Government Spend on Preventive Care as a Proportion of Overall Spending on Healthcare Expenditure

Mr Leon Perera asked the Minister for Health (a) how much does the Government spend on preventive care as a proportion of overall spending on healthcare expenditure; (b) what are the key performance indicators of preventive care programmes and what is their progress so far; and (c) what is the impact of these programmes in addressing health issues that lead to unhealthy ageing and chronic illnesses.

In 2020, about 5% of MOH’s non-COVID-19 related budget, or $590 million, was spent on preventive healthcare. For 2021, a similar 5% of MOH’s non-COVID-19 related budget, or $720 million, is earmarked for preventive healthcare efforts, including $330 million to fund the work of the Health Promotion Board. These preventive healthcare efforts include public education campaigns, healthy lifestyle activities in schools, workplaces and community settings, engaging industry to spur reformulation of staple food products, subsidies for health screening and recommended vaccinations, and regulations to protect our health.

The direct impact of preventive health interventions on overall population health can be challenging to quantify specifically as the overall health and well-being depends on many factors, including the individual’s lifestyle choices as well as other medical and social interventions. The impact of preventive health measures will also take time to manifest. However, the effect of these programmes can be monitored at three levels.

Firstly, we monitor disease prevalence rates and disease burden, measured in the form of Disability Adjusted Life Years, or DALYs. Singapore’s age-standardised DALYs rate in 2019 was 15,045 per 100,000 population, a decrease from 25,491 DALYs per 100,000 population in 1990, which means that our population now, on average, experiences less potential life years lost due to ill-health and premature death. Singapore also ranked first globally for our health-adjusted life expectancy in 2019, which means that, compared to other countries, we live a longer life in good health.

Secondly, in the short- to mid-term, the prevalence of modifiable lifestyle risk factors, such as physical inactivity, diet and smoking, are monitored. From 2010 to 2018, Singaporeans were, generally, eating healthier with more wholegrains, less saturated fat while maintaining their daily levels of energy intake. Singaporeans were also moving about more as the prevalence of sufficient Total Physical Activity (TPA), defined as at least 150 minutes of moderate-intensity or equivalent activities per week, has increased among adult Singaporeans aged 18 to 74 from 73.1% in 2013 to 80.1% in 2019. Smoking prevalence has also decreased from 13.9 % to 10.6% and, with the raising of the legal smoking age to 21 on 1 January 2021, we hope to push smoking rates even lower. However, there remain challenges, such as the increasing prevalence of obesity, diabetes, high blood pressure and high blood cholesterol, and we will need to sustain our efforts to address these.

Thirdly, at the short-term programmatic level, we monitor the impact of different interventions based on desired outcomes, such as improved market share of healthier food choices, improved participation rates and access to health promotion activities, or improved health behaviours. For example, efforts, such as the Healthier Choice Symbol (HCS) programme and the Healthier Dining Programme (HDP), expanded healthier food choices for Singaporeans. The market share of HCS products has risen from 25% in 2010 to 29% in 2019, and the HDP attracted more than 2,600 food and beverage operators, hawker centres and coffeeshops, across 11,500 touchpoints as of December 2020. We will also be implementing mandatory labels and advertising regulations on sugar-sweetened beverages, to further encourage healthier choices. We have programmes that encourage physical activity, such as Sundays At the Park, Sunrise In the City and the National Steps ChallengeTM (NSC). NSC had 1.7 million participants across five seasons and the participation has grown from 129,000 in 2015 to 913,000 in 2020. Regular users have also grown more active over time, recording an improvement of 35 minutes per week of physical activity from 2018 to 2020. This correlates with the earlier observations of the increase in total physical activity over the years.

HPB’s increased efforts targeted at various settings, such as schools, workplaces, community, have improved the population’s accessibility to the various health promoting programmes. For example, our Healthy Workplace Ecosystems increased from 16 in 2015 to 68 in 2020 to bring programmes to over 406,000 workers in 2020. Customised programmes, such as health coaching, are offered to workers in sectors with a greater proportion of older workers, including transport and logistics, security sectors and more. These programmes have also shown good improvements in the health behaviours of their participants. For example, among those who participate in our Healthy Workplace Ecosystem programmes, seven in 10 participants surveyed reported an increase in active time, and one in three reported to be consuming healthier meals. We will continue to monitor the progress of these programmes.

The resources the Government has committed to its preventive health enterprise is evidence of its sustained commitment to move "beyond healthcare to health". MOH will continue to champion the importance of health promotion to keep Singaporeans of all ages in good health.