In October 2022, parliamentarians debated the Ministry of Health’s latest motion—the Healthier SG White Paper. After two days of wide-ranging debate, where more than 30 Members of Parliament from both sides of the House rose to speak, the proposed healthcare reform plan was endorsed.
MEDICUS speaks to Mr Ong Ye Kung, Singapore’s Minister for Health, to find out why now is the right time to embark on this transformation that has been long talked about. He also discusses some of the challenges ahead and shares his approach to health.
Here is a condensed version of the conversation:
MEDICUS: Thank you, Mr Ong, for making time to talk to us about this visionary and ambitious initiative. Like any transformative idea, this initiative comes with challenges but before we get to those, why is Healthier SG being rolled out now?
Ong Ye Kung: All of us know that prevention is better than cure. So, it’s not a new idea. And we have been doing things about it: Screen for life has been a relatively successful programme. HPB was set up to encourage exercise, better diets. But I think the breakthrough was COVID-19.
During the pandemic, we started to do things that we never thought were possible. We got 93 per cent of our population to agree to get vaccinated against COVID-19. We all wore masks, stayed at home, isolated ourselves when sick. We practised good hygiene, exercised and kept healthy. We downloaded apps—HealthHub and TraceTogether—to monitor our test results as well as our status and movement. We all cooperated so that the whole population stayed healthy. And every single one of these actions was preventive in nature.
So, I think there was a whole awakening not just in Singapore, but in every society affected by the pandemic. Suddenly preventive care is not just a theory. It is what we have lived for the last three years. And that gave us the break to say that in some of these things, we really can make a big push beyond what we have done.
During the pandemic, we mobilised almost every GP to participate as public health preparedness clinics. At the height of the Delta and even more so the Omicron wave, GPs were the ones, who together with the polyclinics, formed the frontline looking after people who were infected. With that experience, we think we can continue to mobilise our GPs, build on that relationship so that they become part of the public health system.
But instead of tackling the pandemic, now we ask them to help us deliver preventive care. I see this as a once-in-a-generation window of opportunity and I think that is the real impetus for Healthier SG.
MEDICUS: COVID-19 was an immediate, existential threat for many, particularly during the early days of the pandemic, motivating people to take preventive steps that they might not have liked otherwise and GPs to step up to serve the nation. But chronic health conditions are often not immediate threats. How will you get buy-in from the community?
Ong Ye Kung: It will continue to be a challenge. Because human instinct is such that we tend to indulge ourselves and succumb to instant gratification. We do unhealthy things today because we enjoy them. The fact that these will collectively lead to suffering is a problem for later.
So, to be realistic, preventive care and Healthier SG have to be supply-driven and backed up by government policy.
It was the same during the pandemic. It was not instinctive for people to want to get the vaccination—a fairly large segment of the population did not want to be vaccinated for various reasons. And we had to create a supply-side push for people to do the right thing for themselves. I think Healthier SG will have to be the same. On the supply side, the biggest push will be the mobilisation of GPs.
And then getting the residents to enrol with a GP, with incentives for those who do so. Health screenings and vaccinations as well as preventive care consultations will be free. If you follow up with exercises, health screening, we give you another incentive. So that also removes some friction.
I think we need to create all these little nudges using policies and supply-side levers to get people to do the right thing. And I’m quietly hopeful. It takes 28 days for someone to inculcate a good habit. If we have enough nudges to get people to start adopting the habit, it may become part of their life.
MEDICUS: You’ve mentioned healthy diets, exercise, health screenings and vaccinations as key pillars in Healthier SG. What about sleep?
Ong Ye Kung: How you sleep, eat, use devices and move about in your daily life—these are the most important interventions for preventive care. And for young people, especially children, sleep is extremely important.
Not having enough sleep can impact people’s mental health, something that I think young people are very concerned about. If you want to fundamentally correct it, it requires a therapeutic approach and the starting point is to have enough sleep to give your mind a chance to repair itself.
MEDICUS: With such a strong focus on a healthier population and preventive care, what changes are necessary to medical school curricula to ensure that the next generation of doctors will be able to thrive and contribute?
Ong Ye Kung: I think Duke-NUS already has a very strong curriculum that will prepare its students to be good family physicians because that is the holistic aspect of looking at health.
But what is special about Duke-NUS is that you are training clinician-scientists, which differentiates you from our two other medical schools. Once we go into preventive care, I think the lines of enquiry for a clinician-scientist become a lot more compared with the current focus on curative care, where everything happens in the hospital. But when you look at preventive care, everything happens in your life, in a community, and the interventions are not purely medical, but mostly social and lifestyle. That just opens up so many more lines of enquiry for clinician-scientists.
MEDICUS: What are some of the new areas for innovation that you feel hold the most promise?
Ong Ye Kung: I hope our whole healthcare system, including Duke-NUS, finds more channels of enquiry to look into this extremely exciting area. I just name two examples: One is the digital diagnostic space. AI, sensors, wearables—all these technologies are advancing very quickly. In a few years, I hope that whatever we draw blood for now can be measured with a wearable. It probably won’t give a clinical diagnosis, but it can be a consumer product that can track your trendline and indicate if you are at high risk of chronic illness, at which point you can get a clinical diagnosis.
So, imagine if we have a Healthier SG system in a few years’ time with a working system to embrace all this technology, when the doctor sees you, they prescribe not just social prescriptions[1], they prescribe you a wearable. They can track and review your data and tell you how to adjust your lifestyle.
The other is more complicated and controversial and that’s genetic sequencing. There will come a point when you can sequence a genome with some clinically actionable consequences. Then specific preventive measures can be taken to stave off diseases you may develop.
There are ethical, moral and clinical implications, so laws will need to be relooked. We can embrace such technology provided we have the legal safeguards. It will be controversial but with Healthier SG, we have a much higher chance of leveraging it for good.
MEDICUS: While Healthier SG opens whole new arenas to explore, it will also entail significant changes for GPs. Can you elaborate on the impact of Healthier SG on GPs’ roles as first-line health maintainers for the population?
Ong Ye Kung: I used to be Minister for Education, and when I look at all our aspiring medical students, they all come from a place of gold. They want to help out in the community, keep people healthy, save lives. But when you become a GP today, the reality is that it is not easy. You compete with the polyclinics. You are inundated with patients who are not really sick. COVID aside, most people come with minor colds, coughs and sore throats or because they need medical certificates. Some demand antibiotics even though they have a viral infection and don’t need them.
So, I hope that first with COVID and now with Healthier SG, we can bring back the motivation of why they entered medicine in the first place and elevate the importance of family physicians as it should be.
MOH has always been known as a very fair service buyer and payer and we will make it worthwhile for them to perform this role. And in performing this role, the skill sets needed will be very different.
Looking not just at the person but also their family history. What are their risk factors, their lifestyles? How to adjust them? So you don’t just write a social prescription, but connect the person with the resources in a community. That’s something I’m really keen about.
In my constituency of Sembawang, I have nine GPs. Will all nine GPs know on which day, and at what time, there will be brisk walking, qi gong, Zumba; when will there be pilates, yoga—they will have to know all this as well as where the smoking cessation clinic will be held, the community gardening where the seniors can work on a hobby that they really like?
And when you know all these avenues, you are more than just a doctor to the patient. You’re a friend and mentor, who guides them in between visits to live a life that’s a lot healthier.
MEDICUS: Many adults will remember growing up with such a relationship with their GP. Can you recall yours?
Ong Ye Kung: When I was young, family doctors were operating that way. We all went to the same doctor. He knew us by name, knew all our family history and our problems. When he saw us, he’d ask us about our grandmother. He was more than a doctor. He was like a village elder.
MEDICUS: What do you think has disrupted this model?
Ong Ye Kung: If we trace back over time as people left their old kampongs (meaning village) and moved to new towns, they started to develop a transactional approach with their doctors, often to get medical certificates or medication.
Patients with chronic conditions tended to go to the polyclinics and less to GPs. And as the role of GPs in preventive care receded, we saw the government’s role becoming bigger. Employers offer health plans but with no relationship with their doctors. And step by step through our progress, modernisation, moving of people across the island, building of the public infrastructure—all these factors eroded that relationship bit by bit.
MEDICUS: Eight, ten years down the road, what outcomes are you looking for?
Ong Ye Kung: I would say there are two very long-term outcomes. One is a change in our health-seeking culture. While we must start with supply-side interventions, the ultimate outcome is a change in demand and habits and health-seeking behaviour.
The second, which is the holy grail of preventive care, is that your healthy lifespan approximates your biological lifespan—that will be the ultimate outcome for Healthier SG.
In addition, once we have Healthier SG as a strategy, we can build a lot more on it. I mentioned some of the technological advancements that we can embrace.
Another very important piece we need to build is an aged care system, which becomes very relevant because of our ageing profile. The aged care system is not about building more and more nursing homes. It sits on top of the population health system, where you enable the aged to live normally within their social context, with access to physical activities and friends, leading independent lives with dignity in the community. That, too, requires supply-side interventions.
We have some successful pilots and models in Singapore, but they are not mainstream. And we need to change so that aged care equals ageing in the community, where seniors feel like wherever I’m living is my home truly and that’s where I age.
MEDICUS: Thank you, Minister Ong, for sharing your insights with us.