Singapore Country Report

for The 5th Asian And Pacific Population Conference

SECTION 1 – Overview of the Population and Development Situation and Prospects, with Special Attention to Poverty

The key Singapore demographic indicators are given in the table below.

SECTION 2 – Fertility Levels and Trends, and their Implications for Reproductive Health, Including Family Planning Programmes

Singapore, like many developed countries, is experiencing sub-replacement population growth. The Total Fertility Rate (TFR) was 1.60 in 2000. The government appointed a Working Committee on Marriage and Procreation to study the demographic trends and their implications, and propose solutions. A package of measures was introduced in Aug 2000 to supplement those introduced under the New Population Policy in 1987.

Recent Demographic Trends

The measures introduced under the New Population Policy in 1987 seemed to work in the beginning, with the Total Fertility Rate (TFR) rising from 1.62 in 1987 to 1.96 in 1988. It was 1.75 in 1989 and 1.86 in 1990, after which it started to decline. Recent key demographic trends are as follows:

(a)Rising Singlehood – The resident single population has increased from 747,200 in 1990 to 760,400 in 2000.

(b)Delay in Marriages – The median age has increased 1.6 years for grooms and 2.0 years for brides since 1985. In 2000, the median age at first marriage for resident grooms and brides was 28.6 years and 26.2 years respectively.

(c)Delay in Family Formation - The median age of mothers at the birth of their first child has increased from about 26 years in 1985 to almost 29 years in 2000.

(d)Sub Replacement TFR – Consequent to the above factors, TFR for 2000 was 1.60.

There was a need to supplement the measures introduced in 1987 to help remove some of the obstacles couples faced in having (more) children. In Feb 2000, the Government formed a Working Committee on Marriage and Procreation to study the demographic trends and their implications, and propose solutions.

Current Obstacles to Marriage and Procreation

Based on public feedback, the main challenges young Singaporeans face in getting married could be summarised as follows:

(a)Changing attitudes towards marriage - Although survey data continues to indicate that the vast majority of Singaporeans still desired to marry and have children, it is not a top priority. Because education, career and home ownership goals take precedence, the search for a suitable marriage partner is frequently left too late.

(b)Lack of opportunities to socialise and lack of social skills - Surveys and feedback showed that this was a key obstacle for many young people.

(c)Financial Cost - The high cost of a wedding and the need to save for a house of their own are often cited as reasons for delay in marriage.

The key challenges in couples having (more) children are as follows:

(a)Financial cost of raising children - This is the topmost concern for Singaporeans wanting to have more children.

(b)Inability to balance between work and child rearing - This is a critical concern, especially in a 24x7 global economy.

(c)Lack of suitable childcare arrangements - Availability of childcare at convenient locations is an important issue of concern for many.

Supplementary Measures of Aug 2000

Singapore has adopted the following guiding principle to underpin measures to raise the TFR:

Creating a total social environment conducive to family formation and well being - No one measure by itself might work. However, taken together, a package of measures might have a reasonable chance of arresting the decline in TFR.

In line with the above philosophy, the Working Committee introduced a host of measures in Aug 2000 to supplement those introduced in 1987. The measures were aimed at removing the main obstacles couples faced in marriage and procreation.

The success of the package of measures is unclear as its implementation coincided with the onset of an economic recession. Past evidence shows that there is a close positive correlation between economic performance and number of marriages and births. Thus, the full impact of the package of measures will not be known for some time.

SECTION 3 – Mortality and Morbidity Trends and Poverty

Singapore has undergone tremendous socioeconomic changes in the last three decades. Economic progress, improved housing and sanitation, clean drinking water and good public health services have contributed to the markedly reduced incidence of communicable diseases such as tuberculosis, diphtheria, poliomyelitis and enteric fever. Over the same period, our health care services have also improved dramatically. Today, Singaporeans are better informed about health issues, expect and receive good, affordable medical care and generally enjoy good health with high life expectancy.

The rate of natural increase, increased from 8.3 per 1,000 resident population in 1999 to 9.2 per 1,000 resident population in 2000. There were 46,997 births in 2000, which was an increase of 8.4% from 43,336 births in 1999. The Crude Death Rate remained at 4.5 deaths per 1,000 resident population in 2000.

Infant Mortality

Singapore’s infant mortality rate continued to remain low at 2.2 per 1,000 resident live births in 2001. This was lower than the rate of 3.3 per 1,000 resident live births reported in 1999. The neonatal mortality rate and the perinatal mortality rate were 1.8 per 1,000 live births and 4.3 per 1,000 live and stillbirths, respectively.

FIGURE 1: INFANT MORTALITY, 1957 – 2000

Maternal Mortality

There was an increase from four maternal deaths in 1999 to eight in 2000. The maternal mortality has maintained at low rates of 0.07 1,000 live and stillbirths in 2001. Singapore’s maternal mortality rate is comparable with that of the developed countries.

FIGURE 2: MATERNAL MORTALITY, 1957 –2000

Life Expectancy

The average life expectancy at birth of Singapore residents was 78.4 in 2001 compared to 77.6 years in 1999. Expectancy of life at birth for males was 76.4 years and that for females was 80.4 years.

FIGURE 3: LIFE EXPECTANCY AT BIRTH, 1957 – 2000

Major Causes of Mortality and Morbidity

Since 1960, death rates have fallen for all age groups. The total number of deaths increased marginally, from 15,516 in 1999 to 15,692 in 2000. The crude death rate maintained at 4.5 deaths per 1,000 resident population. The leading causes of death in Singapore continued to be cancer and heart disease. In 2000-2001, these diseases constituted more than 50% of all causes of deaths in Singapore.

TABLE 1: 10 LEADING CAUSES OF DEATH, 1999 and 2000

Cause / Percentage of
Total Deaths
1999
(15,516) / 2000
(15,693)
Cancer / 26.6 / 27.0
Ischaemic & other heart diseases / 25.7 / 25.1
Pneumonia / 10.6 / 11.4
Cerebrovascular disease / 10.5 / 10.4
Injuries / 6.9 / 7.2
Diabetes mellitus / 2.3 / 2.3
Nephritis, nephrotic syndrome & nephrosis / 1.2 / 1.3
Bronchitis, emphysema & asthma / 0.9 / 0.7
Chronic liver disease & cirrhosis / 1.0 / 0.7
Septicaemia / 0.8 / 0.6
Non-communicable Diseases

Chronic non-communicable and degenerative diseases are the most important public health problems in Singapore today. Cancer, coronary heart disease, and stroke are the leading causes of mortality, accounting for over 60% of all deaths and a high burden of disability. Most of these conditions can be prevented or their impact ameliorated through the adoption of healthy life styles, optimal long-term control of major risk factors such as diabetes and hypertension, and screening and early treatment. Successful containment of these chronic non-communicable diseases at a national level requires a comprehensive and coordinated approach involving various agencies, healthcare facilities, and teams.

The Ministry of Health initiates and coordinates the development and implementation of National Disease Management plans for stroke, coronary heart disease, common cancers, myopia and renal failure. These plans set out strategies for each disease, spanning the continuum from primary, secondary and tertiary prevention, to early disease detection, effective treatment and rehabilitation. Health promotion activities are conducted to educate the public on the prevention of chronic diseases through the reduction of behavioral risk factors such as smoking, a sedentary lifestyle, unhealthy diets, obesity and stress.

Cancer

Cancer has been the leading cause of death in Singapore since 1991. In 2000, it accounted for 26.9% of all deaths. The main cancers causing death among men during the year were cancers of the lung, colo-rectum, liver and stomach. For women, these were cancers of the breast, lung, liver and colo-rectum. Pap smears for cervical cancer and mammography for breast cancer are screening tests offered at polyclinics and hospitals.

Cardiovascular Diseases

In 2000, cardiovascular diseases, including coronary heart disease and stroke accounted for about one third (34.8%) of all deaths. Coronary heart disease is the major cardiovascular disease. People with a high risk of developing cardiovascular disease are encouraged to undergo tests to screen for risk factors. The three-year community health screening initiative “Check Your Health” programme was launched last year to provide people aged 55 years and older with a chance to be tested for risk factors and counselled on the disease, at subsidised rates.

Diabetes Mellitus

Diabetes was the sixth most common cause of death in 2000. It is also the leading cause of end-stage renal disease and blindness in adults. The Comprehensive Chronic Care Programme (CCCP) was launched in 2001, with the aim to improve the management of these three common cardiovascular risk factors, namely diabetes, hypertension and high blood cholesterol. The benefit for patients in the CCCP is the personalised care given by a case manager who tracks and encourages each patient. This will facilitate patients’ compliance to treatment and follow-up, thus ensuring good control and management of their medical conditions.

Myopia

Myopia is a major public health problem in Singapore. About one-third of primary-one (6-7 years old) students had myopia. A National Myopia Prevention Programme, targeted to screen children at a young age, has been developed so that preventive actions can be taken to arrest the progression of myopia among them. The Ministry is working closely with the Ministry of Education on a special programme for school children.

Mental Health

The major mental health disorders seen in Singapore are depression, anxiety disorders, and schizophrenia. About one in ten persons have anxiety disorder. The national plan for the prevention and control of major mental health disorders aims to increase mental health awareness and promote good mental health. The Early Psychosis Intervention Programme which is a comprehensive and integrated treatment programme targets to reduce chronic disability among schizophrenic patients.

End-stage Renal Disease

Renal disease has been among the top 10 leading causes of death in Singapore since 1960. The number of new patients on dialysis has been continuously increasing in the past decade. A national renal disease control plan is currently under development. It involves strategies to reduce prevalence of risk factors like diabetes and hypertension; detect renal disease at its early stages; and ensure good clinical management of patients with chronic renal disease to prevent the progression to end-stage renal disease (ESRD).

Communicable Disease

Legislation

The Infectious Diseases (ID) Act was enacted in 1976 to prevent the introduction and spread of infectious diseases into Singapore. The Ministry of Health and the Ministry of the Environment jointly administer this act. For the control of infectious disease in Singapore, the ID Act provides for the notification of specified infectious diseases. For the list of notifiable diseases, see Annex A.

Childhood Diseases

The Childhood Immunisation Programme offers our children protection against nine important childhood diseases namely, tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis (Sabin), measles, mumps, rubella (MMR) and Hepatitis B. Diphtheria and measles immunisation are compulsory by law. All immunisations except Hepatitis B, are given free at the polyclinics and schools.

Poliomyelitis

The Western Pacific Region, of which Singapore is a member, was certified by the World Health Organisation (WHO) to be free of poliomyelitis (or polio) on 29 Oct 2000. After the Americas, this is the second region in the world to have achieved polio-free status.

Tuberculosis

Since 1987, after more than a decade of stagnation, the rate of new tuberculosis cases is started a declining trend since 1999. This could be attributed to improved surveillance and treatment strategies adopted since 1997 under the Singapore TB Elimination Programme (STEP). STEP was implemented in Apr 1997 to strengthen the existing TB Control Programme with the aim of eliminating the disease in fifteen years’ time. Strategies include treatment of infectious TB cases, early detection, chemoprophylaxis for infected contacts, and prevention (BCG vaccination). The STEP Surveillance System was enhanced in 2000 to facilitate surveillance and monitoring of TB cases.

Hepatitis B

Reported cases of Hepatitis B infection in Singapore has deceased over the past few years. The overall Hepatitis B immunity rate is 40%, with the young age group of 18-29 years having the lowest immunity rates. Prevention through immunisation is a key strategy in the Hepatitis B control programme in Singapore to prevent liver cancer. Over the last six years the coverage of infants who completed the full course of Hepatitis B immunisation has been about 90%.

HIV

See section 8.

SECTION 4 – Migration, Urbanisation and Poverty

CIRD to fill in based on inputs from relevant agencies ……...

SECTION 5 – Population Ageing

Current Situation of the Elderly Population

In Singapore, the number of residents aged 65 years and over has increased significantly .In 1990, there were 164,000 elderly and they constituted 6% of the resident population. In 2000, their size increased to 238,000 or 7.3%

Overall, there were fewer men than women among the elderly population. This is largely contributed by the longer female life expectancy as compared with the male is a major contributing factor.

With increased longevity, the old-old population (aged 85 years and over) increased at a faster pace than the overall elderly population. From 1990 to 2000, the old-old increased by 6.1% as compared with 3.7% for the elderly. Male had a slightly higher growth rate than females in both the elderly and old-old populations.

Policies and Programmes to Provide Support to the Elderly Population

Policies and programmes that need to be developed to provide support to the elderly population are wide ranging. We will consider those in the areas of healthcare, housing, income security, caregiving facilities and living arrangements.

Healthcare

In the area of healthcare Singapore adopts a multi-prong approach to address the needs of the elderly and to support the elderly.

Health Promotion and Prevention of Disability

We emphasize health promotion and prevention of disability. Public education is conducted through public forums and workshops. We have set up an exhibition zone on healthy living, where exhibits and fun models are placed and open to visitors. A Committee on Health Screening was set up to work out guidelines on the types and frequency of screening for the adult population. Health screening programmes are conducted for early detection of problems and early treatment through a national community health screening programme. which screens for hypertension, diabetes and blood cholesterol levels.

Health Services for the Elderly

A range of health services is in place to cater to the needs of the elderly. This includes acute hospital services, specialty services, outpatient services, community hospitals, nursing homes and home care services.

Licensing and auditing standards are set for the healthcare institutions to ensure that care standards are of an acceptable level.

Training courses for caregivers are available at many healthcare institutions and also at the grassroot organisations. This courses serve to teach caregivers basic skills in caring for the elderly

Housing and Living Arrangements

Project to Improve the Living Conditions of the Elderly

This project was introduced in 1993 jointly by Ministry of National Development (MND), HDB, and the Ministry of Community Development and Sports (MCDS) to improve the living conditions of 1-room rental blocks with a high concentration of the elderly. Improvements include:

  1. installing support handlebars in toilets, common corridors and lifts
  2. alert alarm systems
  3. non-slip tiles
  4. having lift landings on every floor.

These improvements are fully paid for by the government. MCDS also arranges for VWOs to provide care and support services and organise activities for the elderly residents. To facilitate the provision of care and support services, HDB provides space for the VWO to set up and operate a Seniors Activity Centre (the Neighbourhood Link now replaces the Seniors Activity Centre) within the block. The provision of both hardware and software (assistance from MCDS) has allowed the elderly to live independently while being assured of help when they need it.

Studio Apartment

Studio Apartments was launched in 1998 to meet the needs of a growing number of senior citizens. These customised apartments with 30-year leases will better meet the elderly citizens' housing needs as well as allow them to live near their children and other elderly people in HDB estates where public amenities are easily accessible. Elderly-friendly features such as brightly lit corridors and lever tap handles are complemented with safety features like pull cords linked to an alert system, as well as heat detectors linked to the central fire alarm system to create a hospitable living environment. There are also Voluntary Welfare Organisations (VWO) providing care and support services to the elderly in these apartment blocks.

Lift Upgrading Programme (LUP) and the Main Upgrading Programme (MUP)

LUP provides easy access and mobility for the elderly who may find staircases an obstacle to their movements. In MUP, standardised elderly-friendly features such as non-slip bathroom tiles have also been included as an optional item.

Cash Grants

Other schemes that complement the elderly projects are incentives in the form of cash grants or priority allocation of new flats. These encourage married children to live together with their parents or near their parents for mutual care and support. Examples of such schemes include the Multi-Tier Family Housing Scheme, and the Joint-Selection Scheme.

Income Security

Older workers are more vulnerable because of seniority-based pay system pushes wages up beyond what their skills and productivity can justify. When older workers lose their jobs, they tend to have higher wage expectations, which makes it more difficult for them to find re-employment. The 40% CPF contribution rate exacerbates these problems, because it discourages employers from taking on older workers, and also discourages older workers from working for lower take-home pay.