COS Speech By Parliamentary Secretary for Health, A/Professor Muhammad Faishal Ibrahim - Healthy Together, Anytime, Anywhere - Making the Connections, 12 March 2013

Minister Gan had earlier emphasised the importance of health, rather than healthcare: I fully support Minister’s view and this is a motto that I often tell my residents, family and friends. In my experience, I have found that at the heart of every issue or policy, are our people. The success of a policy or program hinges on what we make of it. This is especially true when it comes to health promotion initiatives.

2.         Very often, Singaporeans tell me that they would like to lead a healthier lifestyle. Many have also shared that they appreciate the Government’s effort to encourage them to do so. It is heartening that we have made some inroads over the past years.   

Preventive care for all ages

3.         Dr Teo Ho Pin and Ms Ellen Lee asked about preventive care services for children, elderly, and in relation to mental wellbeing, respectively:

4.         MOH has a range of preventive care services for Singaporeans of all ages. We want to provide good support especially in the early years and through childhood. This lays the foundation for good health habits to continue into adulthood. We have various programmes from conception through birth and pre-school.  The HPB’s School Health Services provides annual medical checkups, vaccinations and oral health services.

5.         For our elderly, there are initiatives such as the Community Functional Screening Programme, which aims to detect functional decline in older adults. MOH will look into introducing a vaccination schedule for adults and elderly.

6.         Health is not just about physical health. Indeed health promotion also needs to address mental wellbeing. We have mental wellbeing programmes tailored for the different stages in one’s life: There are online Mental Wellbeing Scales for Children & Youth as well as for adults. For the elderly, there is a Mental First Aid Kit Programme that improves mental wellbeing through positive experiential activities. Next month, HPB will be working with the National Arts Council to roll out an “Arts for Mental Wellbeing” programme that makes use of drama and recycling art and craft.

Measuring the effectiveness of our programmes

7.         Dr Teo Ho Pin would be happy to hear that we do measure the effectiveness and health outcomes of health promotion programmes at the national level.

8.         The National Immunisation Registry monitors immunisation coverage. For school-going children, the Student Health Survey assesses key health behaviours.

9.         Regular nationwide health surveys monitor the prevalence of chronic diseases, behavioural risk factors, and preventive health behaviour in adults and the elderly.

10.       These surveys show progress in many areas. However, some trends continue to be worrying: more Singaporeans are getting obese, and more young adults are taking up smoking. As we age, our risk of developing chronic diseases such as diabetes and high blood pressure increases. Doing things the same way is simply not enough: As individuals, as a government, and as a society, we need a new approach to healthy living. One way or another, healthy living should be everyone’s business; it should not be something we have to think about, it should be second nature to us.  

Making Healthy Living Our Way of Life

11.       Our focus is to ensure that no Singaporean is deprived of a healthy lifestyle. To achieve this, it means first, that the right environment needs to be developed throughout Singapore, so that leading a healthy lifestyle is not just easy, but natural for all of us. Secondly, everyone is actively engaged and aware of opportunities for leading healthy lifestyles. Last but not least, adopting a healthy lifestyle need not be the more expensive option.

12.       In summary, our vision for healthy living is to be healthy together – anytime and anywhere through the 3Ps: Place, People and Price

What is the Master Plan?

13.       We want to translate this vision into action. Earlier, Minister Gan mentioned the Healthy Living Master Plan Task Force, which I am leading. We aim to develop a national blueprint for healthy living.

Local health landscape

14.       The Task Force is studying the factors that motivate Singaporeans to change behaviour and to maintain a healthy lifestyle. In our discussions, we were very heartened to hear that some ideas are already being considered by various agencies for implementation. I will go into more detail later.

International reference: New York as an example

15.       The Task Force has also studied innovative practices from other cities. One inspiring example is New York: they reported a successful 5.5% decrease in childhood obesity rates from 2006 to 2011. This is after years of multi-agency efforts to improve nutrition, and built environment to encourage physical activity. For example, New York requires restaurants to post calorie information on their menu boards. They also came up with active design guidelines to create healthier buildings, streets and urban spaces. Learning from such examples, we aim for similar success in Singapore.

16.       Staying healthy concerns every one of us. During a recent Our Singapore Conversation session, one of the participants, Madam Rohani, provided much inspiration. She told us about how she prepares healthy snacks such as carrots, cucumber sticks and cherry tomatoes for her grandchildren. They also exercise together as a family at least once a week. This is a fine example of how we as individuals, families, and as part of the society, can encourage one another to live healthily. I was encouraged that there was strong support among participants for a healthier lifestyle.

Working Together as One

17.       Therefore, Healthy Living Master Plan is about making connections at three levels: firstly, across government. Secondly, it is about connections across communities. Thirdly, between communities and the government. We hope to strengthen these connections so that everyone gets involved in working towards a common goal. This involves initiatives that cover the Place, the People and the Price, or the 3Ps. Let me share with members in more detail.

The 3Ps - #1: Place

18.       Finally, the ‘Place’ element of the Master Plan involves changing the physical environment that we live in, so that we can go about our daily activities in a healthy way without even thinking about it.

Developing the physical infrastructure

 19.      Ms Faizah Jamal asked about access to nature spaces as a health promotion measure. We know that Singapore has limited land, yet we have innovatively maximised the use of spaces, whether natural or man-made, for physical activities to promote healthier lifestyles.

20.       We have designed our built environment to promote healthy living. MND, MOT and other infrastructure agencies have also contributed to the health agenda. Our housing estates are designed to encourage residents of all ages and abilities to go outdoors for fresh air and exercise. These estates have facilities such as parks, park connectors, playgrounds and cycling paths.

21.       With the right infrastructure for physical activity in place, the next step is to experiment with programmes and micro-designs such as innovative signage. As such, we will be working with town planners and government agencies to create visual cues in public spaces to prompt physical activity. For example, you will see more exercise maps, and appealing visual designs to encourage the use of stairs at workplaces, shopping malls, schools and public places like train stations.

22.       By connecting the dots between the different ministries and agencies and the community, we are all working together to achieve the common goal of good health for our people, Singaporeans. One example is the Healthier Hawker Centres initiative. I am pleased to say that the pilot was a resounding success, with up to a 30% increase in sales of wholegrains and with the hawkers reporting a 20% increase in business.

Healthier food establishments

23.       A conducive environment for healthy living also includes food establishments. During the Our Singapore Conversation sessions, some of us were asked, “Why can’t you scale up Healthier Hawker centres faster? We want it in our neighbourhoods too!” I am pleased to say that Healthier Hawker Centres will be extended to forty more hawker centres, food courts and coffee shops in FY2013. For greater impact, we are also reaching out to centralised kitchens that supply workplace canteens, coffee shops and household “tingkat” meals to use healthier ingredients. The target is to reach out to five centralised kitchens, supplying more than 50,000 meals per day, by end of FY13. Dr Lam Pin Min would be glad to know that we have similar initiatives in our schools. More than 90% of our schools subscribe to healthy eating guidelines under the Healthy Eating in Schools programme.

Healthier workplaces

24.       As Mr Heng Chee How had emphasized, healthy living should also occur in workplaces. Employers are realizing more and more now, that health is very much linked to productivity at work. We have a comprehensive health promotion support infrastructure for companies, such as the Workplace Health Promotion Grant, and capability building courses.

25.       The Healthy Living Master Plan Task Force visited a SME called UMW Equipment and Engineering Pte Ltd. We wanted to learn first-hand how a SME can use their limited resources to build a strong health-promoting workplace culture. I found that their philosophy, ‘a healthy worker is a safe worker’, to be a good start. Some of their staff got together to form a workplace health executive committee that plans and drives health promoting initiatives. In order to encourage active participation, many of these programmes are free, and held during office hours. They even have a small gym for employees. This is a good example of how a company and its workforce come together to take ownership of their health.

MOU with NTUC on low-wage workers

26.       Some industries that employ many low-wage workers, such as the cleaning and security sectors, have limited access to health programmes. We have not forgotten about them. As such, I am pleased to announce that HPB will collaborate with NTUC to reach out to workers from these sectors, to offer health screening and follow-up services.

The 3Ps - #2: People

27.       The ‘People’ element of the Master Plan has two aspects. First, it means to be inclusive of all segments of society, especially the vulnerable groups such as those with lower income, the youth, and the elderly. Secondly, the ‘People’ element also means improving peoples’ understanding of health, or health literacy, so that we can make informed choices about how we live and how we eat.

10, 000 Health Ambassadors by 2015

28.       As part of reaching out to all segments of society, HPB will ramp up its ground-up movement. One key enabler is getting ordinary citizens – our Health Ambassadors - to champion health promotion within their respective communities. To date, HPB has trained and deployed nearly 5000 Health Ambassadors since 2011. We target to have 10,000 Health Ambassadors by 2015.

29.       Some of the stories of how these Health Ambassadors have made an impact on their loved ones are very encouraging. Madam Peh Leh Khim, a 55-year old Senior Health Ambassador, shared that she first became a Health Ambassador because she started to realize the importance of maintaining health as she ages. She then thought about her family and felt compelled to keep them healthy too. As she became more active in HPB events, she started encouraging her friends to adopt healthier lifestyles as well. She has also used her persuasive skills to counsel people who come for screening at community screening events to go for medical follow-up. This is the very attitude towards health and the community that we hope will become pervasive through the Health Ambassador network.

Improving health literacy

30.       The other aspect of the ‘People’ element is about improving health literacy: We can shape food choices by more clearly labelling the nutritional contents of what we are buying. Last month (7 Feb), HPB announced that all products with the Healthier Choice Symbol (HCS) will also have to carry the Guideline Daily Amount (GDA) labelling on the front of their packaging. These labels will better guide consumers on the amount of calories, fat, salt and sugar that are contained per serving, hence enabling consumers to make better informed choices.

31.       HPB has garnered the support of major multi-national companies in this regard, and will continue to work with the food industry on this initiative. Our goal is that by 2014, all HCS products will carry this GDA labelling, to be followed thereafter by non-HCS products.

32.       We will also provide better guidance on how much to eat. Today, HPB’s Healthy Diet Pyramid shows us the recommended number of servings of each type of food group. However, more Singaporeans are exceeding their recommended daily intake of fat and carbohydrates as compared to a few years ago. This means that we still need to understand what the right portion size actually looks like. We will therefore shift from the current Healthy Diet Pyramid to the Healthy Plate. The Healthy Plate will visually link nutrient requirements to the recommended portions that should be consumed in a meal.

The 3Ps - #3: Price

33.       Last but not least, we come to the Price element of the Master Plan. We cannot be inclusive of all segments of society if we do not make healthy living affordable.

34.       We agree with Dr Lam Pin Min, Dr Lily Neo, Dr Teo Ho Pin, Mr Heng Chee How and Dr Chia Shi Lu that we should look at how to better incentivize healthy living. We are open to exploring some good ideas that you have suggested: For example, Dr Chia mentioned tax rebates or discounts for those who participate in wellness programmes. Also, volunteers who help promote healthy lifestyles such as the Health Ambassadors can be given expanded recognition and benefits. Dr Lam also suggested insurance rebates for those who can demonstrate that they are living out healthy lifestyles.

35.       We will study various feasible incentives, including those tied to insurance premiums.  It is equally important that, as individuals, we ourselves are motivated to live healthily.

36.       We also agree with Dr Lam on the need for affordable healthier food options. HPB has worked with the ingredient suppliers and stall vendors in the Healthier Hawker Centre programme to make sure the healthier dishes offered are affordable. HPB also partners major supermarket chains to offer regular promotions of healthier products at discounted prices. We are also working with local R&D institutions and the food industry to build capacity to produce affordable and healthier foods and beverages.

Improving screening affordability

37.       Next, we need to address affordability for screening. Screening enables early detection and treatment of diseases. Yet, I appreciate that for many of us, finances are tight. We have to attend to the basic necessities first and would not even consider spending moneyon screening, especially if we feel ‘OK’. I guess, others may be worried not so much about the cost of the screening, especially if you have to pay, but more about the financial costs and affordability of treating a condition should one be diagnosed. We are therefore focusing our screening outreach on the groups of people who need help most.   

38.       To this end, the Task Force recently visited the Henderson Seniors Activity Centre (SAC) run by the Thye Hua Kwan Moral Society. We wanted to understand the voluntary welfare organizations’ outreach work and the issues that they face on a day-to-day basis. I was struck by how the SAC’s programmes helped give the elderly residents a greater purpose in life, and motivated them to enjoy better physical independence and mental wellbeing. I enjoyed the visit and learnt a lot from this engagement. We can have better engagement with Singaporeans, to enhance their lifestyle. However, I asked myself, “Can these programmes be even more effective, if different organizations got together to implement them?”

Senior Holistic Engagement Programme (SHEP)

39.       I am therefore happy to announce that such public-private connections are already being made: HPB’s pilot Senior Holistic Engagement Programme (SHEP) will bring health programmes to low-income seniors through connecting with VWO partners and SAC platforms. It will tap on HPB’s expertise and the reach and passion of VWOs, to provide free health promotion programmes and subsidised health screening.

Introducing free vaccinations in polyclinics, and use of Medisave

40.       Lastly, in response to Dr Lam’s question on vaccinations, we have an Expert Committee on Immunisation (ECI) advises MOH on which vaccines to include in the National Childhood Immunisation Schedule (NCIS). This is based on factors such as how common and serious a disease is, or the availability of safe and effective vaccines. Dr Lam will be happy to hear that we will be adding the vaccine against Haemophilus influenzae type B, or Hib for short, into the NCIS.

41.       We appreciate Dr Lam’s concern that increased connectivity and movement of people across borders heightens the risk of local outbreaks of vaccine-preventable diseases. Our strategy is to ensure high local vaccination coverage to protect our residents. Vaccination coverage has been maintained at above 95% in Singapore.

42.       To improve affordability for childhood vaccinations for Singaporeans, I am pleased to announce that the 5-in-1 combination vaccine will be available for free at the polyclinics. This vaccine covers Hib, diphtheria, tetanus, whooping cough and polio.  We will also introduce free Hepatitis B vaccination at the polyclinics.   In addition, we will also allow Medisave use for all vaccinations recommended on the NCIS, up to a cap of $400 per Medisave account, be it in the public or private sector. 

43.       We will soon provide the public with a schedule of preventive health services that apply from birth till old-age that includes screening and immunization. As part of our commitment to preventive care, we would like to consult the public on how we can make it more accessible and affordable.

Public Consultation

44.       I have shared some initial thinking and ideas today. The Master Plan is still under development. We hope to touch the hearts and minds of Singaporeans, and gather ideas on how we can together achieve a healthier lifestyle.  As such, the Ministry would be holding a public consultation on the Healthy Living Master Plan in the coming months. Please give us your ideas, and feedback.

Conclusion

43.       Madam, most people know the common taglines: we should be active, eat wisely, be happy, not smoke, and attend health screening. Saying it is the easy part. Translating it into action requires a radical change in our mindsets. We hope that you will join us in this journey to be healthy together, anytime and anywhere.

44.       Thank you.