Healthcare systems are facing major challenges as they struggle to meet increasing demand with limited resources. Demographic changes, changing disease patterns, illegal immigrants, industrialization, issues of quality and efficiency, shortages or misdistribution of human resources, financial constraint, inadequate research and globalization are the major challenges faced by Malaysia’s healthcare system as it prepares to restructure itself.
Globalization can be described as the integration of economic systems, capital movements and opportunities for different peoples through better information and communication technologies. But locally it has come to mean the increased insecurity and powerlessness that people (particularly poor people) feel in the face of global processes. Impact of globalization on populations’ health is predictable since globalization will change trade processes and also social and cultural shift. The future healthcare must transform the healthcare system, by making it more integrated, disseminated and virtual.
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The Malaysian future healthcare system will need to align with and support national health vision and goals. The services must be seen in the context of achieving the vision and the value it adds in achieving national health goals. Existing and the health system of the future must be guided by clear guiding principles and philosophy as well as being robust. Malaysia will develop one of the most advanced health systems of the world by harnessing the power of information and multimedia technologies to transform the delivery of healthcare.
Hypertension is one of the most common worldwide diseases affecting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge. 33% of the Malaysian adult population suffering Hypertension and it is including overall gender, race and ages (Lim, Morad et al, 2004) Over the past several decades, research widespread patient education and a concerted afford on the part of healthcare professional have led the decreased mortality and morbidity rates from the multiple organ damage arising from years of untreated hypertension.
Hypertension is the most important modifiable risk factors for coronary heart disease, stroke, congestive cardiac failure, end stage renal failure and peripheral vascular disease . Many interrelated factors contribute to these mechanisms and may differ between individuals, such as the rennin-angiotensin system, endothelial dysfunction, salt intake, obesity, genetics and low birth weight (Beevers et. al 2001).
The significance on the high blood pressure condition will be more critical, which may lead to the complex complication such as stroke, increase mortality rate and also increase risk of cerebral haemorrhage.
The increasing prevalence of the Hypertension due to ageing process, the identification of the risk factors and diagnosis will able to control the Hypertension among the elderly people ( Ong, Oung et al , 2010).
In view to improve the healthcare system to be more healthy, the responsibilities of the healthcare provider will focus on the preventive strategy as it will be able to decrease the prevalence of Hypertension in the general population. The main issue to be focused will be on the unhealthy eating habits among the population, lack of physical activity, genetic factor, unhealthy lifestyle, stress and other contributing factors related..
Prevention From Intervention Strategy
The prevention and management of Hypertension is to reduce morbidity and mortality by the least intrusive means possible. This maybe accomplish by achieving and maintaining the systolic blood pressure below 140mmHg and diastolic blood pressure below 90mmHg and lower if tolerable, while controlling other modifiable risk factors for cardiovascular disease. The treatment to lower levels maybe useful particularly:
1. To prevent stroke
2. To preserve renal function
3. To prevent or slow heart failure progression
The above goals maybe achieved by non-pharmacological and pharmacological methods. Before we consider any active treatment of establish hypertension, there is an even greater need to look at the prevention of the disease.
Without planning prevention, the hypertension problem will always remain and it will only rely solely on the detection of existing high blood pressure. Primary prevention provide an attractive opportunities to interrupt and prevent the continue costly cycle of managing hypertension and its complications. This primary prevention (non-pharmacological treatment) can be achieved by the following manners:
There is no direct randomized evidence demonstrating that reducing blood pressure through lifestyle measure will reduce the risk of cardiovascular disease but it seems likely since trials have shown that benefits of anti-hypertensive treatment are determined primarily by the blood pressure reduction. The benefits of the lifestyle modification are summarized as below
To lower the blood pressure in the individual patient.
To reduce the need for anti-hypertension drugs and maximize the efficacy
To address the other risk factors presence
For primary prevention of hypertension and associated Cardiovascular disorders in population. Although there are difficulties in achieving and maintaining proper lifestyle changes, a systemic team utilizing health care professionals and community resources when possible can assist in providing the necessary education support and follow up.
Cigarette smoking is one of the most powerful risk factor for cardiovascular disease and avoiding of tobacco in any form is essential. There is significant raise in the blood pressure accompany the smoking of each cigarette. All hypertensive patients who smoke should receive appropriate counseling for smoking cessation and nicotine replacement therapy should be considered. Those who continue to smoke may not receive the full degree of protection against cardiovascular disease from anti-hypertensive therapy. The cardiovascular benefit of discontinuing tobacco use can be seen as early as within 6 months in all age groups and by 2 years; they are probably at the same risk with non smoker. Manson et al 1992, Doll et al 1994 (Breen J, 2008) state that Smoking cessation is probably the most effective lifestyle measure for the prevention of a number of cardiovascular diseases .
Excess body mass is correlated closely with an increase of blood pressure. Excess body weight increases the risk of hypertension (Stamler, 1991). Usage of nonpharmacological therapy can be used to reduce the weight loss as it has been proven that it is also able to reduce the blood pressure level (Kuller, 2009). The responsibilities on the weight reduction should be begin with own awareness by the high risk population. However with the frequent advertisement by the healthcare provider in the electronic advertisement will be able to create the depth understanding on the important of the reduction of weight. The losing of weight should not drastically occurs, as it lead to the haemodynamic status in the cardiovascular circulation
In Malaysia, most of the adult and elderly ages develop habit to take heavy supper meal late of the night and sometimes it is contain of high saturated fat that might lead to increasing fat deposition among the population. Fast food consist of high carbohydrate and high sodium contain in prepared foods, that also introduce to the risk of Malaysian population to develop Hypertension. This unhealthy dietary habit only lead to the high statistic of incidence Hypertension. Increasing fruit and vegetable, higher intake of calcium, magnesium or potassium has contributed to the beneficial effects of some of this diet. Regular fish consumption may enhance blood pressure reduction in obese hypertensive patient and yield additional benefits on the lipid profile. Hence all hypertensive patients should be advised to eat more fruit and vegetables, fish and to reduce their fat intake. This diet habit should be developed by providing continuous awareness among the high risk population with providing them a pamphlet at the public area and introduction on the preparation of low salt diet copyright in the compact disc or download into the website, as it will assist the public on the good eating habit on their own convenience.
Sedentary patients should be advised to take up moderate level of aerobic exercise on regular basis such as a brisk walk or swim for 30 – 45 minutes, 3 – 4 times a week. Regular aerobic exercise reduces BP in nonmotensive and hypertensive individuals (Cooper et al 2000).When compared with more active and fit individuals, sedentary individuals with normal blood pressure have 20 – 50% increase of developing hypertension. Regular exercise activity has been documented to lower the systolic blood pressure by about 4 – 8mmHg. Isometric exercises such as heavy weight lifting can have a pressor effect and it should be avoided. Patient with cardiac while other serious health problems need a more thorough evaluation, often including a cardiac stress test and may need referral to a specialist or medically supervised exercise program.
Prioritization the Health Issue
Government and private healthcare should consider on the development of the policy for the benefit for all. Reinforcement of the government policy will enhance the public oriented program on the important of preventive the hypertension rather than treat the hypertension.
The prioritization will be focus on the high risk group of population, such as executive, professional, new graduate adolescence, obesity individual and genetic. These groups are exposing to the risk of hypertension. The fast pace in the working environment , compounded the fact that work was physically demanding and influence the workers on the limited role (Rafnsdottir and Gudmundsdottir, 2004) especially on their well being activities. The proactive intervention will be able to assist the healthcare provider to prepare the public towards the reduction of the prevalence hypertension, especially in managing obesity, improve diet and increase physical activities.
Activities and Reward Program
Suggested that all the organization or company focus to improve the healthy well being environment such as formation of the mini gymnasium in order to encourage the involvement of the workers after duty or during break. Nevertheless, it will encourage high commitment to improve their healthy lifestyle without prejudice. Rewards program introduced to the actively participation in the gymnasium will be boost the enthusiasm among the workers in the organization. Thus, it will reduce risk of incidence hypertension and increase healthy life style among the population in cosmopolitan era.
Involvement of the broadcasting in promoting the important of healthy lifestyle will enhance the awareness among population on the management of preventing hypertension. Billboard along the highway, public area also able to assist the improvement of knowledge among the public.
Should be conducted at all ages, begin with primary school students, elementary schools, universities, seminars, workshop and promotion using bunting and banner, as it will create continuous understanding of the disease.
In 2006 The Third National Health and Morbidity Survey, The Prevalence of hypertension among adult 30 years old and above was 43% has increase 30% compared to 10 years ago (Merican, M, I., 2008). This figures shows that the hypertension can be considered serious illness which may effect the healthy well being among Malaysian population. Furthermore it can cause potentially life threatening if not detect and treated early.
Awareness on the hypertension will be no ending as this condition might occur at any level of ages. Contribution of the public towards reducing the hypertension prevalence and early identification of the risk factor enable the well being lifestyle among Malaysian.
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