Caring for our People Prime Minister’s Message Good health is important for individuals, for families, and for our society. It is the foundation for our people’s vitality and optimism, and a reflection of our nation’s prosperity and success. A healthy community is also a happy one. Singapore has developed our own system for providing quality healthcare to all. Learning from other countries and taking advantage of a young population, we invested in preventive health, new healthcare facilities and developing our healthcare workforce. We designed a unique financing system, where individuals receive state subsidies for public healthcare but at the same time can draw upon the 3Ms – Medisave, MediShield and Medifund – to pay for their healthcare needs. As responsible members of society, each of us has to save for our own healthcare needs, pay our share of the cost, and make good and sensible decisions about using healthcare services. Our healthcare outcomes are among the best in the world. Average life expectancy is now 83 years, compared with 65 years in 1965. The infant mortality rate is 2 per 1,000 live births, down from 26 per 1,000 live births 50 years ago. This book is dedicated to all those in the Government policies have adapted to the times. We started by focusing on sanitation and public health and went on healthcare sector who laid the foundations to develop primary, secondary and tertiary health services. In recent years, we have enhanced government subsidies of a healthy nation in the years gone by, substantially to ensure that healthcare remains affordable. We introduced the Community Health Assist Scheme (CHAS) who devote themselves to caring for our and the Pioneer Generation Package. MediShield Life will be introduced in November this year, a major milestone in people today and who are creating a better providing life-long coverage and assurance to all Singaporeans. healthcare system for the generations to come. While the Ministry of Health provides good and affordable healthcare services, individuals must do their part, adopting healthy living habits to stay healthy and active well into old age. I am glad to see more people doing this. Healthcare professionals and providers need to play their part in delivering quality and cost-effective care to our people. By focusing on healthy living, prevention and early intervention, we can help Singaporeans to enjoy longer, healthier lives. Singaporeans from all walks of life – including myself – make use of public healthcare services. We witness first-hand the dedication and passion that healthcare workers bring to their work, be they an ambulance driver, doctor, laboratory technician, nurse or pharmacist. It is right that we celebrate SG50 with them. This book tells many of their stories, alongside the stories of patients who have benefited from their care. I thank all members of our healthcare family, especially the pioneers, who have devoted their lives to making ours healthier and happier. Lee Hsien Loong Prime Minister Minister’s Foreword Singaporeans, while ensuring sustainability. As we all live longer, what is more 2015 is a special year for us. We have achieved tremendous progress over the past important is that we live healthily, so that we can enjoy active, happy and fulfilling 50 years because of the hard work of Singaporeans, in particular the blood, sweat lives in our golden years. and sacrifices of our pioneers who built our nation. My wish for Singaporeans is that we nurture the habits of maintaining good This book chronicles the journey of our healthcare system – from the difficult health and leading good lives – this is what the Chinese saying 养生之道 beginnings in the 1800s when Singapore was under British rule, through our means. To lead a good life, we must treasure our health, by practising post-independence growth, to the quality healthcare system we have now. healthy living in what we eat, drink and do. Together with our Our pioneers laid the foundations for a healthy nation through public and families, neighbours and communities, we can create a environmental health programmes, built up our healthcare facilities and nurtured harmonious and gracious society for all to live in. our healthcare workforce. We developed innovative policies and came up with our own unique healthcare financing system. We put in place a robust legislative I wish all fellow Singaporeans live life fully and healthily, framework to ensure patient safety. We remain vigilant against the scourge of as we begin our journey for the next 50 years, among communicable diseases even as we battle the growing chronic disease burden. family and friends, and with peace of mind. This journey would not have been possible without the many healthcare professionals, administrators, planners and policy-makers who have dedicated their lives to caring for the people of Singapore. They displayed ingenuity and resourcefulness in coming up with creative solutions to address the many problems of the time. With good foresight, they planned for our future healthcare needs, ensuring our public healthcare system is not just a high-performing one, but also a cost-effective one. And every day, they have dedicated themselves to saving lives, curing illnesses, and comforting the dying. We owe all of them a debt of gratitude. As we look towards the next 50 years, the Ministry of Health will continue to work Gan Kim Yong hard to improve the accessibility, quality and affordability of healthcare for Minister for Health Contents C Chapter 1: 1819 – 1965 The long dawn From colony to independence © MINISTRY OF HEALTH Chapter 2: 1965 – 1975 First published in 2015 by MOH Holdings Pte Ltd for the Ministry of Health Forging new paths All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, Fighting public health battles; developing specialist care mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. Chapter 3: 1975 – 1985 Printed in Singapore by Shifting paradigms Raising capabilities in public healthcare ISBN 978-981-09-6201-2 Chapter 4: 1985 – 1995 Taking responsibility Cornerstone of public health Support for this publication was provided by: Chapter 5: 1995 – 2005 Better prepared Moving to a new century National Archives of Singapore (NAS) is the official custodian of the corporate memory of the Government as well as much of the social memory of the nation and its people. The archives that NAS acquires, organises, preserves and Chapter 6: 2005 – 2015 presents allow current and future generations of Singaporeans to understand our different cultures, explore our common heritage and appreciate who we are and how we became a nation. These archives include Government records, private papers, maps, photographs, posters, oral history interviews and audio-visual materials. Discover more of what NAS has the Towards a more inclusive society privilege to care for at Archives Online: http://www.nas.gov.sg/archivesonline/. Accessible, affordable and quality care Chapter 7: 2015 and beyond Singapore Press Holdings Ltd Nudge Photography offers a range is Asia’s leading media organisation that of photography services, working with Looking ahead engages minds and enriches lives across clients to create meaningful, powerful multiple languages and platforms. imagery that connects with viewers. Transforming for the future I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh 1 the surgeon’s knife or the chemist’s drug. Extract from the modern version of the Hippocratic Oath, traditionally taken by new physicians to abide by a set of ethical guidelines in their work. Said to be written by either Hippocrates or one of his disciples in the late fifth century BC, the modern version was written in 1964 by Dr Louis Lasagna, academic dean of the School of Medicine at Tufts University. The long dawn From colony to independence Grocery shopping in the 1930s… public hygiene, and 1819 - 1965 its effect on health, were not major factors in the Singapore of that era. 1819 - 1965 1819 Early days… Singapore in 1819 - 1965 1819 the early 1800s was a fishing village with barely 1,000 people. he birth of modern Singapore as we know it now is inextricably linked to the arrival of Sir Stamford Raffles on 28 January, 1819. It was not an easy beginning. Singapore then was little more than a fishing village, mostly covered Tby jungle and a few buildings and a few acres of land under cultivation. It had a population of about 1,000 – about 500 Orang Kallang, 200 Orang Seletar, 150 Orang Gelam and other Orang Laut, 20 to 30 Malays and about the same number of Chinese. But Raffles moved fast. Within days of landing, he had concluded the Singapore Treaty with the local rulers to secure rights for a British trading post in Singapore. By 1824, Singapore and its surrounding islands had been ceded to the British East India Company and subsumed under the rule of the Straits Settlement government, founded in 1786 by Sir Francis Light and based in Penang at that time. In Raffles’ retinue in 1819 was a detachment of European and Indian troops and their accompanying doctor, young sub-assistant surgeon Thomas Prendergast. By most accounts, western medicine is said to have arrived in Singapore in the person of Prendergast, given his European soldiers, sepoys (Indian soldiers) and the were dreaded as hardship assignments. Not hospitals in the 1820s but, as charges were high, Trading places… as trade responsibility for the health of the expedition. colonial government. The medical staff was made surprisingly, few came willingly. only the well-heeled could afford them. grew and more ships docked at up of military doctors, consisting of an assistant Singapore, the captains of the True to Raffles’ vision, Singapore grew rapidly.