HEALTH PROMOTION BOARD BILL

[Mr Speaker in the Chair]

Debate resumed.

Mr Chiam See Tong: Sir, I support the Bill in principle. I hope that this new Board can do a better job than its five other predecessors, namely, the National Health Education Department, Department of Nutrition, School Health Service, School Dental Service and Health Promotion Division (Administration). The functions of the five mentioned departments, I suppose, are basically also to promote good health and healthy lifestyles among the people of Singapore. But they do not appear to have done a particularly good job. Take, for example, the campaign against smoking. Smoking is something bad. It causes lung cancer and increases the chances of smokers having heart problems. Many public policies have been implemented to reduce or eliminate smoking among Singaporeans. Yet, we read in the press that smoking is on the rise among our young Singaporeans, especially young female Singaporeans. I hope that this newly-formed Health Promotion Board can do a better job than its predecessors and reduce the number of smokers in Singapore.

The Government has been promoting good health and healthy lifestyles among Singaporeans for many years but somehow major diseases like cancer, cardiovascular diseases, diabetes mellitus, have been on the rise. Cancer has now become the number one killer in Singapore. It has edged out coronary heart disease to take the number one spot among the major killer diseases. Diabetes, although it is the sixth leading cause of death in Singapore in 1999, can be very debilitating for those who suffer from it. I hope the Health Promotion Board can promote better healthy lifestyles to reduce the incidence of this dreadful disease among Singaporeans.

In America, one of the main killers is coronary disease. The people there realise the seriousness of this problem and have taken steps to stop smoking and cut down on their meat diet and replace it with more vegetables. Many have even gone on to be vegetarians.

In Singapore, the main killer is cancer. Cancer is a diet-related disease. I should like to see the Government allocate more funds to the Health Promotion Board to investigate and do research on our local food to see if there is something in our food we eat which causes cancer in our population, for example, like monosodium glutamate (MSG) which is widely used as a cheap addictive by our restaurants and hawkers to enhance the taste of their food.

The other thing I would like to see the Board do is to give more dental aid not only to school children but also to adult Singaporeans. I see that there are many polyclinics where adult Singaporeans can see a doctor at a subsidised rate. The Government should do the same for dental treatment. At the moment, there appears to be not enough Government dental clinics. The waiting time for a dental appointment at a Government dental clinic is about three months. I think this is too long. A worker cannot be expected to visit a private dentist because the charges are beyond him. As a result, I see too many Singaporeans with bad teeth. Without a reasonable availability of subsidised dental treatments, we shall see more and more of our Singaporeans with bad teeth. I hope that the Government can provide affordable dental treatments widely to our workers.

Mr Yeo Guat Kwang (Cheng San): Mr Speaker, Sir, I support the Bill. Before that, I would like to advise Mr Chiam to inform the particular workers to go to NTUC Dental Care.

Since 1998, the National Trades Union Congress has taken the initiative to work with companies to set up workplace health programmes. These programmes have two key objectives. One is to help prevent workers from running into hardship as illnesses can cost job losses and increase health expenses. Two, it helps companies save medical cost by keeping their workforce healthy. The companies' bottomline will improve and the workers get better wages. The ultimate goal is to ensure that our workers enjoy a better life with healthy body and healthy mind. We understand that health affects our work performance, earning capacity and our employability. Job creation, job security and good wages will be meaningless if the workers are unable to enjoy the benefits due to poor health.

In the past, as mentioned by the Minister, most deaths in Singapore were caused by infectious diseases. Today, it is the lifestyle diseases that take the greatest toll - heart illnesses, cancer and stroke. It is pertinent that now all the tripartite social partners work more closely to help our employees reduce the risk factors in developing all these diseases and illnesses. The National Health Survey done by the Ministry of Health in 1998 found that the level of high blood cholesterol and high blood pressure among Singaporeans has increased. The survey showed that hypertension was more common among the elderly workers - 49.5% of those aged between 50 and 59, that is half of this age group, and 64.3% for those aged 60 to 69. It is alarming because hypertension increases kidney disease risk and, on average, a person with high blood pressure is seven times more likely to suffer a stroke. This means that there are more than 655,000 stroke candidates here.

Mr Speaker, Sir, it is said that a good worker works hard. In today's workplace, our workers are working so hard that they have been taking their health for granted. Company policies and programmes at work to improve the physical, social and emotional well-being of employees now play an increasingly important role. If health care costs go up, the company's competitiveness will be adversely affected. As a firm believer of prevention is better than cure, I welcome the move by the Government to establish the Health Promotion Board (HPB) as a statutory board to better promote healthy lifestyle and good health for all. It is appropriate that the Government now intensifies its effort in health promotion and preventive health care. Like the PSB for the productivity movement, I hope the HPB will be a champion for good health for all and to provide more resources to help improve the health of our workers and spare them from unnecessary medical expenses. Today, unlike the babies and the young Singaporeans who are students or national servicemen, our working adults are not provided with or subjected to any structured health programmes. Our employers at the same time also tend to be more concerned about the cost of medical treatments only, rather than proactive programmes to improve their workers' health. The idea of a workplace health promotion is still relatively new in Singapore and it has not yet taken root in the private sector.

Mr Speaker, Sir, we have to do more in this area to make our workers healthier and happier. We have no other alternative. Our workforce, which is the world's number one, is the nation's best asset we have.

Mr Lim Hng Kiang: Mr Speaker, Sir, I would like to thank the three Members for their support of the Bill. I think we are all agreed that the intention of the Health Promotion Board Bill is to provide the framework to encourage Singaporeans to take better care of their health and this is the approach that the Board will undertake. They are systematically looking at the 10 most common causes of death in Singapore, analyse each disease, try to understand what causes the incidence of disease and then work out a strategy to try and bring down the incidence. Take, for example, cancer. The incidence of cancer is indeed rising, primarily due to two main reasons. First, because our population is getting older and therefore many cancers related to an ageing population are now on the rise. Second, there are also many types of cancer related to lifestyle that are more prevalent now than 10 or 20 years ago. So we are seeing a shift in the pattern of diseases. In particular, breast cancer is on the rise.

Looking at each of the cancer types, the Board would devise strategies to deal with them. For breast cancer, we are going to set up mammography facility in every polyclinic. But the key is to get Singaporean women to go for breast screening. This requires both education, promotion and to get the women to act upon awareness, and not just know that breast cancer is a rising disease and mammography is important, but, more importantly, to get them to act and go for the screening. Second, coronary diseases and diabetes. These are related to lifestyle and therefore the messages we put out to the children, the adults and the elderly are very important.

Diabetes is a condition that can be managed. What we need is to screen the people, particularly, the elderly. If they know that they have a diabetic condition, they will take active steps to manage this and mitigate the complications that may arise due to diabetes.

Dr Lily Neo also mentioned pneumonia. We are studying this. Also, the problem of elderly falling. This is related to what I mentioned earlier about osteoporosis. It is not just building up the bone mass when we are young, but also taking part in exercises so that the bone structure continues to be strengthened. But, as Dr Lily Neo stressed, we need a more holistic approach to also make sure we have non-skid floors and less barriers in the design of our walkways. So HDB will undertake all these in conjunction with other agencies.

Mr Chiam See Tong made the comment that he hopes that the Board would do a better job, implying that the current departments are not doing a sufficiently good job. The idea of creating the Board is of course to do a better job, but not to cast a judgement on the present departments. The present departments are doing a commendable job. What we want to do with the Health Promotion Board is to make sure these efforts are integrated and more focused on the children, adults and elderly in different settings, in schools, institutions, at the workplace and in the community. By putting the five departments together and by integrating the efforts and by focusing on each disease, we hope to be able to achieve better outcomes based on the strategies for each disease.

On dental health, I hope when Mr Chiam said that he saw many Singaporeans with bad teeth, he is not doing so in a professional capacity. Indeed, the dental health of Singaporeans is improving. We have statistics on children's dental health status when they are seven, 13 and 19 years old. The number of cavities has reduced. Therefore, we are monitoring very closely the dental health of our population. Anecdotally, many dentists would tell you that in fact the volume of business has gone down because they are seeing fewer and fewer Singaporeans with bad teeth. The dental health of our population, by and large, is definitely improving.

We agree that we should do more in the campaign against smoking. But I must emphasise that smoking is addictive and the trick is to prevent the teenagers from taking up smoking. Once they smoke and if they do so regularly in their early years, then they will be addicted and they will be hooked. We are tracking the incidence of smoking. By and large, the incidence of smoking in Singapore, as a whole, is dropping. But I do agree that the incidence for young females is rising which is a cause for concern. Therefore, one of the tasks of the Health Promotion Board is to target the anti-smoking campaign at these vulnerable groups - the younger people, including the younger females.

Mr Yeo Guat Kwang emphasised about the importance of health promotion among the workforce. This is one of the new strategies that we are embarking to promote workplace health promotion programme. We recognise that the younger people in schools and institutions of higher learning provide us with an institutional setting for which we can conduct health promotion, health education and prevention programmes. But once they go into the workforce, there is less of this directed effort at the workforce. Therefore, we have embarked on this workplace health promotion programme to bring what we are doing in the schools also to every workplace. We are more successful in the community than in the workplace. So one of the priorities of the Health Promotion Board is to direct their efforts at the workplace.

Sir, these are the key issues that the Health Promotion Board, when set up, will deal with. Let me next turn to some of the administrative provisions in the Bill which Dr Lily Neo pointed out. These are standard provisions. But, nonetheless, since she raised them, it is worth my while to clarify them. First, on the qualification of the board of directors. We do not believe that we should restrict the board of directors to just medical or professional people. The Board should encompass a wide range of Singaporeans - those who can add value to the Board, whether they are educationists, whether they are people from the media that can help us promote and deliver the messages - who can in fact contribute to the Board.

Regarding the conduct of the Board, like most statutory boards, the conduct would be based on the majority vote, and not requiring 75% vote for serious issues. I would like to assure the Member that for serious issues involving larger sums of money, the Board would comply with proper financial procedures which would require approval by a certain committee of the Board as well as the approval of the Ministry headquarters.

On disclosure of interests of members, this is a standard provision. Most board members meet together to discuss projects and papers, and that is a convenient time for them to indicate their disclosure. However, if there is a project or decision paper that is done through circulation, then the board members can indicate the disclosure of their interest through writing and circulation as well.

On the powers of the auditor, again, this is a standard provision. The powers given to the auditor is necessary to make sure that they conduct effective audit of the Board. The auditor would be appointed by the Ministry, in consultation with the Auditor-General. On appointment, the auditor or his representative would be required to sign an undertaking to safeguard official information. So confidentiality will be safeguarded.

The next point is on the use of the Board's seal. This is a standard provision. The provision allows the Board to have a seal to affix on to important documents and, if the Board wishes, it could break the seal, amend and create a new seal. I would like to assure Dr Lily Neo that even though a new seal may be created, any document that is sealed with the old seal will continue to be valid as long as the seal is applied in the correct manner by the Board.

Dr Lily Neo also made the point about composition of offences. The provision to compound offences is an administrative way in which we give the offender the option to compound it by paying a composition fine. If the offender does not want to accept the composition, then the full process of the law would take its course.

Let me assure Dr Lily Neo that these are all the standard provisions in setting up a statutory board. I recognise her concerns and these concerns are duly catered for in the Bill.

Dr Lily Neo: May I seek clarification, Sir? I would like to clarify that I did not ask for specific types of qualified people in the medical board. I only asked for their qualifications, be it medical or others, to be specified in the Bill. The Minister earlier said that mammography will be made available to all polyclinics. I would like to ask him whether this facility is operational now. Could I also ask the Minister whether representatives from the other Ministries can be made available with this Health Promotion Board so that the implementation and cooperation can be got from other Ministries as well? And earlier in my speech, I also asked for proactive action regarding chronic cases. Could he say something about that, please?

Mr Lim Hng Kiang: Mr Speaker, Sir, we do not think it is necessary for us to set out in specific terms the qualifications of the board members. It is suffice to know that we will select a Board with different members to look at different aspects and who will add value to the Board. We will include of course medical professionals, with interest in the things that we are doing. We will include educationists, as I said earlier, maybe media people, who will help us devise the promotion strategy. We may include representatives from the various Ministries, for example, someone from the Ministry of Education or maybe someone from the Sports Council would be also useful. So we will look at all the various possibilities and put together a Board that can lead the management.

On mammography facilities, we have started with two polyclinics and our intention is to extend this to all polyclinics in due course. This will happen by the middle or third quarter of this year. The polyclinics are now actively undergoing renovations to be able to take on these new facilities.

On chronic cases, we have started the chronic care management programme some time last year so that people who suffer from chronic diseases, such as diabetes, high cholesterol, or high blood pressure, can be managed at the polyclinic level. They will be given a package to help them monitor as well as to go for regular consultations. This requires the people suffering from such chronic conditions to take an active interest and to manage their conditions actively. We are still in the early stages of the programme. It is not as successful as we like it to be. Some Singaporeans still take a fairly laid back attitude towards this, for example, towards diabetes. They do not realise that diabetes is a silent killer, even though it may not manifest itself in very obvious symptoms. If you do not manage the condition carefully, you will end up with quite serious consequences. So this requires a lot of education as well as active assistance to the people, to make sure they are able to manage their conditions well. So it is an uphill task and we will continue to plug at it.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. - [Mr Lim Hng Kiang].

Bill considered in Committee; reported without amendment; read a Third time and passed.