KUALA LUMPUR, Sept 25 – Instead of conventional tobacco control measures, Singapore health authorities used a creative way of cutting smoking rates at juvenile detention centres by 30 percentage points.
Singapore Health Promotion Board (HPB) introduced its plan to provide education to at-risk youth who were smoking in 2011, according to PwC’s Health Research Institute (HRI)’s new report on the urgency of addressing social determinants of health.
But it was quickly understood that a top-down approach from government might not find a welcome audience among juveniles.
“While tobacco control policies could facilitate prevention, we were mindful that young persons picked up the habit usually due to peer pressure,” HPB senior deputy director Vasuki Utravathy told HRI.
“Collaborating with partners who had access to a number of adolescents outside the traditional school settings was important to HPB.”
The project targeted Singapore Boys and Girls Homes, residential centres for youth admitted for committing minor offences, and partnered with two organisations that worked on improving education — Mendaki and the Singapore Indian Development Association.
The collaboration trained people from various racial and ethnic backgrounds for the project. Young participants were attracted to weekly meetings through programming such as a futsal clinic that showed how smoking affected one’s stamina during a game.
The project resulted in the reduction of smoking rates in the cohort from 40 per cent to 10 per cent in six months.
“Meeting the adolescents’ social needs — for example, the need to belong to a group of futsal players, the need to look good — [was] important in ensuring attendances in the health activities,” Utravathy said.
HRI’s report discusses social determinants of health, which are non-clinical factors that affect health.
According to HRI, these determinants, which include employment status, income level, educational attainment, pollution levels and neighbourhood crime, all affect how people experience the world and the choices they make.
“In fact, clinical care, while vital, is responsible for only 20 per cent of a person’s health. The other 80 per cent is attributable to health behaviours, the physical environment and socioeconomic conditions,” the report said.
The report warned against the soaring rate of obesity in Organisation for Economic Co-operation and Development (OECD) nations.
Since 2014, there has been an increase of more than 10 percentage points in the share of the population in OECD countries deemed overweight or obese, from 53.9 per cent in 2014 to 65.2 per cent in 2017; a condition which is attributed to people being more prone to chronic health problems including diabetes, cardiovascular diseases and cancers.
“By 2025, the Organisation for Economic Co-operation and Development projects many countries will see obesity and overweight rates exceeding 68 per cent of the population.”
The report also mentioned that half of global biopharmaceutical executives surveyed by HRI in February 2019 said traditional drug pricing practices were unsustainable, whereas 90 per cent said the health care system would be challenged to afford the next wave of innovative medicines in the absence of fundamental changes to drug evaluation and payment models.
“As drug pricing comes under scrutiny from politicians, policymakers and consumers, pharmaceutical and life sciences companies have started experimenting with value-based models, which tie the price of medications to clinical or economic outcomes.”
The report further suggested five steps to address issues related to social determinants of health and to create an action plan to lead a better lifestyle.
The steps are to build the collective will; develop standard but adaptable frameworks; generate data insights to inform decision making; engage and reflect the community; and measure and deploy.
