Beyond the little red dot: Time for Singapore to step up in global health

From infectious diseases and aged care to smoking and sanitation, Singapore prides itself on health innovation. It’s time the city-state did more to share its expertise with the rest of the world, Tikki Pang and Gayle Amul write.

In September last year, it was reported that Singapore is topping the world when it comes to progress on the health-related Sustainable Development Goals. Given Singapore’s chairmanship of the Association of Southeast Asian Nations (ASEAN) in 2018, what lessons can countries in the region and the world draw from the Singapore experience?

There are three contemporary health challenges in particular where Singapore can share knowledge and experience.

First, Singapore can contribute in mitigating epidemics of infectious diseases, particularly the intractable regional health problem of mosquito-borne diseases.

Following the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, and more recent outbreaks of dengue, chikungunya and Zika, Singapore has developed a huge trove of knowledge in the latest laboratory diagnostic technologies, clinical expertise, basic biomedical research and advanced information systems to deal with future epidemics. As an example, the city-state recently approved the world’s first clinical trial for a potential drug against Zika.

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Aside from drug development, Singapore has also pioneered the development of affordable, easy-to-use mosquito traps called ‘Gravitraps.’ It is contributing to the Asian experience in testing novel technologies to control mosquito populations using the Wolbachia bacteria. Through UNITEDengue, Singapore has taken the regional lead in the timely collection, dissemination and sharing of information related to dengue in the region. It has also been very successful in efforts to raise public awareness and involvement in dengue control through campaigns such as the ‘Mozzie Wipeout Campaign’ and the Dengue Community Alert System.

Second, Singapore can offer lessons on tackling chronic diseases such as cancer, diabetes and heart disease which now cause more than 70 per cent of deaths globally. Many of these diseases are linked to smoking and pose significant health system challenges, especially for ageing populations.

Singapore is consistently held up as one of the leading examples of successful implementation and enforcement of the articles within the World Health Organization Framework Convention on Tobacco Control (FCTC), an evidence-based international legal treaty to curb tobacco use globally. Singapore has implemented tobacco control since the 1970s and has developed innovative demand- and supply-reduction policy measures. These include raising taxes and prices of tobacco products, strictly enforcing bans on advertising, promotion and sponsorship, and establishing smoke-free environments.

Singapore also recently increased the price of cigarettes by another 10 per cent, raising excise taxes on tobacco to 60 per cent. In addition, it has raised the legal smoking age from 18 to 21 while also being vigilant in cracking down on cigarette smuggling, seizing an annual average of three million packets for the past five years. Smoking havens like Indonesia and the Philippines could learn lessons from Singapore’s experiences in tobacco control.

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The city-state is also well aware of the problems it will face in the future as its population ages, with many of the elderly suffering multiple chronic diseases and posing a hefty burden on the health care delivery system. The Ministry of Health and the Health Promotion Board has identified this as a top priority, and has developed innovations around home-based and people-centred care, task sharing among health care workers, nudges toward healthy eating, and the National STEPS Challenge.

It has also announced a ‘war’ on diabetes and involved citizens through an innovative Citizen’s Jury to crowdsource ideas to control diabetes. Many countries in the region are facing similar challenges with chronic diseases and ageing populations.

Third, Singapore’s water technologies can benefit developing countries and improve the health of its populations.

It is well known that many diseases in the developing world are closely linked to a lack of clean water and poor sanitation services. A case in point is the massive recent outbreak of cholera in Yemen with more than one million cases and 2,000 deaths due mainly to a failure of clean water supply and poor sanitation.

Around 2.1 billion people, mostly in the developing world, lack safe water at home. Of these 2.1 billion, 844 million do not have basic drinking water services and 159 million drink water directly from surface sources such as rivers, streams or lakes.

In this regard, Singapore’s NEWater is a world leader in technology to produce high-grade reclaimed water from treated used water. The process involves further purification using advanced membrane technologies and ultra-violet disinfection, resulting in water which is ultra-clean and safe to drink. Following the establishment of the first NEWater plant in 2001, it has passed more than 150,000 scientific tests and is well within World Health Organization requirements and standards for water quality.

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With more than 2.3 billion people globally without basic sanitation services and 4.5 billion lacking toilets at home to safely manage excreta, Singapore’s sanitation story should also be shared. Singapore is the home of another WTO – the World Toilet Organization, which pushed for the “Sanitation for All” resolution at the UN General Assembly. That WTO has been involved in ‘education and training of individuals and building local marketplace opportunities to advocate for clean and safe sanitation facilities in communities’ since 2001.

In the spirit of the ASEAN Community, it’s time for Singapore to step up to the plate and assume its leadership role in the region to spread such mutually beneficial and much-needed ideas. How could it do this?

Perhaps it’s time for Singapore to think beyond its own shores and establish a Singapore International Development Agency, akin to USAID in the USA and DFID in the UK. This development agency would have the objective of spreading and sharing Singapore-led innovations to help countries in the region collectively solve shared health challenges.

Lee Kuan Yew emphasised why Singapore needs to make itself ‘relevant’ in the international arena – so that “other countries have an interest in our continued survival and prosperity as a sovereign and independent nation.” Playing a leadership role in tackling global health challenges in the region is a pragmatic way to keep Singapore relevant.

To paraphrase President John F Kennedy, is it time for Singapore to ‘ask not what Singapore can do for itself, but ask how the rest of the world can learn and benefit from Singapore’?