As part of Singapore’s continued efforts to stem the rise in diabetes, authorities have enacted a ban on advertisements for drinks made with high levels of sugar[1]. With this regulation in place, Singapore became the first country in the world to outlaw the advertising of sugary beverages across print, broadcast and online platforms by 2020
Such decisive action by the government is not surprising given that by 2050, an estimated one in two Singaporeans aged 70 is expected to suffer from the condition[2]. While the country is moving to prevent diabetes at the root, a third of Singaporeans who already have diabetes are struggling to control their condition.
Emerging health technology and smart solutions mean that patients today will become more empowered to self-manage and make informed decisions about their diets and lifestyles. However, access to technology and literacy are not equal, and therefore, efforts must be made to ensure everyone continues to enjoy unfettered access to these tools.
As the use of digital health management tools becomes more widespread on a global level, Singapore has continued to take steps to increase local adoption of these tools.
For instance, SingHealth is working with the Agency for Science, Technology and Research (A*STAR) to study the epidemiology and socioeconomic dimensions of the disease, with an aim towards innovation and establishing a “diabetes clinic of the future”[3].
SingHealth has also partnered with the Duke-NUS Diabetes Centre to develop Singapore’s largest diabetes registry. This now covers roughly 200,000 patients, and includes over a decade of historical data, which will be used to evaluate diabetes care in Singapore and develop clinical decision support systems.
Patients who suffer from Type-I diabetes are also directly benefiting from the transformative effect of health technology[4]. With glucose sensors, they are now able to scan their own glucose levels without finger pricks — easing the management of the condition and making it pain-free.
Unfortunately, these are not universally available: Access to this technology is still driven and decided by socioeconomic status.
Because technology develops rapidly, the question of access is constantly in flux. Those with the means are well-placed to adapt and ensure they have access, but there are less advantaged groups who lack the means and knowledge to make the fullest use of technology.
As such, policymakers find themselves confronted by several urgent questions: What plans are in place to define digital access, in view of continued technological evolution? And how can we ensure that the most vulnerable are not excluded from easy access to tech-enabled diabetes management tools?
Ensuring equal access to health technology is a complex process. That said, there are ways to make the latest technologies in diabetes management more accessible to the most vulnerable among us. Some things we can do include:
1. Making diabetes-related technology more affordable
The Ministry of Health’s (MOH) Citizens’ Jury recently gave significant recommendations to make diabetes management more affordable. In response, MOH agreed to raise the Medisave withdrawal limit of outpatient treatment for chronic diseases to help individuals supplement the cost of managing their condition[5].
Among other changes, MOH also extended the Chronic Disease Management Programme (CDMP) to cover diabetes-related consumables such as lancets and test strips for patients who require regular blood glucose monitoring and insulin injections.
While these are steps in the right direction, CDMP still does not cover emerging diabetes-related technologies under Medisave. As more of such technologies become commonplace, a second look at Medisave’s payment policies may be needed to make these solutions more readily accessible for those who may not have the financial ability to afford them.
2. Leveraging laws to bring diabetes-management tech into community spaces
To make diabetes management technologies accessible to all, we must not only think about financial support. We must also think of ways to bring these solutions to the doorstep of those who need it most.
Professor Dame Hazel Genn of University College London (UCL) wrote a report in Paths to Justice that identified “justiciable problems” that can be addressed through legal aid and litigation. This suggests that lawyers could be critical in identifying the “justiciable problems” for the war on diabetes and use the law to counter such issues.
To illustrate, we might consider new planning laws to allow the land at the upcoming Punggol North Enterprise District, or other public places, to be zoned for diabetes outreach. We could also use the law to designate areas for telemedicine consultancies to encourage community involvement in diabetes management.
By harnessing the legal skills and civic consciousness of our lawyers to identify the justiciable problems of our war on diabetes, we could mould a more comprehensive plan to help the less advantaged in society.
3. Expanding outreach campaigns
We should continue building on the momentum of grassroots communities and social organisations in Singapore, which have been engaging in continued dialogue with the government about diabetes.
The People’s Association, serving as the bridge between the people and government, has organised outreach campaigns, dialogue sessions and events to bring about greater awareness and deeper insights into this pressing national health issue[].
The popular online platform Giving.sg should also be used more actively to sustain the outreach. For example, appropriate tax deductions might be given for donations by Singaporeans to encourage deeper participation in these outreach initiatives
Type- I and II diabetes and pre-diabetes are complex and serious public health problems which require medical management that relies heavily on digital technology.
Yet the more powerful technology becomes, the more we must reaffirm our profound human instincts to connect. Our war on diabetes must be a just war, where the vulnerable who are most affected have the digital access they need to fight.
[1] Bloomberg (Oct 2019): Singapore to set world’s first ad ban for high sugar drinks
[2] Asiaone (Oct 2012): 1 in 2 Singaporean adults will have type 2 diabetes by 2050
[3] GovInsider (Jan 2019): The Asian-centric approach to diabetes
[4] TODAY Online (Jan 2019): Making digital technology more accessible in the fight against diabetes
[5] Ministry of Health (Jan 2018): Ministry of Health’s response to the citizens’ jury for the war on diabetes
[6] People’s Association (2018): Annual Report 2017 – 2018: Expanding Networks, Deepening Engagement