- 2 days ago
Join Prof. Dr. Murallitharan M., Managing Director of the National Cancer Society Malaysia, as he unpacks the critical intersection between healthcare and economics.
This session explores how economic principles shape healthcare systems, influence policy decisions, and impact access, quality, and sustainability of care.
With rising healthcare costs and increasing disease burden, Healthonomics offers valuable insights into how smart investments and evidence-based strategies can lead to better health outcomes for individuals and societies alike.
This session explores how economic principles shape healthcare systems, influence policy decisions, and impact access, quality, and sustainability of care.
With rising healthcare costs and increasing disease burden, Healthonomics offers valuable insights into how smart investments and evidence-based strategies can lead to better health outcomes for individuals and societies alike.
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00:00Thank you for joining us. This is The Economy. I'm your host, Ibrahim Sani.
00:122026 is also quite a year for Malaysia as we are grappling with the silver economy status.
00:18We're also trying to understand a little bit better in terms of how we're managing the reproductive rate.
00:22That stands at 2.1 right now, barely making it in terms of trying to break through growing the population.
00:30And of course, trying to see how the healthcare sector is going to impact the economy.
00:34Here to discuss this and more is the renowned professor, Dr. Murali Taren Munisamy, or Dr. Murali, as we all know him.
00:43The last time I spoke to him was roughly about four or five years ago, so it's a good time to catch up on things.
00:48Dr. Murali, very recently you wrote on a very interesting piece in The Edge where you talk about the economics of healthcare
00:57and how healthcare and health is impacting the economy.
01:01Maybe you would like to walk through with us in terms of what was the genesis or the philosophy behind you coming up with that op-ed
01:08on how healthcare is impacting the economy and vice versa.
01:12Lovely. So first of all, thank you so much for having me.
01:15It's always a pleasure and an honour to be on anything with you, really.
01:20So I think the problem is, I think, for two disconnects that I think we keep on facing in terms of with stakeholders,
01:29with policy makers and that, a lot of people think that health is a cost.
01:33You know, it's either, you go at two ends of the spectrum.
01:38They either see healthcare as a cost, it's an expenditure.
01:42You know, no one thinks about healthcare as an investment.
01:45And that's a case to be made for that as well.
01:49But there's also a very interesting perspective now that healthcare is also a big revenue generator.
01:55It's also a kind of money earner for individuals, for the country.
02:02And that's where there's kind of a disconnect, if you will,
02:08between these two different, very different perspectives of looking at health.
02:12But also on an individual level, health impacts us in different ways economically.
02:18So with good health, you're able to generate a lot more income.
02:22But you also spend quite a bit of your income on health as well.
02:27So it's something which is very correlated, I think very entangled,
02:33but people don't kind of understand or actually work towards balancing these things out.
02:40But of course, you look at developed countries, very highly developed countries,
02:44you're looking at paternity leave being a mandatory one year.
02:48Maternity can go up to two years.
02:50And that's the reason for this, especially when it comes to breastfed babies
03:02that have a lifelong impact.
03:04For instance, you can see health results, healthcare of the individual reducing risk significantly
03:12if it's being breastfed for up to two years.
03:15So this kind of thinking is also quite important because it's not a loss on the productivity of the nation
03:21when a person, say a mother, takes off for, let's say, one year or up to two years.
03:27It's actually going to save the country a significant amount of economic savings
03:33because then the public health care system is reduced, lifelong care is going to be reduced,
03:39and you're going to have a much more productive people, a citizen running into the 65 age or 70 year old age.
03:48These are all fantastic lifelong learnings and we know about this.
03:51I'm surprised that we don't know, we don't apply it here in this country.
03:54Absolutely.
03:54I think, as you say, the thing is, people allude to this, they think about it,
04:01but no one is kind of incorporating it into how we're actually exercising our kind of fiscal thought processes at all.
04:10Yeah.
04:10So things like, for example, I can even tell you, breastfeeding a child even reduces the risk for the mother to pick up cancer.
04:17Yeah.
04:18So that's another...
04:18Oh, so it works both ways.
04:20Absolutely.
04:21So there's just a lot of interplays, but in our world, we consider that,
04:25hey, you're not coming to work.
04:27It's like...
04:28Yeah.
04:28And unfortunately, and this is a sad reality, women on long maternity leaves,
04:34or even those who are taking out time from the workforce to take care of their kids,
04:39they actually face an imbalance.
04:41Their careers never go back to normal.
04:43So it's...
04:43I refuse to believe that our current health minister, Dr. Zul, is unaware of this.
04:48I'm pretty sure he is.
04:49And I'm pretty sure a lot of our friends over at KKM is also thinking about it.
04:54And, you know, we have a lot of medically qualified MPs right now being voted into the office of...
05:01They were not yet.
05:03What is stopping us from changing our health care policy to reflect the upside on the economics of things when it comes to health care
05:11and having good lifelong health care with economic policies?
05:14So, ironically enough, almost all of economic policy lies outside health care.
05:21And that's the major disconnect.
05:24Health care, actually, in this country, the way it's being viewed now, is really sick care.
05:29The Ministry of Health should be called the Ministry of Illness.
05:32Because everything that they govern is around illness.
05:36When you're healthy, actually, the Ministry of Health has nothing to do with you.
05:40In fact, we have very little kind of interaction with those who are healthy within the health care landscape.
05:47But everything to do with keeping you healthy lies outside that.
05:50It's with every other ministry, if you will.
05:52It's with your workplace.
05:54It's with your residential kind of area.
05:58So, it's within those pockets that we actually have no interaction.
06:02And I would say we have a poorer kind of acceptance of health care within this ecosystem.
06:10So, once you're sick, off you go.
06:12But before that, there's all these different things that you do which impact your health care and impact your economic kind of output or your depreciation value, if you will.
06:28But these lies outside health care.
06:30For example, we had a very interesting discussion when the government first came up with this My50.
06:37Remember this idea of I'm paying for you to get public transport.
06:41So, sure, it's a subsidy.
06:43But interestingly, if you compare head-to-head, us versus Malaysia, Kuala Lumpur especially, versus any other metropolitan city in the world, our commuters just walk a lot less.
06:57Yeah.
06:57So, we struggle.
06:58There's a study on that I just read.
06:59Yeah, absolutely.
07:00We struggle to reach 10,000 steps or whatever.
07:03If we could, Malaysians would drive into the toilet bowl.
07:06Yeah, yeah, yeah.
07:06They're not going to get andas.
07:07But every other urban city, because you prioritise and you incentivise, that's an economic incentive of public transport, you get an inordinate optimum kind of positive gain on health by making people use public transport.
07:24But again, it's a dividend that we don't see or we don't capitalise on.
07:28But still, these are well-founded research.
07:32Yeah, absolutely.
07:33Folks like you and me can talk about this until the cows come home.
07:38But yeah, what's stopping us from exemplifying that so-called sick ministry to health ministry?
07:45Yeah.
07:45Because I'm sure there is a national policy here that we're not seeing.
07:50Absolutely.
07:51And I think one of the kind of takeaways from today's discussion, I think, should be exactly that.
07:57Is there a policy overarching kind of cohesively tying kind of health into all policies?
08:04By the way, the WHO looks at this very seriously.
08:07Yeah.
08:07They have this stand on health in all policies.
08:10But how much is it being translated across government?
08:13That's, I think, a good question too.
08:15One item that I saw that is quite interesting in the op-ed that you wrote was the impacts of economics on health.
08:25And then later on, you wrote the impacts of health on economics.
08:29And that interplay sometimes quite forgotten.
08:32What would be the two or three things that you think we should know of when it comes to health and economics that we must really think about?
08:39Just now that you're mentioning, when you're healthy, you've got nothing to do with the health ministry.
08:45That's perhaps one of the bigger things that I can take away from this conversation.
08:49But the two or three other things that you want to share?
08:51Absolutely.
08:52So let me take a workplace perspective.
08:54I think this is the kind of, we spend 10 hours at work every day.
08:58It's the biggest environment in which a functioning, productive Malaysian is in.
09:02So we cover health insurance for our colleagues at work, which essentially does not kick in until they are ill.
09:11So we're paying for risk protection, but there's no real health gain per se.
09:18However, in a similar setting, employees or employers actually will balk from, for example, putting up a gym membership.
09:28Or even, for example, incentivizing their colleagues at work to go and get a health preventive screening.
09:35We don't pay for checkups, by the way.
09:37People pay out of pocket.
09:38So something along that line.
09:39And that's your C-suite or something like that.
09:41Yeah, absolutely.
09:42And even then, it's offered as like a buy-to-buy kind of.
09:46Yeah.
09:46Yeah.
09:47So essentially, even things as simple as that go a long way towards kind of driving the health kind of perspective of a saving that you actually can.
10:00And the bizarre part, I'm sorry, I'm already thinking numbers now.
10:03Yeah.
10:04Because what is the cost of a gym membership or health screening as opposed to chronic illness disease care?
10:11Absolutely.
10:12I'm telling you it's a fraction.
10:14I'm telling you.
10:14Absolutely.
10:15And it's so much of a saving that it doesn't even make sense that we don't think about it.
10:22But we don't think about it.
10:23Yeah, exactly.
10:24So at best, and this is even worse.
10:27For example, you get Social Security per KSO.
10:30Per KSO offers you health screenings for free at the workplace.
10:33Yeah.
10:34But no one even thinks of kind of even pushing in a program or, for example, making sure that, hey, I would make sure that your KPIDC includes for you to get a health screening,
10:44which is already being paid for at the very minimum.
10:48Try to get that sorted out.
10:49So it's things like this.
10:51We have a lot of programs in different ministries, for example, that could fund some of these things.
10:57I mean, screening is not an end-all thing.
10:59It's just one of those little things pertaining to health.
11:02But even those little things, we can't optimize.
11:05Okay, that's one idea.
11:07Another idea?
11:07Okay.
11:08And now on a personal level, we always talk about food.
11:13Food essentially is what makes all of us, the world go around, especially in Malaysia.
11:17But we speak about healthy eating, okay, but healthy eating is not cheap, not in this country.
11:27So, and again, there's a lot of skewed kind of perspective that healthy eating is kale.
11:32It's, what is this, some bean which is grown on a volcano, some at the end of the ocean, you know.
11:40But it's not these things at all.
11:43It's regular produce, fruits, vegetables, even meat, which is obtained or grown in a healthy environment.
11:54And making sure that you get enough amounts of that is something which is almost impossible to do.
12:00If you are an average, like say, even an, I forget about B40, M40 cannot eat healthy in this country.
12:06It's almost impossible.
12:08None of our meals are tailored to it.
12:10For example, if you walked around even our workplace today, if you wanted a so-called healthy meal, you're talking upwards of RM30.
12:17So, what does everyone do?
12:20You resort to low value, high fat, high kind of correct choices.
12:26This is something we should be incentivizing again.
12:29But this is an area that no one even looks at.
12:33Yeah, because, you know, Roti Canai with dal is what, RM3, RM4.
12:39Yeah, absolutely.
12:41A salad or Greek yogurt with salad is easily 25, easily.
12:46Yeah, exactly.
12:47But why can't, I mean, why can't a policy like drive something like, you don't have Greek yogurt with salad.
12:55Right out with, you guys, right?
12:58Yeah, but, yeah, exactly.
13:00Yeah, exactly.
13:01So, it's these kind of things that no one's kind of pushing the envelope on.
13:05Unless you take your own personal awareness seriously, lah.
13:08Absolutely.
13:10But this is a time that we need to talk about all these items, our workplace incentivizing healthcare lifestyle, eating healthy also.
13:19I think if we haven't gotten the memo yet, we need to actually look at this.
13:26Malaysia has the highest non-communicable diseases per ratio rivaling our friends in India and Sweden for some reason.
13:33I don't know why.
13:34I think we've repeated them flat though, but, you know.
13:36Oh, really?
13:36My data must be five years dated now.
13:41That's just one item where NCD is a growing concern.
13:46And then cardiovascular illnesses, that's the number one killer in Malaysia.
13:51Absolutely.
13:52Number two being road deaths, lah.
13:53Road deaths, lah.
13:54So...
13:55And the problem with cardiovascular deaths is, this is a horrible thing to say, but I'll say it, it would be so much cheaper if they died.
14:04Yeah.
14:04Unfortunately, I'm speaking on, like...
14:06You're a physician.
14:07Yeah, from an economic perspective, it's when they don't die that their families themselves, everybody else has to suffer through the cost of caring for them as well.
14:19Why are you kidding me?
14:20My God.
14:21These are all, like...
14:22This is a horrible statement to make, but it's the actual truth.
14:25Exactly.
14:25It is true.
14:27Because the care element...
14:29I mean, prior to this conversation, I just spoke to the doctor just now.
14:33My sister is a consultant rehab physician.
14:36And she was telling me the cost of caring for a family member that is chronically ill, it's just insurmountable.
14:47And there's only so much that the Ministry of Welfare, Ministry of Healthcare, sorry, Ministry of Health can cover.
14:54Basically, if you're in your T20, it's already troublesome or a nuisance in terms of the expense.
15:00It is debilitating for an M40, let alone crippling for a B40.
15:05So, and then I don't know whether things like, for example, you saw this thing about one or two weeks ago,
15:10there was a little outcry about finding people have started speaking out about...
15:15During holidays, this is a phenomenon that happens all across Malaysia.
15:18During holidays, people dump their old folks into government hospitals.
15:23So they'll show up to...
15:24Wait, wait, wait, you've got to rewind this. What was it?
15:26So during holidays, okay, what happens is Malaysians all walks of life...
15:33Chuti.
15:33Enjoy.
15:34So Chuti, my elderly parents or something that...
15:37Or the ill person I'm caring for at home gets dumped in a kecumasan
15:40and then left to be admitted for a couple of days because, you know,
15:47I've got to take a breather.
15:49So, again, I mean, forget the morality of it and all that.
15:53It's a huge problem.
15:55But talk about the economics of it.
15:57Just that additional load onto public sector healthcare, you know.
16:02So it's crazy.
16:04At a time when during holiday seasons, as you know, that's the time when staffing is low.
16:10So you overload overtime, you overload extra working capacity.
16:17All this is contributory.
16:19So we shouldn't be, from a national perspective, from a national policy perspective,
16:25we shouldn't be looking at the development expense on the health ministry or the OPEX on the health ministry.
16:32We should be looking at other areas like community of women, family development,
16:37ministry of youth and sports, ministry of economy.
16:42Because these are the areas that will reduce the load on the health ministry.
16:47Absolutely.
16:48So what people don't realise is one of the biggest things that contributed to people starting to live longer
16:55was clean water and sanitation.
16:59Yeah.
16:59Yeah, in the 1900s, it changed the entire kind of landscape of Europe.
17:04Clean pipes, nothing to do with the Ministry of Health.
17:07Clean drains, nothing to do with the Ministry of Health.
17:10And buildings in which people didn't die at night.
17:12Because they put asbestos and lead and everything.
17:15Absolutely.
17:15And people started living into their 60s and 70s.
17:18What do you call this?
17:18Soot from open fire inside houses.
17:22None of this, Ministry of Health.
17:25And similarly now today, for example, we talk about road...
17:28Just take the two biggest causes of death, sir.
17:31We're talking about road traffic accidents.
17:33Nothing to do with the Ministry of Health.
17:35Yet, that's how much of cost is coming to the Ministry of Health from all these other...
17:40Yeah, the trauma injury.
17:41Yeah, absolutely.
17:42And let's look at cardiovascular disease.
17:45Largely, again, still a disease of...
17:47Lifestyle.
17:48Lifestyle.
17:49It's lifestyle.
17:50I mean, yes, of course, as a doctor, you will tell me, genetics does play a part.
17:55But it's still lifestyle.
17:57Lifestyle.
17:57You can still mitigate the risks.
17:59Absolutely.
18:00And I make a case that all these can be done by economic measures in no small part.
18:07Oh, okay.
18:10Thanks for painting a bleak picture here.
18:17But I'm sure there are some optimism left in you, doctor.
18:21Oh, no, for sure.
18:21There's a lot of...
18:22So what would be the three or four things that you want to share with us in terms of how do we address this?
18:25Absolutely.
18:27So one is, like I said, on an individual level or your kind of nuclear unit, your family level,
18:36there are a lot of good decisions that you can make which will yield economic results as well as health results.
18:44And these are things which I think are, how to say, really beneficial.
18:49For example, people talk about, oh, you know, I don't have a garden.
18:51There's a reason why people living in rural areas in Malaysia live longer, healthier, happier lives, you know,
19:00even though they're not as economically well-off as those living in the cities.
19:04It's an absolute kind of showpiece.
19:07For example, things like, is it possible to kind of set up a little corner of even your flat to grow your own kind of micronutrients?
19:18Why not?
19:18Microgreens, not too difficult a task.
19:22But interestingly, returns a lot of quality of life.
19:25Returns quite a bit in terms of reducing mental kind of health factors.
19:32Interestingly, giving you quite a return on your economics as well.
19:39Imagine the food bills that start to go away from you not having to buy kale.
19:44So, yeah, I mean, contextualizing it to local produce, we're not talking about rosemary and thyme.
19:51We're talking about chili, daun kari, daun kesom.
19:54Absolutely.
19:55There's nothing wrong that we're growing these kind of items.
19:57And interestingly, what people don't realize is three servings, three servings of fruit, two servings of vegetables, five servings,
20:03which is essentially only about four tablespoons per serving, reduces your cancer risk by about 18-20%.
20:09Because high fiber diet, high protein, high vitamin diet, colon cancer reduction, for instance.
20:17Okay.
20:18What else?
20:19Yeah.
20:20So, this is on an individual level, for example.
20:23On a community level, things like, for example, at workplaces or even within communities,
20:29we have lost, for example, this whole communal kind of, humans are communal animals.
20:36We are creatures who need to be in packs.
20:40And a lot of communal activities, again, I point to countries like Thailand, like China.
20:46We used to have a good culture of getting together and exercising, for example, in communities.
20:52This has disappeared entirely.
20:53Again, almost no cost attached to it.
20:57You know, you get a really expensive gym membership, which you go to twice a year.
21:03And you rarely have any time for.
21:06But in countries, again, I point to countries like Thailand, China, within workplaces,
21:11already after work, hundreds of people getting together.
21:15Interestingly, restoring mental health, physical health, at almost no,
21:19this huge economics gain without any kind of economic cost attached to it.
21:23So, I do see some pucu-pucu crowd, right?
21:26Yeah, but again, if you notice, outside the city.
21:31Outside the city.
21:32In smaller towns, I can see this happening in, like, Kuala Kangsa, Tapai, and all that.
21:37Okay, we're atas, bro.
21:38Yeah.
21:39It's too...
21:41Yeah, so, things like this...
21:42But it's not just...
21:43Of course, of course, it's the cardio part and the community part, but it's the mental health.
21:50Absolutely.
21:50I cannot understate it.
21:52If anything, arrest the mental health decay and the growing concern of loneliness in a number of settings.
22:02Yeah.
22:04And from a national perspective, a national policy perspective?
22:08Okay.
22:08From a national policy perspective, I think the biggest thing to look at is everybody outside the health sector needs to start looking at,
22:16within my sector, what can I do to actually give national health returns?
22:21There are many things that many, many ministries or sectors can do, which will ultimately, I argue,
22:28they'll even give them their own sector and economic kind of gain as well,
22:32but also have this huge multiplier effect on health.
22:37Do you think that Malaysia is, I guess, optimistic or heading in the right direction in terms of looking at this,
22:49or do you think that we are completely unaware of this and we've got everything backwards?
22:54So, I think we have started looking in the correct direction.
22:58But our direction, in the sense that as a nation, we're starting, you can start to see that people have this kind of a bigger tendency or propensity to kind of look at their health.
23:11For example, about eight, nine years ago, if you went to lake gardens in the morning, it'd be dead.
23:21Now, even on a weekday, it's full.
23:24Yeah.
23:24People are starting to kind of look at their health, move a bit more.
23:28Yeah.
23:29So, but what's not there is...
23:30It's a new flex, right?
23:31Yeah, absolutely.
23:31It's a new flex.
23:33People are eating less, they're eating healthier.
23:35I hope they're eating healthier.
23:37God knows it's expensive.
23:38Yeah.
23:38But, so things like this are starting to happen.
23:43But is it making enough of an impact, question mark?
23:46But for sure, what we're lacking is institutional kind of cohesion around policies which are health-promotive, but also economically incentivizing.
23:57But I guess I can agree with you, we are heading in the right direction.
24:02It's just how fast are we going?
24:03How fast are we running?
24:04Are we running fast enough to beat the cardiovascular, the heart attack that's creeping on?
24:08Oh, you know this sort of fact, no?
24:09Yeah, absolutely.
24:10I mean, especially if you're a male and you have co-morbidities, I don't think we're going to last long.
24:16Yeah.
24:16What about cancer growth in Malaysia?
24:19No pun intended.
24:20But the people suffering from cancer, being the head of NCSM, do you think that the cases are getting more severe and frequency and recency and prevalence is also increasing?
24:35Prevalence is increasing.
24:36We're seeing a lot more cancer.
24:38Wow.
24:38That's for sure.
24:40But this is not a Malaysian phenomenon globally as well.
24:45It's just a lot more cancer.
24:47Our problem, which remains very significant, is we're still about 70% of our cancers are being picked up in late stages.
24:55Yeah, because of your earlier statement just now, the health screening part was...
24:59That is a huge system failure.
25:02We're trying our best to start fixing it.
25:05It's a long process.
25:07Okay, that's one.
25:09Yeah.
25:09But in terms of prevalence, but in terms of incidences?
25:14Absolute numbers are creeping up, that's for sure.
25:18But in terms of the population, it's also a population that's living much longer as well.
25:23Yeah.
25:23Compared to like 10 years ago.
25:24Yeah.
25:2510 years ago, I mean, and this is the good news and the bad news, I suppose.
25:2810 years ago, all my teachers died of heart attacks.
25:30Yeah.
25:30They were dead by the time we finished university.
25:32Yeah.
25:33You know, now they're all still alive, but they're picking up cancer.
25:36Yeah.
25:36You know, so it's a demographic shift as well.
25:39Yeah.
25:39But also, again, the problem is, and again, this is the economic cost.
25:45Because we're picking it up so late, we're spending about up to about 10 times more
25:50trying to treat the same people.
25:52Yeah.
25:53When earlier prevention could have actually managed the cost lower.
25:58Yeah.
25:5910 times cheaper.
26:00Yeah.
26:01And then, you know, chemotherapy can be done earlier.
26:05You know, and perhaps even at least warning signs are there so you can even prevent it altogether.
26:12Yeah.
26:12Absolutely.
26:13Is it a stigma issue?
26:15Yes, but also in economics issue.
26:18Because it comes back to, I have to pay.
26:20The way things are nowadays, our insurance doesn't really pay for you to get screening.
26:27So it's something you have to pay out of pocket.
26:29But do I, for example, at the end of the year, prioritize my kids' baju sekolah?
26:34Yeah.
26:34Oh, you know, so it becomes a kind of pick and choose thing.
26:39It shouldn't be.
26:40Yeah.
26:40But also, perhaps the take home is pay a little more attention to making that choice.
26:46Yeah.
26:46A little better, rather than picking up the new phone that's from that fruit.
26:51Right.
26:52So we make choices which are expensive but not necessarily correct.
27:00And I think if we get a lot more political actors coming in and understanding this issue better, then they can perhaps design a policy program or national policy that is a little more facilitative in this grand design.
27:13Yeah, absolutely.
27:15But you think it's a long way?
27:17Or you think that this is a...
27:18I think if we started, like I was talking to you about this, the My50, that's an interesting kind of policy which was rolled out actually to save money but has very interesting unintended positive effects.
27:35I'm hoping people can do stuff in mind having intentional positive effects for health.
27:42And if people want to learn more about this, do they go to the National Cancer Society of Malaysia's website or any other resources that they want to learn more?
27:50I mean, there's a lot of people talking about economics and health. I think I shouldn't plug.
27:57Yeah.
27:57But a lot more of my work on The Edge is exactly going to be around this.
28:01No, you should plug.
28:02I mean, people, you're supposed to do advocacy as well.
28:06But yeah, that op-ed in The Edge is actually quite a very interesting piece to read.
28:13Thank you very much.
28:15That was Professor Dr. Murali Taren Munisami, the Executive Director of the National Cancer Society of Malaysia.
28:23If you want to learn more about this or the kind of shows like this, just head on to astroawani.com and find out more there.
28:28Also, do read up on Professor Dr. Murali's work as well.
28:32That's quite an interesting piece that you can get from bibs and bobs here.
28:36I also drive up the substitution numbers of The Edge for helping out a fellow journalist here as well.
28:42Thank you very much for joining us. Catch you in the next one.
28:44Thank you, Dr. Murali.
28:45Thank you, sir.
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