Associate Professors Chan Wing Cheong and Angelique Chan,
Organisers of the symposium from NUS,
Professor David Matchar,
Director of the Duke-NUS Signature Program in Health Services Research,
Ladies and gentlemen,
1. Good morning. It is my pleasure to join you at this symposium.
Introduction
2. By 2030, one in five Singapore residents will be 65 years and above, from one in 12 today. Our life expectancy has been steadily rising from just 65 at independence to over 80 years today. These numbers are well-known, but we may not fully appreciate its implications for our health care system.
3. And when the word “health care” is mentioned, the first thing many people think of is hospitals and doctors. This is not wrong, but limiting health care to hospitals and doctors misses the forest for some big trees. It also limits the solutions that the health care system must develop to meet challenges of an ageing population: how do we stay healthy for as long as possible; how do we ensure proper care when we fall sick; and, how do we die well.
4. Finding these solutions to these challenges is key to managing health care costs and ensuring a good quality of life at old age. I am pleased to note that this symposium covers palliative care, end-of-life issues, caregiver support, chronic disease management and other issues pertinent to ageing populations.
5. Allow me to share some thoughts on where our Government is headed regarding the three areas I just mentioned. I hope that it will contribute to your ensuing discussions.
6. Firstly, how do we help people stay healthy for as long as possible?
7. The Minister of Health has recently stated that “effective health care starts with prevention”. It will hold a series of preventive health care programmes in the schools, workplaces and the community. If Singaporeans start young and lead more healthy lifestyles, we should see a healthier population with a lower rate of chronic diseases and disabilities.
8. There is much that we need to do. Health promotion efforts need to lead to changes in behaviour, sustained over years. Today, three quarters of our population do not exercise regularly. How do we persuade them to do so? We must make the behaviour change more attractive and less onerous. The gain must be greater than the pain.
9. Even so, it is tough for a person to change his lifestyle if his family and friends do not do so. Recently, an OECD paper observed that 90% of the successful health intervention programmes were group activities which incorporated education and support.
10. One initiative which we hope to implement on community-based health promotion is the Wellness Programme. This programme, led by the People’s Association, with the support of other government agencies, is currently being piloted in 12 constituencies. Residents aged 50 and above are encouraged to undergo health screening and to be more physically and socially active through interest groups. We have seen encouraging results since the programme started over a year ago.
11. We must also recognise the strong body and mind connection in health. Being purposeful and active is essential for our physical, mental and emotional wellbeing. We need a reason to wake up for. This message still needs to be fully embraced by our seniors. This is why the Government supported the establishment of Council for Third Age under Mr Gerard Ee to champion active ageing.
12. While we continue to promote healthy living, it is inevitable for some of us to develop chronic diseases as we age. More people need to understand that managing their chronic diseases can prevent more serious disabilities and complications, which result in large medical bills and a loss of quality of life.
13. Good primary care is critical in managing long-term medical conditions and in keeping people healthy. We are working towards the goal of “One Family Physician for Every Singaporean”. The Chronic Disease Management Programme was introduced three years ago and has been expanded to cover more diseases. We have also just extended the Primary Care Partnership Scheme to cover chronic diseases. If chronic diseases can be managed, our seniors can still lead healthy, happy and active lives.
14. Secondly, how do we ensure that those who need care get care? Connected to this, how do we support those who give care?
15. Even with our best efforts to promote healthy living and chronic disease management, some people will still fall sick, become frail and require care. For those who have been blessed with a life partner and children, we will look to them to take care of us. But with population ageing, that option becomes less plentiful. Hence, we must develop services to care for our elders and support their caregivers.
16. There are several pieces that we need to develop to have a more robust long-term care system.
- Firstly, we need to ensure that the system is sustainable. Singaporeans must save enough or purchase enough insurance to finance their care needs. Services must be cost-effective, appropriate and scalable – to do so requires us to look at who are the providers, how they are funded, whether they have a supply of qualified workers.
- Secondly, services should be packaged around the needs of the person and his family. Overseas experience suggests that a more integrated delivery of services to the person can result in better patient satisfaction, less caregiver stress and cost savings.
- Thirdly, services should be home and community-based as far as possible, although institutions remain important for those who need more care. In this regard, our high population density and urban setting works in our favour. It is easier to deliver services cost-effectively.
17. What I have just mentioned are being tackled by various government agencies. We are studying how to develop a long-term care financing system which parallels our 3Ms framework. The Agency of Integrated Care under the Ministry of Health already coordinates services for adult and elderly patients across various care settings. More services are being rolled out, such as social day care centres, community hospitals and nursing homes. Home care and caregiver training are being given greater attention.
18. Our long-term care services must evolve with the needs of the population. Let me give two examples: One, there have been calls in the past for retirement villages in Singapore. Our land costs make it expensive for private developers, but can our public flats be homes where seniors can receive the care, support and companionship that they need? Secondly, can we do more to help those with dementia live in the community? The solutions may lie in how housing and care services are designed and packaged.
19. Thirdly, how do we die well?
Over the last few years, the taboo over end-of-life issues has been slowly but steadily removed. Organisations including the Lien Foundation have played important roles in encouraging people to think about how and what it means to die well. For people with terminal illnesses, patients and health care professionals are also more aware of available palliative care services and more are being referred to such services.
20. The temptation to seek treatment against all odds is great, not just for the individual but also their loved ones. Very often, it is the family that finds it hard to let go. This is apparently more common in Asia than in the West. To make informed decisions in the interest of the elderly requires empathy and clarity from medical professionals on the cost and benefit of available options. Some elderly may also choose to discuss with their trusted family doctors early and communicate with their loved ones their preferences in advanced planning for health care decisions. I believe this symposium will also look into the ethical and legal dimensions of end-of-life, which should advance our understanding and wisdom of this issue.
Concluding remarks
21. Designing a health care system for a rapidly ageing population is not an easy task. It requires an optimum balance between quality, accessibility and costs, which changes as demands and expectations evolve. We need to look beyond hospitals and doctors, to the roles and needs of the family, community, and wider environment in which we live in.
22. I believe that by the end of today, participants here would have gained useful insights that we can take home. These insights will be useful for policy makers, whom I hope can continue to work closely with the academia and practitioners to shape policies and programmes for population ageing.
23. I wish you all a good day.
