SINGAPORE – Dietary risks are one major challenge for public health in the world today – it is not just about whether people can afford a good diet, but also because they are eating more ultra-processed foods.

Dr Soumya Swaminathan, former chief scientist at the World Health Organisation, said this in her keynote lecture at the third Singapore International Public Health Conference on Thursday. It was held in conjunction with the 17th Singapore Public Health and Occupational Medicine Conference.

“I think public health workers now have to find ways, especially (to move) young people away from a dependence on this type of high-sugar, high-fat, high-salt (diet),” she said.

“There’s a lot of science that goes into these products so that (they are) almost addictive. It does stimulate chemicals in the brain, which makes you want to eat or drink more and more of those products, rather than have a salad or a fruit.”

The commercial factors of health need to be addressed because there is a big food industry behind such foods. “So it’s almost like the new tobacco,” she said.

Dr Swaminathan discussed a list of public health challenges confronting the post-pandemic world today, including climate change, investing in healthcare workers and keeping adolescents safe. The theme of health equity inevitably comes up in these challenges.

Current events such as increased temperatures, sea level rise, changes in rainfall patterns will lead to reduced water availability, poorer soil health, and emerging crop pests and zoonotic diseases, which are diseases that can be transmitted between animals and humans.

“These then will impact human health, increasing heat-related illness. I think all of us are going to see increasing (numbers of) cardiopulmonary illness again because of air pollution,” Dr Swaminathan said.

“And there’s more and more evidence that exposure to prolonged heat can actually increase suicidal tendencies, increased violence and... also non-communicable diseases.”

Another challenge she pointed out was in protecting adolescents, particularly in low- and middle-income countries.

“We have to really pay attention to the mental health of adolescents because we see increasing suicides, violence, road traffic accidents, harmful substance use, but also more and more things like addiction to the Internet… and social media, which are playing a very big role in the physical and mental health of adolescents,” she said.

Dr Swaminathan, the chairwoman of M.S. Swaminathan Research Foundation in India, said the global shortage of healthcare workers is affecting some countries more than others. “Very often, we see healthcare workers from the least developed countries are migrating to high-income countries to fill the gaps there. But then what happens to these very scarce resources in low-income countries?”

Professor Hsu Li Yang, vice-dean of global health at the National University of Singapore’s Saw Swee Hock School of Public Health, told The Straits Times at the conference: “We in Singapore are fortunate that most of such challenges do not affect us, but we should also see how we can help to contribute to mitigate or overcome these challenges as a high-income and technologically advanced nation.”

The quadrennial conference was held at the Grand Copthorne Waterfront hotel after a hiatus of seven years because of the pandemic. Professor Teo Yik Ying, the dean of the NUS Saw Swee Hock School of Public Health, said the delay sets the stage for the conference, as it focuses on contemporary global health threats.

“After all, Asia is presently considered most at risk (with regard to) global megatrends such as changing population demography, driving accelerated population ageing; rapid urbanisation, resulting in tremendous land use changes for agriculture and urban development; and changing climate that challenges health security, as well as the security of water, food, and other essential supplies,” he said. 

“Not only does this mean countries are facing the burden of ageing populations (and) the rising prevalence of non-communicable diseases, but this is also set within a pandemic era where we are likely to see the recurrence of infectious disease outbreaks, where the greatest health burden is again borne by people with underlying health conditions.”

Traditional models of health systems that focus on acute tertiary hospital services have largely failed because they are not only financially unsustainable, but also reactive and specialised – so the root causes of diseases and poor health are never really addressed, he said. 

“Increasingly, we realised that tackling these root causes requires solutions that are not just medicalised, but also involve scrutinising behaviours, societal practices and norms as well as changing the environment,” said Prof Teo. 

Further complicating population health concerns are fast-changing technology and an increasing prevalence of misinformation and disinformation.

This means social and behavioural scientists, economists, architects, communication experts, health promotion and primary care practitioners could play a bigger role than specialised medical doctors in creating good population health, said Prof Teo. 

In Singapore, where workers are ageing, the paradigm shift to preventive health not only enables healthy living and a productive workforce, said Mr Zaqy Mohamad, Senior Minister of State for Defence and Manpower, who was the guest of honour at the conference.

“If Covid-19 was a sprint, addressing the healthcare demands of an ageing population is a marathon.”