The digital healthcare generation gap in Malaysia
The article below appeared in the September 12 issue of Health with Perdana, a regular column in The Star by Perdana University faculty members. This week’s article is contributed by Dr. Sangeeta Kaur Singh, Senior Lecturer, Epidemiology and Public Health Medicine, at the Perdana University-Royal College of Surgeons in Ireland.
Each generation of Malaysians share certain homogeneous experiences by the sheer virtue of living through the same period of time.
Experiences in this context refer to significant external events during the individual’s late adolescence and early adulthood years.
Similarly, the notion of homogeneity and its impact is reflective of the individual’s historical and societal experiences that act as influences, which form values, beliefs and lifestyles that distinguish one generation from the other.
The first five generations of Malaysians can be classified into:
- Veterans – the hardworking and pragmatic generation that survived the Japanese occupation during World War 2.
- Reformers – those born in the 1940s-60s, who believed in a better life, having lived though the communist insurgence, the formation of Malaysia and the May 13, 1969, racial riots.
- Strivers – those born in the 1960s, who focus on stability and comfort, having experienced the nation’s rapid economic and social development.
- Pursuers – those born in the 1970s, who endeavour to achieve their ambitions and goals through the uncertainty of rapidly-advancing technology and economic crises.
- Inheritors – Those born in the 1990s and after into the digital age, who adopt and adapt what is available to them.
So, how did these different generations adapt to the seismic change from the Covid-19 pandemic, and how does this impact their approach towards healthcare?
The way forward
In South-East Asia, the Malaysian healthcare system is lauded as a model for other developing countries.
We are indeed proud of our achievements, but our main challenge lies in the fact that healthcare costs have been rising over the last three decades.
The healthcare inflation in Malaysia stood at 12% in 2017 – the third highest out of 11 Asian countries.
By the end of 2018, this rose to 13%.
The way forward is to redesign the current system, and switch it from heavy curative care to a preventive model with an integrated approach that depends on multisectoral and community-driven engagement.
Such engagement aims to improve primary care with a health system that focuses on the patient.
While the goal is to reduce cost, the healthcare system must still ensure quality, efficiency and effectiveness of its services.
Technology is key to this as it can reduce resources, while improving monitoring and providing quick turnaround information that ensures sustainability over time.
At the same time, improvements of this kind must be able to mobilise communities to engage in preventive care actively.
This emphasises the need to ensure all generations of Malaysians have sufficient literacy and skills to benefit from technological updates within our healthcare system.
In addition, the experience of each generation in the digital age is an essential factor.
As each generation shares formative experiences as they age, this will affect future experiences and behaviour in how individuals perceive and experience digital technology in a healthcare context.
For example, Strivers tend to be less passive and more critical of the healthcare system, in contrast to Veterans.
Meanwhile, Inheritors have unprecedented ease with health-related technology and have the know-how to solve problems, making them quick to decide based on the information available to them.
However, local evidence has highlighted that health literacy is a factor in the use of health-related technology.
For instance, Inheritors from Selangor reported unfamiliarity with mobile health services that aim to improve population health.
The ignorance of available technology is not only a problem among specific generations in Malaysia, but also a lingering cloud over our medically-based system that is struggling with the necessary adaptation to the health information ecosystem.
Trust is an issue
Despite all these challenges, we now know that the seismic change brought about by the Covid-19 pandemic has formed a different perspective of Malaysians’ behaviour towards healthcare.
It brought to light the burden on health and human resources, while promoting the rapid development and adaptation of digital solutions for both service providers and receivers.
Such transformations were doable because 54% of Asia’s population was already online before the pandemic, with this number growing each year.
In 2016, Malaysia ranked 41st in the global digital adaptation index.
In 2019, we ranked among the top five for social media penetration in South-East Asia, with 81% of Malaysians being active social media users.
That year also saw over 90% of Malaysian households having an internet connection and 135% usage of mobile applications, with 93% of the population using smartphones to access the internet.
Additionally, there is evidence indicating that most Pursuers and Inheritors are using at least one health or wellness app.
Finally, 70% of mobile subscribers are using 4G.
Such high use meant that there were no issues when both Federal and state governments introduced a proliferation of apps to track the impact of Covid-19 on Malaysians last year.
Let’s take a look at the most ubiquitous among these apps: MySejahtera.
This app was initially launched to track and treat Covid-19 cases, trace those at risk, and monitor symptoms.
In August 2020, it was made mandatory for all business operations to enforce the use of MySejahtera.
The app was guaranteed to be safe as all the data collected through it is wholly owned by the Health Ministry, and supervised by the National Cyber Security Agency (Nacsa) and the National Security Council (NSC).
MySejahtera quickly evolved to also become a source of Covid-19 health information and data, as well as the point of coordination for vaccination.
Some 42% of Malaysians have installed this app, with 41% actually activating it.
However, only 17% have used it to report if they tested positive.
One of the reasons for this low uptake when it comes to reporting a positive Covid-19 status, could be due to concerns over the misuse of information collected.
Concerns over institutional trustworthiness have always lingered across all Malaysian generations.
In fact, such worries were highlighted in the Malaysian Digital Economy Blueprint, which included strategies to improve the faith in the digital aspect of the national healthcare system.
This is indeed a valid concern as trust issues have only escalated during the pandemic.
For instance, the sharing of specific contact-tracing information has led to stigma and discrimination towards those linked to significant clusters, particularly those considered superspreader events.
However, the good news is that Inheritors, Pursuers, Strivers and Reformers, i.e. three-quarters of Malaysians surveyed last year (2020), claimed they trust the healthcare system, especially in preventive measures such as escalating vaccine uptake.
Such trust in healthcare rose from 63% in 2018.
Promoting literacy and engagement
There is no doubt that the Covid-19 pandemic has encouraged the uptake of healthcare technology both among healthcare professionals and the public.
However, the fact remains that, thus far, the generations that take the most advantage of digital healthcare are the Inheritors and some of the Pursuers.
But health literacy is also an issue among these generations.
Given the fast-paced evolution of technology, there is a pressing need to further understand how health literacy relates to the usage of health information technology, especially apps.
We also need to ensure growth in health literacy and active engagement in healthcare.
If we address these areas, it will ensure that all users receive the full benefits from these technological advances, while we continue to protect health information privacy.