Policies related to non communicable diseases in Malaysia

1. Overview of Non-Communicable
Diseases in Malaysia:
Policy Perspectives
Arunah Chandran
MD, MSc, MPH, DrPH
Non-Communicable Disease Section
Disease Control Division
Ministry of Health Malaysia
LeAd-NCD-Mal
Eastin Hotel, 14 August 2019

2. ORGANISATIONAL STRUCTURE
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3. NCD Section in MOH – Organisational Structure
Sectors Units Notes
CVD/Diabetes/Cancer • CVD/Diabetes
• Cancer
Inc. Salt Reduction
Program
Tobacco Control & FCTC
Secretariat
• Regulatory & FCTC
• Tobacco product control & smoking
• Prevention and quit smoking program
NCD Intervention • Community intervention
• Individual intervention
Workplace intervention
(KOSPEN Plus) – under
KPAS
Mental health; Substance Abuse;
Violence & Injury (MeSVIPP)
• Mental health
• Violence & injury prevention
• Substance abuse
Alcohol is under
Substance Abuse
Occupational & Environmental
Health (KPAS)
• Occupational health
• Environmental health
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4. NCD Prevention and Control
• The activities/interventions cut across “Programs”:
– Bahagian Kawalan Penyakit
– Bahagian Pembangunan Kesihatan Keluarga
– Bahagian Pemakanan
– Bahagian Pendidikan Kesihatan
– Perkhidmatan FMS
– Bahagian Perkembangan Perubatan
– (and other Divisions and Institutions…)
• The interventions involve the full spectrum of:
– Community-based interventions
– Primary care
– Secondary care
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5. BURDEN OF DISEASE
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6. Burden of Disease, Malaysia (2017)
6Institute for Health Metrics and Evaluation (IHME). Health-related SDGs. Seattle, WA: IHME, University of Washington, 2017
Available from http://vizhub.healthdata.org/sdg. (Accessed 26 August 2018)

7. Prevalence of NCD Risk Factors in Malaysia,
2006-2015 (≥18 years)
2006 2011 2015
Diabetes Mellitus 11.6 15.2 17.5
Hypertension 32.2 32.7 30.3
Hypercholesterolaemia 28.2 43.9 47.7
Overweight 29.1 29.4 30.0
Obesity 14.0 15.1 17.7
Physical Activity 56.3 64.3 66.5
Smoking* 21.5 23.1 22.8
Alcohol (Current Drinker) 11.4 11.6 7.7
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*Data for 15 years and above
Source: National Health and Morbidity Survey 2015

8. The Causation Pathway for NCDs
Underlying
Determinants
•Globalisation
•Urbanisation
•Population Ageing
Common Risk
Factors
•Unhealthy diet
•Physical Inactivity
•Tobacco & Alcohol use
•Age (non-modifiable)
•Heredity (non-modifiable)
Intermediate Risk
Factors
•Overweight/obesity
•Raised blood sugar
•Raised blood pressure
•Abnormal blood lipids
Main NCDs
•Heart Disease
•Diabetes
•Stroke
•Cancer
Asymptomatic
8Slides Courtesy of Dr Feisul Idzwan Mustapha, Deputy Director (NCD), MOH

9. Spectrum for NCD Prevention & Control
Early
Detection
Diagnosis
&
Management
Rehabilitation
SEO
Prevention Palliative
Care
9Slides Courtesy of Dr Feisul Idzwan Mustapha, Deputy Director (NCD), MOH

10. POLICY PERSPECTIVES
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11. Policy Documents relating to NCD
 The National Strategic Plan for NCD (NSP-NCD) 2010-2014 was the first
national action plan that provided an integrated framework as a response
to NCDs in Malaysia, followed by NSP-NCD 2016-2025.
 Implementation of NCD prevention and control policies and regulatory
interventions was supported by a Cabinet-level Committee chaired by the
Deputy Prime Minister.
 The commitment to tackle NCDs is now reflected in the Eleventh Malaysia
Plan (2016-2020) and MOH Strategic Plan.
 Within the NSP-NCD 2016-2025, there were seven specific NCD policies
that broadly address the WHO voluntary global targets on NCDs and its
risk factors.
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12. Policy Documents related to NCD
Eleventh Malaysia Plan 2016-2020
Ministry of Health Strategic Plan 2016-2020
National Strategic Plan for Non-Communicable Disease 2016-2025
National Strategic Plan for
Active Living (NASPAL) 2017-
2025
National Plan of Action for
Nutrition of Malaysia III
(NPANM III) 2016-2025
National Strategic Plan for
Tobacco Control (NSP-Tobacco)
2015-2020
National Strategic Plan for
Cancer Control Programme
(NSPCCP) 2016-2020
Policy Options to Combat
Obesity in Malaysia 2016-2025
Malaysia Alcohol Control Action
Plan 2013-2020
Salt Reduction Strategy to
Prevent and Control NCD 2015-
2020
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13. Policy Documents related to NCDs against Global Action
Plan Scope of Disease & Risk Factors
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NSP-NCD NPANM Tobacco Obesity Salt NASPAL Alcohol NSPCCP
Cardiovascular diseases X
Diabetes
X
Cancers
X X
Chronic respiratory
diseases
Smoking
X X
Unhealthy diet
X X X X
Physical inactivity
X X X
Unhealthy use of alcohol
X X
DiseasesRiskFactors

14. SWOT Analysis of NCD Policy Development
Strength
 Policy documents available which shows some
level of commitment by MOH
 Availability of baseline parameters to evaluate
intervention available
 Presence of a high level inter-ministerial
committee
Weakness
 Gaps in implementation and enforcement
 Policy documents not accompanied by budget
and resource allocation
 Lack of strong civil society
Opportunity
 Country is evolving into an upper middle income
country which provide opportunities to improve
general health
 Conducive environment exists to introduce NCD
prevention effort
 Feasibility to introduce new interventions as
MOH is a federal agency
Threat
 Lack of political commitment, particularly in
efforts to contain sugar and tobacco industries
 Strong industry lobbying
 Public objections/resistance
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15. Suggested reading for NCDs
• Mike Rayner et al. An introduction to Population-
level Prevention of NCDs
• Richard Farmer et al. Epidemiology and Public
Health Medicine
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16. Thank you
drarunah@moh.gov.my
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