OPENING ADDRESS BY MINISTER FOR HEALTH MR ONG YE KUNG AT SINGAPORE POPULATION HEALTH STUDIES 20th ANNIVERSARY EVENT, ON 9 NOVEMBER 2024

Professor Teo Yik Ying, Dean, Saw Swee Hock School of Public Health

Distinguished guests, ladies and gentlemen

1. A great pleasure to be here to celebrate the 20th anniversary of the Singapore Population Health Studies (SPHS).

2. First of all, I would like to thank Singapore’s Saw Swee Hock School of Public Health for being a key institution for population health studies in Singapore. Established since 2011, and slightly younger than the SPHS, you make a great impact through your education programmes, research initiatives, and international collaborations.

3. When I travel, I am always very happy to meet people overseas who say they have been to the Saw Swee Hock School of Public Health, and did their Master’s there. You have an eminent network of good people out there internationally.

4. That is also why population health initiatives, because of your contribution, have been implemented recently in Singapore. We have Healthier SG and Age Well SG, and we are establishing a stronger pandemic response system, all because of the whole healthcare system working together and with the contribution of the Saw Swee Hock School of Public Health. I look forward to your continued contribution to Singapore’s population health.

Contributions of Volunteers and the School

5. Secondly, I want to acknowledge and thank all our volunteers of the health cohort studies. Many of you are here today. You contributed blood samples, and shared details about your daily habits and diet. These contributions enable our researchers to measure data, such as your blood sugar levels and cholesterol levels, and then even decode genetic data. When paired against your lifestyle information – how you eat, sleep and exercise – it gives researchers tremendous insights into population health, and tremendous ideas on how to develop population health initiatives to help our population become healthier.

6. A notable initiative coming out of these studies is the Healthier SG cardiovascular disease risk calculator. It estimates a patient’s risk of developing coronary artery disease, and in turn determines their care plan.

7. The wealth of data amassed by the SPHS has also paved the way for other groundbreaking national initiatives such as the National Precision Medicine Programme.

8. In short, without your participation, there is no data, no basis for research, no basis for studies, for initiatives and for healthcare policies. So thank you very much for all your contribution all these years.

9. I think we are in a golden age of population health. Why do I say that? Because of technology. Technology allows us to collect data, and Artificial Intelligence (AI) technology allows us to analyse data and gain insights in a very efficient and unprecedented way. At the same time, it is also driven by an ageing population. The whole world – America, Latin America, Southeast Asia, China, even India – is ageing, except Africa, which is still growing with more young people.

10. As the whole world is ageing, some a lot faster than others, the whole world is looking at how to keep their population healthy. It becomes a big healthcare imperative and a top priority for healthcare systems all around the world. Technology now allows us to do that, because of data and of AI. If we are bold enough to implement the right population health policies, we can intervene and keep people healthy even as they age, so that the healthcare system would not have to scramble and be under so much pressure to continuously try to treat illness. As I mentioned earlier, all this is not possible without data. Without you contributing data to us, scientists and professors will be unable to develop initiatives and insights.

11. I recently gave a speech about what we are doing about technology and population health. We are doing a lot.

12. I will just briefly recap what I announced. We are developing new legislation to govern the use of genetic and genomic test data; we have strengthened our cybersecurity to protect sensitive data; we are encouraging ground-up innovations by our public healthcare institutions, using AI technology to better operate and treat patients for better outcomes; and at the same time, we are driving major nationwide use cases, including the development of predictive preventive care, such that in future, when you see your Healthier SG doctor, the doctor can advise you if you are at a particularly high risk of developing, say, diabetes, rather than having a stroke or having a heart attack, by using data. Your doctor will then advise you to take preventive steps now. The preventive steps are simple steps, often involving your lifestyle, diet and exercise. These are things we can start to develop, and as early as in a year’s time.

13. So, today, I will not repeat all that, but let me talk about two additional initiatives that will leverage data to improve population health and strengthen seamless healthcare delivery in our system.

Shaping Individual Lifestyles

14. The first has to do with the individual, and the second initiative has to do with the broader IT system. Let me start with the individual. We can better leverage personal medical and lifestyle data to better enable you to take care of your own health. How do we do that?

15. Today, wearables and health applications have changed the way individuals monitor and shape your lifestyles. Riding on this trend, our Health Promotion Board (HPB) constantly refreshes their Healthy 365 app. About one-fifth of our Singapore adult population are actively using the Healthy 365 app every month. With Healthier SG, individuals can now view their Health Plan and essential medical data using the HealthHub app as well. So, you have two powerful apps that I hope everybody has. One is the Healthy 365 which tracks your daily exercise and physical activities. The second is the HealthHub app that contains your essential medical data.

16. From end of November, the Health Plan will be enhanced to become more personalised. When you go to your HealthHub app, you are able to see your Health Plan if you have joined Healthier SG. These Health Plans will now become more personalised. For those enrolled in Healthier SG, your family doctor can provide more specific and practical diet and exercise recommendations during the consultation.

17. For example, your doctor may recommend that you do aerobic activity of a certain intensity, frequency, and duration each time. Your Health Plan will now show you the types of exercises that you can do, as well as the resources available in the community, around the place you live. So I hope the advice will become a lot more practical. If your doctor makes dietary recommendations, it will highlight which foods to limit, and the healthier alternatives you can opt for.

18. HPB continues to explore technology and wearables that will help shape healthier lifestyles as well. For example, HPB periodically calls for collaborations with private sector partners to develop various techniques to help us stay healthy.

19. One such initiative, arising from a call for collaboration in 2022, is HPB’s partnership with Google and ConnectedLife, a software company, as well as Fullerton Health, which is a corporate healthcare provider.

20. Under this pilot project, the mobile app will combine patients’ clinical data such as your BMI and blood pressure, and lifestyle data such as the level of physical activity collected through your trackers. This data is accessible to the Fullerton Health doctors in a dashboard. They will review them and engage in deeper conversations with the individuals on the changes and the improvements required. So we are connecting the dots together to your Healthy 365, and through your exercise, it captures the data in your tracker. At the same time, through Healthier SG, all measurements of your medical data is captured in HealthHub. All this will appear in a dashboard for the doctor at Fullerton Health to review, and a consolidated picture will allow them to have a deeper conversation about how you should keep yourself even healthier. This is a pilot, and I think if it is successful, we will look at how this can be broadened and scaled up.

21. In a similar spirit, HPB is in collaboration with Abbott, a pharmaceutical company, and Health2Sync, which is a healthcare start-up, to roll out a health coaching programme. This incorporates a continuous glucose monitoring device (CGM) for individuals at risk of diabetes.

22. CGM is essentially a patch, which you stick on your arm, that enables individuals to link the patch to an app, to monitor your glucose levels across the day, and better appreciate how your glucose levels change with food choices and activities. It is actually quite effective, in the sense that whenever you eat a piece of cake, straightaway you can see your glucose level jump. So, the direct feedback has been useful.

23. Using CGM devices to change lifestyle habits for individuals at risk of diabetes, however, has proven to be quite expensive so far. The patch is not cheap. Therefore when we did our studies, we found that it is actually not cost-effective all these years. Nevertheless, we continue to try out new pilot projects, and I hope with sharper intervention techniques and more competitive pricing of the devices with more players in the market, we hope that this intervention, over time, can become cost-effective. If it becomes cost-effective, it can be better supported and used more widely. This initiative is another attempt to, hopefully, over time, develop to become more cost-effective and we can make it available to more people.

System Wide Data-sharing

24. We move on to the next initiative on population health, which is about the broader IT system. We have been enhancing and expanding our National Electronic Health Record (NEHR) system. It is a national system, a common platform where healthcare providers can access essential health data of patients. That includes your diagnoses, medications, lab test results, and drug allergies. When we use our HealthHub to access our data, we are really taking a peek into the NEHR system. All the data in HealthHub draws from this NEHR system that we have developed.

25. There are immense benefits to having such a centralised repository and data sharing platform. Patients, especially those with chronic or complex conditions, often have to visit multiple clinicians. Historically, electronic medical records were siloed within individual healthcare providers. Every doctor, every clinician looks at you, captures the data, and keeps it in their own IT system. The next time you go to another doctor, they do not have the data from the previous doctor. Traditionally, this is just not shared. It is a siloed system. This has led to care fragmentation.

26. By having a centralised data repository, we can minimise errors. For example, once it is recorded that you have a drug allergy, every doctor you see will know. It reduces the chance of an error where a doctor may give you a drug that you might be allergic to because the data is not shared. We can remove frustrating repeated testing. You may be tested at one doctor, and when you go to another one, they do not have the data, and test you again. Those repeated testing can be eradicated. We can make care much more integrated and seamless, and overall, improve patient outcomes.

27. Another major benefit is that the datasets in NEHR can be properly processed, anonymised, and securely used for research to generate important insights, including training AI models to deliver predictive preventive care. Singapore has established a platform called TRUST to do this safely and securely.

28. Data integration and centralisation is an important point. When I go overseas for healthcare conferences, this is always a subject that I will discuss with fellow Health Ministers all around the world. I realised that many countries also recognise these immense benefits and are working on it. But most of them are quite far from having a working system because their IT systems are fragmented – every individual doctor and clinician has their own IT system, which is not linked up to a central healthcare record system.

29. Certain EU members, such as Estonia and Norway, have working systems, and they are the envy of many other countries. In that sense, Singapore’s position is closer to Estonia and Norway, as we already have a centralised system in NEHR. These are the few countries that are ahead of the pack.

30. What we are missing in Singapore is legislation that mandates all healthcare providers to contribute essential data of patients into the NEHR. The system is there; now we need to mandate that all doctors contribute into it. The majority actually already do. Let me just elaborate a little.

31. For primary care, polyclinics all use NEHR and contribute to it. Private GP clinics on Healthier SG, as a condition for joining Healthier SG, all contribute to NEHR. Together, they account for about 70% of the primary care sector, if we exclude those providing aesthetics services.

32. As for acute hospital care, usually inpatient, public hospitals handle 90% of our hospital workload and they are already contributing to NEHR. The private hospitals, which attend to the remaining 10%, are not yet on board. Therefore we have 70% of primary care already on NEHR and 90% of acute hospital care already on NEHR.

33. So it is really a minority, comprising private healthcare providers, who are still not on NEHR. The new legislation, called the Health Information Bill, will require them to come on board and help us realise the full benefit of a centralised data repository system.

34. We have recently consulted all our private hospitals, and they have unanimously supported coming on board NEHR. Later today, they will be issuing their statements to convey their support. Some have already started working with the Ministry of Health to prepare their IT systems for connection and interoperability with the NEHR.

35. We hope to pass the legislation early next year. Notwithstanding, patients should be able to exercise their individual choice, to opt out of having their essential medical data shared under the NEHR system. It is not ideal in terms of providing care for them, but there are various reasons why some individuals may prefer not to share their data, and we will have to respect their choice. But there is no doubt, that as healthcare providers, everyone should contribute.

Closing

36. In closing, there is much promise in population health to transform health and promote preventive care, but provided data is available, and research is empowered. In Singapore, we have a holistic strategy to harness the power of information to transform healthcare and we are actively doing so. I look forward to the continued contributions of SPHS in this exciting journey ahead. Thank you.