: the experience of satisfaction and the possession or achievement of some characteristic, as illustrated by the expression: "She enjoys good health." Three major life domains are identified: Being, Belonging, and Becoming. The conceptualization of Being, Belonging, and Becoming as the domains of quality of life were developed from the insights of various writers.

The Being domain includes the basic aspects of "who one is" and has three sub-domains. Physical Being includes aspects of physical health, personal hygiene, nutrition, exercise, grooming, clothing, and physical appearance. Psychological Being includes the person's psychological health and adjustment, cognitions, feelings, and evaluations concerning the self, and self-control. Spiritual Being reflects personal values, personal standards of conduct, and spiritual beliefs which may or may not be associated with organized religions.

Belonging includes the person's fit with his/her environments and also has three sub-domains. Physical Belonging is defined as the connections the person has with his/her physical environments such as home, workplace, neighbourhood, school and community. Social Belonging includes links with social environments and includes the sense of acceptance by intimate others, family, friends, co-workers, and neighbourhood and community. Community Belonging represents access to resources normally available to community members, such as adequate income, health and social services, employment, educational and recreational programs, and community activities.

Becoming refers to the purposeful activities carried out to achieve personal goals, hopes, and wishes. Practical Becoming describes day-to-day actions such as domestic activities, paid work, school or volunteer activities, and seeing to health or social needs. Leisure Becoming includes activities that promote relaxation and stress reduction. These include card games, neighbourhood walks, and family visits, or longer duration activities such as vacations or holidays. Growth Becoming activities promote the improvement or maintenance of knowledge and skills.

- Quality of Life Research Unit, University of Toronto

The purpose of the Quality of Life Index (QOLI) is to provide a tool for community development which can be used to monitor key indicators that encompass the social, health, environmental and economic dimensions of the quality of life in the community. The QLI can be used to comment frequently on key issues that affect people and contribute to the public debate about how to improve the quality of life in the community. It is intended to monitor conditions which affect the living and working conditions of people and focus community action on ways to improve health. Indicators for the QOLI include:

• SOCIAL: Children in care of Children´s Aid Societies; social assistance beneficiaries; public housing waiting lists etc.
• HEALTH: Low birth weight babies; elderly waiting for placement in long term care facilities; suicide rates etc.
• ECONOMIC: Number of people unemployed; number of people working; bankruptcies etc.
• ENVIRONMENTAL: Hours of moderate/poor air quality; environmental spills; tonnes diverted from landfill to blue boxes etc.

Quality of Life is the product of the interplay among social, health, economic and environmental conditions which affect human and social development.

Ontario Social Development Council, 1997