Speech by Dr Amy Khor, Senior Minister of State for Health, at ISEAS - Sasakawa Peace Foundation Workshop on Ageing and Demographic Change in Asia “How can we care for the rapidly growing number of elders in our society?”, on 26 February 2018

Mr Choi Shing Kwok, Director, Institute of Southeast Asian Studies -Yusof Ishak Institute 

Mr. Shuichi Ohno, President, Sasakawa Peace Foundation 

Distinguished Guests 

Ladies and Gentlemen 

Good morning. 

            I am happy to join you today at this workshop on ageing and demographic change in Asia, organised by ISEAS-Yusof Ishak Institute and Sasakawa Peace Foundation (SPF). Back in 2004, when I was Mayor of South West District, I participated in ISEAS’s workshop on ageing in Southeast Asia, where we discussed population ageing and the status of older populations in the region.  Today’s session brings together experts from seven countries. I am happy to see the continued spirit of sharing and learning between experts from the region, especially on this important topic of ageing which is a key demographic challenge many Asian countries will have to face.       

Demographic Shifts

2          In the next decade, Asia will be home to around 580 million seniors aged 65 and above^[1]. As a region however, countries are at different stages of economic development and demographic ageing.  For instance, Japan is well ahead in its trajectory, with close to 28% of their population today aged 65 and over.  

3          In Singapore, we have around 500,000 seniors aged 65 and above today.  By 2030, we expect this to double to over 900,000, or one in four Singaporeans.  In terms of old-age-support-ratios (OASR), this places us at where Japan is currently at today -  2 working adults for every senior aged 65 and above^[2]. Thailand will reach the same level in 2035 and Vietnam in 2050.^[3]     

4        Rapid population ageing will bring with it challenges.  We see this in countries that are further along the ageing trajectory compared to us, as many grapple with growing demand for healthcare and aged care services, while balancing the need to keep care accessible and affordable to all.  Singapore is no exception. With an ageing population, healthcare utilisation will increase. The trend of smaller families and rising singlehood will also mean less caregiving support within the family. Without good family and social support, the conditions of seniors may deteriorate resulting in multiple hospital readmissions.

Capacity Expansion 

5          To prepare for an ageing population, Singapore has moved to rapidly expand our healthcare and aged care services.  Since the start of the decade, we have more than doubled our healthcare spending, from $3.9 billion in FY2011 to an estimated $10.2 billion in FY2018. We have opened five hospitals since 2010 and will be opening three more hospitals by 2020.  We have also been growing our aged care capacity so that care is more accessible to seniors.  Nursing home capacity has expanded by more than 50% from 9,600 beds in 2011 to 14,900 beds last year. We have more than doubled centre-based and home care capacity from 5,900 places in 2011 to 13,000 places in 2017.  In tandem, we have increased our healthcare subsidies by 2.5 times from 2010 to 2017 to keep healthcare services affordable. We introduced “Medishield Life” in 2015 to ensure that all Singaporeans have protection against large hospitalisation bills for life. We are also reviewing Eldershield to help Singaporeans with severe disabilities in old age cope with the financial demands of their daily care, to give them peace of mind. 

Care Transformation 

6          But building and providing more care is not enough in itself.  Beyond capacity expansion, many cities are coming to the realisation that it is not just about the amount of care provided, but how care is organised.  Capacity growth alone is not a sustainable solution in the long term.  It must be coupled with efforts to transform our care model, to leverage on strong primary and community care networks, so that we can care for seniors and help to keep their conditions stable in the community, for as long as possible. The successful integration of health and social care services is critical to building a more effective and sustainable community support system for an ageing population. We are doing so in a few ways: 

7          First, we are going beyond hospital to community care, to bring care closer home, for our seniors.  

8          One way in which we are doing so, is to improve access to quality primary care through initiatives such as the Primary Care Network (PCN) and expansion of the Community Health Assist Scheme (CHAS). Under the PCN scheme for instance, General Practitioners (GPs) organise themselves into virtual networks to deliver holistic care as a multi-disciplinary team. The CHAS scheme in turn gives seniors access to subsidised care from participating GPs, thus making quality primary care more accessible. 

9          Our Hospital to Home (H2H) programme is another example of how we can join up care in a seamless manner across care settings. This programme consolidates the care transition arrangements of our hospitals with the aim of facilitating the discharge of patients back home in a more timely and seamless manner.  Our hope is to help patients recover in the community after discharge.  They are supported by a multi-disciplinary team that provides care and services such as rehabilitation and nursing for patients in their own homes to help them recover in the community after discharge.  If more care is required, community care providers come in, to provide long term care for the patients. 

10        We are also injecting aged care services in housing estates to support seniors to age in place.  In Singapore, we have the advantage of density as most of our population live in high rise HDB estates. We are building a network of facilities, including Senior Care Centres that provide day rehabilitation and home care, in HDB precincts to care for seniors who require assistance.  We have also incorporated active ageing services at some of these centres, under our Active Ageing Hub (AAH) model, to provide services that “age” with the senior. AAHs are one-stop-hubs with co-located active ageing and care facilities, so that we can serve both active agers and frail seniors who require care services.   

11        Second, we want to focus on care effectiveness and person-centric care. The health and social care needs of a senior are closely intertwined. For example, seniors who have no support at home may forget to take their medications or have poor diets, resulting in poorer health outcomes.  Hence, we need to go beyond health care and link up with social care, in order to close the “social last mile” to ensure good healthcare outcomes.  Earlier this month, the Finance Minister in his Budget Speech announced the nationwide expansion of the Community Networks for Seniors (CNS) programme by 2020.  The CNS creates local “communities of care” by fostering strong partnerships across different stakeholders to sew up social and healthcare support for seniors with needs. They are supported by a network of volunteers who will help reach out to new cohorts of seniors, with “preventive home visits” that help assess their needs early and provide linkages when health or social services are required. The health and social functions of aged care are now all consolidated under the Ministry of Health to facilitate comprehensive and holistic planning for the community support of seniors. Taken together, these moves will strengthen our system of community services for seniors, to provide more responsive and person centric care. 

12        Third, we are moving upstream, from healthcare to health.   We need to keep Singaporeans healthy and active as they age, and not just focus on treating illnesses downstream. We are cheered by the fact that our Health-Adjusted Life Expectancy (HALE for short) is increasing faster than life expectancy^[4], due in part to good public health and national preventive health efforts from young, particularly in schools. Singaporeans are not only living longer; we are staying healthy for longer!  If we continue to build on this and delay onset of ailments and frailty, we can build a healthier and more resilient population. 

13        We are therefore investing upstream in population health, by focussing on early interventions and healthy lifestyle choices, to keep our people in good health. Since we launched the War on Diabetes for example, the level of awareness on healthier food choices has increased. Getting people to adopt healthier lifestyles is another ongoing challenge.  We all know the benefits are tremendous, not just to individuals but also to society, in that it reduces the need for healthcare services.  But it is not easy to change lifestyle habits and overcome inertia.  Our Health Promotion Board has tried to do this with the National Steps Challenge™, using behavioural nudges to motivate people to exercise.  As at December 2017, we have over 600,000 participants of all ages sign up for the third season of this challenge. 

14        To complement these measures, we are bringing health education and preventive health services to seniors at both communities and workplaces, because health is wealth.  The Health Promotion Board has rolled out the National Preventive Health Programme to empower seniors to take charge of their own health on key aspects such as nutrition, exercise, falls prevention and chronic disease management.  We are also bringing workplace health programmes to mature workers in sectors such as transport and logistics, healthcare, education and retail. Thus far, our workplace health programmes have touched over 44,000 mature workers and effectively helped our older workers improve their health outcomes.       

Towards Productive Longevity

15        But it will be too limiting a view, to perceive population ageing as a “Silver Tsunami”.  Population ageing need not be seen as a negative. The other side of the coin is longevity. We do not all suddenly become frail and dependent once we hit the magical number of 65. In fact, our future generations of seniors will be more educated, skilled and hopefully healthier.  If we can keep Singaporeans healthy and productive in tandem with our longer life years, I believe we can transform this “silver tsunami” into “silver dividends”  or productive longevity. If done right, a rapidly ageing population need not necessarily mean a less vibrant and dynamic society and economy. 

City for all Ages 

16        It was with this in mind that the Ministerial Committee on Ageing launched the Action Plan for Successful Ageing in 2015. Covering more than 70 initiatives in over 12 areas, it serves as our blueprint for a whole of nation effort to help Singaporeans age gracefully and confidently. More fundamentally, it seeks to reframe our individual and societal notions of what it means to grow old. 

17        Our Action Plan has three key thrusts.  First, to unlock opportunities from longevity, that seniors can seize.  For example, we set up the National Silver Academy last year to enable seniors to pursue lifelong learning. We launched a $40 million fund to promote senior volunteerism and created over 7,000 places for seniors to volunteer under the National Silver Volunteerism Movement.  Several initiatives are also in place to support employers’ efforts to re-design jobs for seniors and create age-friendly workplaces. We also raised the re-employment age from 65 to 67 in July last year to enable older workers to continue working if they wish to. 

18        Second, to build inclusive and supportive communities for seniors to age in place.  At the community level, we are systematically promoting community-based befriending and building “dementia friendly communities” so citizens, businesses and the larger community can be trained to look out for seniors with dementia.  We currently have over 900 befrienders serving more than 2,600 seniors. To promote intergenerational bonding, we are also co-locating childcare and eldercare facilities to provide opportunities for the young and old to interact and better understand each other. 

19        Third, to build a City for All Ages that provides a conducive environment for seniors to remain active, independent and to age gracefully in place.  At the city level, we are rolling out a suite of initiatives to transform our homes, our towns, transport system and parks to make our city more senior friendly. 

20        Taken together, these efforts seek to transform our city – both hardware and “heartware”, to make Singapore a nation for all ages, where our seniors can continue to thrive and age actively. 

Conclusion 

21        In conclusion, longevity presents not only challenges but opportunities as well, for us as a country.  With foresight, ingenuity and hard work, we hope we can turn longevity into a positive force for our nation’s development. 

22        On this note, I would like to thank ISEAS and the Sasakawa Peace Foundation for organising this forum. I am confident that the discussions and sharing today will spur innovation and spark ideas for us to help seniors around the world to age well and age happily. I wish everyone a fruitful exchange of ideas and knowledge. 

Thank you.

^[1] United Nations, Department of Economic and Social Affairs, Population Division (2017). Estimated at 582 million seniors aged 65 and above in Asia in 2030. 

^[2]DOS. Refers to the Old-Age Support Ratio (OASR) for the Citizen Population in Singapore i.e. Adults aged 20-64 for every senior aged 65 and above.

^[3] United Nations, Department of Economic and Social Affairs, Population Division (2017). Thailand is at 2.571 at 2035 and Vietnam at 2.605 at 2050.

^[4] Between 2004 and 2010, while the average life expectancy increased by 2.1 years, the HALE increased by 3.4 years in the same time period. Source: Department of Statistics; Epidemiology and Disease Control Division, Ministry of Health.