War on Diabetes in Singapore: a policy analysis

Lai Meng Ow Yong, Ling Wan Pearline Koe, Lai Meng Ow Yong, Ling Wan Pearline Koe

Abstract

Background: In April 2016, the Singapore Ministry of Health (MOH) declared War on Diabetes (WoD) to rally a whole-of-nation effort to reduce diabetes burden in the population. This study aimed to explore how this policy has been positioned to bring about changes to address the growing prevalence of diabetes, and to analyse the policy response and the associated challenges involved.

Methods: This qualitative study, using Walt and Gilson's policy triangle framework, comprised analysis of 171 organizational documents on the WoD, including government press releases, organizational archives, YouTube videos, newspaper reports and opinion editorials. It also involved interviews with 31 policy actors, who were policy elites and societal policy actors.

Results: Findings showed that the WoD policy generated a sense of unity and purpose across most policy actors. Policy actors were cognisant of the thrusts of the policy and have begun to make shifts to align their interests with the government policy. Addressing those with diabetes directly is essential to understanding their needs. Being clear on who the intended targets are and articulating how the policy seeks to support the identified groups will be imperative. Issues of fake news, unclear messaging and lack of regulation of uncertified health providers were other identified problem areas. High innovation, production and marketing costs were major concerns among food and beverage enterprises.

Conclusion: While there was greater public awareness of the need to combat diabetes, continuing dialogues with the various clusters of policy actors on the above issues will be necessary. Addressing the various segments of the policy actors and their challenges in response to the WoD would be critical.

Keywords: Diabetes mellitus; Health policy; Health services; Health system; Policy analysis; Singapore.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. MOH. Diabetes: The war continues. 2017. . Accessed 31 May 2018.
    1. WHO. Diabetes Geneva, Switzerland: World Health Organisation; 2020. . Accessed 26 Aug 2018.
    1. MOH. Ministry of Health studying measures to better support persons with pre-diabetes. 2017. . Accessed 31 May 2018.
    1. MOH. Speech by Minister for Health, Mr Gan Kim Yong, at the MOH Committee of Supply Debate 2016 Singapore: Ministry of Health, Singapore; 2016. . Accessed 14 Apr 2020.
    1. HPB. Health Lifestyle Festival SG to reach over 80,000 Singaporeans in push to shape healthier lifestyles Singapore: Health Promotion Board; 2018. . Accessed 12 Aug 2018.
    1. Schirr-Bonnans S, Costa N, Derumeaux-Burel H, Bos J, Lepage B, Garnault V, et al. Cost of diabetic eye, renal and foot complications: a methodological review. Eur J Health Econ. 2017;18(3):293–312. doi: 10.1007/s10198-016-0773-6.
    1. Stetson B, Minges KE, Richardson CR. New directions for diabetes prevention and management in behavioural medicine. J Behav Med. 2017;40:127–144. doi: 10.1007/s10865-016-9802-2.
    1. WHO. Global report on diabetes. 2016.
    1. Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet. 2013;381(9867):670–679. doi: 10.1016/S0140-6736(12)62089-3.
    1. Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Glob Health. 2016;4(12):e895–e896. doi: 10.1016/S2214-109X(16)30217-0.
    1. de Lacy-Vawdon C, Livingstone C. Defining the commercial determinants of health: a systematic review. BMC Public Health. 2020;20(1022):1–16.
    1. Mialon M. An overview of the commercial determinants of health. Glob Health. 2020;16(74):1–7.
    1. Gómez EJ. Contextualising obesity and diabetes policy: Exploring a nested statistical and constructivist approach at the cross-national and subnational government level in the United States and Brazil. Int J Health Policy Manag. 2017;6(11):639–648. doi: 10.15171/ijhpm.2017.13.
    1. Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994;9(4):353–370. doi: 10.1093/heapol/9.4.353.
    1. Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007. Health Policy Plan. 2008;23(5):294–307. doi: 10.1093/heapol/czn019.
    1. Shiroya V, Neuhann F, Muller O, Deckert A. Challenges in policy reforms for non-communicable diseases: the case of diabetes in Kenya. Glob Health Action. 2019;12(1):1–13. doi: 10.1080/16549716.2019.1611243.
    1. Brownell KD, Roberto CA. Strategic science with policy impact. Lancet. 2015;2015(385):2445–2446. doi: 10.1016/S0140-6736(14)62397-7.
    1. Bryman A. Social research methods. 4. New York: Oxford University Press, Inc.; 2012.
    1. Bryman A. Social research methods. 5. Oxford: Oxford University Press; 2016.
    1. Crow D, Jones M. Narratives as tools for influencing policy change. Policy Politics. 2018;46(2):217–234. doi: 10.1332/030557318X15230061022899.
    1. Prince R. Policy transfer, consultants and the geographies of governance. Prog Hum Geogr. 2012;36(2):188–203. doi: 10.1177/0309132511417659.
    1. Atkinson P, Coffey A. Analysing documentary realities. In: Silverman D, editor. Qualitative research. 3. London: SAGE Publication Ltd.; 2011. pp. 77–92.
    1. Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. USA: SAGE Publications, Inc.; 2014.
    1. Mukanu MM, Zulu JM, Mweemba C, Mutale W. Responding to non-communicable diseases in Zambia: a policy analysis. BMC Health Res Policy Syst. 2017;15(34):1–9.
    1. Buse K, Mays N, Walt G. Making health policy: understanding public health. 2. New York: Open University Press; 2012.
    1. May P, Hynes G, McCallion P, Payne S, Larkin P, McCarron M. Policy analysis: palliative care in Ireland. Health Policy. 2014;2014(115):68–74. doi: 10.1016/j.healthpol.2013.07.016.
    1. MOH. Speech by Mr Chee Hong Tat, Senior Minister of State for Health, at the 2nd Global Summit on Circulatory Health, 12 July 2017 Singapore: Ministry of Health; 2017. . Accessed 28 Apr 2020.
    1. MOH. Speech by Mr Gan Kim Yong, Minister for Health, at the Ministry of Health Committee of Supply Debate 2019, on Wednesday 6 March 2019 Singapore: Ministry of Health, Singapore; 2019. . Accessed 27 Mar 2020.
    1. MOH. Governments strengthen resolve to take comprehensive, coordinated and innovative measures to tackle diabetes (involving 18 countries) Singapore: Ministry of Health, Singapore; 2018. . Accessed 27 Mar 2020.
    1. MOH. Speech by Mr Chee Hong Tat, Minister ofState for Health, at The Food Vision Asia 2017, 26 April 2017 Singapore: Ministry of Health; 2017. . Accessed 28 Apr 2020.
    1. MOH. Diabetes: The war continues Singapore: Ministry of Health; 2017. . Accessed 28 Apr 2020.
    1. TST. Seven drink companies pledge to reduce sugar in beverages to 12% or less by 2020 Singapore: The Straits Times; 2017. . Accessed 28 Apr 2020.
    1. MOH. Public consultation on measures to reduce sugar intake from pre-packaged sugar-sweetened beverages Singapore: Ministry of Health, Singapore; 2019. . Accessed 27 Mar 2020.
    1. MOH. Speech by Mr Edwin Tong, Senior Minister of State, Ministry of Law & Ministry of Health, at the World Diabetes Day 2019, 17 November 2019 at Ng Teng Fong General Hospital Singapore: Ministry of Health, Singapore; 2019. . Accessed 27 Mar 2020.
    1. Shanahan EA, Adams SM, Jones MD, McBeth MK. The blame game: narrative persuasiveness of the intentional causal mechanism. In: Jones MD, Shanahan EA, McBeth MK, editors. The science of stories: applications of the narrative policy framework in public policy analysis. New York: Palgrave MacMillan; 2014.
    1. Lee SM, Lim LC, Koh D. Stigma among workers attending a hospital specialist diabetes clinic. Occup Med. 2015;65:67–71. doi: 10.1093/occmed/kqu150.
    1. Ng CJ, Lai PS, Lee YK, Azmi SA, Teo CH. Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review. Int J Clin Pract. 2015;69(10):1050–1070. doi: 10.1111/ijcp.12691.
    1. Sontag S. Illness as metaphor. Toronto: McGraw-Hill Ryerson Ltd.; 1978.
    1. Hill M, Varone F. The public policy process. 7. Abingdon: Routledge; 2017.
    1. McBeth MK, Shanahan EA, Arnell RJ, Hathaway PL. The intersection of narrative policy analysis and policy change theory. Policy Stud J. 2007;35(1):87–108. doi: 10.1111/j.1541-0072.2007.00208.x.
    1. Lasswell H. Politics: who gets what, when, and how. Gloucester: Peter Smith Publishers; 1936. p. 1990.
    1. MOH. Innovation, social mobilisation and better collaboration critical in the global fight against diabetes Singapore: Ministry of Health; 2018. . Accessed 28 Apr 2020.
    1. Maani N, Collin J, Friel S, Gilmore AB, McCambridge J, Robertson L, et al. Bringing the commercial determinats of health out of the shadows: a review of how the commercial determinats are represented in conceptual frameworks. Eur J Pub Health. 2020;30(4):660–664. doi: 10.1093/eurpub/ckz197.
    1. Lee K, Freudenberg N. Addressing the commercial determinants of health begins with clearer definition and measurement. Glob Health Promot. 2020;27(2):1–5. doi: 10.1177/1757975920939765.
    1. Ndebele P, Shaikh H, Paichadze N, Bari I, Michaels D, Burgoa CS, et al. Commercial determinants of health: an ethical exploration. Int J Public Health. 2020;2020(65):1123–1132. doi: 10.1007/s00038-020-01427-x.
    1. Knai C, Petticrew M, Mays N, Capewell S, Cassidy R, Cummins S, et al. Systems thinking as a framework for analysing commercial determinants of health. Milbank Q. 2018;96(3):472–498. doi: 10.1111/1468-0009.12339.
    1. Giusti A, Maggini M, Colaceci S. The burden of chronic diseases across Europe: what policies and programmes to address diabetes? A SWOT analysis. BMC Health Res Policy Syst. 2020;18(12):1–7.
    1. Ireland R, Bunn C, Reith G, Philpott M, Capewell S, Boyland E, et al. Commercial determinants of health: advertising of alcohol and unhealthy foods during sporting events. Bull World Health Org. 2019;2019(97):290–295. doi: 10.2471/BLT.18.220087.
    1. Walt G, Shiffman F, Schneider H, Murray SF, Brugha R, Gilson L. 'Doing' health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan. 2008;23(5):308–317. doi: 10.1093/heapol/czn024.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する