OPENING ADDRESS BY MR CHAN HENG KEE, PERMANENT SECRETARY, MINISTRY OF HEALTH, AT THE SINGAPORE POPULATION HEALTH CONVERSATION AND WORKSHOP

Professor Ivy Ng, Group CEO, SingHealth

Professor Philip Choo, Group CEO, National Healthcare Group

Mr Chua Song Khim, Deputy Chief Executive, National University Health System

Friends and colleagues from the health and social care sectors

1. A very good morning.  I am delighted to join you for this second edition of the Singapore Population Health Conversation and Workshop.

2. The term population health has become more widely used in recent years.  There are different definitions, including scientific and technical ones.  One relatively simple definition that is easier to understand is that of population health being “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”.

3. By international yardsticks, Singaporean’s overall population health outcomes are good:

• Our life expectancy, at 84.8 years, is among the world’s highest.  Our health-adjusted life expectancy (HALE) is also high, at 74.2 years.

• Infant and Child Mortality Rates in Singapore are both among the lowest in the world.

4. We have also been making greater effort to encourage our population towards improved habits for better health.  There has been some progress.  According to the Health Promotion Board (HPB):

• We are eating less - from 2,600 kcal per day in 2010 to 2,470 kcal per day in 2018.

• We are eating better. Unrefined carbohydrates as a proportion of total carbohydrates has risen, due to increased consumption of wholegrains, fruits and vegetables.  Saturated fat as a proportion of total fat consumed has declined.

• Screening rates for chronic diseases such as diabetes, hypertension and hyperlipidemia have risen among our target populations.

More To Be Done

5. The picture is of course not all rosy.

• The prevalence of preventable chronic diseases is still high. In fact, hyperlipidemia has been on the rise – from 25% in 2010 to 34% in 2017, with more adults suffering from the condition at an earlier age.

• While more Singaporeans are getting screened for diseases, getting us to follow up early after an abnormal screening result remains a challenge.

• And while some aspects of our diets have improved, others have not.  For example, we are consuming way too much salt. 9 in 10 of us exceed the recommended daily salt intake of 5g. Our average intake was 9g in 2018.

6. So clearly, there is yet more that we need to do.  Here, I am heartened to see our healthcare clusters proactively identifying the population needs in your regions and doing your part to address these needs.  One example is the work of Regional Health Systems (or RHS) - led community nursing teams that work with partners including Senior Activity Centres, Residents’ Committees, Community Centres and places of worship. There are now 74 community nursing posts across Singapore providing residents with health coaching, health assessments for early interventions, functional screening, chronic disease management support and care planning.

7. I would like to thank all of you for such efforts.  I also believe we can do more together, and we can do better together.   The Ministry of Health (MOH) would like to work with you on more such population health efforts.  And to me, there are a few aspects worth bearing in mind as we expand our population health efforts.

Population Health Across All Life Stages

8. First, our population health efforts should span all life stages – from young to old.  Or better still, start from the womb.  Traditionally, we have done quite a bit for our young population.  After birth, there is easy access to developmental assessments and childhood immunisations.  In our schools, developmental screening and preventive health services such as dental care are systematically offered through HPB’s school health services. The familiar “health booklet” helps parents keep track of their children’s developmental milestones and growth as well as vaccinations.  All these ensure that our children have a healthy start in life.

9. In recent years, we have started doing more for the adult and elderly populations.  For adults, early detection and timely management of cardiovascular risk factors is important. This is why we have started initiatives such as the Diabetes Risk Assessment tool and enhanced Screen For Life (SFL) Programme.  We are also doing more for seniors. Just last year, MOH worked with Temasek Foundation Cares and some of you to launch Project Silver Screen, which helps our seniors detect age-related decline in vision, hearing and oral health.

10. There is scope for us to build on these efforts and identify and support a Singaporeans’ key health needs more systematically through his or her life course.  At each stage, we can identify the key needs, pick out the right interventions (which could be in health promotion and disease prevention, disease screening, and care and treatment), and see how best we can nudge, empower and support Singaporeans towards leading healthier lifestyles and habits.  Maybe one day, the familiar “School Health Booklet” can become a “Lifetime Health Booklet”.  Online version on HealthHub of course!

Population Health Across Different Groups

11. Second, our population health efforts must recognise that within national or regional populations, there will be groups with poorer health environments, habits or outcomes for one reason or another.  To help these groups improve their health, broad programmes designed for the general population are not likely to be effective. 

12. Often, a wide range of underlying factors and conditions will need to be addressed. These could include what is now commonly known as social determinants of health, such as poverty, poor family ties, and lack of social networks and support. We will need targeted efforts which take into account their unique circumstances, needs and psychology. 

13. I mentioned earlier the wider community nursing effort.  Not too far from here, SingHealth community nurses have expanded from their pilot at Chin Swee to partnering health and social service providers such as Montfort, NTUC Health, Thye Hwa Kwan, and the National University of Singapore’s Neighbourhood Health Service on initiatives and services to reach out specifically to low income seniors, particularly those in rental flats.  This is an example of a targeted effort. 

Population Health Through Working Together

14. Third, in order for population health efforts to span a life course and to address more unique needs of sub-populations, different providers from both the health and social sectors will need to work in concert.  To address more effectively the social determinants of health, we will need to go beyond the healthcare sector’s traditional model.  We will need in some instances to tightly couple health and social interventions.

15. One good example is KIDS 0-3, a programme I had the opportunity to support a few years ago.  A collaboration among KK Women’s & Children’s Hospital (KKH), Ang Mo Kio FSC Community Services and the Early Childhood Development Authority (ECDA), KIDS 0-3 was an early intervention scheme for kids from vulnerable families – from the time their mothers were pregnant, through the time they were born and till they turned 3.  Doctors, nurses and social workers worked together to extend integrated health and social support to both mother and child. These included pre- and post-natal support, nutrition and vaccination, early stimulation for the infant, and parenting advice and family counselling. 

16. Curious how the programme was going, I turned up at an event last year to hear from Dr Winnie Goh, one of the prime movers of KIDS 0-3.  The results were encouraging. For example, the children had higher immunisation rates and were healthier.  They showed improvements in language and cognitive abilities.  I am happy that some of the features of Kids 0-3 have been incorporated into the national KidSTART programme run by ECDA for children from 0-6 from low income and vulnerable families.

Shared Goals and Common Directions

17. To summarise, I believe that a comprehensive, systematic and effective population health strategy should encompass all life stages of our population.  It needs to address not just broad needs but also the unique needs of more vulnerable sub-populations.  This requires the coordinated efforts of different providers across both the health and social domains.

18. Events such as the one today play an important part in helping us develop all three elements.  They create the platform for us to discuss common goals, align directions and foster collaborations.  They can help us arrive at a shared view on how we can segment the population, agreement on the key health needs of the population and more specific needs of sub-populations, as well as a set of common population health measurements.  This will in turn help each of us with our own population and health planning, programme development as well as coordination efforts.

Closing

19. In closing, I would like to thank the organisers and partners for organising this event. You have put together a very thoughtful programme, with a lineup of good speakers and relevant topics which I am sure will add to the richness of the discussions.

20. With this, I wish all of you an enjoyable and fruitful session ahead.  Thank you.