Speech by Dr Amy Khor, Minister of State for Health, at the Liver Disease Awareness Week Opening Ceremony, College of Medicine Building Auditorium, Ministry of Health, Sunday July 28, 2013

President of the Hepatopancreatobiliary Association, Associate Professor Stephen Chang,
Esteemed Colleagues,
Distinguished Guests,
Ladies and Gentlemen.

Good afternoon. I am pleased to be here with you at the inaugural Liver Disease Awareness Week.

About the Liver Disease Awareness Week

2          Every year on 28 July, the World Hepatitis Day is commemorated to raise public awareness and understanding of the diseases caused by hepatitis viruses. These viruses can cause acute and chronic liver infection, which can lead to scarring of the liver and liver cancer.

3          In line with the World Hepatitis Day, the Liver Disease Awareness Week is jointly organised by the Hepatopancreatobiliary Association Singapore (HPBA), and the Hepatitis B Support Group (HBSG) of Singapore. I would like to take this opportunity to acknowledge and applaud their efforts.  

4          The purpose of today’s public symposium is to raise awareness and understanding of the various forms of liver disease. Clinicians and specialists from various hospitals are here today to share the latest information on liver disease, including its preventive and treatment options. I hope the series of talks will motivate you to be pro-active in keeping your liver healthy.

Burden of Liver Disease

5          Worldwide, chronic liver disease is increasingly a major health burden to society. It is estimated to be the fifth most common cause of death, after heart disease, stroke, chest disease, and cancer.^[1] A similar trend is seen in Singapore, where, between 2007 and 2011, liver cancer is the third and fifth most common cause of cancer deaths in our male and female populations, respectively.^[2]

6          In Singapore, chronic hepatitis B virus infection and fatty liver are the two most common forms of liver diseases. Together with other less common types of chronic liver diseases, they can cause progressive damage to the liver resulting in liver failure and liver cancer.

7          While excessive alcohol consumption is often a precursor to fatty liver disease, the prevalence of non-alcoholic fatty liver disease has shown a marked increase, and is estimated to affect 15% of the population in Asia.^[3]  It is largely caused by a combination of lifestyle factors, such as inadequate physical activity and excessive food consumption, leading to obesity, which is a common risk factor for other chronic diseases such as diabetes.

Liver Disease Prevention

8          The good news is, liver diseases can be prevented and in some cases, controlled, by taking active steps to lead a healthy lifestyle. These include maintaining a balanced diet that includes no or low alcohol intake. Alcohol, in moderation, may protect the heart, but in excess, is poisonous for the liver.^[4] Engaging in regular physical activity, leading a smoke-free lifestyle, and going for regular screening, as appropriate to one’s health profile, are also crucial actions one could take to prevent liver disease.

9          In preventing hepatitis B virus infection, childhood immunisation has been shown to be highly effective in reducing the incidence of liver disease and carrier rates in the population.^[5] Singapore has achieved good vaccination coverage of more than 95% through the introduction of hepatitis B vaccination into our National Childhood Immunisation Programme in 1987. As a result, the incidence of hepatitis B infection among children and adolescents has declined over the years. A recent survey showed that among children and adolescents aged 5 – 17 years, the prevalence of chronic hepatitis B virus infection was a mere 0.4%.

10        However, those born before 1987 may not have adequate immunity against hepatitis B. As such, they are encouraged to seek medical advice and be vaccinated against hepatitis B, if necessary.

11        My Ministry is committed to providing good and affordable health care for all Singaporeans. Towards this end, we have announced full subsidy for hepatitis B vaccination at the polyclinics for all Singaporean children, with effect from 1 June 2013.^[6] In addition, Medisave can also be used for hepatitis B vaccination. This ensures that all children and adults in Singapore have access to, and are adequately protected against, hepatitis B infection.

Early Diagnosis and Treatment for Liver Disease

12        Healthcare professionals play an important role in the early detection and prevention of liver disease by identifying, assessing and advising patients with unhealthy lifestyle practices that could adversely affect liver health.

13        However, despite our best efforts, many liver diseases continue to be diagnosed in the late stages, where treatment options become more limited, and complications more common. This does not have to be so, as early diagnosis is possible with regular screening. While our overall hepatitis B infection rates remain stable, certain individuals may benefit from receiving regular screening to test for hepatitis B infection. These include those who are hepatitis B carriers or who have scarring of the liver. They require our constant encouragement and support to come forward and talk to their family doctor about regular screening in order to receive timely medical attention.

Conclusion

14        I end with the old adage, “prevention is better than cure”. Leading a healthy lifestyle is the best one could do to prevent the onset of chronic disease, including diseases of the liver. I would like to encourage individuals to take an active approach towards protecting their personal health, as well as the health of their loved ones. With this, I wish you an educational and enjoyable afternoon, and I declare the Liver Disease Awareness Week open!

15        Thank you.

[1] Estimates from the Office for National Statistics in the UK, as cited in William R (2006). Global challenges in liver disease. Hepatology 44(3): 521-526.

[2] Singapore Cancer Registry. Interim Annual Registry Report. Trends in Cancer Incidence in Singapore: 2006-2010. National Registry of Diseases Office (NRDO). Available online: http://www.hpb.gov.sg/HOPPortal/content/conn/HOPUCM/path/Contribution%20Folders/uploadedFiles/HPB_Online/Publications/Cancer_Trends_Report_07-11_for_website_v2.pdf

(accessed 12 July 2013).

[3] Tan HH and Chang JP (2010). Non-alcoholic fatty liver disease. Proceedings of Singapore Healthcare. 19 (1):36-50.

[4] Harvard School of Public Health. Alcohol: Balancing Risks and Benefits. Available online: http://www.hsph.harvard.edu/nutritionsource/alcohol-full-story/(accessed 17 July 2013).

[5] William R, ibid.

[6] The subsidy is pegged at 50% for Permanent Residents (PRs).