Monday, October 30, 2017

醫療旅遊對國人是利還是弊?

本週檳中對專欄的文章由我撰寫,我就寫有關醫療旅遊的研究心得。可惜主編放了一個相當‘聳/俗氣’的標題。我的文章是要探討醫療旅遊的利與弊。加上週五的預算案,財長納吉也宣佈撥款發展醫療旅遊,所以更值得我們關注這所謂的‘經濟領域’。
以下是我的文章,附上原標題和副題。
*****
醫療旅遊對國人是利還是弊?

近年来我国的百货物价上涨,再加上经济仍缓慢成长,中下阶层的人民频感生活压力。若不幸碰上疾病缠身,更是雪上加霜。要寻求治疗,不少公立医院人满为患已是司空见惯的场景。问题是,在檳城,即使求医者来到私人医院,也未必能如愿顺利就医。
一些私人医院採取领號码排队制度,竟传闻有跑腿代领號码的服务;另一些医院,即使有预约,或许也得等上一两个小时才能见到属意的专科医生。在檳城,尤其是在某些大型的私人医院,处处可见眾多的外籍医疗旅客一起排队等候见医生。笔者常听闻有人控诉这些旅客已侵佔了本地人的医疗资源,但也有些人发现要批评却有口难言因为担心会给人排外的印象。具体的政策还是得有人分析,到底医疗旅游业对当地人是利还是弊?
一个政策或商业活动若完全不利於所有人,大概不可能会有任何基础可持续下去。其实更该问的是,到底是谁会从中得利,和多少人受惠?

经济效益大
从国家经济的角度来看,医疗领域被纳入12个国家关键经济领域(NKEA)的其中一项。
仅是来自私人医院的收入,在2015年已贡献了国家90亿令吉,其中12.9亿令吉来自檳城。而同年的马来西亚医疗旅游理事会(MHTC)数据显示,私人医院从到访檳城的医疗旅客赚取了3.5亿的收入,相等於27%整体私人医院的总收入。对於檳州2015年州內总產值761亿令吉的经济体来说,来自私人医疗和医疗旅客的收入相当可观。
外籍医疗旅客和伴隨著的亲友,来到目的地除了往医院走一趟寻求护理治疗以外,还得安排膳宿和交通。所以传统上与旅游业相关的服务业,例如航空业、交通服务业、酒店饮食业和观光旅游业等都可能分得一份羹。
根据檳城环球旅游机构2016年度的《檳城旅客调查》统计,医疗旅客在檳城的平均消费是一般外国游客的2.2倍,而且將近3/4的受访者已重访檳城。所以,对从事旅游业的业者来说,他们对医疗旅客与亲友的到访趋之若鶩无需感到意外。

本地人有更高的服務要求
撇开旅游业不谈,医疗旅游业同时也增加了医疗护理相关的就业机会。2015年,檳城的私人医疗服务业就僱用了1万1143人,其中包括1118位医生和3928名护士。医疗旅游或许同时促使檳城私人医疗界增码投资,除了提升医疗设施,也增加医疗人力资源,凝聚最佳的专科医生和医护人员。
成果是,檳城的医生和护士对人口的比率比国內平均值和大多数州属还低,意味著檳城人拥有更多的医护人员提供服务。此外,根据2016年的另一份调查,有96.7%的受访者表示可以在住家的方圆5公里的涵盖范围內寻得公立和私立的医疗护理服务。
以上所提及的医疗发展好处,对正寻求医疗援助的当地人来说,他们会直接感受到吗?或许一些人认为在私人医院求医需付费,所以要求和期望就自然越高。2015年的《国家卫生和病態调查》报告透露,有高达9%的檳城人不满在私人医院的等候时间,另外55.1%的受访者不满其医药账单。这些给予私人医院「差劲」评价的檳城人比率,明显比全国平均值高出二至三倍。
比起门诊病人,住院病人通常所需的医护资源是最多的。檳城卫生局2016年的数据显示,檳城私立医院的住院人数(15万7495)高於公立医院(13万3095)。这与全国和其他州的比率趋向是相反的,如在2015年全国公立医院的住院人数是私人医院的2.5倍。
另外,MHTC的数据指出,医疗旅客来檳城的人数(不分门诊或住院者)从2011年的26万8600增至2016年的30万400,涨幅有大约40%。根据檳城研究院尚未公佈的研究分析显示,横跨癌症、循环系统(包括心臟病和中风)和肌肉骨骼系统三大疾病类別,可见医疗游客的住院人数和比率自2009年起逐年增加。
儘管住院比率下降,本地人对私立医院的床位医护需求依然有增加。如此的趋势延伸下去,倘若医疗旅客增长的速度更快但本地人的需求也同时增高,医院却又无法在硬体设施和人力资源方面跟得上,人民对医疗旅游政策的不满积怨就更深。

挖角专科医生
一些私人医院常强调他们能召到不少长期在海外服务的资深专科医生回国,笔者相信这不可能是医院的一般作业,因为这类的大马籍海外专才毕竟还是非常有限,有念头要回国的或许更少。
根据笔者的研究发现,儘管在公立医院服务的医生总人数较多,私立医院拥有的专科医生数目几乎是公立医院的两倍。
由於我国法律的约束,院方不能够隨意或轻易地聘请外国专才,只好从我国有限的人力资源里(不管是来自公立或其他私立医院)挖角一些资深的医生。既然是零和博弈,难道檳城私人医院的挖角就不会影响到公立医疗和其他州属的专科医生人手分配吗?
无可否认,医疗旅游业带来的经济效益是正面的,但这行业伴隨著的社会挑战不小,尤其是如何规划得体应付逐年增长的医疗旅客和本地人的医疗需求。再说,若医院对待医疗旅客和本地人都一视同仁,假设本地人已不满其医疗服务了,难道医疗旅客会满意?


刊登于《東方日報》東方文薈版2017年10月29日

Tuesday, October 10, 2017

撥款不足拖累「全球最佳醫療系統」

預算撥款直接影響公共衛生和醫療護理兩大項目的表現。如果衛生部繼續在資源匱乏下操作,基本化驗樣品和醫藥補給撐不到年底就用完的窘境,最後可能變成常態。這不可能是「全世界最佳的醫療系統」的操作方式。一個負責任愛民的政府應當懂得分輕重,知道哪些公共服務應優先,確保財力資源的投入與承諾的長遠政策相符。當2018年度財政預算案揭曉時,期待衛生部能獲得公平合理的撥款,實際反映出其需要;也希望即將來臨的政府總預算不會花得不知所謂,都消耗在明年大選。

【文/林志翰】
記得今年初,首相納吉風光滿面地宣佈馬來西亞擁有全世界最佳的醫療系統,他的憑據是一份國際雜誌International Living月刊的評估,結果遭受網民冷嘲熱諷。這或許反映出國際雜誌對國內公共和私人界醫療的評估,與一般老百姓的實際體驗或印象有著極大落差。納吉這項宣佈也被譏為「一令吉肉雞」般的務虛政治秀。
其實,大部分國人也不怎麼計劃本身的醫療保健事項,更遑論分析醫療政策——只有當病痛找上,才慌張尋找醫療援助。馬來西亞人何其幸運,因為我們的醫療系統是襲自前殖民國英國的貝弗里奇(Beveridge)模式。在這系統裡,政府不但是資方,同時是主要的醫療服務供者,也是公共醫療衛生的策劃者、監管者和執行者。公共衛生是排在國民教育服務之後,政府(幾乎免費)提供且耗資第二高的福利項目。在我國,求醫看病被看成是人民的權利,因為有政府作為靠山。反之對比鄰國新加坡和印尼,較常強調個人對健康的責任,國民更意識到自身的醫保存款、保險金和共同付款(co-payment)金額,是否足夠應付醫療服務的不時之需。
衛生部經常宣稱我國衛生系統是進步(progressive)和扶貧(pro-poor)的,因為公共衛生的財源主要來自一般稅收(我國稅收架構理論上應是越富有的被課稅越多)。這再對比公共醫療的主要使用者是來自最低的40%社會經濟階層人士。我國的共同付款費用價單自1982年以降已不曾調整,如今已幾乎是象征式收費(一令吉看外科,五令吉看專科)。這些收費匯集起來,估計只達政府用在醫療衛生上的2%開支。
至於國人對我國醫療系統有何要求?大概可歸納為:
一、距離合理:醫療設施與居住社區保持在合理距離以內;
二、可負擔:治療費合理並有可能讓家庭負擔得起;
三、有效率:等候期間和治療需時合理,不至於影響病患者的工作和生活;
四、優質護理服務:以最有效和專業的方式治療護理,同時也尊重病患者。
問題是,衛生部是否已準備好充足「銀彈」,憑著長遠全面的策略計劃來提升硬體設施、增加醫療勞動力以及改進醫療服務效率(即提高產量又控制開銷)?
錢要花在刀口上,是一般生意人熟悉不過的概念。政治上何嘗不是如此?財政預算案就是檢驗一個政府對政策的執行誠意,尤其在資源有限下更能體現政府對各政策拿捏的優先態度。
近來,衛生局總監諾希山公佈2016年政府醫院的外科診戶訪次比起2015年高出一千萬,或22%的需求增長率。正因如此,衛生部長蘇巴馬廉埋怨2017年預算案撥款給該部門並不足夠,敦促政府明年撥出更高預算。
醫藥費上升是全球趨勢,國內私人醫療界也感同身受。2017年的《全球醫藥趨向走勢》報告(Global Medical Trend Rates)預測馬來西亞的醫藥通膨率可達12.0%凈成長,是亞洲區的兩倍(6%)。這無形中也給衛生部增加更大壓力,因為今年的預算只見區區7.7%的成長。
據報導,2016年私人醫院病患者訪次下降了20%至30%,只因更多人寧願選擇公共醫療服務。可見私人醫院本身也是醫藥通膨的受害者。近年來政府大力鼓吹醫療旅遊(medical tourism),對外宣稱我國醫藥費多麼的廉宜可負擔,惹惱了不少本國人。早前2015年《國家衛生與病態調查》報告(National Health and Morbidity Survey)顯示,公眾對私人醫療治理收費的印象傾向負面,高達25.9%的全國受訪者直接給予「差勁」(poor)的評分。這說明了國家經濟停滯不前,更多尤其來自中低家庭收入階級者無法負擔私人醫療,更甭說當發生大病急症。奈何在2015年全民醫療開支帳目裡,只有8%的付費來自私人醫療保險,未雨綢繆投保的人口估計少於10%。政府對此責無旁貸,必須準備好在來年迎接更多病人從私人界「回流」到公共診所醫院。
衛生部官員雖常辯稱更多財政資源無法保證醫療服務素質的提升,不過事實上,去年提呈的「縮水」預算直接影響了公共衛生和醫療護理兩大項目的表現,因為絕大部分的物資和服務供應項目皆被大打折扣。試問在這種情況下,醫療服務素質有可能會提升嗎?如果衛生部繼續在資源匱乏下操作,基本化驗樣品和醫藥補給撐不到年底就用完的窘境,最後可能變成常態。這不可能是「全世界最佳的醫療系統」的操作方式。
為了舒緩醫療系統的強大公共需求壓力,政府應助衛生部一臂之力給予更多發展撥款來提升硬體兼軟體設施,尤其是目前擁擠爆棚的大都市政府醫院。自2010年,衛生部的發展撥款卻不增反減,2017年的13.4億令吉更是八年來最低的數額(見表一)。
參考了多項因素包括預估的15%醫藥通膨率、各部門10%至20%的薪金調整,加上預計中更高的人民需求後,衛生部必須爭取到比2017年還多出15%以上的撥款預算。換句話,該部門明年的預算得大於285億令吉才能安心運作。

一個負責任愛民的政府應當懂得分輕重,知道哪些公共服務應優先,確保財力資源的投入與承諾的長遠政策相符。我個人寄望,當2018年度財政預算案揭曉時,衛生部能獲得公平合理的撥款,實際反映出其需要。希望即將來臨的政府總預算不會花得不知所謂,都消耗在明年大選。

Sunday, October 01, 2017

Bigger budget health allocation an absolute necessity


WHEN Prime Minister Datuk Seri Najib Razak proudly declared that Malaysia has the best healthcare system worldwide (as rated by a monthly magazine, International Living), many social media users responded to his statement with cynicism. This reaction was perhaps due to the discrepancy between the magazine’s evaluation of public and private healthcare and the reality experienced or perceived by Malaysians.
Most people do not give much thought to planning for their health, let alone healthcare policies, until illness strikes and the need for medical assistance arises. Perhaps we Malaysians do not realise how fortunate we are.
In terms of health systems, our country’s model has inherited the Beveridge model from the UK, in which the government acts as the major healthcare provider and payer in addition to the roles of public health planner, regulator and enforcer.
In this welfare-based system, many Malaysians may have taken their right to health for granted, unlike in Singapore and Indonesia, where individual responsibility is more heavily emphasised. There, citizens are more mindful about their own health savings, insurance premium and co-payments for healthcare services.
Those of us who utilise healthcare services would typically rate the system according to the following factors: (i) Accessibility: whether facilities are located within a proximate distance to their community, (ii) Affordability: whether fees charged are reasonable and in accordance with their household income (iii) Efficiency: the waiting period to receive treatment should be reasonable and not impede the patient’s work and life, and lastly (iv) Quality care: care should be delivered in an effective and professional manner, and the patient treated with respect. 
Our Ministry of Health (MOH) often claims that Malaysia’s health system is progressive and pro-poor, as public health financing is largely derived from general taxation (where the richer get taxed progressively more) and public healthcare majority users are mostly from the lowest two socioeconomic segments (Quantile 1 and 2, poorest 20% and the next 20%) of society. Moreover, co-payment user fees (unrevised since 1982) are extremely nominal (i.e. RM1 for outpatient visit, RM5 for specialist visit). This amounts to approximately 2% revenue collection against healthcare spending.
The crux of the issue is whether the MOH has adequate finances to meet the rising demand, and a holistic long term strategic plan to (i) expand the infrastructure and facilities capacity (ii) increase the health workforce while (iii) improving efficiency of healthcare delivery (i.e. containing cost but increasing productivity).
The global rise of medical costs is being felt in Malaysia’s private health sector too. The 2017 Global Medical Trend Rates report has forecasted Malaysia’s medical inflation rates to experience a 12.0% net increase, twice the Asia net average (6%). This increases pressure on the MOH to contain costs, especially given the mere 7.7% increase in allocation in the 2017 Budget.
Recently, the Director General of Health Dato Dr Noor Hisham Abdullah told the media that “(the MOH hospitals are) seeing an additional 10 million outpatientslast year compared to the 45 million received in 2015”. This number translates to a 22% increase in service demand.
To that end, health minister Datuk Seri S. Subramaniam was right in claiming that the 2017 budget allocation was not enough and to urge for greater resource allocations next year.
Private hospitals are also the victims of rising medical cost. Last year, these hospitals suffered a 20-30% drop in patient volume as more patients opted for public health service. The National Health and Morbidity Survey 2015 found public perception towards treatment charges in private healthcare to be somewhat negative, with 25.9% respondents nationwide giving it a ‘poor’ rating.
An increasing proportion of those from middle and lower household income classes could not afford to utilise private healthcare services, let alone in the event of a catastrophic illness. Out of the total population health expenditure in 2015, only 8% of contributions were made from private insurance. While not entirely conclusive, one may safely assume that under 10% of citizens had private insurance coverage. A greater volume of patients may turn to public health facilities in coming years. The government must be prepared for this increased pressure on health services.
Granted, greater financial resources does not necessarily guarantee an improvement of services; nevertheless, last year’s stretched budget did affect Public Health and Medical Care, with across-the-board reductions for most services and supplies line items.
If MOH still continues to operate under-resourced, the likelihood of basic test materials and medical supplies running out of stock may become a more frequent and familiar scenario. In line with the increasing public demand for healthcare services, more resources should be given to MOH’s development budget to expand the current capacity of the healthcare system as well as to alleviate the current stress in the system.
After considering various adjustment factors such as the forecasted 15% medical inflation rate, typical salary  increases of between 10-20% per department, and a projected higher healthcare demand from the public, the MOH should minimally secure a 15% larger budget allocation compared to what it received last year (in other words, more than RM28.5 billion).
Spending priorities should be to ensure that at the very least, all drugs listed in the National Essential Medicine List (NEML) and basic test reagents are readily available at all times. Furthermore, MOH should channel an appropriate level of funds towards increasing capacity and improving service delivery in all its healthcare facilities, especially in congested urban hospitals.
A responsible government should set its priorities right for the type and amount of public investments to make, to reflect how much they care for the well-being of the people. For this, long-term strategic planning, not firefighting, is the way to go. It is my hope that, when the 2018 Budget is tabled, the MOH receives a fair allocation that matches its needs.

Monday, September 04, 2017

族群和睦关係省思

话说好几周前,我注意到友人在面书上分享黄明志最新创作的音乐视频(MV),曲名为《阿里阿狗和木都》。若读者有所不知,黄明志是个颇有爭议性的嘻哈艺人。他就曾在10年前推出了一首《Negarakuku》而大红大紫。当时那首歌被批评为反政府、反伊斯兰教、反马来人和污蔑国歌,而他成为了马来右翼份子的箭靶。强烈对比当年那首「成名曲」,《阿里阿狗和木都》非常政治正確地描述我国三大种族,即华巫印裔之间的族群和谐。副歌里更如此唱:「友谊永固,同心同魂(…kawan selama-lamanya,satu hati satu jiwa)」。

我並未质疑黄明志和其他艺人欲通过歌曲与视频释放善意,努力促成族群和睦关係。只是,我们到底如何才能跳脱表面的族群和谐象徵,去回应现实中复杂的课题,尤其是那些造成我国多元种族社会出现互不满意互不信任、无法良好融合相处的矛盾?

多元社群超越三大种族
首先要指出的是,我国的族群和谐画面一般都只强调三大种族的团结。令人詬病的是,这论述遗漏了我国存在的多元社群,比方说半岛的原住民、东马的土著以及混血族群例如峇峇娘惹、欧亚混血人和印华混血人。这样的画面也似乎暗示著这些社群不入主流,只能委屈退居到被边缘化的「lain-lain(其他族群)」类別。虽然身为公民的一份子,这种排斥性的待遇或忽略往往可能造成这些族群的困惑,让他们觉得自己不受国家认同和重视。

联昌国际银行基金会(CIMB Foundation)在今年初发佈了一个有关族群关係的报告,发现有89.5%马来裔、79%华裔和68.7%印裔受访者拥有很多或几乎所有的朋友都来自本身族群。这显示在日常生活中,各族缺乏深入交流。黄明志MV里宣导的阿里、阿狗和木都的故事似乎不是现实常態。捫心自问,究竟有多少MV观赏者其实非常渴望这类的跨族友谊?如果有,那么到底在现实生活中是什么障碍阻止这类友谊建立?

单一源流教育不是捷径
有些人,包括政治人物,似乎把单一源流教育系统的倡议当成有效地拉近我国族群关係的一种万灵丹。上个月,在一场TN50国家转型计划的政治研討会里,巫青团执委沙里尔韩旦(Shahril Hamdan)直言单一源流学校基於「孩子从小就长时间接触交流」,可成为「促进族群团结的方程式」。但,单一源流学校有可能会是他口中所谓促进族群团结的「捷径」,又或者我们该问,这提议理想吗?

或许某些人已忘了(或不认同)我国独特之处和优势正来自多元文化语言的社会背景。这个多元性恰恰正是吸引许多游客慕名而来並爱上我国的原因。我国自我標榜「真正的亚洲(Truly Asia)」,不是偶然的。

前首相阿都拉巴达威曾建议在国小推动母语课程。当时他表示:「我们应该学习友族的语言,根据需求与时並进」。纵然当时的政府可能拥有其他的议程(若搁置母语科师资短缺的问题不谈),这还是个值得讚扬的语文政策。政府可参考多元语言国家如加拿大和瑞士落实双语政策。孩童们必须学习两个主要的国家语言;前者学习英语和法语,后者则是德语和法语。

语言不应成为障碍
別误会,我全力支持不同源流的学生增加交流互动的机会。这是正面的行动,应该鼓励和表扬。语言不应成为不同族群学生们的交流障碍,因为国民型学校的学生也学习马来文。

即便如此,我仍坚信仅仅语言无法確保族群和谐,尤其是当国民仍根据肤色和宗教被赋予不同的差別待遇和权利。即使学校孩童共用一室,他们仍经常意识到或被提醒自己与他人的不同。近年来就有两宗案例印证问题的纠结:其一是非穆斯林学生被迫在斋月期间在洗手间进食用餐,其二是在另一所国民学校连杯子也被区分为穆斯林和非穆斯林专用杯。

没错,没有孩子一出生就是种族主义者。然而在孩子的成长过程中,在耳濡目染下得到的讯息会影响他们如何看待事物。某些族群偏见可能因此渗透年轻人的思想,进而形成族群歧视的根源。有鉴於此,政府和社会应创造一个优良有利的环境,让孩子们从小就能有积极正面的观念与各族同胞做朋友。

检討积极平权措施
积极平权措施(Positive affirmative action)是一个全世界普遍实践的政策。如果执行妥当,它拥有巨大潜能达到社会正义的目標。因此,积极平权措施应专注於把资源导向最符合资格寻求援助的个人。
一般上主流的积极平权措施是根据阶级作分配资源,虽然在某些国家的少数民族(例如原住民族群)也可享有优惠待遇。

一旦积极平权措施被滥用和扭曲,那些没受惠的人民难免会深感不满,觉得这措施毫无社会正义可言。在我国,或许有些人会认为自己被贬至「次等」公民,不满其他人基於肤色和宗教身份就可享有更多的优惠权利。如此的不满情绪或可酝酿很久並传给下一代。若政府和社会不认真看待,日后这將会是颗计时炸弹,会一再出现令人难堪或不安的衝突。不公平待遇的印象若被默许持续下去,这將会是国民团结精神、跨族群的信任和相互接受的重大障碍。

政府与议员们应不时检討我国现行的政策、法律和宪法,並积极地確保这些条文都能符合「自由、平等和博爱」的普世价值观。若没採取实际行动处理人民的不满根源,再多的表面跨族和谐画面会有用吗?到底何时马来西亚人方可接纳各自不同的身份背景,並得以平等公民自居、共享这片土地?

刊登于《東方日報》東方文薈版2017年9月2日

Reflections on racial harmony in Malaysia


WEEKS ago, I noticed on my Facebook feed that some friends were sharing the latest music video produced and composed by Namewee, entitled “Ali, AhKao dan Muthu”. Namewee is a controversial hip-hop artist who was once condemned by Malay right-wing groups following the release of “Negarakuku” 10 years ago. His song carried some anti-government undertones, and he was accused of disrespecting Islam, the Malay race and insulting the national anthem.
In stark contrast to his previous song, “Ali, AhKao dan Muthu” is a politically-correct portrayal of racial harmony among the three main ethnic groups in Malaysia, namely Malay, Chinese and Indian. Its chorus goes “…kawan selama-lamanya, satu hati satu jiwa”.
While I do not dispute Namewee’s well-meaning intentions (and indeed that of other artistes) who are working hard to promote interracial harmony via songs and videos, how can one transcend stereotypical symbolism of interracial harmony to address the elephant in the room – the real complicated issues that create discordance, mistrust and discontent among the multiracial community?
Firstly, racial harmony in Malaysia typically emphasises the unity of only three major races, leaving out diverse communities, for example, the aboriginals (or ‘Orang Asal’) in Peninsular Malaysia, the native bumiputera in East Malaysia and mixed parentage groups such as baba-nyonya, Eurasian and Chindian, as if they do not fit into the whole picture but only the fringe ‘lain-lain’ position. These groups might feel disconnected or disillusioned at being excluded.
Secondly, a study on interracial relations published by CIMB Foundation on January 2017 found that 89.5% Malay, 79.0% Chinese, 68.7% Indian respondents reported having a lot or almost all of their friends from their own racial groups, pointing to a lack of deeper racial interactions on a daily basis.
This is indeed a disturbing reality, and one that contradicts the “Ali, AhKao dan Muthu” friendship propagated by Namewee’s video. The question we must ask ourselves is this: how many Malaysians actually desire such inter-racial friendships, and if they do, what are the real life obstacles that prevent these relationships from forming?
Certain people, including politicians, have alluded to the single-stream schooling system as the magical silver bullet that will bolster interracial harmony in Malaysia. Some weeks ago, during a TN50x session on politics, UMNO Youth exco Shahril Hamdan claimed that having single stream schools could be “the formula to achieve unity among races” based on “constant engagement with one another from a young age”. But is this “short cut” to promote unity, as he claimed, really something desirable?
People often forget that Malaysia’s strength lies in the diversity of our multicultural-multilingual plural society. This diversity is very reason why so many travellers, from near and far, fall in love with our country – a country that is indeed a Truly Asia, a well-known international recognition.
The former Prime Minister Abdullah Ahmad Badawi once proposed to introduce ‘home language’ classes in national schools.
"We should be learning the languages of other races in line with today's needs," he said.
Although the then government had other motives for that proposal (and if we disregard the issue of shortage in mother tongue language teachers), it was nevertheless a praiseworthy policy proposal mirroring language policies practiced in other multi-lingual countries such as Canada and Switzerland. In those countries, children are made to learn dual major languages in school (English and French for the former; German and French for the latter).
Make no mistake, I am all for students from different backgrounds coming together and interacting more frequently with each other. Such positive actions should be strongly encouraged, moreover language should not be the barrier since vernacular school students are taught in Bahasa Malaysia too.
Still, I argue that language alone will not guarantee racial harmony especially not when Malaysians are still accorded different treatments and rights based on their race and religion. Even if school children were to share a classroom, they would still be constantly aware and reminded of how different each is to other.
One need only recall the incident when poor non-Muslim students had to eat and drink in the restroom during Ramadan, or, in another case how cups were separated according to Muslim and non-Muslim in another national school.
It is true that “no child is born a racist”. Some years ago, a documentary produced by local filmmaker Jason Lim showed that as children grow up, the messages they receive from the surrounding environment shapes and influences the way they perceive things.
Under adverse circumstances, certain racial stereotypes could infiltrate young minds, forming the basis for discrimination. The government and society should do more to cultivate a good environment for children to form multiracial friendships from a young age.
Positive affirmative action is an accepted worldwide practice. When applied appropriately, it holds much potential to reach the goal of delivering social justice. However, to attain that goal, policies for positive affirmative action should focus on channelling resources towards qualified individuals who need the assistance the most.
Class-based positive affirmative action is usually the mainstay, though in certain countries the absolute minorities (e.g. aboriginal tribal communities) do enjoy certain preferential treatment. The abuse and distortion of affirmative action creates social injustice and unhappiness for those who are non-beneficiaries of the system.
In Malaysia, certain quarters might feel they are rightly or wrongfully treated as ‘second class’ citizens, and perceive that some enjoy more privileges and opportunities than themselves. Such sentiment could brew over a long time and pass down through generations if nothing is done to weed out the roots of this dissatisfaction stemming from differential treatment according to racial and religious lines.
Left unchecked, it could even erupt into ugly (not necessarily violent) conflicts. Such cases have already unfolded now and then in our country. If the perception of unfairness is allowed to persist, it would be a real stumbling block to realise the true spirit of national unity, trust and mutual acceptance among various ethnicities in Malaysia.
The government and lawmakers must periodically re-examine our existing policies, laws and constitution, and strive to ensure that these reflect the universal values of liberty, equality and fraternity.
What use is there in propagating a superficial rhetoric of interracial harmony, if no concrete action is taken to deal with the underlying causes of dissatisfaction among the grassroots? When will Malaysians be able to embrace their different identities and daily practices, yet be treated as equal citizens sharing this land? 

Published at The Malaysian Insight, Voices, Aug 28, 2017.

Wednesday, August 02, 2017

谁该为您的健康负责?

標题的答案似乎已呼之欲出。在正常的情况下,大部分人都可能这样答:当然是自己啦!。事与愿违,现实里很多人言行不一致,並没有好好照顾自己的健康。常人说:预防胜于治疗。如果国人都认真地遵照这常理智慧,那么政府在公共卫生和財政规划方面就轻鬆多了。

现实是残酷的。2015年度的《国家卫生和病情调查报告》(National Health and Morbidity Survey 2015)显示,有30%的大马人口超重(overweight),再有17.7%的人过胖(obese)。换言之,若按照世界卫生组织1998年的体重指数(BMI)指南標准,接近半数的大马人口拥有不健康的身形。若根据大马临床实践指南標准,不健康身形人口的比率更高,逼近2/3人口(64%)。

不爱运动爱美食

其中的问题是,国人不爱运动。如果依据《国际体力活动调查问卷》(IPAQ)的定义,估计有33.5%人口被鉴定为「非活跃」的。其实该问卷对于「活跃」的標准要求並不高,如国人能至少每週有5天每日步行超过半小时,或进行中等激烈的运动。然而,1/3的国人连这点都办不到。

不健康的饮食习惯与患上非传染性疾病的偏高风险息息相关。其中泰勒大学2014年的研究发现有64.1%的国人至少每天都在外吃一餐,同时又有31.9%的人习惯在晚餐后仍进食一餐高份量的饮食。

不少大马人常以马来西亚是美食天堂为借口,说这里拥有太多难以抗拒的美食怎能不多吃?那看似有道理,但放眼全世界再检视这说法,就可发现其实美食与肥胖並没有直接关联。
倘若属实,美国和英国其中这两个世界上最胖的国度应同时拥有最多最好吃的美食,何时轮到被公认为西方美食国度意大利和法国呢?看看泰国和印尼,两国的美食也可媲美大马一样载誉全球,却在肥胖国度的排位上低于我国,那又是为何呢?

公共健康危机

社会无法不重视缺乏运动和不健康饮食习惯对公共卫生所带来的严重祸害。仅仅是非传染性疾病病例,已佔据了大马73%的死亡人口。在2012年,至少有70%的大马人被诊断患上非传染性疾病。在2015年,涉及到呼吸管道、心臟血管、消化系统、泌尿生殖系统和癌症相关的非传染性疾病都挤上了十大入院的病例种类排名,病例总数为120万次。

就仅谈治疗糖尿病的花费,估计已达国家卫生预算的16%。2014年一份卫生部报告统计显示,若综合所有的直接和间接费用,政府需为每名糖尿病患者每年支出3750令吉充作治疗费。

那么,健康问题是否该全怪个人没照顾好自己,而政府就可以置身度外,对確保社区国民健康事宜毫无责任?非也,本人不这么认为。

政府难以推搪

大马政府已有很多宣传管道可整合设计出有效的推广健康运动,包括使用本身和官联公司旗下的电台、电视台以及纸媒。提倡活跃能动生活和良好饮食习惯,若在政府有效的宣传指挥下必能事半功倍。可惜,我们在日常生活体验到的反而是连环轰炸的各类快餐广告出现在各大电视台、电台、报纸和宣传看板上。政府其实可创意地鼓吹健康饮食文化,例如把健康讯息置入流行动画例如本地製作的《Upin dan Ipin》,让孩童从小就接触到正面的健康资讯培养良好习惯。学校食堂的饮食选项和营养更不可忽略,尤其是要阻止一些食堂经营者售卖太油或太甜的食物给学生。

至于小学和中学的体育课,我国政府仅安排每週80分钟,被拋于多个区域国家之后:新加坡和韩国拨出每週120分钟、中国105-135分钟,日本则是125-130分钟。问题在于我国的体育课鲜少被重视,只因它不是考试科。家长也应以身作则带领孩子走出並接触户外,以培养热爱运动的习惯。那么户外活动总需要个空间吧?

到了最后,从城市规划的角度来看,政府的责任更难以推搪。政府应根据人口密集度提供足够大小的公园和休閒空间,特別是在稠密的城市地区。据国家城市化政策下的標准,每1000人应享有2公顷的公共空间。地方政府应鼓励人民多步行和骑脚车,所以当务之急是改善行人道和脚车道的衔接网络。那么,能「动起来」的人民或许会更愿意使用公共交通,捨弃私家车。

总而言之,在改变社会行为以达至更好的公共卫生结果的角色上,政府其实能做的还有很多。但人民本身也该回应政府的呼吁,尽本分照顾自己的健康。若双方都配合得体,我国绝对能减少公共卫生和健康问题,那么或许再也不会有人说大马美食和健康不能兼得。

刊登于《東方日報》東方文薈版2017年7月22日

Who is responsible for your health?

The question seems like a no-brainer. Under normal circumstances, the answer is most likely ‘our own good self’.  But in reality, some people do not take care of their health as well as we would like to think. The common wisdom is ‘Prevention is better than cure’; if every Malaysian took this axiom seriously, it would surely ease the task of the government in terms of public health and financing.
The reality is stark. The National Health and Morbidity Survey 2015 recently showed that 30% of the Malaysian population is overweight, while a further 17.7% are obese. In other words, nearly half of the Malaysian population was found to have an unhealthy body size based on the World Health Organisation’s (1998) Body Mass Index (BMI) guidelines. The percentage goes even higher, at 64%, if we are to use the Malaysian Clinical Practice Guidelines).
Based on the definition given by the International Physical Activity Questionnaire (IPAQ), 33.5% of the population is identified as ‘inactive’. This is unsurprising news, given that one third of the Malaysian population do not practise moderate intensity level of physical activity such as walking for more than 30 minutes per day for minimally five days a week.
Unhealthy dietary practice is correlated with a higher risk of non-communicable diseases (NCDs). A study found that 64.1% Malaysian individuals eat at least one meal per day outside of the home daily, while 31.9% habitually eat a heavy meal after dinner.
As a natural defence, many Malaysians would be quick to claim that Malaysia has too much irresistable good food. But contrary to popular belief, there is no correlation between good food and obesity. If that were true, then countries such as the United States and Britain, two countries that currently top the obesity rankings, should also top the world for the best food, instead of countries renowned for their culinary fare such as Italy and France! On a more regional note, Thailand and Indonesia, countries which have equally tempting food choices as Malaysia, are in fact ranked lower than our country in the obesity rankings.
Society cannot afford to ignore the serious consequence of lack of exercise and bad eating habits to public health. NCDs are responsible for 73% of deaths among Malaysians. In 2012, at least 70% of Malaysians were diagnosed with NCDs. As of 2015, NCDs in respiratory, circulatory, digestive and genitourinary systems as well as neoplasms (cancer) made it to the top 10 principal causes of hospitalisation, totalling 1.2 million cases. The cost of treatment for diabetes alone is estimated to account for 16% of the national Malaysian healthcare budget, while the combined direct and indirect per-patient costs for diabetes was found to be RM3,750 in 2014.
Yet, is it right to place the blame solely on the individual, and claim that the government plays no role in attaining good health outcomes in the communities? I do not think so.
The Malaysian government has many tools at their disposal to coordinate effective health promotion, including TV and radio channels as well as newspaper press. These are effective channels through which the government can encourage active lifestyle and good dietary habits among society. These days, we are constantly bombarded by various fast food advertisements on TV, radio, newspaper and billboards. Perhaps the government should emulate the US Food and Drug Agency (USFDA) in regulating food providers, especially fast food outlets, to have compulsory nutritional list on their standard menus.
The government could also come up with creative ways to encourage healthy eating habits using commercial activities. For example, the use of popular animation series such as “Sesame Street” or the locally produced “Upin dan Ipin” to promote good eating habits and encouraging physical exercise could potentially lead to a shift in lifestyle habits among minors, and further reduction in NCDs.
School-based nutrition plays a great role in altering social norms and behaviours. It is not helpful if some school canteen operators could get away with selling foods which are either too oily or too sweet. Current programmes involving poor students such as “Rancangan Makanan Tambahan untuk Pelajar Miskin” are a good platform to educate canteen and cafeteria providers on the importance of including more nutritious food items in their menu. The sale of junk food should be banned if they follow the guidelines set by the government.
In terms of physical education in primary and secondary schools, the government allocates just 80 minutes per week. We are lagging behind other countries in the region – Singapore and South Korea both allocate 120 minutes, China, 105-135 minutes, and Japan, 125-130 minutes. In Malaysia, physical education is seldom prioritised because it is perceived as less important than studying and passing for examinations.
While there has been an increase in the number of running and cycling events in the Klang Valley, such events should be encouraged in other states in the country and younger participants should be encouraged to participate. Parents need to lead by example, by teaching their children to love physical activities . This could be done through enrolling them in running clubs, frequently enjoying indoor or outdoor sports as a family, and limiting screen or internet time so as to encourage outdoor activities.
Finally, from an urban planning perspective, the government must provide sufficient parks and recreational spaces per population density, especially in the urban areas. Local governments can encourage higher activity levels by improving the connectivity of pedestrian walkways and cycling paths, and encouraging the use of public transportation over that of private cars.
In conclusion, there is plenty that the government can do to shape desirable social behaviours towards better public health outcomes. But society, too, must do its part by responding to these calls. If both play their roles right, Malaysia will surely be on the right track to reducing public health issues and living up to the mantra of “prevention is better than cure”. 

Monday, June 12, 2017

Revising the minimum wage levels in Malaysia


Imagine that you are the sole breadwinner in your family. You earn the current minimumwage of RM1,000 to feed a family of 4 living in Kuala Lumpur. How would you plan your daily expenditure and the expenditure of your family? You have only about RM8 per person per day to spend.

That was the underlying context for the “Poverty Line Challenge” organised by Suaram Penang for the past two consecutive years, which challenged participants to survive on only RM7.5 per day for five continuous days. This may be just a five day challenge to some, but in reality, 1.6% of households[1] (or about 106,800 households) in Malaysia had earned less than the minimum wage of RM900 per month in 2014. For the lowest expenditure class of households, on average they would spend 28% of their earnings on food and beverages, 30% on housing and utilities and another 9% on transport[2].

This begs the question of whether the minimum wage of RM1,000 is sufficient for a household living in an urban area.

According to the National Wages Consultative Council of Malaysia[3], the objectives of the minimum wages policy are to i) ensure basic needs of workers and their families are met ii) provide sufficient social protection to workers iii) encourage industry to move up the value chain by investing in higher technology and increase labour productivity and iv) reduce nation’s dependence on unskilled foreign labour.

Malaysia began implementing the minimum wage effective from January 1st 2013, where the monthly minimum wage in Peninsular Malaysia was RM900 and for East Malaysia, RM800. Effective since last year July, the monthly minimum wage was adjusted to RM1,000 and RM920, respectively. Under the minimum wage legislation, the minimum wage levels shall be reviewed every two years.

Critics blame this policy for harming the economy and forcing some businesses to close thus creating more unemployment. Some cast doubt because they feel that the labour productivity increases do not match up with the wage increment. On the other hand, others claim that the minimum wage is set too low and as such does not help the workers to cope with higher living cost in Malaysia. Proponents of a higher minimum wage, such as Malaysian Trades Union Congress (MTUC) and opposition parties repeatedly urge the government to set it at RM1,500 .

Figures from the Labour Force Survey seem to show some of the benefits of the minimumwage policy. This policy may be partially responsible for the improvement in labour force participating rate (LFPR) from 65.6% in 2012 (pre-minimum wage policy) to 67.7% in 2016. The implementation of the minimum wage policy also coincided with an increase in women’s participation in the labour force, where female LFPR reached 54.3% in 2016, up from 49.5% in 2012. The number of employed persons in Malaysia also increased from 12.8million in 2012 to 14.2million in 2016. This clearly shows that employment opportunities and labour participation in Malaysia were not negatively affected by the minimum wage policy. While the minimum wage policy has brought more socioeconomic benefits than harm, the current system in Malaysia is still far from ideal. Allow me to illustrate further.

The current minimum wage rates are only applicable to West and East Malaysia, as 2 general territories. However, inter-state difference is wide. For instance, is it fair to have workers in the Klang Valley and in Kelantan both receive the same amount of minimum wage? Even within a state there is huge disparity in living expenses: taking Selangor as an example, residents in Bandar Utama (an affluent township located in Petaling Jaya district) and Sungai Besar (a rural township in Sabak Bernam district) would have vastly different levels of living costs.

It may be true that some firms might consider laying off its workers due to cost saving when minimum wage is implemented. However, if the firm knows that the minimum wage level for rural or semi-urban area is significantly lower, they might consider moving into and setting up the business there, thus more job opportunities could be brought to the area.

Another issue is the fact that the current system does not distinguish between workers’ age. Employers are often reluctant to pay inexperienced ‘freshman’ workers too highly. In this case, a lower but reasonable wage for young workers may be a good balance. This also allows for the setting of a higher minimum wage at a later age, when the workers are more likely to shoulder bigger financial responsibilities for family needs. In United Kingdom, the government gazettes the National Minimum Wage hourly rates of £5.6 (RM30.33) to £7.05 (RM38.19) for 18-20 to 21-24 years old employees, respectively. However, the National Living Wage is applied to employees of age 25 years old and above, set at hourly rate of £7.5 (RM40.62).  Even more impressive is the fact that the UK minimum wage rates are adjustable or reviewed every half year. Can Malaysia emulate the same “age-sensitive” model?

One may have reservations and might worry that this proposal would complicate matters for the authorities and employers. One needs to be reminded that some countries set the minimum wage rates even according to different demographics, such as India, which has more than 1,200 rates across the country. I do not propose that we wholly follow the case of India, but at the very least, rates should be refined down to state or district level.

Many countries set the minimum wage at 30-60% of the median wage of their country. Thus, if our government takes 60% of the median household income[4] (RM4,585) divided by average number of wage earners per household (1.8), the minimum wage should be RM1,528. If we take the UK standard at 44%, then it would be RM1,120.

The current national minimum wage in Malaysia is set too low. If the lowest grade of workers from the Majlis Perbandaran Seberang Perai have enjoyed a minimum basic salary (including fixed allowance) of RM1,350[5] since 2012, there is no reason why the federal government cannot adjust the national minimum wage to an acceptable and fair level.

In setting minimum wage rates, the main consideration should be creating a social safety net that complements the existing social welfare system, which I believe is inadequate. The minimum wage should serve as a right for workers to avoid being exploited by the employers. Workers deserve sufficient wages to deal with basic living expenses, so they can live with assurance and dignity.


[1] Prices, Income and Expenditure Statistics Division, Department of Statistics Malaysia.[2] Household expenditure survey 2014, Department of Statistics Malaysia[3] T. Shanmugam, “Early effects and challenges of minimum wages in Malaysia: Sharing of pre & post economic and social indicators”, Presentation at the National Minimum Wage: Symposium & Policy Roundtable, Johannesburg, South Africa, 2-4 February 2016[4] Household Income And Basic Amenities Survey Report 2014, Department of Statistics Malaysia[5] “Dasar baru pro-pekerja 2012 MPSP, gaji minima RM1,350”, Bulletin Mutiara, 16 Nov 2011.https://www.buletinmutiara.com/dasar-baru-pro-pekerja-2012-mpsp-gaji-minima-rm1350/

Prudent, strategic planning required for medical housemanship programme

It is stereotypical of Asian parents to dream of the day when their child dons the white doctor’s coat or the green surgeon’s scrubs. In fact, there are plenty of opportunities for one aspiring to be a medical doctor in Malaysia.

Over the years, Malaysia has experienced a boom in the number of medical programmes offered by private higher education institutions in order to cater for this demand.  Parents typically invest a hefty sum into a child’s medical education, which would take 4 to 5 years to complete. From just one college (namely, the Penang Medical College) in 2001 to 11 private institutions in 2014, the number of medical graduates from private institutions entering the workforce is 26 times more than what it used to be in 2001. Those who did not enrol in local institutions may opt to study abroad in one of the 310 recognised foreign medical institutions, some of which have lower entry requirements than local institutions. The sharp surge in the numbers of medical graduates seeking housemanship positions has caused a glut in the public system. In 2015, Malaysian Medical Council provisionally registered 5,147 medical practitioners; only 4,121 housemen having completed and vacated the local positions in the same year.

In a recent interview, Deputy Health Minister Dr Hilmi Yahaya stated that out of a total of 10,835 housemen placed in 44 teaching hospitals and Royal Military Hospitals, only 48.6% medical graduates who went through Public Service Commission interview in 2016 obtained a place[1]. Meanwhile, the Health Minister Dr Subramaniam conceded that the waiting time forhousemanship placement was between 6 to 9 months.[2] This prolonged wait caused anxiety and stress to the housemen, as they were left with no means of income and risked losing touch with the knowledge and skills acquired during their years of study.

Since 2008, the duration of the housemanship programme has increased from one year to 2 years. Now, housemen are required to cover 6 disciplines for their postings, namely Internal Medicine, Paediatrics, Surgery, Obstetrics and Gynaecology, Orthopaedics and Emergency Medicine (or 3 alternative choices of discipline). The total number and the turnover rate of house officer positions are determinants for a fresh houseman to secure a place in one of the training hospitals. On the other hand, the number of experienced specialists who are willing and able to supervise the house officers determines the quality of the housemanship programme.

Another difficulty lies in getting sufficient numbers of available specialists in each discipline. Within ‘Emergency Medicine’, MOH has only 139 specialists, and another 3 core discipline areas have less than 250 specialists each[3]. If one were to divide the aforementioned total number of housemen by 6 postings, there would be 1806 housemen on average seeking a placement in a certain discipline at any one point in time. Even if 100 specialists from a particular discipline enlisted as a mentor, he or she would have to supervise a group of 18 housemen on average. With such constrained resources, how could the training quality be good and sufficient under such circumstances? A study done in 2012 by the MOH further confirmed that in 48.4% of all cases, one mentor had to take on 6 mentees and above[4]. There were even cases of over 20 mentees to 1 mentor!

The ongoing ‘brain drain’ of specialists to the private sector and foreign countries is yet another issue contributing to the shortage of experienced specialists and consequently, poorer quality of training. It was found that between 2009 and 2013, about one-third of housemen reported to have extended their housemanship training at least once[5] ; 55% due to incompetence and the remaining 45% due to disciplinary issues. These “extensions” caused a bottleneck to the placement system within the training hospitals. Coupled with the large influx of incoming medical graduates over the recent decade, the training hospitals are becoming even more bloated and simply cannot catch up with the pace.

While the housemanship bottleneck issue cannot be solved overnight, policymakers should be more prudent in planning to anticipate the possible issues and prevent the situation from worsening. We recommend the following measures: Firstly, MOH should train more specialists and retain them in public sector. Besides that, MOH should also plan and design the housemanship programme better, especially to incentivise specialists to become mentors. In broader terms, the government should work with private sector hospitals, providing the latter with incentives to train housemen while sharing the cost burden of training. Finally, the MMC needs to have tighter regulations of local private and overseas medical education institutions to ensure medical graduates they produced are of desirable quality and not quantity.

Given that housemanship training is the bedrock of good skills and professional development for medical officers, government has to ensure that medical graduates receive proper skills training and have an overall satisfying experience during their housemanship period. After all,housemanship training is an important quality safeguard of the provision of medical services to the general public.


[1] “More slots at training hospitals opening up for housemen”, The Star, 15 March 2017
[2] Hashini Kavishtri Kannan, “Med students told: Don't work illegally, wait for housemanpostings”, New Straits Times, 3 August 2016
[3] National Specialist Register, valid as of 24 Feb 2017
[4] Ang K.T. et al., “Mentoring Junior Doctors in Public Sector Hospitals, Malaysia”, Institute for Health Management, 2012

[5] Norrina J. et al., “Housemen Extension: The Concern of All”, Institute for Health Management, 2014

政策和公共知识份子的角色

如何鼓励人民多乘搭公共交通,从而解决塞车问题?消费税当初应该推行吗?推广医疗旅游会否损及本地人在私人医疗服务上的利益?哪个是永续发展的模式,以确保自然环境与人文精神可被维护及发扬光大?

以上的问题都牵涉到政策讨论:有些具有政治意识,有些则可放在非常技术的层面来探讨。政策影响可大可小,大至决定你在这片国土上的个人身份权利,主宰你的衣食住行;小则跟你没直接关系。无论是良策或下策,有些政策的影响深远至几代人的事,例如70年代的新经济政策;有些政策则会带来永久性不可逆转的改变,比方说允许油棕种植业开辟原始森林的土地政策。

在我国,政策的拟定一般惯性是由上而下产生的。有时候纯粹是政治人物的个人意愿或突发奇想,例如英文教数理政策。一旦政策没经过仔细研究和深思熟虑,没以数据事实和扎实理论为根据推算未来,该政策的失败风险机率颇大。那么最后由谁来收拾烂摊子,代价由谁来负责?当中的问责追究机制,人民除了可委托反对党,本身能不能亲自有效地监督政府的表现?

在一些民众的认知里,政策似乎归属于政治圈子内的话题和权力而已,他们觉得遥不可及,也无从改变结果。遥不可及或源自于有些政策的技术复杂度,导致某些人因无力全面解读而放弃参与讨论。再说,对国家政治制度已失去信心和希望的大有人在,他们甚至认为讨论政策无济于事因为上台的还会是同一集团的同一批人。

前联合国秘书长科菲安南曾说过:“知识就是力量,信息就是解放。教育是进步的前提,对每个社会和家庭都一样”。同样的道理若用在我国的政治和民主教育,有何不可?倘若人民能掌握议题、对政策了解得更多,就能更自觉本身的权利,不会轻易被忽悠受摆布。如此一来,众人更能组织起兴论力量来反对和抵挡不合理不正义的政策,这就是民主成熟、理智进步的社会象征。

政策的讨论虽可在咖啡店里口沫横飞道长短,或在豪华酒店的会议厅里滔滔不绝,到底最后结果怎样还是得回到重点看论政策的人有没做足功课,拿出专业精神实事求是,分析解说能不能信服大众。没错,政策研究是一门学问。我身为槟州州政府的智库和公共政策研究中心的政策分析员之一,除了要做好这门学问,更有责任把思想种子散播出去,以期能发扬新观点促使它影响或改变这社会,达到一定的功用。要取信于社会大众,除了要使用易懂的语言持续性地与公众沟通交流,更重要的是能坚持把住本身的客观专业,公正不阿、问心无愧地交代和捍卫本身的研究结果。

既然是由公费资助的政策研究,必然要有其公共利益,研究成果也理应与公众公开分享。换言之,我是纳税人的雇员,终须对公众负责。而我在其位谋其事就得尽其责,成为公共知识份子之一。那么,我唯有走出冷气房面向大众,才能有效地做到坐言起行。


如果政策是个大版图,围绕着这个大版图的策议者对于时局布阵,防守进攻略都必须拿捏清楚。细节可有错但不能全盘皆落,至少大方向没走错。就如刘备三顾茅庐拜访诸葛亮留下后来的《隆中对》,从此奠定了刘备的蜀国在三国天下定局的立足攻略基础。又称《隆中三策》,诸葛亮提出先取荆州为根基,再夺益州为鼎足补给后方,进而角逐中原的战略构想。若说槟城是我们发挥影响力的出发点根据地,角逐政府决策的中原是我们的理想。那么,我们该有什么政策攻略打造一个进步有希望的马来西亚?我的研究院同僚们将在接下来每逢周日与大家谈政策,叙说故事。


刊登于《東方日報》東方文薈版2017年6月11日