Population health – A new way forward

Meet the people spearheading population health initiatives in SingHealth: Dr Michael Wong, Group Director, SingHealth Regional Health System, and, Dr Edwin Low, Director of Programme Development at the SingHealth Office of Regional Health. Drawing from their decades of experience, they share their candid thoughts about healthcare with a community focus.

Imagine there is a cliff where accidents occur almost everyday. As casualties pile up, the solution might be to send more ambulances, or build a hospital at the bottom of the cliff to receive the casualties. But neither measure gets to the heart of the problem: How do you stop people from falling off the “healthcare cliff” to begin with? When applied to the population health context, falling off the cliff is a metaphor for unhealthy lifestyle habits that lead to chronic illnesses.

The healthcare system would inevitably be taxed if the number of patients with chronic ailments increase. A more sustainable solution might be to prevent people from approaching the edge of the cliff by keeping them healthy, or by helping them to manage their chronic conditions within the community.

Dr Michael Wong, Group Director, SingHealth Regional Health System (RHS), and Dr Edwin Low, Director of Programme Development at the SingHealth Office of Regional Health, give us the lowdown on how the RHS helps people stay healthy, manage chronic conditions well, and why it is vital for healthcare professionals to partner with the community in this endeavour.

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Why is population health so important and how does it stop people from falling off “the healthcare cliff”?

Dr Wong: Based on a study in 2017, Singapore has the highest life expectancy among 195 countries, at 87.6 years for women and 81.9 years for men. What about our “health span”? From the same study, our health-adjusted life expectancy at birth was also the highest at 75.8 years for women and 72.6 years for men. In other words, one may potentially live a long life but would likely have to battle with poorer health in their later years. Thus, population health hopes to address some of the issues to help close the gap between health span and lifespan. Singaporeans should not just live longer but also live healthier for as long as possible.

We do this by promoting health, and preventing diseases instead of taking the traditional approach of treating diseases only after the fact. Sticking to the cliff metaphor, population health is about proactive prevention, such as building fences and putting up signposts to tell people not to go too close to the edge of the healthcare cliff.

Dr Low: It’s also important to acknowledge that healthcare only contributes to around 10 or 15 per cent of a person's health. The rest depends on their socio-economic factors such as living environment, education level, income, and social network. If you do not address these social determinants of health, healthcare systems alone are not going to be very effective.

How does population health take into account these socio-economic factors? Does it change the role of healthcare professionals?

Dr Low: It requires an appreciation of the bigger picture. One of the things we’re trying to achieve as doctors is a deeper, wider appreciation of the social dimensions of health, asking “what matters to you?”, as opposed to “what’s the matter with you?”. It is only when you understand what is important that you can build conversation around it.

Dr Wong: We’re doing this through Wellbeing Coordinators at SingHealth Community Hospitals and SingHealth Polyclinics. In contrast to traditional care providers who prescribe medical interventions like medication, rest, and exercise, Wellbeing Coordinators are there to find out what matters to the patient. If the patient tells us that gardening can contribute to their wellbeing and make them feel healthier, the Wellbeing Coordinator will try to make this possible by linking them to community gardens, for example.

We’re also seeing more collaborations between healthcare professionals and community partners like Social Service Agencies and grassroots organisations, who have strong roots in the community. For example, there was a patient at Marine Parade Polyclinic who had very poorly controlled diabetes and complex social care needs. She was on the radar of all the doctors and nurses at the polyclinic. One day she stopped coming, which was worrying because poorly controlled diabetes can deteriorate and lead to hospitalisation. But unbeknownst to them, this aunty had actually been regularly going to GoodLife! @ Marine Parade, a Senior Activity Centre that was monitoring her condition regularly.

To close the communication loop, the SHP team co-developed the PACE-IT app with these partners, so they can share and discuss their joint care plans for the patients real-time. The app has enabled providers across the health and social spectrum to work more closely, therefore building a tight knit support network around these patients with complex care needs.

Find out about some of SingHealth’s population health initiatives.

Health Up! at Tampines

Residents enrolled into the programme will go through age-appropriate health screening, and be assigned a Wellbeing Coordinator, who will create an individualised care plan based on their health status, medical history and lifestyle. Residents will also take part in a customised six-week exercise programme to learn how to improve their fitness and diet.

To motivate participants on their journey towards better health, the Wellbeing Coordinator will connect them to a wide range of community-based exercise programmes and interest groups offered by the PA, SportSG, and HPB. Click here for more information!

Primary Care Based Integrated Care Team (PACE-IT)

PACE-IT brings together stakeholders in Marine Terrace, including Marine Parade Polyclinic, SingHealth Community Nurses, care coordinators and GoodLife! @Marine Parade, to share care plans and keep one another updated on patients’ progress through the PACE-IT app.

This aims to improve the outcomes of patients in Marine Terrace who live with diabetes and other complex care needs.

Find out more about the RHS

Imagine the future of medicine. Do you see population health playing a large role in it?

Dr Low: When people talk about tomorrow’s medicine, there is usually some futuristic component to it. People think in terms of innovation, robotics, artificial intelligence (AI)… things that are important in genomics or precision medicine. But remember, healthcare only contributes to a small percentage of one’s overall health.

Compared to other medical research areas, population health is not a sexy topic to talk about, and if I were to say the future of tomorrow’s medicine is population health, I do not think I would have a very big following! But it is important—and the Ministry of Health is pretty focused on looking at upstreaming, care integration and the social dimensions of health. What I hope to see in the future is individuals and families looking out for each other and knowing what’s important, so they avoid vices, keep their weight down and maintain their health.

Dr Wong: I’ll add on to Edwin’s ideal state with four “E’s”. We would have done our job well if the patient is empowered, engaged, enabled and educated. Because even if you achieve a certain state of health, if you’re not engaged, you're not empowered, enabled and educated, your condition can deteriorate easily.

Tomorrow’s medicine should be delivered where it is needed most, and that is in the community. We need to go where the residents are, and deliver care in a way that is timely and appropriate for the population, even before they enter the healthcare system.