SPEECH BY MR AMRIN AMIN, SENIOR PARLIAMENTARY SECRETARY, MINISTRY OF HEALTH AND MINISTRY FOR HOME AFFAIRS, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2019, ON WEDNESDAY 6 MARCH 2019

ENABLING SINGAPOREANS TO LIVE HEALTHIER LIFESTYLES

Mr Chairman, I will focus on three areas:

a.    Removing artificial trans fat from our food supply;

b.    Reducing smoking rates; and

c.    Strengthening our health ecosystem

Removing Trans Fat from Our Food Supply

2.            On the first area, artificial trans fat is harmful to health. According to the World Health Organization (WHO), artificial trans fat increases risk of heart disease and has no known health benefits. WHO has called for countries to remove artificial trans fat from the food supply.

3.            Currently, our law requires food manufacturers to declare and limit the amount of trans fat in cooking oil and fats. Local trans fat intake halved from about 2 gram per day in 2010 to 1 gram per day in 2018.

4.            It is timely to build on this. We will be introducing a ban on partially-hydrogenated oil (PHO) in our food. Current trans fat regulation only applies to fats and oil. This ban will also extend to pre-packaged food products such as snacks, baked foods, prepared meals and fat spread. PHO is a major source of artificial trans fat in these foods.

5.            Banning PHO should not have an adverse effect on Singaporeans’ food options and cost. MOH has consulted the local food industry, who are generally supportive. United States (US), Canada, and Thailand have also banned PHO.

6.            The industry will be given time to make adjustments. Details will be shared subsequently.

Encouraging More Smokers to Quit

7.            Mr Chairman, turning to the second area: reducing smoking rates. Dr Chia Shi-Lu asked about efforts to help smokers quit. Smoking remains a concern in Singapore. I had announced in May 2018 that we are working towards a smoking prevalence of less than 10% by 2020.

8.            There are about 400,000 daily smokers today. One in six smokers tell us that they are thinking about quitting. But only three in 100 smokers actually take action. We target to get more smokers to go beyond thinking about quitting to actually take active steps to quit smoking.

9.            Successful cessation rates range from 10% for telephone-based interventions to 20% for programmes that combine intensive counselling and pharmaco-therapy. This is comparable internationally. It is difficult to quit smoking – that is why it is called an addiction. But it is not impossible.

More Actively Engaging Smokers

10.         One story inspired me. Mr Iskandar shared with me about how he successfully quit smoking, and he also helped his father quit a 30-year smoking habit.

11.           Mr Iskandar started smoking when he was 14. After smoking for about eight years, he started his quit journey last year. He wanted to save money for travel and improve himself. He quit cold turkey. He went to the gym and jogged.  

12.         Mr Iskandar shared his quit journey with his father, Mr Muhamed Ibrahim, a smoker of 30 years. Son motivated father. His father has also quit smoking. Mr Iskandar is now working on his brother, Mr Noor Muhamed, to cut back on smoking.

13.         There are learning points from Mr Iskandar’s story. First, personal motivation is important. Studies show that self-motivation and important milestones such as the arrival of a new baby, or a serious disease, are critical turning points.

14.         Second, supportive family and friends.

15.         Third, it is never too late to quit smoking – Mr Iskandar’s father is one example.

16.         We will be speaking with more smokers this year to see how we can help. Details will be shared in the HealthySG Task Force recommendations.

E-cigarettes

17.         There are some who have suggested e-cigarettes as smoking cessation aids. Members are aware that we disallowed the importation, sale, distribution, purchase, possession and use of e-cigarettes since February 2018.

18.         Cessation products and programmes must first be effective and evidence-based. The current evidence for e-cigarettes as a smoking cessation aid is mixed and we are monitoring studies that have been conducted. One concern we have is the “substitution effect” – some smokers substitute cigarettes with e-cigarettes instead of quitting or, worse, they use both. So it’s hardly smoking cessation. It is more like swapping one nicotine/tobacco addiction in one guise for another.

19.         The other concern is the “gateway effect”. The experience with e-cigarettes in US and Hong Kong are instructive. The US Surgeon General has called the alarming increase in youth e-cigarette use an “epidemic”. Hong Kong reported a rise in Primary 2 to 4 students trying e-cigarettes in the last two years and Hong Kong has recently banned e-cigarettes.  

20.         We are open to allowing a specific product to be registered and regulated under the Health Products Act as a therapeutic product for smoking cessation, but there must be good evidence and it must be effective.

Focus on Youth Smoking

21.         Dr Chia Shi-Lu asked about help for younger smokers.

22.         Smoking rate among secondary school, ITE and Polytechnic students dropped from 8% in 2011 to 2013 to 4% in 2014 to 2016. This means that there are still about 12,000 underaged smokers. We are focused not only on preventing initiation, but also helping younger smokers quit, and this is our strategy:

a.    Enforcement against errant retailers: The Health Sciences Authority (HSA) has stepped up ground surveillance and enforcement among tobacco retailers to reduce youths’ access to tobacco. In 2018, HSA suspended the tobacco retail licences of 23 first-time offender retailers and revoked four repeat offenders.

b.    Support for youth smokers: Youth smokers are referred to counsellors, Quitline, or Student Health Advisors at 50 secondary schools, all ITE Colleges and Polytechnics for cessation counselling. In 2017, 3,000 youths were counselled. 43% managed to reduce smoking, and about 10% quit.

c.    Education campaigns: In June 2018, we launched “Better Things to Do”, a campaign for youths. We hope to encourage youths to tap on their network to promote a tobacco-free lifestyle. In January this year, we focused on harmful, emerging products – e-cigarettes, in particular, which contain nicotine and benzene. We will intensify our tobacco-free efforts.

Strengthening our Health Ecosystem Partnerships

23.         Mr Chairman, turning to the third area of my speech – Strengthening our health eco-system partnerships. I have three points to make:

a.    First, growing our healthcare professionals, and Traditional Chinese Medicine practitioners;

b.    Second, making screening and follow-up more convenient; and

c.    Third, progress on the War on Diabetes and the HealthySG Taskforce.

Creating Opportunities for Allied Health Professionals

24.         On the first point, Dr Chia Shi-Lu asked about ensuring sufficient numbers of allied health professionals. MOH had worked with the Ministry of Education and the Singapore Institute of Technology (SIT) to increase intake of four Allied Health degree programmes in Physiotherapy, Occupational Therapy, Diagnostic Radiography and Radiation Therapy from 230 in 2016 to about 300 students in 2018.

25.         There are also Graduate Entry Masters programmes in Speech Therapy, Clinical Psychology and Audiology at the National University of Singapore.

26.         MOH regularly reviews our training pipelines. For example, to meet the growing need for dietitians in Singapore, SIT launched the first local four-year Dietetics and Nutrition degree programme. The first cohort will begin the programme in September 2019.

27.         Earlier this year, we introduced an accelerated Professional Conversion Programme for Physiotherapists. This programme allows mid-career locals with a degree in science-related fields to complete physiotherapist training in less than three years, compared to four.

Launch of Skills Framework for Healthcare

28.         Mr Christopher de Souza asked about continuing development and career progression for allied health professionals. We are launching the Skills Framework for Healthcare for six professions, Nurses, Pharmacy Technicians, Physiotherapists, Occupational Therapists, Speech Therapists and Patient Service Associates.

29.         The Skills Framework for Healthcare is a common reference for skills and competencies for different stakeholders. MOH will work closely with the respective professions to identify training needs and build a future-ready Healthcare Workforce.

Raising Professional Standards for TCM Practitioners

30.          Turning to Traditional Chinese Medicine (TCM) Practitioners. To raise professional standards of TCM practitioners, Continuing Professional Education (CPE) is compulsory when renewing practicing certificates. To defray CPE costs, TCM practitioners can apply for the TCM Development Grant, launched in 2018, at a cap of $200 per year. As of end 2018, we had given more than $70,000 to over 400 TCM practitioners.

31.         TCM practitioners can use their SkillsFuture Credit to attend eligible TCM-related courses and we will work closely with TCM associations to support TCM practitioners.

More Convenient Screening (Non-fasting Tests)

32.         We will make health screening and follow-up more convenient. From May 2019, you can have subsidised checks for blood sugar and cholesterol levels at Community Health Assist Scheme (CHAS) clinics without having to fast overnight or for 12 hours.

33.         We will update our guidelines to recommend the use of glycated haemoglobin (HbA1c), and the non-fasting lipid tests, as alternative screening tests for diabetes and high blood cholesterol respectively. This has been endorsed by international and local medical professional bodies.

34.         A local clinical working group found that HbA1c, if used correctly, was just as capable as the current test in detecting diabetes. The group also recommended the use of non-fasting lipid profiles for screening high cholesterol based on international guidelines and studies.

35.         The non-fasting tests give Singaporeans a wider range of screening options to choose from. This will be particularly helpful for seniors, who are more prone to episodes of low blood sugar. We hope to increase screening uptake with this added convenience.

More Follow-up for Eye Conditions in the Community

36.         Singaporeans with eye conditions can now receive care closer to their homes. We piloted community eye clinics (CECs) with Singapore National Eye Centre, Tan Tock Seng Hospital and National University Hospital. At CECs, patients can have their eyes checked and managed. There are four CECs at Punggol Polyclinic, Keat Hong Family Medicine Clinic, Hougang Polyclinic and HPB at Outram. Later this year, there will be two more CECs at Pioneer and Geylang Polyclinics.

War on Diabetes and HealthySG Taskforce

37.         Dr Lily Neo asked about promoting healthy lifestyles to prevent chronic diseases, and supporting Singaporeans to reduce sugar intake. Mr Melvin Yong asked for updates on the War on Diabetes and Dr Chia Shi-Lu asked for updates on the HealthySG Taskforce.

38.         Healthier eating is now more accessible. As of December 2018, more than 1,200 food and beverage operators, hawker centres, and coffee shops, with 8,900 touchpoints island-wide, have joined the Healthier Dining Programme (HDP). Singaporeans consumed 131 million healthier meals in 2018, double that in 2017.

39.         Lower-sugar beverages are now within reach. We have more drink partners, with about 200 outlets, as well as drink stalls in hawker centres and coffee shops with the HDP.

40.         HPB’s Eat Drink Shop Healthy Campaign nudges Singaporeans to earn points when choosing healthier options during grocery shopping.

41.         We extended the Healthier Ingredient Development Scheme to include sugar-sweetened beverages, desserts and sauces. We partnered five dessert suppliers, three beverage suppliers, and one sauce supplier and there are now healthier options available.

42.         Exercise is another area. The National Steps Challenge^TM Season 3 (October 2017 to April 2018) helped eight in 10 participants who were previously inactive clock more than 150 minutes of physical activity a week.

43.         We are taking another step forward. We are encouraging higher-intensity physical activity, hence better fitness, 740,000 participants in Season 4 of the National Steps Challenge™ were provided with a new step-tracker that can measure heart rate. There were also many exercise programmes in the community.

44.         But there is more we can do. The HealthySG Taskforce, which I chair, seeks to integrate, coordinate, and scale up health promotion efforts across our social and infrastructure agencies and communities, and especially the under-reached and disadvantaged groups such as the lower-income.

45.         Public consultations will start in end March to early May and we are targeting to release recommendations in the early second half of the year.

Partnering the Malay and Indian Communities for Health

46.         Mr Mohamed Irshad asked how our health promotion efforts have reached our Malay and Indian communities. Let me give an update.

47.         Mr Chairman, with your permission, in Malay, please.

48.         Usaha kami memupuk masyarakat Melayu sihat bertumpukan kepada tiga aspek:

49.         Pertama, jaga makan, dan jaga minum. 

50.         Kedua, aktif secara fizikal.

51.         Ketiga, pemeriksaan kesihatan dan rawatan awal.

52.         Berbagai inisiatif telah diperkenalkan tahun ini dan ia telah memberi nafas segar kepada tiga teras tersebut.

53.         Kita berbincang tentang makanan. Pada tahun 2017, hanya ada dua makanan halal yang lebih sihat iaitu “Healthier Choice” di pusat penjaja: iaitu Thosai dan Mee Soto.

54.         Kini pilihan lebih luas dan ada enam hidangan halal yang lebih sihat. Pilihan Healthier Choice halal kini termasuk bubur ayam, Penang Asam Laksa dan mee bakso dan hidangan kegemaran ramai, seperti briyani, nasi padang, nasi ayam, rendang dan bermacam lauk-pauk, juga telah boleh diubahsuai untuk menjadi lebih sihat.

55.         Restoran-restoran Melayu yang terkenal turut serta meluaskan pilihan makanan lazat dan sihat. Rumah Minang, Hajah Maimunah, Sabar Menanti, dan berbagai lagi – dan mereka adalah antara lebih 1,100 kedai makan yang menghidangkan makanan sihat yang halal dan yang lebih sihat. Mereka telah menggunakan beras perang, minyak masak sihat, sayuran dankurang santan.

56.         Bukan makan luar sahaja. Jika ada kenduri atau majlis walimah, juga ada pilihan sihat. Kini ada 107 penyedia makanan catering halal sihat termasuk 24 penyedia majlis perkahwinan Melayu seperti Jamil Catering dan Istana Wedding Services.  Maklum-balasnya baik. Rasa lauk-pauk sihat tidak berbeza dan terjejas.  Pada bulan Januari tahun ini, kami mulakan kursus get-fit untuk bakal pengantin di wedding fair.  140 bakal pengantin menyertai program perintis ini supaya bila naik pelamin nanti, mereka lebih ringan, lebih ramping, dan yang lebih penting, lebih sihat.

57.         Kempen “Kita dah cukup manis!” dan “Korang OK!”, terutama semasa bulan Ramadan dan Syawal, berpesan supaya kurangkan manisan.

58.         Di bulan November 2018, saya melancarkan video senaman “Korang Ok” untuk anak pra-sekolah. Kalau lentur buluh, biarlah dari rebungnya.  Dari muda, amalkan tabiat baik, bersenam, dan ia senang dan menggembirakan.

59.         Enam sesi perbualan berkongsi mutiara kesihatan telah dianjurkan bersama Berita Harian. Kalau hendak bersalin cari bidan, nasihat pakar itu penting. Justeru ini, sesi-sesi seperti ini di mana masyarakat dapat berkongsi petua-petua daripada pakar seperti doctor dari Muslim Healthcare Professionals Association (MHPA)

60.         Perbincangan tidak setakat itu. Malah ia berterusan di ruang maya. Lelaman media sosial “Korang OK” yang dimulakan pada Jun 2018 mempunyai lebih daripada 23 ribu pengikut dan ruang ini rancak berkongsi resipi sihat dan petua kesihatan.

61.           Dan senaman itu penting. Saya terkesan apabila melihat ramai warga emas kita yang sakit-sakit kaki semasa saya menunaikan Umrah pada tahun 2017. Bersama dengan HPB dan agen-agen Umrah, kami melancarkan program “Get Fit For Haji /Umrah” pada November 2017. Program senaman 6-minggu dianjurkan di masjid dan stadium telah menarik 900 peserta. Saya dimaklumkan melalui program ini ini, Jemaah kita lebih ligat bertawaf.

62.         Lepas musim Umrah, ada program senaman seperti ‘Gerak Gelak’ yang dianjurkan oleh kelab-kelab Masyarakat MAEC. Empat sesi “Gerak Gelak” telah dianjurkan pada tahun 2018 oleh GRC Tampines, Marine Parade, Sembawang dan minggu lalu di Jurong, di mana kesemuanya telah menarik 2,200 peserta.

63.         Sebenarnya jaga kesihatan juga seruan agama. Program “Jaga Kesihatan, Jaga Ummah” yang dilancarkan dua tahun lalu dimulakan dengan 5 masjid dan ia telah menebar sayap kepada 23 masjid. Berbagai program senaman, bengkel kesihatan dan pemeriksaan kesihatan telah dianjurkan di masjid-masjid JKJU dan telah memberi manfaat kepada lebih daripada 4,500 jemaah di tahun ini. Nikmat kesihatan anugerah tidak ternilai. Marilah kita sama-sama jaga kesihatan keluarga dan diri kita!

64.         Let me now turn to the Indian community.

65.         I attended a dialogue with 20 Indian voluntary organisations to talk about community health matters and programmes, and we are partnering with various Indian groups such as Sree Narayana Mission, the Central Sikh Temple, and Narpani Pearavai (the Indian Activity Executive Committees Council).

66.         We partnered with Suria, Vasantham and various Mediacorp artistes to run the Family Funival earlier this January. Over 5,000 people bonded over activities such as Zumba workout. We will do more this year.

Conclusion

67.         In conclusion, Mr Chairman, Singaporeans are living longer, and my colleagues and I are working hard to ensure all of us can lead healthy, fulfilling lives.

68.         Let’s grow healthier together!  Let’s build a healthy Singapore together!  Thank you.