She survived pneumonia. Living alone was the real risk

Madam Tan was a 69-year-old widow who lived alone. Over time, her social circle had narrowed. Friends drifted away and mobility became harder. 

When she developed pneumonia, there was no one nearby to notice her condition or encourage her to see a doctor. While struggling with her symptoms, she fell at home, breaking an arm, and was admitted to hospital, weak and frail. 

The pneumonia responded well to antibiotics and she underwent surgery for her arm. From a medical standpoint, her conditions improved. 

It was only when she was transferred to a community hospital for rehabilitation that Madam Tan’s real challenge became clear.

She was anxious and withdrawn, and participated in rehabilitation therapy hesitantly. Progress was slow. She worried constantly about how she would cope alone after discharge. 

Madam Tan’s plight highlights an emerging aspect of healthcare: Modern medicine has reached an extraordinary level of precision, yet we are beginning to see its limits. 

Some patients do not recover as expected. They struggle to regain independence. The science has worked, but something essential is missing.

Research points to factors with a profound impact on health, known as social determinants: the conditions in which people live, work and age. Income, education, housing, job security and social support all matter in determining who stays healthy and who falls ill. 

An older person who lives alone and lacks the social support to attend their medical appointments faces challenges managing their chronic conditions. An unemployed person living in a rental flat may face higher stress levels and poorer nutrition, weakening the foundation for health.

If we are to build a healthier Singapore, we must look beyond the walls of our hospitals and clinics. We must invest in the spaces and relationships that sustain well-being in everyday life. Community connection is not an optional extra but a vital part of health.

Beyond health-promoting strategies

Singapore has achieved remarkable success in health outcomes. With an average life expectancy at birth at 83.5 years in 2024, we now rank among the top in global life expectancy. 

Social engineering efforts by the Government play an outsized role in achieving better population health. Purposeful interventions that guide behaviour through laws, incentives, physical infrastructure and social norms, mean that health-promoting choices become easier, or even the default.

Age restrictions and taxes on tobacco use, Healthy 365 points – redeemable for vouchers – tied to health screening, and the development of green spaces and park connectors are some of the successful strategies to engineer the physical and social environments and influence health behaviour.

However, there remain segments of difficult-to-reach seniors like Madam Tan.

Enhancing the community connections of this group of isolated older persons is essential, but it works best when reaching out grows from everyday relationships rather than through overly structured programmes. This allows seniors to engage at their own pace without feeling labelled. 

The power of social connections

One small action shifted the course of Madam Tan’s life. One day, a hospital well-being coordinator invited her to join a flower-making art activity in the ward. She was hesitant at first, worried about her injured arm. But with gentle encouragement, she agreed to try. 

Something changed that afternoon. She became focused on the task. She carefully shaped and assembled the materials. When she completed her piece, she was surprised and proud. Despite her limitations, she had created something beautiful. It was a moment that restored her sense of agency and dignity.

From that point, Madam Tan’s outlook shifted. She became more engaged in therapy. Her confidence grew alongside her physical recovery. 

The well-being coordinator introduced her to a befriending service in her neighbourhood with volunteers who would check in on her regularly, and which also offered craft workshops.

Knowing that she would have something to look forward to after discharge made a difference. She began to anticipate going home instead of fearing it. She even asked for an earlier discharge date.

Her antibiotics had not changed. Her surgery had already been completed. What changed was her connection to an activity, to other people, and to a sense of purpose.

Reviving the kampung in urban Singapore

This is the essence of what is termed “social prescribing”, a care model that connects people to non-clinical resources in the community to improve their health and well-being.  Recognising Singapore’s leadership in this field, in 2024, the World Health Organization (WHO) designated SingHealth Community Hospitals as the world’s first Collaborating Centre for Social Prescribing.

Two years on, and with Social Prescribing Day on March 26, it is timely to note that, too often, we look towards massive state interventions when the solution is right in our backyard.  

Rather than seeing a community through the lens of needs or deficits, we should start by identifying its existing strengths and assets. 

The community is a treasure trove of informal resources that can improve the health and well-being of its residents. There are examples galore, such as the taiji group at the void deck which fosters active lifestyle and social connections, and the helpful neighbour who checks in on an older person who lives alone.

Through the ground-up activation of a neighbourhood’s resources and trusted relationships, even the most vulnerable and isolated can be reached through everyday community life, rather than waiting to respond only when a crisis occurs.  

One powerful tool to raise awareness about the resources in a neighbourhood is digital maps. In addition to hospitals, clinics and active ageing centres (AACs), imagine Google Map or One Map displaying walking groups, community gardens, faith-based gatherings and the like.

This will enable healthcare providers, community workers and caregivers and residents themselves to “prescribe” social activities and connections which help seniors stay active, connected and engaged close to home. 

What about existing community services?

Singapore now has more than 220 active ageing centres. They serve as the community infrastructure anchoring healthy ageing through shared activities and social connections. While prevalent, AACs may not appeal to every senior. 

Those who are socially isolated and vulnerable are rarely reached through services first. Instead, neighbours, befrienders who repeatedly show up to encourage engagements, and familiar community spaces are probably what will bring about the first steps out of the protective cocoon of their homes.

Strengthening kampung-style social capital in our modern housing estates is key to encourage healthy ageing in place.

Why call it ‘social prescribing’?

“Social prescribing” is a relationship-based approach to understand a person’s everyday life, uncover their social determinants of health, and link them with people and places, not just services, in the community.

The problem arises when social prescribing is seen as yet another medical intervention, tethered too closely to healthcare settings, and government-led systems and services. This risks medicalising what should be social interactions.

When friendships, community activities or shared meals start to feel like “interventions”, we risk seniors disengaging, not because they do not need such support, but because the support feels labelled and transactional.

Should the term be changed to another such as community-led care or simply, neighbourhood support?

Whitewashing the term would be the wrong approach. This is because “social prescribing” challenges healthcare professionals to look beyond medicine as the only panacea to health. It highlights the need for a shift from treating illness to understanding the whole person, and moving holistic care beyond the clinic to the neighbourhood. 

A new dialogue on ageing

Across the Asia-Pacific, the same principle of enhancing community connections is being used to address the health challenges associated with ageing populations. 

In South Korea, its Cultural Solidarity Project operates in multiple regions to connect socially isolated older adults with local cultural and group activities. 

In Japan, “space prescribing” repurposes community spaces in Tokyo for physical and mental well-being activities, while rural osekkai (“nosy”) conferences bring neighbours together to solve social problems for older residents, functioning as a form of grassroots social support during and after the Covid-19 pandemic. 

Singapore and many countries in Asia and the Western Pacific are ageing at a speed unprecedented in human history. Our environment, once designed for a younger, more mobile workforce, must now adapt to optimising the health of an older population.

The urgency is no longer just about building more hospitals; it is about creating health promoting communities where the environment itself encourages movement and social connections.

The WHO’s Regional Action Plan on Healthy Ageing calls for a whole-of-society transformation to create age-friendly environments, strengthen social participation, tackle isolation, and enable older people to stay physically, mentally and socially active in their own neighbourhoods.

Its close alignment with Healthier SG spotlights the shared emphasis on investing in preventive health, strong community connections and supportive environments. 

Connection as care

Madam Tan’s recovery was not driven by a new treatment or a complex intervention. It was sparked by a simple activity that reconnected her to her own strengths and to others around her. 

Her experience is a reminder that health is not only about the absence of disease. It is about the presence of purpose, connection, and confidence.

In recognising this, social prescribing offers a way forward to regard health not just as a medical outcome, but a shared responsibility that lives within our communities.