SPEECH BY YB DATO’ DR CHUA SOI LEK, MINISTER OF HEALTH MALAYSIA, AT THE
FIRST NATIONAL MEN’S HEALTH & AGING CONFERENCE IN CONJUNCTION WITH
UNIVERSITI MALAYA’S 100TH ANNIVERSARY, HOTEL HILTON, KL SENTRAL, KUALA
LUMPUR, 25 JUNE 2005 AT 9.30 AM
Prof Dato’ Mohd Amin Jalaludin, Dean, Faculty of Medicine, Universiti Malaya.
Dato’ Prof Tan Hui Meng, President, First National Men’s Health Conference and
The Malaysian Society of Andrology and the Study of the Aging Male (MSASAM).
Dr. Azhari Haji Rosman, Organizing Chairman.
Distinguished guests, ladies and gentlemen.
1.
First of all I would like to thank the organizers of this conference namely
(1) The Malaysian Society of Andrology and The Study of the Ageing Male
(MSASAM) and
(2) Pusat Perubatan Universiti Malaya
for having invited me to officiate at the opening ceremony of this important conference,
FIRST NATIONAL MEN’S HEALTH CONFERENCE. I also would like to take this opportunity
to congratulate the Pusat Perubatan Universiti Malaya for the centenary celebration of this
august university, which is my alma mater. The Ministry of Health is proud to be a partner in
this conference
2.
I find it somewhat interesting that men’s health (a subject seldom discussed) is being
made a theme of a conference organized by a society dealing with andrology and the ageing
man. This seems to suggest that health problems of men are those related to ageing. This
link between ageing and men’s health may be largely true, and very important, as well as
very “attractive” – as evidenced from the level of interest generated by erectile dysfunction or
impotence, a condition associated most commonly with ageing. However, we must not limit
our paradigm of men’s health only in the context of ageing, and promotion of health of men
must be throughout the life span.
3.
Ageing by itself is a very important force on health and health care. It is gratifying to
note that increasing attention is being paid to the issue of ageing and health. It is not just the
large number of people entering old age that is significant on health and other services, but
also the differential in trend between developed and developing countries. The Western
industralised countries began to undergo ageing after they became “rich”, whereas we in the
developing world have begun to age but many of us are still “poor”. Also the aging in the
industrialized countries occurred over a longer period of time compared to the rate that is
Men’s Health & Aging Conf, 25.6.05
Folder (G) & Disk #33
1
today occurring in the developing world. Thus not only do developing countries have limited
resources, they have to do the necessary in a shorter period of time.
4.
In the year 2000, the world population of “older” people (60 years and over) was 600
million and 400 million of these were in the developing countries. By 2025 it is projected that
the elderly population of the world will double, i.e. to 1.2 billion and of these 840 million will
be in developing countries. In Malaysia, currently 6.7% or 1.6 million of our population is 60
years old and above, and in 2025, the percentage will increase to 11% and the absolute
number will be 4.2 million.
5.
Thus, clearly Malaysia is ageing rapidly, like many other countries. Like other
developing countries, Malaysia will face the socio-economic challenges of the rapidity of
demographic change. Life expectancy has been increasingly steadily; in 1957 the average
life expectancy at birth of a Malaysian was 55.8 years; today the Malaysian has a life
expectancy of 71 years for men and 75 years for women. There is clearly a need to close
this gender gap, there is no reason why men cannot live as long as women.
6.
As we all know, the WHO advises that any country undergoing population ageing
(often defined as having 7% or more of its population as “elderly” which in turn is defined as
60 years and above) must begin to plan for health of older people. In line with this the
Ministry of Health has begun to do this. At primary care level, we have expanded the scope
of services to include health care of elderly, and out of the 864 clinics in the country, 570
have begun to introduce this service. At hospital level, we have clinical geriatrics in a few
hospitals, but the uptake is slow because of the very small number of geriatricians. I have
noticed that geriatrics is one of the less popular fields of specialization among doctors. With
the challenges of ageing, we must try to correct this situation. Currently there are six
geriatricians, two are in the Ministry of Health, two in the universities and two in the private
sector. They are also six psychogeriatricians; three in the Ministry of Health and three in the
universities. We must also take into account the support staff and services that are needed
to provide a holistic and comprehensive geriatric services
7.
Much has been said at various forums on the implications of ageing and health,
therefore I will not dwell on this any further. Let me focus on the theme of this conference –
MEN’S HEALTH. We all are well aware of the fact that men’s health has relatively been
neglected, compared to say woman and child health (especially maternal and child health
which is given the priority it legitimately deserves). This neglect on men’s health can be
explained by two phenomena
Men’s Health & Aging Conf, 25.6.05
Folder (G) & Disk #33
2

Health policies have traditionally emphasized target groups who are
“vulnerable” or “disadvantaged” especially in terms of risk to mortality, and this is the
basis for the special care and high priority accorded to maternal and child health. So
successful have our efforts been in reducing both maternal and child mortality that
the rates have declined considerably, and indeed Malaysia is well on the way to
achieve the relevant Millennium Development Goals (MDG’s). Men’s health on the
other hand, have not been accorded a degree of importance anywhere near maternal
and child health.

The second phenomenon that has led to the neglect in men’s health is the
attitude and behaviour of men themselves. Men all over the world are less likely than
women to see a doctor, to undergo medical examination, to seek help or to show
signs of distress. This “medical arrogance” of men is to their own detriment. Before
we put all the blame on men, we must recognize that this expectation on male
behaviour is largely driven by societal norms of what a “real” man should be – unlike
women, they have to be brave, heroic, strong, silent in the face of suffering etc
8.
This relatively lower importance of men’s health is reflected in medical specialization
- the clinical specialty of obstetrics and gynaecology is well established, but there is no
parallel specialty for men’s health, since andrology is relatively new and is not by itself a
recognized specialty. Thus we note that the plight of men’s health is often in the realm of
urology, and less often of geriatrics
9.
Ageing is frequently, but not inevitably, accompanied by illness and impairments
including immobility, incontinence, imbalance, senility, dementia, impotence and a host of
other common and less common conditions. I would like to stress on the words “not
inevitably”; it is important for us to recognize that while we cannot stop or arrest the process
of ageing, we can do something to prevent many of these conditions or at least delay their
onset. Hence it is reasonable to have the concept of “healthy ageing” or “active ageing”. It is
also important to accept the concept of “productive ageing”, since old people, both men and
women, even long past their official retirement age can, and often do, contribute to families,
societies and the nation. There is scientific evidence to show that a productive or working life
in post retirement years is associated with better health - physical, mental and social health.
10.
It is also pertinent for me to mention something that this conference and the
organizers are most familiar with – the subject of male menopause or andropause. It is
Men’s Health & Aging Conf, 25.6.05
Folder (G) & Disk #33
3
gratifying to note that this has “come out of the closet”, and is gaining almost as much
attention as menopause as a women’s health issue.
11.
Let us go back to general health problems of men. The most common diseases of
men that come to our mind are the chronic diseases - coronary heart disease, hypertension,
cancers, stroke. A study done in USA compared the DALY (Disability Adjusted Life Years)
values of men and women in high, middle and low income countries. Let me just cite the
figures for middle income countries only. The DALY values for men and women were
Men
12.
Women

Heart disease
45 years
46 years (no difference)

Chronic pulmonary disease
35
14

Lung and throat cancer
57
20

Liver cirrhosis
45
13

Car accident
25
8

Self inflicted injuries
10
5

Homicide
28
16
Unfortunately, although there have been several studies on health of the elderly in
Malaysia, these were small studies done by different people at different settings and there is
paucity of information on the nationwide status of older persons’ health. Many of these
studies were on activities of daily living. A study by the Malaysian Medical Association
(MMA) in 1997 showed that 72.4% of elderly people in the study area in Kuala Lumpur felt
they were healthy, 31% of them were on some form of medication. It was good to note that
more than 70% of them were living with family members. A study conducted by the
University of Malaya in the same year showed that 90% of older people were capable of
looking after themselves, they could walk, eat, bathe and use the toilet without help. 805 of
men and 67% of women said they could climb stairs or walk uphill
13.
When we talk of chronic diseases, we cannot avoid talking about lifestyle, as many of
these diseases can be prevented by the adoption of healthy lifestyle. One of the major
initiatives of the Ministry of Health is the HEALTHY LIFESTYLE CAMPAIGN, which although
is approached through an annual launching, must be sustained all the time, year after year
after year. Just two weeks ago, this year’s campaign was launched by the Prime Minister
himself, reflecting the high level of political support and commitment this campaign has
generated.
Men’s Health & Aging Conf, 25.6.05
Folder (G) & Disk #33
4
14.
It is worthwhile for me to repeat the four main lifestyles that are the recurring themes
of the campaign, approached differently each year – these are HEALTHY EATING,
ADEQUATE PHYSICAL EXERCIE, NO SMOKING, and STRESS MANAGEMENT. If we
succeed in promoting these to be practised by all Malaysians, many of diseases can be
avoided; while they do affect both men and women, it is to be noted men have much to gain,
and if the diseases are avoided, men will enter old age in a healthy state
15.
For men’s health, while the Ministry of Health does not as yet have a specific
programme for it, men can and should, avail themselves of the existing services. For
secondary or hospital care, men’s health is integrated as part of the relevant discipline such
as urology, general medicine, psychiatry, geriatrics etc, to manage the particular condition.
For disease prevention and control, there is the healthy lifestyle campaign and the specific
activities under the Disease Control programme. I have been informed that the Family
Health Development Programme is attempting to start a men’s health services at primary
care. Activities such as policy formulation and developing a Plan of Action have begun since
last year. We hope the programme plan for the 9th Malaysia Plan will facilitate the
establishment of a men’s health unit, and that the central agencies will support the requests
to be made
16.
I am glad to know that a men’s health policy has been formulated to be included as
one of the National Health Policies. This policy is still in the draft stage and stated as “All
Malaysian men will achieve optimal health, life expectancy and quality of life to enable them
to contribute to the family, society and nation”.
17.
There are of course many challenges for the Ministry of Health to begin men’s a
health services, but I am confident with the support and commitment from all concerned,
including men themselves, we can do much. We have to begin by raising the awareness on
the importance of paying attention to health of men, and this conference, the first of its kind,
is an appropriate platform. But besides raising awareness, I hope the various programme
managers will also begin to do skills development for the health care providers, conduct the
necessary research to fill any knowledge gap, forge smart partnerships with relevant
agencies and professional bodies (such as MSASM) and NGO’s and start thinking creatively
on how to reach and motivate men, not only when they are old, but throughout the life
course, to take care of their own health.
18.
Like all other health initiatives, the Ministry of Health cannot do it alone; thus the
forging of partnership needs to be emphasized. Professional bodies and societies such as
Men’s Health & Aging Conf, 25.6.05
Folder (G) & Disk #33
5
MSASAM have an important role to play. Besides raising awareness and being an agent foe
advocacy, bodies such as these can complement the government in service provision,
human resource development, research and development and resource mobilization.
19.
I will end by once again congratulating MSASAM and the Pusat Perubatan Universiti
Malaya for having organising this conference, and I wish the conference will meet its
objectives.
Men’s Health & Aging Conf, 25.6.05
Folder (G) & Disk #33
6