DPM Heng Swee Keat at the U.S. National Academy of Medicine’s Global Roadmap For Healthy Longevity: Implementation In Asia

Professor Victor Dzau, President of the National Academy of Medicine
Professor Linda Fried and Professor John Wong, Co-Chairs of the International Commission of the Global Roadmap for Healthy Longevity
Excellencies, 
Ladies and Gentlemen,

I am delighted to join you this morning at the Singapore Summit of the US National Academy of Medicine’s Global Roadmap for Healthy Longevity report. 

Reimagining Ageing  

For much of human history, the average human lifespan was less than 50 years. Ageing and retirement were not mainstream concepts and for those who were lucky enough to live to old age, many continued to work as long as they were able to. 

It is noteworthy that even as life expectancies rose in the past century, the average retirement age has generally stayed the same or become earlier. This is partly due to social safety nets and changing societal norms surrounding retirement. But as lifespans increase, the key question for all societies is how we can support our people in leading meaningful and purposeful lives throughout their years. 

This is something that we have been thinking about for some time in Singapore. We have one of the fastest ageing populations in the world. Today, about 14% of our population are aged 65 and above, and this will rise to almost one in two by 2050¹". This is a challenge that confronts almost all societies. By 2050, the number of seniors aged 65 and above globally will more than double, reaching over 1.5 billion people. With large elderly populations in countries like China, India and Japan, Asia will have the largest share of such seniors, at around 60%. But it is not just Asia. As your report points out, all regions will see an increase in the size of the elderly population from now till 2050. So this new report is most timely, and I am glad that you have chosen Singapore to present the findings. 

I look forward to the presentations by Victor, Linda, and John. They are the experts on this issue. But let me offer a few brief observations, building on some striking datapoints. 

The “100-year life” 

The first datapoint is that if current trends continue, more than half of children born in developed countries will live to 100. The “100-year life” may well become the norm. 

This would be a dramatic development, and has profound implications. Societies and individuals will have to increasingly confront the challenge of how to sustainably fund their healthcare and retirement needs. More broadly, the current life structure that is built around the three stages of education, work, and retirement will have to be reimagined. Some have suggested the need to move towards a multi-stage life, with transitions and breaks in between.  

As we reimagine our life journeys, we must grasp the opportunity to better unleash the potential of people to contribute as they age.Today, many still view ageing through the lens of a “silver tsunami” that will impose a crippling burden on society. This is a very limiting mindset. Instead, as your report rightly puts it, it is critical that we unlock the “longevity dividend”, which will in turn benefit people of all ages and societies around the globe.

Mindsets will need to change. Take employers for instance. It is an unfortunate reality that ageist practices and attitudes are still commonplace. Legislation can help, but the more fundamental solution is for employers to recognise that offering opportunities to older workers is not charity. Rather, it is good for their companies. Research has found that older people in multigenerational teams tend to boost the productivity of those around them, and such mixed teams perform better than single-generation ones. Older workers can also guide and mentor younger or less experienced colleagues.

Work is just one way that the elderly can stay active and continue to contribute. Some prefer to spend more quality time with their family. Some volunteer for causes they are passionate about. Others may decide that they prefer a different tempo of work, and take up part-time work, gigs, or micro jobs.

Mindset change is always difficult. But it is possible. Just look at how female workforce participation has improved in most societies. It would have been unthinkable just a generation or two ago. I am hopeful that in the years ahead, we will similarly be able to tap on the full potential of seniors to contribute to our communities.  

Harnessing Age-Tech

The second striking datapoint is one from your report. Over the last two decades, even though lifespans have increased globally, the years in good health have stayed roughly the same. This means that people are living more years in poor health.  

In Singapore, we have managed to make some progress on this challenge. Our Health-Adjusted Life Expectancy, or HALE, is the highest in the world. It has increased from 66.6 years for the 1990 cohort to 73.9 years in 2019. But this is an ongoing effort, and we can and must do more to improve HALE and alleviate the stresses around the last years of life. As a Member of Parliament on the ground, I see many active and healthy seniors, but I also see cases where families struggle to care for their parents, grandparents and other elderly loved ones.

Science and technology hold great promise to improve the quality of life. Advances in food and nutrition sciences can enable everyone, including seniors, to stay healthy for longer. For example, Changi General Hospital developed the first ready-to-eat texture modified Asian meals to help those with swallowing difficulties, which is common among seniors. Advances in automation and digital technologies can also create a more inclusive work environment for elderly workers and enhance their productivity.  And when the seniors develop frailties, assistive technologies such as robotics can help support ageing in place.  

At the same time, it is critical for us to gain a deeper understanding of the social and behavioural dimensions associated with ageing. Given the multi-faceted dimensions of the challenges and opportunities of ageing, we must adopt a multidisciplinary approach to make progress. The US National Academy of Medicine has launched the Healthy Longevity Global Competition, which has garnered many projects. 

In Singapore, we introduced a National Innovation Challenge on Ageing, to find new approaches and solutions to challenges associated with ageing. The projects span a wide range of domains like cognition, frailty prevention and chronic disease management. For example, NTU is working on a project to use predictive analytics to determine the risk of pre-frailty or frailty for an elderly, and subsequently provide personalised adaptive intervention plans. The initial findings are promising. SUTD developed an application that aims to improve the cognitive functioning of seniors by engaging them in a series of dual-language cognitive tasks such as object categorisation. The application was well-received by seniors, and was shown to be effective in improving their cognitive performance in terms of verbal memory. Moving forward, we will continue to partner innovators everywhere, and provide support for good research projects to be translated and scaled to benefit more seniors.  

Human-Centric Approach 

The third datapoint is that the number of elderly living alone in Singapore has doubled over the last ten years, although the absolute numbers remain small. 

This is not surprising, with a growing elderly population, and changing family structures and living arrangements. But this gives rise to greater concern over loneliness, although loneliness is not limited to elderly staying alone.  

Loneliness has a significant impact on life and health expectancy. A study by Duke-NUS and Nihon University found that lonely elder adults in Singapore and Japan lived at least 3 years less than their peers. They also spent less of their remaining life in good health or being active. As your report rightly points out, health is not just about healthcare, but a state of physical, mental, and social well-being. 

We need to therefore take a holistic and human-centric approach in promoting the well-being of the elderly. In Singapore, our aspiration is to build a City for all Ages. This includes designing cities to be empowering and senior-friendly. Our aspiration is that even seniors with physical or cognitive frailty should have the confidence to continue to go out and lead active lives. We have SilverZones to enhance road safety for seniors, and also ensured that public transport is barrier-free. Our parks have also incorporated amenities for seniors, such as senior-friendly fitness corners and shelters. We also opened therapeutic gardens that offer horticulture programmes to improve well-being of visitors, including seniors.

It is not just about infrastructure. It is also about strengthening the social and community support for our seniors. For example, Singapore has put in place schemes such as the Proximity Housing Grant to encourage children and their parents to stay near each other. Beyond schemes, Singapore has also been working towards better coordination of support for seniors in the community. In 2016, I worked with several of my colleagues to pilot the Community Network of Seniors in our constituencies. The goal was to take care of seniors’ wellbeing, through better integration of efforts across the many institutions and community stakeholders. The results from the pilot were encouraging, and we scaled it up nationally. Today, I am glad that we have a Silver Generation Office that organises this effort across the entire island. Silver Generation Ambassadors proactively identify and reach out to seniors in need, and connect them to the support in the community. 

We are continuing to experiment with new approaches. One major new effort is the Health District @ Queenstown. Queenstown has one of our oldest populations, with almost one out of every four residents aged 65 and above. We are developing a suite of bold solutions in Queenstown to support residents in their journey towards healthy longevity – such as senior-friendly infrastructure, community-driven programmes, integrating health services into the community, and providing opportunities for seniors to stay active and engaged. This is a whole-of-society effort – involving HDB, NUHS and NUS, as well as other multiple stakeholders across the public, private and people sectors. John is one of the co-chairs of this trailblazing project, and I look forward to it helping us to learn more deeply about what we can do to create longevity-ready neighbourhoods. 

Conclusion

Let me conclude. 

There are common challenges that all societies face. Healthy longevity is one of them. I am therefore glad to see so many of our public health experts involved in this meaningful project. Apart from John, Chorh Chuan and Mary Ann, there are also many others. I am also delighted that the International Commission for this project involved members from all over the world – from the US, UK, Australia, Japan, China, and more. This Summit is an excellent platform for us to learn from one another and forge new collaborations. Across countries, we should continue to expand collaboration on major challenges that affect all of humanity, such as ageing, pandemics, and climate change. Instead of frittering away our energies in conflicts and discord, let us work together to advance science, technology and innovation, to address our common challenges. 

I look forward to hearing the presentations, and learning from all of you. 

Thank you. 

[1] The figures cited are from international sources and used for illustrative purposes to facilitate international comparisons.

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