Dato Seri Setia Dr Awang Haji Mohd Amin Liew Abdullah
Dato Seri Setia Dr Haji Mohd Isham Bin Haji Jaafar
Ladies and gentlemen
1. Thank you for inviting me to the 2nd ASEAN Digital Public Health Conference. Unfortunately, I am unable to be with you physically in Brunei, but am glad that I can speak to you virtually, and ‘live’, alongside representatives from various regions.
Demographic challenges in the region
2. As the dust of the COVID-19 pandemic settles, healthcare systems around the world will once again revert to the central challenge of our times, which is rapidly ageing populations across many societies around the world.
3. By 2030, for the first time in recorded human history, the old will outnumber the young. In fact, East Asia is ageing faster than any other part of the world due to declining fertility and people living longer lives.
4. Within East Asia, Singapore is one of the fastest ageing countries, together with Japan and South Korea. One in four Singaporeans will be aged 65 and above by 2030, up from one in six today.
5. Ageing is a key but not the only factor, driving the increasing incidence of non-communicable diseases. In Singapore, we have been seeing a rising prevalence of chronic diseases such as high blood pressure and high blood cholesterol among Singapore adults, alongside other concerning trends such as obesity.
6. In the coming ten years, we will expect a significant rise in disease burden. The impact will be palpably felt across individual lives, families, neighbourhoods and also employers and companies. Families will find it challenging to cope with taking care of their aged loved ones. In the community, we expect vehicle traffic to have to slow down, the green phase for pedestrians need to be longer, every nook and corner needs to be curb- and barrier-free. Hospitals need to cope with significantly high patient load, and Governments need to ensure that it can afford its healthcare budget.
Singapore’s Healthier SG strategy
7. We must move quickly to address this challenge. Singapore has built a strong foundation for our healthcare sector. We expanded the capacity of our healthcare system, strengthened the capabilities of our healthcare workforce through expanding education and training opportunities, and have been promoting healthy living.
8. We will build on this through Healthier SG, a major national strategy to transform our healthcare system, to shift our focus from curative care to preventive care, from hospitals to community care. This is essentially to put our healthcare system on a more sustainable footing. Some commentators thought this is the biggest healthcare reform in Singapore for the past 50-60 years.
9. Let me briefly explain what Healthier SG entails. There are five key components.
10. First, we are mobilising our family doctors from both public and private clinics to deliver preventive care to our people. In Singapore, family doctors are trusted nodes who provide accessible care in the community. Throughout the COVID-19 pandemic, many of them played a significant and critical role in our public health response. Under Healthier SG, we want to retain that. We want to mobilise them to build strong relationships with their patients and play a bigger role in preventive health.
11. Second, health plans. Under Healthier SG, family doctors will guide their patients to develop a personal health plan. This plan will focus on the health status of the patient, health goals to achieve, and an action plan that the patient can undertake. The action plan will centre around preventive health such as completing essential health screenings and vaccinations and picking up healthy life habits such as good diet, adequate sleep and exercise.
12. Third, we will work with community partners to support residents in leading healthier lifestyles because improving health goes beyond a doctor’s visit. It is not easy after seeing the doctor to follow diet or exercise advice to improve our lifestyles by ourselves. Community partners who create a supportive environment for healthy living and organise health related groups and activities, and journey with us on this pathway to better health.
13. Fourth, the last three components will come together as a national enrolment programme. Singapore residents will be invited to enrol with one regular family doctor and build a long-lasting relationship with them. For residents who are healthy or experiencing an early onset of chronic illness, their family doctor will support them to remain healthy for as long as possible. As for residents who already have chronic conditions, their doctor will support them in preventing or delaying illness progression. And for those who require more medical care, their doctor would work with their specialist doctors to manage their conditions. In short, family doctors will support and work with residents to improve or maintain their health, and not only step in when there are acute symptoms.
14. Fifth, we will strengthen our system enablers. These are things in the background that we do not see. For example, we need the right financing system, such as through capitation funding, to provide the incentives for healthcare providers to focus on preventive care. Another significant enabler is the IT system. We need a robust system to collect and share patient data safely and securely, to pave the way for an integrated care model that can also foster team-based care, and improve the way primary care providers interact with their residents.
15. This is the backdrop of the central challenge we face and the response of the Singapore healthcare system. I took some time to explain this, because it is within this context that we are also making a major push for digital health.
16. I want to touch briefly on four aspects of digital health innovation: First, powering healthcare through centralised IT system; second, leveraging individuals’ effort through digital technology; third, raising productivity through telehealth; and fourth, harnessing breakthroughs in medical science.
Powering the Healthcare System
17. First, to drive integrated and seamless care, we need to power the national healthcare system with a few strategic, mission-critical, centralised IT system.
18. In Singapore, one such system is the National Electronic Health Record (NEHR) system. NEHR captures the summaries of patients’ medical records in a central platform that is accessible by licensed healthcare providers. We have enhanced the system to improve the collection and sharing of summarised medical data among healthcare providers such as family doctors, hospitals and community care partners such as nursing homes.
19. Patients in turn has a window into the NEHR to access their own medical data through a web and mobile application called HealthHub, with expanded access to records such as their screening results and their health plan under Healthier SG.
20. To facilitate the proper collection, use and sharing of health data amongst healthcare providers in a safe and secure manner, we will introduce a new legislation, the Health Information Bill, in 2023. The Bill will mandate licensed healthcare providers to contribute patients’ summarised medical records into the NEHR, and in turn they are able to see patients’ health data by their care teams across different settings. The new legislation will also mandate data governance, IT and cybersecurity capabilities by healthcare providers and data intermediaries.
21. The fact is, we cannot view healthcare just as a hospital activity anymore, because that is sick care not healthcare. Healthcare happens in homes, at workplaces and in the community in our day-to-day life. For that to happen, medical records and data need to be accessible safely and securely across settings and healthcare providers.
Leveraging Individuals’ Effort
22. The second digital innovation in healthcare is to leverage individuals’ effort. Ultimately, each of us are responsible for our own health, because we are the biggest and most consequential stakeholder. Yet, most of us visit our doctors infrequently – once a year or half a year. We may abide by his advice for a few weeks and slack off after that. We lack the medical expertise and knowledge and especially the motivation, to continue the course to stay healthy.
23. Digital technology can now be used to empower and motivate individuals to take greater ownership of our health. Wearables for example come in many forms now – watches, rings, even shirts – and paired with a mobile app. With the two working in tandem, they encourage us to adopt healthy lifestyles, eat better, exercise more, sleep more soundly.
24. After the COVID-19 pandemic, we have a great opportunity to promote the use of digital health apps and wearables. All over the world, people are used to checking COVID-19 test results or vaccination status using a health app, which has become a must-have in our smart phones. Now, we can use these digital companions to help individuals take steps toward better health. It will be a powerful multiplier for our Healthier SG strategy.
25. Singapore has a head start in this. Years ago, we developed an application called Healthy 365, which allows sign-ups for healthy lifestyle programmes, as well as easy tracking of lifestyle data such as physical activity and healthier food purchases.
26. With the Healthy 365 app, residents can also participate in the National Steps Challenge, the world’s first population-level fitness tracker-based activity to gamify physical activity and reduce sedentary behaviour. Today, one fifth of our adult population participates in the National Steps Challenge. By clocking steps and engaging in moderate or vigorous physical activity, they can earn “Health Points”, which can be used, just like air miles, to exchange for goods and services at various participating merchants.
27. Additionally, we need an open architecture which promotes system interoperability and compatibility between wearables and digital health apps like Fitbit, Apple, Garmin and Samsung to allow consumers and patients to adopt and use these devices as part of their daily lives, and yet to be compatible with Healthy 365 so they can continue to participate in the National Steps Challenge, earn points, and lead a healthy life.
28. Third, we can achieve a significant leap in productivity in healthcare delivery, through telemedicine. Telemedicine and teleconsultation had not been well-accepted in Singapore. However, during the pandemic, we established telemedicine systems and processes for those recovering from COVID-19 at home. Today, telehealth is well-accepted, and patients begin to see its benefits – that it is convenient, accessible and the doctor can be equally personal and attentive to the patient.
29. We should make telehealth the norm in our healthcare delivery system. It will raise productivity tremendously. This is especially important for an ageing society, where mobility of patients can be a challenge. Telehealth will expand the capacity of primary care to manage patients with chronic conditions and improve their outcomes in a very cost-effective manner.
30. At the same time, home delivery for medicine and contactless transactions can become part and parcel of the new normal. During the pandemic, we deliver medication and oximeters to COVID-19 patients. We are in the process of developing the centralised pharmaceutical distribution system, which can make telemedicine even more attractive and convenient.
31. Finally, and possibly the most significant of all innovation, is to harness the breakthroughs in medical science. The possibilities are many, but let me cite two examples that are just fover the horizon.
32. One is the increasing use of Artificial Intelligence (AI). AI can enable our healthcare workers to better care for their patients. For example, in the area of early diagnosis, the Singapore National Eye Centre, Singapore Eye Research Institute and National University of Singapore School of Computing jointly developed an AI system called SELENA+ (Singapore Eye LEsioN Analyser Plus). It uses deep learning models on retina images to detect Diabetic Retinopathy and has been deployed to 23 polyclinics and reading centres. The system helps to overcome our shortage of trained healthcare professionals and detect high-risk patients early to prevent future blindness.
33. Two, is the powerful convergence of digital technology and bioscience. Genetics is not a new field of science but in 1990, the Human Genome Project generated the first sequence of the human genome. It is literally a human blueprint, which is in turn made up of billions of DNA pairs, each of which in turn comprises four chemical bases – A, G, C, T – as building blocks.
34. In other words, humans are not very different from a very complex set of computer source codes. In the years and decades to come, we are bound to see a convergence of digital and bioscience technology, and it is already happening.
35. We have already witnessed the record-breaking speed in COVID-19 vaccine development. Scientists are now working on a 100-day project, which is the targeted time taken to develop a vaccine for the next pandemic. This is possible because of the mRNA technology, where vaccines are literally programmed – like a software – to be upgraded to fight new pathogens.
36. Hence, Singapore has started administering Moderna bivalent vaccines, which protects against the wild type and BA.1 variant – an improvement from the original vaccine. Soon, we will have the Pfizer bivalent vaccine, which protects against BA.5 subvariant. I commented to a colleague recently that vaccines development now is almost like upgrading of our smart phone operating system – version 15, to 16, to 16.1, 16.2 etc.
37. I think this is just the start of the revolution. In time, there will be treatment and therapies, intervening at the cellular or genetic level, for various diseases. It will also be possible to sequence the genomes of individuals, to find out their health risk with age. The possibilities are exciting, but also poses many difficult legal, moral, social and financial challenges and dilemmas. This will preoccupy policymakers for many years to come.
38. Thank you for giving me this opportunity to share my thoughts. I thank the Ministry of Finance and Economy and the Ministry of Health in Brunei Darussalam for hosting this Conference and wish all of you an enriching and thought-provoking day ahead. Thank you.