Letters to the Editor
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PREVENTIVE HEALTHCARE AND HEALTH PROMOTION
It gives me great pleasure to officiate today at the opening of the Institute of Health. The Public Health Services housed in the Institute of Health has a long illustrious history providing preventive healthcare services and promoting good health. This new building will provide the facilities for the various agencies housed in it to discharge their missions more effectively.
I explained in Parliament recently that there are 4 components in preventive healthcare. The first component is to lay a firm foundation for a healthy population. This means good pre-natal and post-natal care and a comprehensive immunisation against infectious diseases. Our childhood immunisation programme is very successful, and we have eradicated many diseases like polio, diphtheria and whooping cough. We follow up with a very extensive and effective school health and dental programme. For male Singaporeans, they continue with this strict regime when they serve National Service. This means that, by and large, for the first 20 years of their life, young Singaporeans start off with a firm foundation for good health.
The second and probably most difficult component in preventive healthcare is the promotion of healthy lifestyle activities among adult Singaporeans. The message is very simple – do not smoke, eat wisely, exercise regularly and manage your stress levels. We do this through health education programmes. Public education on healthy lifestyles has been propagated by my Ministry for some 15 years. We realise that changing the mindset and changing behaviour is an uphill task. We are going against strong trends, of a more affluent but ageing population, eating rich food, having more sedentary habits and leading more stressful lifestyles. With a more sophisticated population, we will have to use different strategies and approaches so that our appeals are more effective.
The third component is health screening to pick up diseases early for treatment. Not all health screening programmes are cost-effective. The pragmatic approach is targetted screening for specific groups.
The fourth component of preventive health care is secondary prevention. This is early treatment of diseases to prevent complications. Sometimes, it is the severe disability or complications which are expensive and difficult to treat, not the disease itself. Let me use diabetes as an example. If diabetes is not treated early, or if it is inadequately managed after treatment, it can result in blindness, strokes, heart attacks, kidney failure and limb amputations. My Ministry, together with the various professional organisations, has drawn up guidelines for the proper management of diabetes, to ensure a standardised and adequate level of care.
This afternoon, I would like to address the most difficult component of preventive healthcare, that of promoting healthy lifestyles. We have to constantly modify our health promotion approach in order to reach out to the targetted groups. Let me illustrate.
NEW STRATEGIES IN HEALTH PROMOTION
As I described earlier, pursuing healthy lifestyles means do not smoke, eat wisely, exercise regularly and manage your stress levels.
Our “Stop Smoking” campaign has been quite effective. The smoking rate for the population, as a whole, has declined. But we have to do more to target the younger generation.
The smoking rate among our youths aged between 18 to 19 years old is 12%. This is still too high. With the health risks of smoking so clearly demonstrated by medical research, I find it puzzling why young Singaporeans who are better educated still take to smoking. Studies the world over have shown that smoking initiation begins during the late teens – “the age of experimentation” so to speak. “Talking down” and sermonising to young people is not likely to succeed in getting them not to smoke but will instead achieve negative results, shown up as defiance and rebellion. Furthermore providing hard facts, eg. smoking causes heart disease and lung cancer, may not create much impact on the young, as these diseases appear remote to them – most young people tend to live for the present. We need therefore to take new approaches such as getting young people to organise events for themselves to promote smoke-free lifestyles and not to take up smoking. We need role models who do not smoke that teenagers can identify with. My Ministry will work with the different youth groups to try and bring down the incidence of smoking among young Singaporeans.
Food and Health
The second limb of a healthy lifestyle is to eat wisely. Eating features prominently in our everyday activities, and our social lives. Over-indulgence in food leads to medical problems. Several of the chronic diseases faced by Singaporeans today have a definite link to our eating habit.
In the post-war years, the problem was that of insufficient food. Our children, as a result, became underweight and suffered from nutritional deficiencies. Some of you will be able to recall the times when thin and underweight school children were given supplements of milk powder and eggs, to help them grow. Within this very same generation, the situation has reversed and we are having to put overweight school children through programmes of exercise and diet regimes to trim down their excess body fat!
One clear indicator of our increasing affluence and increase in purchasing power is the increase in the amount spent on the family’s food budget and on the purchasing of food products perceived to be “luxurious”. However these are the foods which tend to be higher in calories, saturated fat and cholesterol, and low in dietary fibre.
How does all this affect health? It is common knowledge that overeating leads to obesity, high consumption of saturated fats increases the risk of heart disease, diabetes and certain cancers, and consuming too much salt predisposes to high blood pressure and stroke.
Heart disease, cancers and stroke are the top killers here, responsible for more than three-quarters of the deaths among Singaporeans today. In 1998 alone, these diseases claimed the lives of about 10,000 of our people; many of these deaths were premature and could have been prevented.
Diet of Singaporeans
What do Singaporeans eat? The National Nutrition Survey conducted in 1998 provides the answer, bringing with it both good news and bad news.
First the good news – many Singaporeans are making a conscious effort to improve their diet by cutting down fatty foods and red meat – this is supported by the fact that 70% of people have a fat and cholesterol intake that is within acceptable limits.
Unfortunately there is more bad news than good news. While the total amount of fat consumed by most Singaporeans is acceptable, the type of fat consumed is mainly saturated, coming largely from animal products, coconut milk and certain cooking oils which are used for processing the fried foods commonly eaten by Singaporeans. Blended vegetable oil, which is high in saturated fat, is the choice for cooking oil used by about 40% of all Singaporeans and 67% of Malays, and is also commonly used by hawkers.
What is also surprising is that even with the abundance of fresh and colourful fruits and vegetables found in our markets, more than 80% of Singaporeans do not consume an adequate intake of fruits and vegetables every day.
This pattern of food intake supports the findings from the National Health Survey 1998. The Survey showed that there is a higher prevalence of high total blood cholesterol seen among Malays at 35.6%, among Indians at 24.4%, followed by Chinese at 23.9%.
What is the most worrying finding from the Survey is that it is younger Singaporeans who are the least concerned about their diet. Those in the 18 to 39 years age group tended to consume sufficient fruits, vegetables and wholegrain products in their diet, but exceeded the limits for fat, saturated fat and cholestrol intake. While most chronic diseases occur after middle age, what we do in our younger days lays the foundation for good health later on. Past studies showed that there was evidence of heart disease even in young people. Youth does not confer a natural protection.
Bearing in mind the results of the Nutrition Survey, my Ministry intends to be more focussed in its approach to encourage the public to adopt healthier eating habits. The public has access to information from the range of educational materials which my Ministry produces and from ready sources in the media, the internet and so on. We will be enlisting the cooperation of food providers in hawker centres, food courts, restaurants, and canteens in workplaces to provide healthier food. Consumers will also find it easier to make healthier food choices when shopping, because of the healthier choice symbol displayed by some of the products.
Exercising regularly and managing stress
The national levels of participating in regular exercise, ie. 3 times a week for about 20 minutes, has increased, from 14% in 1992 to 17% in 1997. We can do better. We are promoting regular exercise which is sustainable over the long-term. In other words, each person has to choose the type of exercise he is comfortable with and willing to perform regularly. As walking is a natural activity for most people, we would like to promote brisk walking as a form of exercise. Stair climbing instead of using the lift will contribute towards this end and can be incorporated easily into most people’s lives.
We are aware that in our urban society, many people find their lives quite stressful. However, we must accept that stress is part and parcel of living. The important issue is to manage stress effectively. My Ministry conducts stress management workshops. We have started with civil servants under the aegis of the PS21 Functional Committee on Staff Well-Being. We will review the effectiveness of this approach.
Our preventive healthcare programme has been reasonably successful so far. But we have to constantly adjust and improve. We can do more to give our young Singaporeans a firm foundation of good health. We have to be more innovative in promoting healthy lifestyles. With better medical evidence, we can be more proactive in selective health screening programmes targetted at certain high-risk groups. And we can do so with more effective results if we integrate the efforts of the public sector agencies with the private sector medical professionals and the community organisations.