Prof Lee Chien Earn, Deputy Group CEO, Regional Health System, SingHealth
Distinguished guests, friends, keynote speakers,Ladies and gentlemen,
Good morning. I am delighted to join all of you at the inaugural Asia Pacific Social Prescribing Conference. It’s a very exciting development, and I would like to congratulate SingHealth for leading at the forefront. I would like to thank SingHealth for your leadership on this very important area of work. I also appreciate that so many you from different fields and areas of expertise, both from Singapore and abroad, physically and virtually, have taken the time to be with us today.
Preventive Health and Social Prescribing
2. Now, population health emphasises a holistic approach to achieving positive health outcomes. We have to move beyond treatment of medical problems, towards upstream preventive health, to address risk factors, including social factors, which are sometimes not easy to put our arms around. These can be also key “determinants of health”.
3. This is particularly salient as our society ages, and chronic diseases become more prevalent.
a. One in four citizens are expected to be 65 and above by the end of this decade, up from one in six today. And in some HDB towns in Singapore, we have already reached that kind of ratio. And as people get older, they are more likely to fall sick or suffer from disabilities.
b. Chronic diseases such as hypertension and hyperlipidaemia has also risen to worryingly high levels, at 32% and 37% of our population respectively – this is something that affects Singaporeans of all ages, not just seniors.
c. Together, these challenges will cause significant health, emotional and financial burden on individuals and families. In fact, just a couple of weeks ago, I met a gentleman who was in his sixties. He was working as a professional all his life, the breadwinner of the family. And because of his work, his health took a toll and he had a stroke. Recovery has been a long process. He was utterly distraught, from being the breadwinner of the family to suddenly feeling a sense of helplessness, wanting to just get back to life again. After this medical episode, a lot of issues came to the forefront. And the family, feeling burdened, that the breadwinner is feeling so down. So there are wider ramifications to not taking care of population health.
4. We must take decisive action now to prevent or delay the onset of ill health, and slow or even reverse these trends. Instead of only making care available when urgent issues arise, we are transforming our healthcare system to emphasise preventive care. This is why my colleague, Health Minister Ong Ye Kung, introduced Healthier SG, to help prevent or delay the deterioration of health, reduce the burden on loved ones, extend healthy life years and improve residents’ quality of life. And to achieve this, colleagues at MOH aim to anchor Singaporeans with a family doctor, and foster community support for healthier lifestyles.
5. Good health is sustained through everyday choices and habits, which take place outside clinical settings. This is where social prescriptions play a key role in these efforts, making it easier for individuals to connect to the wide range of healthy lifestyle activities. Social prescribing complements health care in institutional settings by connecting residents to local, non-clinical social programmes such as group exercise programmes, community gardening or smoking cessation programmes. This helps residents lead a healthier lifestyle and benefit from stronger community support, and addresses social issues early on, before they lead to worsening health.
SingHealth’s efforts in social prescription
6. Globally, SingHealth is one of the earlier adopters of social prescribing. In fact, SingHealth started with a pilot in October 2019 in a hospital setting, and plans to roll it out to polyclinics and GP partners.
7. SingHealth has introduced Wellbeing Coordinators, who are non-clinical staff incorporated into clinical teams to identify and support patients who face social risk factors, that may affect their health outcomes. They also help serve as an important link between care providers and patients. To date, Wellbeing Coordinators in SingHealth Community Hospitals have screened more than 1,570 patients, and the Social Prescribing programme has benefitted 953 patients.
8. SingHealth is also working with community partners to better design educational programmes for health and social care workers, with the skills and expertise to better improve the wellbeing of our fellow Singaporeans. I am glad to hear that SingHealth is launching SCHOOL, or the SingHealth Community Hospitals Office of Learning today.
9. One of these educational programmes is the Health and Social Care Coordinator Course, that they have created in collaboration with Ngee Ann Polytechnic. The course allows learners from different walks of life to join the health and community care workforce by equipping students with skills and knowledge to develop programmes to support social prescribing and to work in multi-disciplinary teams of social and healthcare professionals. They help oversee and coordinate the medical and social needs of patients, which could include ensuring that patients discharged from hospitals comply with their care plans, assessing potential risks at home, and connecting them with social support services.
10. Let me share the story of one of these course attendees, Caral. Caral was an editor for a meditation and health magazine. During her free time, she volunteered at Bright Vision Hospital to engage patients and help with various activities – such as weekly morning exercises and hairdressing. Today, Caral is a part-time Patient Activity Coordinator at Sengkang Community Hospital.
11. People like Caral play an important role in improving the care outcomes of patients. They help us go beyond our professional silos, and allow us to deliver the best care support that can meet the unique and specific needs of patients.
Social-Health-Community Integration
12. In the work of the social sector, we also see that individuals and families that have the most complex needs, often face inter-locking challenges. This often involves social, health, family issues, housing issues and various other issues.
13. In such families, the association between health and social outcomes is evident. On one hand, poor health can have a significant impact on their social outcomes, such as limiting an individual’s ability to perform in school and at work. On the other hand, social issues can also impact a person’s health – low-income families might have a less balanced and nutritious diet, or feel deterred from seeking early medical help before their health conditions worsen and require more drastic interventions.
14. This means that to support these families and address the challenges that they face, we have to understand the underlying causes and tackle them before the symptom can be addressed. We cannot address each of these issues in a silo, a piecemeal manner. Community partners play an important role in this regard. We need to tap on their extensive local networks and areas of expertise, and they can help to identify and fill gaps and needs on the ground. Through this, we are able to close the triangle of social, health and community integration.
15. This is why we have introduced a wide range of social services to meet the needs of vulnerable and lower income households. For example
a. For families and individuals who do not have other housing options, HDB provides public rental flats at heavily subsidised rates. It serves as a social safety net, and offers shelter, stability and a safe space for them.
b. Lower-income households can benefit from a range of programmes such as Workfare, ComCare and the Progressive Wage Model.
c. They can enrol their children in KidStart, for better upstream support and a good start in life. For our friends from abroad, KidStart is for kids aged 0-6, an early intervention programme.
d. Through UPLIFT, which starts from 7 onwards, we have built up networks between schools and community partners to provide more support for disadvantaged students.
e. Through ComLink, we take a case-management approach to look at a family’s needs holistically and organise health, social, and community support around their needs, in a way that does not overwhelm them. For our foreign friends, ComLink involves reaching out to families with children living in rental housing, proactively engaging them, bringing them onto the ComLink club, with their consent assembling the data around the family, working with them, family by family, to work out a roadmap that they own. And then, weaving the health and social support around one of these customised plans, almost 14,000 of them. Earlier this month, we had announced the launch of the ComLink Rental scheme, to integrate rental housing assistance with holistic ComLink support. So, social, health, community, with infrastructure and housing. And this means that families with children that need housing support, don’t just get housing – it comes with the assurance of integrated social and community health support as well. All packaged as one, indivisible.
f. We also set up SG Cares Community Networks in every HDB town, to bring together government agencies, social service agencies, schools, secular and religious organisations and healthcare institutions to understand one another’s efforts, know one another on the frontlines, and build personal relationships and make it easier to collaborate better on the ground, around the families that we serve.
g. These are just some examples of what we are trying to do to strengthen the triangle between social, health and community – beyond offering a plethora of social and health services to meet different needs, we are seeking to make assistance more targeted and tailored to individual, especially families who are most vulnerable, and actively involving community partners to walk with them on this journey. And with data, and a clear sense of what each family needs, we don’t have to guess what support is needed on the ground. We know, because we are able to educate them.
16. We are expanding our efforts to improve the health outcomes of these vulnerable individuals and families, and of Singaporeans in general. I had earlier spoken about how we are doing this through Healthier SG and social prescribing, and how this complements other social services. We are also integrating healthcare into our housing and urban environment, to design our housing estates and provide active community programmes to achieve preventive health outcomes. So that’s the belief that designing our community spaces, our precincts, our housing, that they will also contribute to the social and health outcomes of the population that reside in those communities. In fact, some of this is being studied as part of the Health District @ Queenstown pilot. And I understand that SingHealth is also working in other parts of Singapore to pilot this approach.
Conclusion
17. I’ve spent some time talking about our efforts to expand preventive care and social prescribing, as well as how this fits into our broader national efforts on social, health and community integration, with individuals, patients and families at the centre of our work. This work is challenging and is something that communities around the world have to deal with, in their own unique contexts and circumstances. We can only succeed if we draw on one another’s strengths, learn from one another and work on issues together. I hope all of you will take this opportunity to share your experiences on the ground, and learn from the best practices in the region and from around the world.
18. I congratulate SingHealth, and I wish all of you a fruitful and engaging learning experience. Thank you.