Smoking Rates Down, Chronic Disease Prevalence Remains of Concern

National Population Health Survey 2020 findings highlight need to tackle unhealthy lifestyle habits

1.     The National Population Health Survey (NPHS) report 2020, which tracks the health and risk factors, as well as lifestyle practices of Singapore residents¹ for the period of July 2019 to March 2020², has found that smoking prevalence has fallen, and screening for colorectal and breast cancer has increased. However, the Survey has highlighted some areas of concern, including the rising prevalence of hypertension and hyperlipidaemia, higher body mass index (BMI) and overall lower physical activity.

2.     The results of the NPHS are a reminder for Singaporeans to continue engaging in healthy lifestyle habits amidst the ongoing COVID-19 pandemic. The Ministry of Health (MOH) and the Health Promotion Board (HPB) will continue to support Singaporeans to stay healthy. We encourage Singaporeans to take ownership of your health and play your part in leading a healthier lifestyle.

Results of NPHS 2020

Chronic disease continues to be a concern

3.     The prevalence of hypertension and hyperlipidaemia showed an increasing trend over the years. During the period of 2019 to 2020, over one in three (35.5%) had hypertension, and about four in 10 (39.1%) had hyperlipidaemia (or high blood cholesterol) compared to about one in four (24.2%) and slightly more than one in three (35.5%) in 2017 respectively. The increasing trend was observed even after adjusting for the possible effect of an ageing population³. The increase in prevalence for both conditions was greatest among those 40 years and above. While the crude prevalence of diabetes showed a slight increase from 8.8% in 2017 to 9.5% for the period of 2019 to 2020, a stable trend was seen after adjusting for age⁴.

More were obese or had high risk BMI, and fewer engaged in sufficient total physical activity

4.     During the period of 2019 to 2020, over one in 10 (10.5%) Singapore residents were obese⁵ and over two in 10 (20.7%) had high risk BMI⁶. This is a slight increase from 2017⁷.The prevalence of obesity and high risk BMI was more common among adults aged 30 to 59 years, almost double that of those aged 18 to 29 years.

5.     From the survey, fewer Singapore residents were engaged in at least 150 minutes of moderate-intensity physical activity per week⁸ in 2020 (76.4%)⁹, compared to 2017 (80.9%), despite the increase in the number of Singapore residents engaging in leisure-time regular exercise¹⁰ in 2020 (33.4%) compared to 2017 (29.4%). Similar trends were also observed after adjusting for age¹¹.

Smoking prevalence continues to decrease while binge drinking has increased

6.     Smoking prevalence has seen a steady decline over the past decade. The NPHS results showed that smoking prevalence for Singapore residents has decreased to 10.1% in 2020, from 11.8% in 2017.

7.     However, the crude prevalence of binge drinking¹² has increased in 2020 (10.5%), compared to 2017 (8.8%). This increase was seen mainly in the younger age groups, particularly among individuals aged 18 to 29 years and 30 to 39 years.

Slight decrease in chronic disease screening rates while screening for colorectal cancer and breast cancer increased

8.     In 2020, 63% of Singapore residents aged 40 to 74 years with no previous diagnosis of diabetes, high blood pressure and high blood cholesterol were screened for all three health conditions within the recommended frequency. This was a slight decrease from 66.4% in 2017.

9.     Screening rates for colorectal cancer increased in 2020 (41.1%), compared to 2017 (35.0%). Similarly, screening rates of breast cancer screening increased in 2020 (37.9%) compared to 2017 (30.9%). Screening rates for cervical cancer remained stable in 2020 (45.4%) compared to 2017 (46.3%).

Influenza and Pneumococcal Vaccination Coverage has increased

10.     Influenza vaccination¹³ coverage among Singapore residents aged 18 to 74 years showed an increase from 13.1% in 2017 to 17.0% in 2020. While vaccination rates increased across all age groups, adults aged 18 to 29 years and 60 to 74 years had the highest influenza vaccination coverage compared to other age groups.

11.     Similarly, Pneumococcal vaccination¹⁴ coverage among elderly aged 65 to 74 years increased from 11.9% in 2017 to 14.4% in 2020.

Prevalence of poor mental health remained stable

12.     The crude prevalence of poor mental health¹⁵ among Singapore residents remained stable in 2020 (13.4%) compared to 2017 (12.5%). A similar trend was observed for age adjusted prevalence¹⁶. Younger adults aged 18 to 29 years had the highest proportion (21.5%) with poor mental health while the prevalence for other age groups were lower.

Findings highlight pressing need for action

13.     The NPHS 2020 findings highlight the need to build upon our ongoing health promotion efforts while moving ahead to innovate new ways to empower the population to take charge of their health, especially as Singaporeans' behaviours may have changed due to the COVID-19 pandemic. We will continue to press on in the following areas:

a) Encouraging Singaporeans to increase physical activity and adopt a heathier diet

14.     An observed increase in prevalence in obesity and high risk BMI can potentially increase the risk of developing chronic diseases. Aside from genetic factors, obesity can also result from a lack of physical activity and an unhealthy diet. To encourage Singaporeans to be more active, we will continue to improve accessibility to our regular exercise programmes, such as bringing the programmes online and creating more exercise sessions in available community spaces. We will also encourage Singaporeans to lead more active lifestyles through population-wide programmes such as the National Steps Challenge.

15.     With the increase in hypertension prevalence, we need to do more to reduce sodium consumption in our diets. Salt is the primary source of sodium, and high sodium intake is associated with increased risk of hypertension. Singapore residents are consuming 3,600mg of sodium per day on average in 2018, higher than before¹⁷, and 9 in 10 Singapore residents exceeded the World Health Organization’s (WHO) recommendation to consume less than 2,000mg of sodium per day (i.e. no more than 1 teaspoon of regular salt). To address this issue, HPB is planning to ramp up existing efforts to spur reformulation of reduced-sodium sauces and seasonings, and embark on a nationwide campaign to encourage Singaporeans to reduce sodium consumption in their diets. More details will be released in the coming months.

16.     To promote healthier diets, we also need to do more to reduce our sugar intake. To help Singaporeans reduce their sugar intake from beverages and spur industry reformulation, we announced in October 2019 that we would be introducing mandatory nutrition labels, also known as ‘Nutri-Grade’, and advertising prohibitions on pre-packaged non-alcoholic beverages sold in Singapore. These measures will come into effect from Q4 2022 onwards to allow the industry more time to comply with the measures and reformulate their products given disruptions caused by the COVID-19 pandemic. We are also working on extending these measures to freshly prepared beverages, which is a key and growing source of sugar in our diets. More information will be made available in the coming months.

17.     These efforts will work in tandem with other ongoing efforts such as the Healthier Choice Symbol, Healthier Dining Programme and Eat, Drink, Shop Healthy Challenge to create an ecosystem to support individuals in making healthier food choices.

b) Efforts targeted at smoking and binge drinking will continue

18.     While we have seen a reduction in smoking prevalence, we will continue our efforts to keep smoking prevalence low. We will be enhancing our educational efforts in mainstream schools to prevent smoking initiation from young while continuing to help smokers quit through our smoking cessation programmes. In addition to our programmes, policies such as Minimum Legal Age 21 and standardised packaging for all tobacco products form part of a multi-pronged approach to tobacco control, which aim to reduce smoking among our youth and young adults.

19.     To target binge drinking, we will continue our educational efforts in mainstream schools and Institutes of Higher Learning on the harmful effects of alcohol consumption while continuing collaborations with industry partners to include pertinent messages on responsible drinking in their campaigns.

c) Encouraging early detection through regular screening

20.     It is important to go for regular, recommended health screening for early detection of diseases so as to enable early intervention. As part of Screen for Life (SFL) programme, eligible Singapore residents are offered heavily subsidised screening tests for cardiovascular risk factors (obesity, diabetes, hypertension, hyperlipidaemia), cervical cancer and colorectal cancer at no more than $5 for the screening tests, screening visit and first follow-up consultation (if required). We will continue our efforts to reach out to the unscreened population, to encourage Singaporeans to participate in screening regularly.

d) Encouraging vaccination uptake

21.     Influenza and pneumococcal vaccination is recommended in the National Adult Immunisation Schedule (NAIS) to prevent serious complications and death among high risk groups such as the elderly and persons with certain medical conditions. The increase in uptake is promising. All persons who have been recommended to receive the vaccination should take it up to protect themselves. To encourage further uptake, since November 2020, subsidies have been extended to these vaccination as recommended under the NAIS for eligible Singaporean adults, and made more accessible through CHAS GP clinics as well as polyclinics. In partnership with healthcare professionals, HPB and other stakeholders, we will continue to reach out and promote the uptake of influenza and pneumococcal vaccination among these groups.

e) Supporting better mental health and wellbeing

22.     Taking into consideration the increased stress and worry that the COVID-19 pandemic has caused, there is a greater need to improve the population’s mental wellbeing and foster a conducive environment for support. The COVID-19 Mental Wellness Taskforce (CoMWT) has made recommendations to develop a national mental health and well-being strategy, a national mental health resource portal to help individuals access useful and accurate information, and a national mental health competency training framework to align and standardise training curriculums on mental health in the community. These recommendations will be implemented under the new Interagency Taskforce on Mental Health and Well-being. In addition, HPB continues to offer mental wellness programmes at schools, workplaces and community, aimed at helping Singaporeans cope with challenges faced in the new normal

23.     To further address the concerns of youth mental health issues, the Youth Mental Well-being Network was formed in February 2020 and brought together over 1,500 passionate like-minded individuals including mental health professionals, practitioners, parents and youths, to work on projects to support youth mental health. The Network is supported by the Ministry of Social and Family Development (MSF), MOH and the Ministry of Education (MOE). In addition, MOH and the Agency for Integrated Care(AIC), together with community partners, have set up youth community outreach teams to reach out to youths in mental distress to provide basic emotional support and resources, and link them with social and health services.

Let’s take charge of our health

24.     As we adjust to living with COVID-19, MOH and HPB will continue to working closely with various agencies to create an ecosystem that enables Singaporeans to live healthy lifestyles. Many of these efforts will take time to show longer term health outcomes, and we will continue to push on with our efforts, such as those under the War on Diabetes.

25.     To empower people to take charge of their health, we are also leveraging technology, such as HealthHub which offers a wide range of reliable and locally relevant content to improve their health literacy. This allows individuals to take charge of the health of their families and themselves, through using secure and personalised health information and tools. More tips, resources and programmes are available for from HealthHub at www.healthhub.sg.

26.     As health is ultimately a personal responsibility, everyone has a role to play in achieving and sustaining better health of our nation. Individuals can play a part by making conscious decisions towards a healthier lifestyle.

27.     The full NPHS 2020 report is available on the MOH website at https://www.moh.gov.sg/resources-statistics/reports/national-survey-2019-20 .

MINISTRY OF HEALTH
18 NOVEMBER 2021

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[1] Singapore Residents aged 18 to 74 years old.

[2] The fieldwork was completed before Circuit Breaker which took place between 7 April 2020 and 1 June 2020.

[3] Age-standardised prevalence for hypertension has increased from 21.9% in 2017 to 31.7% during 2019-2020, while the age-standardised prevalence for hyperlipidaemia has increased from 33.8% in 2017 to 36.9% during 2019-2020.

[4] Age-standardised prevalence for diabetes was 7.8% in 2017 and 7.9% during 2019-2020.

[5] Obese refers to BMI ≥ 30 kg/m2

[6] Recognising that the risk for cardiovascular diseases and diabetes mellitus starts from a lower BMI for Asian populations, the WHO expert consultation recommended an additional classification of BMI for public health action among Asians where having a BMI ≥ 27.5 kg/m2 was considered as having high risk BMI.

[7] In NPHS 2017, 8.6% were obese and 18.7% had high risk BMI.

[8] Based on WHO's recommended level of physical activity, and indicated as sufficient total physical activity in the NPHS report.

[9] In 2020, the largest contributor to total physical activity was commuting (49.6%), followed by leisure-time physical activity (26.8%) and work-related physical activity (23.6%).

[10] Leisure-time regular exercise refers to the participation in any sports or exercise for ≥ 20 minutes per occasion for ≥ 3 days a week.

[11] Age-standardised prevalence for Singapore residents engaging in at least 150 minutes of moderate-intensity physical activity per week has decreased from 80.9% in 2017 to 76.8% during 2020, while the age-standardised prevalence for leisure-time regular exercise has increased from 29.8% in 2017 to 33.8% during 2020.

[12] Binge drinking refers to consumption of five or more alcoholic drinks for males or four or more alcoholic drinks for females in any one drinking session during the past month preceding the survey.

[13] Influenza vaccination coverage refers to Singapore residents aged 18 to 74 years who reported having had an influenza injection in the past 12 months. Annual influenza vaccination is part of the nationally recommended vaccinations for individuals at risk of serious flu complications including the elderly, young children and people with certain chronic conditions.

[14] The National Adult Immunisation Schedule (2017) recommends all persons aged 65 years or older to be vaccinated against pneumococcal disease.

[15] A 12-item General Health Questionnaire (GHQ-12) was used to measure mental health. A respondent is identified to have poor mental health if he or she have a score of 3 or more from the questionnaire.

[16] Age-standardised rate for poor mental health prevalence was 13.8% in 2020 and 12.6% in 2017.

[17] Based on National Nutrition Survey 2010, Singapore residents’ average daily sodium intake is 3,000mg.