The spread of HIV, SARS, influenza and the recent COVID-19 pandemic have brought attention to the need for a concerted effort to strengthen and innovate the global health landscape to build a resilient and sustainable future. Differing from International Health whereby the focus is placed on developing countries and foreign aid, Global Health is an area of study, research and practice that places a priority on improving health and achieving health equity for people the world over.
In 2019, the SingHealth Duke-NUS Global Health Institute (SDGHI) was launched to advance the health and well-being of people in Southeast Asia and beyond. As part of the SingHealth Duke-NUS Academic Medical Centre (AMC), SDGHI harnesses the capacity of SingHealth, Singapore’s largest cluster of healthcare institutions, and the Duke-NUS Medical School, to advance interdisciplinary global health research and capacity development across the region. Funding from the Khoo Teck Puat Foundation helped support the Institute’s activities from 2019 to 2021, including those carried out outside of Singapore.
“Asia is home to almost 4.6 billion people – nearly 60% of the total world population, and its population density far exceeds that of other regions1. Yet, most healthcare institutions studying global health exist outside Asia,” said Prof Tan Hiang Khoon, Director, SDGHI, who added that the Institute is uniquely positioned to bring an Asian perspective to solve some of the region’s pressing health challenges. Today, SDGHI has over 70 active projects in 14 Asian countries.
Addressing capacity and capabilityThe population density and close proximity of humans to nature, make Asia a hotbed for emerging infectious diseases. The COVID-19 outbreak is a timely example, which has also shed light on the visible effects of the health inequity in Asia and beyond. Some nations lack the systems and capacity to curb the spread of the virus and care for those infected, while most others struggle to rollout immunisation programmes. The effect of the virus on local economies and the lives of people have further aggravated the dire state of their health landscape.
While the burden of communicable diseases is quite apparent, the disease load and effects of non-communicable diseases such as diabetes, hypertension, heart disease and cancer are far larger says Prof Tan. According to the World Health Organization, 68.6% of mortalities in Southeast Asia in 2019 were linked to non-communicable diseases2. “This has a direct impact on a nation’s economic capacity and ultimately the world economy.” he said.
Citing an example, Prof Tan shared that the economic cost of people not being able to access timely and safe surgical procedures is estimated to be 12.3 trillion dollars from 2015 to 2030– a problem further aggravated by the COVID-19 pandemic. His team, together with counterparts in other Asian nations, have formed the Asian Surgical Network to study the impact of deferring elective surgeries during a pandemic. The study is funded by a gift from Musim Mas Holdings.
“A person with a gallbladder infection or colorectal cancer for example, would have had to postpone their non-emergency surgeries to free up hospital capacity during the pandemic. As a result, their conditions may have worsened or there could have been loss of lives. Our study aims to understand the true cost of such policy decisions so that we can be better informed and prepared for the next health emergency,” said Prof Tan.
Another area that SingHealth medical teams have made a big impact is in maternal and child health.
In 2016, a team from the Singapore General Hospital embarked on a three-year programme with the government of Karnataka in India and the Singapore International Foundation to enhance maternal and child health services. The programme has helped to halve the number of women dying during pregnancy and child birth in the Indian state. Similar programmes have also been rolled out in other Indian states, with a fully-equipped skills laboratory being developed in Madhya Pradesh with the support of Tata Trust and Temasek Foundation (read full story here).
The benefit is mutual and far reaching“Many of the mortalities and comorbidities we see in the region are preventable with the proper support and infrastructure in place,” said Prof Tan who added that the overseas programmes have also been an opportunity for knowledge exchange. The teams that worked on maternal and child health programmes in India returned with a broader mindset and new knowledge of creative and low-cost alternatives to counter the rising healthcare cost.
Prof Tan shared that he, too, was able to pick up surgical skills from his counterparts in Vietnam and Thailand and bring them back to Singapore. “Our medical teams get to experience the true essence of providing care under challenging circumstances and to learn to think out of the box, improvise, and devise solutions in less than ideal situations. It also helps to build the resilience and adaptability of our own healthcare workers,” he said.
Looking ahead, Prof Tan hopes the AMC can form a global health alliance with regional partners to foster an ecosystem of innovation and knowledge sharing with a view to elevate healthcare standards and achieve health equity in the region. The network would catalyse opportunities to conduct research into health problems relevant to Asian populations and devise solutions that are relevant and scalable within varying economic conditions. Leveraging the high rate of smart phone penetration in Asia, there lies a real opportunity to use digital tools, data science and artificial intelligence to establish platforms to increase access to knowledge and health services in far corners of the region.
With these platforms, it is also imperative to introduce systematic programmes to evaluate their effectiveness and continuously improve to stay relevant, as the healthcare landscape is constantly evolving.
Through the years, support from donors have played an integral part in enabling many of the AMC’s global initiatives, says Prof Tan. “The biggest upside in supporting global health initiatives is that the cost to implement programmes is relatively low in Asia, but they have the potential to impact the lives of half the world’s population. Every life saved adds productive years to a country,” he added.
In today’s connected world, diseases transcend boundaries and we can only be safe if everyone is safe. Join the SingHealth Duke-NUS Academic Medical Centre in its global health efforts by making a gift with a far-reaching impact.
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