It’s often not what we know, but what we do that matters. This is especially true for citizens’ health today.

Although citizens are aware of the causes of chronic illnesses, “we’re still not getting the kind of population health results we want”, says Loke Wai Chiong, Head of Integrated Health Promotion, Singapore’s Ministry of Health Office for Healthcare Transformation (MOHT).

It’s crucial to engage with citizens before they become patients and “move beyond healthcare into health, beyond hospitals into the community”, he adds. He shares how his team is piloting “healthy precincts” that tackle environmental and social barriers to healthy behaviour.

Environment matters

One in four Singaporeans above 40 have at least one chronic illness, according to the Health Promotion Board. This requires a “holistic” approach to healthcare, which comprises environmental and social factors that influence healthy behaviour, MOHT believes.

Loke’s team is studying how the design of neighbourhoods can affect the health of citizens. Factors like how many trees line the road, or what food is sold at hawker centres, all play a part in the health of citizens, Loke says.

A person may know it’s healthier to walk instead of taking the car, he explains, but because there’s “no covered walkway … not enough trees lining the road”, or if the walk is too long, the person ends up not walking.

MOHT then works with agencies to improve factors like walkability and access to healthy food in neighbourhoods. It uses data to identify such “barriers of entry to health”, and shares it with grassroot advisors.

This allows leaders on the ground to plan for targeted intervention programmes, says Danny Quek, Senior Assistant Director of the Integrated Health Promotion team.

Data from wearables or environmental sensors will also play a huge role in helping to understand and correlate social and environmental determinants on citizens’ behaviour, Loke adds.

The Housing Development Board’s Green Town Programme, for instance, aims to make public housing estates cooler and more sustainable. More than a hundred blocks will be painted with heat-reflective paint to reduce temperatures by almost two degrees, The Straits Times reported.

This could improve “thermal comfort and encourage physical activity”, Quek says. “When it’s too warm, it will discourage all our efforts to promote healthy behavior like walking or cycling.”

You never walk alone

Covid-19 also highlighted the need for “social togetherness”, Loke says. With physical distancing measures isolating citizens from their loved ones, there was a “hyperlocal” need for neighbours to look out for each other.

MOHT saw “a lot of social activation during that time – people who rose up to the challenge”, Quek says. Volunteers distributed hand sanitisers, sewed masks, and even set up a translation website to help healthcare workers communicate with migrant workers.

Citizens’ mental health also “took a beating” during the pandemic, Loke says. Suicide rates in Singapore were at an eight-year-high last year, The Business Times reported.

MOHT created mindline.sg, a tool for citizens to anonymously self-assess their emotional and mental health. A chatbot provides advice on how to reduce stress levels, and can direct them to local resources to receive support on mental health, caregiving, or domestic violence.

This tool is “especially important” in helping people seek help in an anonymised and safe environment. “Because unfortunately, after all these years we still have some stigma around admitting mental distress”, Loke says.

Agencies including the Ministry of Social and Family Development, the National Council of Social Service, and the Institute of Mental Health were part of the advisory board, he adds.

mindline.sg was first developed for the general population, Loke says. MOHT plans to work with workplaces, public agencies, educational institutions and youths next.

Healthcare should not only happen within the hospital walls, but in our homes and neighbourhoods. MOHT’s efforts to influence healthy behaviours with the environmental and social factors could go a long way.