Children, The Family and Health: What it Takes to Give Children Long Life
The Singapore Workshop: Child Health in Singapore: Past, Present, and Future
This report is a summary of the talk Dr. Chia gave using statistics and overhead materials. Dr. Chia also serves as a Pedatric Consultant to the School Health Service of Singapore.
Healthy children will most likely become healthy adults who will contribute to a strong and ecenomically viable nation. In Singapore, it is felt that children are the most important national resource. The child care she focused on is pre-natal through adolescence.
Children in Singapore enjoy a high standard of health today. About 2.8% or 4,039 billion dollars was spent on health care in 1997. The Ministry of Health is responsible for high quality, up to date, readily accessible and cost effective health care.
The mortality rate of children under five years old is considered by many to be the single most important undicator of the state of a nation’s children. In 1995, in UNICEF’s State of the Children Report, Singapore ranked third with Japan and Hong Kong, behind Sweden and Finland. This rating is a gauge of the nutritional health, level of immunisations, income and food availability of the family. It is also a reflection of the availability of maternal and child health services.
In an overview of child health history in Singapore, Dr. Chia observed that there was poor record keeping. Generally child health care was negligible with plague, TB, small pox and infectious diseases the major causes of mortality. After 1946 the focus shifted to combat malnutrition, meningitis, tetanus and polio. Malaria was endemic. The mortality rate in the pediatric wards from diarrhea was 50%. The period 1962 - 1976 saw the start of compulsary vaccination against diptheria and polio. Family Planning was introduced in 1966 to reduce the high birth rate. Compulsary smallpox vaccination in 1964 and free immunsations for other childhood diseases improved children’s health greatly. Proactive programs in neonatal and pediatric health, nurses and physicians training upgraded resulted in Singapore rating a 6th best rating in infant martality by 1976. This was a major overhaul of the system and vast improvement over 30 years.
The significant advances of Child Care from 1976 to the present include good obstetric practice with ultrasound, amniocentesis used to decrease congenital abnormalities. Genetic counseling and early identification of genetic disorders has advanced. Neonatal care continues to improve. In 1986, the Hepatitus b vaccine for newborns was introduced. Surgery can now correct many cases of congenital heart disease, and cancers have better cure rates.
Singapore citizens enjoy easy access to health care. Government clinics and private practitioners are located all over the island, especially in the new towns where the population density is high. Dental services are also readily accessible. Good quality pharmaceutical products are available in clinics.
The financial policy of the health care delivery system is based on individual responsibility coupled with government subsidies to keep basic health care affordable. The cost for children’s clinic visits is half that charged for adults. Immunisations are free. Financial assistance is available for needy children at clinics and hospitals. Dental treatment in schools is free of charge.
The holistic concept of health in Singapore includes physical, mental, emotional, social and spiritual health. In the future we hope to address more than the child’s physical health.
Future challenges include improved methods for screening for congenital abnormalities, prevention of accidents and home injuries, stress reduction at school and home, childhood HIV infections, and in the area of adolescent health issues like eating disorders, teen pregnancies, suicides and substance abuse.
Health care services play only a small part in the total development of a child. A study done in South America shows that children develop best physically and mentally if given a loving, stimulating environment, improved diet and good health care. This is part of what we are all striving for in our future.
Questions and Answers following Dr. Frances Chia’s Presntation.
Q - Malaysia - How many mothers in Singapore breastfeed their babies?
A- About 50% give it a try, beyond that there are no records to show how many continue.
Q - M. Taylor, New Zealand - What kind of efforts are you making to reduce the number of accidental deaths and injuries among children?
A - School health educators address this with children in schools and parents receive instruction through their clinics.
Q - L. Kanitta, Thailand - What is the scoliosis rate among children in Singapore?
A - Of the 4% of children found in school screening between the ages of 6 and 11 years, 5% are referred to specialists, 20% wear braces and another 40% require surgery. The school nurses do the health screening.
Q - G. de Castro, Philippines - Please comment about family planning in Singapore. Are families limited?
A - At one time families were encouraged to have only 2 children. Now that has been modified to more if they can afford it.
Q - G. de Castro, Philippines - How are teenage pregnancies handled?
A- The school health programs uses a pro-active approach in giving sexuality seminars, discussing contraception and teaching refusal skills.
Q - P. Walker, Cook Islands - How is spirituality encorporated into the curriculum? Is there a holistic approach?
A - At first our program was struggling only with better survival for children. We are now looking to add more of this work in the future.
Comment - official of the Singapore Health Education Department - There is an element incorporated into the curriculum of values education and this is taught in the child’s home language.
Comment - A. Samuel, Singapore - Pastoral Care and Career Guidance has been introduced in our schools. It is one way we can help reduce the stress students experience. Schoolwork and exams are times of high stress.
Q - Dr. Karim, Malaysia - Has there been a significant rate of increase in asthma in Singapore. In Malaysia it is something like a 25% increase.
A - Yes, it has increased with increased industrialization.
Q - R. Ishak, Malaysia - Concerning children with disabilities, has there been big increase in retardation? I observe that Singapore has more participation in the Special Olympics.
A - Genetic Counseling with parents has lead to a decreased number of children born with disabilities. Also it is now more acceptable for parents to acknowledge a child with disabilities, increasing the participation in activities like the Special Olympics.
Q - V. McAdams, Singapore - Is Physical Education a formal part of the curriculum in Singapore?
A- Yes, now it is even a part of the University entrance requirements.
Q - Has there been an upsurge in the illicit use of drugs by teens?
A - Drugs are tightly controlled and this is not a big part of the school health program. There is a big anti-tobacco campaign in the schools.
Q - J. Dominguez , Philippines - How is rape handled here in Singapore?
A - The Ministry of Child Development has instituted a common protocol for rape victims in all hospitals. There is education for the medical staff to watch for signs of abuse in children and young adults.
Comment - A. Tan - Singapore - Since 1996 there has been a special rape taskforce in the Police Department. The Singapore Women’s council lobbied for 4 1/2 years to get this established. Under this plan medical help, counseling and police services for victims were merged into one program.
Last Modified: November 29, 2002