Live long and live well

04 Mar 2011

By Mr Hawazi Daipi

1. Let me first thank Members for their contributions. Dr Lam Pin Min, Dr Fatimah Lateef, Prof Paulin Straughan and Mr Ong Ah Heng have all given useful suggestions on how to make our healthcare system more wellness centric and pro-health. Indeed, this shift to prevention has been one of the biggest health trends in the past decade. People are more empowered than ever before to take personal ownership over their health. Information on how to eat and live healthily is readily available. Just whip out a smart phone, or log onto the internet and you will find dozens of applications to help you count your calories, track your exercise regime and even help quit smoking.

2. Healthcare systems around the world are responding to these challenges. And in Singapore, we are too. In Minister Khaw’s speech, he has outlined wellness as one of the main priorities of MOH over the next few years. What this means is that our healthcare system should not only focus on taking care of the 10% of Singaporeans who fall sick , but also ensuring that the 90% of Singaporeans who are well can continue to stay healthy.

3. This is a significant shift. It will require fundamental changes in the way our healthcare institutions work. It will involve community partners coming together to champion health. It will be a very difficult and uphill journey, but we should strive to succeed; because if we do, it will mean that people will lead longer, fuller and healthier lives. And in the final analysis, this is really what the Ministry of Health should aim to achieve for Singaporeans.

Lessons from the Blue Zones

4. This is why I was quite intrigued to learn about blue zones. Blue zones are communities of people tucked away in different parts of the world who are living out the mantra – “live long, live well”. People there commonly lead active lives past the age of 100 years, with high levels of well being. One of the blue zones is Okinawa in Japan, which Dr Lily Neo has spoken about before, and which Minister Khaw has visited.  Another blue zone is Sardinia in Italy, which has one of the highest rates of centenarians in the world.

5. Researchers have gone to study these blue zones and have come back with a list of common lifestyle characteristics from these areas. If you allow me to paraphrase, they include simple things like: keep moving, eat till you are 80% full, put more vegetables in your diet, manage stress, surround yourself with supportive friends and belong in your community.

6. If these ‘secrets’ sound familiar to all of us, they are in fact quite similar to some of the simple prevention messages that the Health Promotion Board (HPB) has been advocating – stay active, eat wisely and strive for positive mental well being. However, the difference is that the people in the blue zones have made it a way of life.

Remaking our National Healthy Lifestyle Efforts

7. In Singapore, we know this is the hardest part. Many of us eat out and work late. By the time we get home from work, we are too tired to exercise. This has led to more sedentary lifestyles and rising obesity as Dr Lam Pin Min and Mr Sin Boon Ann have pointed out.

8. This was why we launched the National Healthy Lifestyle campaign in 1992. We introduced programmes to help Singaporeans make prevention a way of life. We are reaching the 20th year anniversary of the campaign now, and it is timely to do a stock take. The campaign has led to a greater awareness of healthy lifestyle among Singaporeans, but as Dr Fatimah Lateef has said, we need to do more to encourage proactive health promotion. The prevalence of obesity has increased to double digits, i.e. 11% in 2010. If we do not do anything to arrest the increase, we will soon be plagued with an obesity epidemic and the associated chronic conditions, which would be a huge drain on our healthcare system, let alone at the personal level.

9. The approach towards promoting healthy lifestyles amongst Singaporeans has been largely top-down thus far. To successfully move towards a wellness centric healthcare system, we will need a more ground-up approach as articulated by Minister Khaw.

10. This is what they do in the blue zones – rely on social capital to live long and live well. They surround themselves with supportive friends and community. In Okinawa, they have what they call “moais” – groups of five friends committed to each other for life. Many of these social circles support healthy behaviour, which can be equally, if not more ‘contagious’ than obesity and smoking.

11. The other thing about the blue zones is that communities work out what makes best sense for them. The communities have different diets, different ways of managing stress. The Sardinians for example manage stress by gathering in the streets to laugh with each other. The Okinawans like to do gardening. They recognise that different things work for different people.

12. In a similar way, we need to find what works for us. Members have raised some suggestions.  Dr Fatimah Lateef has urged more health promotion programmes to increase awareness of health risks associated with certain personal behaviours.  Mr Ong Ah Heng has asked if more can be done to engage our well developed and well connected grassroots organisations and networks to nudge us toward better health behaviours. I agree with these suggestions. We should find ways to better empower the individual to take ownership of health, and leverage the power of social capital in our communities, or what we call our ‘kampung spirit’. We need to inspire Singaporeans to health. From there a movement will emerge with a natural momentum.

13. The National Healthy Lifestyle Campaign will be remade to support this. Together, we will build a new health promotion model, with a ground-up approach supported by all Singaporeans. In reply to Dr Lam Pin Min and Mr Sin Boon Ann, we will also make obesity the focus of the campaign. MOH and HPB will work with the grassroots to co-create a model of health that works for each community and which targets obesity. We will provide the expertise, tools and training to develop a team of Health Champions in each constituency, who will then act as agents of change to champion healthy living. The analogy I would use is that we are handing Singaporeans the keys to health; and together, we will open the door.

14.  I know of one of these Health Champions, Mohamad Hashim Mohamad Shah, the Chairman of Marsiling Malay Activity Executive Committee, who has started his own journey. Before becoming a Health Champion, he weighed 91 kg.  However, after a year of exercising and adopting a healthier diet, he now weighs 83 kg! Seeing the benefits of his efforts, together with other Health Champions, they have formed a health interest group with about 80 residents in Marsiling. There are seven other Health Champions in Marsiling. Having learned about elements of chronic illnesses and how to be effective health advocates, they each reached out to 10 residents. That is why they are called “Ketua Sepuluh” (Leaders of 10). The health interest group meets every month to share tips on healthy cooking and weight management. Many of them go for brisk walks every weekend, while others have taken up aerobics, cycling or swimming. The Champions are not stopping there. They intend to grow the interest group to 200 people. In fact there is also a pipeline of residents being trained to become Health Champions.  HPB provides the experts guidance and North West Community Development Council helps to coordinate the Health Champions Network in Sembawang GRC and Nee Soon Central and Nee Soon East. I applaud the Health Champions for the efforts to start their own ‘blue zones’ and hope others can also share their enthusiasm and keep the momentum going. 

15. From Health Champions, we move to activities. Activities tailored to the needs of the local community will be developed, and include Healthy Cooking Demonstrations and physical activity programmes like community aerobics and qigong. Non-traditional stakeholders will also be roped in. For example, childcare centres and schools will be engaged to roll out programmes like Walk-to-school with Kids. Shopping malls will also be encouraged to implement health promoting initiatives for shoppers. One of these initiatives is ‘Mall Walks’ where Singaporeans can do briskwalking and other exercises in a safe and weather-proof setting.

16. A prototype of this new “ground-up” National Healthy Lifestyle model has already started in the Southwest CDC District. Here, the Health Promotion Board and National Environment Agency are partnering with Yuhua Hawkers Association, to engage hawkers on using healthier ingredients like whole-grain noodles, brown rice and healthier oil. Other prototypes in Northwest CDC and Sembawang GRC are in the works; they will develop their own unique programmes. Where best practices emerge, we will see if they can work for the rest of Singapore. We hope to gain a natural momentum that will lead to other such initiatives being rolled out across the island.

Workplace Health

17. This movement towards health has another important setting – the workplace. As Dr Fatimah Lateef, Mr Ong Ah Heng and Mr Heng Chee How have pointed out, this is an ideal place to promote wellness and good health practices, since working Singaporeans spend a significant portion of their time at the workplace. But it is not just about being pro-health, it is also about being pro-business and pro-worker. I agree with Dr Fatimah and Mr Heng that workplace health is intricately tied to productivity. Better health means better effectiveness on the job, more alert employees, lower absenteeism and overall improvements in workforce morale and engagement. For employers to want to promote workplace health, it must make business sense, and it does.

18. Many organisations have effectively created health-oriented work cultures. In the US, Kaiser Permanente, a leading healthcare group eliminated trans-fats from its patient menus, employee cafeterias, and vending machines in 2008 to protect its patients and employees from the risk of coronary heart disease. In Singapore, some of our hospitals have also made healthier foods cheaper. The Austrian Health Minister recently visited KTPH and was impressed by how health promotion was built into the design and workings of the hospital. They were pleasantly surprised when fruit grown on the hospital compound was served to them as snacks!

19. For smaller employers, there are understandably more challenges. But it is not impossible. Some SMEs have shown the way. Asia Polyurethane Manufacturing for example is a small outfit of just 29 employees. Yet, they have launched initiatives like health screening, aerobics classes and talks on nutrition for their employees. To their CEO Mr Erman Tan, the business case for workplace health is strong. It enhances employee morale and teamwork, and has a huge impact on productivity.

20. SMEs will be our focus over the next few years to spark this health movement. Collectively, they are Singapore’s largest employers. In reply to Dr Fatimah Lateef and Mr Heng Chee How on what our plans are to enhance health at the workplace, we will do three things to persuade business leaders. First, we will make it simple for SMEs to implement workplace health programmes. We will offer customisable off-the-shelf workplace health packages to SMEs. They will simply have to choose the packages they want. This frees them from the administrative hassle of sourcing and coordinating health activities for their employees. Second, we will continue our funding support for SMEs through the Workplace Health Grant which offers 90% funding to implement programmes, up to a cap of $10,000 per application. Since the scheme was extended to SMEs in 2009, 90 SMEs, including Asia Polyurethane Manufacturing, have benefited. For larger companies, a further 200 firms benefit each year from the Workplace Health Grant. Third, we will strengthen and form new partnerships with trade associations so that health activities can be offered to their member companies. The Singapore Manufacturers Association is the first to partner HPB; 100 of its member companies have pledged to implement comprehensive workplace health promotion for their employees.

21. The National Tripartite Committee, or TriCom, on Workplace Health which I spoke about last year has been key in driving these ideas. They have just reported their recommendations in November last year. Under the TriCom, Workplace Health Promotion elements have been integrated into national frameworks like SPRING’s Business Excellence Framework and the Guidelines for the Re-employment of Older Employees. HPB is now collaborating closely with MOM to further tie Workplace Health with Workplace Safety as Mr Heng Chee How suggested. MOH has set up a group to oversee and monitor the implementation of the TriCom’s recommendations.

Our Children’s Health

22. Children and their parents are a key link in the health movement. We see many parents attending parenting seminars to find out from experts how to bring up their children to be healthy, confident individuals.  Here we have many opportunities to create healthy habits in the way our children eat and keep fit. And we know that what we learn when young, stays with us.

23. Again we are approaching this from many angles. The National Healthy Lifestyle Campaign this year will focus on the family. Parents will find accessible resources right at the community level, throughout Singapore, such as organised walks, classes and support groups.

24. Schools are also an important setting for influence. Jamie Oliver, the British TV chef, is leading the school food revolution in Britain. He said that “eating a healthy school meal is a great foundation for a kid’s education and future health”. We share the same vision. HPB has thus worked hard to change children’s eating habits and attitudes. Dr Lam Pin Min spoke about school meals. In Singapore, HPB has partnered with schools to incorporate guidelines on healthy eating and to limit student’s exposure to foods that are high in fat, salt and sugar. We are encouraged by the efforts schools have undertaken to translate this vision into reality. About 90% of our schools have adhered to HPB’s guidelines and achieved Healthy Eating Awards.

25. HPB has also partnered infant and child care centres and pre-schools to provide supportive environments. Through the Healthy Eating in Child Care Centres Programme, centres are provided with guidelines on offering healthy food and drinks to children. This is now included as one of the items in the licensing of child care centres.

26. On the supply side, culinary training workshops have been introduced for tuckshop vendors to raise their awareness of nutritional guidelines and healthy meal preparations.  We are also working with the food suppliers to modify and introduce healthier food items in school tuckshops. You may know now that schools are not allowed to sell certain types of drinks that are sugary and gassy and not allowed to sell fried food more than once a week.

27. Aside from diet, we know that exercise is also important. Research has shown that exercise helps children to be more attentive and think better. I am happy that MOE has reviewed its physical education curriculum and increased physical activity time across the various educational levels.

28. Apart from targeting school-going children, there is evidence that suggests that conditions in the womb and during early childhood can influence health later in life, including risk of obesity and chronic diseases. This is why HPB has expanded its target audience to include parents-to-be as well as parents of young children through the Healthy Origins and Firm Foundations programme. Here, HPB, in partnership with maternity and children’s hospitals, are developing resource packages for new mothers-to-be to provide them with tips on how to maintain healthy pregnancies and raise healthy children.  

At Home and All About

29.  We have spoken about changes that will be taking place across many physical sites in our communities. There is one development however that will place active health management right at the fingertips of Singaporeans, so that health promotion can be 24/7, anywhere and everywhere. Members already know about MOH’s development of the National Electronic Health Records (NEHR). While most of the NEHR will transform the way that hospitals work, one part that will directly impact you and I is the development of a personal health management platform. While this will take a couple of years to develop, we have already taken steps toward better personal health management like the HPB Diet Tracker i-Phone App. What we can look forward to are mobile applications built upon the platform that will support healthy behaviour and personal responsibility for health. In fact this is the way that many countries around the world are moving toward – telehealth and mobile apps for personal health management.

Conclusion

30. Getting healthy is a process, a journey of small steps. And if we go back to the blue zones, it is the simple things that make a difference – what we eat, whether we exercise, how much we sleep. We can all take small manageable steps in our everyday life. These small changes will lead to big improvements in our health. When these changes become a natural part of our routines, we would have formed our own personal blue zones. Let us journey together to live long and live well.