Reimagining public health in a post-Covid world

By Shirley Tay

Dr Loke Wai Chiong from Singapore’s Ministry of Health’s Office for Healthcare Transformation shares his strategy to tackle the uncertain future ahead.

“The most reliable way to predict the future is to create it,” said Abraham Lincoln.

As we face an uncertain future, thinking of new ways to forge a path to a resilient and stable future has become the new imperative of many governments.

The healthcare industry, in particular, has been put under the microscope. Healthy city planning, innovative science technologies and leveraging on data will be key in helping public health forge ahead, says Dr Loke Wai Chiong, Clinical Director (Programmes) and Head (Integrated Health Promotion) of the Singapore Ministry of Health’s Office for Healthcare Transformation. The unit specialises in developing and experimenting with transformative ideas to create innovative healthcare solutions.

Dr Loke recently spoke at the seminar ‘Beyond Good Healthcare: Designing Healthy Cities’ organised by the Centre for Liveable Cities. GovInsider caught up with him to understand how his unit is using urban design and tech to tackle the uncertain future ahead.

Healthy precincts

City planning and public health are intrinsically linked, and the pandemic has given cities the opportunity to reevaluate existing designs. MOHT believes that the opportunity should be seized to entice people into picking up healthy behaviours.

The office has a “healthy precinct framework” to tackle environmental and social barriers to healthy living in a holistic manner. “It’s a purposeful strategy that can center on settings and place, and where that unit of leadership [can have] clarity around organisation, resourcing, and decision making,” says Loke.

However, Loke maintains that this framework needs to be reevaluated and repurposed for the new normal. He shares three aspects of the healthy precinct framework, and how they can be amended for a post-Covid world.

1. Urban design

The framework first looks at how our environment affects whether we exercise, says Loke. MOHT works with the Urban Redevelopment Authority, the National Parks Board, and the Building and Construction Authority to ensure the design of precincts encourages healthy behaviour. Things such as the density of traffic intersections and the number of parks, for example, can be taken into account when designing a new precinct.

But new constraints of physical distancing have raised the need to reimagine existing designs. People are fearful to exercise in public spaces — an unpublished study revealed that there was at least a 40 per cent decrease in physical activity after the start of circuit breaker, Loke notes.

Singaporeans also have an increased interest to work remotely after the pandemic, a factor Loke says will change the future of transport and thus road use. Cities like Bogotta, Auckland, Paris and Milan have already reclaimed roads meant for cars to be used for bicycles and pedestrians instead.

These factors have raised questions about the built environment. The design of public fitness facilities and their maintenance are factors that need to be carefully reassessed, says Loke.

2. Social fabric

Community is another aspect of ensuring health. MOHT previously worked together with social service agencies to connect with vulnerable and hard-to-reach groups. However, the pandemic has halted these programmes to a stop.
Families are now forced to work and study from home — and cabin fever can place strains on family relations. “Physical distancing shows up and highlights the gaps in our social fabric, more than anything else,” says Loke.

This, again, highlights the need to reevaluate urban planning. “Is there a different way to design, to ensure personal space and privacy despite a space constraint?” asks Loke. Social cohesion must be fostered, where people can be empowered to take care of their direct neighbours, and the community is strengthened.

3. Healthy eating

The pandemic has also permanently changed the way people choose food, says Loke. Many have turned to online grocery shopping, but those who don’t cook choose delivery services or takeouts from nearby eateries. So, the availability of healthy food in everyone's neighborhood within walking distance is going to be especially important.

“I think it's going to be an impactful way of how we design, how do we ensure sufficient density of healthy food outlets in every neighborhood, and how might we nudge people to actually go for the more healthier options even in this environment where takeaway is more frequent than dining in,” says Loke.

Cutting-edge technology

Technology will certainly play a part in the newly imagined future of public health. The MOHT has teams that span across Singapore’s three pillars of healthcare — health promotion, primary care and hospital care — to provide cutting-edge science and technology solutions. The office runs several pilots, and a few successful ones are poised for nationwide scaling.

One such scheme tested a telehealth monitor device on a group of 120 patients last year. The bluetooth-enabled unit empowers chronic patients with hypertension to take their blood pressure readings at home, and transmit them automatically to a polyclinic. The scheme is also trialling tele-consultation and bilingual chatbot support. “Through this, we hope to empower and continue caring for individuals with chronic conditions through remote monitoring, which is especially crucial in this Covid-19 situation,” says Loke.

An application known as iConnect was originally designed to connect care teams and facilitate transition between health facilities by sharing patient information. But the app was recently repurposed to help polyclinic staff manage information and communicate with patients being tested for Covid, says Loke. “iConnect.COVID significantly improves the patient and clinician experience in swab-related registration, results management, and results notification.”

The MOHT team is looking to leverage new IoT technologies to assist in health promotion. Wearables and environmental sensors, for example, can come together to give a holistic understanding of where and what influences people to exhibit healthy behaviours in their lifestyles. “Technology is helping us to integrate new capabilities and methods to make healthy living easier for Singaporeans,” says Loke.

Leveraging on data insights

Masses of data are collected and stored every day, but how much of it is actually analysed? One thing the pandemic has revealed is a gap in the availability of health data and complex evaluation methodologies. “With the Covid-19 pandemic, new challenges are emerging every day, and more data and insights are required to help us plan and design for healthy cities, especially if we are emerging into a ‘new normal’,” says Loke.

The increasing availability of data on our activities will inform urban design and the modelling of facilities. It will also improve the walkability of neighbourhoods and narrow socio-ecological disparities of health. Once these data are analysed, targeted, integrated and scalable initiatives can be developed to achieve sustained behaviour change across the community, Loke says.

As countries move out of lockdown, engineer Tomás Pueyo has coined a phrase for the delicate balance between mitigation and suppression - “the hammer and the dance”. The hammer refers to strict lockdown measures to suppress the spread of the virus, while the dance refers to the careful reopening of economies with measures in place to mitigate a second wave.

Indeed, battling this pandemic is akin to a carefully choreographed dance with a partner that's still relatively unknown. We must approach with caution but stay open to new techniques that will help us maintain a fine balance.