SPEECH BY MS RAHAYU MAHZAM, PARLIAMENTARY SECRETARY FOR HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2021, ON FRIDAY 5 MARCH 2021

      We remain committed to our long-term priorities even as we focus on containing the pandemic. We continue to transform from Beyond Healthcare to Health, to support Singaporeans to lead healthier lifestyles and stay healthy in the “new normal”.

State of our Health

2.   It is important to take stock of our state of health. I am happy to report that Singapore ranked first globally for life expectancy at birth and healthy life expectancy at birth in the Global Burden of Diseases 2019 study. However, based on our National Population Health Survey 2020, there are still areas for improvement. While our smoking prevalence rates decreased to 10.1%, down from 13.9% in 2010, compared to 2017, 

a.  The proportion of Singaporeans with sufficient total physical activity has dropped; 
b.  The proportion of Singaporeans that are obese or overweight has increased. In 2019 and 2020, about two out of five are overweight; and
c.  The age-standardised prevalence of the three common chronic diseases, high blood pressure and high blood cholesterol has risen and the prevalence of diabetes has not decreased.

3.    There is a need to better understand the current situation among different groups. Additionally, COVID-19 and the various measures and socio-economic challenges have impacted our lifestyles and our health. Dr Tan Yia Swam has also asked about supporting healthy living in this new norm. I will therefore share:

a.   Our plans to innovate health promotion efforts for Singaporeans to remain healthy in the “new normal”; and
b.   How to better prepare Singaporeans to lead healthy lives for the future.

Remaining Healthy in the New Normal

4.    Indeed, in the past year, Singaporeans faced challenges pursuing healthier habits in ways they were used to. With safe distancing concerns, we were unable to hold our usual health promotion programmes such as mass exercises. As working from home became the norm, we also observed a drop in physical activity time, likely from reduced commuting. This drop is also demonstrated in the daily average step count data from the Health Promotion Board’s (HPB) National Steps Challenge. 

5.    We quickly pivoted to delivering our programmes virtually, in line with the safe management measures (SMMs). 

6.    We shifted physical activity programmes online, and produced exercise routines on YouTube and an edutainment series on free-to-air TV channels to help Singaporeans keep active. We understand that some seniors have found it challenging to adapt from physical to virtual modes of exercise. To help seniors navigate around these platforms, we worked with partners such as the People’s Association to organise workshops to provide assistance, and equip them with basic IT skills.

7.     I am heartened to hear that our regular participants have benefitted. For example, for the senior-centric virtual Community Physical Activity Programmes, over 5,000 participated across more than 190 sessions from July to December 2020. To benefit as many as possible given the current guidelines, we will be scaling up our virtual programmes progressively this year.

8.     We understand that some still prefer physical interaction for health programmes. To reach out to more Singaporeans, we have gradually resumed physical sessions both in the community, such as our popular Sundays at the Park, and at the workplaces with the appropriate SMMs. 

9.     Like physical health, mental wellbeing is also important for one’s health. I echo Senior Minister of State Janil on creating a supportive environment to empower Singaporeans to take care of their mental wellbeing. 

10.    In August last year, we launched the “Brave the New” campaign with the Ministry of Culture, Community and Youth (MCCY) to build psychological resilience of individuals. The campaign provided tips for self-care, and information to support their peers and loved ones.

11.    It reached 2.1 million Singaporeans, and three-quarters of those surveyed reported being more motivated to self-help or help others in their mental wellbeing. 

12.    To complement this, the “Hi!JustCheckingIn” movement started in January this year to equip targeted segments of the population with the appropriate skills to help them identify and reach out to those who may need support. Building a supportive community is important, to encourage Singaporeans to seek help if they are unable to cope.  

13.    Through our community partners, we included seniors in our mental wellbeing efforts. We understand that many seniors are mentally and physically affected during this pandemic, especially during the Circuit Breaker. Last year, we trialled the virtual “Balik Kampung” programme to link up 100 seniors over 22 Senior Activity Centres over activities to stay mentally stimulated. With good feedback on how it has helped many seniors stay socially connected, we will ramp up these efforts.

14.    We will continue to promote holistic wellbeing. The HPB’s National Steps Challenge™ saw over 900,000 participants in its fifth season. The sixth season will start in the third quarter of this year, and will augment the traditional Steps Challenge with a different dimension of wellbeing – sleep, via the first pilot Sleep Challenge.

15.   Having good sleep habits is key to good health and wellbeing. Through the Healthy365 application and a wearable, there will be nudges to achieve the recommended sleep duration, and tips on good sleep habits. Interested participants can look out for more details on Healthy365 and HealthHub.

16.   We will continue to work on avenues for Singaporeans to keep healthy while staying safe.

Preparing for our Future

17.   We recognise that at different life stages, Singaporeans face different health needs, challenges and risks. Going forward, we will add a person-centric approach to address these across our population segments.

18.   Dr Tan Yia Swam has highlighted health literacy in her Budget speech, and Dr Lim Wee Kiak has also suggested boosting our efforts with technology. We have embarked on initiatives similar to Dr Lim’s vision. I am happy to update that the first digital version of My Health Booklet is ready on HealthHub, developed based on ground insights. This version provides an overview of your health screening records drawn from national health databases, and smoking cessation messages for those motivated to quit smoking. We will add more features and health topics such as stress management and the nationally recommended vaccinations starting from July this year. 

19.    Another example is LumiHealth, a free, two-year personalised health programme designed by HPB, in partnership with Apple, using the Apple Watch. Under this programme, participants will embark on customised health journeys, and earn rewards as they complete health-related challenges. They will also receive personalised reminders, to encourage them to meet their goals. Since its launch in end October 2020, we have seen more than 100,000 downloads.

20.   We must also not forget our efforts to keep chronic conditions at bay – like our ongoing War on Diabetes.

21.   MOH developed the Patient Empowerment for Self-Care Framework to empower patients to co-own their care journeys and achieve better care outcomes with support from their healthcare team, family and friends. Under this framework, we developed the first tranche of the National Diabetes Reference Materials that provides fundamental information and hosted it online on HealthHub.

22.   We are now working on the next tranche of materials with more in-depth information to help patients, their family and friends, better understand and manage diabetes. This resource is being co-created by the people for the people – about 700 citizens highlighted additional topics and content that would be useful, and suggested design features for a more user-friendly online experience. These materials will be ready from 2022. 

23.   Beyond our broad plans for our Singaporeans, I will elaborate on targeted efforts. Mr Leon Perera has highlighted the lower-income groups. Minister Gan has shared how we ensure they have good access to affordable care. While our health promotion efforts remain inclusive to all, there are also efforts targeted to address their health needs, and we work across agencies to provide holistic support. One example is the Healthy Living Passport programme which Mr Perera referred to. The programme is designed to improve health literacy and promote healthy lifestyles.  It is customised based on the lifestyle needs of lower-income families with tailored messaging and education. This is a multi-agency effort, and will commence after the SMMs are reviewed. We aim to benefit 15,000 residents over three years. We intend to track changes in our participants’ health literacy as well as their behavioural improvements. This will allow us to evaluate the impact of our programmes, as we generally do with our efforts.

24.    We see significant disparities in health behaviours and outcomes across ethnicities and will be ramping up efforts in this area. For chronic diseases, in 2020, 14.4% of Malays and 14.2% of Indians have diabetes, compared to 8.2% for Chinese. 37.5% of Malays and 36.1% of Chinese have higher blood pressure, compared to 29.5% for Indians. For cancers, the Chinese consistently have the highest age-standardised cancer incidence rates, but the proportion of Malays among all cases of cancer has gradually increased over the decades.

25.    Looking upstream at other modifiable lifestyle risk factors, the Malays have the highest obesity rates, and Indians have the highest prevalence of being overweight. The prevalence of daily smokers is more than twice as high amongst the Malays as compared to the Chinese and Indians.

26.    Research has shown that poor health behaviours can affect life expectancy. Therefore our community needs to take stronger action, and support one another against poor health habits. 

27.    Cultural preferences may influence health behaviours and we recognise the importance of engagement and collaboration with the different ethnic minority groups to design culturally relevant programmes. Some of our earlier efforts have seen good progress.

a.    For the Malay community, we have built our partnerships under HPB’s Jaga Kesihatan, Jaga Ummah from 23 in 2018 to 32 mosque partners, and 18 other partners such as the Malay Activity Executive Committees (MAEC) and Mendaki. With their support, we were able to provide a range of healthy living programmes for their congregants.

b.    Our Indian community partners such as Hindu Endowment Board, Sikh Welfare Council, SINDA and places of worship have provided strong support in engagement efforts with their networks. For example, NARPANI Pearavai provides Indian Activity Executive Committees funding to co-create health activities for their residents. Between 2018 and 2020, close to 15,000 Singapore Indian residents have participated in the various health promotion programmes.

28.   We will build on early successes to improve our work, to make healthy living a sustainable achievement.

29.   Moving forward, 

a.    We will expand community partnerships and harness ground-up efforts to multiply our impact and;
b.    Ensure that our programmes are culturally relevant through customisation.

30.   We will engage key community leaders through significant platforms to garner commitment towards health. For example, at a forum in end-March 2021, leaders from the Hindu Endowment Board, SINDA, NARPANI, Sikh Welfare Council and HPB will discuss the state of health among Indians and co-develop culturally relevant efforts to facilitate healthier lifestyles among Singaporean Indians. We look forward to an invigorating discussion, and a year of fun, healthier activities for all Singapore Indian residents.

31.    Let me share further for the Malay community. Mr Chairman, allow me to say a few words in Malay, please.

32.    Untuk mengukuhkan usaha-usaha kesihatan untuk masyarakat Melayu, kami akan membentuk kumpulan kerja yang baru. Saya bakal mengetuai kumpulan ini bersama Dr Wan Rizal dan Puan Mariam Jaafar, serta badan-badan masyarakat seperti M3 dan Persatuan Karyawan Penjagaan Kesihatan Islam (MHPA).

33.    Kami akan terus bergabung tenaga dengan rangkaian “Jaga Kesihatan, Jaga Ummah” (JKJU) dan para pemimpin masyarakat untuk melakar dan melaksanakan pelan-pelan kesihatan sepanjang tahun untuk memupuk nilai tabiat hidup sihat.

34.    Kami akan menghasilkan tips-tips mudah untuk masyarakat Melayu untuk mengingati langkah-langkah yang penting untuk memelihara kesihatan kita. Untuk mengekalkan usaha kesihatan ini, kami akan memanfaatkan Duta-Duta Kesihatan dan terus mengembangkan rangkaian sukarelawan ini.

35.    Puan Rahimah merupakan salah satu daripada Duta Kesihatan kami yang sangat komited sejak 2012. Sebagai ahli Jawatankuasa MAEC MacPherson, beliau merancang ceramah-ceramah motivasi kesihatan untuk masyarakat Melayu. Beliau juga meluangkan masa untuk mengajar warga emas kita untuk melungsuri alam maya. Usaha Puan Rahimah patut dicontohi. Saya ingin menggalakkan semua warga Singapura untuk mengikuti jejak beliau dan menyumbang kepada masyarakat. 

36.    Beyond ethnic minorities, I echo what Minister Masagos said on the importance of supporting our children and women to lead healthy lives, for a healthier next generation. It is key to support couples who wish to start their own families.

37.    Mr Louis Ng asked about supporting couples undergoing IVF. Today, eligible Singaporean couples undergoing Assisted Conception Procedures, or ACP, in public Assisted Reproduction centres can receive co-funding support for the different procedures.

38.    The co-funding applies to each Assisted Reproduction Technology (ART) cycle, and the patient would either receive the co-funding of 75% of the cost or the capped co-funding amount, whichever is lower. As such, there is no remaining balance to be rolled over. However, MOH regularly reviews the clinical evidence around the number of cycles to co-fund. At present, on average, women undergo two ART cycles before achieving pregnancy successfully. Evidence shows that the success rate of ART decreases with maternal age, as each successful cycle progresses. It is not just about government funding, but the strain on couples to keep trying. Hence, we must continue to encourage couples to marry and start families early, to maximise the chances of conception.

39.    After co-funding, the current MediSave per-cycle limits are generally sufficient to cover the cost of an ACP cycle at public Assisted Reproduction Centres. As not all couples go through multiple cycles, we have allowed a higher MediSave withdrawal limit for the first two cycles so that more of the lifetime limit can be used. MediSave can be used to pay for all standard procedures for each method of treatment, such as the priming of the uterus, egg recovery and fertilisation processes. However, as Traditional Chinese Medicine treatments associated with IVF are not part of mainstream evidence-based treatment, there are no plans to allow MediSave for their use currently.

40.    MOH remains committed towards supporting Singaporean couples in their parenting journeys, and will continue to review the MediSave withdrawal limits to ensure they remain relevant and adequate for Singaporeans, as we balance immediate expenses with retaining sufficient savings for basic healthcare needs in old age. 

41.    Apart from supporting couples, we enabled early intervention and enhanced subsidies for vaccinations under the National Childhood Immunisation Schedule (NCIS) for all Singaporean children at polyclinics, and extended them to CHAS GP clinics across Singapore in November 2020. We have also added vaccines against chicken pox, influenza and pneumococcal disease to the NCIS. 

42.    For Singaporean children up to the age of six, we have extended full subsidies for childhood developmental screenings at CHAS GP clinics, to allow for early detection and timely intervention for any developmental delays. 

43.    There is also support for their families. From last November, subsidies have been extended to vaccinations under the National Adult Immunisation Schedule (NAIS) at CHAS GP clinics and polyclinics for all eligible Singaporean adults. 

44.    Dr Lim Wee Kiak asked about the progress of our national immunisation efforts.  Based on the National Population Health Survey 2020, the take-up rate is estimated to be 23% for influenza vaccination, and 14% for pneumococcal vaccination in persons aged 65 to 79 years of age. I am happy to update that three months after the enhancements, a total of 158,000 and 121,000 doses of the NAIS and NCIS vaccinations respectively have been administered nationally. In particular, for pneumococcal and influenza vaccinations that are recommended for the elderly aged 65 years or older, the uptake has been encouraging, with more than 38,000 and 62,000 doses received respectively. 

45.    One of the families that benefitted is the Chiam family. The three-generational family has been regularly consulting Dr Lim Hong Shen from A Medical Clinic, under the NUHS Primary Care Network. With Dr Lim’s strong support, their two children, aged 2 and 4 years old, have undergone their childhood developmental screenings and received subsidised vaccinations for influenza, as well as measles, mumps and rubella. The grandfather, aged 69 years old, has also received both the pneumococcal and influenza vaccinations. 

46.    We hope that this improved accessibility and affordability will encourage Singaporeans to protect themselves and their families against vaccine-preventable diseases by getting vaccinated as recommended, and support children in starting off well and healthy.

47.    MOH is committed to increase the uptake of nationally recommended vaccinations, and will encourage eligible Singaporeans to be vaccinated.

48.    Together, we can encourage one another to take greater ownership of our health and lead healthier lives, for a better future. Thank you.