NOTICE PAPER NO. 990
NOTICE OF ADJOURNMENT MOTION
FOR THE SITTING OF PARLIAMENT ON 14 FEBRUARY 2022
Name and Constituency of Member of Parliament
Mr Leon Perera
MP for Aljunied GRC
Rethinking Preventive Health to Generate Better Outcomes
Answer
1. Mr Deputy Speaker Sir, Mr Perera spoke about rethinking preventive health. I thank him for the suggestions that he has made. These are useful improvements that the Ministry of Health (MOH) will consider, but I would not describe them as a rethink of preventive health. In fact, improving Preventive Health has been on the agenda of MOH for many years now.
2. In 2016, MOH put forth the Action Plan for Primary Care 2.0, to anchor the role of General Practitioners (GPs) in chronic disease management. A point, which Mr Perera has made, to make GPs an anchor. This sets the stage for the formation of Primary Care Networks (PCN) to strengthen the doctor-patient relationship in the management of chronic diseases. The Community Health Assist Scheme (CHAS) was also enhanced to support the financing.
3. In 2017, MOH announced our “Three Beyonds” strategy – Beyond Healthcare to Health; Beyond Hospital to Community; and Beyond Quality to Value. Minister Gan Kim Yong in his Committee of Supply (COS) 2017 speech emphasised the importance of focusing on early interventions and healthy lifestyle choices to go “Beyond Healthcare to Health”. He further gave the example of how one front of the War on Diabetes would be fought via healthy living and prevention, encouraging the population to stay active and eat healthy to reduce the risk of diabetes.
4. At the MOH Workplan Seminar last year – which was his first public speech as Minister for Health – Minister Ong Ye Kung focused his speech on preventive care, emphasising how interventions should move (and have moved) upstream to tackle lifestyle risk factors for chronic diseases. In comments made during the ministerial panel on Primary Care at the session of the World Health Organization (WHO) Regional Committee for the Western Pacific held in October 2021, Minister Ong also shared that MOH was looking to change the system focus from acute hospital care, back to preventive care provided in the community and/or primary care settings, which would result in a very good quality system that is also sustainable.
5. Since then, we have been engaged in dialogues and in-depth discussions with our GP leaders and many of our Healthcare Cluster leadership. One of the things that we have discussed is on the possibility of a capitation model, to transform our primary care providers’ way of engaging our patients. So MOH’s big push to revamp preventive care in recent months is really no big secret, and we thank Mr Perera for weighing in, and supporting this move including providing some useful suggestions.
6. Over the weekend, at the topping out ceremony of the Woodlands Health Campus, Minister Ong said that he would be announcing a national programme focusing on preventive care at the coming COS. So, I hope Mr Perera and the Workers’ Party members will give it your full support at COS.
7. Mr Perera also suggested more subsidies and incentives to promote screening. His underlying assumption is that if we make things cheaper, in fact make it free, the take-up rate will improve. But actually, having sat across a table of many patients advising them on health screening, in preventive health, the hardest hurdle to overcome is the mindset and health beliefs of the patient. We all know what is good for us, health-wise. Every doctor counsels wants his patients to do the right things for his own health. But alas in real life, changing mindset and health-seeking beliefs is not something that policy or clinical protocols alone can change.
Access to affordable screening
8. For example, the national Screen for Life (SFL) programme was introduced across more than 1,100 CHAS GP clinics, to provide easy access to affordable and appropriate screening for eligible persons for cardiovascular disease risk factors (such as diabetes, high blood pressure, and high blood cholesterol) and also certain cancers (cancers of the breast, cervix and colorectum). Eligible individuals pay no more than $5 for screening under SFL and MediSave can be used for approved screenings, including colonoscopy screening for colorectal cancer.
9. In fact, based on the National Population Health Survey (NPHS) done in 2020, despite efforts to make screening so accessible and affordable for all, cancer screening uptake rates remained between only 40 to 50 percent for each of these three cancers (cervical, breast and colorectal). This illustrates the point that despite efforts to reduce the cost barrier to screening, more still needs to be done to address the individual’s perceptions, the barriers, their fears to undergo screening, and we have to do more to nudge them to undertake screening.
Accessibility to vaccinations against preventable diseases
10. Vaccination is an important component of preventive health interventions, a point that Mr Perera also made. In fact, all recommended vaccinations under the National Childhood Immunisation Schedule (NCIS) are free for Singaporean children at polyclinics and CHAS GP clinics, under the Vaccination and Child Development Screening Scheme (VCDSS), as part of the Government’s efforts to support marriage and parenthood, and to encourage vaccinations as a cohort basis. So, Mr Perera’s call for free vaccination, it is already in effect. All adult Singaporeans are eligible for means-tested subsidies at both CHAS GP clinics and polyclinics for recommended vaccinations under the National Adult Immunisation Schedule (NAIS). MediSave can also be used for approved NAIS vaccinations, which means that co-payment could in fact be zero, and this includes influenza vaccination for our elderly.
11. MOH also uses other touchpoints to increase adoption of these important vaccinations. For example, the Human Papillomavirus (HPV) vaccine that Mr Perera talked about, was actually introduced as a part of the school health programme in 2019, and all cohorts of Secondary 1 females are offered the fully subsidised HPV vaccine in their respective schools. Fully subsidised means it is free. This is in addition to fully subsidised vaccinations provided as part of the immunisation schedule delivered in schools via the Health Promotion Board’s (HPB) School Health Service. MOH has also been working with our primary care partners to increase vaccination uptake, especially among seniors for influenza and pneumococcal vaccinations. Seniors are also able to learn more about the importance of vaccinations through interactive health workshops conducted within the community and through online platforms.
STRENGTHENING THE DELIVERY OF PREVENTIVE HEALTH
Creating an integrated and supportive ecosystem
12. Tackling preventive health requires an “integrated” as well as a “life-course” approach.
13. Over the years, we have built a strong foundation in various key domains across different agencies: health promotion under HPB, health screening and chronic disease management by our GP clinics, our polyclinics as well as our healthcare clusters, promoting sports and active lifestyle by ActiveSG and encouraging citizens to remain active in our community sports clubs and interest groups.
14. Having built up all these key pieces, we now move to enhance the delivery of evidence-based preventive health to the population by integrating them together.
15. For example, the ‘Health Up!’ initiative in Tampines, an initiative led by SingHealth Polyclinics, in partnership with agencies such as HPB, Changi General Hospital, Tampines GRC and SportSG, is a very good example of how the different stakeholders have come together to provide a holistic and structured health journey for residents by increasing awareness of healthy lifestyle habits and promoting appropriate screening for disease.
16. With this integrative approach, a resident who undergoes health screening by the GP to determine the health parameters that needed improvement (could be his BMI, or his blood sugars control targets) could be subsequently assessed by a fitness coach under ActiveSG to customise a fitness regime targeting these particular goals. A structured exercise regime, which also connects the resident with the Community Sports Club, builds a network of peer support, friendships, peer groups, that eventually enables a sustained active lifestyle. Dietary counselling is also provided where needed. In fact, a Care-Coordinator from Changi General Hospital serves as an “account manager” to help coordinate the health journey of the participant and transmit data, help coordinate programmes between the GP, the coach and the dietician. This entire process will be data-driven such that the GPs and the coaches have a shared view of the progress, participation and target goals that the individual has achieved. Suitable incentives and gamification can eventually be built into the process to further encourage and ingrain healthier habits.
17. The ‘HealthUp!’ integrated approach aims to build an ecosystem within the community, and centre it around the individual, so this hopefully provides stronger support to encourage more upstream preventive health.
Adopting a life course approach
18. MOH is also moving upstream to promote healthy lifestyle by adopting a life-course approach. Healthy habits start young. Prevention is better than cure. HPB works with the Ministry of Education and Early Childhood Development Agency, to provide school health promotion initiatives and healthier food options for students in pre-schools and our schools. For the general adult population, our health promotion efforts include public education to increase health literacy and awareness of modifiable lifestyle risk factors for chronic disease with health messages.
19. Together with the Ministry of Manpower and other partners, HPB also aims to improve the health of working adults by transforming workplace clusters into Healthy Workplace Ecosystems through partnering developers and key industry partners, to deliver customised programmes to mature workers in seven priority sectors and the gig economy workers. Programmes are also offered directly to companies, including SMEs and mid- to large-sized companies and organisations. As of end December 2021, HPB has reached out to more than 1.24 million workers, with more than 213,000 workers participating in both virtual and face-to-face programme sessions.
LOOKING FORWARD: THE FUTURE OF PREVENTIVE HEALTH
20. Today, doctors are supported by the National Electronic Health Records to access their patients’ records for patient management. Singaporeans have access to our consolidated health records and eligibility for screening subsidies through HealthHub to empower self-management. We will certainly leverage on technology and analytics to transform citizens’ experience in health promotion programmes, moving from a ‘one-size-fits-all’ approach to a more precise and personalised approach. LumiHealth, an example that the Member has quoted, was launched in 2020, is one such intervention that has empowered individuals to take charge of their health through precise and personalised insights and recommendations. The programme has encouraged individuals to be more active, with their daily exercise minutes increased by over 39 percent when compared to the month before they started the programme.
CONCLUSION
21. Sir, MOH conducts regular population health surveys and is able to examine health behaviours and outcomes of the different population segments. These reports are actually publicly available via the MOH website.
22. While we have made progress over the years, the latest NPHS 2020 saw an increase in the prevalence of hypertension and hyperlipidemia, and a reduction in the prevalence of Singaporeans with sufficient total physical activity and screening participation, partly due to the COVID-19 disruptions. There is a need to double up the preventive health efforts as we seek to regain the momentum and improvements that were lost due to the impact of COVID-19. There is an urgent need for the population to take action and participate in improving their health as we emerge from COVID-19.
23. Sir, I urge all Singaporeans to play an active role in their own health journey by making sensible lifestyle choices and informed decisions. MOH, together with relevant stakeholders, will also continually refine our approach to preventive health to bring about a healthier Singapore.