Speech by Permanent Secretary Mr Chan Heng Kee at the 16th Singapore Stroke Conference, 7 October 2016

Associate Professor Ng Wai Hoe, Medical Director, National Neuroscience Institute
Associate Professor Deidre Anne De Silva, Chairperson, Organising Committee
Distinguished Speakers,
Colleagues,
Ladies and Gentlemen, 

1.         Good morning. I am delighted to be here this morning at this 16^th edition of the Singapore Stroke Conference. I would like to commend NNI for organising this important conference. Let me also extend a warm welcome in particular to our overseas speakers and participants. 

Stroke in Singapore 

2.         All around the world, stroke carries a high burden. It is no different in Singapore. In 2015, stroke and other cerebrovascular diseases was the fourth leading cause of death in Singapore. It was also one of the leading causes of long-term physical disability. With a rapidly ageing population, stroke incidence will increase. We need to be prepared. 

3.         We are making some progress in stroke care. In 2014, our 30-day mortality rate after an Ischemic Stroke was 7%. This was an improvement over the 9% figure in 2010. The 30-day mortality rate for haemorrhagic stroke also improved from 31% to 24% over the same period. 

Striving for Better Stroke Management 

4.         We want to do better. To improve stroke management, MOH recently set up with a Stroke Service Improvement team together with healthcare institutions and relevant non-healthcare organizations. Some useful initiatives are coming out of this effort. For example, SCDF paramedics will be trained to better identify stroke and notify emergency departments before the patient reaches the hospital. This will reduce the time taken to provide time-critical interventions such as thrombolysis, leading to improved clinical outcomes for stroke patients.

5.         Another potentially impactful initiative is the ongoing work with primary care setting providers to reach out to Singaporeans at higher risk of stroke. To date, some 330 primary care physicians and healthcare professionals have been trained to better identify risk factors and early stroke symptoms^[1]. This includes doctors from the Singhealth Group Polyclinics (SHP), National Healthcare Group Polyclinics (NHGP), and two family clinics. I hope we can reach out to more healthcare professionals. 

Prevention Better Than Cure 

6.         Beyond improving stroke management, we must place equal emphasis on stroke prevention. As the saying goes - “An ounce of prevention is worth a pound of cure.” As you all know, some risk factors for stroke are treatable. These include hypertension, obesity and diabetes. 

7.         Take diabetes for example. Two in five stroke cases in Singapore have diabetes. MOH has recently declared “War on Diabetes”. If we are able to enhance prevention, strengthen screening and post-screening follow-up, improve diabetes management and substantively expand public education on diabetes, we can beat diabetes. I am sure it will have a positive knock-on effect on stroke prevention. 

The Science and Art of Stroke Care 

8.         In embarking on new efforts, we will need to leverage on both the science and the art of stroke care – which is also the theme of this year’s conference.

9.         We need to invest in scientific research to come up with new treatments and ways of widening the scope of current treatments. NNI’s Stroke and Cerebrovascular Programme is a good example. I know it has an active arm spanning basic, translational, clinical, technology and health service research. Likewise, the National Medical Research Council, which comes under MOH, funds stroke related research and researchers.

10.       At the same time, we need to hone the art of “nudging”. By this, I am referring to how we can influence the choices of people – in their everyday diet and lifestyle, in their screening and post-screening decisions, and in their adherence to stroke management and rehabilitation regimes. Much of these efforts take place beyond healthcare institutions, and involve more than just healthcare workers. They need to happen at homes, in schools, at the workplace and in the community. 

11.       And while I have referred to “nudging” as an art, I believe it is in many ways no less a science. In fact, the application of behavioural science and behavioural economics in health promotion and healthcare are increasing important and seriously researched fields. There has been increasing research on how small changes in the environment can facilitate behaviours and influence decisions If I could make a suggestion, perhaps next year’s conference can feature more sharing of research and programmes which show these concepts can be applied in stroke prevention and stroke care. 

Singapore Stroke Conference 

12.       The sharing of such knowledge is where the Singapore Stroke Conference is valuable. I am delighted to note the diversity among the participants today. We have amongst us experts from different fields as well as stroke survivors, caregivers and community volunteers. All of you play an important direct or indirect role in the prevention, management and rehabilitation of stroke patients. 

13.       I am confident that the conference will continue to serve as a useful platform to pick up and exchange up-to-date knowledge and recent advances in the science and art of stroke care. I am also hopeful that it will catalyse many useful collaborations and partnerships. 

14.       On that note, let me close by wishing you a fruitful conference. Thank you.

^[1] From SingHealth Polyclinics, National Healthcare Group Polyclinics and 2 Family Medicine Clinics