Did Asean’s health ministers look out the window last week?

As Asean’s health ministers gathered in Kuala Lumpur recently, one wonders if they glanced beyond the conference-room window, searched their conscience, and asked the uncomfortable question: when the next haze emergency threatens millions across the region, what will we actually do — beyond declarations and carefully negotiated language?

Another promise to strengthen cooperation cannot be the answer.

For more than two decades, Asean has monitored hotspots, exchanged information and developed regional plans, yet families still receive essentially the same advice when smoke arrives: remain indoors, reduce outdoor activity and wait.

In Serian, Sarawak, the air pollution index reached 519 on Sept 4, triggering a haze emergency. Although that emergency has since been lifted, it exposed the distance between knowing danger is approaching and protecting people from it.

For parents, including me, this is not an abstract failure of regional cooperation. It is watching children breathe air we know may harm them while having little power to protect them. Satellites can identify fires and monitors can show pollution worsening, but information is inadequate unless it activates a response.

The 17th Asean Health Ministers Meeting provided an opportunity to change at least part of this equation. It was not taken up.

Health ministers were not expected to resolve every political, commercial and environmental cause of transboundary haze before leaving Kuala Lumpur, nor take over the responsibilities of their respective environment, forestry and agriculture ministries.

They could, however, have agreed that the health response to haze will no longer be improvised country by country after populations have already been exposed.

A practical outcome would have been an Asean haze health-protection protocol, agreed in principle at this meeting and developed within a fixed timetable. It could establish what every health system must do when predetermined pollution and population-exposure thresholds are crossed, regardless of where the fire originated or whether arguments over responsibility have been resolved.

Such a protocol should begin with common health triggers. Different air-quality indices, monitoring arrangements and public messages make cross-border conditions difficult to compare. Health ministers should agree on a common method of communicating risk, with aligned protective advice for children, pregnant women, older people, outdoor workers and those living with chronic illness.

Crossing an agreed threshold should automatically activate a defined package of protections. These should include public-health warnings, school and workplace measures, restrictions on strenuous outdoor activity, guidance for employers, extended access to essential respiratory medicines and clean-air spaces in severely affected communities.

Hospitals and clinics should have haze surge plans covering staffing, oxygen, inhalers, masks, filtration and referral capacity before each dry season, rather than trying to assemble them when emergency departments are already under pressure.

Asean must also measure the harm differently. Hotspot counts and daily pollution readings describe the environmental event, but they do not tell us how many people were exposed, for how long or with what consequences. A serious regional health response should report population exposure-days, emergency and outpatient attendances, respiratory exacerbations, medicine demand, school closures, working days lost and the impact on vulnerable communities.

This information should feed into an annual Asean haze health review presented jointly to health and environment ministers. Its purpose must not be to produce another regional publication that is politely noted and then shelved. Countries experiencing repeated or prolonged harmful exposure should publish a time-bound improvement plan covering preparedness, population protection and weaknesses in health-system response, with progress reviewed the following year.

None of this requires health ministers to settle the question of entering another country to fight fires. The Asean haze agreement makes external assistance dependent upon the receiving state’s request and consent. Health ministers can nevertheless pre-authorise cooperation within their sphere: cross-border health alerts, epidemiological data sharing, technical assistance, emergency supplies and mutual support. These arrangements should be settled before the dry season, not while smoke is already spreading.

The Asean Lung Health Progress Framework, which is currently being developed offers a useful starting point. It builds upon the integrated lung-health resolution championed by Malaysia and adopted by the World Health Assembly, which calls for whole-of-government and whole-of-society action involving health, environment, labour, education and finance. The framework can incorporate haze exposure, preparedness and measurable health outcomes without pretending to replace environmental regulation.

Sultan of Perak, Sultan Nazrin Shah, speaking at the opening of the National Cancer Congress Malaysia last weekend, drew attention to the environmental conditions affecting the air children breathe. Asean’s health ministers should heed his warning. The haze cannot remain somebody else’s portfolio until breathing difficulties begin appearing in clinics and hospitals.

Before leaving Kuala Lumpur, Asean’s health ministers should have approved the mandate for a regional haze health-protection protocol, identified the institutions responsible for delivering it, set a deadline before the next dry season and required a public progress report.

Asean has spent more than two decades improving its ability to detect fires and monitor smoke. This meeting should mark the point at which those warnings finally begin to produce consistent protection for the people breathing the air.

The views expressed are those of the writer and do not necessarily reflect the views of FMT.

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