“I am declaring war
on diabetes” was Health Minister Gan Kim Yong’s bold declaration in Parliament
last week.
Warning Singaporeans of the worsening scourge of diabetes,
Mr Gan emphasised the need to take decisive action. The statistics are sobering
— four amputations every day due to diabetes, two in three kidney failure cases
attributable to diabetes and if unchecked, one million Singaporeans afflicted
by the year 2050.
Globally, the situation is equally grim. The World Health
Organization reports that the number of adults with diabetes has quadrupled
since 1980, with more than 420 million diabetics today. In America, the annual
costs of treating diabetes has crossed the US$100 billion (S$134 billion) mark
and is on track to triple in the next two decades.
But this is not any ordinary war. This is a war with
ourselves, a war with the way we eat, with the way we live.
We have created a world where it is all too easy to eat
badly, to overeat and be sedentary. Mr Gan articulated this crisply when he
focused the “war” on “shifting mindsets and changing habits”. How should
Singapore fight this war? Albert Einstein is said to have described insanity as
“doing the same thing over and over again and expecting different results”.
We cannot fight this war with more of the same — we need
new weapons and new thinking.
Advances in technology and new insights into behavioural
change are probably the most potent weapons we can harness in this war. These
weapons were not available or sufficiently matured even a decade ago and their
inclusion now is, thus, very timely.
Technology allows us to fundamentally change how we deliver
care for diabetics and promote health to everyone else. The power of “Big Data”
and the “Internet of Things” together allow patients to be remotely monitored
and engaged in much more inexpensive ways. The analogy in consumer services
would be how Alibaba or Amazon build up profiles of users which they then use
with great success to encourage purchases.
Instead of blunt dualities categorising patients as having
“well-controlled” or “poorly-controlled” disease, we can much more finely
segment patients by their health status, social habits and motivators,
customise the advice and interventions to achieve correspondingly higher
adherence rates.
On applying more adroitly behavioural sciences, there is so
much to be done. Pulitzer Prize-winning journalist and author Charles Duhigg in
the book The Power of Habit describes a simple neurological loop at the core of
every habit.
The loop consists of three parts: A cue, a routine and a
reward which satisfies a craving. Mr Duhigg describes how P&G’s Febreze — a
commercial flop when launched as an odour-killing product — became a
billion-dollar blockbuster when a pleasant smell was added and Febreze was
rebranded as the “finishing touch” to cleaning.
Placing this into the “cue, routine, reward” loop, we can
see how Febreze positions well. Seeing a messy home is the “cue”, cleaning is
the “routine”, and the pleasant smell the “reward”. The craving is for the
smell, which signals that cleaning is complete and a “reward” is due. In
healthcare, how do we create a similar sequence?
The cue might be a daily alert at 8pm informing one of the
number of steps walked thus far which triggers a routine, eg walking a mile
with the reward being a congratulatory message from one’s physician or coach
and, perhaps, even a voucher for fresh fruits.
CAN SINGAPORE SET An EXAMPLE FOR THE WORLD?
Tools aside, the economics for patients and healthcare
providers have to make sense and the government will have its work cut out to
shift the entire health and healthcare financing systems. We need to move away
from a predominantly “fee-for-service” model where doctors are paid more when
more “sick care” services are provided, to one which incentivises wellness and
healthy living.
Tax policies will also be important in sending the right
signals about lifestyle choices and encourage appropriate behaviours. The
science exists today to enable “nudging” patients and citizens into the right
mindset and habits, but without a favourable financing and payment system,
change will be slow and reluctant.
Finally, it is encouraging that the Diabetes Prevention and
Care Taskforce being set up to lead the war against diabetes will be
multi-sectoral. Coming back again to Einstein, a quote commonly attributed to
him goes: “No problem can be solved from the same level of consciousness that
created it”.
While the composition of the task force has not been
announced, it would be ideal if it includes a good mix of leading digital
health start-up founders and independent, innovative thinkers from sectors that
have enjoyed success in shaping public perception and behaviour.
No country in the world has won the “war against diabetes”.
Most are actually losing. If Singapore can turn the tide against diabetes, it
would set the country as a shining beacon amid a gloomy landscape strewn with
failed efforts and worsening disease burdens. Singapore’s model can then become
the example for the world, and that might be the greatest contribution our
“Little Red Dot” can make to humankind.
By Jeremy Lim
ABOUT THE AUTHOR:
Dr Jeremy Lim is head
of the health and life sciences practice for the Asia-Pacific for Oliver Wyman,
the global consultancy. He is the author of Myth Or Magic: The Singapore
Healthcare System.
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