SUSS Service-Learning & Community Engagement Sectors: Health & Wellbeing

River of Life approach to health: The physical, mental and social dimensions

In 2019, the National Healthcare Group published the ‘River of Life’¹ population health framework that guides a holistic and developing approach to health. This largely shifts our mindset – not just to look into healthcare services, but also to integrate social care services.

Social Determinants of Health

The social determinants of health explains that one’s health is shaped not just by personal motivation and genetic make-up, but also the environment we live in, as well as the people we interact with. These aspects all exert profound influence on our health.₂ The framework looks into the social, psychological, cultural and economic factors order to address health and well-being of the society.

Table 1.1: Components to Social Determinants of Health³

According to a health and well-being survey study conducted by insurance company Cigna on 13 economies.⁴ Sociologist Tan Ern Ser shared that contributing factors such as an ageing society, embued with high cost of living; as well as an increasingly challenging external environment had caused a degrading sense of financial adequacy, and downward mobility in a large middle class population. Such financial worries can result in social tension in society, and other stressors in life revolving work, relationships can negatively impact one' s mental health and well-being.

This survey study contextualizes how both physical and mental health should be seen as a single entity and put on par with each other to regard health and well-being issues. Poor physical health increases the risk of developing mental health conditions, and poor mental health is associated with a higher risk of physical health challenges.⁵

Health issues and concerns of young and old in Singapore

As of 2020, the top 3 causes of death were Cancer, Ischemic heart diseases and Pneumonia. These three diseases accounted for nearly 67.6% of the total causes of deaths in 2020.⁶ These diseases share many common risk factors such as smoking, obesity, physical inactivity and alcohol consumption.

For our younger population, the issue of myopia is often overlooked. The prevalence of myopia in Singapore is amongst the highest in the world, with 65% of our children being myopic by Primary 6, and 83% of young adults being myopic. By 2050, it is projected that 80 to 90% of all Singapore adults above the age of 18 years will be myopic and 15 to 20% of these individuals may have high myopia.⁷

This is largely attributed to frequent near-work activities done with handheld gaming devices, personal computers, mobile phones and iPads.⁸ Myopia is an irreversible condition and puts one at risk of many eye disorders later in life such as early cataracts, glaucoma and macular degeneration. These complications often cause significant morbidity and may even lead to blindness.⁹

As for physical health concerns affecting adults, Singapore residents have done well in decreasing smoking prevalence, from 11.8% in 2017 to 10.1% in 2020. However, the prevalence of binge drinking has increased to 1.5% in 2020, as compared to 8.8% in 2017.¹⁰

Additionally, the prevalence of chronic disease such as hypertension and hyperlipidaemia had showed an increasing trend over the years. The increase in prevalence for both conditions was greatest among those 40 years and above. During the period of 2019 to 2020, 10.5% Singapore residents were obese, and 20.7% of these individuals had high risk BMI. This was a slight increase from 2017. The prevalence of obesity and high risk BMI was more common among adults aged 30 to 59 years, and almost double that of those aged 18 to 29 years. These can potentially increase the risk of developing chronic diseases. As such, programmes encouraging Singaporeans to lead a more active lifestyle will be pushed through population-wide programmes such as the National Steps Challenge. ¹⁰

As of 2021, the life expectancy of Singaporeans is at 83.5.¹¹ With a growing older population, the society and health systems are evolving to support people throughout their life through methods such as long-term care and community level social services. These services may include palliative care or providing community services for seniors to connect with peers and includes activities/programmes such as social time with peers at senior activity centres, therapeutic gardens, sports¹² and social prescribing.  Social prescribing is the process of connecting a person to assets within his or her community, with the specific aim of improving their Social Determinants of Health. As many seniors are socially isolated amidst the COVID-19 pandemic, electronic social prescribing has emerged as a way to keep these vulnerable groups meaningfully engaged.¹³

Since October 2019, SingHealth Community Hospitals (SCH) started a social prescribing pilot with a small group of wellbeing coordinators. In this COVID-19 pandemic where social distancing is encouraged, many seniors suddenly find themselves isolated at home. To address this, SCH wellbeing coordinators developed electronic social prescribing to equip seniors with simple digital skills so that they could stay socially connected.¹³ The eSP lessons received very positive feedback from all participants after the launch. Seniors were very satisfied that they could contact their loved ones freely without the need to travel, and access various places independently to maintain their daily routines. Most patients who attended the lesson shared that they experienced a newfound independence that they never had before. Caregivers also gave feedback that they could stay connected with their parents without taking too much time off work for physical visits.

Disruption has unraveled new opportunities of growth. Social prescribing may become more important now than ever in these uncertain times¹³ and highlighted the importance between health and social care.

Keeping it together: Addressing mental health

The connection between physical and mental health has become even more prominent during the COVID-19 pandemic. A Covid-19 mental wellness taskforce was formed to look into the mental health impact of the pandemic on the Singapore population.¹⁴

Mental heal conditions are not uncommon in Singapore, as about one in seven Singapore residents has experienced a mental health condition in their lifetime.¹⁵

To address mental health issues in Singapore, research conducted by Chow Zi Siong points out that Singapore will need to take on a life-course approach to address Mental Health issues. He explains, “A life-course approach recognises that the individual’s mental health at each stage of life is shaped by unique and common factors, and that mental health accumulates throughout life. In Singapore, this approach is critical due to the way social engineering constrains the trajectory of many domains in life; having a life-course approach ensures Singaporeans have the resources to combat against the ravages of biology, psychology and social factors.”¹⁶

The COVID-19 crisis also brought the issue of mental health and wellness to the forefront and there was an increase in people calling in to mental health helplines. Suicide prevention agency Samaritans of Singapore saw an increase of more than 22% in the number of calls attended to on their 24-hour hotline in March 2020 as compared to that of the same period in 2019. Likewise, the Singapore Association for Mental Health (SAMH) received an increase in helpline calls by 50% in February and March 2020, as compared to the average calls from April 2019 to Jan 2020.¹⁷

Based on a study conducted by Institute of Mental Health (IMH) in 2021, 8.7% of surveyed Singapore population met the criteria for clinical depression, while 9.4% met the criteria for anxiety. 9.3% met the criteria for mild to severe stress. The top sources of stress identified during the pandemic were risk of family members or friends getting infected by COVID-19, financial loss and unemployment.¹⁸

Despite the increase in mental health issues faced by the population, the stigma against mental health is still high. The“Quality of Life Study” by NCSS found that seven in 10 persons with mental health conditions faced challenges living with dignity, because of negative attitudes and actions of others.¹⁹ The study on Public Attitudes towards Persons with Mental Health Conditions by NCSS revealed that the public had many misperceptions about persons with mental health conditions. Fear and the lack of understanding, coupled with stereotype knowledge and the influence of media, contribute to the issue of deep-seated stigma that is prevalent in society.

According to a study conducted by the National Council of Social Service (NCSS) on Public Attitudes towards Persons with Mental Health Conditions in Singapore, 70% respondents believed that experience of stigma and discrimination exist in our daily lives, but yet more than 50% acknowledged that they do not want to work with, or stay with/nearby persons with mental health condition.¹⁹ Much more needs to be done to address misconceptions on mental health issues, and to raise greater public awareness on social inclusion of persons impacted by mental health conditions.

In 2018, Beyond the Label, a movement to address stigma faced by persons with mental health conditions in society was launched. The campaign was co-created with different persons in recovery, allowing the campaign to be centered on authentic and real-life stories of resilience, family and social integration.²⁰ It aims to encourage he public to go beyond the label of a mental health diagnosis, to view and regard persons with mental health conditions for who they are.²¹

References:

1. National Healthcare Group. (2019). River of Life.TM NHG’s perspectives on population health. https://corp.nhg.com.sg/ROL/Pages/RiverOfLife.aspx
2. Lim, J. (2016, July 6) Health equity in Singapore: A plan for action. https://www.todayonline.com/singapore/health-equity-singapore-plan-action
3. Artiga, S and Hinton, E. (2018, May 10) Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/
4. Lai, L. (2017, June 15). Singaporeans rank low in sense of well-being and health. Cigna Corporation. https://www.cigna.com.sg/health-content-hub/health-insights/low-in-sense-of-health-and-well-being-for-singaporeans
5. Chong, S. A. (2013, Oct 7). Put mental health on a par with physical health, Singapore doctor says. Asiaone. https://www.asiaone.com/health/put-mental-health-par-physical-health-spore-doctor-says
6. Ministry of Health. (2020). Principle causes of death resources & statistics. Singapore Government Agency. https://www.moh.gov.sg/resources-statistics/singapore-health-facts/principal-causes-of-death
7. Lam, P. (2019, August 16). Speech by Dr Lam Pin Min, senior minister of state for health, at the opening of the Singapore national eye centre’s myopia centre. Ministry of Health. https://www.moh.gov.sg/news-highlights/details/speech-by-dr-lam-pin-min-senior-minister-of-state-for-health-at-the-opening-of-the-singapore-national-eye-centre-s-myopia-centre-16-august-2019#
8. Teo, J (2019, January 7) What’s behind the high rate of childhood myopia. Singapore National Eye Centre. https://www.snec.com.sg/news/patient-care/behind-high-rate-of-childhood-myopia
9. Lam, P. (2019, August 16). Speech by Dr Lam Pin Min, senior minister of state for health, at the opening of the Singapore national eye centre’s myopia centre. Ministry of Health. https://www.moh.gov.sg/news-highlights/details/speech-by-dr-lam-pin-min-senior-minister-of-state-for-health-at-the-opening-of-the-singapore-national-eye-centre-s-myopia-centre-16-august-2019#
10. Ministry of Health (2021, November 18). Smoking rates down, Chronic disease prevalence remains of concern. https://www.moh.gov.sg/news-highlights/details/smoking-rates-down-chronic-disease-prevalence-remains-of-concern
11. Department of Statistics Singapore (2021). Death and Life Expectancy. https://www.singstat.gov.sg/find-data/search-by-theme/population/death-and-life-expectancy/latest-data
12. World Health Orgsnization (2021, June 14) Promoting healthy ageing in Singapore. https://www.who.int/news-room/feature-stories/detail/promoting-healthy-ageing-in-singapore
13. Lee, K H. (2021, Feb 23) Digital Social Prescribing. https://www.singhealth.com.sg/rhs/news/defining-med/digital-social-prescribing
14. Ministry of Health. (2021). COVID-19 Mental wellness taskforce report. https://www.moh.gov.sg/resources-statistics/reports/covid-19-mental-wellness-taskforce-report
15. Institute of Mental Health (2018, December 11). Singapore mental health study release. https://www.imh.com.sg/Newsroom/News-Releases/Documents/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf
16. Guanyinmiao (2022, February 20). Social determinants of mental health in Singapore. https://socialservice.sg/2020/02/20/social-determinants-of-mental-health-in-singapore/
17. Yeoh, G. (2021, June 05). The rise of mental health awareness – and the stigma that remains attached to certain conditions. CNA. https://www.channelnewsasia.com/singapore/singapore-mental-health-awareness-stigma-conditions-depression-1973166
18. Ministry of Health. (2021). COVID-19 Mental wellness taskforce report. https://www.moh.gov.sg/resources-statistics/reports/covid-19-mental-wellness-taskforce-report
19. National Council of Social Service. (2018). Understanding the quality of life of adults with mental health issues. https://www.ncss.gov.sg/press-room/publications/detail-page/UnderstandingtheQualityofLifeofAdultswithMentalHealthIssues
20. National Council of Social Service. (2018). Beyond the Label. Let’s unite against mental health stigma. https://www.ncss.gov.sg/our-initiatives/beyond-the-label/about-the-campaign
21. National Council of Social Service (2018, September 8). NCSS launches first nation-wide campaign to fight mental health stigma. [Press release]. https://www.ncss.gov.sg/docs/default-source/ncss-press-release-doc/mh-anti-stigma-campaign-launch-release-pdf.pdf

Tags:Health and Well-being