In 2010, the Asian Journal of Exercise & Sports Science published a lengthy report authored by eight experts titled “Obesity Prevention in Singapore: Collaborative Efforts Among Government, Health Professionals and the Community.” The authors identified three major reasons for Singapore‘s success in persuading its citizens to adopt better nutritional practices, which in turn contributed to the reduction of overweight and obesity rates. In condensed form, these are the reasons:
First, and perhaps most important, is that Singapore has one of the world’s most effectively integrated social, cultural, environmental, political and economic systems.
Second, Singapore has promoted many innovative programs and services. As a country, Singapore often leads the world in creating and testing new ways to address problems, concerns and issues.
Third, Singapore has adopted a world view… Singapore draws best practices from across the world… Programs and services are uniquely offered in such a way as to reflect the culture and customs of the Singapore community.
Elaborating on Reason #2, the report touts the effectiveness of the country’s health establishment in creating and promoting sustainable, holistic programs, thanks to the government’s very close working relationship with non-governmental organizations and businesses. The Ministry of Health has a welcome influence on what the schools do in a way that is not easily accepted in, for instance, the U.S. Another way in which Singapore hopes to demonstrate leadership and set a good example for other countries is by setting up and paying attention to early warning systems. The Journal says:
Health problems are not ignored until they reach epidemic status, but rather are addressed in a systematic fashion emphasizing prevention…
This implies that the government keeps a very close eye on things, and if the culture is not heading in a good direction, the authorities are not shy about intervening or, as some Americans might characterize it, interfering. One example of preventive or pre-emptive action was the 2003 Step With@It program, aimed at youth in the 17-21 age bracket. This initiative included road shows for awareness and education, and hands-on training for both students and teachers in how to use such tools as the stepometer (pedometer), which they would use to measure their participation in weekly runs and periodic marathons, as well as their daily exercise.
Also in 2003, Singapore’s Health Promotion Board launched the Model School Tuck Shop Program, which was designed to make healthier snack alternatives more readily available to kids. (A “tuck shop” is what the British, who used to run Singapore, call the sort of snack shop that tends to spring up near schools.) The program steadily gained adherents, and within four years, 74% of Singapore’s schools were on board with the project.
Another Health Promotion Board program, instituted after the publication of this report but typical of the kind of intervention authorities hope will be beneficial, is the Healthy Origins and Firm Foundations program, which aims to increase the wellness of expectant mothers and to educate all parents on nurturing a healthy lifestyle. Then in 2012, there was the Let’s Drink Water campaign, the benefits of which need no explanation. This movement includes the multiplication of water coolers in every educational establishment from primary schools to junior colleges.
Sensitivity to Difference
The third reason given for the self-congratulation of Singapore’s health establishment is its awareness of and sensitivity to cultural differences. Obesity varies greatly among the various ethnic groups. The Malay obesity rate is 19.1%, the Indian figure is 13.4%, and the Chinese rate is an astonishingly low 4.2%. This means members of the Malay community face a far greater risk of cardiovascular disease and other obesity-related illnesses. They need special attention in this area, and the government is also aware of the difficulty:
One possible reason for the high obesity rate among Malays could be Ramadan, a holy month. Fasting (abstaining from food and drink during the daylight hours) during this month is among the five duties of those practicing the Islamic faith. Paradoxically, it has been found that caloric intake, and lipid intake and total cholesterol levels were increased during Ramadan fasting.
Taken together, reasons 2 and 3 draw a picture of an administration that is willing to watch and listen, and to use what works from other places. Singapore has a knack for taking advantage of its very unusual situation of being a small yet wealthy nation of racially diverse people who are willing to tolerate paternalistic governmental supervision in exchange for a high quality of life, even if it means their freedoms are somewhat circumscribed.
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Source: “OHCHR Study on Children’s Right to Health,” OHCHR.org, 10/10/12
Source: “Obesity Prevention in Singapore,” nie.edu.sg, 2010
Image by stephanie ho