SPEECH BY MS RAHAYU MAHZAM, PARLIAMENTARY SECRETARY FOR HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2022, ON WEDNESDAY 9 MARCH 2022

Mr Chairman, preventive health is an important part of ensuring overall health and well-being. Good preventive health will lead to lower health risks, earlier detection, and management of diseases, as well as longer-term sustainability of our healthcare system.

2. To support good preventive health, we constantly evolve and adjust our approach to build a healthy ecosystem for Singaporeans. In response to Ms Ng Ling Ling’s question on how we encourage individuals to take ownership of their health, we do so by making it easier to adopt and prioritise healthy living and bringing more lifestyle programmes closer to our residents.  

3. Our efforts can only succeed with strong participation of Singaporeans. Today, I seek the continued support of Singaporeans as I share our upcoming efforts to collectively nudge the community towards healthier ways of life and strengthening support for women, seniors, and their families. 

(B) REDOUBLING EFFORTS TO PROMOTE HEALTHIER LIFESTYLES

B(i) Increasing measures to further curb sugar and salt consumption

4. The key components of a healthy lifestyle include good nutrition and diet as well as sufficient physical activity. 

5. First, good nutrition and diet. We actively encourage Singaporeans to adopt a healthier diet, particularly for sugar and sodium consumption.

6. Mr Ang Wei Neng asked about the War on Diabetes which we declared in 2016. Since then, based on the recent National Population Health Survey, age-standardised prevalence of diabetes has remained stable at 7.9% from 2017 to 2020. In 2019, the Ministry of Health (MOH) announced plans to introduce regulatory measures for beverages high in sugar content. From 30 December 2022, Nutri-Grade beverages sold in Singapore in prepacked form and from automatic beverage dispensers will be subject to new labelling requirements and advertising prohibitions.

7. The Health Promotion Board (HPB) also extended the Healthier Ingredient Development Scheme (HIDS) in 2018 to support the development and commercialisation of lower-sugar products. As of December 2021, seven beverage suppliers were on board the scheme.

8. Through these efforts and support from the industry, we have observed early success with the industry accelerating the reformulation of sweetened beverages. 

9. Singaporeans can now choose from a larger variety of healthier drinks. From when engagement started with the industry in 2017 to 2019, the proportion of healthier choice beverages in the market increased from 58.6% to 71.7%. The median sugar level of sweetened beverages has also decreased from 8.5% to 6.3% over the same period.

10. To further reduce the intake of sugar, MOH also announced in 2020 that the labelling and advertising measures for sugar will be extended to freshly prepared beverages. HPB has conducted an implementation consultation with the industry on the proposed specification. More details of the measures will be released when ready. 

11. Together with public education, we will continue to explore using regulation and industry support to make healthier ingredients and foods easily accessible to Singaporeans.

12. Mr Ang Wei Neng will also be pleased to know that we will also be doing more to reduce Singaporeans’ sodium consumption. Singapore residents are on average consuming 3.6 grams of sodium a day. This is almost double that of the World Health Organization’s recommended limit, translating to more than 1.5 teaspoons of salt daily. 

13. High sodium intake is associated with increased risk of hypertension, which is in turn associated with higher risks of stroke and heart attack. The National Population Health Survey revealed that slightly more than one in three Singapore residents aged 18 to 74 years had hypertension during the period 2019 to 2020. This is a significant increase from 2017 and reminds Singaporeans of the need to adopt better dietary practices.

14. We will introduce a three-pronged strategy to reduce sodium consumption.

15. First, sodium substitution. We will increase support through HIDS to shift the food service sector towards using lower-sodium alternatives such as lower-sodium salt, which contains about 30% less sodium compared to regular salt at the same quantity. 

16. Second, increasing the range and variety of lower-sodium salt, sauces, and seasonings. HPB will work with major salt suppliers and retailers to expand the range of lower-sodium salt. We will also ramp up existing efforts using HIDS to spur reformulation of lower-sodium sauces and seasonings. 

17. Thirdly, public education. HPB will launch a multi-year nationwide campaign to raise awareness of the effects of overconsuming salt in our diet and educate the public on available alternatives and ways to replace salt without compromising on taste. 

B(ii) Continuing our efforts to promote physical activity

18. Sufficient physical activity is also important for a healthy lifestyle. There are various efforts to support Singaporeans to exercise. For example, the National Steps Challenge™ continued amid COVID-19 and is now in its sixth season. 

19. Additionally, HPB’s leisure-time physical activity programmes such as mall workouts at health promoting malls, Sundays at the Park, and Community Physical Activity Programme are still available where possible, in line with prevailing safe management measures. Where feasible, some on-ground programmes are taken virtually, for participants who work from home or prefer to work out remotely or individually to keep active.

B(iii) Enhancing tobacco control policies to reduce smoking prevalence

20. Another area of concern impacting healthy living is smoking. Tobacco use is the single greatest cause of preventable death globally. About 10.1% of Singaporeans smoke daily based on results from the National Population Health Survey 2020.

21. In Singapore, we are committed to our long-term goal of bringing the overall smoking rate to a level that is as low as possible. We need to consider Singapore’s context and local trends of tobacco use in developing our tobacco control strategy.

22. Globally, there is an increasing trend of smokers using vaporisers. Together with HPB and the Health Sciences Authority, we are employing heightened multi-pronged measures against vaping. These include increasing education on the harms of vaping, enhancing the penalty framework for vaping, and better whole-of-Government coordination in preventing smuggling and illicit sale and use of vaporisers. 

23. To strengthen public education efforts and reduce demand for vaping, HPB is planning to roll out a vape-free campaign later in 2022 targeted at youths and younger adults through popular digital platforms. 

24. To support smokers who wish to kick their smoking habits, we previously announced plans to provide subsidies under new tobacco cessation pilots at public healthcare institutions. I am pleased to share that we have received proposals from our healthcare institutions and are evaluating them closely.

25. Concurrently, we will continue to strengthen our existing multi-front approach to curb tobacco consumption and vaping. 

26. With a healthy diet, active and smoke-free lifestyle, we can all live better. To help us make timely adjustments to our lifestyle behaviours and seek treatment early if needed, I encourage Singaporeans to seek appropriate, evidence-based health screening. Chronic disease screening participation rates had hovered around 63% to 66% from 2017 to 2020.   We note Dr Lim Wee Kiak’s interest in health screening. We will be doing more to increase take up, such as working with partners to further encourage the use of Screen for Life, a national health screening programme that provides heavily subsidised chronic disease and cancer screenings.  

B(iv) National Adult Immunisation Schedule (NAIS)

27. As Dr Lim Wee Kiak also pointed out, immunisations are important to protect ourselves against vaccine-preventable diseases. The National Adult Immunisation Schedule (NAIS) was introduced in November 2017 to provide national-level guidance on important vaccinations for persons aged 18 years and older. Based on the National Population Health Survey 2020, the uptake for influenza vaccination in persons aged 65 to 74 years has increased from 14% in 2017 to 23% in 2020.

28. To make vaccinations recommended under NAIS more affordable and accessible, subsidies have been extended to these vaccinations since November 2020, at both CHAS GP clinics and polyclinics. MOH actively works with our primary care partners and other stakeholders such as HPB to increase uptake of these nationally recommended vaccinations, especially among seniors for influenza and pneumococcal vaccinations. We urge Singaporeans to proactively find out more and take up these vaccinations.

(C) TARGETED POPULATION EFFORTS TO STRENGTHEN EFFECTIVENESS OF OUR HEALTH PROMOTION STRATEGIES
  
29. To support everyone to be as healthy as possible, we also cannot adopt a one-size-fits-all approach, as everyone faces different risks and challenges. Our health promotion efforts are inclusive to all, and targeted efforts taking into consideration different backgrounds and cultural preferences are layered on for select groups to increase their access to healthy living resources. 

C(i) Healthy Living Passport for lower-income groups

30. HPB’s Healthy Living Passport programme was piloted with about 50 families last year to serve the needs of our lower-income families. Activities that parents and children engage in include planning for healthier and economical meals as well as games emphasising the importance of parent-child communication, and a balance of physical activities with age-appropriate use of smart devices. Volunteers who befriend the families also participate in the programmes and continue to provide health tips based on the families’ needs after the programme.  

31. Preliminary results from the pilot indicate that more than 90% were satisfied with the programme and about one-third of them have started to adopt healthier habits in the areas of nutrition, mental well-being, and physical activity. HPB will be reaching out to more families this year.

C(ii) Strengthening health care support for ethnic minorities

32. Madam Chairman, please allow me to say a few words in Malay. 

33. Dr Wan Rizal bertanya tentang usaha mendekati masyarakat minoriti. Tahun lalu, saya telah berkongsi rancangan membentuk sebuah kumpulan kerja baru yang bertujuan untuk mengukuh usaha kesihatan bagi masyarakat Melayu. Setelah mengenal pasti isu-isu utama yang perlu diberi perhatian HPB telah menyatukan para pemimpin masyarakat yang berpengalaman dan punya kepakaran, untuk membentuk Kumpulan Kerja Jangkauan Masyarakat Melayu, atau MCO. Di bawah naungan MCO, terdapat lima jawatankuasa kecil baru yang memberi tumpuan kepada kesejahteraan mental, mengurangi (tabiat) merokok, memperbaiki tabiat pemakanan, meningkatkan kegiatan fizikal dan pemeriksaan kesihatan dalam kalangan masyarakat Melayu. 

34. MCO akan bekerjasama dengan pelbagai pihak untuk meningkatkan jangkauan program-program HPB yang berkesan. Contohnya, HPB telah bekerjasama dengan M3, Jawatankuasa Eksekutif Kegiatan Melayu atau MAEC, dan masjid-masjid untuk menganjurkan bengkel kesejahteraan secara online bagi lebih daripada 200 penduduk Melayu. Tahun ini, HPB akan meluaskan jangkauan mereka dengan berkerjasama dengan semua MAEC.

35. Bagi menggalakkan tabiat pemakanan yang lebih sihat dalam kalangan masyarakat Melayu di bulan Ramadan, HPB bekerjasama dengan MAEC, Mendaki, masjid dan pertubuhan Melayu-Islam seperti Dana Amanah Tabung Amal Aidilfitri (TAA) dan Perdaus untuk mengagihkan barangan runcit yang lebih sihat kepada lebih daripada 24,500 keluarga Melayu. Kami akan bekerjasama dengan lebih banyak MAEC, masjid dan pertubuhan Melayu-Islam untuk menggalakkan tabiat pemakanan lebih sihat pada bulan Ramadan tahun ini.

36. Saya ingin berkongsi dan meraikan kejayaan Encik Azrin, seorang penyokong kuat gaya hidup sihat dalam masyarakat. Encik Azrin telah berkhidmat di MAEC Marsiling selama lebih 10 tahun. Sebagai pengerusi MAEC Marsiling, beliau bergiat dengan HPB dan pemimpin lain bagi menganjurkan pelbagai aktiviti khusus untuk keperluan para penduduk, seperti ceramah dan pemeriksaan kesihatan. Pada bulan Ramadan tahun lalu, beliau membantu HPB untuk mengagihkan pek-pek runcit sihat kepada keluarga berpendapatan rendah dan menggalak mereka memilih makanan lebih sihat semasa tempoh perayaan. Sebagai naib pengerusi Masjid An-Nur, beliau juga menyertai masjid dalam inisiatif Jaga Kesihatan, Jaga Ummah (JKJU). Encik Azrin juga mengamalkan apa yang beliau sarankan dalam kehidupan sehariannya. Beliau sekeluarga kekal aktif melalui berjalan-jalan dan berbasikal, dan memilih barangan lebih sihat yang membawa logo Pilihan Lebih Sihat apabila membeli barangan runcit. Semoga usaha Encik Azrin memberi inspirasi kepada masyarakat untuk menjalani gaya hidup yang lebih sihat.

37. Similarly, HPB also considers cultural sensitivities and partners stakeholders to implement health promotion activities for the Indian Community.  

38. For example, HPB has been working with key stakeholders like the Singapore Indian Development Association (SINDA) to tap on their programmes and culturally significant events such as Deepavali to reinforce healthy cooking and eating as a family. HPB also actively engages Indian food and beverage outlets to participate in the Healthier Dining Programme, which provides and rewards customers for selecting healthier options. 

39. Individuals such as Mdm Lalitha have also stood out to promote health within the community. Believing that mental well-being is just as important as physical health, she co-founded Club2Care in 2017, a non-profit organisation to create awareness of the importance of mental well-being and seeking help when needed within the Indian community. Club2Care is a supporter of HPB’s “It’s OKAY to reach out” campaign for good mental well-being. Thank you Mdm Lalitha for your support and extension of our work. 

(D) SUPPORT FOR CITIZEN-LED SOLUTIONS

D(i) Our Healthy Singapore Fund

40. HPB is partnering the Ministry of Culture, Community and Youth to establish a $1.5 million Our Healthy Singapore Fund. The fund will support more community volunteers and partners like Mr Azrin and Mdm Lalitha to develop programmes that are closely in tune with their communities’ needs, and therefore be more targeted and effective in developing a healthier nation.  

(E) STRENGTHENING SUPPORT FOR WOMEN AS PART OF DRIVING BETTER POPULATION HEALTH OUTCOMES 

41. Other than keeping the general population healthy, MOH is adopting a whole-of-Government approach to provide holistic support to women as well as their partners and families for better population health outcomes.

E(i) Child and Maternal Health and Well-being (CAMHW) Strategy

42. Minister Masagos and SMS Janil shared on the Child and Maternal Health and Well-being Strategy to give our young a head start. Please allow me to elaborate on some of our communications and engagement efforts under the Strategy. 

43. Over the course of last year, HPB has conducted focus group discussions and in-depth interviews with parents-to-be, fathers, mothers, medical and social service professionals to gain insights to their needs and preferred type of support.

44. HPB has also launched Parent Hub recently. It is a one-stop evidence-based resource portal providing local health information. Resources are broken down into actionable steps that parents can adopt for children and youth’s health and well-being. This addresses feedback from couples and parents about being “lost” in the varied opinions that are available online and consolidates reliable information in one place. 

45. Parents like Ms Richelle and Mr Tan have given their stamps of approval for Parent Hub.  As parents of two children of different ages, Ms Richelle and Mr Tan shared that most online resources and e-books they referred to previously were age-specific and time consuming to go through, but they now can find all the information they need for their children on one portal. As relatively new parents, my husband and I are also benefitting from the nuggets of information and quizzes on Parent Hub.  

46. In addition, we are working across the various public agencies to co-ordinate programmes so that parents-to-be and parents are kept up to date, equipped with relevant information and skills, and can easily navigate programmes from different agencies. For example, updates on school-based health programmes are also shared via the Ministry of Education’s (MOE) Parent Kit, a resource kit that parents can conveniently access digitally via the MOE’s Parent Gateway mobile application.

E(ii) Supporting couples to begin their parenthood journey

47. We understand Ms Cheng Li Hui had concerns about how we are supporting couples on fertility health. Firstly, as fertility declines with age and the likelihood of pregnancy complications increases with maternal age, we should continue to encourage couples to marry and start their families early. We are looking into supporting couples with ready access to evidence-based fertility health information to empower them to make fertility decisions and enable them to seek help when needed. 

48. Secondly, Minister Indranee had earlier shared that we will be introducing new funding support for certain types of Pre-implantation Genetic Testing, which will benefit Singaporean couples who would like to conceive but are at risk of transmitting serious inheritable diseases to their offspring.  We also recognise the psychosocial impact that fertility treatments may have on couples and are exploring how we may better support them.

E(iii) Support from Women’s Health Committee for women across life stages 

49. Our partners in the community have done good work to increase awareness of women’s health issues and promote healthier lifestyle practices amongst women. Some of these partners like Breast Cancer Foundation, Singapore Cancer Society, and Persatuan Pemudi Islam Singapura (PPIS) have been encouraging women to come forth for their recommended breast and cervical cancer screening tests.  Other partners such as Osteoporosis Society Singapore, have been reaching out to the wider population from primary school students to adults and seniors to increase awareness about bone health, osteoporosis and fall prevention.

50. To amplify awareness and create sustainability for some of these initiatives, the Women’s Health Committee that I chair will run a women’s health event in the later part of the year. This would strengthen our outreach efforts by bringing together all the members’ efforts, events, and activities with the aim of getting women to take charge of their own health under a common umbrella.

(F) ANCHORING CARE FOR SENIORS IN THE COMMUNITY TO LIVE TO THEIR FULLEST

51. Finally, I would like to bring your attention to another core segment of our society: our seniors. We are committed to celebrating our seniors and enabling them to live to their fullest potential in the community.

52. Mr Yip Hon Weng asked about the Ageing Plan refresh. We have engaged over 5,000 Singaporeans from all walks of life to discuss the refresh of our Action Plan for Successful Ageing.

53. Over the past year, we also started working on our plans to support seniors in the three Cs – Care, Contribution and Connectedness.

F(i) Care for Seniors

54. The first C – Care. Many seniors take pride in staying active and taking charge of their own well-being. To support this, MOH actively onboard aged care facilities onto the new Eldercare Centre Service Model, where seniors can receive Active Ageing, Befriending and referral to Care services. 

55. Ms Tin Pei Ling spoke about engagement with seniors. This model enabled seniors to remain connected to both care staff and other seniors even during the pandemic. For example, Mdm Jarnail, who stays alone, has received continuous support and social engagement from the Blossom Seeds’ Eldercare Centre care staff. With their support, she continues to engage in both physical and virtual activities, such as the National Day Intergenerational Programme with schools. She also participates in exercise sessions, where she made friends with other seniors, and became healthier and more alert. Mdm Chua from the same Eldercare Centre, also benefits from the Healthy Ageing Promotion Programme For You (HAPPY) which consists of dual-task exercises incorporating cognitive and social engagement elements to delay physical frailty and prevent dementia. This enables her to stay socially connected and healthy, while her son works in the day.

56. We are encouraged by these and many other positive stories and feedback received and are expediting the onboarding of more Eldercare Centres. By June 2022, we will set up over 115 Eldercare Centres. These will be accessible and located near both existing and new BTOs.

57. Ms Ng Ling Ling can be assured that we will provide care and support services for seniors, including those living in new two-room Flexi flats. Befriending is also a key part of the Eldercare Centres, especially for seniors staying alone. This will be complemented with outreach by the Silver Generation Ambassadors.

58. In addition, we provide tele-befriending and emergency response services to seniors through the “CareLine” social support hotline. CareLine runs 24/7 and is supported by call agents trained in vernacular languages. I would like to share with Mr Pritam Singh that CareLine is supporting around 17,000 vulnerable seniors, as of December 2021. Each month, we also receive around 30 calls that require emergency services. To reduce the burden on emergency services, call agents are trained to triage seniors’ conditions after a distress episode and provide remote assistance or activate non-urgent in-person assistance through nearby community providers.

59. Over the past few years, we have taken many steps to strengthen care initiatives for seniors in a comprehensive, accessible, and cost-effective manner. We will share more details during the launch of the Refreshed Action Plan later this year.  

F(ii) Contribution by seniors 

60. The second C – Contribution. Many of our seniors want to contribute meaningfully. This may be through learning, volunteerism, and employment.

61. One interesting project which emerged during our engagement sessions with Singaporeans was “Stories for Our Seniors”. Through this initiative, seniors can volunteer to tell stories using their Mother Tongue Language. This encourages the building of inter-generational bonds with younger Singaporeans, and the imparting of life learnings and values through recounting their own experiences, history, and heritage. These active interactions can help to address concerns raised by Ms Tin Pei Ling about the deterioration in mental acuity, and emotional and physical well-being that seniors may face during the pandemic.

62. I would like to assure Ms Tin Pei Ling and Mr Henry Kwek that we have also been actively resuming active-ageing programmes and revising the guidelines to facilitate seniors’ participation in a safe manner.

63. Next, HPB and the People’s Association will also jointly roll out a new Health and Wellness Programme called “Live Well, Age Well” in our community nodes.

64. Through a holistic programme, it aims to empower seniors to improve and maintain their physical, mental, and social wellbeing. It will be gradually rolled out nationwide from May 2022.

F(iii) Connecting with Seniors

65. The last C – Connectedness. We will continue to support seniors to age-in-place by increasing access to diverse home and community-based care options within an inclusive built environment.

66. For example, as Mr Yip Hon Weng pointed out, palliative care is an important focus. We have grown our home palliative places steadily from 2,900 places in 2019 to 3,400 places in 2021 to fulfil seniors’ wishes to pass on at home.

67. This enables seniors to access affordable care options, even at the end of life, and as they stay close to their families and friends.

68. Last year, we also launched the Community Care Apartments at Bukit Batok, which was oversubscribed. We therefore see potential in expanding the housing-cum-care model to the private sector.

69. As announced by the Ministry of National Development (MND), we will launch a private government land sale in 2022 to catalyse care innovation for seniors, where tenderers will be invited to propose innovative assisted living models. This will complement the public Community Care Apartment model. Seniors can look forward to a continuum of care that supports their physical and mental wellbeing.

(G) CONCLUSION

70. To conclude, MOH will continue to enhance upstream efforts to sharpen our preventive health strategy. We are also committed to strengthening our support for couples before and throughout their parenthood journey, and seniors to age well in their golden years.

71. As the Government puts in place various measures and resources, we would also like to urge Singaporeans to take greater ownership of your health today and make positive strides so that together, we can all live better, for longer. Thank you.