Average Life Expectancy and Prevalence of Chronic Illnesses Amongst Different Groups of Singaporeans

Mr Leon Perera asked the Minister for Health in each year from 2011 to 2020, comparing by household income quintile, education attainment or housing type if income data is unavailable (a) what is the average life expectancy in Singapore; (b) what is the prevalence of (i) one chronic illness and (ii) two or more chronic illnesses; and (c) if this data is not available, whether the Ministry will consider collecting such data.

Life expectancy and prevalence of chronic illnesses are statistics calculated at the population level. Therefore, comparisons of these statistics across population sub-groups on the basis of household income quintile, education attainment or housing type, need to be interpreted carefully given the fact that older cohorts of Singaporeans had, on average, lower levels of education attainment compared to younger cohorts; household income often decreases when a household member retires, and some older persons may move from a larger HDB flat to a smaller one when their children grow up and leave home. The older cohorts, regardless of socio-economic status (SES), grew up without the benefits of today’s healthcare system and health promotion initiatives in their younger days. Outcomes associated with education attainments, income quintiles or housing types would thus partly be a reflection of differences between older and younger cohorts, rather than SES per se. In addition, life expectancy is calculated with the assumption that the mortality rates we observe today remain unchanged. The better health and access to better healthcare of younger cohorts may mean that they experience improvements in mortality rates compared with what is observed today as they age, and hence better life expectancy than calculated.

Keeping the above in mind, Singapore residents aged 25 years old in 2019 with a highest education attainment of below secondary education level are expected to live up to 81 years of age while those with post-secondary and above can expect to live up to 86.8 years old. This difference is comparable to that observed among OECD countries. Life expectancy has been increasing for both groups over the years. The life expectancy of our lower educated population is higher than the lower educated population in most OECD countries. However, there is room for further improvement, and we will continue to work on ensuring that life expectancy of our lower SES groups continue to improve.

On chronic diseases, as income level can be volatile and housing types change throughout life and is confounded by age, a more accurate measure would be to control for multiple confounders such as age, gender, ethnic groups and educational levels at the same time using regression analysis. Based on regression analysis, for chronic conditions, men with below secondary education level were 1.7 times more likely to have diabetes, 1.2 times more likely to have hypertension and 1.2 times more likely to have high cholesterol, as compared to those with post-secondary education. For women with below secondary education level, the chances were 1.5 times for diabetes, 1.7 times for hypertension, and 1.4 times for high cholesterol compared to those with post-secondary education.

We have put in place measures to help all Singaporeans, including those from the lower SES groups, have good access to care with good health outcomes. Among Singaporeans with primary education and below who have chronic conditions like diabetes, hypertension and high blood cholesterol, more than 90% visited their doctor in the previous year for their condition. Hence in spite of their increased risks, they had good access to healthcare and comparable outcomes with better educated Singaporeans in managing their blood sugar, cholesterol levels and blood pressure control.

Our health promotion programmes are inclusive and affordable so that healthy living is within the reach of all Singaporeans regardless of income. In addition, HPB has also rolled out customised programmes for lower-income Singaporeans. This include the 'Healthy Living Passport Programme' to provide lower-income families with health education and healthy living activities supported by an incentives/reward scheme. In addition, a dedicated group of Health Ambassadors (HAs) and volunteers called the 'HealthySG Buddies' will be trained by HPB to better support these lower-income families to adopt a healthy lifestyle.

Our public healthcare financing system comprises several components that work together to keep healthcare affordable for Singaporeans. Firstly, MOH provides means-tested government subsidies across all healthcare settings to help significantly reduce the cost to patients, extending greater support to lower-income households. Lower-income households also receive higher subsidies for primary care under the Community Health Assist Scheme (CHAS), which provides means-tested subsidies for medical and dental services at participating CHAS general practitioner and dental clinics. Secondly, MediShield Life was launched in 2015 to provide all Singaporeans with lifelong protection against large hospital bills and selected costly outpatient treatments. To keep premiums affordable, premium subsidies are extended to lower and middle income households, and additional premium support is available to those in need. Thirdly, MediSave can be used to defray Singaporeans’ out-of-pocket cash payments for inpatient and selected outpatient treatments. MediFund also assists Singaporean patients who are unable to afford their medical bills, after government subsidies, MediShield Life and MediSave.

MOH will continue to ensure good access to health promotion programmes, that all Singaporeans have access to affordable, timely, and quality healthcare.