Official Opening Of The Institute Of Health

14 Oct 1999

By Mr Lim Hng Kiang

Good afternoon ladies and gentlemen

It gives me great pleasure to officiate today at the opening of theInstitute of Health. The Public Health Services housed in the Instituteof Health has a long illustrious history providing preventivehealthcare services and promoting good health. This new building willprovide the facilities for the various agencies housed in it todischarge their missions more effectively.

I explained in Parliament recently that there are 4 components inpreventive healthcare. The first component is to lay a firm foundationfor a healthy population. This means good pre-natal and post-natal careand a comprehensive immunisation against infectious diseases. Ourchildhood immunisation programme is very successful, and we haveeradicated many diseases like polio, diphtheria and whooping cough. Wefollow up with a very extensive and effective school health and dentalprogramme. For male Singaporeans, they continue with this strict regimewhen they serve National Service. This means that, by and large, forthe first 20 years of their life, young Singaporeans start off with afirm foundation for good health.

The second and probably most difficult component in preventivehealthcare is the promotion of healthy lifestyle activities among adultSingaporeans. The message is very simple - do not smoke, eat wisely,exercise regularly and manage your stress levels. We do this throughhealth education programmes. Public education on healthy lifestyles hasbeen propagated by my Ministry for some 15 years. We realise thatchanging the mindset and changing behaviour is an uphill task. We aregoing against strong trends, of a more affluent but ageing population,eating rich food, having more sedentary habits and leading morestressful lifestyles. With a more sophisticated population, we willhave to use different strategies and approaches so that our appeals aremore effective.

The third component is health screening to pick up diseases early fortreatment. Not all health screening programmes are cost-effective. Thepragmatic approach is targetted screening for specific groups.

The fourth component of preventive health care is secondary prevention.This is early treatment of diseases to prevent complications.Sometimes, it is the severe disability or complications which areexpensive and difficult to treat, not the disease itself. Let me usediabetes as an example. If diabetes is not treated early, or if it isinadequately managed after treatment, it can result in blindness,strokes, heart attacks, kidney failure and limb amputations. MyMinistry, together with the various professional organisations, hasdrawn up guidelines for the proper management of diabetes, to ensure astandardised and adequate level of care.

This afternoon, I would like to address the most difficult component ofpreventive healthcare, that of promoting healthy lifestyles. We have toconstantly modify our health promotion approach in order to reach outto the targetted groups. Let me illustrate.

NEW STRATEGIES IN HEALTH PROMOTION

As I described earlier, pursuing healthy lifestyles means do not smoke,eat wisely, exercise regularly and manage your stress levels.

Our "Stop Smoking" campaign has been quite effective. Thesmoking rate for the population, as a whole, has declined. But we haveto do more to target the younger generation.

The smoking rate among our youths aged between 18 to 19 years old is12%. This is still too high. With the health risks of smoking soclearly demonstrated by medical research, I find it puzzling why youngSingaporeans who are better educated still take to smoking. Studies theworld over have shown that smoking initiation begins during the lateteens - "the age of experimentation" so to speak."Talking down" and sermonizing to young people is not likelyto succeed in getting them not to smoke but will instead achievenegative results, shown up as defiance and rebellion. Furthermoreproviding hard facts, eg smoking causes heart disease and lung cancer,may not create much impact on the young, as these diseases appearremote to them - most young people tend to live for the present. Weneed therefore to take new approaches such as getting young people toorganise events for themselves to promote smoke-free lifestyles and notto take up smoking. We need role models who do not smoke that teenagerscan identify with. My Ministry will work with the different youthgroups to try and bring down the incidence of smoking among youngSingaporeans.

FOOD AND HEALTH

The second limb of a healthy lifestyle is to eat wisely. Eatingfeatures prominently in our everyday activities, and our social lives.Over-indulgence in food leads to medical problems. Several of thechronic diseases faced by Singaporeans today have a definite link toour eating habit.

In the post-war years, the problem was that of insufficient food. Ourchildren, as a result, became underweight and suffered from nutritionaldeficiencies. Some of you will be able to recall the times when thinand underweight school children were given supplements of milk powderand eggs, to help them grow. Within this very same generation, thesituation has reversed and we are having to put overweight schoolchildren through programs of exercise and diet regimes to trim downtheir excess body fat!

One clear indicator of our increasing affluence and increase inpurchasing power is the increase in the amount spent on the family'sfood budget and on the purchasing of food products perceived to be'luxurious'. However these are the foods which tend to be higher incalories, saturated fat and cholesterol, and low in dietary fibre.

How does all this affect health? It is common knowledge that overeatingleads to obesity, high consumption of saturated fat increases the riskof heart disease, diabetes and certain cancers, and consuming too muchsalt predisposes to high blood pressure and stroke.

Heart disease, cancers and stroke are the top killers here, responsiblefor more than three-quarters of the deaths among Singaporeans today. In1998 alone, these diseases claimed the lives of about 10,000 of ourpeople; many of these deaths were premature and could have beenprevented.

DIET OF SINGAPOREANS

What do Singaporeans eat? The National Nutrition Survey conducted in1998 provides the answer, bringing with it both good news and bad news.

First the good news - many Singaporeans are making a conscious effortto improve their diet by cutting down fatty foods and red meat - thisis supported by the fact that 70% of people have a fat and cholesterolintake that is within acceptable limits.

Unfortunately there is more bad news than good news. While the totalamount of fat consumed by most Singaporeans is acceptable, the type offat consumed is mainly saturated, coming largely from animal products,coconut milk and certain cooking oils which are used for processing thefried foods commonly eaten by Singaporeans. Blended vegetable oil,which is high in saturated fat, is the choice for cooking oil used byabout 40% of all Singaporeans and 67% of Malays, and is also commonlyused by hawkers.

What is also surprising is that even with the abundance of fresh andcolourful fruits and vegetables found in our markets, more than 80% ofSingaporeans do not consume an adequate intake of fruits and vegetablesevery day.

This pattern of food intake supports the findings from the NationalHealth Survey 1998. The Survey showed that there is a higher prevalenceof high total blood cholesterol seen among Malays at 35.6%, amongIndians at 24.4%, followed by Chinese at 23.9%.

What is the most worrying finding from the Survey is that it is youngerSingaporeans who are the least concerned about their diet. Those in the18 to 39 years age group tended to consume sufficient fruits,vegetables and wholegrain products in their diet, but exceeded thelimits for fat, saturated fat and cholesterol intake. While mostchronic diseases occur after middle age, what we do in our younger dayslays the foundation for good health later on. Past studies showed thatthere was evidence of heart disease even in young people. Youth doesnot confer a natural protection.

Bearing in mind the results of the Nutrition Survey, my Ministryintends to be more focussed in its approach to encourage the public toadopt healthier eating habits. The public has access to informationfrom the range of educational materials which my Ministry produces andfrom ready sources in the media, the internet and so on. We will beenlisting the cooperation of food providers in hawker centres, foodcourts, restaurants, and canteens in workplaces to provide healthierfood. Consumers will also find it easier to make healthier food choiceswhen shopping, because of the healthier choice symbol displayed by someof the products.

EXERCISING REGULARLY AND MANAGING STRESS

The national levels of participating in regular exercise, ie 3 times aweek for about 20 minutes, has increased, from 14% in 1992 to 17% in1997. We can do better. We are promoting regular exercise which issustainable over the long-term. In other words, each person has tochoose the type of exercise he is comfortable with and willing toperform regularly. As walking is a natural activity for most people, wewould like to promote brisk walking as a form of exercise. Stairclimbing instead of using the lift will contribute towards this end andcan be incorporated easily into most people's lives.

We are aware that in our urban society, many people find their livesquite stressful. However, we must accept that stress is part and parcelof living. The important issue is to manage stress effectively. MyMinistry conducts stress management workshops. We have started withcivil servants under the aegis of the PS21 Functional Committee onStaff Well-Being. We will review the effectiveness of this approach.

CONCLUSION

Our preventive healthcare programme has been reasonably successful sofar. But we have to constantly adjust and improve. We can do more togive our young Singaporeans a firm foundation of good health. We haveto be more innovative in promoting healthy lifestyles. With bettermedical evidence, we can be more proactive in selective healthscreening programmes targetted at certain high-risk groups. And we cando so with more effective results if we integrate the efforts of thepublic sector agencies with the private sector medical professionalsand the community organisations.