Tembeling 2.0

Category: Public Health

  • Separating Prescriptions and Medicines: Can It Reduce Healthcare Costs?

    Healthcare costs in Malaysia are rising, and one of the main reasons is the high price of medicines. A policy that is often discussed as a possible solution is dispensing separation (DS). This means doctors will only diagnose and prescribe medicines, while pharmacists will be the ones to supply the medicines.

    Right now in Malaysia, especially in private clinics, doctors can still give medicines directly to patients after a consultation. But many believe this system can lead to doctors prescribing more than necessary, as they also profit from selling medicines. In many developed countries, DS has already been in place for years to make healthcare more transparent and safe for patients.

    What Happened in Korea and Taiwan?

    South Korea introduced DS in the year 2000 to reduce overprescribing and the rising cost of medicines. After the policy was introduced, the cost of medicines per visit went down. However, other charges such as consultation fees and dispensing costs increased. In the end, the total cost of healthcare for patients did not go down.

    Taiwan started DS around 1997. Studies showed that the number of medicines prescribed and the cost per visit went down, especially in clinics that did not have their own pharmacy. But again, the total cost of healthcare remained mostly the same. These cases show that while DS can reduce the cost of medicines, it does not automatically reduce the total cost of care unless other changes are made.

    What About Malaysia?

    If Malaysia wants to introduce DS, there are some important points to consider. Right now, many patients only pay one fee at private clinics. This includes both the consultation and the medicine. With DS, patients may have to pay twice – once to see the doctor and again to get their medicine at a pharmacy. Without price control or proper insurance coverage, this can make treatment more expensive for patients.

    Small clinics, especially in rural areas, depend on income from selling medicines. If DS is introduced without financial support, some clinics may not survive. This will make it harder for people in remote areas to access healthcare.

    Another issue is that some pharmacies now offer health screening and even give medicines without proper prescriptions. If this continues without control, it can lead to wrong treatments and higher long-term costs due to complications. So, there must be stronger enforcement to ensure only qualified doctors make medical diagnoses and that more medicines can only be given with a proper prescription.

    A Policy Made in Desperation?

    There is growing concern that the push for DS may be driven less by long-term healthcare planning and more by political pressure. When the cost of living goes up, people expect the government to act. In such times, introducing a policy like DS may be seen as a quick way to show that something is being done to help reduce costs, even if the real effect on total healthcare spending is small. While the intention may be good, hasty implementation without a full understanding of the consequences can make things worse.

    What Can Be Done?

    DS is not the only way to control healthcare costs, but it can help if introduced correctly. It must come with other changes such as:
    • Clear and fair consultation fees,
    • Strong rules to ensure only doctors can diagnose,
    • A longer list of prescription-only medicines,
    • Better healthcare financing, like insurance or subsidies,
    • And more pharmacies in both cities and rural areas.

    Conclusion

    Separating prescriptions and medicine supply is not an easy step, but it is worth thinking about for a better, safer, and fairer healthcare system. We can learn from countries like Korea and Taiwan, but we must adjust the plan to fit our local needs. If done carefully and supported by proper policies, DS can bring long-term benefits for patients and help improve the whole healthcare system in Malaysia. But it must be done for the right reasons, not just as a quick response to public pressure.

  • The Evolution of Research on Vape

    The increasing prevalence of vaping, particularly among adolescents and young adults, has sparked significant research interest in its potential health implications, especially regarding mental health and addiction. This synthesis aims to chronologically highlight the progression of research on the dangers of vaping by organizing studies according to emerging questions and findings.

    In early studies, concerns were primarily centered on nicotine dependence and the health risks associated with e-cigarettes. (Foulds et al., 2014) conducted a foundational study emphasizing the need for systematic data collection to understand e-cigarette use patterns and their health impacts. This study initiated a series of research questions related to user characteristics and product safety, culminating in a growing recognition of the unique health risks posed by e-cigarettes, especially among young populations (Foulds et al., 2014).

    Midway through the 2010s, findings increasingly linked vaping with psychological disorders. (Becker & Rice, 2021) highlighted how vaping among adolescents correlates with mental health issues, suggesting that physical and behavioral health risks emerged alongside the rising tide of e-cigarette popularity (Becker & Rice, 2021). Furthermore, (Javed et al., 2022) underscored the connection between vaping culture and adverse mental health outcomes, specifically noting the appeal of flavored e-cigarettes to school-aged youths (Javed et al., 2022).

    This period raised critical questions regarding whether e-cigarette use functioned as both a gateway to traditional smoking and a contributor to existing mental health struggles.

    As research continued to evolve, the impact of vaping on both mental health and substance use behaviors became clearer. Studies like those by (Morean et al., 2015; and Becker et al., 2020) explored how e-cigarettes were used by high school students for both nicotine and cannabis, raising alarms over polysubstance use and its potential to exacerbate cognitive deficits and other mental health issues (Morean et al., 2015; Becker et al., 2020). The growth of such usage patterns provoked inquiries regarding the adequacy of current health policies and intervention strategies aimed at youth tobacco control.

    By 2020 and beyond, researchers began to focus on dual vaping behaviors, assessing the interplay between nicotine and cannabis use among adolescents. (Lanza et al., 2020) reported that the prevalence of dual-use further complicated health outcomes, attributing risks such as cognitive impairment and increased substance dependence to this behavior (Lanza et al., 2020). This segment of research established critical precursors to understanding the holistic ramifications of vaping on adolescent health, emphasizing the need for nuanced public health messaging.

    Current research emphasizes the role of psychological factors as significant predictors of vaping uptake and continuation. Studies by (Jongenelis et al., 2024; and Oliver et al., 2023) have demonstrated that perceptions of harm and existing mental health symptoms significantly influence both vaping intentions and behaviors among youths (Jongenelis et al., 2024; Oliver et al., 2023).

    These findings have led to increased urgency in addressing vaping from a preventive health perspective, raising questions regarding the effectiveness of educational interventions and health promotion strategies within school systems (Thomas et al., 2024).

    The evolution of research on vaping highlights a complex interplay between substance use, mental health, and public health implications. As vaping continues to rise among youth, ongoing studies will need to address the changing landscape of both products and user behaviors, ensuring that health initiatives effectively mitigate the risks associated with e-cigarette use. This synthesis underscores the dangers of vaping as evidenced by existing literature and encourages further exploration into tailored interventions that address the unique challenges posed by this rapidly evolving public health issue.

    References

    Becker, T. and Rice, T. (2021). Youth vaping: a review and update on global epidemiology, physical and behavioral health risks, and clinical considerations. European Journal of Pediatrics, 181(2), 453-462. https://doi.org/10.1007/s00431-021-04220-x

    Becker, T., Arnold, M., Ro, V., Martin, L., & Rice, T. (2020). Systematic review of electronic cigarette use (vaping) and mental health comorbidity among adolescents and young adults. Nicotine & Tobacco Research, 23(3), 415-425. https://doi.org/10.1093/ntr/ntaa171

    Foulds, J., Veldheer, S., Yingst, J., Hrabovsky, S., Wilson, S., Nichols, T., … & Eissenberg, T. (2014). Development of a questionnaire for assessing dependence on electronic cigarettes among a large sample of ex-smoking e-cigarette users. Nicotine & Tobacco Research, 17(2), 186-192. https://doi.org/10.1093/ntr/ntu204

    Javed, S., Usmani, S., Sarfraz, Z., Sarfraz, A., Hanif, A., Firoz, A., … & Ahmed, S. (2022). A scoping review of vaping, e-cigarettes and mental health impact: depression and suicidality. Journal of Community Hospital Internal Medicine Perspectives, 12(3), 33-39. https://doi.org/10.55729/2000-9666.1053

    Jongenelis, M., Gill, M., Lawrence, N., & Wakefield, C. (2024). Quitting intentions and behaviours among young australian e‐cigarette users. Addiction, 119(9), 1608-1615. https://doi.org/10.1111/add.16530

    Lanza, H., Barrington‐Trimis, J., McConnell, R., Cho, J., Braymiller, J., Krueger, E., … & Leventhal, A. (2020). Trajectories of nicotine and cannabis vaping and polyuse from adolescence to young adulthood. Jama Network Open, 3(10), e2019181. https://doi.org/10.1001/jamanetworkopen.2020.19181

    Morean, M., Kong, G., Camenga, D., Cavallo, D., & Krishnan‐Sarin, S. (2015). High school students’ use of electronic cigarettes to vaporize cannabis. Pediatrics, 136(4), 611-616. https://doi.org/10.1542/peds.2015-1727

    Oliver, A., Kossowsky, J., Minegishi, M., Levy, S., & Weitzman, E. (2023). The association of vaping with social/emotional health and attitudes toward covid-19 mitigation measures in adolescent and young adult cohorts during the covid-19 pandemic. Substance Abuse, 44(1-2), 73-85. https://doi.org/10.1177/08897077231165860

    Thomas, L., McCausland, K., Leaversuch, F., Freeman, B., Wolf, K., Leaver, T., … & Jancey, J. (2024). The school community’s role in addressing vaping: findings from qualitative research to inform pedagogy, practice and policy. Health Promotion Journal of Australia, 36(1). https://doi.org/10.1002/hpja.895

  • Training Critical Thinking and Logical Thinking in the Age of AI for Biostatistics and Epidemiology

    The arrival of generative AI tools like ChatGPT is changing the way we teach and practise biostatistics and epidemiology. Tasks that once took hours, like coding analyses or searching for information, can now be completed within minutes by simply asking the right questions. This development brings many opportunities, but it also brings new challenges. One of the biggest risks is that students may rely too much on AI without properly questioning what it produces.

    In this new environment, our responsibility as educators must shift. It is no longer enough to teach students how to use AI. We must now teach them how to think critically about AI outputs. We must train them to question, verify and improve what AI generates, not simply accept it as correct.

    Why critical thinking is important

    AI produces answers that often sound very convincing. However, sounding convincing is not the same as being right. AI tools are trained to predict the most likely words and patterns based on large amounts of data. They do not understand the meaning behind the information they provide. In biostatistics and epidemiology, where careful thinking about study design, assumptions and interpretation is vital, careless use of AI could easily lead to wrong conclusions.

    This is why students must develop a critical and questioning attitude. Every output must be seen as something to be checked, not something to be believed blindly.

    Recent academic work also supports this direction. Researchers have pointed out that users must develop what is now called “critical AI literacy”, meaning the ability to question and verify AI outputs rather than accept them passively (Ng, 2023; Mocanu, Grzyb, & Liotta, 2023). Although the terms differ, the message is the same: critical thinking remains essential when working with AI.

    How to train critical thinking when using AI

    Build a sceptical mindset

    Students should be taught from the beginning that AI is only a tool. It is not a source of truth. It should be seen like a junior intern: helpful and fast, but not always right. They should learn to ask questions such as:

    What assumptions are hidden in this output? Are the methods suggested suitable for the data and research question? Is anything important missing?

    Simple exercises, like showing students examples of AI outputs with clear mistakes, can help build this habit.

    Teach structured critical appraisal

    To help students evaluate AI outputs properly, it is useful to give them a structured way of thinking. A good framework involves five main points:

    First, methodological appropriateness

    Students must check whether the AI suggested the correct statistical method or study design. For example, if the outcome is time to death, suggesting logistic regression instead of survival analysis would be wrong.

    Second, assumptions and preconditions

    Every method has assumptions. Students must identify whether these assumptions are mentioned and whether they make sense. If assumptions are not stated, students must learn to recognise them and decide whether they are acceptable.

    Third, completeness and relevance

    Students should check whether the AI output missed important steps, variables or checks. For instance, has the AI forgotten to adjust for confounding factors? Is stratification by key variables missing?

    Fourth, logical and statistical coherence

    The reasoning must be checked for soundness. Are the conclusions supported by the results? Is there any step that does not follow logically?

    Fifth, source validation and evidence support

    Students should verify any references or evidence provided. AI sometimes produces references that do not exist or that are outdated. Cross-checking with real sources is necessary.

    By using these five points, students can build a habit of structured checking, instead of relying on their instincts alone.

    Encourage comparison and cross-verification

    Students should not depend on one AI output. They should learn to ask the same question in different ways and compare the answers. They should also check against textbooks, lectures, or real research papers.

    Practise reverse engineering

    One effective exercise is to give students an AI-generated answer with hidden mistakes and ask them to find and correct the errors. This strengthens their ability to read carefully and think independently.

    Make students teach back to AI

    Another good practice is to ask students to correct the AI. After finding an error, they should write a prompt that explains the mistake to the AI and asks for a better answer. Being able to explain an error clearly shows true understanding.

    Why logical thinking in coding and analysis planning remains essential

    Although AI can now generate codes and suggest analysis steps, it does not replace the need for human logical thinking. Writing good analysis plans and coding correctly require structured reasoning. Without this ability, students will not know how to guide AI properly, how to spot mistakes, or how to build reliable results from raw data.

    Logical thinking in analysis means asking and answering step-by-step questions such as:

    What is the research question? What are the variables and their roles? What is the right type of analysis for this question? What assumptions need to be checked? What is the correct order of steps?

    If students lose this skill and depend only on AI, they will not be able to detect when AI suggests inappropriate methods, forgets a critical step, or builds a wrong model. Therefore, teaching logical thinking in data analysis planning and coding must stay an important part of the curriculum.

    Logical planning and good coding are not simply technical skills. They reflect the student’s ability to reason clearly, to see the structure behind the problem, and to create a defensible path from data to answer. These are skills that no AI can replace.

    Ethical use of generative AI and the need for transparency

    Along with critical and logical thinking, students must also be trained to use generative AI tools ethically. They must understand that using AI does not remove their professional responsibility. If they rely on AI outputs for any part of their work, they must check it, improve it where needed, and take ownership of the final product.

    Students should also be taught about data privacy. Sensitive or identifiable information must never be shared with AI platforms, even during casual exploration or practice. Responsibility for patient confidentiality, research ethics, and academic honesty remains with the human user.

    Another important point is transparency. Whenever AI tools are used to assist in study design, data analysis, writing or summarising, this use should be openly declared. Whether in academic assignments, published articles or professional reports, readers have the right to know how AI was involved in shaping the content. Full and honest declaration supports academic integrity, maintains trust, and shows respect for the standards of research and publication.

    Students should be guided to include a simple statement such as:

    “An AI tool was used to assist with [describe briefly], and the final content has been reviewed and verified by the author.”

    By practising transparency from the beginning, students learn that AI is not something to hide, but something to use responsibly and openly.

    Building a modern curriculum

    To prepare students for this new reality, we must design courses that combine:

    Training in critical thinking when using AI outputs Training in logical thinking for building analysis plans and writing codes Training in ethical use and transparent declaration of AI assistance

    Students should be given real-world tasks where they must plan analyses from scratch, use AI as a helper but not as a leader, check every output carefully, and justify every step they take. They should also be trained to reflect on the choices they make, and on how to improve AI suggestions if they find them weak or incorrect.

    By doing this, we can prepare future biostatisticians and epidemiologists who are not only technically skilled but also intellectually strong and ethically responsible.

    A new way forward

    Teaching students to use AI critically is not just a good idea. It is essential for the future. In biostatistics and epidemiology, where errors can affect public health and policy, we must prepare a new generation who can use AI wisely without losing their own judgement.

    The best users of AI will not be those who follow it blindly, but those who can guide it with intelligence, knowledge and ethical care. Our role as teachers is to help students become leaders in the AI age, not followers.

    References

    Ng, W. (2023). Critical AI literacy: Toward empowering agency in an AI world. AI and Ethics, 3(1), 137–146. https://doi.org/10.1007/s43681-021-00065-5

    Mocanu, E., Grzyb, B., & Liotta, A. (2023). Critical thinking in AI-assisted decision-making: Challenges and opportunities. Frontiers in Artificial Intelligence, 6, Article 1052289. https://doi.org/10.3389/frai.2023.1052289

    Disclaimer

    This article discusses the responsible use of generative AI tools in education and research. It is based on current understanding and practices as of 2025. Readers are encouraged to apply critical judgement, stay updated with evolving guidelines, and ensure compliance with their institutional, professional, and ethical standards.

  • Epidemiology and Biostatistics in the Light of Divine Unity

    In the Islamic worldview, knowledge is not categorised into ‘Islamic’ and ‘secular.’ There is only one knowledge — al-‘ilm — bestowed by Allah, whether discovered through divine revelation (wahy) or human reason (‘aql). All beneficial knowledge should ultimately draw us closer to Allah, the All-Knowing. This article explores the field of epidemiology and biostatistics through this lens of divine unity, affirming that scientific inquiry and statistical reasoning are not merely technical disciplines, but pathways to understanding the patterns and wisdom embedded in Allah’s creation.

    John M. Last (1988) defined epidemiology as “the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.” This definition highlights three core components: distribution, determinants, and application. Distribution refers to patterns — who is affected, where, and when. Determinants delve into the causes, risk factors, and protective factors. Application demands action — the use of findings to prevent and control diseases.

    In Islam, observation of patterns in nature and society is encouraged. The Qur’an repeatedly invites reflection (tadabbur) on signs (ayat) in the universe and within ourselves. Understanding patterns of disease aligns with this call to contemplation and action. Epidemiology, therefore, becomes a means of fulfilling the Islamic obligation to protect life (hifz al-nafs), one of the five higher objectives of Shariah (maqasid al-shariah).

    Sir Austin Bradford Hill (1965) introduced a set of principles to guide causal inference in epidemiology. His criteria — strength, consistency, temporality, biological gradient, plausibility, coherence, experiment, specificity, and analogy — serve as guides rather than strict rules.

    Yet, we must recognise the epistemological humility within our methods. In regression models, confidence intervals, and Hill’s criteria, there is always an element of uncertainty. This aligns with the Islamic view that human knowledge is inherently limited. As Allah reminds us: “And you (O mankind) have not been given of knowledge except a little.” (Qur’an, Al-Isra’, 17:85)

    Hence, we strive to understand cause and effect through careful observation and reasoning, but ultimately, we acknowledge that true causality is known only to Allah. Our frameworks are approximations — tools to aid, not final truths.

    Historical accounts during the time of the Prophet Muhammad ﷺ and his companions demonstrate the application of outbreak control principles. One notable example is the plague (ṭā‘ūn) during the rule of Caliph Umar ibn al-Khattab. When the plague broke out in Syria, Umar decided not to enter the area, and advised others not to leave or enter — an early form of quarantine.

    The Prophet ﷺ said: “If you hear of a plague in a land, do not enter it; and if it breaks out in a land where you are, do not leave it.” (Sahih al-Bukhari, Hadith 5728; Sahih Muslim, Hadith 2219)

    This hadith reflects core outbreak control principles such as isolation, movement restriction, and collective responsibility — key strategies in modern epidemiology.

    Islam strongly advocates prevention. The Prophet ﷺ advised moderation in eating: “The son of Adam does not fill any vessel worse than his stomach. It is sufficient for the son of Adam to eat a few mouthfuls to keep him going. If he must do that (fill his stomach), then let him fill one-third with food, one-third with drink, and one-third with air.” (Sunan Ibn Majah, Hadith 3349)

    This guidance is preventive in nature and closely aligns with public health nutrition. Islam connects overindulgence and lack of restraint to the whispers of Shayṭān. Preventive health, therefore, is not just a matter of science, but a matter of spiritual discipline.

    Islamic rituals incorporate hygiene into acts of worship. Ablution (wudu’), performed five times daily before prayer, involves washing the hands, mouth, nose, face, arms, head, and feet — the very areas associated with microbial transmission.

    The Prophet ﷺ also instructed: “Cover your utensils and tie your water skins, for there is a night in the year when plague descends, and it does not pass an uncovered utensil or untied water skin without some of that plague descending into it.” (Sahih Muslim, Hadith 2014)

    These teachings reflect divine wisdom in infection prevention, centuries before the discovery of microbes and germ theory.

    Biostatistics provides us with essential tools to summarise data and draw meaningful inferences about populations from sample observations. Among its most powerful techniques is regression analysis, which allows us to explore and quantify the relationship between an outcome (dependent variable) and one or more explanatory (independent) variables.

    The general form of a multiple linear regression model is:

    y = β₀ + β₁x₁ + β₂x₂ + … + βₖxₖ + ε

    In this equation:

    • y represents the outcome or response variable we aim to predict or explain,

    • x₁ to xₖ are the predictor variables that we believe influence the outcome,

    • β₀ is the intercept, the expected value of y when all predictors are zero,

    • β₁ to βₖ are the regression coefficients that quantify the effect of each predictor on the outcome, and

    • ε is the error term, capturing the variability in y that the model cannot explain.

    This error term is more than just a technical component; it is a profound acknowledgment of the limits of human understanding. Even with the most refined models and abundant data, there will always be elements of unpredictability — due to omitted variables, imprecise measurements, biological variation, or other unknown factors. The presence of this uncertainty is a built-in reminder that our knowledge is partial and conditional.

    From an Islamic perspective, this aligns beautifully with the concept of epistemic humility. As Allah states in the Qur’an: “And you (O mankind) have not been given of knowledge except a little.” (Qur’an, Al-Isra’, 17:85)

    Thus, while biostatistics helps us make informed decisions and uncover meaningful relationships, it also teaches us to recognise the boundaries of what we can know. The error term symbolises the divine reality — that ultimate knowledge lies only with Allah. It invites us to pursue knowledge responsibly, with sincerity, but never with arrogance.

    This concept is further reinforced in the Qur’an: “And above every possessor of knowledge is one [more] knowing.” (Qur’an, Yusuf, 12:76)

    Every estimate, statistical model, and inference must be grounded in this awareness. We can model, measure, and approximate, but only Allah knows the unseen, the future, and the full complexity of creation. Biostatistics, therefore, is not only a scientific tool but also a spiritual exercise in recognising our role as seekers of knowledge, always dependent on the One who knows all.

    Epidemiology and biostatistics, when viewed through the Islamic perspective of tawḥīd (oneness of Allah), are not detached from faith but are deeply connected to it. These sciences offer not just understanding but also tools to protect life, serve society, and fulfil the trust placed upon us as khalifah (stewards) on Earth. By unifying rational inquiry with spiritual awareness, we find that knowledge — whether derived from revelation or observation — is ultimately from the same source. Through this lens, our pursuit of health knowledge becomes a journey toward Allah.

    References
    1. Last, J. M. (1988). A Dictionary of Epidemiology (2nd ed.). Oxford University Press.
    2. Hill, A. B. (1965). The Environment and Disease: Association or Causation? Proceedings of the Royal Society of Medicine, 58(5), 295–300.
    3. The Noble Qur’an, Surah Al-Isra’ (17:85), Surah Yusuf (12:76).
    4. Sahih al-Bukhari, Book 76, Hadith 5728.
    5. Sahih Muslim, Book 39, Hadith 2219; Book 23, Hadith 2014.
    6. Sunan Ibn Majah, Book 29, Hadith 3349.
    7. Al-Ghazali, I. H. Ihya Ulum al-Din – On the virtues of knowledge and its relation to action and worship.
    8. Nasr, S. H. (1992). Science and Civilization in Islam. Harvard University Press.

  • A Decade Too Soon: Uniting Tawhid and Public Health for Malaysia’s Future

    Jamalludin Ab Rahman

    Malaysia is facing a silent but accelerating epidemic. Cardiovascular disease (CVD) is not only the leading cause of death in the country, but it is also affecting Malaysians a decade earlier than in advanced nations (APAC CVD Alliance, 2024). Nearly one in four CVD patients was under the age of 50 in 2019, and the largest increase in stroke incidence occurred among those aged 35 to 39. Ischaemic heart disease is 1.6 times more prevalent in men, while stroke affects more women—showing no demographic is spared. Malaysia now records one of the highest rates of heart failure in Southeast Asia, with hospitalisation rates of 10 percent and 30-day readmission rates reaching 25 percent. Worse, heart failure in Malaysia is diagnosed six to ten years earlier than in other countries.

    Behind these clinical realities lies a lifestyle in crisis. Nearly 50 percent of adults are overweight or obese, with women slightly more affected (54.7 percent). Three in ten Malaysians suffer from hypertension, and one in five has diabetes—often without knowing it. Salt intake remains well above the WHO recommended limit, while the intake of fats and sugars has increased by 80 percent and 33 percent respectively over the last 45 years. The consequences are severe: Malaysia incurs USD 1.68 billion annually in direct and indirect costs from premature CVD mortality and disability (APAC CVD Alliance, 2024).

    These are not just numbers—they are warnings. And the root cause is not simply medical, but spiritual and behavioural. The overconsumption of food, physical inactivity, and dependence on chemical cures without lifestyle transformation are symptoms of deeper imbalance. It is in this light that Islamic teachings and ethical models of care must reclaim their place—not only in public health planning, but in the consultation room, the community, and the curriculum.

    Islam offers profound guidance on eating and health. The Prophet Muhammad (peace be upon him) said, “The son of Adam does not fill any vessel worse than his stomach. It is sufficient for him to eat a few bites to keep his back straight. But if he must, then one-third for his food, one-third for his drink, and one-third for his breath” (al-Tirmidhi, Hadith 2380). Likewise, the Qur’an instructs, “Eat and drink, but do not be excessive. Indeed, He does not like those who commit excess” (Qur’an 7:31). These teachings embed moderation, gratitude, and accountability within the act of eating—turning what we consume into a reflection of our spiritual consciousness.

    Public health models, such as the Health Belief Model (HBM), help explain why people change or fail to change behaviour. The model shows that individuals are more likely to adopt preventive actions when they perceive a personal risk, understand the severity of the disease, believe in the benefits of change, and encounter minimal barriers (Becker, 1974; Champion & Skinner, 2008). In Malaysia, however, these elements must be delivered within local, spiritual, and cultural frameworks. That means moving beyond posters and pamphlets to engaging communities through trusted voices—especially doctors, religious leaders, and educators.

    Doctors have a unique and sacred role. They are not only healers but also leaders, educators, and examples. Every consultation is an opportunity not just to prescribe medication, but to prescribe a lifestyle. Patients with hypertension, diabetes, or obesity must be advised on dietary change, physical activity, spiritual discipline, and fasting—not merely given chemical interventions. Lifestyle prescriptions must become part of routine clinical practice, not optional or secondary. Hospitals and clinics must transform from treatment centres into wellness institutions.

    This responsibility begins with doctors themselves. Their credibility is strengthened when they live the lifestyle they promote. A doctor who fasts regularly, avoids gluttony, walks or cycles, and maintains balance in diet and conduct offers a silent but powerful form of da’wah. Islamic hospitals and medical faculties should reinforce this vision, ensuring that doctors are seen as moral exemplars and not merely technical experts. Their example can shift norms and inspire communities to follow a path of moderation.

    To make this sustainable, preventive health education must be strengthened at the foundation. Medical schools should embed modules that combine behavioural science, nutrition, spiritual wellness, and Islamic ethics. Students should be trained to give khutbahs, lead community dialogues, and understand the social determinants of health from a tawhidic worldview.

    Tawhidic epistemology gives this approach its moral clarity. It asserts that all knowledge—whether biomedical or behavioural—must lead to Allah. The body is a trust (amanah), and health is a blessing that demands stewardship. Healing, therefore, is not limited to the removal of symptoms but must also serve to realign the human being with divine balance (mizan). As articulated by Bakar (2021, 2025), tawhid integrates rational and revealed knowledge to ensure that science and healthcare are spiritually accountable. By embracing tawhid, we move from seeing the patient as a consumer of treatment to a servant of the Creator, responsible for preserving his or her own body and influencing society.

    Malaysia’s battle against early-onset CVD will not be won in hospitals and pharmacies alone. It will be won in the hearts, homes, and habits of the people. By combining the insight of the Health Belief Model with the moral depth of tawhidic epistemology—and empowering doctors to lead through both words and example—we can return to the prophetic path: to eat moderately, to live purposefully, and to heal with meaning.

    References

    APAC CVD Alliance. (2024). Malaysia: A call for cohesive action—Redefining cardiovascular care in the Asia-Pacific. https://apac-cvd.org/publications/

    al-Tirmidhi, M. I. (n.d.). Jamiʿ at-Tirmidhi (Hadith 2380)

    Bakar, O. (2021). Tawhid and science: Essays on the history and philosophy of Islamic science (2nd ed.). UBD Press.

    Bakar, O. (2025). Defining the core identity of a 21st-century Islamic university. In The Muslim 500: The World’s 500 Most Influential Muslims (2025 Edition) (pp. 70–73). The Royal Islamic Strategic Studies Centre.

    Becker, M. H. (1974). The Health Belief Model and personal health behavior. Health Education Monographs, 2, 324–473.

    Champion, V. L., & Skinner, C. S. (2008). The Health Belief Model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 45–65). Jossey-Bass.

    The Qur’an. (n.d.). Surah al-Aʿraf, 7:31

  • Microplastics in Food and Potential Health Implications

    Recent studies have highlighted the pervasive presence of microplastics in various food items, raising significant concerns regarding human health and environmental safety. Among the foods identified with the highest levels of microplastics are seafood, honey, beer, and certain fruits and vegetables. The contamination of these food items is primarily attributed to environmental pollution and the use of plastic in food packaging and processing.

    Seafood, particularly bivalves such as mussels and oysters, has been extensively documented as a major source of microplastic contamination. These organisms filter large volumes of seawater, leading to significant bioaccumulation of microplastics in their tissues, which subsequently enter the human food chain (Miller et al., 2020; Dambrosio et al., 2023). A study conducted in Taiwan indicated that residents could ingest approximately 16,000 microplastic particles annually through seafood consumption (Lin, 2024). Furthermore, marine fish, which may consume smaller fish containing microplastics, can also accumulate these contaminants, thereby posing risks to human health (Samarajeewa, 2023).

    In addition to seafood, recent research has uncovered microplastics in honey, beer, and dairy products. A study in Ecuador found microplastics present in honey and beer, emphasizing the need for broader investigations into terrestrial food sources (Diaz-Basantes et al., 2020). Moreover, microplastics have been detected in milk and other refreshments, indicating that the contamination extends beyond aquatic environments (Diaz-Basantes et al., 2020). The presence of microplastics in these products raises concerns about their potential health impacts, as they can disrupt gut microbiota and lead to inflammation (Pramaningsih, 2023; Hwang et al., 2020).

    Fruits and vegetables are also increasingly recognized as potential carriers of microplastics. A recent study from Turkey reported the occurrence of microplastics in commonly consumed fruits and vegetables, highlighting the importance of assessing food safety from the ground up (Aydın, 2023). The contamination of these food items may occur through soil pollution or the use of plastic-based fertilizers and pesticides, which can introduce microplastics into the agricultural food chain (Fiore, 2023).

    The mechanisms of microplastic contamination are multifaceted, involving not only environmental pollution but also the processing and packaging of food. Research indicates that food processing techniques and the materials used in packaging can contribute to the release of microplastics into food products (Fiore, 2023; Hussain et al., 2023). For instance, microwave heating of plastic containers has been shown to release millions of microplastic and nanoplastic particles into food (Hussain et al., 2023). This highlights the critical need for improved regulatory measures and analytical techniques to monitor and mitigate microplastic contamination in food products.

    In conclusion, the latest findings underscore the alarming prevalence of microplastics in various food items, particularly seafood, honey, beer, and fruits and vegetables. The implications for human health are significant, necessitating further research and action to address this emerging environmental issue.

    References

    • Aydın, R. (2023). Occurrence of microplastics in most consumed fruits and vegetables from Turkey and public risk assessment for consumers. Life, 13(8), 1686. https://doi.org/10.3390/life13081686

    • Dambrosio, A., Cometa, S., Capuozzo, F., Ceci, E., Derosa, M., & Quaglia, N. (2023). Occurrence and characterization of microplastics in commercial mussels (Mytilus galloprovincialis) from Apulia region (Italy). Foods, 12(7), 1495. https://doi.org/10.3390/foods12071495

    • Diaz-Basantes, M., Conesa, J., & Fullana, A. (2020). Microplastics in honey, beer, milk and refreshments in Ecuador as emerging contaminants. Sustainability, 12(14), 5514. https://doi.org/10.3390/su12145514

    • Fiore, C. (2023). Are microplastics a macro issue? A review on the sources of contamination, analytical challenges, and impact on human health of microplastics in food. Foods, 12(21), 3915. https://doi.org/10.3390/foods12213915

    • Hussain, K., Romanova, S., Okur, İ., Zhang, D., Kuebler, J., Huang, X., …

  • Social Determinant of Health

    The historical evolution of social determinants of health (SDOH) has significantly influenced the field of preventive medicine. SDOH encompass the conditions in which individuals are born, grow, live, work, and age, and they are increasingly recognized as critical factors that shape health outcomes and health disparities across populations (Gard et al., 2020).

    The World Health Organization (WHO) has played a pivotal role in framing health not merely as the absence of disease but as a state of complete physical, mental, and social well-being, a definition that has guided public health initiatives since 1946 (Abnousi et al., 2019). This broader understanding of health has led to a growing recognition that addressing social factors is essential for effective preventive medicine. Historically, the focus on SDOH can be traced back to the mid-20th century when public health efforts began to emphasize the importance of social and economic factors in health outcomes.

    The WHO’s Commission on Social Determinants of Health, established in 2005, further catalyzed this movement by highlighting the need for comprehensive strategies that address the root causes of health inequities (Galea et al., 2020). This shift towards a more holistic view of health has prompted researchers and practitioners to explore how social, economic, and environmental factors intersect with individual behaviors and biological predispositions to influence health (Amador, 2023; Braveman et al., 2011). The evolution of SDOH research has also highlighted the importance of “upstream” interventions—those that target systemic and structural factors—over “downstream” measures that focus solely on individual behaviors (Carey & Crammond, 2015). This perspective is crucial for preventive medicine, as it underscores the need for policies and programs that address the broader social context in which health behaviors occur. For instance, interventions aimed at improving housing stability, access to nutritious food, and educational opportunities have been shown to have a more profound impact on health outcomes than traditional medical interventions alone (Taylor et al., 2016; Nichols & Taylor, 2018). Moreover, the historical context of SDOH has revealed persistent challenges in integrating these factors into health policy and practice.

    Despite the growing body of evidence supporting the significance of SDOH, there remains a gap between research and implementation. Many health systems continue to prioritize clinical care over social interventions, often due to entrenched interests and a lack of sustainable funding for SDOH initiatives (Irwin & Scali, 2007; Bambra et al., 2009). This disconnect highlights the need for a paradigm shift in how health care providers and policymakers conceptualize health and wellness, moving beyond a purely medical model to one that incorporates social determinants as fundamental components of health care delivery (Galea, 2022).

    In recent years, the COVID-19 pandemic has further illuminated the critical role of SDOH in shaping health disparities. The pandemic disproportionately affected marginalized communities, revealing how factors such as income inequality, access to health care, and housing instability can exacerbate health risks (Amador, 2023; Brady, 2020). This has led to renewed calls for integrating SDOH into preventive medicine strategies, emphasizing the need for a comprehensive approach that addresses both individual and systemic factors (Larson et al., 2023; Silverstein et al., 2019).

    The historical evolution of SDOH has also prompted a re-examination of the role of health care providers in addressing these determinants. Physicians and other health professionals are increasingly being called upon to recognize and respond to the social contexts of their patients’ lives, which requires not only clinical skills but also cultural competence and an understanding of the broader social landscape (Kucherepa & O’Connell, 2021; Schwenk, 2020). This shift necessitates a transformation in medical education and training, ensuring that future health care providers are equipped to address the social determinants of health effectively.

    In conclusion, the historical perspective on social determinants of health reveals a complex interplay between social, economic, and environmental factors and health outcomes. The evolution of this field has underscored the importance of addressing SDOH in preventive medicine, highlighting the need for systemic changes that prioritize health equity. As the understanding of SDOH continues to evolve, it is imperative that health care systems and providers adapt their approaches to incorporate these critical factors into their practice, ultimately leading to improved health outcomes for all populations.

    References:

    Abnousi, F., Rumsfeld, J., & Krumholz, H. (2019). Social determinants of health in the digital age. Jama, 321(3), 247. https://doi.org/10.1001/jama.2018.19763

    Amador, Y. (2023). Social determinants of health and chronic diseases post covid-19. salinas. ecuador, 2023. International Journal of Health Science, 3(51), 2-10. https://doi.org/10.22533/at.ed.1593512307073

    Bambra, C., Gibson, M., Sowden, A., Wright, K., Whitehead, M., & Petticrew, M. (2009). Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. Journal of Epidemiology & Community Health, 64(4), 284-291. https://doi.org/10.1136/jech.2008.082743

    Brady, K. (2020). Social determinants of health and smoking cessation: a challenge. American Journal of Psychiatry, 177(11), 1029-1030. https://doi.org/10.1176/appi.ajp.2020.20091374

    Braveman, P., Egerter, S., & Williams, D. (2011). The social determinants of health: coming of age. Annual Review of Public Health, 32(1), 381-398. https://doi.org/10.1146/annurev-publhealth-031210-101218

    Carey, G. and Crammond, B. (2015). Systems change for the social determinants of health. BMC Public Health, 15(1). https://doi.org/10.1186/s12889-015-1979-8

    Galea, S. (2022). Moving beyond the social determinants of health. International Journal of Health Services, 52(4), 423-427. https://doi.org/10.1177/00207314221119425

    Galea, S., Abdalla, S., & Sturchio, J. (2020). Social determinants of health, data science, and decision-making: forging a transdisciplinary synthesis. Plos Medicine, 17(6), e1003174. https://doi.org/10.1371/journal.pmed.1003174

    Gard, L., Cooper, A., Youmans, Q., Didwania, A., Persell, S., Jean-Jacques, M., … & O’Brien, M. (2020). Identifying and addressing social determinants of health in outpatient practice: results of a program-wide survey of internal and family medicine residents. BMC Medical Education, 20(1). https://doi.org/10.1186/s12909-020-1931-1

    Irwin, A. and Scali, E. (2007). Action on the social determinants of health: a historical perspective. Global Public Health, 2(3), 235-256. https://doi.org/10.1080/17441690601106304

    Kucherepa, U. and O’Connell, M. (2021). Self-assessment of cultural competence and social determinants of health within a first-year required pharmacy course. Pharmacy, 10(1), 6. https://doi.org/10.3390/pharmacy10010006

    Larson, C., Mukolo, A., Buck, T., Lollis, K., & Black, M. (2023). A call to action to address the social determinants of health. Journal of Ambulatory Care Management, 46(2), 143-151. https://doi.org/10.1097/jac.0000000000000461

    Nichols, L. and Taylor, L. (2018). Social determinants as public goods: a new approach to financing key investments in healthy communities. Health Affairs, 37(8), 1223-1230. https://doi.org/10.1377/hlthaff.2018.0039

    Schwenk, T. (2020). What does it mean to be a physician?. Jama, 323(11), 1037. https://doi.org/10.1001/jama.2020.0146

    Silverstein, M., Hsu, H., & Bell, A. (2019). Addressing social determinants to improve population health. Jama, 322(24), 2379. https://doi.org/10.1001/jama.2019.18055

    Taylor, L., Tan, A., Coyle, C., Ndumele, C., Rogan, E., Canavan, M., … & Bradley, E. (2016). Leveraging the social determinants of health: what works?. Plos One, 11(8), e0160217. https://doi.org/10.1371/journal.pone.0160217

  • MSM is Rising and Islam is the Solution

    Introduction

    The HIV epidemic continues to evolve globally, with men who have sex with men (MSM) emerging as a key population in the transmission of HIV. According to UNAIDS, MSM accounted for 44% of new HIV infections globally in 2023, making this group a significant driver of the epidemic. In the Asia-Pacific region, MSM represented approximately 50% of new infections, contributing to 230,000 cases in 2023 (UNAIDS, 2023).

    In Malaysia, the trend is similarly concerning. While injection drug use was once the primary mode of HIV transmission, MSM have overtaken this group as the most affected population. Recent data indicate that MSM accounted for 64% of new infections in Malaysia in 2023 (Ministry of Health Malaysia, 2023). The prevalence of HIV among MSM has risen sharply, from 3.9% in 2009 to 21.6% in 2017, with the 2022 Integrated Bio-Behavioural Survey (IBBS) reporting a slight decline to 18.2% (IBBS, 2022). Despite ongoing efforts, this trend signals the need for more effective and culturally relevant approaches to tackle the epidemic.

    What Has Been Done

    Efforts to combat the HIV epidemic have included biomedical, behavioural, and structural interventions. Globally, measures such as pre-exposure prophylaxis (PrEP), antiretroviral therapy (ART), and harm reduction programmes have been implemented with varying degrees of success. Malaysia’s response includes community-based outreach initiatives that provide HIV testing, counselling, and prevention services to MSM. These efforts have resulted in higher rates of condom use and increased uptake of PrEP (Ministry of Health Malaysia, 2023).

    Despite these advancements, significant barriers remain. Stigma and discrimination deter many individuals from seeking HIV-related services, while structural challenges, such as the high cost and limited availability of PrEP, restrict its accessibility. The National Strategic Plan to End AIDS (2016–2030) identifies MSM as a priority population, but the persistent rise in new infections highlights the limitations of conventional approaches.

    The Tawhidic Approach

    Islam provides a holistic framework for addressing the HIV epidemic, rooted in the principles of Tawhid (the oneness of Allah). Islamic teachings emphasise personal accountability, moral conduct, and the preservation of life. The Qur’an states, “And do not approach unlawful sexual intercourse. Indeed, it is ever an immorality and is evil as a way” (Qur’an 17:32). This directive underscores the importance of adhering to Islamic principles to prevent behaviours that lead to harm.

    Central to the Tawhidic approach is a strong belief in Allah, which serves as a moral compass for Muslims. This belief fosters self-discipline, accountability, and a sense of responsibility to avoid harmful actions. Parents and community leaders play a vital role in nurturing youth with Islamic values, protecting them from negative influences such as exposure to media that normalise immoral behaviours.

    Prevention is a cornerstone of Islamic teachings. By promoting chastity, self-restraint, and the value of family, individuals can develop a strong moral foundation. Religious leaders and mosques can reinforce these principles by providing education, raising awareness, and reducing stigma. Faith-based interventions can address the spiritual and social dimensions of HIV prevention, complementing biomedical efforts.

    Way Forward

    The solution to the HIV epidemic among MSM lies in the belief and practice of religion. A Tawhidic approach aligns with public health objectives while addressing the moral and spiritual needs of Muslim communities. Strengthening family values, providing comprehensive Islamic education, and promoting community engagement are essential steps.

    Educational institutions should integrate Islamic teachings into their curricula, focusing on the consequences of immoral behaviour and the importance of accountability to Allah. Policymakers should work with religious leaders to design culturally sensitive interventions that resonate with Muslim communities.

    Ultimately, the Tawhidic approach offers a sustainable and holistic solution, emphasising spiritual growth and moral integrity. By fostering a strong connection to Allah and adhering to Islamic principles, individuals and communities can effectively combat the HIV epidemic while ensuring the well-being of future generations.

    References

    Integrated Bio-Behavioural Survey (IBBS). (2022). Malaysia report. Ministry of Health Malaysia.

    Ministry of Health Malaysia. (2023). Global AIDS monitoring 2023: Malaysia report. Retrieved from https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/Laporan_Global_AIDS_Monitoring_2023.pdf

    UNAIDS. (2023). Global AIDS update 2023. Retrieved from https://www.unaids.org/en/resources/documents/2023/global-aids-update

    Qur’an. (n.d.). The Noble Qur’an: English translation of the meanings and commentary. Retrieved from https://quran.com/

    Kamarulzaman, A., & Saifuddeen, S. M. (2017). Islamic biomedical ethics: The way forward for HIV prevention. Journal of the International AIDS Society, 20(1). https://doi.org/10.7448/IAS.20.1.21749

  • The Triple Burden of Disease in Malaysia

    Malaysia faces a significant public health challenge known as the triple burden of disease, encompassing non-communicable diseases (NCDs), infectious diseases, and the health implications of an ageing population. These interconnected challenges are further compounded by environmental and planetary health issues, requiring a comprehensive and integrated approach.

    Non-Communicable Diseases (NCDs)

    NCDs, including cardiovascular diseases, diabetes, cancers, and chronic respiratory conditions, are the leading causes of mortality globally, accounting for 74% of deaths (World Health Organization [WHO], 2022). In Malaysia, the situation is similar, with NCDs responsible for 71% of total deaths annually (Institute for Public Health [IPH], 2020). The National Health and Morbidity Survey (NHMS) 2019 revealed alarming figures: 50.1% of Malaysian adults are overweight or obese, while diabetes prevalence has reached 18.3%, more than double the global average of 8.5%.

    Adding to these concerns, environmental pollution, particularly microplastic contamination, poses emerging risks to human health. Microplastics, classified under “novel entities” in planetary boundaries, have breached safe limits globally (Stockholm Resilience Centre, 2023). These tiny particles, found in water, air, and food, can disrupt endocrine systems, cause inflammation, and increase the risk of cancer and cardiovascular diseases (Galloway, 2022). Addressing NCDs requires targeted prevention strategies, such as lifestyle modifications, environmental policies, and the integration of planetary health principles into public health measures.

    Infectious Diseases

    The COVID-19 pandemic highlighted Malaysia’s vulnerability to infectious diseases, with over 5 million confirmed cases and more than 39,000 deaths as of December 2023 (Ministry of Health Malaysia, 2023). Zoonotic diseases, which account for 60% of emerging infectious diseases globally, pose a significant threat, particularly in tropical Malaysia, where rich biodiversity and human activity intersect (Centers for Disease Control and Prevention [CDC], 2022).

    Lessons from the pandemic underscore the importance of the One Health approach, which integrates human, animal, and environmental health to prevent and manage infectious diseases. Malaysia’s geography and climate also make it prone to vector-borne diseases like dengue and malaria, as well as waterborne diseases exacerbated by frequent floods. Strengthening cross-sector collaboration, improving surveillance systems, and addressing environmental factors are critical to reducing the burden of infectious diseases and preparing for future pandemics.

    Ageing Population and Elderly Health

    Malaysia is transitioning towards an ageing society, with the proportion of individuals aged 65 and above projected to reach 14.5% by 2040 (Department of Statistics Malaysia, 2016). This demographic shift brings an increased prevalence of age-related health conditions such as dementia, osteoporosis, and frailty. The healthcare system faces mounting challenges in managing the complexities of geriatric care, including multimorbidity, limited access to specialised services, and inadequate long-term care facilities.

    Geriatric illnesses are further compounded by social and economic factors, such as financial insecurity and insufficient family support. Effective management requires the development of age-friendly policies, expanded healthcare services for older adults, and increased investment in geriatric education and training for healthcare professionals.

    Conclusion

    Malaysia’s triple burden of disease—NCDs, infectious diseases, and elderly health challenges—underscores the urgent need for a multifaceted public health response. Addressing these issues requires prioritising prevention, enhancing healthcare infrastructure, adopting the One Health approach, and integrating planetary health principles into national strategies. Collaborative efforts across sectors and alignment with global best practices are essential to ensure a healthier, more resilient Malaysia.

    References

    Centers for Disease Control and Prevention. (2022). Zoonotic diseases. Retrieved from https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html

    Department of Statistics Malaysia. (2016). Population projections (revised), Malaysia, 2010-2040. Retrieved from https://www.dosm.gov.my/v1/index.php

    Galloway, T. S. (2022). Health implications of microplastic pollution. Retrieved from https://www.environment-prize.com/ceremony/2022/

    Institute for Public Health. (2020). National Health and Morbidity Survey (NHMS) 2019: Non-communicable diseases, healthcare demand and health literacy. Retrieved from https://iku.moh.gov.my/nhms-2019

    Ministry of Health Malaysia. (2023). COVID-19 updates. Retrieved from https://covid-19.moh.gov.my/

    Stockholm Resilience Centre. (2023). All planetary boundaries mapped out for the first time, six of nine crossed. Retrieved from https://www.stockholmresilience.org/research/research-news/2023-09-13-all-planetary-boundaries-mapped-out-for-the-first-time-six-of-nine-crossed.html

    World Health Organization. (2022). Noncommunicable diseases. Retrieved from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

  • The Silent Toll of Excess Mortality During the COVID-19 Pandemic

    Introduction

    The COVID-19 pandemic has reshaped global health systems, revealing vulnerabilities in healthcare and public health infrastructure. While official COVID-19 death counts capture the immediate impact, excess mortality estimates uncover the pandemic’s broader effects, including indirect deaths caused by disrupted healthcare services and societal changes. This study examines global and regional excess mortality data and emphasises the role of Malaysia’s White Health Paper in preparing for future pandemics.

    Global Excess Mortality Estimates

    Globally, the World Health Organization (WHO) reported approximately 14.9 million excess deaths between January 2020 and December 2021, nearly three times the officially recorded COVID-19 deaths (World Health Organization, 2022). Similarly, the Institute for Health Metrics and Evaluation (IHME) estimated approximately 18.3 million excess deaths during the same period (Wang et al., 2022). These figures underscore the extensive direct and indirect impacts of the pandemic.

    Regional Variations in Excess Mortality

    Excess mortality varied significantly across regions. In Malaysia, a study in The Lancet Regional Health – Western Pacificreported an 8.5% increase in mortality from January 2020 to December 2021, reflecting indirect effects such as healthcare system disruptions and delayed treatments (The Lancet Regional Health – Western Pacific, 2022). In contrast, India reported a 20% increase in excess deaths, highlighting challenges in healthcare access and reporting (The Lancet, 2022). Other countries, such as Brazil and the United States, also faced substantial increases in excess mortality, further demonstrating regional disparities (Faust et al., 2021).

    Indirect Effects of the Pandemic

    Beyond direct COVID-19 fatalities, excess mortality includes deaths exacerbated by the pandemic. Delayed medical treatments due to overwhelmed healthcare systems led to increased deaths from chronic diseases, including cancer and cardiovascular conditions (Maringe et al., 2020). Mental health crises and substance abuse also contributed to rising mortality, particularly among younger populations (Faust et al., 2021).

    The Role of Public Health Specialists and Policymakers in Malaysia

    The pandemic has emphasised the importance of proactive public health leadership. In Malaysia, the White Health Paper provides a comprehensive framework for strengthening healthcare systems and preparing for future pandemics. Key recommendations include:

    1. Strengthening Public Health Infrastructure

    Investments in healthcare infrastructure and workforce capacity are critical. Public health specialists must advocate for equitable healthcare access and improved resource allocation.

    2. Enhancing Surveillance and Data Systems

    Surveillance systems must be upgraded to enable real-time detection and response. Leveraging digital health technologies, such as artificial intelligence and machine learning, is essential for improving data collection and analysis.

    3. Developing Comprehensive Pandemic Preparedness Plans

    Establishing a national pandemic preparedness plan that includes protocols for outbreak management, resource allocation, and community engagement is crucial. This plan should align with the White Health Paper’s strategic vision.

    4. Community Engagement and Health Literacy

    Public health specialists must prioritise health literacy and foster community participation in public health initiatives to ensure compliance during emergencies.

    5. Sustained Investments in Health Systems

    Policymakers must allocate adequate budgets for public health and encourage research in infectious diseases and healthcare innovation.

    Conclusion

    Excess mortality data highlight the devastating effects of the COVID-19 pandemic and the importance of strengthening healthcare systems to mitigate future public health crises. Public health specialists and policymakers in Malaysia must align their efforts with the White Health Paper’s recommendations to ensure preparedness and resilience. By addressing healthcare disparities, improving data systems, and fostering community engagement, Malaysia can build a robust framework for future pandemic responses.

    References

    Faust, J. S., Du, C., Mayes, K. D., et al. (2021). Mortality from drug overdoses, homicides, unintentional injuries, motor vehicle crashes, and suicides during the pandemic in the United States. JAMA, 326(1), 84–86. https://doi.org/10.1001/jama.2021.8012

    Maringe, C., Spicer, J., Morris, M., et al. (2020). The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: A national, population-based, modelling study. The Lancet Oncology, 21(8), 1023–1034. https://doi.org/10.1016/S1470-2045(20)30388-0

    The Lancet. (2022). Estimating excess mortality due to the COVID-19 pandemic: A systematic analysis of COVID-19-related mortality, 2020–21. The Lancet. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext

    The Lancet Regional Health – Western Pacific. (2022). Excess mortality in Malaysia during the COVID-19 pandemic. The Lancet Regional Health – Western Pacific. Retrieved from https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(22)00071-2/fulltext

    Wang, H., Paulson, K. R., et al. (2022). Estimating global excess mortality associated with the COVID-19 pandemic. The Lancet, 399(10334), 1513–1536. https://doi.org/10.1016/S0140-6736(21)02796-3

    World Health Organization. (2022). 14.9 million excess deaths were associated with the COVID-19 pandemic in 2020 and 2021. Retrieved from https://www.who.int/news/item/05-05-2022-14.9-million-excess-deaths-were-associated-with-the-covid-19-pandemic-in-2020-and-2021