Speech by Parliamentary Secretary for Health A/P Muhammad Faishal Ibrahim at the MOH Committee of Supply Debate, 12 Mar 2015

SPEECH BY PARLIAMENTARY SECRETARY FOR HEALTH A/P MUHAMMAD FAISHAL IBRAHIM AT THE MOH COMMITTEE OF SUPPLY DEBATE, 12 MAR 2015

Introduction

1                 As a nation, we have made tremendous progress in health: we have more than halved our death rates in the last 40 years, resulting in about 17 years of increased life expectancy. This can be credited to improvements in nutrition, healthcare advancements, disease prevention and health promotion. Our health promotion efforts are focused on effecting sustainable healthy habits in Singaporeans of all ages, and from all backgrounds. To Ms Ellen Lee’s question, the main challenge in adopting healthy living is in translating knowledge to action. Hence, central to our approach is a greater emphasis on behaviour change, and not just public education. To do this, the Health Promotion Board (HPB) has been engaging the community and private sector to understand their needs and motivations. This enables the HPB to implement relevant initiatives to effect behaviour change on the ground.

2                 I agree with Dr Chia Shi-Lu that investing in health is important. While we welcome innovative ideas such as HealthFuture accounts, Singaporeans do not necessarily have to spend money to keep healthy, as I will illustrate in the next few minutes. First and foremost, investing in health needs to start with our own personal decision to stay healthy. Then, it needs to be sustained across generations, to have a healthy population in the long term.

3                Sir, if I may have your permission to show some slides.

A.               Master Plan for a Healthy Nation

4                 The Healthy Living Master Plan (HLMP) was launched last year to serve as a compass for systematic and sustained health promotion. The aim is to make healthy living every day a natural choice for everyone.

5                 Dr Chia and Mr Gan Thiam Poh asked about the progress of the HLMP. I am pleased to say that we have been creating opportunities for everyone to live a healthy life and making it fun, with the aim of making healthy lifestyles a pervasive culture for whole communities. Allow me to explain further.

B.               Making Healthier Choices Available and Accessible

6                 Essentially, we want to make it easier for people to make healthier choices their preferred choice. An example is food.

a.     Food strategy in Schools

7                 For the children in school: Today, only 1 in 5 of our Secondary school students eats at least 2 servings of fruit and vegetables every day. Yet about 1 in 2 drink sweetened drinks every day.

8                 So, we want to bring healthier meals to children in school. HPB has been working with schools and Post-secondary Educational Institutions to provide healthy food choices in canteens. Stalls are encouraged to offer healthier options: increase vegetables and fruits in menus, reduced gravy and fried food. We will also link up suppliers with canteen vendors to offer wholegrain rice, noodles, bread, and healthier oils.

9                 Our children should have drinks with less or no sugar. Currently, only drinks with the Healthier Choice Symbol (HCS) are allowed in schools. HPB has been working with MOE to further reduce sugar content of drinks in vending machines and drink stalls. We aim to partner all schools in this effort by 1^st January 2016.

10             At the national level, we have introduced advertising guidelines so that our children are not constantly exposed to unhealthy food messaging. I urge parents to stand with us, by reinforcing healthy eating to your children at home.

b.    Food strategy in Communities

11             We aim to make healthier food choices the preferred choice for everyone. The HPB’s Healthier Dining Programme works with 25 large-chain Food & Beverage partners, including McDonald’s, Kopitiam, Swensen’s and Dian Xiao Er, to offer 500-calorie meals through more than 700 food outlets and stalls. Swensen’s observed that sales percentage of its six 500-calorie meals was about 15 percent in the three-month period after they were introduced. It’s currently a small percentage of overall sales, but it’s growing.

12             The Siu Dai, or “Life’s Sweeter with Less Sugar” campaign, encourages us to remove unnecessary calories from our daily diet. More than 800 drink stalls in food courts, coffeeshops and hawker centres are taking part. I was quite delighted recently, when the drink stall gave me a Scratch n Win card because I ordered a drink with less sugar. I won a 50 cents rebate for the next “healthy” drink that I buy! I understand that prizes had ranged from this to $300 shopping vouchers.

13             As many Singaporeans eat out, HPB has started a pilot scheme to work with suppliers to deliver healthier oil to food outlets, restaurant chains and volume caterers.  HPB provides grants to help nudge the food outlets to adopt the healthier oil.  HPB will review the this scheme after a year.  This is one example where HPB is willing to test out different ideas, to identify those which can lead to a sustained change in behaviours and habits.

C.               Making Healthier Choices Fun

a.  Leveraging IT for health

14             We also want to make healthy living convenient and fun through leveraging information technology. Ms Tin Pei Ling and Mr Alex Yam asked how we might do this. On average, each person in Singapore owns 1.5 phones. Since mobile applications can be conveniently used to gain health knowledge and track personal health efforts, we are developing HealthHub to do just this.

15             HealthHub users will be able to access general health and wellness content, and personalised healthcare information such as medical and immunisation records. We can access information such as hospital fees, health financing schemes, and eventually, waiting times at A&E departments. We will launch a first release of HealthHub in the second half of 2015.

b.  Healthy Living App & Tag

16             We are using IT in the community too. We have developed a Healthy Living @ SG App for individuals to track their physical activity, and find out the nearest exercise locations and healthier dining options.  As part of a trial in Tampines, the app had tested a loyalty programme, translating healthy behaviours - such as attending physical activity programs - into loyalty points that were redeemed for rewards.

17             For those of us without smart phone access, there is the Healthy Living Tag system, which is a small RFID tag. Let me show you, I have it with me. It is a small one [Parl Sec held up the RFID device]. If we go jogging with this tag, we can tap it against RFID receivers located at exercise checkpoints to collect points for  rewards.  

18             I am inspired by people like Mdm Yong Yoke Chin, who, at the age of 79, still exercises regularly to keep healthy. She signed up for an RFID tag. See, she’s holding one there, and it shows Tampines Healthy Pathway, and in the back, we have the tagline, “Healthy Living Every Day”. Every morning, Mdm Yong will make her way to the Healthy Pathway in Tampines for her morning walk with friends. Through this, Mdm Yong has made friends with other residents who enjoy exercising together. With the RFID tag, Mdm Yong collected many points and rewards for her active lifestyle.

D.               Childhood Vaccinations

19              So far, I have talked about prevention of chronic diseases. Prevention of infectious disease is also important. Mr Gerald Giam suggested that vaccines for pneumococcal disease should be fully subsidized. Since 2009, Medisave can be used for pneumococcal vaccine. Singaporean babies born on or after 26 August 2012 are given a Medisave grant of $3,000 that can be used to pay for vaccinations. Mr Giam would be pleased to know that following the introduction of these measures, our coverage with regards to pneumococcal in 1-year old children has increased significantly from 24.1% in 2009 to 75.4% in 2014. In absolute numbers, it means that the number of children who were vaccinated by the time they were 1 year old increased from 7,180 in 2009 to  23,000 children in 2014.

20             Vaccines in the National Childhood Immunisation Schedule (NCIS) are fully subsidized at the polyclinics when there is a need to strongly encourage high take-up of vaccinations for highly infectious diseases. This is so that the community can develop immunity as a whole against the disease, and outbreaks are prevented. In the case of pneumococcal disease, the potential for a public health epidemic or outbreak is relatively low.

E.              Tobacco Control Measures

a.     Health consequences of smoking

21             Dr Chia Shi-Lu asked for an update on tobacco control. I feel that this is an important issue. We all know that smoking can seriously harm our health. In Singapore, it is the second most important cause of premature death and ill health.

b.     Support for smokers: I Quit

22              To quit smoking can be daunting, but it is certainly worth the effort. Quitting not only protects our own health, but also the health of our loved ones from exposure to second hand smoke. To facilitate smoking cessation, we have set up the I Quit campaign since 2011. It adopts a community-based yet personalized approach to build a network of support that helps smokers quit. This movement has reached 13,000 smokers through various platforms at the workplaces, hospitals, in the uniform groups, and in the community. It has proved effective simply because it involves not just the smoker who wants to quit, but also support from his family and friends. In many cases, it has helped to bring the family closer together.

23             67-year old retiree Hanafi Bin Ismail had been smoking for almost 50 years. After suffering a heart attack, he decided to quit for both his health and his family. However, going from one pack of cigarettes a day to none was not easy, so Hanafi gradually cut down. Signing up for the Ramadan Challenge, he received encouragement through regular text messages. His children and grandchildren were supportive, and constantly reminded him of his commitment to quit. Today, Hanafi feels happier and healthier. Ever since he quit smoking, he exercises at least once a week – doing push-ups and even walking up to 7km. His grandchildren are also much happier for him now.

c.     Point of sale display ban

24             Our strategies to control smoking are multi-pronged.

25             We want to reduce the advertising effect of point of sale displays, particularly on our youth. When tobacco products are no longer prominently displayed near the cashiers, it could decrease impulse purchases, and help smokers trying to quit. This year, MOH will be banning point of display of tobacco through an amendment of the Tobacco (Control of Advertisements and Sale) Act. There will be a 12-month grace period to provide retailers enough time to comply.

d.     Emerging tobacco products

26             While we are doing well compared to OECD countries, I worry that smoking rates are high among young men, and younger women are picking up the habit. Tobacco companies have been coming out with new tobacco productsthat appeal to the youth. We are concerned about the health risks of such products, and have been studying ways to address this growing trend. Shisha was the first emerging tobacco product to be banned in November last year, to prevent its proliferation and entrenchment in Singapore. We intend to do the same for other types of emerging tobacco products later this year.  Compliance with the shisha ban has been good. My Ministry will continue to monitor the situation, and assess the full effect of the ban after the transitional period ends on 31 July 2016.         

e.     Announcement: Public Consultation on Standardized Packaging

27             Our efforts do not end here; we constantly scan the world for new ideas. For example, we have been studying developments in Australia, the world’s first country to implement plain packaging. This requires tobacco products to be sold in drab green boxes, with graphic health warnings, the brand name in standardised typeface, and minus all corporate logos and trademarks.

28             We will be conducting a public consultation on requiring the packaging of tobacco products to be standardised in Singapore, towards the end of this year. I would like very much to hear your views.

F.               Conclusion

29             In conclusion, Sir, I am pleased to say that we are making good progress: In the last six years: more Singaporeans have rated themselves in good overall health; more young adults are exercising regularly; and more than two thirds of Singaporeans aged 40-69 years have regularly attended chronic disease health screening.

30             Sir I am also inspired and very pleased to see, whether formal or informal groups, coming forward for health promotion. I have met many groups coming together to facilitate more Singaporeans to live healthily, and bring this to the ground. We hope to work towards a growing people’s movement for good health over time and encourage more members to also start similar movements in other parts of Singapore. Together, a healthy nation for all ages.