Healthy Singaporeans, Resilient Nation

09 Mar 2010

By SPS Hawazi Daipi

Venue: Parliament

1. I thank Members for speaking on, among others, special needs children and health promotion. Speaking of health promotion, last month, two UK researchers revealed preliminary findings suggesting that it was possible to be bored to death. Before Members get worried about their own health since all of us get bored from time to time, let me qualify that statement. What the study found was that people who regularly feel bored are more prone to becoming unhappy and unmotivated. This in turn can lead them to adopt unhealthy habits such as smoking, drugs or drinking, which increase their chances of dying from conditions such as stroke and heart diseases.

2. Most Singaporeans I know have the opposite problem: they are so busy they hardly have time to feel bored! We are a time-starved people: work deadlines, family commitments, and countless errands to run. Small wonder that we often hear people grumble, “I wish I had more time for the things that matter in life.”

3. Good health is one such thing that matters to all age groups, as Dr Fatimah Lateef has rightly pointed out. MOH invests heavily in health promotion precisely because it is the crucial first step to good health. It is much better to keep healthy rather than seek treatment when conditions develop. This is why our preventive healthcare budget has increased by 67% over the past decade to $112m in FY10. Our aim is to help Singaporeans of all ages – children, adolescents, adults and the elderly – have the means and ability to lead healthier lifestyles. We want to nip chronic health problems in the bud and reduce the disease burden on our ageing population. I think many members have alluded to the silver tsunami that is coming and asked how we are going to manage it. It is a tall order which requires hard work from us all, but it is worth doing.

The Case for Workplace Health

4. Unfortunately, when we need to prioritise our time, a healthy lifestyle is often the first to go. Many Singaporeans, stressed from work, often do not eat healthily or exercise regularly. Worse still, they succumb to high-risk habits like smoking and heavy drinking, mistakenly viewing them as a pressure-reliever or lifestyle choice. They do not realise or may ignore the fact that it could cause them greater pressure both financially and emotionally when health conditions develop down the road.

5. This is why there is a strong case for healthy lifestyles to be advocated at the workplace. The outreach strategy is sound as 2 out of 3 Singaporeans aged 15 years and above are working. I spoke briefly about workplace health in last year’s budget, and I will spend more time outlining our plans for workplace health promotion this year.

6. The business case for improving workplace health is simple. Healthier workers mean less absenteeism and lower medical costs for the company – the first step to boosting productivity and bottomlines. Healthy, active employees are also good “walking advertisements” for a company’s work ethos and culture, which helps in talent recruitment and retention. Healthy and alert employees also contribute to a safer work environment. Indeed, more local companies are recognising the value of good workplace health programmes and have taken steps to implement these.

7. NatSteel is a good example. I visited them last month and was impressed by the fruits of their employee wellness programme. They have wisely banned the sale of cigarettes within their premises and extended the lunchtime break to encourage participation in on-site health programmes. I was told that they actively take part in programmes to promote the good health of their workers Employees are also given subsidies and other incentives to participate in healthy lifestyle activities. There have been tangible results: the average days of medical leave taken has fallen from 3.4 days in 2005 to 2.3 days in 2009. With more motivated and healthier staff, the monthly average resignation rate has also fallen from 0.9% in 2005 to 0.7% in 2009. For comparison, the monthly average for the manufacturing industry is double that, at about 1.6%.

8. One employee’s effort in keeping himself healthy left a lasting impression on me. Mr Arumugam Kerisnasamy, a security guard, has a family history of chronic diseases. Determined to keep these diseases at bay, he put himself through HPB’s “Lose to Win Challenge” and NatSteel’s own “Weight Optimisation Challenge” late last year, losing 8 kg over a four-month period. Mr Arumugam continues to exercise and watch his diet. He now weighs 96 kg, 11 kg less than when he first started. His fitness level has also improved considerably. During my visit, he shared how grateful he was to NatSteel for their support and encouragement in his weight loss journey. He also told me that he was driven by the strong desire to take charge of his own health so that he can better his work performance and provide for his loved ones. I think we all have much to learn from Mr Arumugam.

More Support for SMEs

9. Some SMEs may want to roll out similar measures like NatSteel, but they lack the scale, resources and infrastructural support to do so. MOH and HPB recognise the constraints faced by our SMEs and will do more in the coming year to help them.

10. Today, several industrial and commercial landlords, e.g. Ascendas Services, CapitaLand Commercial, JTC Corporation, HDB and Mapletree Investments, participate in HPB’s WHP@SMEs’ Doorstep programme. A simple but popular programme, it conducts health screening and health programmes for SME employees at the doorsteps of industrial parks and commercial buildings where the SMEs are located. This is how HPB brings the program to the doorstep of the companies. It has been well received and we intend to roll this out to more locations over time.

11. I agree with Mr Ong Ah Heng and Mr Yeo Guat Kwang that we can do more. The National Tripartite Committee on Workplace Health co-chaired by Mr Lucas Chow and Mr Yeo himself has recommended to MOH a slew of measures to better support our SMEs in workplace health promotion. Let me mention a few we have implemented or are considering in the coming year:

12. To help SMEs who face budgetary constraints in starting workplace health programmes, the TriComm and HPB have introduced an enhanced SME Grant since May 2009. The grant now funds up to 90% of the cost of such programmes, capped at $10,000 per application. HPB also recently relaxed the grant guidelines to allow funding for off-site health programmes, such as basic health screening at CDMP-GP clinics and chronic disease intervention programmes. HPB has committed up to $180,000 to 22 SMEs under this enhanced scheme. I encourage more SMEs to sign up for the scheme.

13. Money alone cannot fully address the situation. SMEs often lack dedicated manpower and protected time to implement workplace health programmes well. To help them, HPB will introduce a workplace health package this month where pre-selected vendors will deliver the packaged health screening and interventions, covering four key areas of healthy lifestyle -- physical activity, healthy eating, mental wellbeing and smoking control. Companies simply have to choose their preferred activities from among the health interventions in these four areas. Some members have raised the concern over mental well being of employees and at company level, this is one way HPB is reaching out to employees, to help them through activities.

14. We also know that the work demands of each sector are different. Some sectors, like Hospitality, Wholesale & Retail, and Transport & Logistics, face greater challenges in implementing workplace health initiatives. For example, in the hospitality sector, it is hard to get service staff who work different shifts to get together to exercise, especially those who work the night shift. To address this, HPB and its partners will be adopting a more customised approach, by tailoring outreach activities and capacity building sessions tailored for specific industries. Industry workgroups, comprising representatives from trade associations, unions and private companies, will be set up to provide feedback on the needs and challenges of their respective industries.

15. Within Government, HPB has already started working with other agencies to align and streamline our promotional efforts. For example, HPB and the Ministry of Manpower (MOM) have been working closely to integrate workplace health promotion into the Workplace Safety and Health legislative framework, as well as the Guidelines for Re-employment of Older Workers. They will also be engaging employers, employees, healthcare providers and insurers to pilot a health management framework linking corporate and individual health to appropriate incentive systems. This will be an exciting area for development as we push for greater productivity in our workforce.

16. I know I can count on unions and trade associations, like NTUC and the Singapore Manufacturers’ Federation (SMa), to step forward and lend us their support. NTUC has already partnered HPB to launch a weight management programme next month to promote healthy living at the workplace. SMa will also hold a kick-off event in May 2010 where some of their SME members will pledge their commitment to implement workplace health programmes. So we have the union and associations to help us in promoting weight management with their members and employees. As we intensify our engagement efforts with SME leaders and associations, I hope more will do the same and motivate their members to improve workplace health.

Updating Smoking Control Legislation

17. Let me move on to our smoking control efforts. Singapore is a pioneer in this area on several counts. We were the first Asian country to ban tobacco advertisements in 1971. In 2004, we again led Asia by using graphic warnings on cigarette packs to discourage smokers from lighting up. To date, we are one of only nine countries in the world recognised by WHO for our nationwide network of smoking cessation services.

18. Nevertheless, smoking is an issue that will take years to address and we will persist in it. We already have some successes. Less contraband is being hawked on the streets, in no small part due to Customs’ vigorous enforcement efforts. Many public places are also going smoke-free, thanks to NEA’s smoking ban. Over the years, smoking rates dropped from 20% in 1980 to 12.6% in 2004, but the latest figure of 13.6% in 2007 shows a slight rebound. So we still have a lot of work to do.

19. This is mainly due to an increase in smoking amongst certain population segments, in particular young adults. The smoking rate for young males, aged 18 to 29 years, has increased from 18% in 2004 to 25% in 2007. For young females, the increase was from 7% in 2004 to 9% in 2007. I am concerned about this trend as young adults might not fully appreciate the negative consequences of being hooked on smoking.

20. Besides stepping up HPB’s public education efforts, we intend to augment HSA’s regulatory arsenal by updating the Smoking (Control of Advertisement and Sale of Tobacco) Act to current operating realities. The Act was last amended in 2003 and the latest proposed amendments are to incorporate more stringent tobacco control measures in response to an increasing trend of smoking among young adults, and the emergence of new tobacco products. After extensive public and industry consultation, we are planning to ban misleading labelling, and lower the maximum tar and nicotine limits, among other changes. I look forward to Members’ support for the amendment bill when we table it in this House later.

Detecting and Preventing More Diseases

21. Minister Khaw earlier spoke about our considerations in making screening more affordable through the use of Medisave. I shall now update the House on the clinical developments.

22. The Integrated Screening Programme was introduced in June 2008 to facilitate appropriate health screening for Singaporeans aged 40 years and older at CDMP-registered GP clinics. Five conditions are currently covered: diabetes, high blood pressure, lipid disorders and obesity – all risk factors for hearts attacks and stroke -- as well as cervical cancer. The programme has served Singaporeans well by lowering the cost of screening through bulk purchases and subsidies for lower-income Singaporeans.

23. We are looking at including colorectal cancer screening under the Integrated Screening Programme. Colorectal cancer is the most common cancer here: 1500 Singaporeans become afflicted with this disease annually. Over the course of a lifetime, 1 in every 20 men and 1 in every 30 women will get colorectal cancer. Last November, we started a pilot in Queenstown, Tiong Bahru, Bishan and Ang Mo Kio where Singaporeans aged 50 years and older were invited to go for colorectal cancer screening at CDMP-GP clinics. To date, 416 participants have completed the screening, and 39 participants (9%) were referred for further assessment. We also intend to step up efforts to increase awareness and uptake of colorectal cancer screening among Singaporeans.

24. Cervical cancer is another noteworthy disease that we are tackling. Pap smear screening is key to detecting this cancer at its early and even pre-cancerous stages, when treatment is most effective. Vaccination against the human papillomavirus (HPV) is an interesting new approach, though not without limitations. For example, it is only effective against 70% of cancer-causing HPV viruses, and there is limited data on its long-term effectiveness. The Expert Committee on Immunisation is reviewing the evidence on HPV vaccination and will report its findings to MOH subsequently.

Improving Our Children’s Health

25. Good health also boils down to eating enough and eating right. A balanced diet is crucial to improving physical wellbeing and our resistance against diseases.

26. But we must guard against too much of a good thing. Chinese New Year is just over and like other festivals, some of us would have suffered from the side-effects of over-eating. Imagine the ill-effects of our kids over-eating on a daily basis! Childhood obesity is fast becoming a problem in developed countries. Left unchecked, it would lead to our children developing all sorts of chronic illnesses that they would have to live with the rest of their lives. The problem is becoming so severe in America that it has caught the attention of President Barack Obama. He recently set up a taskforce under the First Lady to tackle this growing problem.

27. In Singapore, we have made obesity the focal point of our National Healthy Lifestyle Campaign last year, and this will continue in 2010. As a lead up to the campaign proper, HPB will launch a weight loss reality TV challenge, similar to the highly popular Lose to Win Challenge in 2009. Community and workplace stakeholders will also be engaged to champion health programmes to provide supportive health promoting environments for optimal weight management.

28. We know that food advertising to children is a problem, and are working with industry stakeholders to address this. To complement these efforts, HPB is developing guidelines on food marketing to children in schools and will continue health education efforts in the school setting. HPB will also work with MOE to instil a culture of physical activity among our young, so as to build lifelong habits for a healthy lifestyle.

29. Mrs Mildred Tan asked specifically if MOH will consider banning trans fat in food sold here due to the increased risk of coming down with cardiovascular diseases from consuming it. I share her concern. Today, 3 in 10 adult Singaporeans exceed WHO’s recommended daily limit of < 2 g of trans fat a day. Two thirds of these people are younger adults aged 18 to 39. Our children, especially those who snack frequently, are affected as well. We clearly need to limit the intake of trans fat in Singapore before it gains a foothold in our daily diet.

30. Regulating trans fat is a complex issue. We have adopted a more cautious, voluntary approach so as not to create trade barriers, reduce consumer choice and bring about unintended increases in food prices. The concerns that we raised in 2006 are still valid but we are looking at some ways to ensure more people are informed about their choices. After carefully studying the experiences of other countries and taking into account our local situation, we are now prepared to take targeted steps to control the problem.

31. The experts tell me that a total ban is not practical. Many of the catchy headlines we read about trans fats bans in New York and California actually refer to limiting trans fats to very low levels. We will do likewise. We are considering limiting the trans fat content in fats and oils to not more than 2 g of trans fat per 100 g of product. This is in line with the practice of developed countries which have implemented trans fat reduction measures.

32. For other food products besides fats and oils, HPB will continue its approach of engaging the food industry and encouraging all of them to voluntarily reduce the trans-fat content in their products. Response has been encouraging, especially from larger players in the market. Some companies that have voluntarily reduced trans fat in their products are Gardenia, Sunshine, FairPrice, Lam Soon and Nestle. SMEs like Al Dente Food Pte Ltd have also come forward to partner us in this effort. I look forward to the support of other industry players on this and other healthy eating initiatives like HPB’s Healthier Choice certification.

33. Mr Low Thia Khiang asked about the state of myopia in Singapore. Myopia develops mainly in childhood, but stabilises as we get older. Many of us will recall that one generation ago, fewer children wore spectacles. The proportion of school children in Singapore with myopia is indeed high but has also stabilised over the past 5 years. Today, about 30% of Primary 1 school children or two-third (66%) of Primary 6 school children have myopia.

34. The causes of myopia are not well defined, although studies have identified risk factors like near work and protective factors like regular outdoor activity. Local research is on-going to gain more insights into risk factors and causes of myopia. Our schools have taken the necessary measures to manage the problem but a large part of the solution depends on habits at home. Through the National Myopia Prevention Programme, MOH and HPB help tackle both sides of the equation by educating parents, educators and children themselves on good eye care. Vision screening for pre-school to secondary school students is also provided through the Programme. We must collectively press on our efforts to delay the onset and reduce the progression of myopia in children on these fronts.  But we acknowledge that it is challenging.

35. As these recent cohorts of children age, myopia will inevitably become more prevalent among adults. The concern is that myopia may predispose older adults to other eye problems. HPB will encourage seniors to go for vision screening as part of a broader suite of elderly functional assessments which it will roll out soon. We are also augmenting optometry and optician services nationwide to deal with problems as they emerge.

36. Fortunately, myopia is a problem easily correctable by spectacles or contact lenses. With affluence, many adults have also gone for the more costly option of laser surgery or LASIK. The technology is evolving. Surgeons are now able to make more precise, three-dimensional measurements of the eye that better guide their reshaping of the cornea. However, as with any surgical procedure, patients have to be carefully assessed for suitability, and LASIK itself carries risks that patients should be aware of. At our public hospitals, the success rate of improving vision in adults via LASIK is more than 98%, though not all will achieve perfect vision. This is comparable to results overseas. Rates of serious complications are low, but side effects such as dry eyes are common, occurring in up to half of all patients.

More Resources for Special Needs Children

37. Besides mainstream schoolchildren, I want to highlight another group that we are devoting more resources to: special needs children. Dr Lam Pin Min and Dr Amy Khor have raised some good questions about our plans to support this group of children. Since 1991, the Child Development Programme has helped identify and treat children with developmental problems in their early childhood. Under this programme, child development experts from KKH, NUH and three community-based clinics work together to provide diagnostic and early intervention services for special needs children, aged 0 to 6, complementing MCYS and MOE’s efforts under the wider Enabling Masterplan on Disability. Through these efforts, and the determination of patients and their families, many have risen above their developmental difficulties. Some ex-patients have since secured places at our tertiary institutions and even participated actively in National Service.

38. I have seen our healthcare professionals in action. They are doing good work and coping relatively well despite the huge caseload of some 5,200 patients, including 2,000 new cases annually. However, certain support services like psychological counselling, and speech therapy are stretched as we had only catered for a projected total caseload of 3,200 patients, with 1,200 or so new cases per year. This was the global norm as recently as 3 years ago.

39. This rising trend in workload, which experts attribute to increased awareness and better diagnostics, is not unique to Singapore. The situation is exacerbated by a global shortage of trained manpower, which has led to a resultant increase in waiting times worldwide. We acknowledge that parents have to wait for their children to go for screening but this is not a problem just in Singapore but also faced by many other countries. This is why we are injecting $46 million into the Child Development Programme, to help us expand capacity and bring down waiting times for these early childhood developmental services. It will cover our needs over the next four years and is on top of the $16 million already committed from 2007 to 2009. Most of these monies will go towards the training and recruitment of child development manpower, especially psychologists and speech, language and physiotherapists.

40. But let me add that the holistic management of children with special needs is a complex issue. Multi-agency efforts across the social, educational and healthcare sectors are required for the child to reach his or her full potential, as I am sure Mr Ong Ah Heng is aware. In the majority of children with special needs, such as those with severe mental retardation, autism, and cerebral palsy, medical intervention plays only a limited and supportive role compared to the provision of social and educational support measures. These children require early placement in special schools where they can receive appropriate training and education. The Child Development Programme which I have just outlined caters to those with mild to moderate problems. The most appropriate developmental setting for this group is in the mainstream: integrated and inclusive schools where they can receive educational, social and community support as well as therapeutic intervention from healthcare professionals.

Raising the Quality and Standard of Traditional Chinese Medicine

41. Before I conclude, let me address Ms Ellen Lee and A/Prof Paulin Straughn’s questions on raising the quality and standard of TCM in Singapore. Today, MOH does this through raising the standards of TCM training courses and continuing professional education of TCM practitioners. Since 2006, MOH has worked with the two main local TCM colleges to replace certificate and diploma courses with higher-requirement Bachelor’s courses, jointly conducted with top TCM universities in China. NTU’s School of Biological Sciences has also started a double degree Biomedical Science and Chinese Medicine course with the Beijing University of Chinese Medicine. Its first batch of 59 students will graduate this year. Taken together, these measures have augmented the pool of TCM practitioners with degree-level training from 101 in 2006 to 164 in 2009.

Conclusion

42. There is a saying “Health is wealth”. This is true in more ways than one. By staying healthy, one need not spend so much on medical bills and have more for his or her other pursuits. But besides that, keeping healthy will enable an individual to have a higher quality of life, which he can enjoy with his loved ones. This is something that no amount of money can buy. I urge all Singaporeans to take the simple first step of taking control of their diets and start exercising so that by 2020, we will be a healthier and "wealthier” nation.