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  1. Fulltext Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia
    Pocock NS, Phua KH
    Global Health, 2011;7:12.
    PMID: 21539751 DOI: 10.1186/1744-8603-7-12
    Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.
  2. Fulltext Healthcare financing and social protection policies for migrant workers in Malaysia
    Loganathan T, Chan ZX, Pocock NS
    PLoS One, 2020;15(12):e0243629.
    PMID: 33296436 DOI: 10.1371/journal.pone.0243629
    BACKGROUND: For Malaysia, a nation highly dependent on migrant labour, the large non-citizen workforce presents a unique health system challenge. Although documented migrant workers are covered by mandatory healthcare insurance (SPIKPA), financial constraints remain a major barrier for non-citizen healthcare access. Malaysia recently extended protection for migrant workers under the national social security scheme (SOCSO), previously exclusive to citizens. This study aims to evaluate healthcare financing and social security policies for migrant workers to identify policy gaps and opportunities for intervention.

    METHODS: A total of 37 in-depth interviews were conducted of 44 stakeholders from July 2018 to July 2019. A mixed-methods analysis combining major themes from qualitative interviews with policy document reviews was conducted. Descriptive analysis of publicly available secondary data, namely revenues collected at government healthcare facilities, was conducted to contextualise the policy review and qualitative findings.

    RESULTS: We found that migrant workers and employers were unaware of SPIKPA enrolment and entitlements. Higher fees for non-citizens result in delayed care-seeking. While the Malaysian government nearly doubled non-citizen healthcare fees revenues from RM 104 to 182 million (USD 26 to 45 million) between 2014 to 2018, outstanding revenues tripled from RM 16 to 50 million (USD 4 to 12 million) in the same period. SPIKPA coverage is likely inadequate in providing financial risk protection to migrant workers, especially with increased non-citizens fees at public hospitals. Undocumented workers and other migrant populations excluded from SPIKPA contribution to unpaid fees revenues are unknown. Problems described with the previous Foreign Workers Compensation Scheme (FWCS), could be partially addressed by SOCSO, in theory. Nevertheless, questions remain on the feasibility of implementing elements of SOCSO, such as recurring payments to workers and next-of-kin overseas.

    CONCLUSION: Malaysia is moving towards migrant inclusion with the provision of SOCSO for documented migrant workers, but more needs to be done. Here we suggest the expansion of the SPIKPA insurance scheme to include all migrant populations, while broadening its scope towards more comprehensive coverage, including essential primary care.

  3. Self-Esteem, Narcissism, and Aggression: Different Types of Self-Esteem Predict Different Types of Aggression
    Amad S, Gray NS, Snowden RJ
    J Interpers Violence, 2021 12;36(23-24):NP13296-NP13313.
    PMID: 32065011 DOI: 10.1177/0886260520905540
    The aim of this study was to examine the relationship between self-esteem, narcissism, and measures of proactive and reactive aggression in two large community samples of young adults from two countries (the United Kingdom and Malaysia). Self-esteem and narcissism were measured through the Multidimensional Self-Esteem Inventory and the Narcissistic Personality Inventory, whereas aggression was measured by the Reactive-Proactive Aggression Questionnaire in 501 young adults with approximately equal numbers of men and women. In both countries, low levels of self-esteem were associated with reactive aggression while high levels of narcissism were associated with proactive aggression. Although this pattern was similar for both genders, the associations between both types of self-evaluation and proactive aggression were greater for men. The results suggest that people with low self-esteem are prone to greater reactive aggression due to anger and hostility, whereas those with high levels of narcissism can act with deliberate, planned aggression to achieve a goal. These effects appear stable across gender and culture.
  4. Universal health coverage in 'One ASEAN': are migrants included?
    Guinto RL, Curran UZ, Suphanchaimat R, Pocock NS
    Glob Health Action, 2015 Jan;8(1):25749.
    PMID: 28156768 DOI: 10.3402/gha.v8.25749
    Background As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. Design A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. Results In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC beyond the basis of citizenship and reimagine UHC systems that transcend national borders. Conclusions By enhancing migrant coverage, ASEAN countries can make UHC systems truly 'universal'. Migrant inclusion in UHC is a human rights imperative, and it is in ASEAN's best interest to protect the health of migrants as it pursues the path toward collective social progress and regional economic prosperity.
  5. Fulltext Migrant Women's Access to Sexual and Reproductive Health Services in Malaysia: A Qualitative Study
    Loganathan T, Chan ZX, de Smalen AW, Pocock NS
    Int J Environ Res Public Health, 2020 07 26;17(15).
    PMID: 32722563 DOI: 10.3390/ijerph17155376
    Providing sexual and reproductive health (SRH) services to migrant workers is key to fulfilling sustainable developmental goals. This study aims to explore key informants' views on the provision of SRH services for migrant women in Malaysia, exploring the provision of SRH education, contraception, abortion, antenatal and delivery, as well as the management of gender-based violence. In-depth interviews of 44 stakeholders were conducted from July 2018 to July 2019. Data were thematically analysed. Migrant workers that fall pregnant are unable to work legally and are subject to deportation. Despite this, we found that insufficient SRH information and contraceptive access are provided, as these are seen to encourage promiscuity. Pregnancy, rather than sexually transmitted infection prevention, is a core concern among migrant women, the latter of which is not adequately addressed by private providers. Abortions are often seen as the only option for pregnant migrants. Unsafe abortions occur which are linked to financial constraints and cultural disapproval, despite surgical abortions being legal in Malaysia. Pregnant migrants often delay care-seeking, and this may explain poor obstetric outcomes. Although health facilities for gender-based violence are available, non-citizen women face additional barriers in terms of discrimination and scrutiny by authorities. Migrant women face extremely limited options for SRH services in Malaysia and these should be expanded.
  6. Imminent health crises among the Rohingya people of Myanmar
    Pocock NS, Mahmood SS, Zimmerman C, Orcutt M
    BMJ, 2017 11 15;359:j5210.
    PMID: 29141900 DOI: 10.1136/bmj.j5210
  7. Fulltext Developing an evidence assessment framework and appraising the academic literature on migrant health in Malaysia: a scoping review
    de Smalen AW, Chan ZX, Abreu Lopes C, Vanore M, Loganathan T, Pocock NS
    BMJ Open, 2021 01 18;11(1):e041379.
    PMID: 33462099 DOI: 10.1136/bmjopen-2020-041379
    BACKGROUND: A large number of international migrants in Malaysia face challenges in obtaining good health, the extent of which is still relatively unknown. This study aims to map the existing academic literature on migrant health in Malaysia and to provide an overview of the topical coverage, quality and level of evidence of these scientific studies.

    METHODS: A scoping review was conducted using six databases, including Econlit, Embase, Global Health, Medline, PsycINFO and Social Policy and Practice. Studies were eligible for inclusion if they were conducted in Malaysia, peer-reviewed, focused on a health dimension according to the Bay Area Regional Health Inequities Initiative (BARHII) framework, and targeted the vulnerable international migrant population. Data were extracted by using the BARHII framework and a newly developed decision tree to identify the type of study design and corresponding level of evidence. Modified Joanna Briggs Institute checklists were used to assess study quality, and a multiple-correspondence analysis (MCA) was conducted to identify associations between different variables.

    RESULTS: 67 publications met the selection criteria and were included in the study. The majority (n=41) of studies included foreign workers. Over two-thirds (n=46) focused on disease and injury, and a similar number (n=46) had descriptive designs. The average quality of the papers was low, yet quality differed significantly among them. The MCA showed that high-quality studies were mostly qualitative designs that included refugees and focused on living conditions, while prevalence and analytical cross-sectional studies were mostly of low quality.

    CONCLUSION: This study provides an overview of the scientific literature on migrant health in Malaysia published between 1965 and 2019. In general, the quality of these studies is low, and various health dimensions have not been thoroughly researched. Therefore, researchers should address these issues to improve the evidence base to support policy-makers with high-quality evidence for decision-making.

  8. Fulltext "Because if we talk about health issues first, it is easier to talk about human trafficking"; findings from a mixed methods study on health needs and service provision among migrant and trafficked fishermen in the Mekong
    Pocock NS, Tadee R, Tharawan K, Rongrongmuang W, Dickson B, Suos S, et al.
    Global Health, 2018 05 09;14(1):45.
    PMID: 29739433 DOI: 10.1186/s12992-018-0361-x
    BACKGROUND: Human trafficking in the fishing industry or "sea slavery" in the Greater Mekong Subregion is reported to involve some of the most extreme forms of exploitation and abuse. A largely unregulated sector, commercial fishing boats operate in international waters far from shore and outside of national jurisdiction, where workers are commonly subjected to life-threatening risks. Yet, research on the health needs of trafficked fishermen is sparse. This paper describes abuses, occupational hazards, physical and mental health and post-trafficking well-being among a systematic consecutive sample of 275 trafficked fishermen using post-trafficking services in Thailand and Cambodia. These findings are complemented by qualitative interview data collected with 20 key informants working with fishermen or on issues related to their welfare in Thailand.

    RESULTS: Men and boys trafficked for fishing (aged 12-55) were mainly from Cambodia (n = 217) and Myanmar (n = 55). Common physical health problems included dizzy spells (30.2%), exhaustion (29.5%), headaches (28.4%) and memory problems (24.0%). Nearly one-third (29.1%) reported pain in three or more areas of their body and one-quarter (26.9%) reported being in "poor" health. Physical health symptoms were strongly associated with: severe violence; injuries; engagement in long-haul fishing; immigration detention or symptoms of mental health disorders. Survivors were exposed to multiple work hazards and were perceived as disposable when disabled by illness or injuries. Employers struggled to apply internationally recommended Personal Protective Equipment (PPE) practices in Thailand. Non-governmental organizations (NGOs) encountered challenges when trying to obtain healthcare for uninsured fishermen. Challenges included fee payment, service provision in native languages and officials siding with employers in disputes over treatment costs and accident compensation. Survivors' post-trafficking concerns included: money problems (75.9%); guilt and shame (33.5%); physical health (33.5%) and mental health (15.3%).

    CONCLUSION: Fishermen in this region are exposed to very serious risks to their health and safety, and their illnesses and injuries often go untreated. Men who enter the fishing industry in Thailand, especially migrant workers, require safe working conditions and targeted protections from human trafficking. Survivors of the crime of sea slavery must be provided with the compensation they deserve and the care they need, especially psychological support.

  9. Fulltext Reflections on migrant and refugee health in Malaysia and the ASEAN region
    Pocock NS, Suphanchaimat R, Chan CK, Faller EM, Harrigan N, Pillai V, et al.
    BMC Proc, 2018;12(Suppl 4):4.
    PMID: 30044886 DOI: 10.1186/s12919-018-0100-6
    Migrants and refugees face challenges accessing both healthcare and good social determinants of health in Malaysia. Participants at the "Migrant and Refugee Health in Malaysia workshop, Kuala Lumpur, 9-10 November 2017" scoped these challenges within the regional ASEAN context, identifying gaps in knowledge and practical steps forward to improve the evidence base in the Malaysia.
  10. Fulltext Occupational, physical, sexual and mental health and violence among migrant and trafficked commercial fishers and seafarers from the Greater Mekong Subregion (GMS): systematic review
    Pocock NS, Nguyen LH, Lucero-Prisno Iii DE, Zimmerman C, Oram S
    Glob Health Res Policy, 2018;3:28.
    PMID: 30288452 DOI: 10.1186/s41256-018-0083-x
    Background: Little is known about the health of GMS commercial fishers and seafarers, many of whom are migrants and some trafficked. This systematic review summarizes evidence on occupational, physical, sexual and mental health and violence among GMS commercial fishers/seafarers.

    Methods: We searched 5 electronic databases and purposively searched grey literature. Quantitative or qualitative studies reporting prevalence or risk of relevant outcomes were included. Two reviewers independently screened articles. Data were extracted on nationality and long/short-haul fishing where available.

    Results: We identified 33 eligible papers from 27 studies. Trafficked fishers/seafarers were included in n=12/13 grey literature and n=1/20 peer-reviewed papers. Among peer-reviewed papers: 11 focused on HIV/AIDS/sexual health; nine on occupational/physical health; one study included mental health of trafficked fishers. Violence was quantitatively measured in eight papers with prevalence of: 11-26% in port convenience samples; 68-100% in post-trafficking service samples. Commercial fishers/seafarers whether trafficked or not worked extremely long hours; trafficked long-haul fishers had very limited access to care following injuries or illness. Lesser-known risks reported among fishers included penile oil injections and beriberi. We found just one work safety intervention study and inconclusive evidence for differences in the outcomes by nationality. Findings are limited by methodological weaknesses of primary studies.

    Conclusion: Results show an absence of high-quality epidemiological studies beyond sexual health. Formative and pilot intervention research on occupational, physical and mental health among GMS commercial fishers and seafarers is needed. Future studies should include questions about violence and exploitation. Ethical and reporting standards of grey literature should be improved.

    Trial Registration: Review registration number: PROSPERO 2014: CRD42014009656.
  11. Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update
    Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Jones D, et al.
    Cont Lens Anterior Eye, 2020 02;43(1):9-17.
    PMID: 31761738 DOI: 10.1016/j.clae.2019.11.002
    PURPOSE: A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later.

    METHODS: A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies.

    RESULTS: Of the 1336 respondents, concern was highest (9.0 ± 1.6; p 

  12. Fulltext ARIA-EAACI statement on asthma and COVID-19 (June 2, 2020)
    Bousquet J, Jutel M, Akdis CA, Klimek L, Pfaar O, Nadeau KC, et al.
    Allergy, 2021 03;76(3):689-697.
    PMID: 32588922 DOI: 10.1111/all.14471
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