PM Lee Hsien Loong at World Health Summit Regional Meeting - Asia (Apr 2013)

Towards Better Health For All

Prof John Wong
President, World Health Summit 2013
Chairman of the Organising Committee

Prof Dr Detlev Ganten
Founding President, World Health Summit
Chairman, Charité Foundation

Distinguished Guests, Ladies and Gentlemen

I am delighted to welcome everyone to Singapore.

HEALTH: FOUNDATION FOR HUMAN DEVELOPMENT

I am struck by the diversity of participants at the Summit. We have representatives from Asia, Africa, the Americas and Europe. There are academics, doctors, public health officials, CEOs, and journalists among us. Our jobs range from delivering basic primary care in rural areas to developing cutting-edge, personalised medicine.

Despite our diverse backgrounds, we all agree that health is the foundation of human and social wellbeing. Healthy people are happy individuals, productive workers and engaged citizens. A healthy population underpins economic growth and social progress. That is why almost half of the Millennium Development Goals are directly related to health.

Yet achieving good health is a challenging endeavour. Individuals, families, companies and Governments must all work closely together. We need sound policies and effective delivery across many areas – preventive and public health; primary, secondary and tertiary care; traditional and complementary treatments, etc. Healthcare services must be accessible, affordable and of high quality.

As Singapore developed from Third World to First, so too our approach to keeping citizens healthy has evolved. I thought it might be useful to share our experience as a basis to discuss our common challenges and possible solutions.

SINGAPORE’S HEALTHCARE JOURNEY

When Singapore became self-governing in 1959, we faced serious problems of over-crowding and poor public sanitation. The top causes of death were infectious diseases like tuberculosis and pneumonia.

Our first priority was to get our basics right. We focused on developing our primary and preventive services. We invested in public sanitation and cleaned up the Singapore River – relocating pollutive industries, dredging the riverbed to remove rubbish, and bringing wholesome leisure activities to the River (e.g. dragonboating, kayaking). We built a wide network of outpatient dispensaries and primary health clinics, especially for maternal and child health. We introduced Nutrition Supplement programmes to help malnourished children. We vaccinated children against infectious diseases such as measles, diphtheria and polio. Our small size helped us to reach our whole population quickly and efficiently, although back then doctors and nurses had to travel along dirt trails to rural villages or endure choppy boat rides to offshore islands!

As we made progress on these basic public health challenges, we consolidated our outpatient dispensaries and maternal and child health clinics into polyclinics. Polyclinics acted as one-stop centres for general curative treatment, screening, immunisation and dental services. We sited them in our public housing estates, so we could deliver primary healthcare to Singaporeans’ doorsteps.

Subsequently, we built up hospitals and specialty centres to deal with more complex medical challenges. We corporatised our public healthcare institutions to make them operate more efficiently and be more responsive to patients’ needs. If our healthcare institutions had continued to run as government departments, it would have been much harder for them to improve, and upgrade themselves.

We also restructured our healthcare financing to strike the right balance between individual responsibility and state support. The Government continues to subsidise hospital and primary care generously, especially for the lower-income and elderly. We built up our health financing system progressively over the years. Medisave is our compulsory individual savings scheme for healthcare expenses. MediShield is a national insurance scheme for catastrophic illnesses. Medifund is a social safety net to help those who are unable to pay for their own medical expenses. This combination of state subsidies, insurance, and co-payments out of compulsory savings has helped keep our healthcare spending at 4% of our GDP while delivering good outcomes.

More recently, we invested in the biomedical sciences (BMS) industry. This enables us to understand diseases better and develop improved treatments for our patients, especially diseases that affect Asians in unique ways. One example is gastric cancer which is the second leading cause of cancer death worldwide. Gastric cancer is considered an “Asian disease”, and Chinese men are especially susceptible. We established the Singapore Gastric Cancer Consortium comprising multiple universities, research institutes and hospitals. The Consortium has identified two sub-types of gastric cancer using genetic profiling, and is currently conducting clinical trials to improve treatments for gastric cancer. The BMS industry has become one of the engines of our economy, with positive spillovers to job creation, manufacturing and logistics.

At the heart of any healthcare system is people. Hence besides building physical infrastructure, we also introduced training programmes for our healthcare professionals. We created many opportunities for promising officers to further their knowledge after graduation, such as through the Health Manpower Development Programme. Most importantly, we uphold the ethos of care and concern for all patients. I am proud of our healthcare team and their commitment to Singaporeans’ health.

Overall, Singapore’s healthcare system has not done too badly. The Lancet’s Global Burden of Disease Study 2010 ranked Singaporeans as having one of the highest healthy life expectancies in the world, while Bloomberg ranked Singapore the world’s healthiest country. These are encouraging endorsements, but we still try to do better. For example, we need to improve the way we screen Singaporeans for diabetes and hypertension. Our outcomes in certain chronic diseases, such as chronic obstructive pulmonary disease, can be improved, compared to the best-performing OECD countries. We must continue to learn from one another to improve our healthcare systems.

MEETING FUTURE CHALLENGES

Looking ahead, there are four challenges that we need to prepare for. These are not unique to Singapore, but face all countries in Asia and around the world.

First, non-communicable diseases (NCDs). Over 60% of all deaths each year are due to NCDs. According to the WHO, the leading risks for NCDs are high blood pressure, high blood glucose, physical inactivity, and obesity. These are challenges for developed and developing countries alike.

Singapore has adopted a community-based approach to promote healthy living, through volunteer Health Ambassadors, who champion healthy lifestyles, and organise health promotion activities. We have also introduced Healthy Hawker Centres, more public spaces for exercise, and are working on food advertising guidelines for children. There is tremendous potential for innovation here. For instance, the UK has gotten some fish and chip shops to use salt shakers with fewer holes to reduce salt consumption. Stanford University researchers have found that people who watched avatars of themselves running on a treadmill were more likely to exercise, compared to those who watched their avatars lounging. We look forward to learning from other participants how to encourage people to live healthily.

Second, ageing. From now until 2050, the number of people aged 65 or older worldwide is expected to triple from around half a billion to 1.5 billion. Several of the world’s fastest ageing countries are in Asia, such as China, Korea and Singapore. Developing countries are in fact ageing three times faster than developed countries. Today’s elderly are more healthy and active, but their growing numbers will increase the load on our healthcare systems.

We are making Singapore more elderly-friendly by making neighbour-hoods barrier-free, and building more nursing homes and Senior Care Centres so our seniors can age gracefully in the community. More importantly, we are encouraging our seniors to lead active lives through Wellness Programmes and community work. For example, the YAH! (Young At Heart) Community College in Singapore promotes active ageing by running lifelong learning programmes for seniors and encouraging them to forge new friendships with one another.

Third, healthcare affordability. Healthcare must be affordable both to the patient and the State. In many Western countries, healthcare financing is a sensitive political issue. It is not yet such a vexing problem in Asia today, but healthcare spending will inevitably rise as populations age, expectations increase and medical cost increases continue to outpace general price inflation. Keeping healthcare affordable is a key challenge for many countries.

We are currently reviewing Singapore’s healthcare financing system, to continue to give Singaporeans peace of mind. The Government will take on a larger share of healthcare costs, make insurance play a bigger role, and allow greater flexibility in the use of Medisave. We will ensure that out-of-pocket costs remain affordable, and provide additional help to needy Singaporeans. We will also study how the state can provide more targeted financial support, such as in chronic disease management, preventive care and long-term care.

Keeping healthcare affordable also requires an efficient delivery system. It is better and cheaper to keep Singaporeans healthy and manage diseases at the primary or community level instead of in hospitals. We are thus developing Regional Health Systems which integrate primary, acute and long-term care providers in the community to serve patients better. Other countries have also introduced interesting innovations, such as e-consultations and mobile phone diagnostic kits. There is much that we can learn from one another.Fourth, emerging infectious diseases. This year marks the 10th anniversary of SARS. It was a dark episode for many countries, especially in Asia. More than 8,000 people were infected, and about 800 died. New infectious diseases have continued to emerge around the world, including the first cases of H7N9 infection in humans just days ago.

Many Asian countries improved their capabilities to deal with infectious diseases after SARS. In Singapore, we strengthened coordination across the whole of Government to prepare for future pandemics. We are also building a new infectious diseases hospital in case of future outbreaks.

One important way to fight infectious diseases is to strengthen international cooperation. Infectious diseases do not respect geographical boundaries. Early warning surveillance systems, information sharing and coordinated cross-border infection controls remain critical to combatting this threat. We must therefore continue to strengthen our links with the WHO and other public health agencies as a vanguard against future pandemics.

Besides global public health crises and pandemics, international cooperation is also useful for sharing information and experiences. Our circumstances and needs may vary, but we share a common goal of keeping our people healthy.

Hence, healthcare platforms at the UN, WHO, APEC and ASEAN are useful channels for countries to share experiences and professional expertise. Institutional collaborations – between universities and research institutes – also help us to enhance our capabilities. Our medical education landscape has been enriched by the collaborations between the National University of Singapore (NUS) and Duke University, as well as between Nanyang Technological University and Imperial College London. Our recently established Saw Swee Hock School of Public Health has also benefitted from a strategic partnership with the London School of Hygiene and Tropical Medicine, whose Director Peter Piot is with us this evening.

CONCLUSION

International cooperation also includes sharing experiences at conferences like these. The annual World Health Summit in Berlin is a unique gathering of academics, policy-makers and practitioners. Singapore is honoured to host the inaugural World Health Summit in Asia.

The focus on Asia is timely. With economic growth, urbanisation, environmental change and ageing societies, Asia is facing significant healthcare challenges. By bringing this Summit to Asia, we can bring our collective wisdom to bear on the diverse challenges and opportunities we face in Asia. At the same time, we hope that the solutions and models we have in Asia can enrich the discussions back in Berlin later this year.

I hope that you will make use of the Conference to interact with one another, and build new friendships. I wish you all a successful Summit.

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