SPEECH BY SENIOR MINISTER OF STATE DR JANIL PUTHUCHEARY AT THE LAUNCH OF THE ASIAN CENTRE FOR HEALTH BEHAVIOURAL INSIGHTS AND INTERVENTION (HABITS)

            Good morning. It is my pleasure to be here today to launch the Asian Centre for Health Behavioural Insights and Interventions — HABITS. Very aptly named.

2.              It is a significant milestone not only for Singapore but also for our region. The Centre will contribute efforts to address population health concerns in Singapore and other Asian countries, through public health research and evidence-based interventions.

Challenges to Public Health

3.             All around the world, our healthcare systems, including Singapore’s, are facing increasing pressures — the population ageing, the rising prevalence of chronic diseases. And you know the statistics for us here in Singapore: by 2030, one in four of our population in Singapore is expected to be 65 years and above. As we all get older, we are all more likely to fall sick, to develop chronic conditions, to suffer from disabilities, and to live with these conditions and disabilities.

4.             Between 2010 and 2022, the prevalence of hypertension nearly doubled from about 20% to 37%. Hyperlipidaemia prevalence also increased from about 26% to 32%. The prevalence of diabetes, if your glass is half empty, will say we kept it steady at around 8.5%, without a rise in that time period. But 8.5% is already very high, compared to many other populations in the world.

5.             Chronic diseases have long-term implications. The rising prevalence of these diseases will lead to a significant burden on individuals, a burden on families and caregivers, and a burden on the healthcare system, if we do not address it successfully.

6.             Our objective is to keep Singaporeans as healthy as possible for as long as possible, for us to pay attention to our healthspan, and not just our lifespan. To do this, we need to ensure that our healthcare system remains sustainable and accessible for all. This is the imperative for us to launch Healthier SG in 2023, a significant transformation of our healthcare system, emphasising preventive health, population health, and the outcome being that we, as residents, as Singaporeans, are empowered to adopt positive health behaviours, managing our own health for our own benefit in the long term, and then of course, cumulatively, for a better society for all of us.

Role of Behavioural Health

7.             What we need for good health lies in the choices that we make on a daily basis and the habits we form over time. Just like other types of behaviours, health behaviours are influenced and reinforced by a combination of factors such as social norms, environmental influences, and health literacy.

8.             Our health behaviours, we know, are prone to a present bias. We prioritise the current benefits over the long term. We, as individuals, prefer immediate gains over long-term returns, especially if the immediate impact of a long-term return is not a gain, but a net loss. And so, we think in this way, even though the long-term return may be greater.

9.             An example is food, eating unhealthily because of tasty fast food, instant gratification of the sweetness of the coffee. But the long-term consequences for that instant gratification are not immediately apparent: weight gain, nutrition, and increased risk of chronic conditions. Health screening is another example. You get no gain in immediate perception, and instead, you have to take an hour or two or an afternoon off to go, from many other things that we do. But you need to do so in order to then think about your long-term health. Some of this is also unconscious. People do not want to contemplate the possibility that they may have bad news on the health screening that they do. So, there are a series of short-term losses or short-term pains for a very significant long-term gain. This is a behavioural habit that we need to break.

10.          There are, to my mind, two significant reasons why we should be hopeful that we can indeed shift behaviour and shift our habits. One of that is that we, as people, as human beings, we are very adaptable. Our biology, actually. We are one of the few organisms on the planet that has a capability called taste plasticity. Biologically, many organisms have a certain type of food. You learn about this in biology, or even in popular science. Certain animals, they only go for certain types of foods. But humans, if you look at our cuisines around the world, we have a very wide variety of foods, and part of that is because we have this adaptability as humans and taste plasticity. The other thing that we can do is we can imagine a future — and there are not many organisms on this planet that can imagine a future — but we can, and collectively as a society, we can even imagine a shared collective future, what our future together looks like.

11.          I think these are two reasons why we can encourage people, in the right settings, with the right nudges, to shift their habits. And this has been my experience as well. I too liked my coffee, and still do like my coffee, and I did also like the kopi ka dai. I mean, I would say siew dai, but if the guy misheard me and made it ka dai, I did not ever object. But when I learned about taste plasticity and I learned about human omnivorousness and adaptability in our cuisine, I decided I would try it myself. I read that sometimes it requires about eight to 10 doses for the taste plasticity to fully set in, and for the adaptability to fully set in. So, I wrote myself a little to-do list, and I said I would try a progressive series of 10 cups of coffee over 10 days, significantly reducing. Being the little bit of a geek that I am, I also plotted a little bit of a graph, and I decided that I would hit the kopi c kosong at the 17th percentile, the seventh day. I stuck to this and indeed, for me, it has been very successful. I went from someone who had coffee with condensed milk to the kopi c kosong, which is now my standard default drink. Those of you that I have had the pleasure of sharing a cup of coffee will know that I very much have to stick to the kosong today.

12.          And so, I proved to myself about taste plasticity and my own adaptability. And proving it to myself was just as important, I think, because it meant that whatever was going to be my next habit that I had to break, I had to demonstrate to myself that I could do so. And I thought that was a very useful lesson for me.

13.          Imagining a better future is also something that, of course, I have to do in a variety of my jobs and roles. But when it comes to my own health, this was the second lesson that I learned. Some of you may know that a couple of years ago, I injured my knee very badly, and I wasn't able to do my favorite exercise of running, gained quite a bit of weight, which, of course, worsened my rehab from the knee. I took the opportunity, then, when I finally decided that I had to do something about it, to think about my diet and my intake. I decided that I would cut out certain things from my intake. As a way of setting up a behavioural incentive, I said to myself, when I reach my baseline distance and time, I will celebrate. Likewise, set out a little graph, and I said, at this point, I will go back to ice cream; at this point, I'll go back to alcohol; and at this point, I'll go back to my coffee. My wife, with a great deal of insight, said, “Can you please go back to the coffee today?” But I persisted with the alcohol and the ice cream, both of which are things that I enjoyed quite a lot beforehand. As a result, I actually cut out ice cream completely from my diet. My alcohol consumption – I suspect five years ago, if you had asked me, “would you like red wine or white wine?”, my answer would have been “yes”. But I very significantly cut down my alcohol intake, which of course, helped with the weight, and then helped me rehabilitate, get my exercise going, and perhaps then, reconditioned myself very significantly.

14.          So to my mind, those are two lessons that as we encounter patients, as we encounter clients, as we set up our programmes and our interventions, I think are worth reminding ourselves of and thinking about as we set up the programmes, that actually, no matter how recalcitrant the patient, client, family, or individual, all of us have inherently a significant amount of adaptability. We should try to find a way to bring that out of the family, the client, and the patient that we serve.

15.          Secondly, in order to create the right sorts of incentives, the environment, the social norms, we have the ability to imagine a better future, and whether from the perspective of an individual patient or individual counselling session, or painting a picture of what our national healthcare ecosystem looks like, what our society might be 10 years, 15 years from now. If we can do so and articulate and have everybody have that imagined, shared, better future, these are two very powerful tools that we can use to shift the habits of ourselves, of our families, and of our society.

Opportunities for innovation

16.          Understanding of what motivates individuals to perform the desired behaviours – this is crucial to the design and successful implementation of any impactful solution. And so, HABITS will serve the broader community, furthering our knowledge of the factors that shape our health behaviours, our decisions, and consequently, outcomes.

17.          The centre will employ a multidisciplinary approach to do this, drawing from social and behavioural sciences, economics, and environmental studies, working with key stakeholders, government agencies, academic institutions, and healthcare providers. I am glad that HABITS will also be working with partners in the behavioural health space, such as the SingHealth Centre for Population Health Research and Implementation, and the Centre for Behavioural and Implementation Sciences Interventions. I look forward to seeing future collaborations that HABITS will have with a further expanding group of local partners and international partners.

18.          Our lives are increasingly digital, increasingly hyperconnected. This means that there are also new possibilities for how we can conduct behavioural health research, the data sources we can glean insights from, the ways in which we can design and deliver health interventions. All of this can take advantage from the technology that have now become an everyday part of our lives. The health and lifestyle data from wearables and mobile devices, social media analytics, and even generative artificial intelligence – these are data sources and tools that can and already are being leveraged, to think about how we can shift the habits of our population in the correct direction.

Singapore as a Behavioural Health Hub

19.          Further, Singapore’s diverse society offers us a unique opportunity to learn what approaches are more impactful for the different segments in our population. Understanding the interaction between that diversity and the interventions that you have in programmes that might be looked at by HABITS will help us address what we should do in terms of targeting health promotion and prevention. Indeed, this approach that your one single intervention is not going to fit everybody’s starting position or the trajectory. We have to tailor our health programmes and our interventions so that they meet each individual’s needs and preferences, and each segment of our population’s ability to adapt, how long it takes them to adapt, the extent to which they would adapt, and their incentives to do so.

20.          If we can learn the correct lessons from engaging our very diverse groups here in Singapore, we can extrapolate and apply these beyond our shores to the wider Asian region. We can support our neighbours as they navigate their public health challenges. We can collaborate with international stakeholders and add value to them as they are trying to address their population needs. The HABITS team has recently conducted a behavioural health study of 10 Asian countries, including Singapore, on aspects such as health behaviours and attitudes toward preventive care. The study’s findings indicate an intention-behaviour gap that exists across the 10 countries for behaviours such as attending screenings for breast cancer. I look forward to hearing more about the insights from the study later on today.

21.          I would like to commend NTU and NHG for their dedication and commitment in establishing HABITS, and I am heartened that it will serve as an Asian centre from the outset. Your work will make a meaningful difference in shaping the future of population health in Singapore and beyond. I look forward to seeing the research and innovations that will emerge from the Centre.

22.          And on that note, it is my honour and my privilege to officially launch HABITS, the Asian Centre for Health Behavioural Insights and Interventions. May this be the start of a transformative journey towards better health for all of us. Thank you all very much.