The Health Promotion Board Bill

22 Feb 2001

By Mr Lim Hng Kiang

Mr Speaker, Sir, I beg to move, "That the Bill be now read a second time."

Objective of the Bill

The Government intends to set up a new statutory board, the Health Promotion Board by integrating five departments in the Ministry of Health, namely the National Health Education Department, Department of Nutrition, School Health Service, School Dental Service and Health Promotion Division Administration. The objective of the Bill is to provide the legislative framework for the formation of the new statutory board.

Rationale

Sir, let me explain the rationale for the formation of the statutory board.

The health of Singaporeans today is good. We have done quite well by any parameter. Our infant mortality rate of 4 deaths per thousand live births, maternal mortality rate of 0.1 per thousand live births and still births and life expectancy at birth of 78 years are comparable to those in developed countries. We have made significant progress in improving the health of Singaporeans in many areas through our health promotion and disease prevention programmes.

Let me start with the children. Our children represent the future of Singapore. We need to ensure the health and well-being of our young. We have done well in this area. The National Childhood Immunisation Programme has resulted in the elimination of severe infectious diseases such as diphtheria and poliomyelitis. We have also reduced childhood tuberculosis, whooping cough, measles, mumps, rubella to a very low level.

Our comprehensive School Health Programme of health screening, immunisation, dental care and health education have contributed to the good health of our young. However, there are one or two gaps that we need to plug. For example, many of our secondary school students who were born before we introduced Hepatitis B immunisation for babies, have not been immunised against Hepatitis B and are at risk of Hepatitis B infection and liver cancer. We have taken action to address this. Earlier this month we implemented the Hepatitis B Immunisation Programme for students. This 4-year programme will cover over 300,000 students in secondary schools, junior colleges, centralised institutes, ITEs, polytechnics, universities and the full-time national servicemen.

Currently, we have a comprehensive dental health programme for primary schools. Every primary school has a dental clinic where dental health screening and basic dental treatment is done. However, the programme for secondary school is less comprehensive. As a result the dental health status of secondary school students is not as good as that of the primary school students. We are working with the Ministry of Education to build dental clinics in secondary schools so that these students can benefit from having dental care on site in their schools.

Defective vision (myopia) among school children has continued to increase from an overall rate of 43% in 1990 to 51% in 1999. The rate among Primary 1 children has increased from 19% to 30% over the same period. We need to implement measures to arrest and reverse this trend as high myopia is associated with potentially blinding conditions in later life.

Among the adults and the elderly, there are some areas where we are not doing so well, such as heart disease, stroke and cancer. Although the incidence of heart attacks has decreased from 94 per 100,000 in 1990 to 88 in 1998, our death rate of 76 per 100,000 population from coronary heart disease is higher than the rates of 58 and 60 per 100,000 in Canada and Australia respectively. Similarly, our death rate of 29 per 100,000 from stroke is higher than the rate of 14 per 100,000 in both Canada and Australia.

These diseases often strike people in the prime of their life, resulting in premature mortality or severe disability. This results in both economic and social burden for the family and the nation. Fortunately, studies have shown that these conditions are preventable. The lifestyle related risk factors of these diseases, such as physical inactivity, unhealthy diet, smoking, obesity, high blood pressure and high blood cholesterol, can be controlled. Reduction of these risk factors can improve the health of the individual and the population.

We must improve the health of our adult population by focusing our efforts on the areas that we are not doing so well, otherwise, although Singaporeans are living longer, their quality of life in their autumn years may actually be quite poor due to ill health. Singaporeans must take responsibility for their own health. They must adopt healthy lifestyles, go for health screening to detect chronic diseases early and if they have chronic diseases they should go for treatment and regular follow-up. Unless Singaporeans take health education, health promotion and prevention seriously, many Singaporeans will live the last years of their life burdened with ill health and disability.

There are other areas of concern such as breast cancer and osteoporosis. Breast cancer is the leading cancer among women in Singapore today. The incidence of breast cancer has more than doubled over the last 30 years. A study among women showed that they are not well informed about breast cancer and its risks, or that mammography (X-ray of the breast) is effective for the early detection of breast cancer and for improving the survival rate.

Osteoporosis (or brittle bones) is a disease of old age. It is associated with higher risk of hip fractures and results in significant morbidity and mortality. The rate of hip fractures has risen by 38% from 42 cases per 100,000 in 1990 to 58 cases per 100,000 in 1999. With an ageing population, the number of hip fractures is expected to increase, giving rise to much ill health, disability and suffering. As the build up of bone mass reaches its peak by about 30 years of age, we need to ensure that measures to prevent osteoporosis start from young and continue throughout life.

We need to embark on a more focused, integrated and concentrated approach to get the health outcomes we want. The setting up of the Health Promotion Board will provide the framework for a greater focus on these major health problems and spearhead health education, promotion and prevention programmes and create a supportive environment to tackle these and other health problems in children, adults and the elderly. This will benefit Singaporeans.

HPB will work in collaboration with public, private and community organisations to develop and sustain national efforts to manage these problems. This building of close partnerships with other agencies and organisations will enable the Health Promotion Board to reach out to Singaporeans in various settings and to reinforce the messages in many different ways.

The formation of HPB will also ensure more efficient use of financial and manpower resources, and strengthen the capacity and capability to develop, implement, monitor and evaluate these programmes. The Board will focus on outcome and standards and will provide the impetus to ensure that results especially in the problem areas are achieved.

Main Features of the Bill

Mr Speaker, Sir, I will now touch on the main features of the Bill.

Part III, Section 11 sets out the functions, objects and duties of the Board which are :

to advise the government on all matters connected with the promotion of good health and healthy lifestyles amongst the people of Singapore;

to organise and implement effective health education programmes and other activities to promote good health and healthy lifestyles and to prevent and detect diseases;

to determine, establish and recommend standards and guidelines on diet and nutrition to encourage healthy eating habits;

to provide medical, dental, health screening and immunisation services to school children and other persons;

Part VII, Section 42 of the Bill covers the consequential amendments made to the Infectious Diseases and Dentists Acts, portions of which will now be administered by the Board on behalf of Ministry of Health.

Conclusion

Sir, we are facing new challenges in the pattern of diseases in Singapore. The formation of the HPB will enable us to focus on and spearhead health education, health promotion and disease prevention programmes to meet these challenges to benefit all Singaporeans.

Mr Speaker, Sir, I beg to move.