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Two speeches of our Ministers have been included in this issue of the SMA News as they provide food for thought in the implementation of strategies for better health of our Singaporeans for the years to come.

Countries undergo transition in population structure in response to the environment and interventions and this in turn lead to a transition in its disease structure. This transition of disease structure has been coined the “epidemiologic transition” by Omran (1971). He identifies three phases in this transition: the age of pestilence and famine, the age of receding epidemics, and the age of degenerative and man-made diseases.

Olshansky and Ault (1986) proposed a fourth phase in the epidemiologic transition - the age of “delayed degenerative diseases”. This phase was proposed because of the progressive decline in the death rates from some chronic diseases associated with steady gains in life expectancy among the aged in the United States and some other industrialised countries. Crimmins, Saito, and Ingegneri (1989) have reported for the United States that these gains in survival among the aged have in large measure been in “disabled” years rather than “healthy” life. In this circumstance, improved survival among the aged implies that there will be an increasing and not decreasing demand for health services (Verbrugge 1984, 1989).

Fries (1989) sees a solution out of this pessimism. He observes that “successful aging” with lessened infirmity can be achieved if medical systems pursue vigorously the path of prevention rather than concentrating on developing sophisticated means of treating diseases after they have been recognised.

In other words, prevention is still better than cure in more than one sense of the word. As Minister of Health, Mr Lim Hng Kiang said in his speech, “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.” This, in the main, will be stopping smoking, eating a healthy diet, exercising regularly and managing stress in our modern world.

With regards to the elderly, the most important preventive measure is to change our individual and society attitude and mindset on what is aged. This was highlighted by the Minister for National Development and Chairman of IMC on Ageing Population, Mr Mah Bow Tan in his keynote address which is reproduced in this issue of the SMA News.

Furthermore, for the elderly to continue to enjoy good health, not only physically, but also mentally and socially, there is a need to pay attention to multiple aspects at the individual, family, and community level. At the individual level, prevention of physical disability through a healthy lifestyle is still important. Attention to maintenance care of chronic diseases, timely and aggressive medical attention for acute problems are important preventive measures against a disabled elderly life.