Speech by Dr Amy Khor, Senior Minister of State for Health, at the 17th Congress of the Asian Society for Vascular Surgery, 21 October 2016

Dr Peter Robless, President, Asian Society of Vascular Surgery, Organising Chair of ASVS 2016

Professor Stephen Cheng, Secretary-General, Asian Society of Vascular Surgery

Dr Leong Yew Pung, President, Asian Venous Forum Council

Distinguished Guests,

Ladies and Gentlemen, 

Good morning.

1.        It is my pleasure to be here at the 17th Congress of the Asian Society for Vascular Surgery and the 11th Asian Venous Forum held this year in Singapore.

DIABETES AND CARDIOVASCULAR DISEASES ARE RISING IN ASIA

2.        Cardiovascular diseases are the leading cause of premature deaths and ill health in Singapore. Of particular concern is the link between cardiovascular diseases and diabetes. In Singapore, one in two heart attack patients have diabetes. Diabetes often co-exists with high blood pressure and high blood cholesterol, all of which are risk factors for cardiovascular diseases.

3.        Addressing the preventive and disease management aspects of diabetes will, therefore, lower the risk and complications of cardiovascular diseases. This was one of the reasons why the Ministry of Health declared war on diabetes in April this year. Our goal is to create a supportive environment for people in Singapore to lead lives free from diabetes, and for those with diabetes, to be able to manage their condition well.

4.        Indeed, diabetes if not well managed, places patients at risk of serious complications, including lower limb amputation. Thankfully, we have made some progress here. Between 2010 and 2015, the incidence of minor lower limb amputations decreased, from 3.18 to 2.77 per 1,000 diabetic patients. The incidence of major lower limb amputations also decreased from 2.11 to 1.49 per 1,000 diabetic patients over the same period. But we can certainly do more to screen and detect those with vascular disease for early intervention.

5.        Diabetic foot screening facilitates the early detection of those who will benefit from limb salvage interventions. To make diabetic foot screening, diabetic eye screening and nursing counselling more accessible and affordable, we have made these services available at our Family Medicine Clinics and Community Health Centres at subsidised rates for Community Health Assist Scheme (CHAS) and Pioneer Generation card holders. With current techniques for limb preservation, minimally invasive endovascular surgery is performed and complex wounds are often managed in an outpatient setting, emphasizing the return of patients to functional activity while avoiding costly amputations and prolonged hospital stay.

LIVE HEALTHY, BEAT DIABETES AND VASCULAR DISEASES

6.        For those with diabetes, prompt risk factor management can allow the patient to have a good quality of life and prevent downstream complications. However, good management is not good enough. We need to shift our focus upstream, to prevention.

7.        Adopting a healthy lifestyle such as having regular physical activity, a balanced diet and not smoking, is the first step to mitigate risk factors for the development of cardiovascular diseases. In addition, regular and age-appropriate health screening is also important for timely detection of chronic conditions for early intervention to achieve better health outcomes.

8.        Most of us recognise the importance of a healthy diet and regular exercise. But for many of us, “the spirit is willing but the flesh is weak”, and we need extra prodding to do the right thing. To this end, the Health Promotion Board (HPB) has been hard at work rolling out a slew of initiatives to encourage Singaporeans to eat healthily and to exercise more.

9.        We are increasing the availability, accessibility and range of Healthier Choice Symbol (HCS) products in supermarkets, so as to encourage families to prepare meals with healthier ingredients. We are making healthier dining options more pervasive and accessible to those who eat out, by partnering large-chain food and beverage operators to offer low-calorie food options and lower-sugar beverages as part of their menu. We are also making school meals healthier and have reduced the permitted sugar level in drinks sold in schools.

10.       On increasing the level of physical activity in the population, I am glad to note that Season 2 of the National Steps Challenge has expanded to include more youths and working adults. Exercise programmes such as Sundays@The Park and Fitness@Work will also be scaled up, to bring group exercise opportunities closer to homes and workplaces. We want to make exercise convenient and fun for everyone, so as to achieve a sustainable impact.

11.       Taken together, I hope that our collective health promotion efforts will empower Singaporeans to take positive steps towards healthier living, so that they can enjoy more years of life, free of disease.

REMEMBERING THE LATE DR ALEX CHAO

12.       At this juncture, I would like to take a moment to say a few words about the late Dr Alexandre Chao Kwang Howe (or Alex Chao, as he was known amongst his friends and colleagues). Dr Alex Chao was a young, dynamic vascular surgeon who tragically passed away from SARS in 2003, after getting infected in the line of duty.

13.       The last time this meeting was held in Singapore in 2002, Dr Alex Chao was the chair. He was recognised by his peers for his excellent work in pioneering key programmes in the field of vascular surgery. One such example was the $2.5 million LEAP for Life programme (Lower Extremity Amputation Prevention), which was aimed at maximising limb salvage and preventing cardiovascular deaths in patients with diabetes. Dr Alex Chao also co-founded the Prevention of Aneurysm Rupture (PAR) Programme with other vascular surgeons from the Singapore General Hospital, and was one of the first vascular surgeons to perform endoluminal stenting for thoracic aortic aneurysms in Asia.

14.       For his contributions to advancing the treatment of vascular diseases, and for his courage and dedication to his patients and profession in a time of crisis, I am indeed happy that the Society is honouring him with the inaugural “Dr Alexandre Chao Memorial Lecture”. It is my hope that his passion and public spirit will inspire current and future generations of professionals in this field to press on towards achieving not only better treatment and outcomes for the individual patient, but also a better continuum of care for our population.

CONCLUSION

15.       From upstream prevention and screening, to risk factor management, to acute treatment and intervention, to chronic disease management, we all have a part to play to improve the system of care surrounding our patients. The government has taken steps to shift our healthcare system towards this vision of integrated, patient-centred care, but it is still a work in progress and we will need the partnership of all stakeholders to move together.

16.       In closing, I wish you all a most fruitful conference ahead. Thank you.