SINGAPORE: At 72, Madam Tan still walks to the market every morning. She knows where to cross safely, where the shady spots are as she waits at the traffic light and, importantly, where there is a bench where she can stop to rest. Don’t mistake that unassuming bench for a convenient piece of furniture – it’s part of Singapore’s quiet health evolution.

For decades, we have thought of “healthcare” as what happens when we fall sick. However, Singapore’s ageing population and rising healthcare costs are forcing a crucial rethink of how healthcare can come before illness strikes.

Increasingly, Singapore has been investing in population health. Unlike conventional healthcare, which treats one patient at a time, population health looks at the bigger picture of how people behave and how our environment and the tools we have influence our choices and behaviours so that people can stay healthy and prevent illness for as long as possible.

Population health asks: How can the design of our Housing and Development Board (HDB) estates influence how much we move? How do people interact with technology to help people manage conditions like diabetes? How can we identify less visible health challenges before they worsen?

Three examples can help us understand what population health can achieve in our lives.

DESIGNING NEIGHBOURHOODS FOR AGEING IN PLACE

When researchers visited Marine Parade and Bedok estates for the Community Ageing In Place Ecosystem (CAPE) project, they did not bring medical supplies or devices – they brought maps and questions.

Where do seniors like to walk? When and where do they stop to rest? How far is too far when it comes to access to amenities?

They learnt that having public benches helped seniors travel further by giving them places to rest along their journey. This could allow older residents to stay active, stay independent to pursue activities of interest and stay connected to their community.

Where conventional aged care would make us think of nursing homes after reaching a state of frailty, population health looks for answers in how public spaces are designed. Such small touches to the built environment will help seniors to better age in place.

HEALTH AT ONE’S FINGERTIPS

That same principle is transforming our approach to managing chronic diseases. Today, more in Singapore live with chronic conditions like diabetes and hypertension. Managing one’s care happens mostly outside the clinic.

Technology can offer innovative ways to extend care beyond clinic visits into everyday life if we understand how to harness them effectively.

Take EMPOWER+, a population-based digital health research project to help patients with chronic conditions. Patients get guidance on daily habits from an AI-based app, including reminders to exercise, check their blood sugar, and take other small steps towards better health. Users reported improved blood sugar and blood pressure levels in just a few months.

While conventional chronic care includes advising lifestyle changes, it is challenging to do more than remind patients during their occasional clinic visits. Instead, population health finds ways to meet people where they are – at home, at work, or even on their morning walk.

SPOTTING SILENT STRUGGLES EARLY

Population health isn’t just about seniors or chronic disease. It is also uncovering the invisible struggles affecting the well-being of groups in our community. One such group is new mothers.

In Singapore, one in 15 women experience depression after childbirth, but few talk about it. Many assume they just have “baby blues” or feel that they should cope on their down. But conventional healthcare often has to rely on a mother reaching out first to seek help.

Population health takes a different approach. By studying trends across the population, our researchers realised that mental health challenges after childbirth were part of a broader social issue affected by stress, lack of support networks and social stigma. Instead of focusing only on treatment, researchers asked: “What’s happening in the lives of these mothers? What is stopping them from getting help early?”

The findings highlighted a clear need for holistic care and identified opportunities for early intervention, eventually leading to the launch of a nurse-led screening programme at SingHealth Polyclinics. Since 2022, more than 8,000 mothers have been screened and over 200 have received timely emotional support.

THE BIGGER PICTURE

Benches, apps and post-natal screenings may seem like unrelated stories. But together, they show what a population health approach is about. It is a new way of thinking that helps us see how everyday things in our lives are linked to health and how we can make those connections stronger to help people stay healthy.

Turning these ideas and research, however, takes time and effort. Population health studies often take years. Researchers also have to manage shifting real-world conditions such as participants dropping out, keeping pace with new policies or community needs evolving faster than the study.

Turning research into real change takes combined efforts across government agencies and time for initiatives to take form.

This is where population health complements conventional healthcare. While doctors and nurses in our healthcare institutions focus on treating illness, population health takes a broader view. It works quietly in the background to help Singaporeans live longer and healthier lives by preventing disease, creating healthier environments and intervening early.

So, the next time you see a senior resting on a park bench or someone tracking their steps on a smartwatch, remember that small moments are part of a bigger vision of healthcare that goes beyond treating illness.

Associate Professor Low Lian Leng is Director of the SingHealth Centre for Population Health Research and Implementation (CPHRI).