Speech by Permanent Secretary (Health), Mrs Tan Ching Yee, at the 8th Public Health and Occupational Medicine Conference, 29 Aug 2013

Dr Eugene Shum, President College of Public Health and Occupational Physicians,

Prof John Ashton, President, UK Faculty of Public Health,

Distinguished guests and colleagues,

Good morning

Introduction

1.      Thank you for the invitation to address this conference.

2.      I think it takes a special kind of doctor to be in public and occupational health, where the challenges are broad-based at the population and workforce levels. So I am pleased to be able to join you here today to honour Prof Goh Kee Tai.

3.      This is also a good opportunity for me to thank our public and occupational health doctors who provided valuable inputs and expertise during the recent haze crisis management.  We had to advise the Government on the public health impact of the haze, and the use of appropriate respirators for different work settings and different types of workers. Like all population-level work, it was a team effort, involving not just doctors but also weather forecasters, pollution engineers, air quality experts, logistics companies and many others.   Your professional expertise and leadership lent credibility to the Government’s public health messages in the face of this unconventional public health threat.

The Changing Local Landscape – Challenges Presented to Singapore Healthcare

4.      The theme of this year’s conference is “Advancing the Health of Populations”. I understand the conference organisers have put together a wide-ranging programme to discuss the issues facing the different demographic groups in Singapore. Singapore faces new public health challenges stemming from demographic change and the onslaught of lifestyle diseases brought about by the industrialisation of food production and changing family structures. Chronic diseases form a larger proportion of cases in our healthcare institutions. Cardiovascular diseases, cancers, neurological and sense disorders, diabetes mellitus and mental disorders collectively contribute to more than half of our disease burden. In 2010, they accounted for 70%¹ out of approximately 400,000 disability adjusted life years (DALYs). With an ageing population, we should expect that neurological and mental disorders will be more prevalent. As the daily stresses of modern living rise, the overall physical and mental well-being of our people will be affected. We have begun preparations to address these challenges, but more work remains to be done.

5.      At the same time we must stand ready to contend with external challenges that will affect the health of the population. With a well-travelled population, and Singapore as a travel and work destination for many foreigners, the risk of Singapore being a node in the global transmission of infectious diseases is heightened.  We need to be vigilant in our surveillance of emerging threats, and work closely with our international partners, including the World Health Organisation. Monitoring novel global disease outbreaks such as the H7N9 and the Middle East Respiratory Syndrome (MERS-CoV) must take place alongside robust surveillance of perennial threats like dengue, and even the haze.

Addressing Challenges to Capacity and Capabilities

6.      The Ministry of Health is reviewing what we are doing to improve the health and wellness of different population groups, and looking ahead to address the needs that we see emerging. Together with our community partners, we have started preparing for the population increase and for ageing. Let me sketch out a few key initiatives.

7.      To ensure sufficient capacity to meet the increasing demand from a growing population, we are ramping up infrastructure in the acute, primary and long term care sector. We are improving our models of care, such as transition care and home care, to ensure appropriate treatment and services are available to support the changing profile of diseases. We are also aiming to boost healthcare manpower in terms of numbers and professional capabilities. Importantly, we are working on implementing the concept of the Regional Health Systems, where care services across different sectors are integrated around patients living within a certain region, with the aim of delivering a seamless care experience.

8.      Beyond the walls of healthcare institutions, we have also been building up community capabilities to address the healthcare needs of a more diverse and ageing population. As part of the Regional Health Systems, our public healthcare clusters and the Health Promotion Board (HPB) have been working with community partners to reach out to their local population and proactively identify those at risk of chronic diseases like hypertension and diabetes, to help them better manage their own health. For example, the Eastern Health Alliance has a chronic disease prevention programme – the Eastern Community Health Outreach – that is offered in partnership with HPB and grassroots organisations. The programme helps people with simple chronic conditions make more informed and better lifestyle choices through annual health screening, physical activity and nutrition workshops. They work closely with the community to refer individuals to other follow-up events promoting a healthy lifestyle.

9.      The Health Promotion Board complements the efforts of the RHSes through its Health Ambassador Programme. 4000 health ambassadors have been recruited and are being trained to help guide their friends and neighbours, to influence them to live healthier lifestyles. Activities include reminding residents who have undergone health screening to see their doctor for follow-up where needed, as well as promoting low impact strength and flexibility training exercises – for example, using resistance bands. A corporate health ambassador programme has also been started, where two organisations have since been recruited to show their commitment to ensuring their employees’ general health and well-being.  With more and more organisations coming on board over time, we can strengthen individuals’ physical and mental well-being to meet the stresses of work.

10.  These are good programmes, but there is more that we can do. People do not want to fall sick. As far as possible, they want good health, or at least a good quality of life, even if they have chronic illness. Preventive care is therefore a vital part of population health. As healthcare professionals, you have the skills and expertise to proactively help people live physically and psychologically healthy lives.

11.  Rather than focus on just treating disease, let us emphasise health promotion and prevention, and work towards the long term goal of creating a Singapore environment that promotes healthy lifestyle choices and preserves wellness. Work is in progress on a National Healthy Living Masterplan, which will consolidate recommendations from healthcare professionals and citizens in six areas – Balanced Diet, Physical Activity, Mental Wellbeing, Health Screening and Follow-up Care, Smoke-free Lifestyle, and Immunisation. The Masterplan is intended to guide and help people stay on the healthy living track. If you have been involved in this work, we are grateful for the input you have given to these plans.  

12.  We are also focused on helping our seniors to age-in-place. MOH has also implemented the City for All Ages programme at four pilot sites. Under this programme, we have worked with the community to better understand the needs of their elderly residents and how we can work with them to customise solutions to meet these needs. Examples of initiatives include health screening and wellness programmes, senior-friendly infrastructure enhancements to the town environment, and greater service integration with various health and social care providers. Besides creating more senior-friendly towns, these pilots also galvanised the community to come together to make the seniors feel comfortable ageing within the community and their homes rather than in medical institutions. The programme has since been expanded to more constituencies so that we can have more seniors enjoy the benefits.  

13.  Central to all these efforts is developing a good understanding of health needs and behaviours of different population groups – the young, the elderly and working adults. We must get to know them well, understand what they need to live healthily, and appreciate what works for them. As public health professionals, you are in a unique position to generate insights from the epidemiological profiles, health-seeking and health-spending behaviours of different segments of the population. These insights drawn from survey data, screening activities and administrative data – in short, the population health analysis – are crucial to informing public health policymaking, so that we can formulate more effective policies and programmes to support healthy living.

Role of Public Health Professionals in Policy and Operations

14.  Public health professionals are therefore indispensable to our efforts in delivering accessible, affordable and quality healthcare services, promoting healthy lifestyles and curbing infectious disease threats. Through your active roles in public health administration and surveillance, you provide the research and evidence on which policy options are weighed and decisions made. The collaborative relationship between public health professionals, policy-makers and frontline operations staff therefore remains critical to ensuring smooth and effective implementation of public health policies.

Conclusion

15.  Allow me to offer a suggestion. Often it is not the lack of knowledge but the inability or unwillingness to change behaviour that is hard to achieve. The College could organise a simple workshop or symposium with behavioural scientists and behavioural economists to generate some ideas. MOH and HPB would be happy to see how to turn them into reality.

16.  This conference is a great opportunity for public health colleagues across different institutions to network, learn and hopefully even collaborate on projects. I also hope that all of you will be able gain insight from each of the sessions and put the knowledge to good use building a healthier Singapore. I wish everyone a productive and meaningful conference experience.

17.  Thank you.

[1] Estimated figure from data captured in the Singapore Burden of Diseases Studies.