World Health Day is celebrated every year on April 7th; and this year’s theme is Universal Health Coverage (UHC). Malaysia, having undergone a period of rapid socioeconomic development over the last many decades is said to have achieved universal health coverage. UHC is about everyone having access to quality health services and equity of these access is fundamental in UHC. The distribution of health is argued to be unfair when distributions of adverse health outcomes (such as mortality) are skewed towards the socioeconomically less advantaged.
So, we asked ourselves, are our socially less advantaged Malaysians dying younger than the more advantaged. Ms Jeevitha Mariapun, a PhD candidate with Julius Centre University of Malaya (JCUM) published a paper in PLOS ONE entitled “Are the Poor Dying Younger in Malaysia? An Examination of the Socioeconomic Gradient in Mortality”. Specifically, we asked is there a socioeconomic gradient in child and premature mortality in the country? Ms Jeevitha is supervised by A/P Dr Ng Chiu Wan and A/P Dr Noran N Hairi.
The findings of this paper showed that child mortality in Peninsular Malaysia is concentrated among the poorer districts. These socioeconomically less advantaged households were found to have higher rates of infant and under-five mortality. This study also showed the existence of a socioeconomic gradient in all-cause age-gender standardised mortality in Peninsular Malaysia. The poorest quintile has an average standardized mortality rate (SMR) of about 10% higher than the average population – in other words – having shorter life expectancy, whereas the richest quintile has an average SMR which is about 20% lower than the average population, meaning that they live longer. After adjusting for ethnicity, with the exception of the richest quintile, this evidence of socioeconomic disparity disappeared in the other four quintiles. However, the concentration index from the inequality analysis still showed that inequality is present in the age-gender-ethnicity adjusted SMR distribution. In plain words, our findings show that there are significant disparities in child and all-cause mortality between the richest quintile and the rest of the Peninsular Malaysian population.
In light of this evidence, it is important for us to reflect and evaluate existing policies. Reducing inequities is something that we have to act on, urgently.