Opening Address by Mr Gan Kim Yong, Minister For Health, at the NUS Initiative to Improve Health in Asia (NIHA) Forum on 1 November 2011, Grand Hyatt Hotel

Increasing burden of NCDs

1. I am honoured to address you at the opening of second NUS Initiative to Improve Health in Asia (NIHA) Forum. This year, NIHA‟s theme is “Combating Chronic Disease in Asia – Gaps and Innovations”. The focus on non-communicable diseases (NCDs) is an apt and timely choice, considering the severe challenge posed by NCDs to societies. This has been recognised by governments worldwide and just recently in September, the United Nations convened the High-Level Meeting on NCDs, making it only the second time in history that the august body has addressed a significant health issue. The other was the AIDS epidemic a decade ago.

2. NCDs are a growing concern worldwide and is the leading cause of death globally, accounting for more than 60% of all deaths. Significantly, NCDs are no longer diseases of the affluent alone. The idea that only rich and developed countries are affected by NCDs is a myth that needs to be dispelled. In the WHO Western Pacific Region, NCDs are responsible for four out of every five deaths, with 80% of these deaths occurring in low- to middle-income countries.

3. The enormity of the problem is made clearer when one takes into account the interaction between two major demographic trends  – that of an increasing world population coupled with that of an ageing population. The proportion of those aged 60 years and above is increasing and is expected to remain so. At the same time, it is recognised that NCDs affect older people disproportionately. Therefore, the incidence of NCDs can be expected to increase rapidly in the future. Singapore, too, is not spared from this phenomenon. NCDs such as heart disease, stroke, cancers, diabetes, mental disorders, and chronic respiratory diseases constitute more than 60% of our burden of disease. We expect the number of Singaporeans with NCDs to grow in the next 2 decades as our population ages.

4. The effects of globalisation, urbanisation, and lifestyle changes are also exacerbating the NCD epidemic. People are eating less healthily because traditional dietary patterns have been replaced in favour of “Western” diets that are dominated by higher intakes of meat and lower intakes of vegetables. The situation is made more complicated as this change in diet is also accompanied by aggressive marketing of unhealthy foods high in fat, sugar and salt. Sad to say, some of these marketing strategies are targeted specifically to vulnerable populations like our children. Urbanised societies are more sedentary, with people engaging in less and less physical activity, and they have become more obese as a result. Aside from a sedentary lifestyle and an unhealthy diet, the use of tobacco also contributes significantly to the burden of NCDs.  

Economic burden of NCDs

5. NCDs not only pose a cost to the individual patient and his family but also on healthcare systems and economies. Economists suggest  that each 10% rise in NCDs is associated with 0.5% lower rates on annual economic growth. According to a recent study conducted by the World Economic Forum with the Harvard School of Public Health, the cumulative costs of heart diseases, chronic respiratory diseases, cancer and diabetes in lower income countries are expected to exceed US$7 trillion in the next 15 years (2011-2025).  This comes to an average of nearly US$500 billion a year. This is not a paltry sum at all and only serves to underline the significance of NCDs in today‟s world.

Targeting NCD risk factors

6. However, behind every dark cloud lies a silver lining. As lifestyle risk factors contribute significantly to the development of NCDs, they are „preventable‟ to some extent. In our fight against NCDs, the greatest good can be brought about by focusing efforts on preventing the development of the disease itself, rather than managing the complications after its occurrence. Tackling the risk factors common to many of the diseases must be given  top priority and healthcare systems must be upgraded or modified to deal with the considerable challenge of controlling the risk factors. As they say, prevention is better than cure.  

Multi-sectoral collaboration against NCDs

7. We are gathered here over the next two days to discuss how best we can deal with the problems of NCDs especially in the context of Asia. One thing is for certain - the health sector cannot remain isolated in fighting this battle against NCDs. Our colleagues in clinical care have come to acknowledge that interdisciplinary teams produce good outcomes by being able to draw upon the wide array of skills from various healthcare disciplines in managing the needs of an individual patient.  Likewise, the health sector must also recognise the importance of working with other sectors in tackling the NCD challenge.  

8. The health sector can begin by reaching out and enlisting the support of our colleagues in agriculture, the food industry, pharmaceutical companies, urban
planning, transport and education and other sectors to form a united front for the public‟s health. Whilst these industries and sectors might seem disparate and
unrelated, common goals can be found to establish partnerships that can improve public health.  

9. For example, in Singapore, our Health Promotion Board‟s (HPB) Centre of Excellence for Nutrition (CoEN) is collaborating with the Singapore Food Manufacturers Association (SFMA) to make healthier food pervasive. Together with SFMA and SPRING Singapore, CoEN‟s new FINEST (Functional, Innovative, Nutritious, Effective, Science-based & Tasty) Food Programme will take the lead in equipping our Small and Medium Enterprises (SMEs) with the knowledge and skills to develop functional healthier products.

10. HPB also launched the Healthier Hawker Programme in April this year, where their team worked with the hawkers at the Yuhua Market and Food Centre to sell healthier food choices, for example, by using whole grain noodles and brown rice in their dishes instead of the usual yellow noodles and white rice. They were careful to develop healthier food products that look and taste exactly like the original. This switch has proved to be a win-win situation. Since the introduction of the healthier food choices,  the hawkers have reported a 20% increase in sales, demonstrating that there is indeed a strong business case to sell healthy food. These are just a few examples of inter-sectoral collaboration. We will need more of such innovative solutions that can lead to the betterment of our population‟s health.

11. Inter-sectoral cooperation does not always come easy though, and this is where a “whole-of-government” approach is needed. Governments can play a role by being a driving force in the formulation of inter-sectoral policy and implementation of interventions. Government agencies are the best placed to oversee the reform of policies, legislation, services and infrastructure to tackle the rise of NCDs. In addition, there is room for regional cooperation and collaboration and to share knowledge and best practices across systems and countries.

Working with academia

12. Good policies must be appropriate to the local context of each country and its own health system, and based on sound data and evidence. Governments therefore also need to work in close conjunction with prominent academic institutions that are able to provide reliable data and a strong evidence base for policy and action. With this in mind, I am happy to note that the NUS Saw Swee Hock School of Public Health was launched last month. The School of Public Health is an extension of the former Department of Epidemiology and Public Health and will focus on bringing different disciplines and different sectors in the community together to study and address the prevention of common health problems, including NCDs.

NIHA

13. Just as the Saw Swee Hock School of Public Health intends to promote intersectoral collaboration and establish regional networks, similarly, NIHA, which was established last year through the GSK-EDB Trust Fund, is an innovative platform to bring together government leaders, academics, and industry representatives. NIHA comprises a high quality portfolio of cutting edge research, high-level forums and leadership programmes. It  reflects the direction that health policies are heading in the future by integrating leadership and research to aid in the formulation of sound health policies. NIHA‟s work complements that of the new School of Public Health. Together, NIHA and the School of Public Health can form research collaborations with other countries in the region that can benefit all involved and contribute to building public health knowledge and capacity in Asia. 14. This Forum is therefore an ideal representation of the inter-sectoral collaboration that NIHA promotes. As leaders in healthcare and public health, I believe that by working together,  we can mount strong efforts against unhealthy diets, physical inactivity, tobacco use and other risk factors. This is the time for a comprehensive and sustained collective response to NCDs. Our goal remains as
always, better health for all our people. I wish you all a productive and fruitful two days together.