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Ministry of Health
Speeches

Speech By Mr Edwin Tong, Senior Minister Of State, Ministry Of Law & Ministry Of Health, at the 5th Temasek Foundation International Healthcare Executives in Asia Leadership Programme, 3 December 2018

3 December 2018

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Mr Goh Geok Khim, Chairman, Temasek Foundation International
Professor Fong Kok Yong, Deputy Group CEO, Medical and Clinical Services, SingHealth
Professor Philip Choo, Group CEO, National Healthcare Group
Distinguished Guests & Colleagues

1.            Good afternoon. I am happy to join all of you here at the opening of the 5th Healthcare Executives in Asia Leadership Programme. To those who have come from abroad, a very warm welcome to Singapore. I always look forward to attending meetings that involve a diverse range of participants from different countries, so that we can share and learn from our varied experiences and different challenges, and generate fresh ideas and solutions.

2.            One of the most universal and pressing healthcare challenges that our region faces is the rising burden of non-communicable diseases, especially from diabetes. The impact of diabetes is significant. Not only does it affect the quality of life of individuals and their families, it also imposes a heavy cost burden to society and our healthcare system. The Ministry of Health (MOH) organised the Ministerial Conference on Diabetes last week, where Ministers, government representatives and speakers agreed that diabetes is a serious public health concern globally which requires a coordinated, comprehensive and innovative approach to solve it at different levels. As global attention turns towards curbing the incidence and prevalence of diabetes, many countries have been in some way or another innovating and developing new strategies to tackle this disease. Hence, the focus of this year’s programme on diabetes is timely and appropriate.

Burden of Diabetes in the World and Singapore

3.            One in eleven adults worldwide or approximately 425 million individuals are estimated to have diabetes[1] in 2017, and this number is expected to rise to around 629 million, or one in ten adults by 2045[2]. Diabetes is the seventh leading cause of death globally, and this global figure may well be underestimated, given that there are one in two adults who may be living with undiagnosed diabetes. 

4.            The situation in Singapore is equally serious. Diabetes already contributes to an estimated 10%[3] of the total disease burden in Singapore, with over 450,000 Singaporeans living with diabetes[4]. This number is projected to rise to about 1 million, by 2050, if no action is taken. Of those who know they have diabetes, one in three has poor control of their condition, which increases the risk of serious complications such as kidney failure, blindness and lower limb amputations.

Singapore’s War on Diabetes 

5.            This is why Singapore declared War on Diabetes in 2016. We want to rally the whole nation to take steps to prevent diabetes, to raise awareness on the impact and consequences of diabetes, and to galvanise support for a strong environment for the people of Singapore to live healthily, and for those with diabetes, to manage the condition well.

6.            Our strategy for this War straddles three key pillars: prevention, screening and management, which aim to shift the population towards a healthier and more active lifestyle, promote early detection and intervention, and improve diabetes care, thereby reducing the risk of complications. However, the Government cannot do this alone. We need to tap on the collective wisdom and strengths of multiple stakeholders, including the community and industry partners, researchers and individuals. Let me share more on some of our efforts. 

7.            As part of our preventive efforts, the Health Promotion Board (HPB) has been working with food and beverage operators under the Healthier Dining Programme to include more low-calorie options and dishes that use healthier ingredients as part of their core menu offerings. In this way, Singaporeans can enjoy easier access to a diverse range of healthier food options when dining out. 

8.            Second, Screening is crucial for early detection and intervention of diabetes. To encourage more Singaporeans to go for regular screening and follow-up, we made enhancements to screening subsidies under the national screening programme, also known as Screen for Life (SFL). All eligible Singaporeans now only need to pay $5 or less for screening of cardiovascular conditions and some cancers. The first follow up visit is also covered. By doing so, Singaporeans have better access to screening of diabetes and other conditions at affordable prices. We have also developed a self-administered Diabetes Risk Assessment tool to encourage young adults aged 18 to 39 years to assess their current risk for diabetes online, and subsequently give them access to subsidised screening for diabetes if they are found to be at higher risk.

9.            Third, proper management is key to helping individuals with diabetes enjoy a good quality of life even while living with the disease. We have introduced several programmes and policies to provide holistic support for individuals with diabetes, their caregivers and healthcare professionals, so as to facilitate better care management and intervention.  These include empowering General Practitioners (GPs) to provide comprehensive team-based care and better-resourced support services in the primary care setting for patients with diabetes and more complex chronic conditions.  We are also developing a set of national reference materials under the Patient Empowerment for Self-Care Framework to help patients with diabetes and caregivers to initiate and sustain lifestyle changes and improve treatment adherence for better disease management. 

Importance of Strong Healthcare Leadership from the Public and Private Sectors to Tackle Challenges in Health

10.         Advancing the health of our populations is a shared responsibility between the public and private sector, to achieve better integration and holistically address the wide range of healthcare issues that we face. As such, it is crucial to have committed leaders from both the public and private sector who can work together, articulate a clear vision, and deliver a strategy that yields the best health outcomes for the population. 

11.         An example of a public-private partnership to support Singaporeans in adopting a healthier lifestyle is the HPB’s Healthier Ingredient Development Scheme (HIDS). Under this scheme, HPB works closely with ingredient suppliers from the private sector to innovate and develop healthier alternatives to ingredients like noodles and rice, which are staple foods for Singaporeans. 

12.         For those with chronic diseases, there are programmes in the community to ensure that they have easy access to primary care services. Under the Chronic Disease Management Programme (CDMP), participating providers from both public and private sectors provide chronic care to patients in the outpatient setting, with reduced out-of-pocket payments for management of chronic diseases. Another example is the Community Health Assistance Scheme (CHAS). Through this initiative, participating private GPs are able to tap on portable subsidies to offer subsidised medical care for Singapore Citizens from lower-to-middle income households, as well as for our Pioneer Generation.

The Need for Collaboration and Sharing of Ideas as a Region

13.         There is still more work to be done. As policymakers, we have to always continue to learn from best practices and adopt innovative approaches where relevant to our local context.  This would help us to create supportive environments for individuals and their families, introduce more effective and efficient interventions, and shape better healthcare delivery for our people. Each of us work in unique settings and the approaches that we choose to tackle diabetes, other non-communicable diseases and other clinical aspects are also unique and must be tailored to our local contexts. Nonetheless, there are common challenges shared among us, and there is much to be learnt through open sharing and collaboration as a region. 

14.         For example, Singapore’s Tan Tock Seng Hospital worked with Cambodia’s Calmette Hospital from 2014 to 2017, to customise a training programme for doctors and nurses in managing trauma care under the Skills in Trauma and Resuscitation Programme (or STAR). The collaboration has now been extended to focus on training for the management of intensive care unit patients, use of clinical quality improvement tools to deliver quality and safe care, and sharing of best practices through seminars on leadership and innovation in both countries.

15.         In another example, the KK Women’s and Children’s Hospital is also collaborating with the Surabaya Haji General Hospital in Indonesia to enhance paediatric emergency and neonatal care services across six public hospitals in Surabaya. The training programme aims to build capabilities of healthcare workers and equip them with the necessary skills to manage time-sensitive emergencies and improve care outcomes. 

16.         The Ministerial Conference on Diabetes is another example of how much we can gain from engaging in discussion at an international platform, and translating insights and ideas into solutions customised for our populations. The conversations covered a wide range of topics from fostering a supportive environment through health promoting policies, to harnessing the power of technology to enable behavioural change. At the end of the Conference, the Health Ministers and senior government representatives affirmed their commitment to enhance innovation and strengthen international partnerships and collaborations with key stakeholders, so as to foster a supportive environment that encourages citizens to take active steps towards preventing and managing diabetes.

Conclusion

17.         At the end of the day, we want our people to not just live long, but also live well. To do that, we must all do our part to create supportive environments and encourage individuals to adopt a healthy lifestyle.  We also need a good healthcare system that is both accessible and sustainable in the long term.  I would like to thank SingHealth, the National Healthcare Group, and Temasek Foundation International for creating this useful platform for all of us to come together to share our experiences and insights, and exchange best practices with one another. I wish everyone a fruitful and meaningful discussions in the days ahead. Thank you.


[1] Source: IDF Diabetes Atlas 8th Edition 2017 

[2] Source: International Diabetes Federation (IDF) Diabetes Atlas – 8th Edition 2017

[3] Singapore Burden of Disease Study 2010

[4] Include individuals with undiagnosed diabetes