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Asian countries watch as Singapore expands ‘war on diabetes’

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Via Financial Times

Allson Sim has been a fan of climbing for years, but his bouldering session on a recent morning at a Singapore gym was particularly enjoyable because it was free, courtesy of the government. 

“Climbing is relatively expensive in Singapore,” said Mr Sim, a 24-year-old university student, adding that free classes encouraged people to try sporting activities that were outside their comfort zone.

Singapore’s famously interventionist government is betting that he is right. It declared “war on diabetes” in 2016 and spent S$940m ($693m) on measures to fight the disease in 2017, according to the most recent data available. Its free workouts programme, Sunrise in the City, that it launched in 2013 is part of that effort, but it has added a national “steps” challenge, introduced subsidised health screening programmes and is considering a sugar tax and a ban on unhealthy drinks.

Singapore’s programme is one of the most aggressive in the Asia-Pacific region, according to Ying-Ru Jacqueline Lo, the World Health Organisation representative to Malaysia, Brunei Darussalam and Singapore. However, it will take 20 to 30 years to see results, she added.

The city state is in a race against time. The proportion of adults under 70 affected by the disease grew from 8.3 per cent in 2010 to 8.6 per cent in 2017, according to the most recent government data. A 2016 study found that diabetes cost Singapore S$1bn in 2010 in medical expenses and lost productivity.

However, while Ms Lo says Singapore’s efforts are being closely watched especially in Malaysia, one of Asia’s most obese countries, some experts doubt that the interventions will have much impact.

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Christian von Stolk, executive vice-president at Rand Europe, an independent research institute, said that Singapore’s approach was “progressive” but that the free exercise programmes and steps competitions were more likely to attract healthy individuals. The link between screenings and behavioural change was also “tenuous,” he added, given that unhealthy individuals “often perceive their health to be much better than it is, even after receiving information to the contrary”.

Nonetheless, Singapore is claiming some progress, at least in the efforts it is making. In September 2017, the city state increased subsidies for its national screening programme, leading to an almost 30-fold jump in the number of people who were screened for cardiovascular diseases and cancer to more than 65,000.

The country also reported an increase in healthier meal options at its popular hawker centres from 50m in 2017 to 180m in 2019. And the number of free workouts offered per week has grown fourfold from 2016 to more than 1,000.

In August, Singapore’s Health Promotion Board announced a tie-up with Fitbit, the wearable device supplier, to help motivate participants into adopting healthier habits.

But perhaps the most aggressive measure to date is the proposed absolute ban on advertising drinks with a high sugar content, which Zee Yoong Kang — chief executive of Singapore’s health promotion board — said is “unprecedented”. “We do intend to implement this. We are working out details in consultation with the industry”.

Most countries tend to impose time limits on television advertising to shield children from unhealthy food, whose “impact can be very small,” Mr Zee said. Singapore’s total ban, however, would have a “huge impact” on unhealthy products, hopefully pushing food manufacturers to reform these goods. Whereas “if you’re taxed, often they [manufacturers] pass the cost of the tax on to the consumer,” he added. 

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The city state is also, however, planning to impose a sugar tax on manufacturers and importers, Edwin Tong, health minister, said in a speech in October.

Despite the costs of its efforts and some expert doubt over how much effect they will have, the urge to try to do something is understandable. If left unchecked, by 2050 1m Singaporeans — or almost a fifth of the country’s 5.7m population — will be diabetic and the disease will cost the city state $1.8bn, according to government data. The costs will add to social and fiscal pressures caused by the country’s ageing population. The United Nations has estimated that 40 per cent of Singaporeans will be aged 60 or above by 2050.

If Singapore can make headway, other Asian countries will be watching. According to a 2017 Asian Development Bank Institute report, at 1bn, the Asia-Pacific region hosts the largest absolute number of obese and overweight people in the world. 

Fighting a “complex lifestyle disease” like diabetes requires a broad policy approach, said Ms Lo. Besides involving medical institutions, the healthcare system and significant financing, she said Singapore had been successful in involving individuals in its war on diabetes. “That’s the key thing other countries can look at, that they can learn from”.

If Mr Sim’s feedback is any indication, Singapore might be on the right track. He plans on sticking to Sunrise in the City. What is more, he wants his family to join in. “It’s a pretty good initiative,” he said.

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