TASKFORCE HEALTHYSG REPORT - MOH'S

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TASKFORCE HEALTHYSG REPORT - MOH'S
HEALTHYSG
TASKFORCE
  REPORT
TASKFORCE HEALTHYSG REPORT - MOH'S
TAB L E   OF   CONT ENT S                                                                                                                                                      FO R E WO R D

CONTENTS                                                                    FOREWORD
                        FOREWORD                                       3    Over the years, the Ministry of Health (MOH) and the Health Promotion Board (HPB) have been
                                                                            increasing efforts to encourage Singaporeans to lead healthier lifestyles. However, we recognise
                                                                            that such efforts need to be extended beyond the health sector and involve other parts of

                        EXECUTIVE SUMMARY                              4
                                                                            government and society. We understand that in a fast-paced society such as Singapore,
                                                                            health may not always be at the forefront of our minds. As such, we need to make healthy living
                                                                            easy, convenient, and accessible, to encourage Singaporeans to embark on their life-long

01
                                                                            health journeys.
                        THE STATE OF HEALTH IN SINGAPORE
                        BURDEN OF DISEASE                              8    The HealthySG Taskforce was set up to explore ideas that harness the power of our community,
                                                                            infrastructure, and technology, to better nudge Singaporeans towards adopting a healthy lifestyle.
                        MODIFIABLE RISK FACTORS                        9    The Taskforce is not just about coming up with a one-off list of recommendations, but it seeks
                        HEALTH TRENDS AND STATISTICS                   10   to generate a national movement, a call to action. In order to succeed in transforming the health
                                                                            promotion landscape, we will need the active participation of everyone from all walks of life.
                        SOCIOECONOMIC GRADIENT AND HEALTH INEQUALITIES 13   We hope that this report will raise awareness of the importance of making healthier choices,
                                                                            so that we may not only lead longer lives, but also enjoy a better quality of life.

02
                        PUBLIC CONSULTATIONS
                                                                            MEMBERS OF THE HEALTHYSG TASKFORCE
                        WHO DID WE CONSULT?				                        15
                        WHAT DID WE TALK ABOUT?			                     16
                        WHAT DID WE FIND?				                          17
                        SUMMARY TABLE OF IDEAS GENERATED 		            20
                        ON MENTAL & WORKPLACE HEALTH			                22

03
                        HEALTHYSG TASKFORCE RECOMMENDATIONS                     CHAIRMAN
                        THE 3Es –                                      25
                                                                                                                   MR BAEY YAM KENG                 MS LOW YEN LING
                        EMPOWERMENT                                    26                                           Senior Parliamentary           Senior Parliamentary
                                                                                                                 Secretary for Transport and      Secretary for Education
                        ENGAGEMENT                                     31                                           Culture, Community                and Manpower;
                                                                                                                          & Youth                  Chairman of Mayors’
                        ENVIRONMENT                                    39                                                                         Committee and Mayor of
                                                                                                                                                    South West District,
                        IMPLEMENTATION TIMELINES			                    46                                                                                PA Board

04
                        CONCLUSION
                        WORKING WITH SINGAPOREANS, FOR SINGAPORE       49          MR AMRIN AMIN
                                                                                  Senior Parliamentary
                        ACKNOWLEDGEMENTS                               50         Secretary for Health
                                                                                   and Home Affairs

                                                                                                                                                                                          REPORT
                        ANNEX A:                                       51
                        Terms of Reference

                                                                                                                                                                                          TAS K FO RC E
                        ANNEX B:                                       52                                          A/PROF MUHAMMAD                  MS SUN XUELING

                        Partner Agencies and Ministries                                                             FAISHAL IBRAHIM
                                                                                                                    Senior Parliamentary
                                                                                                                                                   Senior Parliamentary
                                                                                                                                                       Secretary for

                                                                                                                                                                                          H E A LT H YS G
                                                                                                                   Secretary for Social &          National Development
                                                                                                                    Family Development              and Home Affairs
                                                                                                                       and Education

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TASKFORCE HEALTHYSG REPORT - MOH'S
EXECUTIVE   S U M M ARY                                                                                                                                                           EXECUTIVE       S U M M ARY

EXECUTIVE                 Singaporeans are among the                                      For five months between January and May 2019, we actively engaged experts and the public to
                                                                                          help identify gaps in the current health promotion landscape and ideate for potential solutions.
                          longest living and healthiest                                   More than 300 Singapore residents were consulted via online and face-to-face platforms.

SUMMARY
                                                                                          Participants included health professionals and experts in fields such as public health, social work,
                          people in the world.                                            health technology, behavioural insights, built environment, sociology, as well as members of the
                                                                                          public, both young and old, from different backgrounds.
                          This serves as a testament to the strong foundation that
                          has been laid by the Ministry of Health (MOH), the Health
                          Promotion Board (HPB) and partners over the years               AIM OF THE PUBLIC CONSULTATION
                          to encourage Singaporeans to lead healthier lifestyles
                          through efforts such as the Healthy Living Master Plan.
                          Nevertheless, societal changes and technological progress
                          continue to pose challenges, such as sedentary lifestyles
                          and over-consumption of unhealthy foods.

                          Such lifestyle habits can have a negative impact on our
                          health. Over the last few decades, chronic diseases in our
                          population has increased and now make up more than
                          80% of the disease burden. The key risk factors affecting
                          the development of chronic diseases in Singapore include
                          poor dietary habits such as our high salt and sugar
                          intake, tobacco use, and sedentary lifestyles. In light of              GATHER                      UNDERSTAND GAPS IN                      IDEATE AND COME
                                                                                              PERCEPTIONS OF                  THE CURRENT HEALTH                     UP WITH POTENTIAL
                          these trends, we recognise that there is still more that
                                                                                               HEALTH FROM                  PROMOTION LANDSCAPE, AS                 SOLUTIONS TO BRIDGE
                          we can do. Moreover, while our overall life expectancy is            PEOPLE OF ALL                OBSERVED FROM DIFFERENT                   OR FILL GAPS AND
                          relatively high, health inequalities exist in our population,        WALKS OF LIFE.                 DEMOGRAPHICS IN THE                       CHALLENGES.
                          with higher smoking and overweight prevalence among                                                     COMMUNITY.
                          Singaporeans from lower income families. There is thus
                          a need for us to move Singaporeans towards healthier
                          lifestyle habits, to prevent or delay the development of        While there were diverse views on what health meant to each individual, many faced similar
                          chronic diseases amongst our citizens.                          challenges in leading a healthy lifestyle. To the participants, staying healthy meant being free of
                                                                                          physical illness and mental stress, being physically active, and eating well. Most agreed that health
                          To collectively enhance the quality of life of all              should be a top priority. While many felt that leading a healthy lifestyle was mainly a matter
                          Singaporeans, we need to coordinate efforts and                 of personal motivation and commitment, challenges such as time constraints and competing
                          maximise the use of resources for health in a more              demands (i.e. work, caregiving) were key barriers that were difficult to overcome. In fact,
                          synergistic manner. Going further upstream means that           participants shared that they wanted to act on their health, and would appreciate more support
                          efforts towards health promotion need to be extended            – be it from the government or the community around them – to empower them to do so.
                          beyond the health sector, towards a whole-of-society

                                                                                                                                                                                                           REPORT
                          and whole-of-government collaboration.                          To overcome these challenges, participants gave ideas that centered around increasing the
                                                                                          accessibility and affordability of healthier living options, to make them more convenient.
                          The HealthySG Taskforce, led by Senior Parliamentary            This included suggestions to improve the physical and social environment around the individual
                                                                                          – such as making healthier dining options even more readily available, and organising physical

                                                                                                                                                                                                           TAS K FO RC E
                          Secretary (SPS) for Health – Mr Amrin Amin, was hence
                          set up in November 2018, with the vision to transform           activity programmes which they could attend together with friends and family, such as making
                          our health promotion landscape with the infusion of             healthier dining options even more readily available, and organising physical activity programmes
                          health in various aspects of our lives, policies, and           which they could attend together with friends and family, since the community would help to
                          environment. Together with the SPSes from other                 bolster motivation to take part. Participants also mentioned how technology could help,

                                                                                                                                                                                                           H E A LT H YS G
                          ministries, the Taskforce explored how best to incorporate      by providing them with greater access to services that would allow them lead a healthier lifestyle,
                          health considerations into each ministry’s work.                or giving them more information on healthier habits.

4                                                                                                                                                                                                           5
TASKFORCE HEALTHYSG REPORT - MOH'S
01
EXECUTIVE   S U M M ARY                                                                                                                 CHAPTER   1   -   THE   S T AT E   OF   H E A LT H   IN   SI NGAPOR E

            The feedback gathered from the public consultation gave us valuable insights into the complexity
            of how people view health and what influence their behaviours, which in turn, affect their
            health outcomes. Personal motivation is key. However, it is also important to ensure that
            the surrounding community and environment facilitate healthier lifestyles, given the various
            challenges the individual faces in everyday life.

            Arising from this, the Taskforce recommendations centred around three thrusts, namely
            Empowerment, Engagement, and Environment.

            THE 3Es

                                                                                                                      THE STATE
                                                                                                                      OF HEALTH
                    EMPOWERMENT
                    OF INDIVIDUALS:

              Encourage and equip individuals to
               take charge of their own health
                by lowering access barriers and
                     leveraging technology.
                                                        ENGAGEMENT OF
                                                        OUR COMMUNITY:

                                                   Targeted programmes, enhancing
                                                    service journeys, strengthening
                                                      social-health integration.
                                                                                          MODIFYING OUR
                                                                                           ENVIRONMENT:

                                                                                       Enhance physical and social
                                                                                      aspects of the environment to
                                                                                       become more conducive for
                                                                                              healthy living.
                                                                                                                      IN SINGAPORE
            We will elaborate on the eleven recommendations under these three thrusts in this final report.
            Collectively, they aim to promote the health of Singaporeans of all ages and backgrounds.
            We hope that this HealthySG Taskforce Report will highlight to Singaporeans that healthy living
            is a journey rather than a destination, where we can spur and support each other. The key to
            our success is also to partner with Singaporeans and the community, to work together,
            and ensure effective co-delivery of these initiatives.

                                                                                                                         Singaporeans are living longer,
                                                                                                                         but not necessarily healthier
                                                                                                                         lives. For a better quality
                                                                                                                         of life, good health in these
                                                                                                                         added years is key, and this
                                                                                                                         starts upstream.

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TASKFORCE HEALTHYSG REPORT - MOH'S
CHAPTER           1   -   THE    S T AT E   OF    H E A LT H   IN   SI NGAPOR E                                                                                                                                             CHAPTER        1   -   THE   S T AT E   OF   H E A LT H   IN   SI NGAPOR E

Disease
                                      BURDEN OF
                                                                                                                       Modifiable
                                                                                                                       RISK FACTORS
                                  With the improvements in healthcare services and ongoing health promotion efforts,
                                  Singaporeans are living longer. Between 1990 and 2017, life expectancy at birth
                                                                                                                            RISKY HEALTH BEHAVIOURS
                                  in Singapore rose by 8.7 years, from 76.1 to 84.8 years on average. The health-
                                                                                                                                                                                                                    According to the 2017 Burden of Disease study in
                                  adjusted life expectancy (HALE) at birth also rose, increasing by 7.2 years, from
                                                                                                                                                                                                                    Singapore, behavioural and metabolic risks (blood
                                  67.0 to 74.2 years.
                                                                                                                                                                                                                    pressure, glucose etc.) were the leading risk factors
                                                                                                                                                                                                                    for the disease burden.
                                  However, while Singaporeans may be living longer, we need to ensure that these
                                  added years are quality years of life.
                                                                                                                                                                                                                    Key behavioural risks factors that affect the development
                                                                                                                                                                                                                    of chronic diseases include poor dietary habits and
                                                                                                                               SMOKING                 LACK OF EXERCISE               UNHEALTHY DIETS               tobacco use. These risk factors are habits and behaviours
                                                                                                                                                                                                                    that we can change and improve. Hence, it is crucial for
                                                                                                                                                                                                                    us to intervene and improve health promotion efforts,
                                                                              +8.3 yea
                                                                                       rs                   84.4                                                                                                    so that we can spend as many years of our lives as
                                                                                          Y                 years                                                                                                   possible in good health.
                                                                                   ECTANC
                                                                           LIFE EXP
                           76.1
                          years                                                                                                                                                                                   (Years of life lost)                    (Years lost to disability)

                                                                                 rs                         74.2
                                                                        +7.2 yea                                                              DIETARY

                                                                                PECTAN
                                                                                      CY                    years                                 RISK
                                                                        LIFE EX
                           67.0                                  HEALTHY
                          years                                                                                                              TOBACCO

                                                                                                                                         HIGH BLOOD
                                                                                                                                           PRESSURE

                          1997                                 ........................                     2017
                                                                                                                                     HIGH FASTING
                                                                                                                                  PLASMA GLUCOSE

                                                                                                                                                                                                                                                                                                        REPORT
                                                                                                                                                HIGH
                                                                                                                                          BODY-MASS
To do this, we need to address risk factors for chronic diseases such as cardiovascular diseases, stroke,                                      INDEX

                                                                                                                                                                                                                                                                                                        TAS K FO RC E
high blood pressure, and diabetes, which now make up more than 80% of the disease burden. Of the                                                                        0                  20,000               40,000                60,000                80,000               100,000
total burden, 35% was due to modifiable risk factors, which are defined as risky health behaviours such as
smoking, lack of exercise, and unhealthy diets.                                                                                                                                                       DALYs (Disability- Adjusted Life Years)

                                                                                                                                                                                                                                                                                                        H E A LT H YS G
1                                                                                                                      2
    The HALE at birth is the average number of years a person can expect to live in full health at birth.                  The burden of disease is measured using Disability-Adjusted Life Years (DALYs). This time-based measure is calculated as the sum of the Years of Life Lost (YLL) due to
                                                                                                                           premature deaths in the population, and the Years Lost due to Disability (YLD) for people living with a health condition or its consequences.

8                                                                                                                                                                                                                                                                                                       9
TASKFORCE HEALTHYSG REPORT - MOH'S
!
CHAPTER          1   -   THE   S T AT E   OF    H E A LT H   IN   SI NGAPOR E                                                                                                                                                                                    CHAPTER   1   -   THE   S T AT E   OF   H E A LT H   IN   SI NGAPOR E

                                                                                                                                                                                                                                                                 Singaporeans are exercising

           HEALTH TRENDS
                                                                                                                                                                                                                                                                 more, however leisure time
                                                                                                                                                                                                                                                                 physical activity remain low

           AND
                                                                                                                                                                                               90.0                      82.3
                                                                                                                                                                                                                                                          81.0                               Sufficient Total
                                                                                                                                                                                               80.0                                                                                          Physical Activity
                                                                                                                                                                                                                                              73.9
                                                                                                                                                                                                                                                                                             Leisure Time
                                                                                                                                                                                               70.0                                                                                          Physical Activity
                                                                                                                                                                                                                                60.9
                                                                                                                                                                                               60.0
                                                                                                                                                                                                                                                                                   Based on our national health
                                                                                                                                                                                                                                                                                   surveys, Singaporeans are
                                                                                                                                                                                               50.0
                                                                                                                                                                                                                                                                                   getting more physically active.
                                                                  In order to better tackle the risk factors that contribute to poorer health                                                                                                                                      This comes mainly from incidental
                                                                  in Singapore, we need to take a closer look at the trends and statistics of                                                 40.0                                                                                 physical activities, such as our
                                                                  these factors to identify possible gaps.                                                                                                                                                                         daily commute to-and-from work.
                                                                                                                                                                                                                                                          29.4
                                                                                                                                                                                               30.0                      23.6                                                      While this is a good trend, such
                                                                                                                                                                                                                                              23.3
                                                                  Dietary Patterns and Physical Activity                                                                                                                        19.0                                               physical activities are generally of
                                                                                                                                                                                               20.0                                                                                lower intensity, as compared to
                                                                  From the latest National Nutrition Survey (NNS) 2018 conducted by                                                                                                                                                moderate-to vigorous-intensity
                                                                                                                                                                                                                                                                                   physical activities, which can
                                                                  HPB, we have seen improvements in both the diet quantity and quality                                                         10.0
                                                                                                                                                                                                                                                                                   provide additional benefits to
                                                                  of Singaporeans’ diets. Singaporeans are consuming fewer calories,
                                                                                                                                                                                                                                                                                   one’s health. Leisure time regular
                                                                  with the average daily energy intake dropping five per cent from                                                                0.0                                                                              exercise remains low, and the
                                                                  2,600kcal in 2010 to 2,470kcal in 2018, although this is still higher than                                                                             2007   2010          2013        2017                     level of physical activity also
                                                                  in 2004. Singaporeans are also consuming more wholegrain, fruits and                                                                                                 Year                                        reduces with age.

                                                                                                                                                                                                                                          !
                                                                  vegetables, as well as substituting saturated fat with unsaturated fat.
                                                                  However, salt and sugar intake remain high3 .

                                                                                                                                                                                            Tobacco

     !
                                                                                                                                                                                            Our smoking rate has been
                                                                                                                                                                                            fluctuating between 12% to 14%                           Prevalence of daily smoking           among
                                                                                                                                                                                            in the last ten years, with no clear                     Singapore residents aged 18-69 years has
                                                                                                                                                                                            pattern of continuous decline.                           been fluctuating over the years.
                     Average daily salt intake      of Singaporeans was 9.0g,
                     almost twice the recommended amount of 5.0g as advised by
                     the World Health Organization.

                                               10% of                                                                90% of
                                Singapore’s population                                                     Singapore’s population

                                                                                                                                                                                                Smoking prevalance (%)
                               meet recommended intake                                                          exceeded the
                                                                                                            recommended intake

                                                                                                                                                                                                                                                                                                                                    REPORT
                                                                                                                                                                                                                                                                                                                                    TAS K FO RC E
                                                                                                                                                                                                                                                                                                                                    H E A LT H YS G
3
    WHO recommends reducing daily salt intake to less than 5g, and daily sugar intake to less than 10% of daily energy intake (and further to less than 5% of daily energy for additional                                                                Year
    health benefits). Preliminary NNS 2018 data showed that the average daily salt intake of Singaporeans was 9.0g, and average daily sugar intake was 10% of daily energy intake.

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TASKFORCE HEALTHYSG REPORT - MOH'S
CHAPTER     1    -   THE   S T AT E   OF   H E A LT H   IN   SI NGAPOR E                                                                                                                                       CHAPTER   1   -   THE   S T AT E   OF   H E A LT H   IN   SI NGAPOR E

                                                                                                                                       SOCIOECONOMIC
Vaccination                                                                                                                            GRADIENT and

                                                                            !
Although chronic diseases make up the bulk of the                                                                                      Overall, while life expectancy and HALE are high
disease burden in Singapore, it is notable that certain                                                                                at the national level, health inequalities exist in our
infectious diseases contribute significantly to the                                                                                    population. There is a clear socioeconomic gradient
burden as well. Pneumonia, for example, is a serious
                                                                                             Adult vaccination rates                   in health risk behaviours and outcomes, with higher

                                                                                                                                                                                                       INEQUALITIES
lung disease that is consistently ranked as the                                                                                        smoking and overweight prevalence among people
second most common cause of death in Singapore                                               for influenza and                         from lower income families. Diets tend to be poorer
in the past five years, second only to cancers.
Two common causes of pneumonia are infection
                                                                                             pneumococcus are                          in this group, with lower protein and higher salt and
                                                                                                                                       sugar consumption.
by influenza virus and pneumococcus bacteria.                                                very low compared
Vaccination against pneumococcus and influenza
                                                                                             to compulsory                             This is consistent with what has been observed in other developed countries such as in the United
                                                                                                                                       Kingdom, Australia and Japan. These findings have also been published in scientific studies and
are recommended under the National Adult                                                     childhood vaccinations.                   literature reviews, where it has been established that socioeconomic factors such as education and
Immunisation Schedule for personal protection,                                                                                         income levels do affect health statuses. As such, higher mortality and morbidity rates have been
to help lower the risk of developing pneumonia and                                                                                     consistently observed groups with lower socioeconomic statuses (SES) in many countries.
other complications. However, vaccination rates
among adults remain low.                                                                                                               In view of the health trends stated above, as well as the health inequalities observed within our
                                                                                                                                       population, we need to have more effective strategies to protect the health of all Singaporeans.

                              CHILDHOOD VACCINATIONS                                               ADULT VACCINATIONS

                             95%                              96%                            14%                                12%

                                                                                                                                                                                                 Living and
                                                                                                                                                                                                 working condition

                                                                                                                                                                          Work                                       Unemployment
                                                                                                                                                                          Environment
     100%

     80%                                                                                                                                                                                                                          Water and
                                                                                                                                                                                                                                  sanitation
                                                                                                                                                              Education
     60%

     40%
                                                                                                                                                                                                                                        Healthcare
                                                                                                                                                                                                                                         Services
     20%                                                                                                                                                 Agriculture
                                                                                                                                                          and food
     0%                                                                                                                                                  production
                                                                                                                                                                          2        1

                                                                                                                                                                                                                                                                                  REPORT
                                                                                                                                                             3                                                                             Housing
                                                                                                                                                   4

                                                                                                                                                                                                                                                                                  TAS K FO RC E
                          MEASLES,                       DIPHTHERIA,                    INFLUENZA                       PNEUMOCOCCAL
                        MUMPS AND                        TETANUS AND                      65-74                             65-74
                          RUBELLA                          PERTUSSIS                    YEARS OLD                         YEARS OLD
                        (DOSE 1 AT 2                      (COMPLETED
                                                            PRIMARY                                                                                                                               Dahlgren and Whitehead
                                                                                                                                                                                        Dahlgren and  Whitehead
                        YEARS OLD)
                                                           COURSE AT
                                                         2 YEARS OLD)                                                                                                                             model   of health determinants

                                                                                                                                                                                                                                                                                  H E A LT H YS G
                                                                                                                                                                                        model of health  determinants
                                                                                                                                                                                                  show the social and economic
                Source: Communicable Diseases Surveillance Singapore 2017   Source: National Population Health Survey 2016/17 Pilot                                                     show the social  and economic
                                                                                                                                                                                                  circumstances    that determine
                                                                                                                                                                                        circumstances   that determine
                                                                                                                                                                                                  the health of a population
12                                                                                                                                                                                      the health of a population                                                               13
TASKFORCE HEALTHYSG REPORT - MOH'S
02
CHAPTER   2   -   PUBLIC   C O N S U LT AT I O N S                                                                                                                          CHAPTER   2   -   PUBLIC   C O N S U LT AT I O N S

                                                                                                      WHO

                                                                                        Consult?     DID WE

                                                                                            More than 300 Singapore residents
                                                                                                      consulted via:

          PUBLIC                                                                                          aged between
                                                                                                       18 and 60 years old                         In order to understand and gather public views on
                                                                                                                                                   the current and future health promotion landscape,

          CONSULTATIONS
                                                                                                                                                   the Taskforce consulted with members of the public,
                                                                                                            • Online Consultation                  professionals and experts between January and April
                                                                                                              on REACH                             2019. We engaged over 300 Singaporean residents
                                                                                                                                                   aged between 18 and 60 years old, from different
                                                                                                            • 4 closed focus group
                                                                                                              discussions (FGD)                    ethnicities and socio-economic backgrounds.
                                                                                                                                                   We heard their views on the existing gaps and

          ‘YOU SPOKE, WE LISTENED’
                                                                                                            • 5 open public group sessions         challenges in adopting a healthy lifestyle, and sought
                                                                                                                                                   ideas on how to address them.

                                                                                        Participants Included:

                                                                                        1
                                                                                             Members of public, both young and old, from
                                                                                             different backgrounds

                                                                                        2
                                                                                             Health professionals and experts in fields such
                                                                                             as public health, social work, health technology,
                                                                                             behavioural insights, built environment, sociology.

                                                                                                                                                                                                                           REPORT
                                                     We engaged the public to              We reached out to different
                                                                                           communities through open
                                                     better understand the different

                                                                                                                                                                                                                           TAS K FO RC E
                                                                                              online recruitment and
                                                     communities’ motivations, needs,        specific avenues such as
                                                     and challenges in adopting a           social service agencies and
                                                                                         non-governmental organisations.
                                                     healthy lifestyle.

                                                                                                                                                                                                                           H E A LT H YS G
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TASKFORCE HEALTHYSG REPORT - MOH'S
Talk ?
CHAPTER   2   -   PUBLIC   C O N S U LT AT I O N S

                   WHAT
                  DID WE
                                                                       ABOUT
Topics Discussed:

                                                                    In the closed FGDs, professionals in relevant fields,
                                                                    such as technology, infrastructure and the social
                                                                    sector, shared their perspectives on healthy living.
                                                                    Their views helped us to deepen our understanding of
                                                                    the issues, and they offered ideas on how to tackle the
     Physical                      Diet and                         challenges of living healthily in different contexts and
     Activity                      Nutrition              Tobacco
                                                                    for different segments of the population.

                                                                                                                               WHAT DID
                                                                                                                                                        find?
               Mental                            Screening and
              well-being                          vaccinations

                                                                                                                               WE
                                                                                                                               Public Attitudes Towards Health
                                                                                                                               Across all public consultation sessions, being healthy
                                                                                                                               was perceived as an essential part of life – a goal
                                                                    Public sessions were then organised to build on the        everyone strives to either achieve or maintain.
                                                                    findings from the FGDs, and to gather more views and       Healthy living was seen to be beyond physical health,

                                                                                                                                                                                            REPORT
                                                                    perspectives from diverse participants. Feedback was       to include mental health.
                                                                    sought on gaps and challenges to healthy living, and
                                                                    ideas and initiatives to address these gaps.               Physical health was perceived as a balance between

                                                                                                                                                                                            TAS K FO RC E
                                                                                                                               eating healthy and exercising frequently. It was
                                                                    The online consultation served as an additional avenue     widely agreed that this was a difficult goal to achieve,
                                                                    for the public to provide feedback. All the feedback       however some participants also recognised that these
                                                                    and ideas contributed to the development of the final      are individual lifestyle choices, which they had better
                                                                    recommendations, and helped make them relevant and         control over. As for mental health, external triggers

                                                                                                                                                                                            H E A LT H YS G
                                                                    useful for addressing the identified gaps.                 such as work stress, transitional life issues and juggling
                                                                                                                               multiple roles and responsibilities were cited as factors
                                                                                                                               that impact people’s emotional well-being. Some
                                                                                                                               participants expressed that these were societal issues
                                                                                                                               that they had less control over.
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TASKFORCE HEALTHYSG REPORT - MOH'S
CHAPTER   2   -   PUBLIC   C O N S U LT AT I O N S                                                                                                                                            CHAPTER   2   -   PUBLIC   C O N S U LT AT I O N S

                                                                                                       Overall, findings from the public consultation support
                                                                                                       that health is multi-faceted, and goes beyond the
                                                                                                       individual, to include socioeconomic and environmental                        ENVIRONMENTAL
                                                             “We only exercise when you                factors. Individuals hold personal attitudes, values and
                                                               fall sick, only if you see              beliefs on what health means and how to attain health.
                                                                                                       These factors interact with their social environment,
                                                               a need to. If I don’t see               including their families, friends and communities, and                               SOCIAL
                                                             anything wrong now, I won’t               finally intersect with larger systems in the society
                                                                                                       and environment these collectively impact on various
                                                            do anything. As long as I have             health outcomes for the individual.
     Interestingly, the mind-sets, motivators and
     influences of health across the different age
                                                            no illness, it won’t drive me to
     groups differed widely. The young adults                        do anything. “                    It is thus crucial to adopt the view of the micro
     and youths tended to be more externally                                                           (individual), meso (social influence) and macro
     motivated, with societal and peer pressure                                                        (environment), in understanding health concerns
     forming the main sources of influence that                                                        and challenges of Singaporeans, as well as to look at                            INDIVIDUAL
     shape their health behaviours. Also, most                                                         ways of improving existing programmes, policies,
     “healthy behaviours” such as eating well and                                                      and initiatives to encourage healthy living in Singapore.
     exercising were for aesthetic purposes of
     looking good, rather than for better health.

                                                           On the other hand, the older working
          “Need to set personal goals,                     adults and elderly were more likely to
           because when you have no                        be intrinsically motivated. There was a
                                                                                                                                                         Ideation
                                                           stronger sense of personal responsibility
            goals in mind, you won’t                       and accountability for their health
                                                                                                                                                         In line with this framework, ideas were generated for these
                 go anywhere.”                             outcomes. The idea of ageing gracefully
                                                                                                                                                         three tiers based on the five broad health topics. Based on
                                                           and ageing well was a greater concern,
                                                           and hence actions were generally taken                                                        the public feedback received, lack of time for healthier
                                                           with the idea of self-maintenance in                                                          behaviours (e.g. exercise) and perceived lack of accessibility
                                                           mind. Setting personal goals was seen as                                                      and affordability of healthier choices were raised as common
                                                           important in maintaining one’s health.                                                        barriers to participants’ pursuit of good health. Specifically,
                                                                                                                                                         participants highlighted that competing demands on time, such
                                                                                                                                                         as work and caregiving responsibilities, often made it hard to
                                                                                                                                                         exercise during leisure time. Often times, the unhealthy option
                                                                                                                                                         was also perceived to be more convenient to opt for when
                                                                                                                                                         looking for a quick meal.
     Persons from lower income families said that
     they faced competing demands for their limited
     time and resources. Their priorities were to                                                      Many of the ideas generated were hence centred around increasing the convenience, accessibility and
     ensure a basic standard of living for their family.          “In the heartlands and               affordability of healthy options, for food, exercise, and preventive health services.
     Tending to the family’s needs, such as their              coffee shops, you don’t really
                                                                                                       Social support and influence were cited as major factors for many to start getting healthy. Many brought
     children’s health and well-being, often took
                                                                  get healthy options like

                                                                                                                                                                                                                                             REPORT
     precedence over their own health. Healthy living                                                  up instances in which they continued an exercise regime because they had a friend to exercise with.
     would need to be made inclusive, communal,                 salads. If you want to make            Similarly, participants who smoked shared that the support from their family and friends was key to helping
     convenient, and affordable in order to engender                 it yourself, it gets              them quit the habit.

                                                                                                                                                                                                                                             TAS K FO RC E
     long-term behavioural changes.
                                                                      quite expensive.”                There were also suggestions to further leverage advances in technology to nudge and guide individuals
                                                                                                       towards healthier options and behaviours, as these would be easy and effortless to incorporate into their
                                                                                                       daily lives.

                                                                                                                                                                                                                                             H E A LT H YS G
                                                                                                       These were insightful suggestions, and the Taskforce had taken many of them into consideration in the
                                                                                                       crafting of its final recommendations.

                                                                                                       A summary of the key insights gathered is provided in the following summary table on the next page.
18                                                                                                                                                                                                                                          19
ideas GENERATED
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     SUMMARY TABLE OF
                                                                                       INDIVIDUAL                                                   SOCIAL                                            ENVIRONMENTAL

                                                      Physical
                                                                     • Increase affordability     • Increase incentives for      • Encourage more group       • Create a platform          • Create separate             • Build more parks
                                                      Activity         of gym memberships.          participating in existing      activities as that would     to find people with          walking and cycling           and green spaces
                                                                                                    government-run physical        be more motivating.          similar sporting             lanes to encourage 		         that will be nice to
                                                                                                    activity campaigns (e.g.                                    interests to make            active mobility.              run and walk in.
                                                                                                    National Steps Challenge).                                  friends and
                                                                                                                                                                exercise together.

                                                      Diet and
                                                      Nutrition                                                                                                                            • Increase the availability   • Increase water coolers
                                                                          Have more             • Increase affordability         • Create recipes and 		     • Consider the                  of healthier options          to encourage drinking
                                                                          educational campaigns 		 of healthier food.              cooking demonstration       minority or                   as Singaporeans are           water instead of sugar-
                                                                          for health literacy.                                     videos for easy and 		      disadvantaged groups.         eating out more.              sweetened beverages
                                                                                                                                   healthy home-cooked food.                                                               or introduce sugar tax.

                                                      Mental
                                                      well-being                 • Increase awareness about the                  • Engage companies and       • Educational campaigns
                                                                                   avenues that are available for                  employers to improve         to help identify persons           • Have more de-stigmatising campaigns
                                                                                   mental health assistance.                       work-life balance.           at risk or in need of 		             as mental illness and mental health
                                                                                                                                                                mental health aid.                   is still seen as a taboo subject.

                                                                                                                                                                   •••

                                                                                                                                                                                                                   NO
                                                      Tobacco                                                                                                                                                    SMOKING
                                                                                                                                                                                                                  ZONE

                                                                                 • Increase the affordability and                • Encourage social and peer support in                            • Have more no smoking zones.

                                                                                                                                                                                                                                                                        REPORT
                                                                                   acessibility of smoking cessation tools.        quit journeys instead of using scare tactics.

                                                                                                                                                                                                                                                                        TAS K FO RC E
                                                      Screening
                                                      and
                                                      vaccinations

                                                                                                                                                                                                                                                                        H E A LT H YS G
                                                                       • Educate on the             • Reduce the cost            • Incentivise employers to give time-offs                         • Make vaccinations and screening
                                                                         importance of                of adult vaccinations.       for screening and vaccinations.                                   more easily accessible.
                                                                         early detection.

              Represents ideas that were incorporated into the final recommendations
20                                                                                                                                                                                                                                                                     21
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              On                                                                                     &
                                                     WORKPLACE HEALTH
                             The Taskforce recognised that mental health is an issue of concern across the various
                             demographic groups. The feedback highlighted the gaps that exist in the current system.
                             One main area of concern which participants across the age groups brought up, was the
                             stigmatisation of mental health. They also commented that it would be helpful if more
                             information was provided on how they could help those around them who are suffering
                             from mental health issues.

Each age group faced their own challenges with
regards to mental health, given that it is a complex
and multi-faceted issue. Among the youths, mental
health issues generally revolved around stress and
anxiety, particularly in the context of managing school
work. With adults, a large part of the discussion was
on issues from the workplace and challenges faced                                                                                by Senior Minister of State for Health, Dr Amy
trying to achieve work-life balance. For older adults,                                                                           Khor and Minister of State for Manpower, Mr Zaqy
concerns arose around dementia and ageing.                                                                                       Mohamad, looks into promoting the safety, health and
                                                                                                                                 well-being of workers. Apart from physical health,
The Taskforce noted that a lot of work has been
done for mental health in recent years, such as the                 Existing efforts are also in place to help address
                                                                                                                                 the Committee also explores how to promote good
                                                                                                                                 mental well-being amongst the workforce, such as
                                                                                                                                                                                            Summary
Beyond the Label Campaign which was launched by                     the concerns raised by the participants. For youths,         providing programmes aimed at helping working              Overall, the public consultations
National Council of Social Service (NCSS) in 2018 to                NurtureSG had identified mental well-being as an area        adults cope with stress, which can lead to burnout if      reflected that current initiatives
address the mental health stigma faced by persons                   of increasing concern for our students. To address           not managed properly.
living with mental health conditions in our society, and            this, MOE and HPB invested in efforts to strengthen                                                                     introduced by the government
the enhanced Community Mental Health Masterplan                     peer support in schools and institutes of higher learning    Lastly, regarding mental health issues faced by the        to encourage healthy living have
announced in 2017, to support persons with mental                   (IHLs), by providing resources and training for students.    elderly, the Agency for Integrated Care (AIC) has          been effective. However, there
health conditions.                                                  The Tote Board also set aside funding to develop             been promoting a dementia-friendly Singapore.
                                                                    upstream programmes to help the young achieve better                                                                    remains challenges, and more can

                                                                                                                                                                                                                                                            REPORT
                                                                                                                                 This includes creating a community where citizens
We understand that the key to addressing mental                     mental well-being and resilience.                            are aware of dementia and are able to ensure that          be done. There were many good
health is to enhance mental resilience, and strengthen                                                                           their neighbourhoods are safe and easy for persons         ideas proposed during the public
medical and community support. As such, MOH will                    For working adults, the workplace was regularly identified   living with dementia to navigate in. For this, they have

                                                                                                                                                                                                                                                            TAS K FO RC E
be looking into these areas going forward, while also               as the main influence on mental wellness, as it was a                                                                   consultation process. The discussions
                                                                                                                                 established Go-To Points within the community, which
allowing time for the new government initiatives to                 primary source of stress for many. Since working adults      function as safe spaces for those living with dementia;    helped shape the Taskforce’s
bear fruit. These efforts require comprehensive and                 spend most of their time at work, the workplace also         and have created a mobile application that provides        recommendations, which will be
long term attention. As such, the Taskforce has not                 serves as a key touchpoint for participation in health       resources for individuals and care-givers alike.
addressed mental health in its recommendations, but                 programmes. The Tripartite Oversight Committee                                                                          elaborated in the following chapter.

                                                                                                                                                                                                                                                            H E A LT H YS G
the feedback will be relayed to the relevant agencies.              for Workplace Safety and Health, which is co-chaired         Given the existence of good work to promote physical
                                                                                                                                 and mental health at workplaces, the Taskforce has
                                                                                                                                 also focused its attention on the other areas.

22                                                                                                                                                                                                                                                        23
03
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                                                                                                      THE              3
                                                                                                                               E            S         Following the feedback gathered from the public
                                                                                                                                                      consultation sessions, the Taskforce adopted the
                                                                                                                                                      same three-tiered individual-social-environment
                                                                                                                                                      framework and developed eleven recommendations
                                                                                                                                                      along three thrusts – the 3Es:

                                                                                                  Empowerment                          Engagement                                   Modifying our
                                                                                                            of individuals              of our community                                  Environment

          HEALTHYSG
                                                                                                  Encourage and equip individuals      Targeted programmes,                        Enhance physical and social
                                                                                                  to take charge of their own health   enhancing service journeys,                 aspects of the environment to
                                                                                                  by lowering access barriers and      strengthening social-health                 become more conducive for
                                                                                                  leveraging technology.               integration.                                healthy living.

          TASKFORCE
          RECOMMENDATIONS
                                                                                                       Adult Vaccination                 HealthySG Programme                                     Health promoting
                                                                                                          Subsidies                     for disadvantaged groups                                  Infrastructure

                                                                                                      Smoking cessation                 Active Living programme for
                                                                                                          support                        working adults and seniors

                                                                                                                                                                                                 Healthy Precinct
                                                                                                                                                                                                      Toolkit

                                                                                                                                                                                                                                          REPORT
                                                                                                         e-Coaching &

                                                                To transform our health                    wearables                   One-stop service platforms

                                                                                                                                                                                                                                          TAS K FO RC E
                                                                promotion landscape with the
                                                                infusion of health in various                                                                                                      Healthy food
                                                                                                                                                                                                    ecosystem
                                                                aspects of our lives, policies,

                                                                                                                                                                                                                                          H E A LT H YS G
                                                                and environment.                        Lifelong Virtual                  Enhanced community
                                                                                                        Health Booklet                  outreach and volunteerism

24                                                                                                                                                                                                                                       25
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                                                                                                                                   One 1
                                                                                                                      RECOMMENDATION

                                                                                                                                                                                 Increase the affordability and
                                                                                                                                                                                 accessibility of vaccinations
                                                                                                                   BACKGROUND                                                    recommended under the
                                                                                                                   Vaccination is an important                                   National Adult Immunisation
                                                                                                                   public health intervention.While                              Schedule (NAIS).
                                                                                                                   NAIS vaccinations are generally                               •    MOH will subsidise vaccinations recommended

          EMPOWERMENT
                                                                                                                   recommended for personal                                           under the NAIS for Singaporeans and Permanent
                                                                                                                                                                                      Residents. The subsidies will be available at all
                                                                                                                   protection, they are currently not                                 Community Health Assist Scheme (CHAS) General
                                                                                                                   subsidised. This could be a reason                                 Practitioner (GP) clinics and polyclinics for
                                                                                                                   for their low take-up rates.                                       Singaporeans, and at all polyclinics for Permanent
                                                                                                                                                                                      Residents, to be rolled out before end 2020.

                                                                       OF INDIVIDUALS
                                                                                                                   High coverage rates of
                                                                                                                                                                                 •    With increased affordability and accessibility,
                                                                                                                   recommended vaccinations can                                       we expect more adult Singaporeans to take up
                                                                                                                   lower both individual and societal                                 vaccinations, and target a more than three-fold
                                                                                                                   disease burden, and can lead to                                    increase in coverage to over 50% in five years’ time.

                                                                                                                   better overall health outcomes for                            •    In the long run, we aim to protect more
                                                                                                                   the country.                                                       Singaporeans from vaccine- preventable diseases.
                                                                                                                                                                                      At the system-level, this will also enable us to
                                                                                                                                                                                      reduce the healthcare costs due to these diseases.

                                                                                                                                        NAIS VACCINATION               18-26 years                   27-64 years                             ≥ 65 years
                                                                                                                                                    INFLUENZA                           dose annually                                            dose annually

                                                                                                                                                                                                                                                  dose each
                                                           The Taskforce recommends addressing the
                                                                                                                                          PNEUMOCOCCAL*                          or                 doses

                                                           barriers that prevent Singaporeans from                                                                                    doses

                                                                                                                                                                                                                                                                          REPORT
                                                                                                                                 HUMAN PAPILLOMAVIRUS

                                                           taking greater personal responsibility for their     TETANUS, DIPHTHERIA AND PERTUSSIS                                                  dose for each pregnancy
                                                           health. We want to encourage individuals to

                                                                                                                                                                                                                                                                          TAS K FO RC E
                                                           take charge of their own health by increasing
                                                                                                                         MEASLES, MUMPS AND RUBELLA                                                            doses

                                                           the affordability of effective interventions,                                            HEPATITIS B                                                doses

                                                           improving accessibility to services, and

                                                                                                                                                                                                                                                                          H E A LT H YS G
                                                                                                                               VARICELLA (CHICKENPOX)                                                          doses
                                                           leveraging technology.
                                                                                                              * Pneumococcal vaccines in the NAIS                 Recommended for adults              Recommended for                   Recommended for
                                                                                                                include PCV13 and PPSV23                          who have not been previously        adults with specific              adults who meet
                                                                                                                                                                  vaccinated or lack evidence of      medical conditions                age requirement
26                                                                                                                                                                past infection/immunity             or indications                                                    27
CHAPTER   3   -   H E A LT H YS G   TAS K FO RC E   R E C O M M E N D AT I O N S

                  Two2
      RECOMMENDATION

                                                                                                   Make smoking cessation support
     BACKGROUND                                                                                    more affordable, accessible, and
                                                                                                   comprehensive.
     Of the estimated 350,000 daily
     smokers in 2017, 1 in 6 thought                                                               • MOH, together with HPB, will work with public
     about quitting in the next 12                                                                   healthcare institutions (PHIs) namely hospitals,
     months. However, only 3 in 100                                                                  national specialty centres (NSCs) and polyclinics,
                                                                                                     to better identify and refer smokers who
     smokers actually attempted to quit.                                                             wish to quit smoking, to structured smoking
     Furthermore, 1 in 7 ever smokers                                                                cessation programmes in our healthcare and
     had quit completely in their lifetime.                                                          community settings.

     While there may be a variety of                                                               • As there may be different care models within
                                                                                                     and across settings that can achieve good quit
     reasons why smokers may not be                                                                  rates, MOH will provide funding for public sector    • To support more smokers to quit successfully,
     willing or unable to take the first                                                             healthcare clusters to test out their proposed         MOH will subsidise the cost of treatment for
     step, we need to do more to                                                                     care models in selected PHIs to determine the          eligible smokers enrolled in the PHIs’ cessation
                                                                                                     most effective model of care. The pilot is planned
     nudge smokers to move from                                                                      to run between March 2020 and March 2022.
                                                                                                                                                            programmes during the testing care model
                                                                                                                                                            period. The treatment can include behavioural
     pre-contemplation to taking actions,                                                                                                                   support and NRT such as nicotine patches, gums,
     and to improve the effectiveness                                                              •   Target groups will include:
                                                                                                                                                            and lozenges to reduce the withdrawal symptoms.
                                                                                                       - Inpatients who are smokers (public hospitals);
     of programmes in helping smokers
                                                                                                     - Expecting mothers and their spouses who              -     Certified quit consultants will support smokers
     to quit successfully. This would                                                                                                                     		      during their quit journey, through intensive
                                                                                                   		 are smokers (public Obstetrics &
     allow us to reduce the smoking                                                                		 Gynaecology settings); and                          		      counselling session(s) and follow-ups for up
     prevalence rate, which has remained                                                             - Outpatients who are smokers (e.g. polyclinics
                                                                                                                                                          		      to a year. The quit consultant will help to assess
                                                                                                                                                          		      the smoker’s nicotine dependence and motivation
     largely unchanged over the past                                                               		 and NSCs)
                                                                                                                                                          		      to quit, and provide advice to assist in quitting
     few years.                                                                                    •   While smokers can quit unassisted, behavioural     		      and reducing the chances of relapse.
                                                                                                       support and nicotine replacement therapy
                                                                                                       (NRT) have proven to be effective in increasing      - For smokers who have been assessed to be
                                                                                                       the success of quitting in those who are           		 suitable for NRT use, he/she will have access to

                                                                                                                                                                                                                                                                                                                                     REPORT
                                                                                                       nicotine dependent.                                		 fully subsidised NRT during the recommended
                                                                                                                                                          		 period. The programmes are expected to reach at
                                                                                                                                                          		least 10,000 smokers in the next two years.

                                                                                                                                                                                                                                                                                                                                     TAS K FO RC E
                                                                                                                                                                                                                                                                                                                                     H E A LT H YS G
                                                                                   QuitLine
                                                                                   1800 438 2000
                                                                                                              QUIT
                                                                                                                                                          4 Only smokers who are contemplating to quit smoking, enrolled in a cessation programme in the participating public healthcare institutions, and have been assessed by a
                                                                                                            GUM                                             healthcare professional as being suitable for NRT usage will be able to have access to fully subsidised NRTs during the recommended period.

                                                                                                                                                          5 8 – 12 weeks of NRT is recommended for most tobacco users undergoing a tobacco quit attempt. Source: Health Promotion Board-Ministry of Health Clinical Practice
                                                                                                                                                            Guidelines 1/2013: Treating Tobacco Use and Dependence

28                                                                                                                                                                                                                                                                                                                                   29
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          Three3
      RECOMMENDATION

                                                                                   Provide e-health coaching via
     BACKGROUND                                                                    wearables and personalised
                                                                                   technology.

                                                                                                                                            ENGAGEMENT
     Over the years, much has been
     done to encourage individuals to                                              • HPB is partnering with industry innovators to nudge
     lead healthier lifestyles. Technology                                           Singaporeans towards better habits in physical
                                                                                     activity, sleep, nutrition and emotional well-being.
     affords us a way to go even

                                                                                                                                            OF OUR COMMUNITY
     further, to empower the individual                                                    MIND                EXERCISE           DIET
     to take greater ownership of their
     health, and support them via timely
     reminders, nudges, and feedback.
     In our public consultation sessions,
                                                                                                  HEART RATE              SLEEP
     participants expressed an interest in
     technology-enabled solutions, given
     the proliferation of mobile phones                                                                                   zzz
     and the public acceptance
     of wearables. E-health coaching
     could be a way to reach our citizens                                          • Individual biometric data such as sleep quality,
                                                                                     heart rate and stress levels, can be collected via
     at scale, with the eventual goal
                                                                                     a wearable device, so personalised nudges can
     of more personalised messaging,                                                 be provided to better encourage users to work
     relevant to the individual.                                                     towards their health goals.

                                                                                     -

                                                                                         One such initiative is FitBit’s Live Healthy SG
                                                                                         that harnesses technology, behaviour insights
                                                                                                                                                To better engage Singaporeans on
     Healthy 365 App
                                                                                   			   and analytics to help Singaporeans get healthier       their health, the Taskforce recommends
                                                                                   			   through behaviour change
                                                                                                                                                enhancing the citizen’s experience of
                                                                                     - Participants can link their wearables to health
                                                                                                                                                available services, which requires agencies

                                                                                                                                                                                                                                               REPORT
                                                                                   			 challenges on HPB’s Healthy 365 application
                                                                                   			 in order to enjoy its incentives and rewards.            to be more integrated and targeted in
                                                                                                                                                their programming.

                                                                                                                                                                                                                                               TAS K FO RC E
                                                                                     -   With algorithms that could better tailor health

                                                                                         advice, messages and programmes to each
                                                                                         individual in a timely manner, Singaporeans            There is also a need to customise health
                                                                                   			   can take greater ownership of their own 		             promotion for disadvantaged segments, to

                                                                                                                                                                                                                                               H E A LT H YS G
                                                                                   			   health and get healthier through meaningful
                                                                                   			   and sustained behaviour change.                        make it easy and convenient for them to
                                                                                      - Programme was officially rolled out in end              adopt and maintain healthy living.
                                                                                   			 October 2019.
30                                                                                                                                                                                                                                            31
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              Four4                                                                                                                                   Five5
      RECOMMENDATION                                                                                                                               RECOMMENDATION

                                                                                   Track personal health status
     BACKGROUND                                                                    via Lifelong Virtual Health
     Every Singaporean child currently                                             Booklet (vHB).
     has a hardcopy Child Health Booklet
                                                                                   • HPB will develop a Lifelong vHB for Singaporeans
     that parents use to track and keep                                              to use as a comprehensive, reliable and
     relevant health records, such as                                                personalised health repository to monitor and
                                                                                     take charge of their health across their life course.
     immunisation history, growth charts,
     and developmental progress.                                                   • We hope to launch a Minimum Viable Product of
     This allows parents or caregivers                                               the vHB by end 2020
     to easily monitor the child’s health
     status and preventive health needs.
                                                                                                                                             Members of the Taskforce visited Kok Fah Technology Farm with families and were treated to a cooking demonstration and
     We want to extend the benefits of                                                                                                       educational farm tour to promote healthier eating.

     the Child Health Booklet to adults,
     such that they would have an easy                                                                                                                                                                                                   Targeted help for
                                                                                                                                                 BACKGROUND                                                                              disadvantaged
     and convenient way of referring to
     their health records. This empowers                                                                                                         There is evidence to suggest that there are health                                      groups to improve
     the individual to better understand                                                                                                         inequalities in our population. In general, people                                      their health.
     their health status, nudging them to                                                                                                        from lower income background have a higher
                                                                                                                                                                                                                                         • The Taskforce recommends
     adopt healthier lifestyle behaviours.                                                                                                       prevalence of smoking and overweight/obesity,                                             to provide a more targeted
                                                                                                                                                 and exercise less.                                                                        programme delivery, with
                                                                                                                                                                                                                                           activties and incentives
                                                                                                                                                 In terms of nutrition, people from low income

                                                                                                                                                                                                                                                                                                     REPORT
                                                                                                                                                                                                                                           that are customised to the
                                                                                                                                                 households consume higher proportion of refined                                           needs and circumstances of
                                                                                                                                                                                                                                           the disadvantaged groups.
                                                                                                                                                 carbohydrates and lesser protein. These health

                                                                                                                                                                                                                                                                                                     TAS K FO RC E
                                                                                                                                                 behaviours contribute in part to their poorer                                           • We will focus on improving
                                                                                                                                                 health outcomes. Given the unique challenges                                              nutrition for a start,
                                                                                                                                                                                                                                           before expanding to other
                                                                                                                                                 that this population segment may face, a targeted                                         areas such as health

                                                                                                                                                                                                                                                                                                     H E A LT H YS G
                                                                                                                                                 programme, designed around their lifestyles,                                              screening, physical activity,
                                                                                                                                                 has the potential to have a better impact on their                                        and mental well-being.

                                                                                                                                                 health status.

32                                                                                                                                                                                                                                                                                                 33
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                                                                                                                                                                         6
                                                                                                                                         RECOMMENDATION

                                                                                                                                                                                Targeted active living programmes
                                                                                                                                        BACKGROUND                              for working adults & seniors.
                                                                                                                                        From the public consultation            •   Two pilot projects will be jointly introduced by
                                                                                                                                        feedback, we have identified the            SportSG and HPB to improve physical activity
                                                                                                                                                                                    levels amongst the working adults and seniors.
                                                                                                                                        need for targeted physical activity
                                                                                                                                        programmes for working adults and       1) The Working Adults Project will target at-risk
                                                                                                                                                                                   Professional, Managers, Executives and Technicians,
                                                                                                                                        seniors. The former is an age group
                                                                                                                                                                                   by offering them an integrated package comprising
                                                                                                                                        that has to balance their careers          HPB’s workplace programme and a 12-week
                                                                                                                                        and family, and hence finds it hard        Active Health programme, to increase the adoption
                                                                                                                                                                                   of healthy habits and a more active lifestyle.
                                                                                                                                        to maintain healthy habits. For the
                                                                                                                                        seniors, with rising life expectancy,     -   We will offer Active Health’s physical activity
                                                                                                                                                                                		    readiness assessments as part of an integrated
                                                                                                                                        we need to help them age well.          		    package to companies which are participating in
                                                                                                                                                                                		    HPB-run workplace activities.
• This will be manifested as a ‘healthy living 		                                                                                       By tapping on their respective
  passport’ programme for lower income families,                                                                                                                                  - The aim is to help individuals understand their
                                                                                                                                        domain expertise, SportSG and
  with incentives/rewards given upon completion                                                                                                                                 		health and fitness baseline through a
  of healthy living activities such as                                                                                                  HPB can develop integrated and          		 comprehensive assessment protocol developed
                                                                                                                                        holistic programmes for these two       		 by Active Health for adults.
  - Guided healthier eating trails, supermarket                                                                                         identified population two groups.         - A pilot involving three companies (Sushi Express,
		 tours, cooking classes and nutrition
                                                                                                                                                                                		 Chinese Swimming Club, and Raydent Supplies
		workshops.
                                                                                                                                                                                		 started in October 2019.

  - Subsequently, other components such as
		health screening and mental wellness can be
		 weaved in for holistic engagement.

  -   The healthy living activities will be tailored
		    to meet their needs and circumstances, such
		    as literacy levels, working hours, and access.                               • We will also actively identify social service
		    It will also aim to address affordability via 		                               agencies and community volunteer groups

                                                                                                                                                                                                                                                                      REPORT
		    tailored messaging and education.                                              who serve the lower income families to weave in
                                                                                     the healthy living components to the services
• Trained HPB Health Ambassadors will also 		                                        they already provide. This would ensure that

                                                                                                                                                                                                                                                                      TAS K FO RC E
  partner with and engage the families, to provide                                   health is included on their agenda, and in their
  support on their journey.                                                          conversations with these families.

• We will explore multiple channels to reach                                       • We aim to reach at least 15,000 residents after
  out to this community, among which existing                                        launch of the full programme in Q2 2020.

                                                                                                                                                                                                                                                                      H E A LT H YS G
  networks and platforms under the Ministry of                                                                                                                                                             On-site assessments to help
  Social and Family Development (MSF) and 		                                                                                                                                                               individuals understand their health
  People’s Association (PA) would be key.                                                                                                                                                                  and fitness baselines and obtain
                                                                                                                                                                                                           tips on how to manage and/or
                                                                                                                                                                                                           improve their health.

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                                                                                                                                             Seven7
                                                                                                                                            RECOMMENDATION

                                                                                                                                                                                  One-stop Service Platforms.
                                                                                                                                           BACKGROUND
                                                                                                                                                                                  •   To better synergise government services and
                                                                                                                                           There are numerous services and            resources to make it more convenient for the
                                                                                                                                                                                      public, three one-stop service platforms
                                                                                                                                           facilities for health and wellness
                                                                                                                                                                                      are recommended.
                                                                                                                                           which are available to the public.
                                                                                                                                                                                  1) The Ministry of Culture, Community and Youth
                                                                                                                                           Examples include government
                                                                                                                                                                                     (MCCY) and SportSG will embark on an initiative
                                                                                                                                           facilities booking, rewards systems       to make the search for available spaces more
                                                                                                                                           and programmes calendaring.               convenient, and enhance citizens’ experience in
                                                                                                                                                                                     booking facilities.
                                                                                                                                           Common one-stop service platforms
                                                                                                                                           should be built to help Singaporeans   •   The initiative will provide citizens with seamless
                                                                                                                                           enjoy better access to these public        access to sports and community facilities,
2) The Integrated Seniors’ Pilot aims to improve                                                                                           resources by creating a more               to make it easier for citizens to participate in
                                                                                                                                                                                      sports and community activities.
   and maintain functional mobility among seniors                                                                                          seamless and convenient experience.
   aged 50 years and above. Seniors will attend                                                                                                                                   •   We will roll it out by Q3 2020.
   a 6-week programme by HPB to learn about
   falls prevention, importance of strength, balance                                                                                                                              2) SportSG and HPB are running the Incentives
   and flexibility exercises and be equipped with                                                                                                                                    Exchange Project which will allow Singaporeans to
   strategies to minimise the risk of injuries, in the                                                                                                                               redeem their reward points across the platforms.
   event of a fall.
                                                                                                                                                                                  •   Singaporeans may convert their HPB Healthpoints
     Upon completion of the 6-week programme,                                                                                                                                         to ActiveSG Credits.
     seniors will be encouraged to attend an extended
     programme by SportSG, which will reinforce the                                                                                                                               •   This will incentivise greater participation and
     importance of strength, balance and flexibility                                                                                                                                  enable cross-promotion of health promotion
     through regular and progressive exercises.                                                                                                                                       activities by both agencies.
     In addition, seniors will also be introduced to a wide
     variety of exercise programmes and sports interest                                                                                                                           •   It is expected to commence in Q2 2020.
     groups as a way to seed strong social bonds
     among the seniors and sustain active living through                                                                                                                          3) SportSG and HPB will also jointly roll out a

                                                                                                                                                                                                                                                                        REPORT
     sports and exercise, at the same time, maintaining                                                                                                                              calendar of physical activity programmes.
                                                                                     -   We will roll the pilot out in selected ActiveSG
     functional fitness.                                                           		    and PA venues, including community 		                                                    •   The joint calendar will offer and allow citizens
                                                                                   		    centres of pre-selected group representation                                                 to view programmes offered by participating
  - This pilot will raise awareness of strength,

                                                                                                                                                                                                                                                                        TAS K FO RC E
                                                                                   		    constituencies (GRCs) and such as Hong Kah                                                   agencies to suit their needs, ages, abilities
		 balance and flexibility (SBF) exercises which aids
                                                                                   		    Community Centre and Bukit Gombak Sport                                                      and interests.
		 in fall prevention.
                                                                                   		    Centre, by Q4 2019.
  - It would also serve to help maintain and improve                                                                                                                              •   We will roll it out by Q3 2020.
                                                                                     - These two pilots will support healthy habits in
		 functional fitness through both SBF exercises

                                                                                                                                                                                                                                                                        H E A LT H YS G
                                                                                   		 working adults in transition, and help
		 and regular participation in sports.
                                                                                   		 seniors maintain strength and prevent falls.

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                                                                                   8
        RECOMMENDATION

Enhance community activation via quality
volunteer engagements.

      BACKGROUND
      Volunteers are key to

                                                                                                                                                MODIFYING OUR
      community outreach efforts.
      Community bonding and building
      health conversations are

                                                                                                                                                ENVIRONMENT
      mutually reinforcing.
      To this end, HPB will enhance
      its engagement, training and
      deployment plan for its volunteers,
      the Health Ambassadors,
      to maximise this potential.

•    We aim to enhance the outreach of health volunteers                           •   Pilot the integration of HPB Health Ambassador
     by shifting from quantity to quality, from an 			                                 network with public hospital volunteers:
     ad-hoc touch-and-go, to a longer-term relationship
     building between volunteers and residents.                                      - Cross-train and deploy volunteers to optimise
                                                                                   		 volunteer pool.
•    Volunteers will receive enhanced volunteer training
     by HPB to include health skills (for example, skills 		                         - Expand range of volunteers’ skills to better
     in conducting an exercise class for seniors) and                              		 meet beneficiaries’ needs.
     soft-skills (for example, in the areas of
                                                                                     - Target to implement the integrated volunteer
                                                                                                                                                    Our environment encompasses
     communication and befriending).
                                                                                                                                                    both physical (e.g. facilities and

                                                                                                                                                                                                                                                   REPORT
                                                                                   		 programmes across the public hospitals by
                                                                                   		 Q1 2020.
•    HPB will pilot the integration of HPB Health
     Ambassador network with public hospital volunteers,
                                                                                                                                                    infrastructure) and social (e.g. availability
                                                                                                                                                    of food options and social programming)
                                                                                     -   Early pilots include assisting with Horticultural

                                                                                                                                                                                                                                                   TAS K FO RC E
     which includes the following:
                                                                                   		    Therapy Sessions for rehab patients in Yishun

                                                                                         Community Hospital, promoting post-screening
                                                                                         health coaching services with SingHealth
                                                                                                                                                    aspects, and the Taskforce recommends
                                                                                   		    under their Eastern Community Health Outreach 		           making both domains more conducive to
                                                                                                                                                    healthy living and influencing individual

                                                                                                                                                                                                                                                   H E A LT H YS G
                                                                                   		    programme, and participating in the National
                                                                                   		    University Hospital System’s Health Peers training.

                                                                                     - On-board other agencies’ volunteer networks                  choices to that end.
                                                                                   		 in the future via SG Cares.

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Nine9
      RECOMMENDATION

                                                                                                   Continuous enhancements to the Built Environment to support
                                                                                                   healthy living.
                                                                                                   •   To further support healthy living among residents, HDB will continue enhancing the planning and design
                                                                                                       of both existing and new estates.

     BACKGROUND
     In developing Housing & Development Board (HDB) towns, HDB continues to
     plan, design and programme spaces to promote healthy living by encouraging
     physical activity. Where possible, such spaces are also introduced to older
     estates through upgrading and rejuvenation programmes.
     Beyond HDB towns, NParks has also put in place more than 350 parks and
     gardens linked by approximately 300km of park connectors. Our green spaces                      - Tengah Town will have community spaces close                - Where possible, the environment of older
     are curated to attractmore people to go outdoors and reconnect with nature.                   		 to residents’ doorsteps, a car-free town centre            		 estates will also be improved through upgrading
                                                                                                   		 for better walkability, and a 5km-long forest              		 and rejuvenation programmes, such as through
     The Ministry of Transport (MOT) and Land Transport Authority (LTA)                            		corridor to connect residents with nature.                  		introducing new or improved community
                                                                                                                                                                 		 spaces, amenities, and connectivity infrastructure.
     have built an extensive network of 200km of covered link-ways to make
     walking to the nearest transport hub a more pleasant experience. There is
     currently also about 440km of cycling paths, including park connectors.
     To encourage more Singaporeans to participate in active mobility like walking
     and cycling, MOT/LTA will continue enhancing our physical environment with
     supporting infrastructure.

                                                                                                                                                                                                                                                      REPORT
                                                                                                                                                                                                                                                      TAS K FO RC E
                                                                                                                                              Photo by: NParks                                                               Photo by: NParks

                                                                                                   •   NParks will continue enhancing its parks to attract more visitors and to encourage a more active lifestyle.

                                                                                                                                                                                                                                                      H E A LT H YS G
                                                                                                     - Enable both young and old to experience health and well-being effects of nature through more
                                                                                                   		 therapeutic gardens and nature playgardens, as well as organise more healthy lifestyle activities with
                                                                                   Photo by: LTA
                                                                                                   		 HPB and SportsSG.

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                                                                                       Ten10
                                                                                    RECOMMENDATION

                                                                                                                             Encourage greater community
                                                                                   BACKGROUND                                ownership in shaping environments
                                                                                                                             via the Healthy Precinct Toolkit
                                                                                   Presently, health promotion policies
                                                                                                                             (HPT).
                                                                                   and programmes are largely
                                                                                   government-led. However, a much-          •   The MOH Office for Healthcare Transformation
                                                                                                                                 (MOHT) has developed a HPT to empower
                                                                                   needed complementary approach                 the community and its leadership to take
                                                                                   is to facilitate more community               ownership of, and shape their social and physical
                                                                                   ownership in enhancing their                  environment based on their needs.

                                                                                   lived environment to facilitate           •   This involves a three-step process:
                                                                                   healthy living.                               (i) engage the community to understand their needs;

                                                                                   This is important as the community          (ii) collaboratively plan and coordinate solutions
• MOT and LTA will work together with agencies to                                                                            			 with relevant stakeholders; and
  triple the distance of our cycling path network by                               can provide useful insights on the
  2030. LTA will also add another 150km of covered                                 issues that matter most to them.           (iii) evolve and refine initiatives to support
  link-ways to the existing 200km to facilitate a                                                                            			healthy living.
                                                                                   Residents may play a part in deciding
  more comfortable walking environment.
                                                                                   how best to infuse health in where        •   As part of the development of the Healthy Precinct
  - By 2030, eight in ten households will be within a 		                                                                         Toolkit, MOHT established a Co-Creators’ Group
                                                                                   they live, that is best suited to their
		 ten-minute walk of a train station.                                                                                           in July 2019. The Co-Creators’ Group consists of
                                                                                   needs and preferences.                        volunteers from Jurong Spring grassroots
•    On 2 November 2019, MOT and LTA rolled out the                                                                              organizations, VWOs, HPB Health Ambassadors,
     Active Commute Grant for co-funding of end-of-                                                                              and SportSG Team Nila.
     trip facilities such as showers and lockers at
     workplaces to allow commuters to freshen up at
     their destinations.

  - This will make it easier and more convenient for
		 Singaporeans to walk, run or cycle to work, and
		 stay physically active and healthy.

                                                                                                                                                                                                                   REPORT
                                                                                                                                                                                                                   TAS K FO RC E
                                                                                                                                                                                                                   H E A LT H YS G
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                                                                                                                                                   11
                                                                                                                                                      RECOMMENDATION

                                                                                                                                               Eleven
                                                                                                                                                    BACKGROUND
                                                                                                                                                    In recognition that Singaporeans are dining out more frequently, HPB
                                                                                                                                                    introduced the Healthier Dining Programme (HDP) in 2014 to encourage
                                                                                                                                                    Singaporeans to choose healthier options when eating out. Since December
                                                                                                                                                    2016, the HDP was extended to the mass meal settings, specifically hawker
                                                                                                                                                    centres and coffee shops. Currently, 100% of hawker centres have 50%
                                                                                                                                                    of stalls offering at least one healthier option under the HDP. HPB continues
                                                                                                                                                    to work with various partners across the food ecosystem to increase the
                                                                                                                                                    accessibility and availability of healthier options.

•    MOHT held multiple engagement sessions                                        •   The DET will be piloted in two precincts, Jurong
     with the Co-Creators’ Group to design the HPT.                                    Spring and Woodlands, through a Healthy Precinct
     An initial concept, defined within the HPT, is a                                  Committee, while exploring other potential sites.
     Digital Engagement Tool (DET). The DET aims to                                    The pilot in Jurong Spring started in Q4 2019.
     empower community leaders to collect non-
                                                                                   •   Formation of a Healthy Precinct Committee has
     sensitive public opinions about their neighbourhood.
                                                                                       begun in Jurong Spring, with key community
     This will provide ground sensing on the precinct’s
                                                                                       volunteers taking the lead to scout for and recruit
     health behaviours and its health-influencing socio-
                                                                                       health-enthusiastic members for the Committee
     environmental determinants allowing the community
     to intervene on their own.
                                                                                       These founding volunteers have engaged multiple
                                                                                       community groups serving resident seniors,
                                                                                                                                               The Taskforce recommends a two-prong approach to improve the
  -    A trial of the first component of the DET (version                              families, ethnic minorities and vulnerable segments,    food ecosystem with greater availability of healthier options.

                                                                                                                                                                                                                                                                                                   REPORT
		     0.1), a digital survey, was successfully completed 		                           to ignite interest and rally support for their
		     on 27th August 2019, with a closed group of 		                                  community’s health promotion efforts. Over time,        1) Incorporate health as a consideration in Price-Quality     2) HPB will increase the number of stalls that offer
		     39 people. In collaboration with an identified group                            the Committee will be able to use the Healthy              tenders for new eating houses tendered out by HDB.            at least two healthier options by 400 by 2021.

                                                                                                                                                                                                                                                                                                   TAS K FO RC E
		     of users within Jurong Spring, MOHT is currently                                Precinct Toolkit to improve the healthy behaviours
		     working on version 0.2 of the DET.                                              of their community. If successful, the toolkit          •   A portion of the tender score is dedicated to health 		   •   This is expected to increase the availability of
                                                                                       can then be rolled out to other Healthy Precinct            component, to encourage healthier food offerings              healthier options at eating houses and hawker
  -    Version 0.2 includes a refined dictionary for the                                                                                           or products.                                                  centres, reducing the barrier to healthier eating.
                                                                                       Committees or similar committees across the nation.
		     digital survey component based on feedback from

                                                                                                                                                                                                                                                                                                   H E A LT H YS G
		     August 2019, and the next immediate DET                                                                                                 •   21 tenders have been awarded so far, and HDB will 		      •   By reaching the target, it is estimated that an
		     component – an automated report that allows                                                                                                 be tendering about 34 more in the next five years.            additional 500,000 meals bought by
		     users to filter results by demographics. MOHT                                                                                                                                                             consumers per month, or six million per year,
		     will test version 0.2 in late 2019.                                                                                                                                                                       would be healthier.

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