Singapore Health Promotion Fund

Introduction

Singaporeans have one of the longest life expectancy at birth in the world.¹ In part, this is contributed by Singaporeans enjoying good access to quality and affordable healthcare. However, with a rapidly ageing population and the shift towards a fast-moving, knowledge-based economy with more sedentary jobs, non-communicable diseases have been on the upward trend and drove 80% of Singapore’s burden of diseases in 2017.²

One major thrust in Singapore’s approach in its design of the health system is the emphasis on preventive efforts to keep Singaporeans healthy. The Health Promotion Board (HPB)³ was set up by Singapore’s Ministry of Health (MOH) in 2001 as a statutory board to drive Singapore’s national health promotion and disease prevention programmes. In line with the MOH’s twin philosophies of individual responsibility and affordable healthcare for all, HPB’s approach to health promotion is to drive behaviour changes for healthier lifestyles in the population through awareness, adoption, and sustaining of healthy behaviours using public education, intervention programmes and digital engagement, as well as influencing the environment to support healthier choices.

Governance Structure and Funding

A Board of Directors is appointed for corporate governance and oversight. This Board comprises independent members from a variety of sectors including academia, audit, finance, healthcare, and the public and private sectors. The Board reviews and approves HPB’s strategies, plans and financial budgets to ensure that activities and resources allocated are optimised to meet HPB’s objectives and key priorities as well as the MOH’s mandate.

HPB operates on a 5-year block budget from the MOH, on a predetermined set of deliverables (performance indicators) with MOH. HPB has the operational flexibility to reallocate resources within the budget based on operating conditions. In Financial Years 2018, 2019, and 2020⁴ , HPB operated on an approximate budget of SGD282 million, SGD328 million, and SGD486 million, respectively. Yearly reports are provided to the MOH to apprise funders on the health of key performance indicators. By law, HPB is also required to report to the Parliament annually. In addition, a mid-term review is also conducted during the 5-year funding cycle to ensure that the board is on track to achieve the strategic goals.

Approach to Health Promotion

HPB takes a life-course approach in influencing common modifiable lifestyle risk factors, including eating well, being physically active, not smoking and having good mental health. This is complemented by secondary prevention efforts such as early detection of diseases through evidence-based health screening for adults, children/ youth. In addition, HPB also promotes communicable disease education and prevention.

Outreach efforts are focused on three key settings – Schools, Workplaces, and Community – as well as digital engagement to ensure that the preventive programmes are of sufficient scale and reach the mass population. This is supplemented by targeted efforts to reach out to hard-to-reach segments such as the families of lower socio-economic status and ethnic minorities. HPB also works closely with public sector agencies, the industry, and grassroot organisations using a combination of approaches including programmes, policy and regulatory levers, and grants to change the environmental context and influence social norms to make healthy living more accessible and acceptable for the larger population.

Physical Activity
For example, we encourage Singaporeans to be physically active through a wide range of physical activity programmes, which are available at community spaces across the island, such as neighbourhood parks and shopping malls. This normalises the concept of having people come together in shared spaces, exercising anywhere and everywhere.

To influence a shift away from a sedentary lifestyle and physical inactivity, HPB also initiated a nationwide physical activity steps movement, more commonly known as the National Steps Challenge (NSC) in 2015. Leveraging the concept of gamification and technology, the programme empowers Singaporeans to take responsibility for their health and wellbeing and by tracking their progress towards their personal physical activity goals with the aid of a steps fitness tracker and HPB’s Healthy 365 mobile application. Participants are encouraged to clock steps and engage in moderate to vigorous intensity physical activities and are rewarded with Healthpoints when they achieve certain physical activity milestones. The Healthpoints can be used to redeem rewards such as grocery vouchers and transport credits. The programme has reached 1.7 million unique participants, spanning from youth to working adults and seniors, across 5 seasons from October 2015 till March 2020⁵ .

Diet Quality and Nutrition
To improve diet quality and reduce excessive calorie intake among the population, HPB is working across the whole-of-government and with various stakeholders across the value chain to increase the accessibility of healthier food options and increase demand through education and ground promotion efforts. This involves reformulating key staples and ingredients available in the food supply by providing grants for activities such as new product research and development, marketing and publicity, trade promotion, etc. Year-round consumer promotions and public education campaigns complement the upstream efforts in the food chain.

High sugar levels are linked to increased risk of obesity and diabetes. More than half of Singaporeans’ daily sugar intake comes from beverages, of which prepacked beverages contribute 64 percent. To help consumers 1) identify beverages that are higher in sugar and make more informed, healthier choices, 2) reduce the influence of advertising on consumer preferences, and 3) spur industry reformulation, MOH and HPB announced mandatory nutrition labels and advertising prohibitions for pre-packaged beverages in 2019, which will take effect in December 2022. The policy has persuaded major beverage manufacturers to reformulate their higher-sugar drinks to lower-sugar alternatives, ahead of the effective date of the measures. MOH and HPB will be expanding the policy to include freshly prepared beverages, such as local coffee/tea, bubble tea and juices/smoothies.

Tobacco Control
Singapore has one of the world’s toughest policies on smoking control. To complement the policies, HPB adopted a multi-pronged approach which includes a comprehensive mix of strategies including public education, provision of smoking cessation services (e.g I Quit Programme), partnerships with businesses and grassroots communities, legislation controlling tobacco advertising, sales of cigarettes to minors and tobacco taxation. Agencies such as the Health Sciences Authority (HSA) and the National Environment Agency (NEA) are also undertaking efforts in the tobacco control programme. HSA administers and enforces the Tobacco (Control of Advertisements and Sale) Act while NEA is progressively extending the Smoking (Prohibition in Certain Places) Regulations to more public places where the public are more likely to be exposed every day to second-hand tobacco smoke. Efforts such as the above have driven a downward trend in smoking prevalence in Singapore over the years and maintained at a low prevalence of 10.1% as of year 2020.

World Health Organisation Collaborating Centre
HPB’s contribution in public health extends beyond Singapore’s shores. As a World Health Organisation Collaborating Centre for Health Promotion and Disease Prevention, HPB collaborates with health promotion institutions around the world. The collaborations have facilitated many valuable exchanges and discourse around the prevention of non-communicable diseases (NCD), contributed to the building of health promotion capabilities in the region, strengthened the ties with international counterparts and affirmed Singapore as a leading player in health promotion globally.

The Future of Health Promotion in Singapore

With an increasingly complex health landscape, it is pertinent to ensure that health promotion efforts continue to evolve to be relevant to individuals and maintain their mindshare on healthy living. Developments in technology and data analytics provide new tools and approaches to do so. To this end, HPB is making its foray into precision public health to leverage technology and data-driven approaches to deliver more tailored health interventions to individuals in a timely manner at scale, with the aim of deepening engagement with Singaporeans and sustaining their healthy living journey throughout the life-course and drive greater impact for NCD prevention and control.

For example, Health Insights Singapore (hiSG) is a study undertaken by HPB to understand the health behaviours and lifestyles of Singapore residents through wearable technology. Through that study, HPB is able to monitor participants for at least two years and collect lifestyle and behavioural data across various health topics such as physical activity, nutrition and mental wellbeing. This will in turn contribute to the development of health promotion policies and programmes.

With a growing population of digital natives, HPB will continue to build our capabilities to harness technology and data to enhance our programmes. Going forward, accelerating shifts in lifestyle behaviours through technology-enabled insights, evidence-based research and programmes and innovative engagement and partnership models will be HPB’s key strategic priorities to sustain health promoting environments and empower Singaporeans with the knowledge and skills to make healthy living within reach for everyone.

For more information on HPB, please visit https://hpb.gov.sg/

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