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A recent article based on the National Health Survey in Singapore found that the prevalence of diabetes in our country was 8.4%. What was more disturbing was the fact that more than half of these patients were previously undiagnosed. Another article showed that almost a quarter of people aged 40 - 64 years had hyperlipidemia and despite intense efforts to control smoking, 20% of the population were still regular smokers, with the increasing prevalence in the young. What are the underlying implications in view of these findings?

It is perceived that many Singaporeans are not taking a proactive role in leading healthy lifestyles, with the result that risk factors for preventable chronic diseases are high. For example, many Singaporeans continue to consume high-fat, low-fiber diets and lacking adequate exercise. Many Singaporeans are not well informed about hypertension and diabetes, and the poor control of these diseases is still common as a result. There is a pressing need for better health awareness and for the promotion of a healthy lifestyle. Are our patients knowledgeable about their own health and disease? How many of our patients regularly ask for screening, be it for diabetes, hypertension or hypercholesterolemia? How many of our diabetic or hypertensive patients know the impact of their own disease?

A public health approach to this problem is needed. Who is responsible for the health education of our patients? The answer is that everyone is responsible, from the government to the health care providers and, finally the patients themselves. Firstly, the Ministry of Health must be commended in taking a very proactive approach to health education and making patient health education a priority. Certainly, there is an abundance of health information readily accessible to all through a variety of media.

Secondly, as doctors, we also have to shoulder a big part of the responsibility on the lack of education of our patients. We often assume that our patients do not understand beyond the basic information we dispense. We also assume that they have no interest in wanting to know more. This attitude must change. We need to spend more time talking to them and encouraging them to participate in screening and risk assessment.

Thirdly, we need to change the mindset of a large proportion of our patients. Many patients are very passive still about health education and knowledge. When they are diagnosed with a disease or a risk factor, many do not actively seek out additional information, often relying on their doctors to provide them with what they need to know. This leads to a vicious cycle in which both parties have little incentive to engage in health education.

As our health care system evolves, patient education will be increasingly important in the prevention and management of chronic diseases. All of us must play a role.


Dr Wong Tien Yin