SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH, SINGAPORE AT THE UN DECADE OF HEALTHY AGEING DISCUSSION, 23 MAY 2023

Excellencies and distinguished guests

1. Thank you for the opportunity to speak at this event on the UN Decade of Healthy Ageing and to chair this discussion.

2. The world is ageing. It is especially affecting Europe, North America, some 

parts of Latin America, Oceania, and large parts of Asia.

3. Global median age increased from just over 20 years in 1970 to just over 30 years in 2022. In 2019, for the first time, there were more people over 64 than children younger than 5. In fact, the number of people over 64 is growing faster than all other age groups in the world.

4. The United Nations defines a country as “super-aged” if 21% or more of its population is aged 65 and above. Today, countries such as Germany, France, Italy, Spain, Netherlands, Sweden, Portugal, Slovenia, Croatia, Finland, Greece, Latvia, Lithuania and Japan are already super-aged.

5. They are mostly European countries. By 2030, many more countries will join these countries – US, UK, New Zealand, Switzerland, South Korea, Singapore, with China coming very close. By then, 60% of the world’s population aged 65 and above will be in Asia. So this is an issue that Asia is particularly concerned about.

6. This is a major social transformation. In most countries, our labour market legislation, old age social security systems, and importantly, health care systems, were designed without an old population in mind.

7. For example, retirement ages were legislated when people lived till their 50s or 60s. It is now common for people in many countries to live well beyond their retirement ages till their 80s and 90s. How do we ensure that large segments of the retired population with 20 to 40 years to go, can live purposefully and with dignity?

8. How do we ensure that after retirement, national social security systems continue to provide them with old age support, without burdening future generations with high debts?

9. Our healthcare system is another system that was designed with a young population in mind. Therefore it is focused on acute care and treating diseases. How do we ensure that our healthcare systems can continue to cope with the rising disease burden and workload driven by an ageing population?

10. Let me give you an example of what Singapore is currently going through. In Singapore, our average length of stay in hospitals has increased by over 15% over the last three years. It used to be six days. After COVID-19, it has jumped to seven days. The longer stayers are typically older, with multiple illnesses and complexities. Longer average stays alone, within a short period of three years, have therefore added over 15% utilisation rate to our hospital wards. And this is just the beginning of the impact of ageing. Our nurses and doctors are feeling this acutely.

11. The living environment is another example. For example, public housing flats in Singapore. When we were a young population, in some of the older flats, you had to take two steps before you entered your apartment. Today, those two steps mean you are either isolated or you can be out there with social groups. Just two steps, but we built them without thinking that we may have old people living in the apartment one day.

12. It is like we have been training for the Olympics 100m sprint event and realised that we were in fact registered for the Marathon. So how are we going to retrain ourselves?

13. Ageing is therefore a paradox. It resulted from our advancements in hygiene, medicine and quality of life. Yet, it is posing significant and potentially crippling challenges to many countries, to our population spread, social security and healthcare systems.

14. At the risk of over simplifying the challenge before us, there is a silver bullet to solve this problem of ageing, and that is to redefine ageing. Ageing can be redefined from 65 to 75 to 85, and we could solve the problem overnight, but we know it is not so simple. It is not just a numbers game.

15. If our norms change, such that people can work actively way beyond 65, stay healthy way beyond 65, we need to make major changes to our socio-economic systems and policies. Only if we do that, can we redefine ageing. Then the problem of ageing becomes a blessing of healthy longevity.

16. Years and decades of work lie ahead for us to bring that about. The first progress report in implementing the UN Decade of Healthy Ageing presented at the 76th World Health Assembly informs us of the good work that has been done so far. The UN Decade of Ageing Action Plan and National Academy of Medicine Roadmap provide a good framework to guide us forward.

17. The areas of work are well spelt out in those reports. Let me just put them in sharper focus. These are the areas of work and what it means to work on these areas:

18. First, develop age-friendly living environments. An older population requires appropriate public amenities, barrier-free access, road designs that slow down traffic, apartments that assist them in living and places that they can sit down when they are tired. This is especially given the rising rate of urbanisation, which means rural areas will increasingly comprise older populations and they have to be taken care of.

19. Second, maintain economic vibrancy by leveraging an ageing workforce. Retirement ages need to rise in tandem with longer lifespans, if they are required at all. We need to harness technology to drive growth with productivity, rather than injection of sheer manpower. Education, training, and evolving our attitudes towards our career with age, will be key to unlocking this potential.

20. Third, bolster national retirement adequacy. For countries with pension systems that are defined benefits, making the systems affordable nationally with an ageing population is a particularly stringent challenge. For others with old age support systems that are more defined contributions in nature, such as Singapore, we will need to address the issues of lack of retirement savings. Either way, these are difficult challenges. Common to both systems is that if people can work longer, and view a longer working life as something positive rather than a burden, retirement adequacy will be more secured.

21. Finally, we need to reform our health systems. Beyond focusing on expanding our acute care systems, we need to strengthen primary care, to prevent and avoid the onset of diseases. Primary care is the foundation to the resilience of healthcare systems against ageing. It helps generate health in communities and homes.

22. It goes beyond tapping on the expertise of doctors and nurses, but also community stakeholders and families, to get today’s young and middle-aged to do the right things – stop smoking, exercise, eat well, go for regular health screenings. These simple things do not cost a lot, but will have so much savings and bring us so much happiness much later.

23. Much work lies ahead. What I have mentioned are largely domestic occupations but a global conversation on this topic is necessary to enhance our understanding, and allow us to learn from each other and cooperate in this very important challenge.

24. I look forward to hearing from fellow Member States and their experiences in investing in healthy ageing. Thank you.