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Preventing Non-Communicable Diseases (NCDs) Through Health Promotion
Mr Zee Yoong Kang
Chief Executive Officer
Health Promotion Board, Singapore
Panel Session 4 – Non-Communicable Diseases and UHC Ministerial Meeting on Universal Health Coverage 11 February 2015
Why focus on NCDs?
NCDs will cost global economy US$47 trillion by 2030
63% of all deaths worldwide
NCD deaths will increase by 17% over next ten years
Source: WHO, WEF, Harvard School of Public Health 2
Prevention of NCDs is cost-effective
Status Quo Scenario* NCD “Best Buy” Interventions
Low-income countries
Lower-middle income countries
Upper-middle income countries
Annual Economic Loss
Per Person
US$25
Tobacco use
Unhealthy diet Physical inactivity
Annual Return of
Investment
Source: WHO, WEF (2011)
ROI = 3 times
10% – 15% premature deaths
due to NCDs averted
3
Harmful alcohol use
Counselling & drug therapy for CVD
Hep B immunisation Screening for cancer
*Scenario where intervention efforts remain static and rates of NCDs continue to increase as populations grow and age
US$50
US$139
GNI per capita: ≤ US$1,045
GNI per capita: US$1,046 - US$4,125
GNI per capita: US$4,126 - US$12,745
Investment in health promotion improved health outcomes for North Karelia (Finland)
Finland
North Karelia
Mortality from Coronary Heart Disease Finland 1971-2006
-85%
Source: The North Karelia Project: from North Karelia to national action (2009)
Investment: 6% of total health spending in public health & prevention programmes annually
-80%
4
In Asia, tobacco control efforts have shown success in bringing down smoking prevalence
5
Tobacco Control Strategies
1996: 24.8% 2011: 20.9%
Ban on tobacco advertising and sponsorship
Pictorial warning labels
Ban on smoking in public places
Smoke-free in air-conditioned workplaces
Increase taxation
Smoking Prevalence
Malaysia
Thailand Cessation clinics
Anti-smoking campaigns 1991: 32.0% 2011: 21.4%
Singapore
1992: 18.3% 2010: 14.3%
Hong Kong
1982: 23.3% 2012: 10.7%
Source: National Health Survey (2010)
Source: Tobacco Control Office (2012)
Source: Thai Health Promotion Foundation (2011)
Source: Global Adult Tobacco Survey (2011)
In Hong Kong, smoking rate has hit a
30-year low due to its concerted efforts
6
23.3
18.7 16.8
14.9 15.0 14.4
11.8 10.7
0.0
5.0
10.0
15.0
20.0
25.0
Pe
rce
nta
ge (
%)
Smoking ban – Public lifts &
transport vehicles
No sale of tobacco to
minors
Smoking ban – open-air public
transport interchanges
Smoking ban –indoor
restaurants, workplaces,
markets
Tobacco tax ↑300%
Total ban of tobacco
advertisement
Smoking ban –bars,
nightclubs
1983 1984 1994 1999 2007 2009 2010
Prevalence of Daily Smokers (Aged 15 and Over)
Source: Tobacco Control Office (Hong Kong)
Singapore’s Health Promotion Strategy
8
Over the years, Singapore has done well in improving the health of its people
Bloomberg Rankings – Healthy Countries Increasing Life Expectancy at Birth
Source: Bloomberg (2012) Source: Singapore Department of Statistics (2013)
65.8
75.3
81.7 82.5
50
55
60
65
70
75
80
85
1970 1980 1990 2000 2010 2013
Year
s
89.5
0
10
20
30
40
50
60
70
80
90
100
Sco
re
However, NCDs continue to show high contribution to disease burden in Singapore
9
• Chronic diseases • Cancers • Mental ill-health
Burden of
Disease
• Obesity • Smoking
Ageing Population
Population Growth
Changing Lifestyles
70%
25%
Source: MOH (2010)
0
50
100
150
200
250
300
350
Mill
ion
s (S
GD
) So we need to intensify our efforts in health
promotion to focus on the prevention of NCDs
10
Actual
Estimated Source: HPB
Health Promotion Board’s Budget
Healthy Living Master Plan – Roadmap for nation-wide efforts to influence behaviour change
• Shift in approach – Leverage
partnerships (public and private)
– Use nudges (environmental, social and financial)
– Change market dynamics
• Co-creation with the
community
11
INFORM INFLUENCE
Direct Ripple
2014
Singapore’s Efforts Illustrated
Programme – Obesity Control
Food Strategy
Our Strategic Thrusts for Obesity Control
Adults: Maintain obesity rate < 10% by 2020 Children/youth: Reduce overweight rate from projected 14% to 11% by 2020
13
Physical Activity Weight
Management
14
Food Strategy: Targeting key points in the value chain
Suppliers
F&B Partners
Customers
Work with suppliers to make healthier ingredients affordable
Support early adopters to ensure healthier meals are everywhere
Leverage incentives and social media to nudge uptake of healthier meals
Tilting the Market
Driving Demand
FY12 FY13 FY14 FY16 FY18 FY20
No
. of
me
als
sold
(T
ho
usa
nd
s)
Early results for market share of
lower calorie meals are promising
264 316
4,600 (till Dec 14)
10,200
18,500
34,000
Projected Targets
22 companies - 392 outlets & 341 stalls; offering over 600 healthier items
Serving 4.6 million healthier meals in FY2014 (till Dec 14)
Singapore’s Efforts Illustrated
Outreach – Workplace
Need to ensure good health of
workers across all ages
and sectors
Workplace outreach is important to address the
lifestyle risk factors of the working population
17
Health risks impact absence and productivity in workplace
Source: Boles et. al. (2004). Journal of Occupational and Environmental Medicine. Examples of health risks are smoking, physical inactivity, poor life satisfaction, poor physical health, poor job satisfaction, obesity, high blood pressure, and high stress.
Health Risk Factors
-
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
FY15 FY16 FY17 FY18 FY19 FY20
No
. of
Wo
rke
rs
Workplace programmes will extend reach,
focusing on business clusters and industrial estates
Source: The Straits Times (2013)
Companies ……….Business clusters ………. Industrial estates
To reach 900,000
workers by 2020
18
Another focus is to reach out to mature
workers in non-structured worksites
2,800 Taxi drivers
screened for chronic diseases
50%
New Cases
Detected
>80% Return to self-collect health report
and attend 1st coaching session
Oct 2014 – Jan 2015
Source: The Straits Times (2014) 19
Thank You
