Professor Lim Tock Han, Acting Group CEO, National Healthcare Group
Associate Professor Tan Cher Heng, Chairman, Organising Committee, Singapore Health & Biomedical Congress 2019
Distinguished speakers and guests
Ladies and gentlemen
1. Good morning and a very warm welcome to all of you, especially our guests and speakers from overseas. Your presence here today will lend dynamism and we can collaborate and share ideas. I am glad to see that many healthcare professionals, academia and industry experts will gather here over the next three days to discuss and share ideas on research and innovation and how it can help to advance health and ensure the sustainability and continued innovation of our healthcare system. This is a key and vital challenge in our healthcare transformation.
Evolving Healthcare Landscape
2. Singapore’s population is ageing rapidly. In the next ten years, we expect the number of Singaporeans aged 65 and above to about double. That is a very sharp incline. As a result, conditions associated with ageing have also become more prevalent, and the care burden for this population will get heavier as family size decreases over the years. More of our community-dwelling older adults are getting frail, and more people are living with chronic conditions such as diabetes, hypertension, and high cholesterol. These conditions need to be managed well, and as far as possible early, because if not, the risks of debilitating events and deterioration become high. We also seek to ensure people adopt healthier lifestyle habits throughout their life, which decreases the risks of developing chronic conditions. We now want to focus not only on looking after the ill, but to go upstream and look after the well. That is something that we should all embrace.
3. Our rapidly ageing population and rising prevalence of chronic diseases will lead us to an unsustainable, costly system with poorer health outcomes if we do not intervene. Hence, the theme for this year’s SHBC, ‘Sustainable Healthcare Through Innovation’ is aptin several ways as it could equally be ‘sustaining innovation through healthcare’. I would encourage you to look at it from both sides – how do we improve healthcare through innovation, and what healthcare can do to innovation as well. We must continually innovate and transform health and care delivery, so that people can stay healthy and prevent deterioration as much as possible.
Innovating Care Delivery Beyond Hospital into the Community
4. Rapid technological advancement, particularly in the field of digital technology, facilitates our shift towards the community, where care for the physical, social and mental health of patients can be better integrated and delivered with better outcomes. For instance, advancements in TeleHealth have helped to redefine the way in which we deliver care, and enabled us to extend care to patients beyond hospital walls into the community and homes in which they live. The Smart Health Video Consultation for Healthcare programme, implemented for selected services at several public hospitals including Tan Tock Seng Hospital and the Institute for Mental Health, has a Tele-Consult service that allows patients to speak with care providers from the comfort of their homes.
5. Beyond access and convenience, telehealth applications have the potential to significantly improve outcomes through encouraging personal ownership of health by equipping patients with relevant resources, and also knowledge and know-how to manage their conditions. Sometime it is through ignorance and lack of awareness that people do not know how to manage their healthcare conditions better. For example, the Primary Tech-Enhanced Care (PTEC) pilot for hypertension at NHG’s Ang Mo Kio Polyclinic allows hypertension patients to monitor their blood pressure (BP) at home through the use of a Bluetooth BP monitoring device, which automatically sends BP readings intermittently to the healthcare team.
Innovating Upstream for Population Health
6. Undoubtedly, technology will continue to be an important enabler for healthcare innovation. Apart from healthcare, it also provides opportunities for innovations upstream in health promotion. For example, wearable technology has allowed the Health Promotion Board (HPB) to reach out to the masses, galvanise a national movement to walk more and exercise more. We have seen a marked increase in physical activity rates at the population level. We will continue to think out of the box, be innovative in the way in which we approach our population and to see how else we can encourage physical activity and lifestyle changes to drive better health outcomes.
7. Another example is in the Food and Beverage (F&B) manufacturing industry, which has made advances in food technology to reformulate their products to be healthier, yet at the same time, maintaining and retaining their taste. Singaporeans love our food so the challenge in food technology has to be how we ensure that the food quality – the taste, texture, and feel – is if not the same, at least as best as we can, approximately the same. To encourage innovation, HPB introduced the Healthier Ingredient Development Scheme (HIDS) for cooking oils and staple grains. Its success encouraged us to also extend it to sugar-sweetened beverages (SSBs), desserts and sauces, to reduce sugar consumption in our food supply. We have seen a seven-fold increase in the number of unique ingredient suppliers since the launch of the scheme in 2017.
8. I am indeed encouraged by the rapid growth in the healthier SSBs segment. However, there remains still a ‘sticky’ segment of drinks with a sugar level of more than 10%, and that has not come down over the years. Moreover, more than half of our sugar consumption still comes from SSBs which are easily available, enticing, and not expensive. It is something that we need to tackle more closely. In terms of the sugar consumption coming from SSBs, there is a focus on pre-packaged drinks, because within this group, pre-packaged drinks account for the highest proportion. This is a concern to us, because as on average, an additional 250ml serving of SSB per day would increase the risk of diabetes by up to 26%. This is not a small number.
9. As part of the War on Diabetes, the Ministry of Health (MOH) and HPB held a public consultation. We looked at it widely, broadly, with different interest groups, to seek views on measures to reduce Singaporean’s sugar intake from pre-packaged SSBs. In general, there was strong support from both the public and industry stakeholders for the Government to do more to tackle the overconsumption of SSBs. We have studied the feedback carefully, thought of how to drive behaviour, and what measures we would seek to achieve that, not just for now, but to ensure that in the long term it is sustainable and changes consumption pattern and behaviour rather than just to shift it temporarily. So we looked at the feedback and studied the submissions, along with the local and overseas evidence for the various measures.
10. To encourage Singaporeans to make a more informed, healthier product choice and accelerate the industry reformulation efforts to reduce sugar content in SSBs, we decided to introduce two measures.
a. First, we will introduce a graded and colour-coded front-of-pack nutrient-summary label to provide consumers with quick, at-a-glance information on the nutritional quality of the product, particularly on the sugar content – the sugar level, and percentage ratio in that SSB – so that they can immediately make an informed choice and make a conscious choice to choose the healthier product. The SSBs will be assigned a summary grade based on their nutritional quality – sugar will of course be a key but not the only determinant of that summary grade. The label will be mandatory only for the less healthy SSBs, and we are considering highlighting their sugar content on the label as well to warn consumers of these less healthy and high-sugar-content drinks.
b. Second, we will introduce an advertising prohibition for the least healthy SSBs with the poorest label grade, across all mass media channels and online channels as well. This will greatly reduce consumers’ exposure to advertisements of such products.
11. In our earlier consultation, we also asked for views on the possibility of introducing an excise duty or a tax on manufacturers and importers, as well as an outright ban on sale of high-sugar SSBs. We will study these more. These are still on the agenda and we intend to study them more carefully. We want to find measures that are sustainable in the long-term, that shape not just market consumption behaviour but also on the supply side to drive reformulation. This we feel, in the long term, will be more sustainable. Nonetheless, both on the excise duty as well as the ban on higher sugar SSBs, we are still continuing to study them and will decide on them at the appropriate time. At the same time, even as measures help to shape the pattern of consumption, I would emphasise that we urge manufacturers of SSBs to consider reformulating their drinks to contain less sugar even as we study these two additional measures.
12. Taken together, the two measures we are introducing seek to shift demand and consumption patterns towards the healthier options. Under the new nutrient summary label, healthier SSBs can receive a positive grade, and we leave it as an option for the manufacturers to decide whether they want their products to bear the label. We will nonetheless encourage manufacturers to label healthier SSBs as well, to aid in consumer decision-making, and this can also continue to be advertised.
13. The front-of-pack nutrient summary label and advertising regulations will work in concert to provide consumers with nutrition information, particularly on the sugar content, to make informed choices and reduce influence from advertising. Alongside our existing promotional and educational efforts, these measures will be part of a sustainable long-term approach to reshape consumer behaviour towards healthier choices. Apart from these two measures, we intend to continue as strongly, if not more strongly, on our road to ensure that there is awareness. We will raise education levels, and continue to provide the public with information so that they can be empowered to make their own choices on which products are healthier.
14. With advances in food technology, on top of everything else, I am confident that companies can reformulate them to healthier SSBs. The Government will of course continue to support the industry in their reformulation efforts through grants and incentives, and will provide the industry with sufficient time to reformulate their products before the measures kick in. Ultimately, we want the whole pattern of consumption to shift, and not just at one end of the spectrum, but to bring the whole average pattern downwards, and to drive that behaviour, not only from the demand side, but also from the supply side.
15. While the Government can shape the environment for healthy living, this cannot be done alone, and it is complemented by efforts by many other partners. On this front, I am pleased to note that NHG’s Centre for Medical Technologies and Innovation (CMTi) has developed new technological solutions for enhancing clinical outcomes and population health. To encourage staff to adopt better lifestyle habits, NHG has developed a health and wellness mobile app that goes beyond traditional diet and activity tracking to incorporate additional elements such as medication management and educational tools on disease management, all on a single platform. NHG will progressively integrate more features, and eventually roll out the app to patients and the broader population that it serves. In the field of additive manufacturing for designing food, steps are being taken to apply 3D printing technology to large-scale production of palatable meals, instead of using additives to hold foods in their shape. For patients with a soft diet, 3D printer can be used to produce food that is a lot more palatable, and does not look mushy and mixed-up on the plate. That improves the quality of the care that will be delivered. Such foods will still contain the appropriate and requisite amount of nutrients needed, and in the right consistency to prevent choking or aspiration, particularly for people with swallowing difficulties, and also encourage them to look forward to, enjoy and appreciate their meals.
Driving Innovation
16. While innovation at the level of individual services is important, innovation at the service planning scale, at a higher whole-of-ecosystem level, is another key enabler. The drive to innovate in redesigning care and delivering value-based care requires a mindset of envisioning. The Woodlands Health Campus (WHC), slated to open progressively from 2022, envisions itself as a Care Hub, integrating care within and encompassing self-supported ecosystems of care for residents living in the North to live, to grow and ultimately, to age in place, as far as possible. WHC will include Singapore’s first SMART hospital, where technologies such as Artificial Intelligence, chatbots, Virtual Reality way-finding, and Autonomous Mobile Robots are being explored and where feasible, will also be integrated seamlessly to enhance patient activation and experience. These innovations for care solutions will seek to boost productivity, and also allow the care staff in these institutions to focus on what they do best, which is direct patient care.
17. Fundamentally, innovation entails co-learning and working together with local and overseas partners to explore better ways of doing things. Sometimes, it is a new way of doing an old thing, sometimes it is a completely new item that is being delivered, but either way, it requires collaboration and an open mindset to think about and embrace and to share ideas across different jurisdictions and platforms. To do this, we need to support and encourage that collaborative spirit between healthcare practitioners, and researchers from academia. We should not look at the two aspects as being separate but look at it seamlessly as one. As the topic of this congress goes, how do we collaborate between healthcare and innovations? I am therefore pleased to witness the signing of a Memorandum of Understanding (MOU) between NHG and the Lee Kong Chian School of Medicine (LKCMedicine), Nanyang Technological University (NTU) for a Joint Programme for Translational Research. This MOU and the parties in the MOU demonstrate aptly what I said earlier, that we try to integrate learning expertise and know-how between the different platforms. This MOU will create opportunities and build capabilities for translating “deep tech” generated from research into bedside clinical practice. Ultimately, technology developed in the lab or conceived of as an idea has to be translated into practice and this collaboration and MOU will help to facilitate that.
Closing
18. Finally, as I started by welcoming so many overseas guests, I am heartened by that and I would like to encourage all of you to share best practices and your own experiences. No one has a monopoly over good ideas. I am also heartened to note that with the support of the Agency for Integrated Care, this year’s Congress also sees a very strong turnout from our community care partners. It really goes back to the theme I started off with – that healthcare is not about delivering health services only in the hospitals or a healthcare setting, but really how we deliver healthcare to the patients and residents in the community. Let us learn in this congress, interact, make new friends, share ideas, but ultimately strive together to make health and healthcare accessible and sustainable through innovation for all. I wish all of you an enriching, enjoyable and ultimately engaging congress for the next three days.
Thank you.