The Ageing Population in Singapore as an Epidemiology - Essay Example

no. Public Health Project: the ageing population in Singapore as an epidemiology Defining public health and its relationship with the discipline of epidemiology Public health is concerned with educating, promoting, and researching on the protection and improvement of the health of communities. It is the work of public health professionals, therefore, to examine the factors affecting the health of communities and to come up with programs intended to protect community health (McKenzie, Pinger & Kotecki, 64). This is what differentiates public health professionals from their clinical counterparts. While the latter attend to people who are sick and seek to treat them, the former are more concerned with how to prevent health problems in the first place. Additionally, a clinician is usually concerned with the course of disease in an individual, while a public health professional considers a whole community, the latter which may range from a local community to an entire nation. One of the branches of public health is epidemiology, which is concerned with the conducting fieldwork to determine the causes of disease and injury, assessing the risk involved and formulating preventive measures (McKenzie, Pinger & Kotecki 64). In collecting information about unexpected diseases, injuries, or deaths, epidemiologists are often said to use the five “Ws” to assess the situation: how, who, when, where, and what. An epidemiologist would want to know how many people have been affected by the epidemic, who has been affected, when the epidemic took place, where the affected people were, and what the affected people have in common (McKenzie, Pinger & Kotecki 65). The historical development of epidemiology The history of epidemiology can be traced back to 300 B.C, when a scientist, Hippocrates, proposed the existence of a relationship between disease occurrence and the physical environment (McKenzie, Pinger & Kotecki 66). The occurrence of malaria in swampy areas, for example, was discovered. However, since most people believed that diseases occur naturally, epidemiology was ignored. In the meantime, people continued to suffer from disease outbreaks and other epidemics up until 1793 when yellow fever broke out in Philadelphia killing over four thousand people. More than a century later, Walter Reed discovered that the yellow fever had been caused by a mosquito. Then in 1849, there was a cholera outbreak in London which after investigations by John Snow, a prominent physician, was determined to have been caused by water drawn from a communal well. After Snow removed the pump handle, forcing people stop using the well, the epidemic was curbed. The discovery by Snow was instrumental in that it led to another landmark in the field of epidemiology. Almost forty years after the London cholera, Robert Koch discovered vibrio cholerae as the organism that causes cholera (McKenzie, Pinger & Kotecki 66). Since then, a lot of other discoveries have been made in the field of epidemiology thus increasing the effectiveness of public health (ibid). The ageing population as an epidemiology in Singapore According to NG, HL et.al Singapore has one of the fastest ageing populations in the world today. Choon, Shi’en & Chan write that in 2005, the number of people aged above 65 was 296, 000, constituting about 8% of the entire population (8). Statistics from the ministry of statistics show that the ageing population in Singapore, that is people aged 65 years and above, continues to rise annually. Accordingly, by 2011 the ageing population stood at 10.4%, while in 2012 the figure rose to 11.1%. Choon, Shi’en & Chan forecast that by 2030, 19% of the entire population in Singapore will be comprised of the ageing people (8). This is a worrying trend and there is need to conduct more research on the health issues facing the ageing population in Singapore .The high number of ageing people in Singapore could cause a crisis in the country in terms of a reduction in the workforce and putting a strain on healthcare provision. While the workforce reduces, the people in need of healthcare services increases, especially considering that aged people tend to suffer from a number of health-related problems. Catering for the health needs of this population is putting the government under a lot of pressure. As Low &Elias write, the government of Singapore in 2012, revealed plans to increase the budget for healthcare to approximately 8 billion dollars in the next five years (1). In addition, the government plans to increase MediShield coverage for people aged between 85-90 years to enable them receive better long-term care (ibid). However, the government alone cannot be able to adequately meet the healthcare needs of the ageing population. As such, non-governmental organizations need to step up and fill the existing gap in the delivery of health services to the ageing people in Singapore. Fig 1: pie chart showing the increasing number of the ageing people in Singapore Project proposal Healthy living is a local non-profit organization in Singapore that deals with epidemiological matters affecting local populations, by conducting research on the wellbeing of communities in terms of health. Currently, the organization has been involved in the collection of data on the number of ageing people in the population, and the heath services that this group requires, with a specific bias towards the frail elderly. The frail elderly constitute an aged population unable to take of themselves, and who are in constant need of care-givers. The organization has also researched on the availability of these services to this needy group, as well as the sources of funding for various groups interested in offering services to the frail elderly. From the research, Healthy living has found out that although the government through the Ministry of Community Development and Sports has a donor-fund program, these funds are not enough to cater for the needs of the increasing number of frail elderly people in Singapore (Chan, 18). The most disadvantaged are those from low-income families, the uneducated, and those with minimal social support. Healthy living, therefore, plans to start a program in which home-care-givers will be educated on the best health practices for ageing population. Traditionally, the Asian community, Singapore included, has relied on the family to take care of the elderly people, thus placing a huge burden on family members. According to Choon, Shi’en & Chan, the most prevalent form of long-term care in Singapore is the informal care, mostly given by adult family members (4). In fact, Choon, Shi’en & Chan write that a study in 20005 by the OECD reported that 80% of longer-care in Singapore lies in the informal sector (4). Of this 80%, only 20% are cared for by paid domestic care-givers, while the rest taken care of by family members (ibid). This means that family members are forced to reduce their working hours or forego employment all together in order to care for their aged relatives. This means that such families have very little income; sometimes hardly enough to enable them manage the health of the aged relatives effectively. In addition, most family members do not have the knowledge and compete on how to provide long-term care to aged people. As a response to these needs, this project aims at educating care-givers, both family members and paid helpers how to handle the aged people and how to carry out ADLs such as feeding, dressing, washing, toileting, and mobility on these people. This is because, if the ADLs are not done properly, then most aged people end up in hospitals with complications that could have been avoided. For example, improper handling of aged people could lead to bone, particularly hip fractures. Choon, Shi’en & Chan state that approximately 83% of the admissions in hospitals for the aged have to do with hip fractures (14). Projected Budget The start-up phase for the project is expected to take three months during which a number of costs will be incurred. With around $20,000, the organization will be able to set up a small center where people can be trained on how to care for their ageing relatives and how to promote the health of people who fall under this group. The organization already has a building in which the sessions can be conducted, and so the $ 20,000 will be used to buy equipment and tools necessary to conduct the educational programs. For example, the center will need at least a computer and a projector to make the learning process easier. Apart from the projector and computer the center will require seats, and other furniture that will facilitate the learning process. In addition, the center will need to hire educators, mainly health professionals to conduct the sessions and pass the health promotional message to the community. These professionals will need to use a number of teaching aids, especially on how carry out the ADLs practically. From time to time, other sectors will be involved in educating the community on the best practices to promote the health of the ageing. For example, food and nutritional experts will be required to give talks on the types of foods that are best for this age group. The housing sector will also be involved in the process, where, for example, they will give community tips on how to make adjustments to their houses to make mobility easier of the aged. The social services department may also be required to come in from time to time, to inform the community the available services and how people can get access to such services. Lastly, if necessary, the center will sometimes conduct door-to-door training programs especially for people who are unable to attend the educational programs at the center. All these people from sectors outside the health sector will need to be paid for the services rendered to the community at the center. Item Approximated Cost Computer, projector and related accessories $2,000.00 Seats and other furniture $ 1,000.00 Hiring of educators $ 5,000.00 Payment for speakers from other sectors $ 7,000.00 Conducting door-to-door campaigns $ 5,000.00 Total $20,000.00 Table 1: approximated project cost for the first 3 months Traditional versus New Public Health The traditional approach to public health was characterized by emphasis on hospitals and tertiary care, while primary and preventive care was largely ignored. Accordingly, public health did not feature in most health policies and funding of health care, as the focal point was on personal healthcare. According to Tulchinsky & Varavikova, New Public Health (NPH) uses a broad range of scientifically proven methods of controlling diseases and preventing existing and emerging health risks (25). Such methods are derived from evidence of success or failure in past interventions, thus epidemiologists are able to predict the workability of the methods they choose. In order to be effective, NPH requires the collaboration of all stakeholders within the community, ranging from the community itself to organizations providing services to the community, as well as donor-organizations. Tulchinsky & Varavikova summarize NPH as the management of health care for in-patients and outpatients, by relating hospital-based care with home care and primary care throughout the life of a person. By relating hospital-based care with primary and home care, it is evident that public health seeks to incorporate the whole community in the provision of healthcare services. Tulchinsky & Varavikova write that traditionally, public health was largely sidelined in favor of national health services which mostly dealt with providing medical insurance to individuals (28). Prior to, and during most of the 20th century, public health was regarded as a by-the-way but towards the close of the century, there was growing attention on the role played by public health in preventing and managing disease, injury and other health risks. Tulchinsky & Varavikova state that during the 1970s, most western countries began realizing that there exists a positive correlation between the health of individuals and the social, lifestyle, and environmental factors (29). Promotion of community health, therefore, began taking shape and by 2008, health promotion was among the most critical health policies in various countries (ibid). Community participation as an approach in New Public Health to reduce exposure to risk among the elderly in Singapore As an approach to reduce exposure to risk, community participation in public health is very important, since the affected are part of the community. The community should be involved in promoting the health of individuals and in implementing the strategies that have been laid down for health promotion (Tulchinsky & Varavikova, 28-35). In Singapore for instance, the community should be actively involved in promoting the health of the elderly population, which is certainly straining the healthcare system. Considering that aged people are vulnerable to diseases, the community needs to know how best to prevent and manage diseases associated with old age. This knowledge can be gained from health professionals and organizations that deal with health-related matters. Community in this case represents the family members and the care-givers entrusted with managing the health of the aged. These family members and care-givers need to be taught how to care for the elderly, as well as be involved in any decisions that are made concerning the latter. For instance, the family and care-givers need to be equipped with knowledge on what types of foods are appropriate for this age group, how to give medication for those who are ailing, and generally how to give personalized care to people unable to carry out Activities of Daily Life (ADLs). In a normal community setting, it is not possible for the family and care-givers to acquire all this health-promoting knowledge on their own. Other stakeholders such as health professionals and organizations need to be involved in order to make community participation in health promotion successful. Although family members and care-givers are the main targets within the community, the rest of the community needs to recognize that the elderly are a needy group and, therefore, become actively involved in strategies to help manage the health of this group. How inter-sectoral collaboration will help reduce risk among the aged in Singapore Considering how high the population of aged people in Singapore is, a single entity cannot be entrusted with managing the disease, injury, death risks associated with this group. The health care management of this group requires the collaboration of various sectors, each with its own capabilities. Once these capabilities are merged, the management of aged people in relation to health care will be more effective. Community members need to collaborate with health professionals and other non-health sectors towards managing the health of the elderly. Whilst communities become involved in the implementation of health-promoting practices, health professionals are involved in setting those health priorities that need to be implemented. In addition, these professionals work side-by-side with the community and help them implement the health priorities effectively. The role of non-health sectors such as social services, housing, and food production is to support the promotion of the health of the aged by developing policies that best suit this group. For example, the housing sector should strive to ensure that elderly people are properly housed in age-friendly houses, in which the old can easily navigate. Conclusion The various health needs of group require that this Public health, in particular the field of epidemiology has undergone numerous changes in the last century. From the sidelining of public health in preference to individual health, to the inclusion of public health in health policies and funding, the road has been long. New Public Health through epidemiology and evidence-based research has helped in the management of the health of communities over the years. The collaboration of communities, health professionals, and non-health sectors in promoting community health is essential in ensuring the continued success of public health. Accordingly, the project by Healthy living to enable Singapore deal with the epidemiology of an increasingly ageing population is well timed. If care givers, health professionals and other sectors collaborate in promoting the health of the aged, particularly the frail elderly, then the delivery of healthcare services to the ageing will not create a crisis in Singapore. Works cited Chan, Angelique. Singapore's Changing Structure and the Policy Implications for Financial Security, Employment, Living Arrangements and Health Care. Asian Metacentre for Population And Sustainable Analysis, 2001. Print. Choon, Chia, Shi’en, Shawna, and Chan, Angelique. Feminization of Ageing and Long Term Care Financing in Singapore. SCAPE Working Paper, 6 (2008). Print. Department Of Statistics, Ministry Of Manpower. Population in Brief 2012. 2012. Web. 27 July 2013. Donald Low And Melinda Elias. Population Ageing Requires Adaptive Responses, Not Just Technical Ones. The Healthcare Leadership College, 11. 2012. Print. James Mckenzie, Robert Pinger, and Kotecki, Jerome. An Introduction to Community Health. Massachusetts: Jones & Bartlett Learning. 2012. Print. Ng, Deborah, Tiakumzuk Sangtam, and Eong, Kah-Guan. "The Emerging Challenge of Age-Related Eye Diseases in Singapore." Annals-Academy of Medicine Singapore 36.10 (2007): S9. Print. Tulchinsky, Theodore and Varavikova, Elena. What Is The “New Public Health”? Public Health Reviews, 32. 1 (n.d): 25-53. Print. Read More