Parliamentary Secretary COS Speech: Healthy Living for All – From Vision to Reality

Madam Chair,

I thank the points raised by the Members.

I.            Introduction  

1.          As mentioned by Minister Gan earlier, healthy living starts with each of us. By staying in the pink of health, we can enjoy a good quality of life, even as we age. I will share further on how MOH intends to help every Singaporean live a healthy lifestyle. Madam Chair, with your permission, may I display some slides on the LED screens.

2.          In a 2012 study by Bloomberg, Singapore ranked first on the list of the World’s Healthiest Countries. Singaporeans are among the top five longest-lived peoples in the world, according to the World Health Organization (WHO). We should strive to ensure that this good state of health continues and improve on particular areas of concern.     

3.          Non-communicable diseases (NCDs) such as heart disease, stroke, cancers, diabetes, and mental disorders cause approximately 70% of the burden of ill-health and premature deaths in Singapore. These NCDs are highly influenced by a number of risk factors including obesity, smoking, unhealthy diet and lack of physical activity. Fortunately, we can reduce the impact of such risk factors if we adopt healthier lifestyles.

4.          MOH and HPB’s role then is to help individuals and families better take charge of their health, by improving accessibility and affordability, and by leveraging peer and family influence. We will do this by working together with fellow Singaporeans, government agencies, community organisations and the private sector.

I.        Update on Progress of HLMP

5.          I led a Task Force to develop the Healthy Living Masterplan (HLMP). We agree with A/Prof Fatimah Lateef on the need for more community involvement, collaboration, and education to create a living environment that sustains healthy lifestyles. The vision of the HLMP, “Healthy Living Every Day: Making the Connections” addresses these key components. It also embodies three key elements: “People, Place, and Price”, which will allow healthy living to be accessible, natural and effortless for all Singaporeans.   

6.          First, “People”, the heart of what we do. A/Prof Fatimah Lateef had also expressed concern about low health literacy rates in certain segments of the population. We are aware of their needs and will be inclusive in our outreach to all segments of society, especially the lower income, youth and older people. The second element, “Place” involves creating a conducive environment by integrating the physical environments for seamless access to healthier options. Lastly, “Price” - which means making healthy living affordable and within the reach of everyone through lower cost healthier options.

7.           To ensure that this vision translates to action, we consulted widely and gathered ideas from Singaporeans who shared their views on how we could lead healthier lives. Similarly, they shared the obstacles that stood in the way. We have taken their feedback into consideration as we consolidated our findings and planned our initiatives.

8.          I am pleased to inform Ms Ellen Lee and Ms Tin Pei Ling that we have completed the HLMP report and will be releasing it in April 2014this year. The HLMP cannot remain static, especially with changes in the environment and new scientific discoveries. This That is why the HLMP is a ‘live’ action plan. We will do more as we gather more evidence on what is useful and effective.

9.          Mr Patrick Tay had asked how we intend to translate the HLMP Plan to the people on the ground. The HLMP is anchored on initiatives in three settings – i)firstly, community, ii)secondly, workplace and iii)thirdly, school. This is so that we can reach out to Singaporeans from a young age to inculcate healthy habits that stay with them till adulthood.

II.      Connecting the Dots for a Healthy Community

a.  Evidence-based screening

10.     Through our consultations, we found that screening is not a high priority for some people as they either feel well, or prefer to save their money for more serious medical conditions. This is a misconception because early detection of diseases, followed by good management, can improve health outcomes, and delay or prevent the development of complications.

11.     We are glad to inform Mr Chen Show Mao that we have worked continuously to incentivise participation in health screening by making it more affordable via the Integrated Screening Programme (ISP). The ISP encourages regular health screening for specific chronic diseases and cancers among Singaporeans aged 40 and above. The tests listed under the ISP have been proven to be clinically sound and suitable for population-wide screening.

12.      Mr Gerald Giam had advocated that Singaporeans should be able to use Medisave to pay for the full cost of screening. Mr Patrick Tay had recommended that Medisave use be permitted for more detailed screenings instead. We would like to assure Mr Giam that screening tests under the ISP are affordable. In addition, MOH has increased the flexibility of the use of Medisave over the years to include mammograms and colonoscopies. Subsidies are also available for these procedures.          

13.     Mr Tay and Mr Giam had  similar ideas in mind when they suggested that MOH provide all Singaporeans free basic health screening when they turn 40 years old. We would like to clarify that MOH has already done this for Community Health Assist Scheme (CHAS) cardholders. From 1 Jan 2014, the ISP has been enhanced to offer free screening tests to CHAS cardholders from age 40, at any CHAS-registered GP clinic. CHAS cardholders will also be subsidised for GP consultations to follow-up their screening test results, up to twice a year.

14.     As stated by DPM Tharman earlier last week, all Singaporeans who qualify for the Pioneer Generation (PG) Package will be brought under CHAS from Sep 2014. Mr Gerald Giam can be assured that the PG will similarly be able to enjoy free screening tests under the ISP and subsidies for their health screening consultations. Besides the ISP, seniors aged 50 and above can also participate in the health screening under the Wellness Programme at each of the 87 constituencies at a nominal fee of $2 to $5.

15.     It is important to ensure that the screening tests we undergo are safe, effective and appropriate. Screening tests that are inappropriate are not effective in detecting diseases, and may cause false alarms and undue anxiety. Such screening will incur unnecessary costs.

16.     A/Prof Fatimah Lateef had also emphasised the importance of participating in screening. This is why we track the uptake of our screening programmes and regularly review them to see what we can do to improve the uptake. Reducing out-of-pocket costs was one strategy. Another way is working through the Women’s Health Advisory Committee, led by SMS Dr Amy Khor, to explore initiatives to promote screening in women.

17.     Our measures to improve rates of screening have made an impact, especially for chronic diseases. Though we have worked to address the cost barrier, there are additional factors that deter others from going for screening. For some, “ignorance is bliss” as they may be afraid of receiving poor results. Others perceive screening to be a “lose-lose” situation where they would have “wasted” money if they were told to be in good health. Conversely, finding out that they indeed had a chronic condition would lead to additional financial costs. For this group of people, we will continue with our education messages to dispel misconceptions.  

b. Food Strategy

i.            Healthier Eating 

18.     Most Singaporeans eat out at least once a day. However, Singaporeans on average, consume 300 calories more than our daily requirements. This, together with lower levels of physical activity, leads to more people becoming overweight.  Also, nine out of 10 Singaporeans did not eat enough fruit and vegetables.

19.     Dr Lam Pin Min had proposed that MOH consider subsidising healthier food options, as a way of incentivising healthier living. We have already provided such subsidies through an indirect way. The Healthy Hawker Centres and Coffeeshops were introduced in 2011, and have been successful in encouraging people to switch to healthier meals. Currently, we have 14 Healthy Hawker Centres and Coffeeshops. Under this programme, grants were given to the hawkers to buy healthier ingredients like whole grain noodles, and oils with lower saturated fat.

20.     Moving forward, this grant scheme will be extended to all wholesalers selling healthier ingredients. By targeting large wholesalers who have the potential to promote healthier ingredients across the food service sectors, HPB would be able to effectively utilise the grant to reach out to more people to incentivise healthier eating. We will work with F&B companies including canteens, food courts, fast food eateries and restaurants to create healthier “eat-out” meals, by substituting food items with lower calorie versions and smaller portions.  Our target is for 20% or 500,000 daily “eat out” meals to be healthier by 2020. 

ii. Healthier Groceries 

21.     For those of us who cook, it is important that we buy healthily so that meals at home are nutritious. Singaporeans are already aware of the Healthier Choice Symbol (HCS) products but such products make up only 10% of packaged food sales in supermarkets. We will need to drive demand for HCS products by working together with industry partners so that consumers can have more choice. Through these partnerships, we aim to increase the sales of HCS products from 10% to 20% of the market share by 2020.  

iii. Healthier Beverages 

22.     Sugar-sweetened drinks are a major source of excess calories.

60% of Singaporeans consume two or more sweetened drinks a day. We will encourage everyone to replace such sugared drinks with either plain water, reduced- or non-sugar drinks. This will be done by partnering with major drink manufacturers to expand the availability of such products in the local market.

c.  Health-Promoting Infrastructure

i. Healthy infrastructure and services 

23.     Besides food, the built environment also plays a role in enabling a healthy lifestyle. Specifically, we want people to be more physically active. For this to happen, we need to bring together many elements to enable people to live a healthy lifestyle easily and effortlessly. A/Prof Fatimah Lateef had also asked if there would be more health promotion facilities. MOH will leverage existing projects spearheaded by agencies like the Singapore Sports Council, the Land Transport Authority and National Parks Boards. ActiveSG, the new national movement for sports announced by Ag Minister Lawrence Wong, is one example of an initiative by a fellow ministry that will contribute to healthy living.

24.     Such interlinking of projects and infrastructure will integrate the physical and social environments so as to bring healthy living closer to the homes of all Singaporeans. Currently, the average distance from each HDB home to the nearest physical activity facility is 200 metres. In April 2014this year, we will be launching a mobile location-based service to help locate such exercise facilities.

25.     HPB is working with the Regional Health Systems and the community to create Healthy Community Ecosystems. The “Healthy City for All Ages @ Choa Chu Kang” was launched in July 2013 and the “Sembawang Population Health Project” in August 2013. These initiatives outline a three-year road map for systematic health screening and follow-up for residents aged 40 years and above.

26.     Both initiatives are also supported by a health-promoting built environment in the community. For example, all 119 HDB blocks in Sembawang have visual cues that promote stair climbing. Ms Yeo Shwu Fen has noticed many of her neighbours using the stairs. In fact, Ms Yeo says that unlike before, she now has a busy staircase! It is through such small nudges that we hope to inspire bigger change.

27.     HPB also collaborated with the National Parks Board to bring to the community “Sundays-at-the-Park”, an initiative which provides easy access to activities that promote both physical and mental well-being. Through such Healthy Community Ecosystems, we will increase the opportunities for physical activity in the heartlands.

28.     We intend to build more of such Healthy Community Ecosystems (HCEs).  The target is to enable 50% of Singapore residents to have access to health-promoting choices such as healthier food or exercise facilities, within two kilometres of their homes by 2020. HCEs will certainly benefit the groups that A/Prof Fatimah had expressed concern about, as the facilities and activities provided do not require special memberships and are available at their doorstep.

ii. The One Million Kg Challenge

29.     This Saturday, HPB will launch the “One Million Kg Challenge” (MKC) – the first national incentive-based weight management movement which encourages people to achieve and maintain their healthy weight. As of end February, 16 companies have signed up early through roadshows we started at selected workplaces. From this Saturday onwards, Singaporeans can register for the Challenge at roadshows across Singapore and at the online portal (www.millionkg.sg). The Challenge intends to make weight management fun by encouraging participants to participate in lifestyle activities, track and report their weight at HPB’s Wellness Kiosks or via online to win prizes.

30.     A national programme like this, coupled with making healthy food more available, and creating a physical environment that promotes physical activity, will provide the ecosystem to encourage behavioural change among Singaporeans.

The target is to achieve a collective weight loss of one million kilogrammes from at least 300,000 participants over the next three years.

iii. Creating defaults through policies: Point-of-sale display ban

31.     Besides obesity, tobacco use among Singaporeans remains an ongoing concern. We will be implementing the point-of-sale (POS) display ban in response to the support we received after the public consultation in June last year. This will be carried out through an amendment of the Tobacco (Control of Advertisements and Sale) Act by the end of 2015. When combined with other tobacco control efforts, the POS display ban will protect youths from tobacco marketing.

32.      Through the public consultation, we found that Though the public was supportive. However, tobacco retailers expressed their reservations at having to adapt their current displays to comply with the ban. MOH is mindful that such refurbishment will incur costs, especially for smaller retailers. We will work with the different types of retailers to address these concerns for the implementation. Retailers will also have a grace period to adjust, and this grace period will begin only after we have amended the law.

III.    Healthy Workplace, Healthy Employees

a.    Creating a healthy workplace ecosystem

33.     During the consultations, many young working adults told me that it was hard to sustain the healthy behaviours they cultivated as students because of the competing priorities of working life. We intend to create healthy workplace ecosystems that will support the adoption of healthy behaviours and to sustain a healthy lifestyle.

34.     In October last year, we launched the first healthy workplace ecosystem at Mapletree Business City (MBC). Those working in MBC can now take part in workout sessions, and enjoy healthier meals. Currently, over 90% of the stalls in the food court and over 50% of the F&B establishments in MBC offer healthier meal options, such as lower calorie meals (500kcal) and wholegrain options, as the default choice.

35.     Dr Janil Puthucheary would be interested to know that since the launch of the Healthy Workplace Ecosystem, sustained demand for healthier meals has been observed. Healthier meals comprise 20% (1800 meals) of meals served at MBC daily. Attendance for weekly yoga and running sessions were well-subscribed at 80% of the sessions’ capacities. In addition, four running interest groups have been formed. The ecosystem is still in its early days; it shows promise but it would be too early for a full evaluation of its effectiveness.

36.     The convenience does make a difference to Madam Fauziah Mustapha, who works as an administrative executive. Since the introduction of activities in MBC, Madam Fauziah now participates regularly in HPB’s iRun programme with her colleagues. Madam Fauziah has also begun watching her diet more closely. Also, she Her family hasreceived complimentsed from her family on her weight loss and she feels more energetic. We will continue to add new initiatives to keep the programmes fresh and interesting for MBC employees.

37.     We will work with JTC Corporation, and other landlords to replicate this model across other workplace clusters in Singapore. The approach will be customised to suit the needs of the different working environments. We intend to increase reach out to 350,000 workers through the eco-systemic approach by 2020.

b. Total Workplace Safety & Health

38.     Encouraging health promotion in the workplace will go hand-in-hand with longstanding efforts on improving workplace safety. As announced by SPS Hawazi Daipi, the Ministry of Manpower (MOM), Workplace Safety and Health Council (WSHC) and HPB are working with other stakeholders to develop and implement “Total Workplace Safety and Health” (Total WSH). Total WSH will take an integrated and comprehensive approach to incorporate health promotion within workplace safety frameworks. MOM, WSHC, HPB and industry partners will develop guidelines on integration of workplace safety and health and pilot the implementation. Concurrently, WSH professionals will be trained to enable them to achieve basic competency in workplace health promotion.           

c.    Tripartite Oversight Committee

39.     With these new developments in Workplace Health and leveraging the groundwork established by HPB and partners, a new high level Tripartite Oversight Committee will be formed. This Committee, chaired by SMS for Health and Manpower, Dr Amy Khor, will oversee and drive the development and execution of a workplace health roadmap with strong tripartite partnerships. The vision is to help workers in Singapore achieve “Wellbeing through Work” by adopting a more holistic approach to promoting employees’ health and wellness, and increasing adoption of workplace health promotion programmes by employers.

d.    Reaching out to Lower Income Employees

40.     At the same time, we are mindful that there are sectors and groups which may benefit from more targeted initiatives, for example, the lower income workers. Allow me to share Mr Ong Heng Bock’s story with you.  Mr Ong is 65 years old, and is a cleaner with CMB Pte Ltd. Mr Ong feels it is important to stay healthy as he would like to continue working. He does this by watching what he eats and staying positive. However, Mr Ong does not see the need to go for screening.

41.     Fortunately, Mr Ong’s employer successfully persuaded him to go for health screening last April. Work coverage was arranged on the same day, so he did not have to take leave and suffer a loss of salary. Mr Ong was pleased to find out that he had no chronic diseases. Now, he can continue working with the assurance that he is in good health.

42.     CBM Private Ltd is a workplace health champion, having been a past multiple winner of the Singapore Health Award. Mr Ong was willing to make a positive change in his life when his employer took steps to deal with the barriers that prevented him from going for screening. Mr Ong being responsive to his employer’s efforts resulted in a win-win situation for both parties. We will continue to work with our partners to reach out to other lower income workers like Mr Ong to understand their needs, and help them take care of their health better.

IV.   Starting on the Right Foot - Inculcating a Healthy Generation of Youth

a.    From pregnancy and beyond

43.     Ms Faizah Jamal had suggested that MOH look at the fundamentals of healthcare, starting from pregnancy to birth and beyond, including mental health. We are happy to inform her that we have done just that. Efforts to improve health should therefore begin as soon as possible; in fact, before one is born. The “Healthier Child, Brighter Future” initiative provides resource toolkits and workshops for young parents and parents-to-be.

44.     The “Baby Friendly Hospital Initiative” (BFHI) seeks to promote breastfeeding. In line with the BFHI, our maternity hospitals have implemented initiatives such as the provision of training to all maternity ward staff to provide breastfeeding counselling, consultation and support to mothers. HPB and the Association for Breastfeeding Advocacy (Singapore) (ABAS) are also working together to encourage and advise employers on the establishment of breastfeeding-friendly workplace policies. To complement programmes that focus on healthy physical development, we also have in place mental well-being promotion programmes tailored for various segments of the population, including children, adolescents, adults, the elderly and caregivers.

b.       Protecting children: Food advertising guidelines

45.     Dr Lam Pin Min had also asked if MOH intended to regulate food advertising to children. We are working together with stakeholders from the media, advertising, retail and food industries, and our partners in the Advertising Standards Authority of Singapore (ASAS) to draft guidelines to restrict advertising of food and beverages high in fat, sugar and salt to children. These guidelines will be incorporated into ASAS’ Singapore Code of Advertising Practice and will take effect from January 2015.

c.    The school as a healthy environment

46.     Just as the workplace is an important place for adults, schools remain an important place for our youth. It was highlighted that the structured environment in schools helped many of our students establish healthy habits. Our role then is to help the young ones acquire such habits early so that they may lead healthy lives as they age.

47.     A first step would be to inculcate healthy eating habits. First introduced to primary and secondary schools in 2011, the healthy meals programme allows students to have convenient and easy access to healthier food and beverage options. A similar programme was introduced in childcare centres in 2012. Currently, 240 childcare centres and 96 schools are on board the healthy meals programmes. Our intention is to extend the programmes moving forward to all MOE schools by 2016 and approximately 90% of childcare centres by 2020.

48.     To provide children with a better understanding of what right portion sizes look like, HPB has worked with MOE to incorporate “My Healthy Plate” into primary and secondary school textbooks. The incorporation of My Healthy Plate in textbooks will be done in stages from 2014 to 2016.

49.     Additionally, we will extend our pre-school dental care programme to childcare centres. Poor dental health has a negative impact on the quality of life of a child. Our aim is to reduce the present caries rate in children at age seven to less than 50% by 2020.

V.     Conclusion

50.     Dr Lam Pin Min had asked how MOH intends to encourage healthy living among Singaporeans. Actually, examples of healthy living are all around us already. For instance, in my constituency, if you drop by as early as 5.00 in the morning, you will see individuals and groups of residents starting their day with their own exercise regimes in Yishun Park, Yishun Pond, Nee Soon Central Community Park and some along the footpaths. 

51.     At times, I join a group of residents, mainly ladies, who do aerobics every weekday morning. This group started from only two neighbours or two persons. Now, the group has grown to more than 100 people, with residents from different races, ages and all walks of life.  In fact, I found it hard to keep up with them during my first session. 

52.     There are also formal groups, such as the Northwest Brisk Walking Club, programmes by the Active Ageing Committee and Wellness Programmes by People’s Association, and targeted programmes by Khoo Teck Puat Hospital (KTPH) and Yishun Polyclinic. In addition, KTPH also conducts chronic disease screening under the Wellness Programme.  

53.     Madam, Tthe HLMP will build upon this existing landscape, further strengthening it to allow healthy living to be accessible, natural and effortless for all Singaporeans. Therefore, I would like to invite everybody to join us as we strive towards “Healthy Living Every Day” together.