Towards Health for All

Dr Yeoh Khay Guan, Chief Executive of Singapore's National University Health System (NUHS), maps the road ahead for the nation's healthcare.

Singapore has been called an ‘improbable nation’. The odds were stacked against us at our founding—a vulnerable city-state bereft of natural resources, our only resource our people. Our pioneer leaders recognised this, and while building the economy in those early years, also invested presciently in education and public health.

Their foresight laid the foundations for a healthy Singapore. Today, Singaporeans enjoy a good level of health by global standards. We have one of the lowest infant mortality rates in the world and the highest life expectancy at birth. The merits of our healthcare system are internationally recognised. In 2017, Singapore ranked first among 188 countries on an index measuring progress towards the health-related United Nations Sustainable Development Goals. Bloomberg rated Singapore’s healthcare system as the most efficient out of 57 countries on the 2020 Bloomberg Health-Efficiency Index.

Of course, there is a lot more to be done. Our early health leaps in infant mortality and life expectancy were realised through comprehensive vaccinations, improved prenatal care and better sanitation. Fifty years on, Singapore now combats a different set of challenges: smoking, obesity and physical inactivity. Hypertension, diabetes and high cholesterol are now the major risk factors for the leading causes of avoidable deaths in our adult population. Poor lifestyle habits and the high prevalence of chronic diseases are some of the main drivers of rising healthcare utilisation and costs in Singapore. While we enjoy long life expectancy, our later years may be burdened by frailty and disability from chronic diseases. We must aim to detect these conditions early and empower Singaporeans to manage them well. Encouraging healthy diet, an active lifestyle and regular health screening will prevent or delay the onset of these and other diseases, and more importantly lengthen healthspan, which is the period of good health in life.

One in five Singaporean children are overweight. There is evidence that child and maternal factors in the pre-conception, antenatal and postnatal period influence health throughout one’s life course. Overweight and obese children are more likely to retain unhealthy weight into adulthood, elevating their risk for many diseases. Instilling healthy lifestyle habits in our children’s early years around diet, exercise and mental well-being will lay the foundation for good health and check the development of chronic diseases later in life. We can also help couples better prepare for parenthood by adopting healthy living habits and understanding the impact on their child’s development, to give their child the best start in life.

More support is needed for mental health, for both young and old. A Singapore Mental Health Study conducted in 2016 reported that while one in seven Singaporeans has experienced a mental disorder, more than 75 per cent of them did not seek any professional help. There is certainly more we can do to raise mental health literacy, promote early intervention, improve mental health services and end the stigma surrounding mental illness.

Our living, working and social environment, our consumption patterns and options, and a whole host of other non-medical factors greatly affect health outcomes. We must depart from hospital-centric care where we treat only the disease, and instead take a holistic whole-person approach, recognising the social determinants of health, to achieve and sustain good health. The optimal treatment plan for an elderly patient who suffered a fall goes beyond healing her broken hip, and should identify and address all factors which contributed to the fall—is she living alone and lacking help? Is she suffering from insomnia or anxiety, leaving her fatigued and weak? Is her home a safe environment for independent living? Holistic care is achieved through integration of care between hospital, primary care, and the community, and is supported by enablers such as the national Electronic Medical Record system, and a principal doctor consolidating care for different ailments. Healthcare providers need to work closely with social welfare agencies, especially in looking after the vulnerable and needy in society. Policy makers across all sectors should consider the health implications of their decisions and seek synergies to derive positive health outcomes. The recent increase of Singapore’s minimum legal smoking age from 18 to 21 over three years in 2019-2021 will help reduce our smoking prevalence. Should we impose higher taxes or bans on high-sugar drinks, or introduce guidelines on food advertising and packaging? Are there any changes we can make to our education system to reduce the stress our children face? These policy considerations have great impact on our nation’s health.

The Covid-19 pandemic is the greatest crisis of our age. The death toll continues to climb alarmingly in many countries, and the necessary containment measures have plunged economies worldwide into deep recession. While no country has been spared, Singapore has avoided the worst with a combination of quick and decisive government action, a cooperative and responsible civil society and a strong healthcare system. In 2003 while fighting SARS, I felt a great deal of uncertainty, not knowing the nature of the infective agent, and a great deal of anxiety as colleagues fell in the fight. In 2020, the genetic sequence of the novel Coronavirus SARS-CoV-2 responsible for Covid-19 infection was made known in January. And as a result of lessons learnt during SARS and ensuing rigorous training, not a single health worker in Singapore was lost in the fight against Covid-19. We are much better prepared, equipped and trained, compared to when we faced SARS. Our Covid-19 mortality rates remain amongst the lowest in the world, reflecting our success in containing the infection and preventing it from spreading across the population to elderly and vulnerable groups. Even so, we are clearly not out of the woods yet. The global pandemic has demonstrated how interconnected we all are. Even with a safe and effective vaccine available, we must remember that no one is safe until everyone is safe.

Covid-19 wasn’t our first health crisis, nor will it be our last. In the same vein, Singapore’s health and healthcare system needs continue to change and evolve. Everyone, from public healthcare institutions, private care providers, community partners, to our government and individual citizens, will need to work together in order to meet all of these challenges. We all have a role to play in ensuring human health and well-being in the 21st century. Being in good health enhances our quality of life, strengthens bonds with our family and community, allows us to do productive work and live a happy, fulfilling life. My wish for Singapore is this: for us to achieve good health and well-being for all, and in support of this goal, for health to be considered in all policies.

Prof Yeoh Khay Guan is Chief Executive of the National University Health System (NUHS). He is also concurrently the Irene Tan Liang Kheng Professor in Medicine & Oncology and Senior Vice President (Health Affairs), National University of Singapore (NUS). He practises as a Senior Consultant at the Division of Gastroenterology & Hepatology, National University Hospital (NUH). He served as Dean of the NUS Yong Loo Lin School of Medicine from 2011 to 2018.
Prof Yeoh received his Bachelor of Medicine, Bachelor of Surgery (MBBS) from NUS in 1987 and trained in internal medicine and gastroenterology at the NUH. He is a Fellow of the Academy of Medicine, Singapore, Fellow of the Royal College of Physicians of London and Glasgow, and a member of the American Gastroenterology Association and American Society of Gastrointestinal Endoscopy. He received several awards, including the Nishi-Takahashi Lectureship at the 9th International Gastric Cancer Conference in 2011, Outstanding Clinician Scientist award at the National Medical Excellence Awards 2013 from the Ministry of Health, Singapore as well as the Public Administration Medal (Silver) in 2016 for his outstanding contributions to medical education and healthcare in Singapore.

GovInsider and The Birthday Collective are in collaboration to share a selection of essays from the 2021 edition of The Birthday Book: Are We There Yet?

The Birthday Book (which you can buy here) is a collection of essays about Singapore by 56 contributors from various walks of life. These essays reflect on where Singapore is today, where we came from, and where we might be going.

Lead image by Geoff Whalan - CC BY-NC-ND 2.0.

Image of playground by Choo Yut Shing - CC BY-NC-SA 2.0.