NATIONAL HEALTH SURVEYS HIGHLIGHT NEED TO FOCUS ON HEALTHY DIETS AND LIFESTYLES

                                NATIONAL HEALTH SURVEYS HIGHLIGHT
                   NEED TO FOCUS ON HEALTHY DIETS AND LIFESTYLES

1.      Findings from the Ministry of Health’s (MOH) National Population Health Survey (NPHS) 2022 and Health Promotion Board’s (HPB) National Nutrition Survey (NNS) 2022 highlight that the prevalence of diabetes and hyperlipidaemia has fallen, and screening for cancer and chronic diseases has improved. However hypertension prevalence among Singapore residents has almost doubled since 2010, and obesity continues to be on the rise. The NNS 2022 also found that sodium intake has increased, with nine in 10 Singapore residents exceeding the daily recommended sodium intake, while sugar intake has improved.

2.      The NPHS 2022 tracks the health, risk factors and lifestyle practices of Singapore residents aged 18 to 74 years old for the period of July 2021 to June 2022, and the NNS 2022 monitors the dietary patterns and nutritional status of Singapore residents aged 18 to 69 years old for the period of December 2021 to August 2022.

Results of NPHS 2022

Prevalence of diabetes and hyperlipidaemia decreased but hypertension increased

3.      The NPHS 2022 showed a positive trend of continued decreasing prevalence of diabetes and hyperlipidaemia among Singapore residents, from 9.5% in 2019-2020 to 8.5% in 2021-2022, and 39.1% to 31.9% respectively. However, the prevalence of hypertension continued its long-term rising trend, from 19.8% in 2010, to 35.5% in 2019-2020, and 37.0% in 2021-2022. This was observed even after adjusting for the effect of an ageing population.

4.      The prevalence of obesity has also continued its steady increase, from 8.6% in 2013 to 10.5% in 2019-2020 and 11.6% in 2021-2022.

More participated in health screening and received pneumococcal vaccination

5.   Chronic disease screening participation showed a positive trajectory towards pre-COVID-19 levels in 2022 for diabetes and hyperlipidaemia but not for hypertension, as seen in Figure 1.

6.             Screening participation for breast, cervical and colorectal cancers has also increased towards pre-COVID-19 levels in 2022 after dropping during the COVID-19 period (2020-2021), as seen in Figure 2.

Figure 2: Cancer screening participation (%) among Singapore residents

7.             Self-reported pneumococcal vaccination uptake among Singapore residents aged 65 to 74 years old increased from 10.3% in 2019 to 26.5% in 2022.

Total sufficient physical activity and prevalence on daily smoking decreased

8.             The proportion of residents engaging in sufficient total physical activity[1] decreased significantly from 84.6% in 2019 to 74.9% in 2022, likely due to the reduced commuting from hybrid work arrangements, which has not yet returned to pre-COVID-19 levels.

9.             The prevalence of daily smoking has decreased from 10.6% in 2019 to 9.2% in 2022, continuing the positive trend of declining smoking rates over the past decade.

Greater willingness to seek help for mental health issues

10.             The prevalence of poor mental health has increased from 13.4% in 2020 to 17.0% in 2022.  At the same time, there was also an observed increase in help-seeking behaviour for residents who are unable to cope with stress. 56.6% of Singapore residents were willing to seek help from health professionals in 2022 compared to 47.8% in 2019, and 79.7% were willing to seek help from informal support networks in 2022 compared to 74.5% in 2019. This reflects continued public awareness of mental health, and reduced stigma around mental health conditions.

Results of NNS 2022

11.           The NNS 2022 found that Singapore residents are eating more. The mean calorie intake has increased from 2,360kcal in 2019 to 2,410kcal in 2022, with more individuals (61%) exceeding their daily recommended calorie intake after factoring energy requirement from physical activity[2]. At the same time, residents are consuming more sodium but less sugar. Overall the diet composition has shifted to one that is lower in carbohydrates and higher in fat.

Sodium intake has increased

12.         Daily sodium intake of the population has increased from 3,480mg in 2019 to 3,620mg in 2022, a key source being salt and sauces added during cooking, and in meals eaten outside of home. Nine in 10 Singapore residents exceeded the daily recommended sodium intake of less than 2,000mg (equivalent to one teaspoon of salt).

Sugar intake has improved

13.             The total sugar intake has reduced from 60g in 2018 prior to the announcement of the Nutri-Grade labelling and advertisement prohibition measures, to 56g in 2022. 67% of residents are within the recommended maximum sugar allowance of no more than 10% of daily total energy intake (10 teaspoons of sugar) in 2022, compared to 61% in 2019. Sugar sweetened beverages remain the single biggest source of dietary sugar, contributing 52% of sugar intake.

Wholegrain intake remains low

14.             Singapore residents are not consuming enough wholegrains. Only 4% of staples consumed are wholegrains in 2022 compared to 5% in 2019, which is significantly lower than the recommended 30%.

Protein intake is largely adequate

15.             Protein intake was largely adequate for the population, with more than three in four Singapore residents meeting their recommended protein intake. However, one in two older adults did not meet the recommended protein intake due to lower protein intake compounded by higher protein requirements with age.

Total fat intake has increased and continues to be excessive in saturated fat

16.          The total dietary fat intake has increased from 94g in 2019 to 100g in 2022, of which 36% consisted of saturated fat, exceeding the recommendation of no more than 30%.

Findings highlight need for residents to adopt healthier lifestyles

17.          The NPHS and NNS 2022 findings highlight the need for individuals to take ownership of their health and adopt healthier lifestyles. Earlier this year, MOH launched Healthier SG, a national multi-year strategy that shifts our healthcare system’s focus towards preventive care.

Encouraging residents to adopt healthier diets

18.          A diet high in sodium is a significant risk factor for hypertension. We encourage Singapore residents to use the Healthier Choice Symbol to guide purchases of ingredients and food products with at least 25% sodium reduction. When cooking, herbs, spices and umami ingredients can be used to add flavour to food, without too much salt or seasonings. When eating out, diners are advised to look out for stores with the Healthier Choice identifier, and ask for less gravy, sauces or soup, as these tend to be high in sodium.

19.          HPB will continue to work on salt substitution, with a focus on replacing regular salt with lower-sodium alternatives, as part of its sodium reduction strategy. HPB has garnered strong support from ingredient manufacturers and food operators to increase the variety and demand of lower-sodium ingredients and dishes. In retail, one in four sauces and seasoning is lower in sodium currently. In the food service sector, nine sauce suppliers and three salt suppliers are supplying lower-sodium ingredients to close to 800 eateries. More will be coming onboard in the coming months. Public education efforts will also continue, with a nationwide campaign to raise awareness of the effects of high sodium intake, and the available lower-sodium alternatives and ways to replace salt in our diet.

20.          The efforts to reduce sodium intake will complement other initiatives implemented to encourage Singapore residents to adopt healthier diets. The Nutri-Grade labelling and advertising prohibition measures for pre-packaged beverages will be extended to freshly prepared beverages by the end of this year, as part of our efforts to target sugar and saturated fat intake. HPB will also continue to provide grant support through the Healthier Ingredient Development Scheme to promote the use of healthier oil in the eat-out setting. New tools such as meal logging on the Healthy 365 app will also empower Singapore residents to take a more active role in managing their weight, and incentives via the Eat Drink Shop Healthy Challenge will encourage healthier eating behaviours. 

Encouraging Singapore residents to lead active and nicotine-free lifestyles

21.   To support Singapore residents in leading more active lifestyles, HPB has scaled up the overall capacity of its physical activity programmes by more than 50% from February 2023, through collaborations with more community partners such as Sport Singapore (SportSG), People’s Association (PA) and the Active Ageing Centres. Additionally, HPB has enhanced the Healthy 365 app with links to these community partners’ offerings, to provide residents with access to even more healthy lifestyle activities.

22.          We will continue our efforts to keep smoking prevalence low through a multipronged strategy. HPB continues to educate the public on the importance and benefits of leading a nicotine-free lifestyle. HPB’s national smoking cessation programme, I Quit, is also one of the ways we support smokers in their quit journey. MOH will ramp up outpatient smoking cessation services, and tailor smoking cessation interventions to hospital inpatients. Subsidised nicotine replacement therapy has been made available at the public healthcare institutions since February 2023.

Encouraging screening, vaccination and chronic disease management

23.          Upstream interventions will be enhanced through Healthier SG to improve the preventive care and management of patients with chronic diseases. Singapore residents with chronic diseases such as diabetes mellitus, hypertension and dyslipidaemia will undergo screenings, investigations and other recommended management as clinically appropriate and recommended under Healthier SG.

24.          The increase in uptake of pneumococcal vaccination is promising. We will continue to reach out to eligible Singapore residents through letters and SMS. To encourage further uptake, residents can enjoy fully subsidised pneumococcal vaccination and other vaccinations as recommended under the National Adult Immunisation Schedule (NAIS) at their enrolled clinic under Healthier SG.

Supporting better mental health

25.          The Interagency Taskforce on Mental Health and Well-being is developing a national strategy to strengthen the mental health and well-being of the population. In addition, efforts to increase mental health literacy, raise awareness of mental health services, and enhance community mental health services are ongoing. HPB will also continue to equip Singapore residents with coping skills to improve their mental well-being and foster a supportive environment to encourage help seeking and help giving.

Taking charge of our health

26.          The NPHS and NNS survey findings highlight the need for everyone to pay attention to their health and adopt healthy lifestyle habits. Having a healthy diet, increasing physical activity, managing stress and ceasing smoking all have a direct impact in reducing the risk of chronic diseases. Going for regular health screenings and follow-up is also necessary for early detection and appropriate intervention, to prevent or delay the onset of diseases.

27.      MOH and HPB will continue to work closely with community partners to create an ecosystem that enables all residents to live healthy lifestyles. We encourage individuals to participate in the various activities and programmes available in the community.

28.      The full NPHS 2022 report is available on the MOH website at https://go.gov.sg/moh-nphs2022 and the full NNS 2022 report is available on the HPB website at https://go.gov.sg/nnsreport2023

[1] Defined as participating in at least 150 minutes of moderate-intensity physical activity or at least 75 minutes of vigorous-intensity physical activity or an equivalent combination of moderate- and vigorous-intensity physical activity per week (WHO 2022; WHO 2010)[2] Recommended calorie intake is estimated based on individual’s age, gender, weight and level of physical activity.