Transcription
[Music] Hello and welcome to Lens on Singapore. We are entering a new chapter, not just as a nation, but as a society that's aging rapidly. By next year, nearly one in five of us will be aged 65 or above. And by the 2030s, that number will grow to 1 in four. That presents not just medical challenges, but deeper questions about dignity, belonging, and what it means to grow old in a place we helped build. How do we ensure those extra years are lived with purpose, connection, and joy, not just endured in isolation? Joining me today is Minister Angi Kang, coordinating Minister for Social Policies and Minister for Health to help us unpack what Singapore's aging future could and should look like. I'm Clarissa Montero, Minister, welcome to this conversation and to my show.
And I'm going to go right in. Very somber. I know, right? But you know, it is a somber subject. Yeah. But in Chinese culture and I'm sure in actually many Asian culture to grow old is something to be happy about only if the situation and circumstances are right that you are healthy and you're healthy and you have time to do the things you love and money, I'm afraid it goes together. Okay. But let's talk about defining growing old with dignity. We all say that. You said that officially, you know, everyone talks about it amongst themselves. What does that actually mean in your view for Singaporeans in daily life in our communities and through your policies?
Basic prerequisite of dignity is good health, right? Yeah. If you are disabled, if you are unable, you are not mobile, actually the first thing that hit you is the dignity or unable to perform daily activities. Sure. So health is prerequisite. But let's say someone is healthy. I would say what is the next most important to dignity in old age is contribution. I do home, we do home visits a lot. Okay. And when I see a senior I always ask them, so have you retired? Some say they have retired. Ask them what do you do? They say, "Coron means look after grandchildren." That straight away I know sense of contribution is there. So that actually brings a great sense of fulfillment for many of the seniors I met in the community. We see many volunteers, senior volunteers doing a range of things to help others. I feel they also get a good sense of contribution. But I, I feel the most important is to work as long as you can. I wish that for myself.
So in within your policies, how do you drive this belief that you have? So this is supposed to be a health contri, uh, conversation. Yes. But even doctors will agree the most important determinant of health is not clinical, it is social. Yeah. Uh, so you asking me what does coordinating minister for social policies do? I have an opportunity to coordinate social policies that drive health. Uh, education is critical. Uh, there are reams and reams of research done. The higher your education, the better your health. And I think the better your health, the more dignity you have as you grow old. And work is critical. The longer we can work, the more physically and mentally we are alert, which means we are more healthy. And more we save for retirement. Both health and retirement adequacy can be safeguarded if we can work. So I think to have a good economy that can generate and create job opportunities, to have enlightened hiring practices where ageism is not a problem, and I think we have some way to go on that, to have individual workers who are also, we are enlightened. Okay.
I, I'm glad that you said that because it is something that I personally feel very strongly about being an older worker. I think for me the most important thing is staying relevant. How long have you been doing this podcast? Uh, this particular podcast just about a year. Yeah. So, so this is a very good example at this stage, I'm not saying you're over, just at this stage at this stage of your career and you're very experienced. You did something totally new. It is different, right? And it's a different role and I'm sure it gives you a great sense of fulfillment that you're doing this podcast with good viewership. We need that kind of injection into our career every time and again. But I was very lucky, Minister. I had the opportunity. I think a lot of people don't have those opportunities. So maybe I should invite you again to talk about the social policies of how we can help more individuals find those opportunities. One, one episode at a time. One episode at a time.
You've talked about purpose and meaning and you've said this, it's not just about managing the decline. So, how do we build the systems that support that purpose as much as encouraging the independence? So, healthcare system has to live up to its name. That is not sickness care, it's health care. The epiphany, I think happened during COVID, right? Where, you know, by the time the virus hit you and you are in ICU, it's too late. The system will be overwhelmed. You have to prevent the virus from making people so sick, which means preventive care becomes important. But now when you think about COVID, it happens every cycle of, uh, infection wave lasts a few months, three months, four months. But aging and chronic illness that associated with aging is not very different. No, it just stretches over 20 years. So, how do we prevent people from being inflicted with chronic illnesses, kidney failure, needing dialysis, strokes, heart attacks, leading to paralysis? Uh, we can prevent all that. All these requires healthier lifestyles for us to take actions.
Oh, you're going to nag at me now. No, no, I'm not nagging. Well, anyway, you should take less salt. Oh dear. We can all take do something to minimize the risk of us being struck with such devastating illnesses. But it's difficult because human nature is to enjoy the present and to sacrifice a bit of good food, to sacrifice time to run, which is so strong. Um, especially now it's very hot. Yeah. So run on the spot in the air-conditioned room. No. Uh, so but we don't get that motivation because the payback is so much later. Yeah. Yeah. So how do we have a set of policies that encourage people to lead healthier lifestyles? And that is really today, uh, the key agenda of MOH post COVID-19, right? Switching from sickness care to health care, moving health care away from clinics and hospitals into communities, into homes, because this is where health is built. We don't have to be austere, you know, to lead a healthy lifestyle. Doesn't mean you have to be austere. Still enjoy, depending on your moderation. Yeah, moderation. Of course, depending on your, on your health. Some people have advanced diabetes, so you do have to be quite austere. But for many people who are still healthy, trying to be healthy for longer time, uh, we can enjoy a lot of food. Just need to moderate. The key things, key poisons that we take is sugar, salt, fat.
Now I want to pivot to something that is, is very important to you and you've talked about it a lot, which is mental health. Yes. You've said mental health matters as much as physical health. For older Singaporeans, it's not always a crisis per se. Sometimes it's chronic loneliness. How do we tackle dealing with that at scale while also strengthening social cohesion? So there are many parallels between mental health and physical health. The mind and the body are connected. Yeah. Whether you are a western doctor, whether you're TCM, I think they all believe in that mind and body is connected. To the seniors, it is a very worrying concern. And the biggest enemy of a senior is loneliness. Yeah. Uh, and once you are lonely, your mind deteriorates, your body deteriorates. Um, how do we do this? I was mentioning just now that if we transit from sickness care to health care, care delivery must move, shift to the community and to homes. And in community and homes, you leverage many social partners, neighbors, friends, you know, volunteers all chip in to help to develop that healthy environment for the mind and for the body. So it's likewise, it's the same for for seniors. We have several thousands of Silver Generation Ambassadors now. We started recruiting them during the Pioneer Generation package launch and then we recruited more after Merdeka Generation package. They've been going around Singapore knocking on doors, visiting seniors and I, they are trained to watch out for those who might be at risk or already have a mental condition and then we have resources in the community now to try to intervene. But the best intervention is if we spot someone who is lonely, isolated, bring them out of their home into the community for various activities. Which is why this is a central thesis behind HCSG where we set up 220 now, I think, centers all around Singapore and expanding so that there's always a place for seniors to go to where they can meet friends, where there are activities, where there's free makan, you know, um, where they can have excursions so that they are plugged back into community where there's laughter, where there's friends, and where there's love and friendship.
Is it more of a challenge because they've become so isolated that they don't want to be around people? For the young, it's a challenge, but today is not the topic. Today we are talking about seniors. For the seniors, I don't think it's a huge challenge, right? For many seniors, uh, when they are lonely and we invite them out, my experience is that they, they light up. In my constituency, we make a point to visit every household to look out for seniors who are living alone. Yeah. It's, uh, it is a proxy for possible risk of loneliness. Yeah. I want to share a little personal story that happened just last weekend, right? I was in Westgate shopping and this lady came up to me. She was an older lady, but I would have placed her in her mid-60s. She said, "Can I touch your hair?" I'm like, "Why?" She said, "No, because it looks really soft, but I want to know if it's really soft." So, she started having a conversation with me that probably went on for 10 or 15 minutes. And then she said, "Girl, guess how old I am." And she was in her 80s. Yeah. She looked fantastic. And then she invited me to one of your HCSG events. Really? I was like, I'm not sure how to feel about this. But new policy. We, we welcome everybody. She was in her 80s. She might be an HCSG ambassador. And she could very well have been an HCSG ambassador. So I, obviously that you mentioned, I have met so many seniors now in their 80s looking like they are in their 60s and it's amazing. Yes, there are many more. So I do think there is an impact, uh, in making people active, staying healthy, and looking a lot younger. She must have taken less sugar, salt then. Oh, I knew you were going to egg at me since you invited me to senior care facilities.
You want them to become hubs for active aging, social cohesion. I mean, I actually looked at a place in Bukit Batok where they live there. They have all these activities and my husband, who is 10 years older than I am, and I actually had a serious conversation about whether we would ever be able to live in a place like that. And for us, the big thing was, uh, don't schedule my activities. So, don't wake me up at 6:00 in the morning and tell me I have to go and do Tai Chi. It's not army camp, you know. Even army is not so regimented. But, you know, the thing is, I think that those, those things are great. Yeah. As long as it isn't a situation where we push them into these kinds of places to live in facilities so they can be outside, out of mind. It would be very sad. Some other countries like Japan, Europe, they didn't deliberately relocate their seniors to a place that's outside of mind. But young people moved out of towns and villages, leaving them behind. So they are a little bit outside our mind. Um, I was in Portugal two years ago driving out, and Portugal is aging, uh, faster than Singapore. Really? Yeah. And as I drive out, the further I am from Lisbon, and I drive through villages, all I see are old people. Not a single young person. So they are already isolated in the villages. In other places that we know, in certain European cities, they ran out of space to build, uh, retirement homes, the smaller countries, so seniors live in their own homes and the community nurse will visit them, they say twice a day, sometimes once a day, that's about it. So also tend to be forgotten. Um, we, we should not become like that. All the settings you mentioned, whether it's the active aging centers, whether it's the Bukit Batok, CCA, community care apartments. Yes, those are designed to be vibrant and for social connections. So much so that they might wake you up at 6:00 a.m. for Tai Chi, right? But they are not designed for isolation. They're designed to be part of the community. The good thing about Singapore in the beginning of our development, uh, urban development, we designed HDB estates that encourages social connections, right? So we have a lot of common spaces. We have open corridors, people can see each other. We got hawker centers, coffee shops, uh, neighborhood parks that people can interact, and those are now so valuable as we enter a super-aged status. Yeah. But what I worry about are our nursing homes. Uh, nursing homes are growing very fast. When I became Health Minister in 2021, we have 16,000 beds. Today we are 19,000, over 19,000. Probably by 2030, we have 30,000. Nursing homes can have the risk of out of sight, out of mind. Yeah. Because these are seniors where coming from families, but the family cannot cope with taking care of them, and so means-tested, they have subsidy, relocate the seniors to nursing homes. So my view is we need to build more nursing homes because there is a demand for it, but it cannot be our mainstream solution to aging. It must be about keeping seniors healthy, enabling seniors to live in their current homes in the community, and then surround them with activities and social connections so that they stay healthy and engaged as long as they can. And I think we have put in the elements of that. We started with Healthier SG to help you stay healthy. Hwell SG to help you stay socially connected, which is to stay mentally healthy. Open spaces that are already designed from the outset, and then having all kinds of upgrading programs to make sure streets are friendly. Uh, green man is longer than the red light. Yeah, maybe green man should be bigger also. Green man bigger. We can do all these things, slowing down vehicles, Silver Zones, uh, East too, that allows to to install more handrails in your homes. Uh, and we are doing a lot more in projecting healthcare into the community through nursing posts all over. So when we do all this and we concentrate all these features in one neighborhood, it is as good as a very well-designed retirement village. We call it Hwell neighborhood. Yeah. So we don't have the land to build beautiful retirement villages, and we much prefer seniors to be able to live in a community that's connected with the rest, including young people and babies. Uh, so I think the best thing we can do is to convert existing neighborhoods into Hwell neighborhoods. Yeah.
See, I'm looking ahead. I'm not worried about it right now, but eventually I would like to live in an environment where it is like-minded people my age, I can be active with, gossip with about things that are relevant to us, and see your children, see your grandchildren, see their friends, and be surrounded by kids running around you. Yeah. So this is what you're talking about is great. Yeah. Um, I think I, I think that as long as you don't wake me up by 6:00 in the morning for Tai Chi, I'll be fine. Okay. That your criteria is not hard to meet. My criteria is okay. So I have a question that is actually, to me, really important. You've talked about keeping our healthcare system sustainable, right? It is one of your key focuses as Health Minister. But to someone like me, sustainability means I want to have access to healthcare when I need it. I want to be able to afford it without my family being put into debt. So how do you balance the two priorities of sustainable healthcare at policy government level and to individuals like myself?
Mmm, it's actually more than two priorities. Uh, healthcare systems around the world, health ministers around the world, I think all understand there are three priorities. Okay. Yeah. You mentioned two of them. Mhm. One is it must be affordable. Second, it must be accessible. That means if you need it, it is there. And third, it must be of high enough quality. Right. Yeah. So this is a, what we call the trilemma of healthcare. The problem is there are trade-offs. Okay. Yeah. So you look around the world, um, some countries, I will not name, but some countries put affordability top priority. Sure. And so they subsidize, and when you subsidize, you want to subsidize to the to the maximum extent, sometime even free is very affordable. But once you do that, you cannot run away from excess demand, overservicing, unnecessary treatment because it's free. I seek treatment, someone else pays for it, or taxpayers pay for it. Uh, so queues build up, waiting time is long, so it's not accessible. You have, uh, trade-off accessibility for affordability. There are other systems that say that we go by insurance. Yeah, insurance is a much more disciplined system, right? You purchase your insurance, when you need healthcare, you do a claim, and you'll be assessed. If it's excessive, insurer may deny. So there's a lot more discipline in that system. So the s, the healthcare becomes accessible, but premiums can be high, and therefore, like in America, many people cannot afford the premiums. So it is accessible, but it's not affordable. And then you got other systems like Switzerland is famous for the high quality treatment, uh, but it's not cheap, and so it's not so affordable. So whatever you do, you find that you're always juggling these three objectives, right? To be able to balance all three, you can't achieve 100% for all three. But if we can achieve 80% of each, you reach a certain equilibrium that the trade-off is not so stark. That is a sustainable system. Yeah. So whatever we wish for, don't always push for one at the expense of the other two. Then it becomes unsustainable. So that has been what we do. What has been very fortunate for Singapore, all systems around the world, whether your starting point is subsidized by taxation and make it affordable, or go by insurance to make it accessible, they all came converge back to the same conclusion that I need a blend of subsidy plus insurance plus some personal savings so that to make it sustainable. Fortunately, we did that from the outset. I don't know whether it's brilliant design by our forefathers or a lack of history. We have always relied on the S plus 2M system. S for subsidy, and then M for MediSave, which is the national insurance, and then MediShield, which is compulsory personal savings that we can use to pay whatever co-payments there are. So using these three, I think we strike a good balance.
I can't say that we have a bad system because I, I was my mother's primary caregiver for 10 years through 10 years of cancer, and she had all the cash she needed, and I think the doctors were wonderful, and the nurses who took care of her. If I had one complaint, the wait times are a bit long. Minister, wait times for her treatment, her chemo? Yes. You know, it's like I found myself more than once asking, why do you give me an appointment if I'm still here an hour later? Oh, that kind of wait time when you are at the clinic? Yes. But your appointment, you didn't have to wait months for your appointment? No, no. When I talk about wait time being long and not accessible, um, like certain countries now, your wait is a year, is nine months. That cannot stand. So, so I think in your case, going to a clinic on the appointment day and having work, having to wait longer at the clinic could be a problem of scheduling. But now we have a brand new building at NCCS. I hope I, I'll let you know. Yeah. Okay.
Now, here's the forward question. As we move forward on Singapore's next chapter, what does this renewed social compact that the government is talking about look like for someone already in their 60s? Mhm. Um, because they could probably say they don't really feel connected to the whole next chapter. We just do what we can and what we what is sensible, what we think will work, and hopefully people feel the intention behind those policies. But I would say in healthcare, it is a very major transformation driven by circumstances that we have never experienced this before. Many countries have not. China, with this 5,000 years history, for the first time in their history is experiencing aging. Yeah. We are a younger country, and we're experiencing it earlier than them. Um, so this changes a lot of things. Uh, and therefore, post-COVID, we learned many lessons from it and decided that we need to really decisively pivot our system, as I mentioned earlier, towards preventive care, population health, move health delivery into the community, build health in the community, but still expanding our clinical system so that waiting times is not so long because demand is rising. Yeah. So while we build up capacity, make sure, make that pivot, shift that center of gravity to the community, and once you move to the community, it's a different ball game altogether because building health is not the doctor's job. Doctors can only help. Building health is our personal responsibility. Our family will help a great deal, or community will help a great deal. That is the change in social compact for health, which means from now on, as we get older, we have to bear greater responsibility, but government will do what we can to have the right policies to support us as individuals, as as community to do that. Hence Healthier SG, where we fund 100%. Uh, in Singapore, very few things are funded 100%, but we fund 100% for preventive care, nationally recommended preventive care measures. We fund HCSG and the whole network of active aging centers. We are labeling food products. We are building more park connectors and exercise and fitness. I love the park connectors, by the way. I love them. They're not even a health measure. As I say, social determinants of life are mostly outside of health. Yeah. Um, we, we started Healthy 365, which is very popular. So do all this, do all this, create that atmosphere and the environment where we can take our health, take charge of our own health, and stay healthy as we become older. It, there is nothing we can do to stop the march of time and demography and the progress of demography. But it need not be an aging problem. As I mentioned at the beginning of this podcast, many cultures regard aging as something happy. And I think this is our culture too. But to do so, we, we have to move away from the concept that once you're 65 and above, you are considered aged. You enter that 21% of super-aged. Yep. Yeah. Yeah. Why? Why must we be in that 21% right when we ask? Why indeed? Why indeed? Right. Why not 70? Why not 75? Why at all? As long as you're vibrant and your mind is working and you have something to contribute, what does it matter what your age is? Exactly. Right. So, when we define the problem as 21% of our population is 65 and above, and there's a problem, then the problem will always stay. It will always get worse. But if our problem statement is, regardless of what age you are, so long as you're healthy, you contribute, you have dignity, you're happy, it's not a problem.
Thank you so much. Thank you, Minister Ang, for for speaking with us. And you should carry on singing, you know, if it makes you happy. Yeah. In the shower. Yeah. Now I sing in the shower. Whatever makes you happy. Whatever makes me happy. I did see, I did see a doctor, a TCM actually. I see a TCM once, uh, who told me actually for me to be healthy, I should sing more. Really? Yeah. I should dance more. What was the rationale? The rationale is, as minister, you can't do all these things. And for your mental health. Yeah. It's good for my mental health. Yeah. So, uh, she advised, you can do it in your privacy. You know, why not? Yeah. Have your own personal karaoke session. Yeah. Maybe I do. Maybe you do. Oh, the questions. Uh, okay. We've been celebrating SG60 this year, but aging isn't just a national milestone. I think it's going to become our greatest shared responsibility. What do you say to that? I agree. So I think then it is for all of us, and the true test of a society being how we treat our seniors, which Minister Ang has also alluded to, not just care, but dignity and inclusion. And, and I love that you brought that point up because I really do believe that. So thank you so much for this conversation and coming on and being our first minister in Lens on Singapore. I am. Yes, you are. What an honor. Thank you. Thank you very much. This has been Lens on Singapore. I'm Clarissa Montero. Planning on aging with purpose. [Music] [Music] Heat.