mortality rate for both sexes. Over the past 20 years, the upper-middle and lower-middle-income economies throughout Asia have achieved major reductions in infant mortality rates, but they still remain very high—50 for example, in India, 30 in Indonesia, 17 in China, and 12 in Vietnam (see Table 2.3).
Maternal mortality rates have also declined precipitously, from 86 deaths in 1950 to 12 deaths in 1975, to 3 in 2008.
Table 2.2
Table 2.3
Under-Five Mortality Rate
This measure is an indication of the probability of dying by age five per 1,000 live births, and Singapore has achieved one of the lowest rates in the world. With ten deaths among men and eight among women in 1990, Singapore's current rate is three for men and two for women. Japan's numbers are similar, whereas the United States stands at eight for men and seven for women. The United Kingdom is at six for men and five for women. Under-five death rates are generally lower for women, even in the upper-middle and lower-middle-income countries with the exception of China and India. Within some countries, the disparities based on income are very large. For example, in India, children in the poorest 20 percent of the population are three times more likely to die before turning five as those in the richest 20 percent (see Table 2.4).
Childhood Diseases
Through the National Childhood Immunisation Programme, most childhood diseases have declined, with diphtheria, neonatal tetanus, poliomyelitis and congenital rubella virtually eliminated.3
Adult Mortality Rate
Singapore's adult mortality rate (defined as the probability of dying between the ages of 15 and 60 per 1,000 population) is significantly lower than the rest of Southeast Asia and even lower than developed countries. The rate has halved since 1990 and now stands at just under 60. The United States, by contrast, is just over 100 and Australia just over 60. Among the nations of Southeast Asia, there are very large variations in the rate—much greater than that observed for child mortality. Very high rates include India and Thailand at about 200 and China well over 100 (see Table 2.5).
Number of Physicians and Hospital Beds
Singapore performs well on other health indicators related to system infrastructure, including hospital beds available and physicians serving the population. A common measure of both is the number of beds or number of physicians (physician density) per 10,000 population. Another and perhaps more accurate way to find the ratio is to use the total number of beds in the acute sector in 2011 while excluding those in the Community Hospitals and the Chronic Sick Hospitals. Dividing the acute sector beds by the total Singapore population, we find a 1 bed-to-10,000-population ratio of about 20. Other developed countries have similar numbers, but Japan stands out with an extraordinary 140 beds. For Singapore, these numbers are derived from taking the total number of beds, including Community Hospital and Chronic Sick Hospital beds, and dividing by the resident population of Singapore, resulting in a 1 bed-to-10,000-population ratio of about 30.
Table 2.4
Table 2.5
Singapore is home to over 9,000 doctors according to the Singapore Medical Council, scoring a physician density rate of just over 18—higher than China, Malaysia, Thailand, and most other countries in the region, but behind the US and other high-income economies (see Table 2.6).
The number of physicians and hospital beds in the Singapore system is purposely kept in check to avoid oversupply and the too-easy availability of doctors or of beds. The idea behind this action is to prevent excessive and undue use of healthcare services. I will have more to say about this approach later in the book.
Cancer
With respect to one of the biggest killers of all—cancer—Singapore is making great strides. Overall, the country's five-year age standardized relative survival ratio for men improved from 14 percent in 1973–77 to 45 percent in 2003–07; the ten-year ratio improved from about 15 percent in 1978–82 to 41 percent in 2003–07. For women, the five-year ratio went from 28 to 58 percent during the same periods, and the 10-year numbers improved from 26 to 53 percent in those same 1973–77 and 2003–07 periods.4
While the Asia Pacific region contributes to half of all cancer deaths, survival is highest in Singapore, China, and South Korea with regard to cancers where prognosis depends on the stage of diagnosis. Survival rates in the three countries are in the 80 percent range for breast cancer, 60 to 80 percent for cervical cancer, 70 to 80 for bladder cancer, and 44 to 60 percent for large bowel cancers.5
One interesting comparison I found is that Singapore's one- and five-year relative survival ratios for nasopharyngeal cancer in both genders are higher than in the United Kingdom. Singapore performs at par with Europe for rectal, colon, and lung cancer five-year relative cancer survival rates, for cases diagnosed in 1995–99. And it performs better than Europe in stomach, liver (male five-year RSR), and ovarian cancer. Unfortunately, the county lags in bladder, corpus uteri, and female breast cancer survival rates.
Table 2.6
Cardiovascular Disease
Cardiovascular disease is one of the main causes of deaths in developed countries. In the Asia Pacific region, the disease now accounts for as much as one-third of all deaths. In 2004, death rates in Japan, Australia, Singapore, and the Republic of Korea were lower than 200 per 100,000 people in contrast to the majority of countries in the region where it exceeded 400 deaths per 100,000.6
Singapore does not do quite as well with in-hospital case-fatality (within 30 days of admission) rates for acute myocardial infarction—with a rating of almost nine per 100 patients in 2007. Korea did slightly better with a rate of eight for the same year. Patients in United Kingdom and United States had lower fatality rates: just over six in the United Kingdom for the same year, and just over five in the United States in 2006.7
Ischemic stroke patients in Singapore had an in-hospital case-fatality rate of five, versus the United States’ four (2006), and Korea's just over two. Korea attained a hemorrhagic stroke case-fatality rate of 11 versus Singapore's 25, with the United States at about 25 as well (see Figures 2.1, 2.2, and 2.3).
New Challenges
Singapore's success is also less clear in some of the newer health concerns arising among the populace. Diabetes is an example. Singapore's diabetes rate continues to rise, increasing by three percentage points between 2004 and 2010. As of 2010, over 11 percent of Singaporeans have been diagnosed as diabetic. This finding trends in parallel with increased obesity, which jumped almost four percentage points
