Speech by Mr Gan Kim Yong, Minister for Health, at the SG50 Scientific Conference on Ageing, on 19 March 2015

‘Ageing in Singapore in the Next 50 Years’

Professor Goh Lee Gan, President of the Gerontological Society of Singapore

Distinguished Guests

Ladies and Gentlemen

 

Good morning.

Introduction

2.            I am delighted to be here at this conference. This year marks 50 years of independence for Singapore. It is therefore timely that the theme for this year’s conference is ‘Ageing in Singapore in the Next 50 Years’. Ageing will be a key demographic change impacting Singapore for the next 50 years. The number of seniors aged over 65 years, will more than double from 430,000 today to over 900,000 in 2030. By then, 1 in 5 of us will be 65 and above as compared to 1 in 9 today. Our society in 50 years’ time will be a very different society from today.
 

Two Possible Worlds in SG100

3.            It is not too early to talk about population ageing. How Singapore will pan out in the next 50 years will in part be determined by how well we respond as a people, as a society and as an economy, to an ageing population. There are two possible scenarios:

A Silver Tsunami

4.            The first scenario is a Silver Tsunami. On the economic front, our ageing population may bring about a shrinking workforce, tightness in the labour market and constraints on our economic growth. On the social front, population ageing leads to higher demand on healthcare and aged care provision, but our shrinking local workforce makes it doubly challenging to support these needs. On the fiscal front, population ageing will lead to higher healthcare and social spending to support our seniors, an increasing burden on the young and inter-generational tensions that will strain our social cohesion. The challenge of a Silver Tsunami is a real one. We already see aspects of these challenges and tensions in countries that have aged before us. In those countries, we see individuals struggle with retirement and healthcare costs, and society struggling under the fiscal weight of ageing.

Productive Longevity

5.            But it is not a given that ageing will be a silver tsunami. Now let me talk about a more positive scenario. In this scenario, instead of letting our society be taken over by a “silver tsunami”, we can translate longevity into a positive force for social and economic development. Singapore is ageing not only because of falling fertility rates, but also because achievements in public health and healthcare allow us to live longer as individuals.  50 years ago, a person at age 65 years could expect to live some 8 years more. Today, a person who is 65 years old can expect to live another 20 years[1]. And we can expect life expectancy to increase even more in the next 50 years.

6.             So the question is whether we can take good care of our bodies to last longer. If we can, the opportunities that come with longevity are tremendous. Older persons can be an engine for national development, contributing to our community, our society and to our economic growth, for many years. We can redefine the old age support ratio – even if the downward slope is not reversed, the rate of decline can be greatly moderated. Our society can be older, but no less dynamic and cohesive. Our knowledge economy can continue to flourish with the expertise and experience of older workers, and stay ahead despite an ageing population.

A Nation for All Ages

7.            We can still succeed as individuals and as a nation despite a fast ageing population. But this will not come without effort. We need to take a long term view and start to make fundamental changes in the way we organise our society, economy, systems and policies. I will highlight three key areas.

Workplace for All Ages

8.            Firstly, we need to re-think how we learn and work as we grow older. 50 years ago, when life expectancy was about 70 years, we may retire in our 50s. But as our life expectancy increases to 85 and further closer to 100 in time to come, do we still retire at the same age and spend half of our lives in retirement? That will be decades of our lives in retirement. What do we do with all this time on our hands?

9.            At the individual level, we need to re think our idea about learning, work and retirement. 14 years of formal schooling surely cannot be adequate for an expanding work life. We need different combinations of learning, leisure and work of different forms. For example, some seniors we spoke to told us that they would like to take on a mentoring or coaching role in their current workplaces. Others tell us that they would like to have more flexible work arrangements, such as part-time work so that they can spend time with family, volunteering, or learning new things.  As we live longer, we have to learn longer and work longer.

10.         Workplaces need to adapt to changing employee profiles as well. The challenge to employers is to re-design the workplace into one that is suitable for all ages. The re-design would be needed in various aspects – such as job roles, work hours, model of remuneration, work environment, work culture. The ability of employers to capitalise on the creative energies and experience of a workforce of different ages, will be the key to unlocking productivity and economic potential of a fast maturing nation.

11.         For example, Federal Hardware Engineering, a SME, has leveraged WorkPro, a government scheme which provides funding for companies to put in place measures to augment local manpower, foster progressive workplaces and strengthen the Singaporean core in our workforce. In doing so, Federal Hardware Engineering has enhanced communication and fostered a closer working relationship among its intergenerational workforce. Currently 8 out of 70 employees of the company are re-employed workers, and the company has worked with these employees to re-assign them to jobs which do not require working with heavy machinery.

Health for All Ages

12.         Secondly, we need to organise our healthcare system to better extend the “health span” of individuals and make the delivery of healthcare services appropriate for our ageing population.

13.         The Ministry of Health will place much greater emphasis on preventive health. Over the past 50 years, we have built a comprehensive school health service. This has played an important role in improving our health outcomes by giving our young a healthy start. In the next 50 years, we need to invest more on preventive health for adults, including older adults, so that we can extend the health span of the population even as our life span increases.

14.         We also need to transform the way we deliver services to patients. We have expanded the capacity of our acute and community hospitals.  However, the centre of gravity of the healthcare system will have to increasingly shift to primary care and home and community aged care. We envision a primary healthcare system, where there is a primary care team for every patient. The team, comprising physicians, nurses and allied health professionals, will be able to look after patients in the primary care setting, as well as help them navigate the healthcare system as they transit across the various care systems.

15.         In parallel, we are building a robust home and community care ecosystem to support our seniors to age in place for as long as possible. This includes the expansion of home care services and senior care centres which together can provide a suite of home-based care services to keep our seniors in the community even when they become frail.  The dementia prevention programme being launched today by the Gerontological Research Programme (GRP) of National University of Singapore, in partnership with the Gerontological Society of Singapore is also an example of how our community partners can get involved in developing programmes to better support seniors’ care and social needs near their homes. By working together, we can push back the need for seniors to be institutionalised in hospitals and nursing homes for as long as possible.

16.         Not only does a rapidly ageing population challenge the way we organise services, it also requires a re-think of the mix of healthcare professionals we need, and how we finance health and aged care. Even as we build infrastructure and enhance affordability under Healthcare 2020 masterplan, we are looking ahead and studying ways to articulate and expand the role for Regional Health Systems to promote health and to integrate care for all in different regions in Singapore.

17.         We have already made a start. Today, every one of the six regional healthcare systems are pushing ahead to step up preventive care services for their respective population. Take Alexandra Health Services as an example.  It has worked with local communities in the north and northwest region to screen some 6,500 residents living there. It has also partnered corporations such as SMRT, to bring health screening and chronic disease management programmes to some 780 taxi drivers while their taxis are being serviced. We have achieved some very encouraging results from this pilot. Over six months of health coaching, 50% of taxi drivers with weight issues lost some weight, and 46% of those with some blood pressure issues achieved a normal BP. Of about 250 taxi drivers who followed up with a visit to the community nurse post at least two times, three-quarters had made lifestyle changes to their diet and exercise. We need to do more. We will continue to work with the regional health systems to bring such preventive health services to seniors in the community and workplace.

18.         At the other end of the spectrum, Alexandra Health System has also started the Ageing-in-Place to provide better integrated care for elderly patients in the community.  Under this programme, AHS deploys community nurses to reach out to patients who have been admitted multiple times to Khoo Teck Puat Hospital over a period of six months. These community nurses visit the patients at home and conduct a preliminary assessment of the home and community support needed. Such support may include medication reconciliation to better manage their multiple medication needs, or home modification to allow them to move around at home safely. So far, over 900 patients have benefited from this new programme. The team was also recognised for their efforts last year when they were awarded the 2014 UN Public Service Award.

City for All Ages

19.         Beyond the individual and community, urban planning also has to evolve as our population ages. And the principles we rely on to organise our housing, urban environment and transport have to be reviewed and enhanced. We want to ensure that our seniors, even at a ripe old age, still feel safe and empowered to go out and stay active, and live as independently as possible.

20.         We need to re-imagine our city, and make concrete efforts to improve both hardware and software to make this city a city for all ages. In terms of hardware, we want to make the transport system more senior friendly and our city more walkable, and minimise fall risks in the city environment and neighbourhood.  In terms of software, we want to provide for more assisted living services within our housing estates to complement our aged care system, and involve the community to look out for their older neighbours.

21.         Marine Parade is one of the communities where we first piloted the City for All Ages initiative to re-imagine our city at the local level. Since 2011, we have worked with the residents to understand seniors’ needs in the community. Local partners introduced programmes such as a befriending programme run by Goodlife!, a VWO, to recruit “Angel Ambassadors” to provide psychosocial support for lonely and frail elderly in the community. By working with grassroots and community partners, we have also introduced infrastructural enhancements to make the town more senior friendly, such as having more rest benches and adding anti-slip coating to drain covers. To further promote healthy living, the Marine Terrace Hawker Centre now serves healthier hawker food in most of its stalls. We now have 16 City for All Ages sites spread across Singapore, where localised solutions unique to each community help make their communities suitable for all ages.

An “Ageless” Mindset

22.         The critical determinant of whether ageing will be positive for individuals and our society is in the mindset. We have a much higher chance of achieving successful ageing if individuals do not associate ageing with mere decline, loss of value, or worse, disability. Likewise, we have a better chance at productive longevity if employers do not have a negative view about seniors, and if the young and society as a whole do not hold a pessimistic and deterministic view of ageing.

23.         As part of the Action Plan for Successful Ageing, the Ministerial Committee on Ageing spoke to over 1,300 Singaporeans over six months last year to find out what Singaporeans’ aspirations are, and to gather feedback on how we can do things better. While seniors are aware of the need to take care of their health and financial security, there is a genuine thirst among seniors for continuous learning, and a desire for continued engagement in our community and in the workplace. Singaporeans are also bursting with ideas on how to transform the face of ageing in the next 50 years.

24.         One Singaporean we spoke to last year, Dr Rosemary Khoo, President of NUS Senior Alumni, told us that she wanted to participate in this conversation to contribute to the national effort to prepare for ageing not just for herself, but for the next generation. Dr Khoo will also be speaking today as one of 18 speakers today. There are many seniors like Dr Khoo in the pioneer generation! For example, there was an overwhelming enthusiasm among seniors during a conversation on volunteerism – senior volunteers tell us that we should recognise volunteerism efforts of seniors not just for them, but so that seniors can pass on the values of lifelong contribution to society, to the younger generation.

25.         I am heartened that many Singaporeans of all ages – like the contributors of the book being launched – have already started to join us in our national conversation on ageing. I hope that over time, we can also grow a ground up movement – of seniors, of employers, of union leaders, of community partners, of professionals in various disciplines – to jointly transform ageing in Singapore. 

26.         This book ‘Ageing in Singapore in the Next 50 Years’ is part of this positive transformational process. I would like to commend its authors, for not only celebrating our nation’s achievements over the last 50 years, but also looking to the next 50 years.

Conclusion: Towards an Ageless Nation

27.         At independence 50 years ago, then-Prime Minister Mr Lee Kuan Yew described the nation’s path to the future as a “journey along an unmarked road to an unknown destination”. Singapore in the past 50 years can be described as an extraordinary nation built out of pure will – the will of a resilient people who refuse to yield to the harsh circumstances we have been dealt with.

28.         The next 50 years is just as uncertain. The circumstances and challenges will be very different. But if we have the same “can do, never say die” spirit, we can once again defy gravity and reap the upside to longevity.  Together, we can transform the face of ageing in Singapore, and build an Ageless Nation full of dynamism by the time we celebrate SG100.

29.          May I wish you a fruitful and enjoyable conference. Thank you.

 


 

 

 

[1]http://www.tablebuilder.singstat.gov.sg/publicfacing/createDataTable.action?refId=3612&exportType=csv

 

 

 

 

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