COS 2021: Tackling Healthcare Inequality

Mr Leon Perera (Aljunied): Mr Chairman, Sir, from a recent reply to my Parliamentary Question, we now know that residents aged 25 years old with below Secondary education have a life expectancy 5.8 years lower than that with those with post-Secondary education. I thank the Minister for Health for the detailed answer. We also learnt that people with below Secondary education have a greater likelihood of chronic illnesses like diabetes and high cholesterol.

I, thus, speak on the urgent need to tackle health inequality. It would seem that the prevalence of conditions like obesity, diabetes, hypertension and high cholesterol has risen over the years. Sir, I would suggest that there is an urgent need to revamp for preventive healthcare efforts, particularly for poorer Singaporeans.

 Sir, for many of my lower income constituents, convenient and cheap food options are unhealthy ones, like instant noodles. Research shows poverty often overwhelms one’s cognitive ability to make good decisions on health.

While many efforts have been undertaken, the outcome seems to be moving in the opposite direction. To achieve better outcomes, we need better measurement.

Firstly, could we make public more timely and comprehensive data of chronic diseases by socio-economic groups? Other than the response to my recent Parliamentary Question for what I understand the most recent publicly available data on health risks, behaviours and outcomes by socio-economic class was 2010 National Health Survey. The National Registry of Diseases already collects data on the incidence of cancer and chronic kidney failure. It is an easy next step to include SES indicators like income and education. We must also study the entire life cycle of chronic diseases. Are low-income groups contracting more diseases, more severe diseases or even earlier diseases?

Secondly, can we make more data public and healthcare outcomes for low-income groups? Are they receiving a later diagnosis with poorer outcomes compared to wealthy Singaporeans who can choose top tier private care, for example? I am not suggesting that this is the case but it would be useful to have the data. Some doctors have observed COVID-19-related backlogs and patients transferring from private to public to save money, pressuring the public system and lengthening waiting times for subsidised patients.

Thirdly, could we develop a National Health Equity Index? This could be created by an independent group of academics and include social determinants of health as well as health care accessibility, affordability and outcomes. This will pinpoint areas for targeted action.

Once we have more data, we must act decisively. I note that HPB piloted the Healthy Living Passports Scheme in mid-2020 and aim to reach 15,000 lower income residents over three years. How effective have the incentives been among lower income groups? Other than the number of participants, can we targets in terms of better health outcomes?

The National Health Screening Programme, Screen for Life, heavily subsidies screening for some conditions. What is the take-up rate and outcomes thus far, particularly for those who are less advantaged socio-economically?

Mr Chairman, Sir, we must improve outcomes at the intersection of health inequality and preventive health care. Not only because we have a responsibility to the less fortunate but also because this problem creates spill-over effects that can cause society more if left untreated.

Ministry of Health
5 March 2021

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