COMMENT | Time for a Ministry of Public Health

COMMENT | For 15 years, the Malaysian Paediatric Association and its partners have been fighting for the inclusion of the pneumococcal conjugate vaccine (PCV) into the National Immunisation Programme (NIP).

We studied the burden of the disease, researched the serotypes at play in our community, examined the increasing resistance of the bacterium to our arsenal of antibiotics and demonstrated the cost-effectiveness of the PCV.

It took a new government in 2019 to appreciate our endeavours, empathise with the loss of innocent lives and the disabilities inflicted by the pneumococcus, as well as the need for bigger investment in the health of our children. They rolled out the PCV in our NIP in 2020.

Within the space of a year in office, the Pakatan Harapan guys in the health and finance ministries understood a critical paediatric health issue which the bygone politicians hid in the back burners, and which the technocrats in the Health Ministry paid only lip service and did not envisage as a priority.

The politicians and technocrats paid more attention to secondary, tertiary and curative services patronised by the VVIPs, which therefore gouged an increasing piece of the Health Ministry budget cake.

It is a sad testimony of our state of healthcare priorities when a PM gets a CABG (coronary artery bypass graft) done locally and the nation gets IJN (Institut Jantung Negara). And a PM’s late wife succumbs to cancer and we get IKN (Institut Kanser Negara).

What I am about to suggest next follows this trend of afterthoughts of a reactive Health Ministry.

With the Covid-19 mess that we are in, I think it is time for the nation to have a Ministry of Public Health. This domain of public health has always been secondary and subservient in the Health Ministry scheme of things.

Even the public health physicians had a raw remuneration deal as compared to their clinician peers, they were like “second class specialists”.

The Ministry of Public Health should be helmed by a public health physician, not a paediatrician, obstetrician or surgeon.

The specialty and sub-specialty training is simply 180 degrees apart. The culture of work is different as captured in this doctors joke:

Physicians – wait and see (reflective nuances)

Surgeons – cut and see (radical nature)

Paediatricians – play and see (jovial child-like persona)

Obstetricians – D and C (this was the joke bit I think)

The public health physician wasn’t even featured in the joke!

I think I would propose, public health physician - ABC (they give priority to the ABC, the back to basics of medicine ie preventative health, primary health care, universal health coverage, pandemic preparedness, the cost-effectiveness of health interventions, health economics, socio-economic determinants of health etc).

The abovementioned examples describe the three inter-related but distinct aspects of public health practice namely, health improvement, health protection and health service quality improvement. These draw upon core knowledge and skills of epidemiology, biostatistics, risk communication and data science.

Any discerning person, let alone a doctor would be able to detect the lack of epidemiological and statistical prowess and authority in the daily presentation of the national Covid-19 data.

To bypass a public health physician and instead allow a non-doctor to undertake daily risk communication on the Covid-19 pandemic has been an unmitigated disaster for the rakyat, business community, and our international reputation.

Our northern neighbour has a Health Ministry, with an emphasis on public health thus called, Public Health Ministry, and look at how well they have managed the Covid-19 pandemic. The director-general of the World Health Organisation (WHO) made special mention of them for their success in battling the Covid-19 crisis.

Even if my 2021 wishlist does not come true, I hope the role of public health in the Health Ministry will be elevated by many notches and it would be accorded the position it truly deserves in the mega scheme of protecting and promoting the nation’s health. 

DR MUSA MOHD NORDIN is a paediatrician and chairperson of the Federation of Islamic Medical Associations advisory council.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.