Letter of the day

Forum: Obesity, diabetes - not ageing - are key drivers of rising healthcare costs

An elderly waiting to cross the traffic in Chinatown on Nov 5 2020.
An elderly waiting to cross the traffic in Chinatown on Nov 5 2020.ST PHOTO: KELVIN CHNG

Senior Minister of State for Health Koh Poh Koon attributed Singapore's rising healthcare costs to the ageing population, along with medical advancements and increased operating costs (Koh Poh Koon details key drivers of rising healthcare costs here, Nov 3).

However, it is tenuous to cite ageing as a key driver of rising healthcare costs because ageing and the use of healthcare resources are mediated by many lifestyle and chronic diseases.

Some of these diseases may begin before ageing sets in. Obesity and diabetes are two salient ones.

Ageing people who are obese or have diabetes consume much more healthcare resources as a result of these conditions, compared with their counterparts without these problems.

For example, of the 1,500 diabetic lower-limb amputees annually, the average age for those who undergo major amputations is 66. The amputation and its associated high cost are driven by diabetes, not age.

The MediShield Life Council has recently proposed to raise MediShield Life premiums by up to 35 per cent.

Explaining the hike with ageing alone masks the fact that Singapore is among the countries with the highest proportions of diabetics.

Furthermore, from 1992 to 2017, the number of overweight and obese Singaporeans increased from 26.2 per cent to 36.2 per cent.

The World Health Organisation declares that overweight or obese individuals are at major risk of cardiovascular diseases, diabetes, musculoskeletal conditions and some cancers (including breast, ovarian, prostate, liver and colon).

Obesity is not an inevitable part of ageing. We compare unfavourably with Japan, which has the lowest proportion of overweight and obese people among Organisation for Economic Cooperation and Development countries, at 23.8 per cent.

One wonders, had we been more pre-emptive, interventional and effective with our public health measures, would we be in a better position now?

When the runway is too short, an expedient thing to do is to raise the MediShield Life premiums, which is essentially just a financial solution for a medical problem.

Many initiatives within the "war on diabetes" campaign are educational and voluntary. The effectiveness remains to be seen.

As for obesity, we appear to be very tentative, as if avoiding being labelled "fat shaming" is more important than slowing the trajectory of a major health crisis.

Public health programmes require hard work, are resource-intensive and need a long lead time to see results.

We need to act aggressively now to get to the root of the problem.

Lim Teck Koon

A version of this article appeared in the print edition of The Straits Times on November 06, 2020, with the headline 'Obesity, diabetes - not ageing - are key drivers of rising healthcare costs'. Subscribe