Stay Healthy, Detect and Treat Diseases Early

10 Feb 2009

By Mr Hawazi Daipi

1. When we are hungry, we buy food to eat; if we are looking for entertainment, we watch a movie; and when we fall ill, we go to the doctor. However, unlike food and movies, no one really enjoys being sick. There is wisdom in the old saying: “Prevention is better than cure”.

2. Sir, let me now touch on how Singaporeans can play their part to stay healthy, detect and treat diseases early.

Staying Healthy: Promotion and Prevention

School health

3. Our children spend up to eight hours a day in school. Besides the home, the school also lends itself as a natural setting through which we can help keep them healthy. Over the years, working closely with the Ministry of Education, we have developed a very successful and comprehensive school health programme comprising immunisation, regular medical check-ups, dental services and health promotion.

4. The result? Our school children are among the healthiest in the region, if not globally. They receive essential immunisations against conditions like polio, mumps and measles.  Pre-schoolers receive vision screening annually at their kindergartens and childcare centres. In school, all students are provided with regular screening to ensure healthy growth and development. All this points to the hard work and dedication of our school healthcare professionals.

5. We should build on this strong foundation. Our vision is for Singapore to have the healthiest young population in the world.  To this end, HPB will actively engage more schools on health promotion initiatives, such as the provision of healthy canteen food and active participation in physical education lessons and co-curricular activities. It will also focus on enhancing the mental wellness promotion programme to build the mental resilience of our youths to help them weather challenges in life.

6. Schools and community youth organisations can also tap on HPB’s two grants for their own programmes – School Health Promotion Grant and Community Youth Health Promotion Grant. A similar grant has been extended to pre-schools from 2008. Exemplary schools are recognised with the Championing Efforts Resulting in Improved School Health (CHERISH) Award, which is part of MOE’s Masterplan of Awards. For Dr Fatimah Lateef’s information, 80% of our mainstream schools have already achieved this standard, and more will join the ranks with these initiatives.

7. The CHERISH conference is another platform for engaging schools. The inaugural Conference last year gave Award winners the chance to share their success strategies and learn about international best practices in Hong Kong and Australia. For example, Princess Elizabeth Primary School shared how canteen vendors are taught to serve healthier food. The school even encourages students to play health-related games in the canteen to reinforce the health promotion messages.

8. At the other end of the education spectrum, the Institutes of Higher Learning (IHLs) can help the seed of health promotion sown in the earlier years grow as our youths pursue higher education.  More customised health promotion programmes on various pertinent health issues, e.g. smoking and drinking, will be developed and extended to these IHLs. To effectively reach out and engage our youths, HPB will continue to use the new media and organise activities that young people like such as music, dance and sports.

9. Parents also play a vital role in shaping the lifestyles of their children. HPB will help empower parents to be positive role models so that they can inculcate a smoke-free lifestyle in their children, and take time to talk to them about many health issues, such as sexuality issues.

Workplace health

10. Our youths will eventually graduate and enter the workforce. Our health promotion efforts must therefore be extended to workplaces. Apart from improving the health of employees, these efforts would also bring down healthcare costs for both employers and employees. For example, Jurong Shipyard, an active advocate of workplace health activities saw its average medical cost per employee fall 33% over the period 2000-2007.

11. This is why MOH and HPB have embarked on a multi-year tripartite effort to roll out health screening, health promotion activities and chronic disease management programmes in workplaces. I am grateful to HPB Chairman Mr Lucas Chow and Mr Yeo Guat Kwang from NTUC for spearheading the work of the Tripartite Committee.

12. One focal area for the committee is our SMEs, as they employ more than 60% of our workforce. In these difficult times, we are exploring how we can better support SMEs to do workplace health promotion. For example, we are looking at enhancing the Workplace Health Grant so that SMEs receive more funding to implement our recommended package of health screening, follow-up services and healthy lifestyle activities.

13. At the same time, we cannot neglect the mental and emotional well-being of our workers.  HPB will expand its workplace mental well-being programme to help our workers better manage stress, as well as strengthen their resilience to cope with change positively.

Tackling smoking and obesity

14. We must tackle the twin dangers of smoking and obesity head-on. We have successfully contained the smoking problem over the past 25 years, through the efforts of HPB, NEA and their partners. The incidence of lung cancer today has dropped by about 20% since 1984. Similarly, the premature death rate from heart disease has dropped dramatically, by two-thirds from 25 years ago. We have one of the lowest smoking rates in the developed world, at 13.6%.

15. We will press on in our anti-smoking efforts this year through targeted measures. This includes enhanced regulatory measures. HSA will also continue to take action against retailers who persist in selling tobacco to minors, such as the recalcitrant Cheers outlet whose retail licence we suspended last week.

16. Smoking cessation programmes and campaigns will also be enhanced, particularly for underaged smokers. Partnership with MOE, schools and the community will be key in reaching out to the youths. An opt-out smoking cessation programme for expectant mothers will also be introduced. NEA will complement our efforts by stepping up enforcement against smoking in public places.

17. I am confident we can control obesity too. Obesity is the second most important cause of global mortality and morbidity after smoking. And both of them are preventable. This year’s National Healthy Lifestyle Campaign will focus on obesity prevention and control, by emphasising the importance of maintaining a healthy body weight. We will encourage supermarkets and eateries to increase the availability of healthier food choices. The Singapore Sports Council, NParks, People’s Association and its grassroots organisations will also contribute by promoting physical activity amongst Singaporeans.

18. We will also tackle childhood obesity.  HPB and its partner agencies will ensure that our children have access to healthier food and drinks in schools. More commercial dining outlets should join in the fight by developing healthy children’s menus with guidance from HPB. Youngsters can do their part too – adopt an active lifestyle through regular exercise.

Detect and Treat Diseases Early: Chronic Disease Management

19. Sir, I would like to respond to Dr Muhd Faishal’s question about the state of health of the different ethnic communities. The prevalence of chronic diseases varies among different communities, due in part to genes and environmental factors. In 2004, diabetes was most prevalent amongst Indians, affecting 15% of the Indian community, followed by Malays at 11% and Chinese at 7%. The prevalence of high cholesterol was highest amongst Malays at 23% followed by Chinese (18%) and Indians (17%). However, Malay and Indian communities had a lower prevalence of high blood pressure (23% and 22% respectively) compared to Chinese (26%).

20. Regardless of race, the treatment is the same. Patients should go for regular follow-ups with their doctor, take their medication on time, and make the appropriate lifestyle changes, e.g. in their diet. This will ensure that they enjoy a high quality of life despite their medical condition.

21. I share Dr Faishal’s concerns regarding Malay kidney patients. There was a 17% increase in the number of Malay kidney failure patients from 2005 to 2007. Part of the solution lies in helping diabetic patients manage their condition better: from 1997 to 2006, the proportion of end-stage renal disease due to diabetes increased from 39% to about 60%. Certainly, we need to do better. The Chronic Disease Management Programme (CDMP) guides our GPs to do this, using evidence-based treatment protocols. Patients are also tested regularly to detect the onset of kidney problems early, so that we can intervene and slow any deterioration of the kidneys.  

22. HPB has made headway in facilitating lifestyle change among the Malay and Indian communities, to prevent the development of chronic diseases. It will continue to build on this good work in the year ahead. For example, “Kebayarobics” and “Aarrokia Attam” workout routines have been started for Malay/Muslim women and the Indian community respectively. Healthy cooking classes tailored for the Malay/Muslim community have also been conducted at mosques and community clubs since 2006. This programme will be extended to Malay caterers and restaurants this year.

23. To encourage Malay smokers to quit smoking, HPB has been collaborating with mosques, family service centres, and sports associations like the Singapore Silat Federation and Singapore Sepak Takraw Federation, to organise smoking cessation intervention programmes.  In 2009, HPB will introduce a programme of talks and cessation measures to be held around Ramadan (or the fasting month). Smoking cessation counselling will also be included in the marriage preparatory course for couples that smoke. As you can see this is going to be a very comprehensive approach to help people to quit smoking.

24. On the public education front, HPB has been tasked to coach the public on how to better manage their chronic diseases. As part of this effort, HPB will reach out to the Malay and Indian communities through the Suria and Vasantham television channels respectively, beyond efforts on Channels 5 and 8. It will supplement this with targeted messaging via print and online media. HPB will also be rolling out a pilot skills equipping programme to help Singaporeans at high risk of developing diabetes reduce their risk. MOH will commit an additional budget of $4.2m over the next 3 years for these public education initiatives.

25. Let us not stop there. We should take a step back and spot and address problems early. Singaporeans must take charge of their own health.

26. That is why I want to encourage more Singaporeans to go for regular health screening. MOH has already made evidence-based screening more affordable for Singaporeans through the Integrated Screening Programme introduced last June. Most Singaporeans need only to pay $8 for blood test for glucose and cholesterol. This is free for low-income Singaporeans.  PA and its grassroots organisations promote the screening services through their pilot Wellness Programme. We have some initial success that we should build upon: about 70% of Singaporeans go for regular screening. Going forward, we need to encourage Singaporeans to go for the appropriate follow-up after screening, so that they can manage the detected conditions well.

Mental Health

27. The Minister for Health announced yesterday that the Chronic Disease Management Programme (CDMP) would be extended to cover outpatient psychiatric treatment. Beyond that, the Government is pumping an additional $35m over the next 3 years, on top of the $88m committed in 2007, to identify and treat potential mental health problems early in the community. For Mdm Halimah Yacob, Mr Zainudin Nordin and Mdm Cynthia Phua’s benefit, let me outline some of the initiatives we will be undertaking.

28. Other than IMH, all our restructured and some private hospitals also provide specialised psychiatric services. In the community, there are currently three psychiatric rehabilitation homes and six psychiatric day care/day rehabilitation centres. These provide rehabilitation and vocational training to help stabilised patients re-integrate into society. We will monitor the adequacy of such facilities and build more if required.

29. We will also invest in community support services. Today, the multidisciplinary Community Mental Health Teams (CMHT) which is made up of healthcare professionals follow up with patients discharged from IMH. The teams also render psycho-social support to patients and their families. IMH also has a crisis hotline and crisis teams conduct home visits if needed. The CMHT will achieve national coverage by 2011.  Annually, about 700 more staff from our community partners such as GPs, schools, CDCs, grassroots organisations and VWOs will be trained to detect, counsel and care for individuals in need within the community.

30. Family members can also receive caregiver training and support under a Specialised Caregiver Support Service that MOH, NCSS and the Alzheimer’s Disease Association are enhancing. Aside from this project, we are open to supporting viable programmes offered by VWOs upon application.

31. Thanks to the Yellow Ribbon Project, ex-offenders are gradually being reintegrated back into the community. The same can be done for recovering mentally ill patients. One way is to help patients find and keep meaningful jobs, so that they are able to regain confidence and lead fulfilling lives. IMH has started a new “Job Club” initiative to provide employment readiness training and work placement services for these recovering patients. Educational talks and forums will be conducted to educate the public on mental health issues in the workplace and general community.

32. Let me now address Ms Sylvia Lim’s question on the funding of essential programmes such as psycho-therapy. There are many types of psycho-therapy. IMH provides subsidised psycho-therapy to patients who need it, and needy patients can apply for Medifund assistance. Yesterday it was announced that Medifund assistance will be increased to $80 million, to assist more needy patients including IMH patients who have problems paying their bills. IMH offers another non-standard form of treatment called dynamic psycho-therapy as a pilot; it is currently not subsidised. Needy patients undergoing this treatment are assisted through donation funds received by IMH.

Breast Cancer

33. I am heartened that Dr Lily Neo is concerned about the impact of breast cancer on female Singaporeans. MOH echoes her concerns. Through the various initiatives undertaken over the years, we have made significant progress in the fight against breast cancer. In 2002, HPB introduced BreastScreen Singapore,  a subsidised breast cancer screening programme to make mammogram screening affordable and accessible. We have also brought mobile screening buses to the community and workplaces. The response to the various screening programmes has been good. In 2007, 61% of Singaporean women in our target age-group for breast cancer screening went for mammograms, an increase of 27% from 1998. All in all 317,000 women have undergone the BreastScreen Sg Screening since its inception in 2002.

34. The challenge ahead is to ensure that women make breast cancer screening a regular part of their life. Our long-term target is for at least 70% of Singaporean women in the at-risk group to go for mammograms once every 2 years, up from the current 41%. We will ensure that screening is kept affordable for these women to facilitate this outcome.

35. Public education and awareness is also critical in our fight against breast cancer. In 2007, 83% of Singaporean women in the target age-group for breast cancer screening knew about mammogram screening, a marked increase of 36% from 1998. We can do more. Going forward, HPB and its partners will continue their proactive outreach efforts to women through media campaigns, promotional activities at workplaces and community events, and through GPs to encourage them to go for regular breast cancer screening.

Strengthening Primary Care

Our vision: “One Patient – One Family Physician”

36. Members of the House would agree that staying healthy is also about building strong relationships. Relationships with your loved ones, colleagues, neighbours, and yes, your doctor! Every Singaporean should stick to one family physician.  If you have not, I urge you to identify your FPs and work with them to screen and manage your health. The FP is your long-term partner in ensuring good health.

FP training

37. To further enhance the role of FPs in the community, MOH has augmented the training programmes for doctors to achieve the required qualifications to be FPs. In FY2008, we began to provide up to 50% co-funding for young doctors who want to take on post-graduate diploma training (Graduate Diploma for Family Medicine). At the same time, we also created more programmes for doctors to receive Masters level training. The College of Family Physicians will be the key content provider, with an MOH-appointed Joint Committee for Family Medicine Training overseeing these programmes.

38. The Director of Medical Services also shared last month that we are amending the MRA to include a Family Physician Register. This will set the standard for future FPs. Public consultation is underway and we look forward to presenting the finalised amendments to this House in due course.

Other avenues of support

39. We are considering other avenues to support primary care and achieve better integration with the national health system. First, we will leverage on IT to better link up polyclinics and GPs with the acute hospitals and ILTC providers to help provide patients with seamless, integrated care.

40. Second, we will continue to experiment with various primary care models to see which best suits Singaporean’s needs. We have conducted various pilots in the past, e.g. Jurong Medical Centre for patients and GPs to access Specialist Outpatient Clinic facilities in the community. Going forward, we are considering other initiatives like supporting infrastructural development, and incentivising GPs to come together and practice in groups.

The patient stands to benefit

41. Ultimately, the patient stands to benefit from these enhancements. 450 GP clinics have partnered us under the Primary Care Partnership Scheme to provide subsidised care for the acute and chronic conditions of needy patients. Patients can be assured of the quality of care rendered as the GPs are required to adhere to MOH’s treatment protocols.

42. As the GPs take on a greater role in healthcare management in the community, waiting times at polyclinics should shorten. In the meantime, Mr Ong Ah Heng will be pleased to know that our polyclinics are already adopting measures to manage waiting times, which may be 40 minutes or longer, depending on time of visit and other factors.

43. Patients can also view the patient load at the polyclinics online so that they can know when is a good time to see the doctor. For those with chronic conditions requiring regular or frequent reviews, they can choose to make appointments at the dedicated Family Physician Clinics, to see their regular doctors and save on waiting time as well.

Conclusion

44. I have outlined the policies and systems that MOH will put in place over the coming years to strengthen the primary care sector and help Singaporeans stay healthy. I urge Singaporeans to join us as we shape the healthcare landscape – take personal responsibility for your own health and encourage your loved ones to do so too.