In Singapore, the state plays a huge role in healthcare. The underlying rationale for healthcare in Singapore is economic rationality. Because Singapore’s only “natural resource” are its people, the state needs its people to stay healthy and to join (and stay in as long as possible) the workforce and to power its economy.
There is a top-down management of healthcare in Singapore. In primary school, Health Education as a subject is taught to children. Children are taught to eat a balanced diet, exercise regularly and avoid tobacco. There are compulsory Physical Education lessons, and obesity and underweight among students are managed respectively. The National Physical Fitness Award (NAPFA) test was introduced in schools in 1982 at the secondary and pre-university levels and in 1992 at the primary level as an indicator of fitness levels of students. When males reach the age of 18, they are drafted into the defence forces where they will undergo more physical training. In new towns, there are community centres which have gyms and badminton, basketball, and football courts among other sports facilities. In its battle against smoking, the state bans targets to eventually implement a near-blanket ban on smoking in public places, and cigarette packaging in Singapore has mandatory pictures that show graphic images of a cancerous lung, for example.
The state also has imposed the Central Provident Fund act on working adults such that they set aside 20% of their monthly salary. The money accumulated can be used for hospitalization and withdrawn in old age. This creates a self dependency among the population for their health needs.
From the Sernau reading this week, “an ironic relationship exists between health and population: The sickest populations… have the highest rates of population growth. As a result, seeing each person as unique, precious, and worthy of great investments of time and money goes hand in hand with slowing population growth”. This can be observed in the 1960s. The state implemented the stop-at-two policy in order to curb the rapidly expanding population when there was polio, tuberculosis and cholera, and the state also introduced vaccines. These diseases have been eradicated since then. Shifting the population into HDB flats was also a huge step in improving the health standards because squatter settlements were a breeding ground for diseases.
The healthcare system in Singapore also demonstrates the class inequality that exists. Private (and better) healthcare is available only to the wealthy, while the middle and working class are able to afford public healthcare. If one goes to observe the polyclinics in the heartlands, a long queue of elderly people starts forming even before the opening time to obtain cheap healthcare. On the other hand, private hospitals are situated near the upper class districts to cater to them – Mount Alvernia Hospital at Lornie Road, Mount Elizabeth at Orchard Road, Gleneagles Hospital at Napier Road.
With globalization, we also see the proliferation of health products. Multinational gym companies such as California Fitness have set up branches in Singapore. These are actually reactions to the modern lifestyles of sedentary jobs and fast-food diets, which are products of globalization and capitalism. Health products are also enhanced by the media, which often expounds the image of slim people as beautiful people.
In the field of palliative healthcare, more specifically on the talk of legalizing euthanasia here, a reason cited during feedback sessions with public has been “financial burden”. It is perhaps a veiled protest against the high costs of healthcare. Rather, I feel it reflects how morals in society have degenerated with the spread of capitalism. Everything has an economic value placed on it – old and disabled people are perceived as de-valued because they are expensive to take care of.
References
Agence France Presse. 9 March 2005, “Singapore to extend smoking ban to pubs, bus shelters”, http://www.singapore-window.org/sw05/050309a2.htm
Khalik, Salma. 22 October 2008, “Euthanasia law: Let’s take it slow and easy”, The Straits Times, pg A2, Singapore Press Holdings
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