Carrie Tan on Building a Healthier SG
Investing in Growing Community Care
I would like to thank the Minister of Health for the wonderful efforts to tackle our people’s health challenges and nation’s healthcare cost challenges using an upstream approach. And also to thank SPS Rahayu earlier for going into detail about describing the various technologies and apps. I think it is very creative to tap into Singapore’s national love for food, and taking pictures of food and also considering support to caregivers which is also very important.
Minister Masagos also spoke about the many hands on deck and I believe that is the correct direction to go. I am very supportive of this initiative in Healthier SG.
I would like to expand on all these efforts a little more by highlighting some nuancing I believe are quite important in the way we approach the community efforts for greater ownership of individuals.
One, I am heartened to know that these efforts to reduce cost of healthcare amidst these aging challenges is to mitigate the institutional healthcare costs; and that is by is de-institutionalising care. And I believe the government has already been embarking on this with various “Aging in Place” efforts.
I personally think that the pilot for Queenstown’s Health District is very commendable. And it is really good to see the concerted efforts by the Ministry of Health and the Ministry of National Development to do so.
To supplement the infrastructure design and development of care within the vicinity of people’s homes, we also need to build up the “soft infrastructure”. As my honourable colleague, Ms Denise Phua, brought up yesterday – what is there in between the GP visits to ensure that people follow the health plan that is recommended to them? What is there in our everyday?
To that, I would like to propose that we harness and strengthen the community’s capacity to be the peer influencers and peer enablers for each other.
I would like to make 2 points in my speech to involve other agencies in tandem with the Ministry of Health, to expand our collective efforts towards greater health together.
For the past 2 years since being MP at Nee Soon, I have worked closely with Yishun Health and gotten to know and see the wonderful efforts they created in neighbourhoods as part of their community health outreach efforts. I am very inspired by their approach and model toward health. Which is to decouple it from sickness and to emphasise instead, on empowering an agency within the individual for wellness.
They started initiatives like Share a Pot which nominated MP Ms Janet Ang mentioned yesterday. It is a program that taps on seniors to gather with seniors, cooking and sharing strengthening bone broth to decrease frailty and risks of falls.
The other notable project is called Repair Kakis, where a group of elderly uncles come together to provide handyman services to the neighborhood. It was actually started by a gentleman who suffers from Parkinson Disease. Yishun Health team discovered that he was an aircon service man before and he possesses the technical knowledge and mechanical knowledge to repair appliances. And they encouraged him and he started this group. Before long, more uncles join him. weekly now, they have a session where they welcome neighbours to bring their faulty home appliances for them to repair. What is really beautiful about this initiative was that it harnessed the strength of an individual, created a ripple effect, and it built up his sense of dignity in being able to contribute to his community despite his medical condition. I think the self-esteem that he got, and the wellness he got from such initiatives and being a contributor really showed him to be positive role model among his peers.
I also heard from Yishun Health team that among these groups, there were successful cases where elderly gentlemen saw a friend of theirs pass away due to lung cancer – from having been a chronic smoker – and that prompted them to decide that they would also want to quit smoking. In these examples, we see that it is actually the power of social relationships that works wonders. Often, people do not need an expert to come and tell them what to do. People can make good choices for themselves when they are inspired by the stories and the people amongst us.
As much as I am very glad for the current plans by Healthier SG that focus on physical health, I would like encourage MOH to work closely with other ministries such as MSF because the social determinants of health are equally, if not even more important in upstream efforts. And our efforts might go to waste if we neglect in this important piece.
As Woodlands Health Campus’ COO shared with me a few years back, in my then capacity as the Executive Director of Daughters of Tomorrow, many of the hospital’s frequent flyer users come from lower income segment. In fact, Woodlands Health Campus utilization trend showed that 20% of patients used up to 80% of healthcare cost. And often, these are people who will shun visiting the GP when they are sick because they cannot afford to pay the cash even after subsidies. And they end up getting into A&E when their conditions get too severe. They also avoid seeing the doctor because they are in jobs that are daily paid. They work long hours or are mentally overloaded with too many chronic stressors to make healthy lifestyle choices. Under these circumstances, the mindsets they often are beset with are that ‘I can’t’ or ‘It is too difficult’.
Yet, in the examples of the Yishun Health community outreach team’s – Kampung Wellness – efforts. We see how peers can influence peers to see that, if you can, maybe I can too. Such share and care activities harness the power of the community, and the assets and strengths from amongst residents themselves, to initiate activities that provide a positive influence and share their own knowledge with one another.
Such asset based community development initiatives helps to uplift wellbeing, from lifting the self-esteem and social connection of people, and contribute to their social-emotional health – a key dimension as well as a determinant of physical health. We can scale up such efforts by involving and enhancing the capabilities of People’s Association to do similar.
Now people may ask what’s the difference? We already have so many grassroots activities, interest groups activities, brisk walk, etc. Now, I’d like to highlight that there is a distinct nuance here. Because to date, PA has developed itself and it’s very strong as an organizer, and often seen as a service provider of these activities – both recreation and social. But what we are looking at in ABCD model is to enable residents to initiate and own the programs themselves, thereby increasing the sense of ownership and their personal sense of agency.
Minister Ong mentioned that the community plays a big part in this plan. Specifically, I call for MOH to lead and help fund a dedicated community health team within PA to train specifically personnel in asset-based community development, in collaboration with Yishun Health community outreach team, as well as other community partners who are well-versed and familiar with the ABCD model. I think this will help effect a very important transformational mindset shift from our people being at the receiving end of services to them being the enablers, or change in the community and within themselves.
My next point, how can we better distribute care in the system? So that is not concentrated in formal settings, which are costly to provide? Well, the good news is I believe we can leverage on a very good momentum that a COVID pandemic has provided, where we see that in many parts of Singapore, neighbors are already helping neighbors, whether it’s buying food, helping to fetch groceries when the neighbors are in quarantine, etc. These acts of kindness and helping and care are already happening sporadically in a rather organic manner. Now the question is, how can we be more intentional about it, and grow such mutual support and care within the community more systematically?
In Nee Soon, I’m now piloting an experiment with YishunHealth to explore tapping on neighbors to help so that the hospital can readily discharge patients who are ready to be discharged but may not have people at home to care for them. With the team there, they have created a list of care tasks and micro errands that do not require medical expertise or people to help with. We are enrolling volunteers from the community to step up so that discharged elderlies from the hospital can be adequately cared for. And caregivers can have more support and more respite.
As we worked on this pilot, along the way, I met other initiatives in the form of social enterprises and ground up groups who are doing the same or attempting to do the same. Initiatives like SG Assist by amazing Singaporeans like Adrian Tan and Greg, as well as Denise Tay and Michelle Lau, who founded Kampung Kakis. They are doing great work to excavate and pull together the human power for mutual support and caregiving in a community. And we need to grow the efforts of these leaders and champions for community care. These are social entrepreneurs with hearts that care and a commitment to pledge their careers to create solutions for society. We should support and harness their strengths and invest in them. And I would like to ask the government to enable their growth by incentivizing impact investors and philanthropists to invest in such initiatives to help scale up the work and impact to reach more of Singapore.
I have some specific suggestions to support social enterprises that provide capability building in community care so that we can help to accelerate the de-institutionalization of health and healthcare.
One is possible that to look into expanding the community capability trust with specific funding injections from MOH to invest in social enterprises that provide such capability-building services for the community. We can do this before they show any positive monetary returns or profit. And this is really to help them during their startup stage.
We can also consider providing government tax deduction benefits to impact investors who invest in early-stage social enterprises that provide similar services in the same way that it incentivizes donations to IPCs. Because afterall, if more people can be harnessed and built in their capability to care in the neighborhoods, then we all can hopefully pay less taxes because of institutional healthcare costs.
Now ground up initiatives have closer experience on the ground and often their interventions and services are designed with personal experience of founders or beneficiaries, they can plot the last mile service gap much better than government agencies can.
In summary, I’d like to wrap up my speech to emphasize this point that aligns with the ministries’ intention for Healthier SG, which is that as individuals, we can do more to own and to take charge of our health. And to do this, we need to harness the capacity, strengths and assets from individuals from amongst residents and we need to invest in and grow the capacity of leaders amongst our citizens. In so doing, when we can truly bring the power of the community together and build up our citizens’ agency and health by facilitating their initiative and the pioneering spirit through mutual sharing and caring activities that they start.
There is a Chinese saying, 百花齐放, a 100 flowers bloom.
I hope the government can seriously consider these proposals to nurture and fertilize the flowers to bloom in this community health and community care space. In so,MCCY I urge MOH to set up a dedicated workgroup that includes MSF, and MCCY to help drive Healthier SG because the social determinants of health are key, if you wish to see the outcomes we want.
And hopefully we can create through these collective efforts a virtuous cycle driven by the will and initiatives of our people. The more we can share, the healthier we get. I support the white paper.
Watch the speech here.