by | Mohd Hasan Mohd Saaid, hasan@might.org.my | Sri Widias Tuti Asnam Rajo Intan, sriwidias@might.org.my
Tun Dr Mahathir Mohamad is a world icon. Apart from his political acumen, the statesman has displayed an amazing feat of strength and the ability to lead Malaysia as the 7th Prime Minister at the astounding age of 94.
The vitality shown by Tun Dr Mahathir however, is in stark contrast to the dystopian future that the larger portion of Malaysia’s population is resigned to.
Chief Economist at DM Analytics Malaysia and Economic Advisor to the Prime Minister of Malaysia, Dr Muhammed Abdul Khalid cited the dark realities in-waiting of this dystopian future during a forum called, “Malaysia’s population in 2050: What Does This Mean Socio-Economically?” There, he came up with a thought provoking statement where he said:
“As it stands, there are more of us from 6 million in 1957 to 30 million now and it is going to be 40 million. But we are going to be an old society. Old, poor, sick, have to work and without children or grandchildren by 2050”.
In 2018, about 2.1 million (6.5%) of the Malaysian population were aged 65 and above. Malaysia will be an ageing population by 2035, with more than 15% of the population aged 65 and above. The World Health Organisation (WHO) has identified two key drivers of global population ageing and these are longer life expectancies and falling fertility rates.
Why are more people living longer today?
Until 1998, birth and death rates of the world’s population were about the same, keeping the size of the population stable. However, advances in health and safety in many areas, along with other generational growth factors, have led to a drastic increase in human lifespan and the number of people living (and at older ages) than in the past.
According to the latest WHO data published in 2018, life expectancy in Malaysia was 73.2 years for males and 77.6 years for females and the combined total life expectancy was 75.3 and this gave Malaysia a World Life Expectancy ranking of 71.
During the industrial revolution, the following advances in science and technology led to a significant reduction in the number of deaths:
• Increased food production and distribution
• Improvement in public health (clean water and sanitation)
• Medical technology breakthroughs (vaccines and antibiotics)
Malaysia’s fertility rate is projected to decline to the lowest level in the last 55 years. Malaysia’s Selected Demo¬graphic Indicator 2018 noted that only 15.8 births are expected for every 1,000 people. This is lower than the 16.1 recorded last year. In addition to that, the overall fertility rate of Malaysian women aged between 15 to 49 is estimated at 1.9 children, which is worrying because it falls way below the appropriate replacement level of 2.1 children. This means that the Malaysian population is shrinking, as the average number of babies born to a woman during her period of fertility is not sufficient to replace her and her partner.
Sources of declining birth rates are generally attributed to urbanisation, cultural shifts, and increased education and work opportunities for women.
However, according to Prof Datuk Dr John Antony Xavier, a Principal Fellow at the Graduate School of Business at Universiti Kebangsaan Malaysia, the decline in fertility rates in Malaysia stems from high cost of living. With higher cost of living, families tend to limit the number of children in order to provide better education and quality of life.
Common problems faced by the elderly
Aging comes with many challenges. The loss of independence is one potential part of the process, as are diminished physical ability and age discrimination. Generally, the aging process includes biological, emotional, intellectual, social, and spiritual changes.
Physical and mental health
Declining health can be difficult for many elderlies. As muscles and bones begin to weaken, they lose eyesight and hearing, and mobility often becomes restricted. Seniors also suffer from dementia and Alzheimer’s diseases, which affect about 10% of the population over the age of 65 and the number increases to 32% for the population segment aged 85 and older. Due to physical and mental health conditions, about two-thirds of the population aged 65 or older need assistance with at least one “daily living” activity such as bathing or preparing a meal.
Thus, the issues with ageing and healthcare should be looked at from the supply and demand points of views. An ageing population urdened with healthcare problems need substantial support. If a large percentage of the population is unhealthy, this will contribute to an unproductive nation.
Financial security
Elderlies have less job opportunities that would allow them to move out of poverty. Additionally, many elderlies have to worry about sudden bills such as unexpected medical expenses.
Malaysia’s Employees Provident Fund (EPF) suggests that the minimum EPF savings members should have at the age of 55 is RM228,000. This equates to a monthly withdrawal of RM950 to cover basic needs for 20 years. However, according to a 2016 survey by the Department of Statistics Malaysia, the average monthly expenditure for a typical Malaysian household was RM4,033.
EPF however reported that only 18% of members have the minimum savings target of RM228,000 in their accounts by 55.
Social isolation and loneliness
They retire from jobs, children move out, friends and spouses pass away, and eventually they may become housebound if they lose the ability to drive or become ill. Studies show that seniors who live alone often experience social isolation and chronic feelings of loneliness, which cause depression, illness, and even deaths.
According to data gathered in 2012, nearly 6,000 senior citizens were residents of 11 Welfare Department (JKM) care centres and 165 centres owned by non-governmental organisations (NGOs) and private companies throughout the country and the numbers are estimated to be much higher now.
Elderly abuse and neglect
Abuse of the elderly is a major social problem. Some elderlies are victims of abuse committed by their own relatives. Such abuse involves physical and sexual violence, psychological and emotional abuse, neglect and financial exploitation.
Preliminary 2017 findings from a Universiti Malaya study on mortality among elderly victims, of which the majority of cases were financial abuse, revealed that victims had a shorter life span. The study consisted of 1,927 seniors, mostly aged between 60 and 69. The death rate in relation to financial abuse was 9.6%, compared to 6.8%
among those who were not victims of abuse.
Challenges
Decline in working-age population
A rapidly aging population means there are fewer workingage citizens in the economy. This leads to declining productivity, higher labour costs, delayed business expansion and reduced international competitiveness. To compensate, many countries look to immigration to keep their labour forces well supplied by attracting more highly skilled immigrants and integrating them into the workforce.
Increase in health care cost
Rapidly aging populations tend to have greater demands for health care services and retirement homes. Countries
with rapidly aging populations must allocate more money and resources to their health care systems. Health care
spending share of the gross domestic product (GDP) is already high in most advanced economies due to the increasing demand for home care and the need to invest in new technologies.
Increase in dependency ratio
Countries with large elderly populations depend on smaller pools of workers to collect taxes from to pay for health care cost, pension benefits and other publicly funded programs. The combination of lower tax revenues and higher spending commitments on health care, pensions and other benefits is a major concern for advanced industrialised nations.
Obstacles faced by the healthcare industry
According to the World Health Organisation (WHO), the top killer diseases in Malaysia are coronary heart disease
and stroke. There are treatments for these diseases and other critical illnesses, but they don’t come cheap. To make matters worse, the medical inflation rate in Malaysia, which is the increase of medical cost, is between 10% and
15% every year.
Thus, the implication toward the healthcare system is huge. This is why every stakeholder needs to play their part now. As Malaysia has a rapidly ageing population, the government needs to address the situation with a higher sense of urgency.
Shortage of qualified and specialised medical professionals
It’s not about the sheer number of supply as opposed to quality where today, private colleges that offer medical courses are found to be aplenty. It’s about really competent medical professionals, not just those who qualify on paper. That aside, currently, the doctor to patient ratio stands at 1:791, and in 5 years from now, based on an estimated population size of 34 million, the average ratio will be around 1:400.
Increasing costs of specialty drugs
The rising cost of healthcare is inevitable everywhere around the world. Presently, there is no cap for price of harmaceuticals, which is one reason for the hike. Additionally, the rising costs of specialty drugs could also be attributed to the increasing rate of raw materials, equipment, labour and also the weakening of Ringgit.
Health insurance plan vs lifespan
Private healthcare providers serve as an alternative means for people to avoid long waiting times and reduce the burden of overcrowding public hospitals. The smartest option is to plan for private insurance that allows citizens to seek treatment in both public and private healthcare facilities at later stages of life. Medical cost is one of the most overlooked matters in retirement planning alongside medical emergencies.
Opportunities
For healthcare industry players, wherever there’s a problem, there is usually an opportunity. Opportunity lies in anticipation by stakeholders. Government policy on the other hand is an on-going initiative to outline the importance of addressing the country’s aging population issues, especially in healthcare management. For the most vulnerable group, based on the RMK-11 Plan, RM3million is being allocated annually to mitigate impact
in the future.
Policy has been geared toward prevention rather than curative health care cure. This helps the government to reduce healthcare expenditure. Policy formulated with a particular emphasis on access and affordability could well mitigate the impact on the nation’s most vulnerable group. Emerging trends in certain countries show that more initiatives such as creating retirement villages or old folk villages could help the government manage the group better with the help of recent innovations in healthcare technology.
On the other hand, population ageing provides a significant opportunity for sustainable development. This can be associated with active participation of older citizens in the economy, labour market and the society at large.
The healthcare industry should also take the opportunity to shift healthcare approaches beyond curing toward
prevention. Industry 4.0 technologies are poised to advance the healthcare system industry globally. Technologies such as Artificial Intelligence (AI) for example could diagnose cancer much earlier. This could potentially prevent the shrinking of the working population to a large extent.
Digital technology, especially AI have the potential to enhance economic and social engagement for the elderlies and help improve (at least monitor) their health. Robotics and e-health are two areas which exhibit great promise in this regard.
Conclusion
There are wider implications for how each of us approaches and plans for our old age, and for the old age of our family members. For governments however, it will shape how public services are planned and this will no doubt influence every department. Perhaps, most importantly, it will require a co-ordinated response to be carried out between departments that reflect robust evidence of being affected by population ageing and therefore calling for the necessity of inter-connected policies.
