Climate change and nuclear war are currently the most dangerous challenges to human civilisation and survival. The effects of climate change are now sufficient to persuade many governments to take effective measures to reduce greenhouse gas emissions. Today there are about 27,000 nuclear warheads, many at least ten times more powerful than the Hiroshima and Nagasaki bombs, and a meaningful medical response to a nuclear attack is impossible. Nevertheless, the threat of nuclear war does not raise public concern, and indeed the nuclear-weapon states are upgrading their capability. The only effective preventive measure is the abolition of nuclear weapons. Steps towards this include: a Fissile Material Cut-off Treaty, for the nuclear weapon states to observe their obligations under the Nuclear Non-Proliferation Treaty, and for the Comprehensive Test Ban Treaty to enter into force. The ultimate need is for a Nuclear Weapons Convention; International Physicians for the Prevention of Nuclear War have launched an International Campaign to Abolish Nuclear weapons (ICAN) to promote a NWC.
Throughout the world, policy makers are considering or implementing financing strategies that are likely to have a substantial impact on the equity of health financing. The assessment of the equity implication is clearly important, given the potential impact that alternative finance sources have on households. Households incur out-of-pocket payment directly from their budget, apart from their public or private insurance. Out-of-pocket payment is the primary concern, given their undesirable impact on households. Progressivity measures departures from proportionality in the relationship between out-of-pocket payment and ability to pay. It is the most frequently used yardstick to assess the equity of out-of-pocket payments in empirical studies. This paper provides an evaluation of such progressivity measures, undertaken using four approaches (proportion approach, tabulation approach, concentration curve and Kakwani's index), in order to reveal their usefulness and underlying notion. It is illustrated empirically with data on out-of-pocket payment for health care in Malaysia for 1998/ 1999, based on the nationally representative Household Expenditure Survey. Results indicate that out-of-pocket payments are mildly progressive, whilst the four approaches have their benefits and limitations in assessing equity implications. This analysis is of interest from a policy perspective, given Malaysia's heavy reliance on out-of-pocket payments to finance health care.
There is good evidence that folic acid is safe and efficacious for reducing neural tube defect (NTD). All women capable of becoming pregnant should take 400 microgram daily. This can be given in the form of a daily vitamin supplement, by food fortification, or by increasing natural dietary folates. Compulsory grain fortification has been shown to reduce NTD in a population but supplementation and dietary advice have not. Malaysia should work towards a programme of grain fortification and use alternative strategies to reach sections of the population that would not be covered but several research questions need to be answered before a programme could be implemented in Malaysia.
Balancing economic development with international commitments to protect biodiversity is a global challenge. Achieving this balance requires an understanding of the possible consequences of alternative future scenarios for a range of stakeholders. We employ an integrated economic and environmental planning approach to evaluate four alternative futures for the mega-diverse island of Borneo. We show what could be achieved if the three national jurisdictions of Borneo coordinate efforts to achieve their public policy targets and allow a partial reallocation of planned land uses. We reveal the potential for Borneo to simultaneously retain ∼50% of its land as forests, protect adequate habitat for the Bornean orangutan (Pongo pygmaeus) and Bornean elephant (Elephas maximus borneensis), and achieve an opportunity cost saving of over US$43 billion. Such coordination would depend on enhanced information sharing and reforms to land-use planning, which could be supported by the increasingly international nature of economies and conservation efforts.
The 'seasonal haze' problem is one which afflicts large parts of Southeast Asia in years of drought. The major cause is forest, bush and field fires in the states of Kalimantan and Sumatra in Indonesia, and to a lesser extent in Sabah, Sarawak, and other parts of Malaysia. Almost all of these fires now seem preventable, since they are intentionally set to clear land for cultivation. Theoretically, the government authorities at central, provincial and local levels in these countries should be responsible for controlling activities in their territory. In practice, however, air pollution control through regulatory policies and practices is extraordinarily difficult to implement and maintain in a situation of this kind in developing countries, especially at a time of crippling economic setbacks. Moreover, the establishment of legal liability, through an international tribunal or otherwise, hardly seems a politically feasible course of action for the government of an affluent 'victim state' such as Singapore. Faith in the usual solutions--science, regulation, law and diplomacy--is weakened by one's sense of current realities. The purpose of this paper is to review the issues and suggested responses, the cost implications of each, the responsibilities as well as entitlements that might apply to the various stakeholders, and the special role of Singapore as an affluent 'victim state'. We also discuss the incentive mechanisms that would be needed to manage forest fires.
Since the First Malaysia Plan (1966-1970) many reviews have been done on the five-year health plans of the Ministry of Health (MOH). These included the Mid-Term Reviews and the review done at the end of the respective five-year plan period. There was no structured evaluation method carried out until the Seventh Malaysia Plan (7MP) period (1996-2000), among others because of the complexity of the MOH health plans. The evaluation of the 7MP was the first one conducted using a better-structured process. The findings and recommendations of the evaluation were used and incorporated in the subsequent 5-year health plan, under the Eighth Malaysia Plan (2001-2005).
Within the current exercise of reforming the health care system, underlying all issues, is the reassessment of the role of government. It is a government's responsibility and concern that the health sector be accessible and equitable to the population, and more important that the health sector be more efficient and affordable. Many governments in the world attempt to provide universal health care services to their population through public health care provisions. This paper reviews and analyses the experience of the Malaysian health system, focusing on the performance of the system in relation to access and equity. The performance of the Malaysian health system has been impressive. At minimum cost it has achieved virtually accessible and equitable health care to the entire population. This is evident by analysing almost all the commonly used indicators. These clearly show that when matched to comparable countries, health outcome is even better than predicted value.
State planning plays a central role in Malaysia's social and economic development. The government's rural development policies are designed to promote agricultural incomes and help counterbalance ethnic inequalities. The Federal Land Development Authority (FELDA) implements one of the internationally most successful land development and resettlement programs. In this article, we quantify the impact of FELDA settlements on local out-migration rates, linking macro and micro approaches and using data from the Malaysian Family Life Survey, national censuses, and other sources. A model of instantaneous migration rates specifies an individual's migration rate as a function of individual-level sociodemographic characteristics, the level of urbanization of the origin and destination, and the extent of rural development at the district of current residence. Our results show that in the late 1960s and early 1970s, the existence of rural development centers in a district reduced the levels of out-migration to pre-1965 levels.