Professor Lily Kong, President, Singapore Management University (SMU)
Professor Paulin Straughan, Director, Centre for Research on Successful Ageing (ROSA)
Distinguished Guests
Life Panel Members
Ladies and Gentlemen
1. It is my pleasure to join all of you at the 3rd ROSA Symposium today. I think you have a topic that is at the heart of the Ministry of Health’s work today, which is ageing actively in communities. This is really the key for our nation to age gracefully, be happy, healthy, vibrant, and live purposeful, meaningful lives even as we become a super aged society. As Paulin said to me just now, this is an opportunity, not a crisis.
Singapore As a Blue Zone
2. We can draw inspiration from the Netflix docuseries titled “Live to 100: Secrets of the Blue Zones”. It has recently classified Singapore as one of the six Blue Zones in the world. Blue Zones refer to places with the healthiest, longest living populations, where it is not uncommon to see people living to 100 or beyond.
3. Singapore joined very well-known Blue Zones in the world, such as Okinawa Prefecture in Japan, Sardinia in Italy, Icaria in Greece, Nicoya Peninsula in Costa Rica and Loma Linda in California. These regions have drawn the interest of researchers as well as health enthusiasts all over the world. They want to better understand the lifestyles, social factors and environmental conditions that contribute to the longevity and health of the population.
4. According to Dan Buettner, co-founder of the Blue Zones certification, there are similarities in the lifestyles of people living in Blue Zones around the world. For example, they all eat wisely - diets rich in fruits, vegetables, grains, nuts. I assume they take less sugar and salt. They also eat moderately.
5. They also engage in regular, low-intensity physical activities, as part of their daily routines, like walking, gardening and farming, instead of strenuous workouts like doing a triathlon. They don’t lead a sedentary lifestyle. There are just constant low-level, moderate level of day-to-day activities. Community bonds are strong in all these societies. People maintain close-knit relationships with family and friends. They live life with purpose, no matter how mundane these purposes are, and it keeps them mentally healthy.
6. The series is mostly for entertainment and informative purposes only. It is not to give medical advice, nor is it a presentation of scientific or research findings. Nevertheless, I think there is much truth in the materials being presented. Two major points stand out to me.
7. First, it is indeed common knowledge amongst clinicians, scientists and researchers that health is predominantly shaped by social factors. While it is important to have good hospitals and healthcare professionals to treat illnesses, it is good homes, communities and societies that build health.
8. Second, Singapore is distinctively different from the other Blue Zones. Good healthy habits are not inherent in our traditional culture and lifestyle. Singapore is nothing like Okinawa or Sardinia. On the contrary, we eat food that is rich in sugar, salt and santan, and a lot of our food is deep fried; we are not endowed with a vast expanse of nature that encourages outdoor activities; the pace of life is fast and stressful and many families keep to ourselves and rarely even talk to our neighbours. So we have the opposite attributes of the other five Blue Zones.
9. Yet, we record one of the highest lifespans and health spans in the world and that appears to be an anomaly. The documentary gave a reason. It explained that Singapore created the outcome through infrastructure and programmes that nudge our people towards healthier behaviour. We are therefore termed a “Blue Zone 2.0”. We are different. Just like Singapore is a nation created by conviction and will, Singapore as a Blue Zone is constructed through policy and programmes.
Beyond 2.0
10. We should be encouraged by the Netflix series, which recognises our health and social policies as being effective. In fact, there are studies that show that one of the major social determinants of health is quality of education. It is a good education system, including SMU, that is contributing to health just by delivering good education to people. But I don’t think we should congratulate ourselves yet, for two reasons.
11. First, the gap between health span and lifespan in Singapore is still too wide. Our average lifespan is about 84 years. Our average health span is 74 years. This means the average Singaporean suffers ten years of ill health before passing away. The aim of health policy is not just to help people live for as long as possible, but there has to be quality of life as well, and we must preserve quality of life for as long as possible. Our priority should be to narrow the gap between our health span and lifespan. This is the motivation behind national programmes like Healthier SG and Age Well SG.
12. Second is that Blue Zone 2.0 is not an upgrade of its 1.0 version, because a state of health brought about by policy and programme nudges may not be sustainable. Ultimately, healthier behaviours that were brought about by policies and programmes need to evolve into becoming new lifestyles and habits over time for it to become sustainable. Otherwise, it just a one-time campaign and a temporary change in health behaviour.
13. So that is what we try to achieve. I will give you an example. Healthier SG aims to bring about behavioural changes by encouraging Singaporeans to commit to one family physician. Don’t doctor-hop, which is bad for your health. We must see one doctor, develop a personal relationship with the doctor, come up with a personal Health Plan together with the doctor, and follow the Health Plan. I believe the short-term changes are happening, but over time, we hope individuals adhere to their Health Plan, build a relationship with the family doctor and go for regular screening and vaccinations, as required by the Health Plan. If that change can be sustained, we hope to see our health-seeking behaviour evolving, and preventive care becoming an integral part of our lives.
14. Another example is that agencies such as the Urban Redevelopment Authority, Housing & Development Board and Land Transport Authority have been working very hard in greening our city, planning and building new park connectors, cycling and jogging tracks, and pedestrianising the roads, turning them into Silver Zones. Whenever a new section of the Green Corridor is opened, people rush to see it. But when the crowd subsides, I hope to see the prolonged effects of more people being lured outdoors and leading more active lifestyles.
15. Third, the Health Promotion Board (HPB), under MOH, is also encouraging the F&B industry to make less sugar the default option for beverages, to reset our recipes to 2010, when the average dish had about 20% less sodium compared to now. Somehow, from 2010 till now, our recipes have drifted into containing a lot more sodium. Now our taste buds have evolved to the extent that when we taste less sodium, we think there is no taste. If these recipes change only during the HPB campaign period, our efforts will be futile. Our taste buds need to adapt and we need to wean ourselves off high sugar and high salt content. As consumers’ demand and expectations evolve, we will have a meaningful shift in our national dietary habits.
16. We are therefore embarking on many interventions to reshape the Singapore lifestyle. It takes time but it can be done. Our aspiration is to be not a Blue Zone 1.0 or a Blue Zone 2.0, but a Blue Zone 3.0. It means we recognise we do not have a culture of healthy lifestyle. But as 2.0, we nudge people to adopt better health habits through policies and then over time, we become 3.0, where they evolve into new norms and ways of life.
17. It may take a generation to achieve this, but we are determined in our purpose as we become a super aged society. Many organisations, including government agencies, industry associations, philanthropic organisations and community partners, will need to contribute to this lifestyle-shifting effort. Research institutes such as ROSA can play a role too.
The Role of ROSA
18. Ironically, the fact that SMU does not have a medical or nursing school is an advantage for ROSA. Led by one of Singapore’s most renowned sociologists Professor Paulin Straughan, ROSA is in a unique position to take a stronger social perspective in understanding the health of Singapore, and to provide insights on how best to evolve the Singapore lifestyle into a healthier Blue Zone 3.0 state.
19. For example, ROSA can identify and trigger the motivations for individuals to commit to one family physician, which is a basic foundation of good preventive care. ROSA can explore ways to reshape consumer tastes to crave less sugar, less sodium and fat. It can help us discover methods to encourage seniors, especially the uncles, to form social circles, step out of their house, and engage in community activities. We are having good traction on the ground in attracting seniors to be more active. But women disproportionately (about 80% to 90%) participated in the activities. I think research can help give us insights on how to attract men to join in the activities. ROSA can also test out interventions that can help caregivers better manage their stress and mental well-being.
20. To achieve this, it can run many control group studies, test out numerous hypotheses, and work with various social and community organisations. I think you have a great advantage that you have an 8,000-strong Life Panel. Therefore you have a control group to compare the research results against. This is a very unique strength. It is exciting work, with profound impact on the wellbeing of our population.
21. In conclusion, I think we are not short on policy ideas to nudge people to make the right health decisions. Our challenge is how to sustain the nudges, so that over time they develop into habits. And we need the habits to proliferate and accumulate, so that it becomes a healthier Singapore way of life. I hope ROSA can help contribute to this generational effort, and this symposium can help enhance our understanding and spark new ideas.
22. I wish you a fruitful symposium. Thank you.