SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH, AT THE FORWARD SG CARE PILLAR OVERVIEW SPEECH AT MOH-AIC EVENT, ON 5 DECEMBER 2022, 9.30AM

Friends, Partners and Colleagues

Ladies and Gentlemen

1.       I want to thank Agency for Integrated Care (AIC) for organising today’s session.

2.       As you know, the Government is embarking on the Forward SG exercise. It has a few pillars and one of the key pillars is the Care Pillar, which three Ministers, Minister Masagos, Minister Indranee Rajah and I, are working together on. DPM Lawrence Wong has spoken about the broad directions for the Pillar. Today, with many of our key partners gathered, and after conducting several dialogues with members of the public, I will outline our thinking and key priorities for the Care Pillar.

3.       In the coming weeks, Minister Masagos and Minister Indranee Rajah will be speaking on this issue to further elaborate on our plans.

Doing Something Big Together

4.       Many of us will be familiar with John F Kennedy’s famous quote during his Presidential inauguration speech in 1961: ‘Ask not what your country can do for you, ask what you can do for your country.’

5.       It was a clarion call for the American people to take action to help the less fortunate, contribute to society and serve the community. It came  about 15 years after World War II, during which the American society and economy experienced economic rebound, rising investments and employment.

6.       It was called the ‘Era of Affluence’. But with it came greater inequality, social discontent and disparity. At the same time the civil rights movement was gathering pace. This was the context of the President’s quote.

7.      In Singapore our context is different – we are young, small, compact, multi-racial, constantly adapting to the changing environment around us, like a speedboat in very choppy waters. The question that always confronts us, including through this Forward Singapore exercise, is ‘What are the big things we can do together?’.

8.       I want to highlight two key phrases of this question.

9.       First – ‘Big things’. There are always numerous issues and problems that demand solutions and our immediate attention, and the Government will tackle them. However, these issues aside, each generation lives in unique circumstances which present specific and major challenges that require a national response. These generational challenges are the big things that define an era.

10.      Second – ‘Together’. The nature of certain problems is that the Government alone cannot solve them. They often require every member of society to contribute or even make a sacrifice. The Government synergises these small, disparate individual efforts into an effective collective national response. The outcome is common good for our society. One example is fishing at the coast of a country. Every fisherman must exercise some restraint not to fish too much. Without that discipline, the Government comes up with regulations on how much fish each sector can fish, to have enough fishes to sustain generations. If you do not have that collective response, the seas will be overfished.

From Tripartism to COVID-19

11.      Doing big things together is especially relevant for social challenges. Although Singapore is a young country, our history is peppered with such examples. Let me cite three.

12.      First, and the most recent and salient, is the way we responded to COVID-19. While deemed a public health crisis, it is also a social struggle to restore our lives.

13.      Each individual made the effort, sometimes with a lot of hesitation, to receive the COVID-19 vaccination. These individual efforts snowballed into societal resilience against the virus, which the Government harnessed to progressively open up social and economic activities.

14.      Today, and months later, we have restored our normal lives, while registering one of the lowest death rates in the world. We have overcome a crisis of a generation – a big thing – together.

15.      My second example has to do with the harmonious industrial relations we enjoy in Singapore. It was not always like this. Back in the 1960s, it was a different situation, when there were many industrial actions and strikes.

16.      Over time we managed to engender industrial harmony as the norm in Singapore. It came about because on the Unions’ and workers’ part, against their instincts to protest and fight for better employment terms, they were persuaded by union leaders to lay down their picket signs and go back to the factory to work.

17.      How were they persuaded? On the Government’s part, it gathered the employers to come together and held them to a commitment that now with workers back at work, if your company does well and makes profits, you have to share with the workers, and they honoured their commitment.

18.      A confrontational period was turned into a win-win arrangement. Singapore generated a virtuous cycle of industrial harmony, job creation, productivity and wage increases. This was a big achievement for a newly born nation, struggling to earn a living in a competitive world. That has now become an enduring strength of Singapore.

19.      Finally, our language policy. On the part of each community and their members, they adopted English as our common working language. They exercised restraint and did not push for full rights to practise their cultures, customs, languages and religions.

20.      On the Government’s part, having forged this very delicate understanding amongst different communities, the Government established the bilingual policy, so that all children learn English as the common language, as well as their mother tongues, in school, in order to keep in touch with their languages and cultures.

21.      Language is a key and window to a people’s identity. By paying attention to both what is shared by all and unique to communities, we enable the Singapore identity to evolve over time in a constructive and healthy manner. And it is still ongoing.

22.      For the Forward Singapore exercise, we want to devote most of our efforts to the big generational issues, in the same way that industrial harmony and language policy were big socio-economic issues for the  earlier generation of Singaporeans.

Ageing

23.      I believe there are two big social challenges for this generation – ageing and inequality.

24.      First, ageing. It is unique to this generation. Like many East Asian countries, our population is ageing rapidly – an inexorable trend driven by the advancement of time. Today, one in six of our citizens is aged 65 and above. By 2030, it will be one in four. Furthermore, while people are living longer, they are also spending about 10 years in poor health, increasing the overall burden for themselves and their families, as well as demand for healthcare.

25.      This is a big issue for our generation. Our basic premise is that ageing is a natural course of life and we cannot change that. But the state of health of our seniors is not a given. There is no reason why the age of 65 is the magic number that marks the difference between a non-senior and a senior, between the numerator and denominator of the dependency ratio.

26.      We need a renewed compact and social understanding around ageing. In a nutshell, I describe it as: The Government will decisively implement the policies and set up systems for preventive care, so that people are empowered to take care of their own health.

27.      This is in essence the Healthier SG strategy, where we will shift the centre of gravity of the healthcare system from acute care in hospitals towards preventive care in the community.

28.      We have announced the key elements through a White Paper. We are about six months or slightly more away from the formal launch of Healthier SG where we will urge residents to enrol with their GPs. In the run up, there is already a buzz. GPs surveyed told us they want to be part of the scheme. There are more requests from residents and grassroots organisations for more physical exercise activities in the community. Anecdotally, friends and colleagues appear to be more careful about what they eat, even as they enjoy good food.  These are encouraging signs.

29.      At the same time, we also need to improve aged care. Most seniors tell us that they prefer to continue living in the community, independently or with some help, rather than going to a nursing home.

30.      These seniors know what is good for them. A senior’s greatest enemy, I do not think it is diabetes, hypertension, it is social isolation. When a senior has no companion or friend, has minimal interactions and activities in the community, his health will deteriorate very quickly.

31.      According to a study, lonely older adults not only lived at least three years fewer than their peers, but also spent less of their remaining life in good health.

32.      By enabling seniors to age in their communities, we reduce their risk of social isolation. If they live in the community and have friends, social activities and physical exercises, they can delay and prevent frailty and deterioration of health.

33.      Hence, we are reviewing our strategy for aged care. I spoke about this in Parliament recently. One of the key thrusts is to expand our network of Active Ageing Centres (AACs), so that senior support is ubiquitous and all over Singapore.

34.     What the AACs do will also need to be different from today. They need to be  a big magnet for seniors, drawing them out of their homes, to share nutritious meals at the void deck, engage them in activities, and working with the healthcare clusters to ensure medication compliance and conduct regular health screenings, physical exercises.

35.      We need to encourage volunteering, which is itself a good way for seniors to keep healthy and socially connected. For seniors with more complex care needs, we will need to enhance home-based care, to help them stay at home for as long as possible instead of nursing homes. The care will need to be more tailored and responsive, which can be done if it is first supported by our hospitals and second delivered locally out of an AAC near to seniors’ homes. This can greatly help to relieve the caregiving burden. This is probably the best thing to do for our caregivers.

36.      We need to do this together. In the next bound of aged care, we need to strengthen the eldercare landscape, build up manpower and capabilities, explore new funding structures and service models.

37.      The flip side of ageing is of course fertility. If we have more babies, we will moderate the burden of aged dependency over time. But having children is more than that. It is mostly about the joy of starting a family. It is also a very personal decision between couples.

38.      Many young couples have raised concerns about the challenges to starting a family and raising children. These include the ability to manage the costs of child-raising, juggling work commitments, while also caring for both sets of aged parents. We understand all these concerns.

39.      The Government will continue to build a supportive environment for Singaporeans to start and raise families. We want to build a society that values and supports family well-being and supports caregiving. Minister Indranee will be speaking about these topics in the coming weeks.

Inequality

40.      The second big thing is inequality. We need to pay attention to the income gap. But income gap is inherent in any society, even in a Communist state. There will always be a bottom 20% to 30% income earners in any society. A key role of the Government is to redistribute resources from the wealthy to the poor, through taxation and fiscal spending. The Singapore Government is actively doing this.

41.      The income gap is not the only dimension of inequality. What is more threatening and sinister to social cohesion is whether there is churn and mix between the top and bottom. If there is no churn, it means those at the bottom have no hope of climbing up the income ladder over a generation. Social mobility grinds to a halt, and a permanent underclass emerges.

42.      If there is no mix, the people at the top and bottom do not meet each other, lead separate lives, go to different schools, live in different neighbourhoods and society becomes stratified.

43.      That is when societies become fractured, disunited and then unstable.

44.      In this globalised and technologically advanced world, the threat of stratification of society is especially acute. Because the divide between the haves and have-nots has widened. The skills, knowhow, contacts, social capital required to plug into the global world are set higher and higher. For people at the bottom, it becomes harder and harder to reach upwards.

45.      Society, especially in the world we live in today, is inevitably unequal, but we must at least make it just – where no one is fated to be at the bottom. Instead, there is always a conscious effort by society at large to uplift those at the bottom and the vulnerable, and the next generation can always do better than the previous.

46.      That is why we have a range of programmes and initiatives to achieve this. For the very young we have the KidStart programme, for students we have Learning Support Programmes in schools and UPLIFT. At Ministry of Health (MOH) we have started the Family Nexus.

47.      What more can we do now?

48.      One, is to continually invest in universal public services. We tend to forget that they may be the most crucial response against inequality. The dismal state of public education, housing or healthcare is one of the reasons why the permanent underclass exists in many countries. Universally accessible, high quality public services, be they healthcare, education or public housing, help the low income the most.

49.      Hence, as MOH builds up preventive care as a universal public service, the affluent may not need it because they already have doctors and coaches looking after them. It is the middle to lower income that will benefit most from Healthier SG.

50.      Two, better integration of services, which we are doing through ComLink, so that families can access a suite of interventions through a single befriender.

51.      We can probably expand the concept of integration even better. Beyond packaging different interventions and services, we can combine society’s duty to assist the vulnerable family, with the family’s exercise of personal responsibility.

52.      So the gift of fish comes together with a fishing rod, a training programme to teach you how to fish, and a commitment of the beneficiary that I will attend the programme and learn how to fish. That is a complete package.

53.      The first time I came across this concept was the Brazilian welfare programme called Bolsa Familia – a policy centrepiece of the previous Lula Government. Under the programme, poor families in Brazil receive financial aid, provided they send their children to school and get them vaccinated.

54.     It is a partnership between society and vulnerable families, centering around self-reliance. It is a powerful idea. If it proliferates, it can potentially snowball into a strong social compact, of society at large and the more fortunate helping the less fortunate, and the less fortunate helping themselves.

Closing

55.      All of us have a lot we want to accomplish in life – do well in our careers, raise a family, do voluntary work, embark on further studies, see the world, learn a musical instrument, etc.

56.      Now that I am the Health Minister, and also as I get older, I realise that we can only do as much as our body and mind allow us to. As someone who used to be active in sports, I am acutely aware that one small discomfort in my body will put me off sports for a lengthy period of time.

57.      A country is the same. We want prosperity, growth, higher incomes, more employment, work-life balance, for each citizen, but we can achieve this only as far as our society is strong enough to support and enable us. We need to be conscious of our own fitness and ability. At the same time we need to be mindful that if we over-stretch ourselves we develop injuries.

58.      Ageing and inequality are two major trends that can weaken our society. Both require a collective response between the Government and people, undergirded by a strong understanding of our respective roles.

59.      There will not be perfect solutions and outcomes, but we must at least commit to doing our best to develop a caring and just society – one that will support a population striving to fulfil their dreams and their aspirations.

60.      We have a solid gathering of social leaders with us today. Each of us is in a position to make a change. I look forward to your support as we embark on the Forward SG exercise together.