Children, The Family and Health: What it Takes to Give Children Long Life
The Singapore Workshop: Singapore - Assessment of Health of Primary Four students (10-year olds)
The primary purpose of this Workshop is to enquire into the state of health of the younger children aged 10 and below in our region and to establish how to improve their health condition. The intention of my paper is to portray the awareness that 10-year olds have in relation to health matters.
The data used in this paper is based on informal interviews conducted among 15 ten-year olds, studying in Primary Four in Xinghua Primary School, a neighbourhood school in a public housing area. Although the selection of the interviewees was done at random, it was necessary to include the three main racial groups - Chinese, Malay and Tamil children.
The interview instrument was designed to include five main areas of questions. They are:
(i) Medical Care
(ii) Eating Habits
(iii) Health and Cleanliness
(iv) Dental Health
(v) Diseases and Illnesses
The choice of these areas was influenced by the data taken from the “Global Burden of Disease 1996” in which the WHO had identified that of the 11.6 million deaths among children less than 5 years old in all developing countries in 1995, about 70% are associated with one or more of these 5 conditions:
- Malnutrition 56%
- Malaria 5%
- Measles 7%
- Diarrhea 19%
- Acute Respiratory Infection 19%
- Perinatal 18%
- Others 32%
In general, Singaporeans enjoy good health mainly because of improved living standards, a good public and social care system, and a well-publicised healthy lifestyle campaign. In comparison to the global statistics of the rate of infant mortality, the rate in Singapore (based on statistics of 1995) is 4.0 per 1000 live births and the life expectancy averages 76 years.
This paper discusses issues based on the five areas of the interview. The first area of discussion is related to Medical Care. All the interviewees, who have been chosen from different socio-economic groups, say that they are seldom or never seriously ill, apart from getting the usual cough and cold. Most say that their parents have the confidence to administer medication obtained from pharmacies and traditional Chinese medicine practitioners instead of depending wholly on medical practitioners. This confidence must have derived from the fact that there is a Traditional Chinese Medicine (TCM) Unit in Singapore established in 1995 to oversee the implementation of the recommendations made by the TCM Committee of the Ministry of Health. Also, there is a Pharmaceutical Department to ensure the safety, efficacy and quality of medicinal products in Singapore. As to the question of affordability for medical care, most of the students say that their parents can well-afford to take them to the private doctor or to a polyclinic. In Singapore, the School Health Service complements the provision of primary medical treatment, preventive medicine and health education by general practitioners in private practice (they provide about 90% of primary medical care) and by doctors in government hospitals and polyclinics. Besides many other services, polyclinics provide antenatal and postnatal care, advice on family planning, immunisation, growth and developmental screening of children and health education, all at nominal and affordable fees.
The second area of discussion is that of eating habits. Most of the interviewees say that their meals are cooked at home and that they take at least four main meals a day. At times they take their meals outside their homes, for example, in food centres and at fast food restaurants. As many Singaporean parents are in the work force, there is occasionally a dependency on food centres and restaurants for family meals. From the evidence of large numbers of families having such a dependency, it is clear that the high standard of food safety and hygiene in Singapore consistently maintained by the Ministry of the Environment is a contributing factor. The Ministry’s role is to monitor food safety and food hygiene through import control, licensing and inspection, surveillance, enforcement and public education. Further, restaurants, food centres, eating houses, food courts and other food outlets are inspected regularly for cleanliness, hygiene and compliance with public health requirements. It is also unlikely that there are children in Singapore who suffer from malnutrition. All the interviewees say that they eat at least three of the four main food groups daily and that they and their parents are aware of the importance of maintaining a balanced diet. The problem of malnutrition, therefore, does not exist in Singapore.
In the third area of discussion, Health and Cleanliness, the interviewees say that they are fully-aware of the need for cleanliness and personal hygiene. They wash their hands after using the toilet and before eating. They cut their nails regularly and shower at least twice a day. As school children, they are exposed to a comprehensive health education programme, the objectives of which include the promotion of healthy living through multi-disciplinary and multi-sectoral approaches to impart the necessary skills and the provision of information for healthy living. The health education programme also emphasises individual responsibility and publicises the adverse consequences of an unhealthy diet, a sedentary lifestyle, and harmful habits such as smoking and drug abuse.
In the area of dental health, all the interviewees say that they have good dental health, are aware of brushing their teeth at least twice a day or after every main meal and see the dentist at least twice a year. All of them, however, are not familiar with the value of using dental floss. The students do not have any difficulty in going to dental clinics because there are 183 dental clinics at primary schools and three mobile dental clinics serving public housing areas. For the general public, there are nine dental clinics and 411 private clinics. The goal of the Singapore government is to emphasise the prevention of dental decay and promote good dental health. To achieve this, Singapore’s potable water has been flouridated since 1957.
In the interview about the last area of discussion, Diseases and Illnesses, the students say that they have not suffered any major illnesses or diseases apart from getting chicken pox. This is because, in Singapore, it is required for every child to be immunised against diseases like tuberculosis, poliomyelitis, diphtheria, whooping cough, tetanus, measles, mumps, rubella and Hepatitis B. Major diseases such as poliomyelitis and diphtheria are absent, plague and smallpox were eradicated in 1933 and 1959 respectively and since 1982, Singapore has been certified free from indigenous malaria by the World Health Organisation. School children receive regular medical examinations and those found with abnormalities are either treated in school clinics at the Institute of Health or referred to hospitals. Most of the children, however, in the interview, say that they suffer from frequent headaches and stomachaches. When asked why they say that it may be due to the pressure of school work and nervousness related to school work and examinations. None of the respondents experience constant stomach disorders and vomiting.
There are other external factors which contribute to the healthy lifestyle of our children. The quality of the air they breathe is rigorously maintained by the Singapore government with the average levels of sulfur dioxide and respirable suspended particles kept within the WHO and USEPA (United States Environmental Protection Agency) standards. Water is clean and can be drunk directly from the taps. Basic health care is generally affordable and comes under three schemes - Medisave (a compulsory savings scheme), Medishield (for major or prolonged illnesses) and Medifund (an endowment fund to help the poor and indigent pay for their medical care). The Ministry of Health works closely with the Ministry of the Environment and the Mininstry of Labour to ensure that Singaporeans will continually enjoy good health.
In conclusion, based on the small sample taken, it can be said that in general ten-year olds are quite aware about the importance of health. They are fortunate to experience good health and have the opportunities to enjoy good health-care services.
Last Modified: June 05, 2010