HEALTH PROMOTION BOARD BILL

Order for Second Reading read. 2.38 pm

The Minister for Health (Mr Lim Hng Kiang): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

The Government intends to set up a new statutory board, the Health Promotion Board, by integrating five departments in the Ministry of Health, namely, the National Health Education Department, Department of Nutrition, School Health Service, School Dental Service and Health Promotion Division (Administration). The objective of the Bill is to provide the legislative framework for the formation of the new statutory board.

Sir, let me explain the rationale for the formation of the statutory board.

The health of Singaporeans today is good. We have done quite well by any parameter. Our infant mortality rate of four deaths per thousand live births, maternal mortality rate of 0.1 per thousand live births and still births and life expectancy at birth of 78 years are comparable to those in developed countries. We have made significant progress in improving the health of Singaporeans in many areas through our health promotion and disease prevention programmes.

Let me start with the children. Our children represent the future of Singapore. We need to ensure the health and well-being of our young. We have done well in this area. The National Childhood Immunisation Programme has resulted in the elimination of severe infectious diseases, such as diphtheria and poliomyelitis. We have also reduced childhood tuberculosis, whooping cough, measles, mumps, rubella to a very low level.

Our comprehensive School Health Programme of health screening, immunisation, dental care and health education has contributed to the good health of our young. However, there are one or two gaps that we need to plug. For example, many of our secondary school students who were born before we introduced Hepatitis B immunisation for babies, have not been immunised against Hepatitis B and are at risk of Hepatitis B infection and liver cancer. We have therefore taken action to address this. Earlier this month, we implemented the Hepatitis B immunisation programme for students. This four-year programme will cover over 300,000 students in secondary schools, junior colleges, centralised institutes, ITEs, polytechnics, universities and our full-time national servicemen.

Currently, we have a comprehensive dental health programme for primary schools. Every primary school has a dental clinic where dental health screening and basic dental treatment is done. However, the programme for secondary school is less comprehensive. As a result, the dental health status of our secondary school students is not as good as that of the primary school students. We are therefore working with the Ministry of Education to build dental clinics in secondary schools so that our students can benefit from having dental care on site in their schools.

Defective vision or myopia among school children has continued to increase from an overall rate of 43% in 1990 to 51% in 1999. The rate among Primary 1 children has increased from 19% to 30% over the same period. We therefore need to implement measures to arrest and reverse this trend as high myopia is associated with potentially blinding conditions in later life. Sir, although we have done well in our school programmes, much still needs to be done.

Among the adults and the elderly, however, there are some areas where we are not doing so well, such as heart disease, stroke and cancer. Although the incidence of heart attacks has decreased from 94 per 100,000 in 1990 to 88 in 1998, our death rate of 76 per 100,000 population from coronary heart disease is higher than the rates of 58 and 60 per 100,000 in Canada and Australia respectively. Similarly, our death rate of 29 per 100,000 from stroke is higher than the rate of 14 per 100,000 in both Canada and Australia.

These diseases often strike people in the prime of their life, resulting in premature mortality or severe disability. This results in both economic and social burden for their family and the nation. Fortunately, studies have shown that these conditions are preventable. The lifestyle related risk factors of these diseases, such as physical inactivity, unhealthy diet, smoking, obesity, high blood pressure and high blood cholesterol can be controlled. Reduction of these risk factors can improve the health of the individual and of the population.

We must improve the health of our adult population by focusing our efforts on the areas that we are not doing so well, otherwise, although Singaporeans are living longer, their quality of life in their autumn years may actually be quite poor due to ill health. Singaporeans must take responsibility for their own health. They must adopt healthy lifestyles, go for health screening to detect chronic diseases early and if they have chronic diseases, they should go for treatment and regular follow-up. Unless Singaporeans take health education, health promotion and prevention seriously, many Singaporeans will live the last years of their life burdened with ill health and disability.

There are other areas of concerns, such as breast cancer and osteoporosis. Breast cancer is the leading cancer among women in Singapore today. The incidence of breast cancer has more than doubled over the last 30 years. A study among women showed that they are not well informed about breast cancer and its risks. They are also not aware that mammography is effective for the early detection of breast cancer and for improving the survival rate. Again, much more needs to be done in this area.

Osteoporosis or brittle bones is a disease of old age. It is associated with higher risk of hip fractures and results in significant morbidity and mortality. The rate of hip fractures has risen by 38% from 42 cases per 100,000 in 1990 to 58 cases per 100,000 in 1999. With an aging population, the number of hip fractures is expected to increase, giving rise to much ill health, disability and suffering. As the build-up of bone mass reaches its peak by about 30 years of age, we need to ensure that measures to prevent osteoporosis start from the young and continue throughout life.

Sir, we need to embark on a more focused integrated and concentrated approach to get the health outcomes we want. The setting up of the Health Promotion Board will provide the framework for a greater focus on these major health problems and spearhead health education, promotion and prevention programmes and create a supportive environment to tackle these and other health problems in children, adults and the elderly.

The Health Promotion Board will work in collaboration with public, private and community organisations to develop and sustain national efforts to manage these problems. This building of close partnerships with other agencies and organisations will enable the Health Promotion Board to reach out to all Singaporeans in various settings and to reinforce the messages in many different ways.

The formation of the Health Promotion Board will also ensure more efficient use of financial and manpower resources, and strengthen the capacity and capability to develop, implement, monitor and evaluate these programmes. The Board will focus on outcomes and standards and will provide the impetus to ensure that results, especially in the problem areas, are achieved.

Mr Speaker, Sir, I will not touch on the main features of the Bill.

Part III, clause 11, sets out the functions, objects and duties of the Board which are:

(a) to advise the Government on all matters connected with the promotion of good health and health lifestyles amongst the people of Singapore;

(b) to organise and implement effective health education programmes and other activities to promote good health and healthy lifestyles and to prevent and detect diseases;

(c) to determine, establish and recommend standards and guidelines on diet and nutrition to encourage healthy eating habits; and

(d) to provide medical, dental, health screening and immunisation services to school children and other persons.

Part VII, clause 42 of the Bill covers the consequential amendments made to the Infectious Diseases and Dentists Acts, portions of which will now be administered by the Board on behalf of the Ministry of Health.

The rest of the provisions in the Bill are the standard provisions found in all statutory board Bills.

Sir, we are facing new challenges in the pattern of diseases in Singapore. The formation of the Health Promotion Board will enable us to focus on and spearhead health education, health promotion and disease prevention programmes to meet these challenges.

Sir, I beg to move.

Question proposed.

Dr Lily Neo (Kreta Ayer-Tanglin): Mr Speaker, Sir, I stand to support the Health Promotion Board Bill. It is timely and significant indeed, if by setting up this Health Promotion Board, there can be more emphasis put into the promotion of good health and healthy lifestyles amongst the people of Singapore, as stated in clause 11 of the Bill regarding functions, objects and duties of the Board.

Our national healthcare expenditure, which formed about 2.7% of Singapore's GDP in 1996, had increased to 3.1% of GDP in 1999. This amounted to $4.4 billion or $1,370 per capita. This amount is projected to increase to 7% of GDP in 2030 or about $10 billion. Sir, the best remedy to reduce medical healthcare demands is to ensure that people live healthily for as long as possible, through preventive means and thus requiring less medical care. It is thus vital to have good and successful promotion of good health and healthy lifestyles.

In section 11(1)(d), there is mention to monitor and conduct investigations and research. I would like to urge the Minister to ensure that the Health Promotion Board urgently concentrates on epidemiological studies of diseases that are most pressing and prevalent in our population at present. For example, apart from the commonest diseases, we also need to evaluate and recommend preventive measures to address pneumonia, which is the fourth major cause of death in Singapore.

Sir, another example is the incidence of falls amongst our elderly. Falls amongst them not only can be fatal at times but they can invariably cause the elderly to end up requiring extensive medical care. Efforts to reduce the incidence of falls through having better campaigns, better information on how to prevent falls and better elderly-friendly environment are essential.

May I ask the Minister whether there is a need to mention pro-active actions towards preventive care in this Bill? For example, now that the prevalence of breast cancer is highest for cancers in women, as mentioned by the Minister earlier, it is essential to increase the screening of women to prevent many of them from end-stage cancers. Also, the problem of getting at those chronic-disease sufferers that do not go for long-term preventive medications that can prevent disasters like strokes, cardiovascular diseases and kidney failures, must be addressed.

Under the constitution of the Board in clause 5, may I ask if there is a need to specify the qualification of the members, and especially of the Chairman, as only persons with a medical or other professional degree is eligible to be so appointed?

Clause 4(1) provides that the common seal may be broken, changed, altered or made anew as the Board thinks fit. Sir, if there are such possibilities, then one may have to include a subsection to the effect that all instruments affixed with a broken, changed or altered common seal will nevertheless be deemed to have been validly executed and sealed if the execution and seal are carried out and affixed in the proper manner as prescribed in this section.

In clause 9(4), does "majority of votes" mean 51% by show of hands of members present? What happens if the questions to be decided by votes involve serious consideration such as disposal of the Board's property or any dealings between members and the Board involving substantial amounts of money, etc? Is there a need to provide that at least 75% majority votes are required when a decision is to be made for such important or serious issues?

Clause 10 covers the disclosure of interest of members. In clause 10(1), it appears that disclosure can only be made "at a meeting of the Board". What if there is no meeting held and a disclosure is needed to be made urgently? Can disclosure be made to the Board in writing when there is no meeting?

Under clause 15(3), what if the Chief Executive is incompetent or commits an offence that makes him/her unfit to be Chief Executive? This clause does not seem to include these possibilities.

Mr Speaker, Sir, clause 28, dealing with the powers of the auditors, gives the impression that the Ministry is very concerned about financial matters and hence has given a very wide power (with no limitation or restriction) to auditors. It appears that any such person may be required to furnish information, including confidential information, as long as they relate to accounts or finances. Sir, it is submitted that some form of control or limitation must be included to prevent any abuse of power by auditors and some limits must be set on documents that may be accessed or copied by auditors or at least the auditors may be required to exercise reasonableness or have a duty to keep all documents or information confidential. Although clause 39 deals with preservation of secrecy, it appears that clause 39 imposes duty only on the member, officer, employee or an agent of the Board, and auditors are intentionally excluded.

Clause 40 deals with the composition of offences. May I ask the Minister why the Chief Executive may compound any offence by collecting from a person "reasonably suspected of" having committed the offence a sum of money not exceeding $1,000? Sir, why should a person who is merely a suspect be required to pay a composition fine? It is hence suggested that these words "reasonably suspected of" be deleted.

I hope the Minister for Health will take into consideration my aforesaid comments. Sir, I support the Health Promotion Board Bill.

Mr Speaker: Order. I suspend the Sitting and will take the Chair again at 3.20 pm.

Sitting accordingly suspended at 2.55 pm until 3.20 pm. Sitting resumed at 3.20 pm