Lots of medical care but not enough health - a new reset button
https://www.straitstimes.com/opinion/lots-of-medical-care-but-not-enough-health-a-new-reset-button
In my opinion, there have been two times in the recent past when nearly revolutionary policy statements have been made by our leaders that have signalled reset buttons.
One was on society's development on gender equality made by Law and Home Affairs Minister K. Shanmugam in 2020. The other is the statement by Health Minister Ong Ye Kung in Parliament this month, on preventive and public health.
Both these reset buttons will force us to rethink the way we do things. Singapore is on the path to a more gender-equal and a healthier society as we await the White Papers in these two areas.
I want to focus in this article on the changes to come in healthcare, especially the pivot to preventive care. Under the catchy term Healthier SG, it is a nationwide initiative to get Singaporeans and the healthcare system to focus on keeping healthy rather than just paying attention to health only when ill.
Or as Mr Ong described it: "We usually associate better healthcare with fascinating medical technology or heroics in the operating theatre. Those are important, but good health is more likely to come from an accumulation of the humdrum and the mundane. Because as the saying goes, 'prevention is better than cure'."
As he quipped, the focus is to maintain health not treat sickness and "that is why we are not called the Ministry of Sickness, we are called the Ministry of Health".
This is a welcome and necessary shift in emphasis.
For too long, medicine has been immersed in sick care but not enough health. We must now turn our attention to health and healthcare if we don't want our population just to live longer but also to have concomitant improvement of their health and well-being. This requires making thoughtful policy adjustments that affect health.
We have to look beyond the traditional 30 per cent of the healthcare pie that is focused on medical care and genetics, to the social, behavioural and environmental determinants of health, which we know account for roughly 70 per cent of overall health outcomes and which, in the past, have received far less attention.
At every stage in life, health is determined by complex interactions between social and economic factors, the physical environment and individual behaviour. They do not exist in isolation from one another.
In addition, developed societies are now focusing on using data and advanced technologies to augment medicine towards precision medicine. This is defined as an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.
This is in contrast to a one-size-fits-all approach, in which disease treatment and prevention strategies are developed for the average person, with less consideration for the differences between individuals.
Singapore with its strong biomedical sector is well on its way on this route of precision medicine.
It has a 10-year National Precision Medicine (NPM) strategy. A central entity, Precision Health Research, Singapore (Precise) coordinates the whole-of-government effort to implement this strategy.
According to the NPM website: "NPM Phase II aims to transform healthcare in Singapore and improve patient outcomes through new insights into the Asian genome and data-driven healthcare solutions."
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Singapore can expand the precision approach to precision health and healthcare to fulfil what has been announced in the new health agenda.
In precision medicine, a person's genetic profile, family history and life circumstances are used to help her understand her own health and disease risks, so preventive measures and treatment options can be personalised.
Precision health is broader - it goes beyond the use of precision medicine, and includes healthcare approaches such as disease prevention and health promotion activities that take place outside a clinic or hospital.
As the United States Centres for Disease Control and Prevention puts it: "Precision health involves approaches that everyone can do on their own to protect their health as well as steps that public health can take (sometimes called "precision public health").
The vision in precision health encompasses the prediction and prevention of disease, and the management of health in the population.
The new health policy announced by Minister Ong will help Singapore do better in preventing and reducing the incidence of chronic diseases; and can usher in significant changes in management of chronic diseases, by pairing patients with a team of dedicated general practitioners as dedicated family physicians through their life cycle.
Poor diet, smoking, alcohol abuse, inadequate physical activity, stress and inadequate sleep are all behaviours that create risks for chronic diseases.
Stronger patient-doctor relationships can give doctors more authority to offer personalised medical advice. Such ties can hopefully also encourage patient compliance with treatment options and spur them to make the necessary behavioural changes to lead healthier lives.
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Ongoing research has revealed the biological connections between cardiovascular disease and several cancers to poor diet and inadequate fitness.
Epidemiologists call these "modifiable risk factors" to indicate that these behaviours can often be modified to prevent and reduce health risks.
The latest science indicates that improvements in behaviours can be achieved through comprehensive, sustained efforts across many domains, including schools, homes and workplaces.
Social scientists call this a multifactorial approach to changing behaviours. We have some experience in this area. In 2015, the Health Promotion Board launched the National Steps Challenge. This was a large-scale public health intervention to get sedentary citizens up from their seats and on their feet. It has managed to increase population-level physical activity through incidental daily walking. This was done through multi-level interventions integrating technology, behavioural economics, gamification, marketing, communications and community linkages. Intervention components included giving participants fitness trackers and encouraging people to hit targets for daily steps to win points to redeem rewards.
The latest science indicates that improvements in behaviours can be achieved through comprehensive, sustained efforts across many domains, including schools. PHOTO: ST FILE
Another multifactorial approach used in Singapore to change behaviour and reduce the incidence of chronic diseases is our strategy to reduce smoking.
There are ongoing public health education programmes complemented by health promotion measures such as the use of legislation, control of non-smoking areas, control of sale, fiscal measures and provision of cessation services. These have worked together to help keep the smoking prevalence in Singapore among the lowest in the world.
We could also emulate a "Fat Watch" campaign, run in partnership with supermarkets and other private sector allies, and which brought favourable changes in the consumption of saturated fats in the Netherlands.
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It is therefore imperative that leaders of all relevant sectors in the state come together to collaborate on policies that will promote healthy behaviours at the many touch points outlined.
Specifically, the following sectors must work collaboratively to promote healthy behaviour - schools, community centres, town councils, employers, health insurance companies, the food industry, physicians, philanthropies, media and opinion leaders.
For tangible results, we need a whole-of-nation approach. We will see the path more clearly when the White Paper is revealed.
Without relevant changes in health and social policy, we will continue to see increasing healthcare costs in Singapore. The increase is not only due to the direct costs of healthcare services to treat diseases - costs paid by individuals, families, insurance companies and employers, but also the indirect costs that relate to work absences and reduced economic productivity.
We cannot moderate increasing healthcare costs by just looking at the delivery of medical care in clinics and hospitals and attributing most of the increase to our ageing population.
So, we can see that there can be a virtuous cycle - precision health policy can lead to productivity increase and better population health.
This will ensure that the sentiments of the Minister for Health will be realised, "forcing us to rethink the way we do things to be better, to be smarter".
Dr Kanwaljit Soin is an orthopaedic and hand surgeon and a former Nominated MP.
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