Health and Health Policy in Singapore
Singh, Mohan, Journal of Southeast Asian Economies
This article examines how good health is achieved through the development of public policy on health care. It examines the attainment of health through a detailed analysis of mortality including death rates, life expectancy at birth, and cause and sex specific death rates and thereby the development of health care policy. The key findings are that Singapore has attained good health for all Singaporeans with the development of a comprehensive health care plan that focuses on individual stake-holding in health and keeping public health expenditure at a low level. The article also raises a few concerns such as unlikely high mortality level due to respiratory diseases and motor vehicle accidents as compared to other low mortality countries.
Achieving good health has become an important goal for modern societies. In early history, it was a matter of survival of the fittest. As civilization progressed, the concept of health also changed. Keeping people alive and in good health became a societal rather individual priority. An increase in the skills level of the population created greater interdependence among people and thereby enhanced the price on human lives, stressing the importance to save them from premature death.
Never before has so much emphasis been placed on human health as in this century, and especially since the World War II. It is a period that has seen revolutionary changes in various areas of human life. In all countries, efforts are being made to achieve the best health for their populations. Some countries have succeeded more than others. Why has better health been achieved in some countries and not in others? And, what has caused some the countries to achieve rapid improvement compared to others.
This article addresses these issues and uses the Singaporean experience as an example. The main focus is to measure health and assess the role of health policy in achieving good health for all Singaporeans. This objective is achieved by analysing the mortality situation including trends and causes of death and examining the health policy.
II. Definition of Health
Although the term "health" appears a simple term, a definition of the word is difficult to come by. While health gives a positive connotation of an individual's physical condition, various indicators used to measure health are based on negative manifestations such as disease, death and disability. It is perhaps for this reason that we still use the definition of health given by the World Health Organization (WHO). The WHO defines health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" (WHO 1946). This definition remains widely used. It emphasizes health as a positive experience and places it in a broad social context.
Concepts and measures of health vary depending on the frames of reference used by consumers, different groups of health professionals, health economists and others (Noak 1997). Biomedical concepts of health are concerned with the biological progresses of health and ill-health. Clinical and epidemiological approaches consider mainly death, diseases, disability, life expectancy, and years of healthy life. The social sciences focus more on social, emotional and material well-being as well as the quality of life. Some measures are of everyday factors, such as whether people feel good, energetic or resilient. The understanding and measurement of health, therefore, needs to take account of the processes of diseases, management of illness, and the many factors which lead to improved health and well-being.
Despite the broad context of health that is rather easy to describe, much of the information available is concerned with ill-health. This reflects the difficulty of measuring such concepts as "well-being" and "quality of life".
III. Determinants of Health
Like defining health, the various determinants of health are equally difficult to assemble. …