Speeches
Speech by Dr Amy Khor, Senior Minister of State for Health, at the 2nd Singapore International Public Health Conference and 11th Singapore Public Health and Occupational Medicine Conference, 29 September 2016
29 September 2016
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Your Excellency,
Andrew Norman Scott Wightman,
British High Commissioner
Professor Saw Swee Hock
Professor Chia Kee Seng, Dean,
NUS Saw Swee Hock School of Public Health,
Associate Professor Vernon Lee, President,
College of Public Health and Occupational Physicians, Singapore,
Distinguished Guests,
Ladies and Gentlemen.
INTRODUCTION
1. A very good morning, and thank you for inviting me to the 2nd Singapore International Public Health Conference, held in conjunction with the 11th Singapore Public Health and Occupational Medicine Conference. To the experts, presenters and participants from around the world who have travelled to Singapore for this occasion, I wish you all a very warm welcome.
2. I am reminded of how I was standing in this very same room back in October of 2012 welcoming delegates and guests to the inaugural conference. At that time, I highlighted three public health challenges facing Singapore and the region, namely, (1) new emergent infections; (2) chronic diseases; and (3) the need for financially sustainable healthcare models. As Professor Chia mentioned earlier, although four years have swiftly passed us by, these public health challenges remain just as, if not more, relevant today. Therefore, I think it is important and timely for us to revisit the first two issues again this morning in greater detail.
ZIKA VIRUS IN SINGAPORE
3. Many of you would have read about the recent emergence of Zika and its spread in Singapore. With the high volume of trade and travel, presence of the Aedes mosquitoes, and a large proportion of asymptomatic cases, it was not unexpected that the virus would find its way here. In fact, we had been preparing for emergence of the Zika on our shores for about two years, and had further stepped up our surveillance efforts in February this year. In May, we managed to contain the spread of the virus from an imported case into the community. However, we recently saw the emergence of local transmission and in a very short span of a few weeks, we had to come to grips with the rapidly evolving situation. Many colleagues in this room, including those from the Communicable Diseases Centre, hospitals and various government agencies worked tirelessly round the clock to safeguard the health of our population. Many of this was behind the scenes, and I would like to thank all our “silent warriors” for their dedication and perseverance.
PERSISTENT THREAT OF INFECTIOUS DISEASES
4. Indeed, the infectious disease scene has been particularly eventful here in Singapore these past few months. Earlier this year, we had high numbers of dengue cases, a large outbreak of rotavirus diarrhoeal disease at a food centre, and an unusual cluster of multi-drug resistant tuberculosis in an apartment block. These events, including our latest experience with Zika, highlight the need for multidisciplinary and multisectoral collaboration. We worked with a wide range of ministries and agencies ranging from manpower to trade and industry and port authorities. Not only was such a Whole-of-Government approach required, Zika demanded an effective Whole-of-Society strategy by including public and community ownership for vector control and eradication. Just yesterday, we announced the first closure of a Zika cluster at Bishan Street 12, and would continue to monitor the cluster until 10 October. This closure was possible because everyone in the community, including residents, grassroot organisations, volunteers, premises owners, town councils, and our officers on the ground, stayed vigilant and took care to prevent and eliminate mosquito breeding sites. To get everyone to play their part, we had to be transparent, as well as proactive in public engagement and education. This was especially important when we shifted towards a mitigation approach, similar to that used for dengue control. Finally, we immediately engaged the local research community to learn more about the circulating strain and sharing our experience with the international community.
5. While there are always fires to fight within, we also need to keep a close eye on other external threats such as Ebola and Yellow Fever in Africa, MERS in the Middle East, and the occasional surge in bird flu around the region. With increasing globalization and urbanization, there will surely be other new and emerging diseases in the future. Our international networks, strengthened by interactive platforms such as this conference, play a critical role in bringing us together to share experiences, ideas, and ways to solve regional and global challenges.
6. These issues also link back to the need for robust disease prevention, surveillance and response systems. The Taskforce on Strengthening Outbreak Detection and Response, led by Minister of State Mr Chee Hong Tat, released a set of recommendations in June this year. The report highlighted the need for formal and informal networks to ensure smooth flow of information within a vigilant community of healthcare professionals. At the same time, we should make the most of technology and data analytics to enhance our ability to promptly pick up worrying trends. There is always room to learn from our experiences and improve ourselves.
ANTIMICROBIAL RESISTANCE
7. There are also other infectious disease threats that are not as newsworthy but just as important. One such example is antimicrobial resistance- or AMR in short. AMR is made worse by the inappropriate or inadequate use of antimicrobial drugs, both in healthcare and other sectors such as agriculture. It poses a threat to health security as standard medical treatments become increasingly ineffective. Common infections that can lead to serious disease, such as gonorrhoea and tuberculosis, risk becoming untreatable due to the emergence of “superbugs”. Resistant strains can also spread from person to person and through contaminated environments, making infection control in our hospitals all the more critical so as to protect vulnerable patients. With new patterns of resistance, patients often require more intensive care, tend to stay longer in hospitals and end up saddled with the burden of high healthcare costs.
8. AMR is not confined to just a health issue – the entire situation is increasingly recognised as a market failure. Due to perceived poor returns on investment, the development of new antibiotics has almost come to a halt. Yet AMR is a very expensive problem for society in the long run. A UK report in 2014 found that if AMR was left unchecked, the world would be producing between 2% to 3.5% less than it otherwise would by 2050. In addition, 10 million more people would die every year.
9. However, all is not lost. There has been increased traction to address AMR, with urgency and advocacy for action surfaced at various international platforms. This includes the recent High Level Meeting that was held on the sidelines of the 71st United Nations General Assembly. On our part, the fight against AMR is led by two expert committees, namely the National Antimicrobial Resistance Control Committee and the National Infection Prevention and Control Committee. Both look into different ways to reduce the burden and spread of AMR here. We need to address AMR on multiple fronts. In this regard, the Public Health and Occupational Physicians community, with its wide-ranging spheres of influence, is best positioned to take the lead and make a difference.
DIABETES, OBESITY AND OCCUPATIONAL HEALTH
10. On the non-communicable diseases front, we know that the rising global prevalence of diabetes continues to pose a very real challenge to communities, health services and policymakers. In Singapore, diabetes has already affected the life and health of hundreds of thousands of individuals and families. Researchers at the Saw Swee Hock School of Public Health have predicted that the number of diabetics in Singapore could be close to one million by 2050. In view of this reality, the Singapore government declared war on diabetes earlier this year.
11. The Chinese word for “crisis” (危机) comprises two Chinese characters signifying ‘danger’ and ‘opportunity’ respectively. Indeed, every crisis presents an opportunity for change and improvement. While the increasing prevalence of diabetes and its related complications is of grave concern, it is also a window of opportunity for us to re-look at the challenges, and work together with our partners from all sectors of our society to develop new and enhanced measures to tackle this issue.
12. For example, we know that population ageing is not the only factor driving the increase in diabetes. As Professor Chia had earlier pointed out, the rising number of overweight and obese young adults—particularly males— is a major contributing factor driving diabetes. For example, portions and types of food that young people consume were found to change upon enlistment into military service, and again when joining the work force. Focusing on these critical life transitions may be helpful in curbing escalating rates of obesity, and consequently, diabetes.
13. While some factors cannot be controlled, such as population ageing and genetics, we can empower our population to take charge of their own health to reduce the risk of diabetes. If we do this well, we can also reduce the development of the other chronic conditions or complications associated with diabetes, such as heart attacks, strokes and kidney failure. There are no quick or easy answers, but we must persevere.
14. Likewise, there is room for further transformation of workplace safety and health in Singapore. Unlike traditional occupational safety and health programmes which are primarily focused on workplace safety, we need a paradigm shift towards health promotion. Eventually, this should no longer just be a “good-to-have” where time or resources permit. In 2014, the Ministries of Health and Manpower collectively launched the Total Workplace Safety and Health (TWSH) initiative, with the aim of making both workplace health protection and health promotion “must-haves”. Since we know that many Singaporeans spend most of their day at work, a workplace that promotes health and well-being certainly plays a significant role in our “War on Diabetes”.
CONCLUSION
15. All this work hopefully leads to practical and effective solutions that improve the health of populations. Public health and occupational medicine have so many facets, and these are just a mere sampling of the work that is cut out for us, and the endless future possibilities that we are privileged to shape.
16. This conference not only brings together public health academics, policy-makers and practitioners from around the world, but also our collective wisdom on the diverse challenges and opportunities we face. Looking at the programme, I am sure that the sessions and interactions will be engaging and exciting. I also hope that the next two days will be fruitful in bringing about more concerted and effective solutions to address the public health issues that we face both today and in the future.
17. I wish you all a successful conference ahead.