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First in Health Care, Yet Inequities Persist

November 28, 2017
by Jeannette Ickovics

In my first blog post, I raved about public health in Singapore. Indeed, this nation ranks first among nations for being on-target to reach the United Nations’ 2030 Sustainable Development Goals. These goals seek to end poverty and protect the planet; they create accountability and are used to drive policy action across multiple sectors (e.g., health, education, environment, financial). In contrast, the United States ranks 24th – behind almost all Western European nations, Australia (#11), Canada (#12) and Japan (#21). Of course, country-level performance varies greatly, and is driven by wealth and health inequalities within and across nations.

Since arriving in Singapore, I continue to be amazed by the robust network of programs, policies and infrastructure designed to support citizens from birth through old age. Health, housing and education are all subsidized. There is universal healthcare coverage with compulsory savings, subsidies and price controls, along with a vigorous Health Promotion Board. There are resources to innovate and to leverage technology to improve quality of services and quality of life: Smart Nation.

Nonetheless, I would be remiss not to mention some challenges that I observe as well. One is the health and mental health of migrant workers (unskilled or-semi-skilled). The Ministry of Manpower estimates more than 975,000 work permit holders in Singapore: nearly 20% of the population. There have been improvements in healthcare for migrant workers in the past few years, including a mandated “settling in” program announced just this week to teach foreign workers about social norms, laws, employment rights and resources for help if needed. And there are non-governmental organizations like Healthserve dedicated to providing health and hope to migrant workers.

However, there are still gaps in care along with higher risks for workplace injury, infectious disease and psychological distress – often a result of injury, indebtedness, salary disputes and concerns about ‘left-behind’ families. Vital Yet Vulnerable, a 2015 report from the Lien Centre for Social Policy at Singapore Management University, documents many of these challenges. A more recent report in the British Medical Journal further identifies financial barriers to healthcare for migrant workers in Singapore and the association with symptoms of psychological distress.

Both of these studies were limited to non-domestic workers. When we consider more than 240,000 domestic workers – mostly women from Indonesia, The Philippines, Malaysia and elsewhere who serve as maids, nannies and caretakers – we also must consider reproductive health and social isolation. Every day, when I walk to and from my office, I see truckloads of migrant workers being transported to their construction job sites. The domestics are mostly invisible.

Earlier this month at the Singapore Writers’ Festival, finalists from the Migrant Worker Poetry Competition read their works. Shivaji Das reminded us that “the story of life is essentially a story of migration”– long before this became a vitriolic and divisive political issue. The poetry competition provides a voice to those often voiceless. Here is one voice – part of a poem, Let My Wings Flap/Kepakkan Sayapmu by Anjia Mutiari, who is a domestic worker from Central Java Indonesia (published in Songs from a Distance…. Vanessa Lim, Editor. Singapore: Potato Productions Pte. Ltd. Distributed by Transient Workers Count Too, Singapore).

Let my wings flap

Till they fill the pale clouds with colour

Streak like lightening, single-minded,

Soar high to reach all my goals

Banish my stream of tears

Wipe my dripping sweat

With my wages.

“Leaving no one behind” is the cornerstone of the Sustainable Development Goals. Singapore ranks first, the United States ranks twenty-fourth. Still much to do.


Jeannette Ickovics is the Samuel and Liselotte Herman Professor of Social and Behavioral Sciences at the Yale School of Public Health and Professor of Psychology at Yale University. She is a Visiting Professor at Yale-National University of Singapore for the 2017-2018 academic year. This is her first trip to Singapore, and she will be writing a monthly blog about her experiences that will appear on Yale School of Public Health social media.

Submitted by Elisabeth Reitman on November 28, 2017