Diabetes as a National Health Priority in Singapore

This essay focuses on the national health priority of diabetes in Singapore and why it needs to be controlled. It discusses credible research evidences, the position of the chosen national health priority, and the fundamentals of health promotion that address this priority area.

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s note

1HEALTH CARE
Diabetes mellitus, cancer control, asthma, cardiovascular health are few examples of
issues that have found attention in national health priority area initiative. Recognition of these
issues paves the pathway to reduce the burden of disease and open continuum of care from
prevention to disease management. This essay focuses on the national health priority of diabetes
in Singapore and diabetes has become a national health priority because of the increase in
diagnosis of diabetes in Singapore and the high rate of medical cost due to the issue. The essay
gives an insight into credible research evidences to justify why diabetes needs to be controlled.
The position of the chosen national health priority is also illustrated using the frameworks of
well-being and the essay also discusses the fundamentals of health promotion that address this
priority area.
Diabetes is a national health priority in Singapore and the main rational behind this is the
rise in the number of people with diabetes in the region. Diabetes is a clinical condition that is
associated with insufficient production of insulin, a hormone that balances blood sugar level thus
resulting in high blood glucose level and risk of damage to tiny blood vessels in the heart, eyes
and kidney (Skyler et al., 2017). The people who are getting older and ethnic groups like Asians,
American Asians and Pacific islanders are at more risk of developing diabetes. Kirkman et al.
(2012) reports that ageing of the population is the major driver of the diabetes epidemic and
diabetes in older people is linked to high mortality rate, high rate of hospitalization and reduces
functional status. Type 2 diabetes is a condition that is highly prevalent in Asia and about 4, 40,
000 Singaporeans were diagnosed with diabetes in 2014. This implies that diabetes account for
10% of disease burden in Singapore. It is also estimated that the number of people diagnosed
with diabetes is likely to increase to 1 million by 2050. Diabetes is also the reason for high rate
of hospitalization and increases medical expense. This in turn translates to loss in productivity

2HEALTH CARE
and increased medical expense too (Health Hub, 2018). Hence, the above mentioned statistics
explains why diabetes has become a national health priority in Singapore.
There are many credible research evidences that illustrates why the Singapore
government must regard diabetes as a national health priority and take action against it. The
research by Phan et al. (2014) explains that Singapore is a region with high risk of diabetes as
three major ethnic populations like East Asians, South East Asians and South Asians resides in
the country. These groups have experienced significant changes in lifestyle, diet and
environment thus indicating the reason behind increase in prevalence of type 2 diabetes since the
1980s. Unless urgent action is taken to control the diabetes epidemic, it can turn out to be the
most competing health issues for the aging population in the region. The most recent statistics for
the year 2017 shows that 606, 000 people had diabetes and the prevalence rate in adult was
13.7% (International Diabetes Federation, 2018). People between the age of 18 and 69 mostly
experience glucose intolerance in Singapore and women were found to be at higher risk than
males. The advantage of prioritizing diabetes as a national health issues is that it would lead to
active surveillance and screening of the disorder and early detection of the disease. This stage
would help to screen high risk ethnic group and detect the disorder in asymptomatic individuals
too (Ong, 2017). Prioritizing diabetes as national health issue will help in the implementation of
intervention at the population level and in high risk groups. This would also help in collaboration
with relevant agencies and Health Promotion Board, who would play a role influencing lifestyle
and active of high risk groups.
The National Health priority is framed to engage in a collaborative effort to curb or
control disease in target region. To achieve the goal of a healthy population in Singapore, the
most vital activity is to identify the specific target group who are influenced by diabetes. In

3HEALTH CARE
Singapore, the specific target group for prevention of diabetes includes young people between
the age of 18-30 years. This can be said because National Health Survey shows highest
prevalence of diabetes in youths. About 4, 40, 000 Singapore residents above 18 years were
diagnosed with diabetes in 2014 and the number is expected to rise to 1, 0000,000 by 2050
(Health Hub, 2018).. Hence, diabetes in young age would translate to high risk of other ailments
at old age. Hence, the youth population and those entering this age group must be prioritized
(Diabetes Task Force, 2018). The main reason behind high diabetes risk in ageing people
includes effect of age on insulin function, beta cells, and decrease in physical activity and
increase in adiposity. Therefore, with the loss of beta cell function, the likely of impaired glucose
tolerance and chances of developing type 2 diabetes increases (Yen, 2017). Targeted intervention
will be easy to implement, when the group who are above the risk threshold are identified.
Health managers can then engage in critical thinking for the most effective intervention that
needs to be scales up for young adults in Singapore and determine ways to implement the
intervention in the real world (Diabetes Task Force, 2018).
The Knight and McNaught’s frameworks of health and well-being can be an effective
guidance to understand ways to support health of people at risk of diabetes in Singapore. The
framework mainly defines the elements in the environment for learning that would support well-
being for children and young people. The framework broadens well-being into several domains
such as individual well-being, family well-being, community well being and societal well-being.
(Langford et al., 2015). The National Health Priority of diabetes comes under the domain of
individual well-being and key elements of individual well-being include physical, social,
psychological and spiritual well-being. Hence, in accordance with this framework, well-being is
enhanced for youths of Singapore by improving physical, psychological, spiritual and moral

4HEALTH CARE
experiences in their life. Physical well-being can be enhances by focusing on early screening and
diagnosis of the disease. In addition, psychological well-being can be prioritized by creating
supportive environment for the target group. Currently, the Ministry of Health in Singapore is
adapting the fundamental of health promotion to control and reduce the diagnosis of diabetes.
The Ottawa Charter defines the principles of health promotion which is to support people to
increase control over their own health. Hence, health promotion occurs not just by the action of
the health sector, but also by building healthy public policy, creating supportive environment for
people, empowering communities through community action, developing personal skills and
reorienting health services towards health promotion (World Health Organization (WHO), 2019).
This implies that population health is dependent not just on the public health agencies, but also
by ensuring that target population, community and health services enter into joint collaboration
to make the change possible. In response of the diabetic epidemic, how far the Singapore
government has been able to adapt to Ottawa charter to promote health and reduce diabetes
prevalence needs to be evaluated. This would give help to compare primary and secondary
interventions with the fundamentals of health promotion and find out any gaps in Singapore
government strategy to promote health and control diabetes prevalence.
Based on the awareness of the public health impact of diabetes, health care professionals
and policy makers have taken several efforts to inform public about diabetes. One such effort by
the government to motivate people to change their lifestyle was done by the implementation of
the Diabetes Be-Aware campaign. This was an educational campaign where the main motive was
to target people with poorly controlled diabetes and reduce severe consequences like lower limb
amputation and kidney failure by raising awareness about diabetes mellitus. Apart from
educating people about diabetes, the campaign aimed to support people by means of regular

5HEALTH CARE
blood glucose monitoring, body weight and regular checkup (Health Promotion Board, 2008). In
accordance with the Ottawa Charter of health promotion, the campaign also created supportive
environment by educating people and strengthened community action by enrolled health care
staffs in conducting regular checkup. In order to develop personal skills, nurse educator
programme was launched which provide self-management skills and advise on lifestyle changes
to the population. However, one major drawback of this campaign is that it did not exploit the
internet to enhance access to necessary information for target population group. Hence, flexible
system for public participation was not promoted. A research evaluating the effect of public
campaigns in Singapore revealed that public is well-informed about diabetes except for few
areas. Hence, required knowledge has been passed on. However, what is lagging is lack of
compliance to the health message (Zainudin, Ang & Soh, 2017). Utilization and exploitation of
the internet and digital technology can provide more options to help target population easily grab
messages and inquire about any issues on a daily to daily basis. This would help to advocate,
enable and mediate for health and well-being of the Singaporeans. Therefore, gap exists between
level of knowledge and self-management which requires corrective action.
From the review of statistics on prevalence of diabetes in Singapore and its effect on
health and productivity of the population, it can be concluded that taking diabetes as a national
health priority is justified. As the review of prevalence statistics in the past few years shows an
increase in trend of diabetes prevalence, it is evident that gap exists in current promotion
program. By comparing primary intervention to principle of health promotion, it has been found
that few gaps exist between level of knowledge and self-management. Hence, innovative steps
need to be taken to enable public to comply with positive health behavior.

6HEALTH CARE
References:
Diabetes Task Force. (2018). Diabetes Task Force Report. Retrieved from:
http://www.nmrc.gov.sg/docs/default-source/about-us-library/dtf-summary-report.pdf
Health Hub (2018). Diabetes. Retrieved from: https://www.healthhub.sg/a-z/diseases-and-
conditions/626/diabetes
Health Promotion Board. (2008). Diabetes Be-A-Ware Campaign. Retrieved from:
https://www.hpb.gov.sg/article/diabetes-be-a-ware-campaign
International Diabetes Federation (2018). IDF members in Singapore. Retrieved from:
https://idf.org/our-network/regions-members/western-pacific/members/113-
singapore.html
Kirkman, M. S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., ... & Pratley, R.
E. (2012). Diabetes in older adults. Diabetes care, 35(12), 2650-2664.
Langford, R., Bonell, C., Jones, H., Pouliou, T., Murphy, S., Waters, E., ... & Campbell, R.
(2015). The World Health Organization’s Health Promoting Schools framework: a
Cochrane systematic review and meta-analysis. BMC public health, 15(1), 130.
Ong, Y. Y. (2017). Burden of diabetes: A refocus. Retrieved from:
https://journals.sagepub.com/doi/full/10.1177/2010105817724812
Phan, T. P., Alkema, L., Tai, E. S., Tan, K. H., Yang, Q., Lim, W. Y., ... & Chia, K. S. (2014).
Forecasting the burden of type 2 diabetes in Singapore using a demographic
epidemiological model of Singapore. BMJ Open Diabetes Research and Care, 2(1),
e000012.

7HEALTH CARE
Skyler, J. S., Bakris, G. L., Bonifacio, E., Darsow, T., Eckel, R. H., Groop, L., ... & McElvaine,
A. T. (2017). Differentiation of diabetes by pathophysiology, natural history, and
prognosis. Diabetes, 66(2), 241-255.
World Health Organization (WHO) (2019). The Ottawa Charter for Health Promotion. Retrieved
from: https://www.who.int/healthpromotion/conferences/previous/ottawa/en/
Yen, V. (2017). Diabetes in the Elderly. Principles of Diabetes Mellitus, 179-187.
Zainudin, S. B., Ang, D. Y., & Soh, A. W. E. (2017). Knowledge of diabetes mellitus and safe
practices during Ramadan fasting among Muslim patients with diabetes mellitus in
Singapore. Singapore medical journal, 58(5), 246.