Singapore Government releases White Paper on Healthier SG on 21 September 2022
By Joyce Teo, Senior Health Correspondent, The Straits Times, 21 Sep 2022
Singapore's ambitious plan to have one family physician and one health plan for each and every one of its residents will start with those aged 60 and above in the second half of 2023.
The Healthier SG Programme will also offer cheaper drugs for chronic diseases at general practitioner (GP) clinics, among other benefits. With it, MOH aims to shift its focus from "sick care" to preventive care so as to eventually help every resident stay on the path to better health.
Eligible residents will be invited to enrol in the programme with a primary care clinic of their choice via SMS. Those in the 40 to 59 age group will be invited to enrol in the following two years, the Ministry of Health (MOH) said in a White Paper that was submitted to Parliament on Wednesday. The White Paper will be debated in Parliament in October.
Under the Healthier SG Programme, residents will develop a relationship with a primary care doctor who will holistically manage their health.
At the first visit, which will be free, the doctor will work out a health plan that can include diet adjustments, an exercise regimen and regular health screenings and vaccinations.
Health Minister Ong Ye Kung told the media at the MOH headquarters in College Road on Wednesday that the plan has social prescriptions like "how you eat, how you sleep, how you cut down on salt and sugar, quit smoking, exercise, so on and so forth".
Community partners will be roped in to help manage residents' health, as the idea is to move healthcare away from acute hospitals to the community to help keep people healthy. Residents will be able to join free programmes to keep fit, for instance.
A key change that MOH will introduce to get residents on the programme is to make drug prices at participating GP clinics more comparable with those at polyclinics through a combination of enhanced drug subsidies and drug price limits. This will be done for drugs used to manage common chronic diseases.
With this, people will no longer have to end their relationship with their long-time GPs when they develop diabetes or hypertension just because the drugs for these conditions are cheaper at polyclinics.
MOH will announce the details for this at a later date.
The ministry also said that it will fully subsidise nationally recommended screenings and vaccinations for Singapore citizens, and waive the need for residents to co-pay 15 per cent of their bills in cash when using MediSave for the treatment of common chronic conditions under the Chronic Disease Management Programme.
"We are shifting away from co-payment for this basic preventive care to fully support residents (in) preventive care," said Mr Ong.
There will be a health points reward system to get people to take action, such as to enrol and complete their first consultation, and engage in health activities.
However, to get Healthier SG off the ground, MOH will first have to mobilise family doctors in private practice.
MOH will offer GPs an annual service fee for each enrolled resident, which will vary according to the risk profile, scope of care and the progress made, as well as a tech support grant.
These doctors will need to join a so-called Primary Care Network, partner a healthcare cluster, and be digitally enabled. The Primary Care Networks, which hire nurses and coordinators for chronic disease management and other shared tasks, will support the GPs in their work. There are currently 23 polyclinics and about 1,800 GP clinics, of which 670 clinics have formed such networks.
To ensure the level of care is consistent across GPs, MOH is developing a set of care protocols with primary care leaders to guide family doctors on how to manage key chronic conditions.
Healthier SG will start with the care protocols of three of the most common chronic conditions: diabetes, hypertension and lipid disorders. In the future, the protocols will expand to cover more conditions and areas such as mental health.
"Everyone involved, including healthcare providers, the Government and residents, will need to do things differently," MOH said in the White Paper.
"Healthier SG is probably the most significant change to the health system since Independence. We have had six decades where we emphasised reactive sick care rather than health promotion," said Associate Professor Jeremy Lim, director of the Leadership Institute for Global Health Transformation at the National University of Singapore's Saw Swee Hock School of Public Health.
The incentives under Healthier SG are created to promote health, rather than healthcare and, for the residents, inertia will be the biggest enemy, he said.
It will take years for such a major transformation of the healthcare system to take off and experts said the start will inevitably be challenging before the results show.
"Healthcare expenditure may rise initially and even more rapidly as we discover more people who have medical problems," said Dr Wong Chiang Yin, a public health specialist in the private sector.
"We must have the tenacity to stomach this and stay the course before the benefits of Healthier SG kick in at a later stage," he added.
Section 377A: Constitution will be amended to protect Parliament's right to define marriage, says Home Affairs and Law Minister K. Shanmugam
Government spells out plans to safeguard family as it repeals Section 377A
By Tham Yuen-C, Senior Political Correspondent, The Straits Times, 23 Aug 2022
As it repeals Section 377A, the Government will also make it clear in the Constitution that it is Parliament's prerogative to define marriage as being between a man and a woman and to make other pro-family policies on that basis, Home Affairs and Law Minister K. Shanmugam said on Monday (Aug 22).
This is different from enshrining the definition of marriage in the highest law of the land, which some religious groups and conservative Singaporeans have pushed for. But Mr Shanmugam said the move will stave off legal challenges on the definition of marriage.
In tandem, the Government would move to safeguard marriage, PM Lee said. As the law stands, he added, marriage as it is now defined can be challenged on constitutional grounds in the courts, just like Section 377A has been challenged.
Religious and conservative groups, some of whom see the colonial-era law as a moral marker, have welcomed this guarantee, and suggested that marriage will be defined in the Constitution.
To this, Mr Shanmugam said: "I want to be clear because I think there's some confusion. The definition of marriage is not going to be in the Constitution. That's not the intention."
Instead, the Government plans to explicitly state in the Constitution that Parliament can define the institution of marriage in the way it has been defined in the Women's Charter, and can make other pro-family policies on the basis of that definition. This will make it difficult to challenge the definition of marriage and the policies that rely on it, he added.
"This will not change... under the watch of the current Prime Minister, and it will not happen under my watch - if the PAP were to win the next General Election.
"Likewise, we will not change the laws and policies that rely on this definition of marriage, and that relates to public housing, adoption, what we teach our children in schools, advertising standards, film classification, and so on. Basically, the overall tone of society will not change - our laws and policies will remain the same," he said.
In the interview, Mr Shanmugam said that if the proposed amendments to the Constitution are not made, the prevailing definition of marriage risks being challenged on the basis of being discriminatory under Article 12 of the Constitution, which guarantees equal protection under the law.
"It can be challenged, it can be asked...why should marriage only be between a man and a woman? Why shouldn't it be possible for two men, or two women, to be married?, he said.
"Such arguments about marriage have been made elsewhere successfully."
If this happens, "everything could go in one sweep", including many of the other laws and policies built on the current definition of marriage, such as those on public housing, education and media policies, he added.
Mr Shanmugam, who with Attorney-General Lucien Wong advised the Cabinet on the issue, said: "If Parliament doesn't act, either because of fear or because of a lack of will, and therefore doesn't deal with the law which may be in breach of the Constitution, then...(it) is not doing its job. Then, you make it difficult for the Courts to exercise restraint."
Keeping quiet and letting the Courts deal with it would have been more politically expedient, he noted, since emotions run high on both sides.
But if Section 377A or even the definition of marriage were struck down like that, it would risk damaging the fundamental fabric of society, he added. Such political issues should not be decided by the judiciary, but by the legislature.
In fact, the intended amendment to the Constitution leaves open the possibility for Parliament to change the definition of marriage through a simple majority.
While constitutional amendments require a two-thirds majority in Parliament to pass, changes to other pieces of legislation, including the Penal Code which Section 377A is a part of and the Women's Charter, requires a simple majority.
Mr Shanmugam said: "This government's position is very clear and you've also heard what Deputy Prime Minister Lawrence Wong has said.
"We are committed to strengthening the current structure of marriage, strengthening the family structure and the policies that surround that structure of family. We think that's what is fundamental for Singapore. And in fact, we are amending the Constitution to strengthen their position."
He added that any political party or group that wants to push for same-sex marriage will be able to do so. "They will have to put that in their manifesto, fight elections, get a majority and then change the definition of marriage," he said.
Asked when the repeal of Section 377A would happen, he said "the changes itself, in terms of legal drafting and so on, will not take much time".
He added: "I am not in a position to give you an answer on that right now. But I do not expect that it will be very long."
Singapore must be ready for sudden shifts in region: PM Lee Hsien Loong
By Hariz Baharudin, Assistant News Editor, The Straits Times, 21 Aug 2022
Singapore's neighbourhood has enjoyed peace for so long it is hard to imagine things being different. But anyone who thinks that war cannot break out in the region needs to get real, said Prime Minister Lee Hsien Loong.
Touching on the state of global security in his English National Day Rally speech, PM Lee on Sunday (Aug 21) called on Singaporeans to be mentally ready for disruptions to the region's stability.
Singapore's external environment has become very troubled amid worsening United States-China ties and Russia's invasion of Ukraine, said PM Lee.
Speaking at the Institute of Technical Education (ITE) Headquarters at Ang Mo Kio, PM Lee said that the relationship between the US and China, which sets the tone for global affairs, is worsening.
The two powers are divided over many issues, he warned. This includes their rival ideologies and systems of government, China's growing influence in the world, as well as many specific problems, including trade disputes, cyber espionage, the South China Sea and Hong Kong.
Most recently and worryingly, there have been sharply escalating tensions over Taiwan, added PM Lee.
Yet the two superpowers need to work together on many pressing global issues, including climate change, pandemics, and nuclear proliferation, said PM Lee.
"Their tense relationship is making this almost impossible," he said. "And this is bad news for the world."
US President Joe Biden and Chinese President Xi Jinping recently held a video call and made plans to meet in November, their first in-person meeting since Mr Biden took office last January. But neither side expects relations to improve any time soon, said PM Lee.
"Furthermore, we must all hope that there are no miscalculations or mishaps, which can make things much worse very quickly," he added.
The invasion violates the United Nations (UN) Charter and fundamental principles of sovereignty and territorial integrity, which are particularly important to Singapore given that its existence and security relies on countries upholding these principles, he said.
This is why Singapore cannot legitimise Russia's wrongful actions, he added. In March, Singapore strongly condemned Russia's actions, and imposed sanctions on focusing on the exports of military and technological goods, as well as financial measures.
"Russia claims that what it calls a 'special military operation' in Ukraine is justified by 'historical errors and crazy decisions'. If we accept this logic, what happens if one day others use this same argument against us?" asked PM Lee.
The war has also created deep hostility between Russia and other states, especially the US and North Atlantic Treaty Organisation (Nato), a military alliance of 30 countries in Europe and North America.
With nuclear powers on both sides and relations having completely broken down, it is hard to imagine any satisfactory end to the conflict, said PM Lee.
The war in Ukraine also affects security in the Asia-Pacific as it has complicated already-strained US-China relations, as well as relations between China and America's partners in Asia, like Australia and Japan.
Singaporeans should expect more geopolitical contestation in the Asia-Pacific, said PM Lee.
"Our region has enjoyed peace for so long that it is hard for us to imagine things being different. But look at how things have gone wrong in Europe, how suddenly and quickly," said PM Lee.
"And can you be sure that things cannot go wrong like that in our region too? So we must get real, and we must get ourselves prepared psychologically.”
On how Singapore can respond to these external dangers, PM Lee said that it must stand firm on fundamental principles of international law and work with other countries to uphold a rules-based order.
This can be done by speaking up at the UN. Conversely, taking cover and keeping quiet will hurt Singapore in the long-term, he said.
There is also a need to take national service seriously, and keep the Singapore Armed Forces and Home Team strong and credible. "If we do not defend ourselves, no one is going to defend us on our behalf," stressed PM Lee.
But the bottomline is that Singaporeans must stay together as one united people and never allow themselves to be divided, whether by race, religion, income, social differences or place of birth, he said.
This is especially pertinent in the face of foreign actors looking to exploit Singapore's vulnerabilities and influence its people for their own interests.
"If we are taken in and we are divided, we will stand no chance. But united, we can deal with any problems that come our way," he said.
PM Lee had similarly highlighted the importance of Singapore’s resilience and unity in the face of an increasingly uncertain and complex world in his earlier Malay and Chinese speeches.
A united Singapore, a high-quality leadership and high trust between people and their leaders are essential for the nation to respond creatively and resiliently to challenges it faces, year after year, he said.
“We may have the best laid schemes, but without these three fundamentals, they will come to nothing.”
8 highlights from NDR 2022: Masks optional in most indoor settings, Section 377A to be repealed
By Goh Yan Han, Political Correspondent, The Straits Times, 21 Aug 2022
PM Lee said that with the country's situation stabilising, the Government will reduce mask requirements further to prevent fatigue from setting in.
Masks will be required only on public transport, where people are in prolonged close contact in a crowded space, and in healthcare settings such as clinics, hospitals, residential and nursing homes, where there are vulnerable persons, said PM Lee.
He said schools in particular should not require students to wear masks in class. Children need to see the facial expressions of their teachers and of one another, as this is crucial for their learning and development.
Sentiments have shifted over the years as more Singaporeans accept that sex in private between consenting men should not be a criminal offence, he said.
But most Singaporeans do not want the repeal to trigger a drastic shift in societal norms across the board, including how marriage is defined and what is taught to children in schools, he noted.
In consultations held by the Government on this topic, the main worry among those with reservations is what they feel Section 377A stands for, and that repealing it may encourage more aggressive and divisive activism on all sides.
Even as Singapore repeals Section 377A, it will uphold and safeguard the institution of marriage, said PM Lee. Only marriage between a man and a woman is recognised in Singapore, he said, adding that many national policies such as public housing and adoption rules rely on this definition.
The Government does not intend to change these policies or the definition of marriage.
He added that currently, the definition of marriage could be challenged in the courts, like Section 377A has been. If such a challenge succeeds, it could cause same-sex marriage to become recognised.
Hence, to protect the definition of marriage from being challenged in the courts, the Government will amend the Constitution.
This will help Singapore repeal Section 377A in a controlled, carefully considered way, said PM Lee.
3. Be prepared for external dangers
The external environment has become very troubled, as United States-China relations - which set the tone for global affairs - are worsening, said PM Lee.
Both powers are divided over many issues, from trade to the South China Sea to Taiwan. But they also need to work together on pressing global problems like climate change, pandemics and nuclear proliferation.
Their tense relationship is making this almost impossible, which is bad news for the world, he said.
Russia's invasion of Ukraine has violated the fundamental principles of sovereignty and territorial integrity, which are particularly important to Singapore.
The war has also created deep hostility between Russia and other states, and affected security in the Asia-Pacific by complicating already strained US-China relations, and between China and America's partners in Asia like Australia and Japan, said PM Lee.
Pointing to how things have gone wrong in Europe, he asked: "Can you be sure things cannot go wrong like that in our region too? So we must get real and we must get ourselves prepared psychologically."
To do so, Singapore must stand firm on fundamental principles of international law, take national service seriously and keep the Singapore Armed Forces and Home Team strong and credible, and stay as one united people, he said.
4. Brace for economic challenges
Cost of living is at the top of everyone's minds, acknowledged PM Lee. While most sectors are recovering from the pandemic, the war in Ukraine has clouded the country's outlook.
Inflation was already becoming a problem pre-war and the war made things worse by pushing up energy prices worldwide and causing shortages and price spikes in grain globally.
The Government is doing everything necessary to support Singaporeans, in particular the middle- and lower-income families, and will do more if the situation worsens, said PM Lee.
But the basic reality is that international economic conditions have fundamentally changed. The era of globalisation is over. China's growth and exports are slowing and countries are relooking their own supply chains to prioritise resilience and self-sufficiency.
Singapore has little influence over the global inflation picture, said PM Lee.
To become better off, the country has to press on with economic upgrading and restructuring, redouble transformation efforts and encourage workers to upskill.
5. New homes to be built in Paya Lebar
An estimated 150,000 new homes - public and private housing - can be built where the Paya Lebar Air Base is located, said PM Lee. This is roughly the number of homes in Punggol and Sengkang today.
The new town will have amenities and recreational areas as well as commercial and industrial developments to bring jobs closer to homes.
Once the airbase moves out, some building height restrictions around it in towns like Hougang, Marine Parade and Punggol can be lifted, said PM Lee.
This means the town can be redeveloped to make better use of the space there.
6. Developing Terminal 5 and Tuas Port
After a two-year pause brought on by the pandemic, work on Terminal 5 at Changi Airport will restart, said PM Lee. The new terminal will serve about 50 million passengers a year, more than T1 and T3 put together.
The design of the terminal will draw on lessons learnt from the pandemic and allow spaces to be converted for testing or the segregation of high-risk passengers.
Autonomous vehicles could be deployed to support baggage and cargo transport. T5 will also be greener and more energy-efficient, said PM Lee.
Next to it, the Government will develop the Changi East Urban District, a new business and lifestyle destination.
The mega Tuas Port began operations last December, with two berths opened. Three more will start operations by December this year.
When fully operational, the port will have 66 berths spanning 26km and be capable of handling the largest container ships.
Because Singapore had planned ahead, its port was able to handle extra volumes during the pandemic while ports in other countries experienced closures, severe congestions and long delays, said PM Lee.
Phase 1 of Tuas Port has just been completed, with three more phases to come before it is fully completed in about 20 years from now. It will be the world's largest fully automated port.
Then, it will handle 65 million twenty-foot equivalent units - a cargo capacity measurement - which is almost double today's volumes, he added.
7. Need to attract top talent from around the world
The ministries of manpower and trade and industry and economic agencies will soon be announcing new initiatives to attract and retain top talent from around the world, said PM Lee.
Singapore has attracted the interest of many talented individuals and international companies, thanks to its trusted brand of quality, reliability and efficiency and its track record in tackling Covid-19.
The country must seize the opportunity to secure its place in the post-Covid-19 world, he said.
It needs to do more, especially in sectors with good potential, to get people to come here, said PM Lee.
If Singapore can get the people it wants to come, it will help the country shine brightly as a hub of innovation, entrepreneurship and growth.
It will also make Singapore's own talent want to stay here, to participate in building a dynamic and outstanding nation, he said.
8. Getting three fundamentals right
PM Lee said that to tackle the challenges facing Singapore, the country must get three fundamentals right: a united people, a high-quality leadership team and high trust between the people and their leaders.
"We may have the best laid schemes, but without these three fundamentals, they will come to nothing."
He singled out good leadership as non-negotiable. Pointing to countries with unstable governments and where policies never make it through political gridlock, he said: "Often, it is not just the leaders who disappoint, but the whole system that has failed."
The result is the loss of faith not just in individual politicians or parties but in the whole political system and political class.
He said Singapore's very survival depends on having the right leaders, and leadership succession is therefore of paramount importance.
About 25,000 people gathered at the Marina Bay floating platform to mark Singapore's 57th birthday on Tuesday (Aug 9), in a show that recognised the hardships inflicted by the Covid-19 pandemic and celebrated a return to relative normalcy.
A human sea of red and white sat elbow to elbow, joining in the Kallang Wave and soaking in the rat-a-tat of rifle salutes at the first ticketed National Day Parade in three years.
About the only thing that signalled how the pandemic is not over was some spectators wearing face masks. Parade organisers had "strongly encouraged" this but it was not mandatory.
This year's parade was a world of difference from 2020 and 2021, when Covid-19 restrictions reduced the NDP to symbolic affairs watched live by only small, safe-distanced audiences.
Last year's show even had to be postponed by two weeks following a resurgence of cases in the community.
Amid the noise of Tuesday's celebrations, a moment of hushed silence was, for many, the most poignant of the night.
At the start of the second act of the show directed by theatre veteran Adrian Pang, a single source of light emerged from the pitch-black stage.
There, standing alone, was singer-songwriter Aisyah Aziz. In a velvety voice, she sang a song of compassion: "Have you ever felt like nobody was there? Have you ever felt forgotten in the middle of nowhere? Have you ever felt like you could disappear?... You can reach, reach out your hand."
The song, You Will Be Found, from American musical Dear Evan Hansen, launched a section of the show about the price exacted by the pandemic.
The theme of this year's NDP, Stronger Together Majulah, was chosen for the need to stick together during these tough times. It is embodied in the logo of two figures holding hands to build a caring and inclusive society.
The celebrations at the floating platform kicked off at about 5.30pm, with hosts Joakim Gomez, Sonia Chew, Siti Khalijah and Rishi Budhrani urging the crowd to wave their lights and flags and do the Kallang Roar.
Among those soaking in the atmosphere was housewife Normala Ahmad, 60. "I miss gathering and celebrating like this," she said. "Let's hope there are no more pandemics."
Teacher Ravindran Rajasekeran, 37, who was also watching at the platform, said: "During the pandemic, a lot of normal things we took for granted were restricted. It's good to see the parade back to normal."
At 6.30pm, 10 parachutists from the Red Lions descended in a spiral from the sky to cheers of delight.
The final parachutist landed heavily and was stretchered off.
This information was also conveyed to the spectators, who cheered in relief.
Immediately after came the land, sea and air Total Defence display.
The audience was informed on the big screen that "threatening personnel" were encroaching on Singapore's waters. This sparked a high-speed water chase, helicopters performing climbing manoeuvres close to the crowd, troopers raiding a "hijacked" public bus, and tanks firing into the distance.
Gripping and loud, this segment involved at least 50 vehicles from the air force, army, navy, the police and the Singapore Civil Defence Force.
Last performed five years ago, a display combining such varied elements is unlikely to be seen again for a while.
This is the last parade to be held at the Marina Bay floating platform as it will be replaced by a permanent structure called NS Square, which will be ready by the end of 2026.
The event's master of ceremonies asked those in the audience who had served or were serving NS to stand to receive a salute. There was hesitance and abashed smiles among some men.
But there were those, like Mr Irwan Ramli, who immediately stood up, solemn and straight.
Mr Irwan, 42, who works in logistics operations, served in the Singapore Civil Defence Force. He said of his stint: "We saved lives and learnt a lot of new things every day."
His wife, logistics executive Norlie Ramli, 42, added: "I'm very proud of him for giving back to the country."
Celebrations returned to a high with former Singapore Idol Taufik Batisah's rendition of the theme song Stronger Together, culminating in the national anthem and pledge.
The celebrations struck a chord with Madam Chia Foong Lin, 67, a retiree, who said: "I hope there will be peace and harmony, both at home and in the region, for a long time."
Critics of Singapore's mandatory death penalty for convicted drug traffickers miss the point that it saves lives and protects Singaporeans, Law and Home Affairs Minister K. Shanmugam has said.
"To misquote a well-known quote, a single hanging of a drug trafficker is a tragedy; a million deaths from drug abuse is a statistic. That's what this shows," he said.
In America, there were more than 100,000 deaths due to drug overdose in a year, and life expectancy declined in 2015, for the first time since World War I, due in large part to the opioid crisis.
Mr Sackur accepted that the drug problem was serious, but asked if the hanging of Malaysian Nagaenthran K. Dharmalingam earlier this year was proportionate and compassionate, given he had an IQ of 69.
He added that in October 2021, at around the same time Nagaenthran's appeal was dismissed, the United States executed two men who had similar IQs and whose lawyers argued they were similarly intellectually disabled.
"What's the difference between Mr Nagaenthran and the two persons executed in the US in October 2021, in terms of IQ?" he asked.
Mr Shanmugam added that in the 1990s, Singapore was arresting about 6,000 people a year for drugs, but this has now dropped to about 3,000 people a year.
Compared with 30 years ago, there are more drugs around the region, and Singapore would be completely swamped without tough penalties, he said.
The United Nations Office on Drugs and Crime, he noted, "said that this place is swimming in meth and a record haul of one billion meth tablets were seized in South-east Asia. We are in that situation".
Mr Sackur also asked the minister for his thoughts on racism in Singapore.
The minister said it cannot be denied that racism exists here, as in most other multiracial societies.
"The question is how systemic it is, and how much does it happen?" he said.
"My own experience as a minority in Singapore, and the experience of many others is: On the whole, compared with many other societies, it's much less in Singapore."
Mr Shanmugam was also asked about geopolitics and US-China tensions, and which side Singapore would pick if it had to.
He said: "We will not choose sides. We will go with what we think is right."
Mr Sackur ended the interview with a question on how Singapore is going to survive in a world where globalisation is in retreat.
Mr Shanmugam said it would be much more difficult, but added that people have been asking which countries are safe to physically be in and to put their money in.
"There has been a flight to quality," he said.
"There has been a movement to Singapore - money, as well as people. And I think there's an appreciation that Singapore is one of the good places to do business in."
