SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AND CHAIRMAN OF THE MINISTERIAL COMMITTEE ON AGEING, AT THE LAUNCH OF THE 2023 ACTION PLAN FOR SUCCESSFUL AGEING, 30 JANUARY 2023, 9.00AM

The Coming of Age of the Singapore Society

My Cabinet colleagues 

Distinguished guests

Ladies and gentlemen

1. It is my pleasure to join you today for the launch of the 2023 Action Plan for Successful Ageing.

The Grey Rhino

2. We are familiar with the term the ‘Black Swan’. It means something that is not likely to happen, but when it happens, is a big event that affects us tremendously and profoundly. We are often unprepared for Black Swans.  

3. We are less familiar with the term ‘Grey Rhino’ – which is a very probable event with big impact, but it is obvious and sometimes even inexorable. Therefore the threat is not given enough attention because we are so used to it happening, we may even neglect it. COVID-19 is the ‘Black Swan’. Ageing is the ‘Grey Rhino’.  

4. Ageing is in fact more than probable; it is inexorable. Because time is relentless, none of us can hold back time or stop the advancement of ageing, and the reshaping of our population pyramid is a given. 

5. Many countries in the world have aged before us. Japan, for example has been ageing since the 1980s. A quarter of its population is 65 or older, a level we expect to reach around 2030. Ageing has led to many significant challenges in Japan.  

6. Because of ageing, Japan is facing many issues. One major issue is that villages and towns in the suburbs are being hollowed out of young people, as they migrate to major cities like Tokyo and Osaka in search of better economic opportunities. Japan has announced an incentive programme to pay young people to return to the suburbs.

7. In many developed countries such as the UK, Canada, Germany, France and Italy, populations are also greying which is creating stresses. Pensions become harder to afford. France has put up a proposal to delay the retirement age by a couple of years, which has led to massive protests in Paris and across France. 

8. Healthcare spending is shooting up across Europe, and the public health systems are struggling to cope with rising patient load. This is currently happening throughout Europe where the national health service is under tremendous stress. When it comes to winter like the current one which is a significant flu season, patient load shoots up. It has been reported that mortality in European hospitals is 10% higher than expected in a normal year. We know how this feels like, when patient load shoots up, because during COVID-19, whenever there was a wave, our Emergency Departments became very busy.  

9. The other side of the demographic coin is new births. When this starts to lag rising number of deaths due to ageing, the number of deaths exceeds the number of births, and the population will start to shrink. China just crossed this milestone, even though its population has been ageing for many years.  The implications are profound, and this has generated much discussion in the media and amongst policy analysts and commentators. 

10. Ageing, the ‘Grey Rhino’ of our times, is the most significant social development in Singapore.   

Changes that are All-Encompassing

11. We have started work to prepare ourselves for an older Singapore population many years ago. A significant move is the gradual extension of working age. On 1 July last year, the ages for retirement and re-employment were raised by a year to 63 and 68 respectively and they will be further raised to 65 and 70 respectively by 2030. 

12. At the same time, SkillsFuture as a national movement encourages all workers to upgrade our skills and knowledge throughout our lifetime, so that we can stay as employable and competitive for as long as possible. 

13. To strengthen the social safety net for seniors, over the past years, the Government has introduced significant schemes suck as the Silver Support Scheme, and MOH, under the leadership of then-Minister for Health Mr Gan Kim Yong at that time, has enhanced existing programmes to implement CPF Life, MediShield Life and CareShield Life. All these are safety nets for seniors.

14. We have also embarked on a journey to bring about a fundamental transformation of healthcare. Healthier SG will shift the centre of gravity towards preventive care. While ageing is a demographic fact, rapidly deteriorating health need not be a given. COVID-19 has taught us that with the right preventive steps – through a good diet, exercise, regular health screening, staying mentally healthy – we can stave off frailty and severe disease for as long as possible.

15. At the same time, we need to strengthen the support systems to enable ageing in communities, rather than in institutions like nursing homes. In communities, our seniors are more likely to have friends, loved ones and activities to engage in. These are the best therapies to help them stay healthy and avoid frailty. 

16. These are some of the major policy changes that we have been implementing and thinking through to prepare for an older Singapore. The new policies have been many years in the making, because we have recognised very early on that ageing will be a major challenge for Singapore.  

17. The fact is that ageing will affect every facet of our lives, and we need to make changes and adjustments to many areas such as public policy, infrastructure, social practices, individual behaviour etc, in order to embrace ageing as a reality in the coming years. 

18. Let me share a story. I lived in Toa Payoh for several years as a child. There was a big traffic circle, just next to the current HDB Hub and bus interchange. Over time, the circle disappeared, and became a major traffic light junction. As a child, I was disappointed as I enjoyed traveling round the circle and it was part of my childhood memory.   

19. One of my earlier postings as a Civil Servant was at the Land Transport Authority. I learnt that with heavier traffic, circles are not as efficient, and hence they gave way to traffic junctions. But today, travelling around many housing estates, roads are being narrowed, zebra crossings are painted across lanes, and traffic circles are reinstated. 

20. These are features of ‘Silver Zones’ – to slow down traffic, to make the housing estates more friendly to our seniors. 

21. I share this anecdote not just to explain why road infrastructure needs to be more friendly to seniors, but to illustrate how ageing will lead to adjustments in our lives that will be pervasive and all-encompassing. As a home, Singapore must accommodate all, and everyone, young and old, must feel safe and comfortable living in it. 

The Ministerial Committee on Ageing

22. Hence in 2007, the Government set up the Ministerial Committee on Ageing (MCA) to coordinate efforts across various ministries to prepare ourselves for an older population.  Minister Lim Boon Heng was the first Chairman, before it was passed on to Minister Gan Kim Yong who was instituted the Minister-in-charge of Ageing, and was also Minister for Health.

23. The initiatives go over and above the major policy changes that I just mentioned. The MCA also encourages and supports ground-up, inter-ministerial and people-private-public collaborations. The Government will support these measures as much as we can.

24. In 2015, the MCA launched the first Action Plan for Successful Ageing. It comprised over 70 initiatives across various domains to help seniors age with dignity and purpose. The Plan included initiatives to support seniors to pick up new skills, volunteer and meet new friends; create dementia-friendly communities and befriending services for seniors in need; upgrade estates so that they are more senior-friendly; expand aged care facilities, etc. 

25. Today, we are refreshing the Action Plan, so that our initiatives can go further and deeper into communities. Let me give a broad outline of the refreshed Plan, and my colleagues will further elaborate on some of the important initiatives.  

Care, Connectedness and Contribution 

26. From 2019 to 2021, we engaged over 5,000 Singaporeans through more than 40 engagement sessions. From the feedback, we gathered that in their old age Singaporeans are most concerned about first, health; second, financial security; and third, a more senior-friendly living environment.  

27. The 2023 Action Plan is organised around three key themes – Contribution, Connectedness and Care. 

28. First, contribution. We want to provide greater support to seniors to contribute their knowledge and expertise, learn continuously, and engage in volunteerism. These are central to our strategy for ageing, because they accord purpose and dignity to seniors, which are often a prerequisite for good health and wellbeing.   

29. My colleagues, Minister Tan See Leng and NTUC Secretary-General Ng Chee Meng, will share more about the Tripartite Partners’ efforts in this area. Let me touch on two other aspects of contribution, which are volunteerism and learning. 

30. Volunteerism is an excellent way for seniors to stay engaged in the community around them.  We should not think of this as a way to meet our manpower needs – volunteerism is in itself beneficial to the volunteer.  

31. To further promote senior volunteerism, over the next five years, the SG Cares Office will partner RSVP Singapore to engage 750 corporations and reach out to their employees who are near retirement age.  

32. The Ministry of Health (MOH) and Council for Third Age (C3A) will also roll out an enhanced Silver Volunteer Fund with a sharpened focus on volunteer training, appreciation and opportunities for inter-generational volunteering.  

33. On learning, a lot of work has gone into enhancing the senior learning landscape over the years, such as the development of Geragogy Guidelines to make learning more engaging for seniors. We want to enhance our knowledge and expertise in this area so that learning is more engaging for seniors.

34. Today, the National Silver Academy (NSA) offers more than 1,000 courses across a wide range of topics that seniors are interested in, such as health and wellness, singing and photography. About 100,000 participants have benefitted since NSA’s inception in 2016. In the next five years, NSA aims to reach out to another 70,000 senior learners. 

35. Next, connectedness. There are various dimensions to this – physical and digital, family, friends and community.  

36. The physical living environment makes a huge difference to the ease in which seniors can find common spaces to meet friends and engage in community activities. Minister Desmond Lee will highlight our efforts in this area. 

37. Finally, care. This is where MOH is most involved in, to support and empower seniors to take care of their physical and mental wellbeing through preventive care and preventive health.  

38. Preventive care is often associated with clinical services such as vaccination or health screening. But what is equally and maybe more important are the activities that are even further upstream, namely diet, physical exercise, and just generally living an active lifestyle even as we get old. These are non-clinical interventions which do not need doctors and nurses to help see through. We can do it all these with families and communities, and with encouragement and help from each other.

39. I had earlier announced our plan to double our Active Ageing Centres (AACs), from the current 119 to 220 by 2025. More importantly, it is not just the sheer number of AACs, but what the AACs do. The role of AACs will need to evolve, to become centres for upstream preventive care. But to do that, they need to become magnets that draw seniors out of their homes. From there, AACs can facilitate social interactions, encourage good health-seeking behaviours such as medical compliance, promote volunteering and offer health screening services.   

40. To achieve this, we need to invest in a greater effort to pull community partners together. We can have some activities and health screening done in the physical premises of the AACs, but for social and physical activities, we need to leverage all the common spaces in the community, and work with the Health Promotion Board (HPB) and People’s Association (PA) which organises many active ageing programmes. 

41. AACs, HPB and PA will therefore be focusing on senior programmes. The ‘‘Live Well, Age Well’ (LWAW) programme is one such programme which consolidates a suite of active ageing activities to cater to the diverse needs and interests of seniors. These activities range from physical exercises to activities on mental wellbeing, nutrition and digital literacy. LWAW precedes Healthier SG. Now, we can dovetail the two together. With Heathier SG, the effort will be given even stronger impetus and take on an increased healthcare perspective.  

42. More of these activities will be rolled out at accessible locations nationwide, including Community Clubs, Residents’ Committee Centres, Residents’ Network Centres, and AACs. We intend to reach over 550,000 participants over the next five years. We hope they all become Healthier SG enrolees.

43. Let me specifically talk about the challenge of dementia. An estimated one in 10 people aged 60 and above has some form of dementia, and this is a growing challenge that requires our attention. 

44. Prevention remains the key pillar of our dementia strategy. Many developed countries like the UK and France have been able to lower their age-specific incidence of dementia. So, the trend is not a given despite ageing and can be reversed because of preventive care. One reason is that there is evidence that a proportion of dementia cases are related to diseases and conditions such as diabetes and obesity.  Address these, and we can prevent a good proportion of dementia. That is another reason why Healthier SG is a critical and necessary imperative, even for prevention of dementia. 

45. The other major contributory factor of dementia is social isolation. This goes back to the rationale for AACs, why we are supporting employment, learning and volunteerism.  We will therefore be increasing the number of community outreach teams, also known as CREST, and develop a Post Diagnostic Support programme, for our CREST teams to proactively reach out to families upon diagnosis of dementia, link them up with resources, and equip caregivers with coping strategies and try to slow down deterioration as much as we can. 

Closing

46. The most encouraging aspect of the successive Action Plans for Successful Ageing is the fact that they emphasise ground-up initiatives and collaborations, and active participation by all. In the report you will find that it is not a typical narrative of just what the Government is doing to promote successful ageing, but what society is doing. You will find examples of programmes implemented not just by Government agencies, but by corporations, charity organisations and communities. 

47. Ageing is after all, a societal phenomenon requiring a societal response. Underlying the Action Plan, and all the major policy changes that we are making, are two basic beliefs. First, if we treat ageing as a medical problem, requiring more hospitals and nursing homes to treat or take care of seniors, we are going down an unsustainable path.  

48. This leads to the second belief, which is that while we cannot turn back time and prevent ageing, we can prevent, delay and even reverse frailty while in the early stages. All that we are doing to roll out Healthier SG, encourage ageing in communities, and enhance contribution, connectedness and care for seniors, must gear ourselves towards the goal of preventing frailty among seniors. 

49. In this phase of our demographic shift, the holy grail of our health and ageing policies is to make our healthy and active lifespan almost as long as our biological lifespan. This is something we can all work towards. 

50. We have a solid gathering of leaders across different segments of our society here today. Let us work together to help Singaporeans live life to the fullest!  Thank you.