United Nations Public Service Awards Case Studies

The Singapore Ministry of Health would like to nominate the Singapore Health Promotion Board (HPB) for the UN Public Service Awards. The HPB has played a pivotal role in supporting the Ministry's mission by keeping Singaporeans healthy, fit and economically productive. Strategically, the HPB’s role in promoting workplace health will become strategically more important as we continue to focus on health promotion and preventive care as the pillars of our healthcare system. This is critical given the increasing prevalence of long-term chronic or “lifestyle” diseases in Singapore, and the increasing burden of rising healthcare expenditure.

To this end, the HPB's Excellence in Workplace Health (EWH) project is a truly innovative step to bring health promotion to Singaporeans through their workplaces. Encouraging healthy lifestyles which includes healthy eating, regular exercise, not smoking, mental wellness is a difficult task. It requires painstaking commitment to educating the public, and facilitating platforms to change behaviour to adopt healthy lifestyles and, above all, an inclusive strategy to bring together diverse stakeholders to support the common goal.

Today, the HPB’s efforts are widely appreciated by Singaporeans, who now understand the importance of adopting healthy lifestyles, and the role of the Public Service in encouraging it by providing the necessary infrastructure and the right incentives. Its success is also acknowledged internationally, and the HPB regularly shares its experiences with foreign countries who are keen to learn from it.

Given the strategic benefits that the Excellence in Workplace Health project has contributed to Singapore’s national wellbeing, and the positive impression that it has inculcated among the various stakeholders in society, the Singapore Ministry of Health is proud to nominate the Singapore HPB for the UN Public Service Award 2007.

What is the initiative about? (the solution)
Singapore is a small nation with no natural resources except our people. To maximize the potential of our people, Singapore firmly believes in the importance of increasing the quality and years of healthy life and preventing illness and disability. Only then can Singaporeans lead emotionally assured and economically productive lives, thereby contributing to the wellbeing of their families and Singapore. The Excellence in Workplace Health (EWH) project is an unprecedented national effort to leverage the workplace as a platform for health promotion. It is a broad-based initiative spearheaded by the Singapore Health Promotion Board (HPB), in partnership with companies and employers, to reach out to the 2.4 million working Singaporeans (almost 70% of the 3.6 million Singapore residents). Under the EWH project, the HPB partners organisations to create healthy work environments, develop policies which are conducive to good health, and provide health promotion programmes and services at work. The HPB also educates Singaporeans to seize the opportunities at work to stay healthy. The EWH project involves the following strategies: • Developing national strategic partnerships between Government, employers and employees to enhance the sense of shared ownership; • Ensuring Alignment to Strategic Goals; • Empowering employers and employees to achieve the EWH project goals; • Creating a comprehensive support eco-system that includes awards, grants and resource toolkits; • Introducing tobacco control legislation for the workplace; • Promoting EWH through industry-based promotional campaigns; • Organising a Fitness at Work public campaign. In response to these strategies, the percentage of private workplaces implementing EWH initiatives increased from 32.6% in 1998 to 45.1% in 2003. This translated to a remarkable increase in the proportion of workforce covered by EWH initiatives from 26% in 1998 to 64.9% in 2003. This has helped to improve the health of working Singaporean adults aged 18 to 69 years, and the economic vitality of our businesses.

Who proposed the solution, who implemented it and who were the stakeholders?
The EWH project had its roots in the Workplace Health Promotion Programme for civil servants before being introduced to the private sector and nationwide. The key milestones are: 1991-1992: Implementation of the Pilot Workplace Health Promotion Programme for civil servants 1993: Launch of the first training course on workplace health promotion for human resource and business leaders (in collaboration with the World Health Organisation) 1994: Extension of the smoking prohibition legislation to all air-conditioned office premises and factory work areas 1998: Setting up of the National Tripartite Committee on Workplace Health Promotion 1999: Launch of the first Singapore HEALTH (Helping Employees Achieve Life-Time Health)Award 2000-2004: Setting up of the National Intersectoral Management Committee on Workplace Health Promotion 2001: Implementation of the Workplace Health Promotion Grant 2005: Launch of Fitness at Work to encourage working Singaporeans in the Central Business District to engage in regular physical activity

Describe how and when the initiative was implemented by answering these questions
a. What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
“People are a resource and not a cost.” - Peter Drucker, President of Leader to Leader Institute Given Singapore’s small population and scarce natural resources, it is pertinent that Singapore preserves its most precious resource – people! The Excellence in Workplace Health (EWH) project underpins the Singapore Government’s commitment to build a nation of healthy and fit Singaporeans. The reasons for promoting heath at the workplace are many: • 66.7% of Singaporeans aged 18 - 65 years are working and most workers spend a minimum of eight to ten hours at the workplace. The workplace is thus an excellent setting to promote the physical, social and mental health of workers resulting in a healthier workforce, increase in productivity and a reduction in health care costs; • Singapore’s population and workforce are ageing. The median age of the workforce had risen from 34.7 years in 1993 to 38.8 years in 2004. This ageing of the workforce potentially threatens the productivity and profitability of businesses as older workers tend to take more sick leave and spend more health dollars. Investing in their health at the workplace keeps them economically active and productive; • Lifestyle related diseases such as cancers, heart disease and stroke are the leading causes of death among Singaporeans. They share a common set of risk factors: physical inactivity, smoking, diabetes, hypertension and high blood cholesterol, all of which are modifiable through living a healthier lifestyle. Given the above, there is hence a shared incentive to keep Singaporeans healthy at work, so that they can continue leading productive lives.

b. What were the key development and implementation steps and the chronology? No more than 500 words
The Excellence in Workplace Health project was therefore established to develop a healthy and vibrant workforce that will contribute to Singapore's productivity and prosperity for a better quality of life through a comprehensive, structured and sustainable national programme.

c. What were the main obstacles encountered? How were they overcome? No more than 500 words
The EWH utilizes a broad-based strategy framework involving multiple stakeholders across the public, people and private sectors. The strategies include: 1. Developing strategic partnerships at the national level. A National Tripartite Committee was formed in 1999, comprising the employer’s federation, the trade unions and the government to expand and improve the EWH project. The Committee reviewed local and international evidence on workplace health promotion, consulted with experts and identified issues. In 2000 the Report of the Tripartite Committee was published. It provided a strategic framework for the national WHP programme, bringing the EWH to its next lap. A National Intersectoral Committee comprising employers and employees unions and key government and private agencies was also established. 2. Ensuring Alignment to Strategic Goals. HPB works with organizations to ensure that EWH standards and indicators are aligned to business outcomes by developing a set of user-friendly assessment tools and indicators. More importantly, the EWH project is aligned with nationally recognized productivity and business excellence awards such as the Singapore Quality Award (in recognition of organizations’ attainment of world-class quality standards), People Development Award (in recognition of organizations’ investment in people development), and the Singapore Quality Class Standard of best practices for business excellence. 3. Recognising achievement through the Singapore HEALTH (Helping Employees Achieve LifeTime Health) Award. The HEALTH award was established by HPB to recognise participation in the EWH project based on a set of criteria. The number of Award recipients has more than doubled from 132 workplaces in 1999 to 367 in 2006. 4. Capacity building of employers and employees. HPB empowers all parties to start and sustain their WHP programme through training courses, national conferences and skills building workshops and one-to-one consultations. In 1995, the first WHP training course was organised in collaboration with WHO. From 2003, government funding for WHP training is available. 5. Creating a comprehensive support eco-system that includes: a. Funding through the WHP Grant. This was introduced in 2001 to accelerate WHP. Workplaces can receive up to SG$10,000 to start a new programme or expand existing ones, on a co-sharing basis. b. Toolkit of resources and handy references for top management, human resource managers and workplace health facilitators. These included a guide on how to plan and implement effective WHP programmes, case studies on best practices and a local directory of health promotion service providers. c. One-stop programme. This is specially tailored for smaller companies that are starting WHP for the first time. It is high subsidized and participating companies automatically qualify for the Singapore HEALTH Award. d. Designing customised programmes on a wide range of topics which included HIV/AIDS education, nutrition, smoking cessation, physical activity programmes and promoting EWH through industry-based promotional campaigns. In 2005, HPB launched the Fitness At Work campaign to bring workout sessions to the doorsteps of many Singaporeans working in the Central Business District. More than 35,000 Singaporeans participated in the weekly aerobics workout sessions. 6. Introducing tobacco control legislation that prohibits smoking in all air-conditioned office premises and factory work areas.

d. What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Today, more working Singaporeans than before are aware of the importance of living a healthy lifestyle. This is translated into positive behavioural change and reduced prevalence of major non-communicable diseases such as diabetes and cardiovascular risk factors. In the Singapore National Health Survey, the prevalence of daily cigarette smoking among working Singaporean adults aged 18 to 69 years dropped from 17.6% in 1998 to 15.1% in 2004. Singapore’s smoking prevalence rate is now among the world’s lowest. The survey also showed more working adults exercising regularly, as evidenced by the increase from 14.2% to 21.2% over the same period. More significantly, the prevalence of major chronic degenerative diseases has declined. The prevalence of hypertension dropped from 19.1% to 18.7% while that of hypercholesterolaemia fell from a high of 24.7% to 18.6%. The prevalence of diabetes remained constant at 6.5% - 6.6%. Indicator 1998 2004 Exercise 14.2% 21.2% Smoke 17.6% 15.1% Obese 5.2% 6.6% High Total Blood Cholesterol 24.7% 18.6% Hypertension 19.1% 18.7% Diabetes 6.5% 6.6% More workplaces are implementing WHP. According to the National Survey on Workplace Health Promotion among private companies in Singapore, the number of private sector workplaces with a comprehensive WHP programme increased from 32.6% in 1998 to 45.1% in 2003. This represents 64.9% of the total private sector workforce (1.6 million working Singaporeans) compared to 26.0% in 1998. 97.1% of Ministries and most of the statutory boards have a WHP programme. (Note: A WHP programme is said to be comprehensive when it offers at least one health promotion activity, provides at least one supportive environmental facility and has in place one organisational policy in the twelve month period prior to the survey.) 1998 2004 Proportion of companies with a 32.6% 45.1% comprehensive WHP programme Proportion of workforce covered 26.0% 64.9% by a comprehensive WHP programme When the Singapore HEALTH Award was first introduced, 52% of the recipients were from the public sector. This is because, since 1995 WHP has been instituted in all government Ministries and Statutory Boards under a nation wide public sector Healthy Lifestyle Programme initiative. Over the years, the proportion of private workplaces participating in the Award has increased from 48% in 1999 to 81% in 2006. The quality of WHP has also improved as shown in the increase in the number of Singapore HEALTH Award (Gold) recipients from 12 in 1999 to 138 in 2006. The number of Platinum recipients has also grown from 3 in 2003 to 30 in 2006.

Is the initiative sustainable and transferable?
The Excellence in Workplace Health project is a national project, and is sustainable only if it has the support of three stakeholders: (a) Government agencies, (b) Employers, and (c) Workers. Employers want to see tangible benefits of having a WHP programme. They also want quick access to WHP services and programmes that are affordable and easy to access and implement. The workers themselves must want to participate in the programme. The Public Service’s role is critical, as the central co-ordinator and leader of the national effort. To ensure sustainability, the project has put in place several initiatives: (a) Capacity building – workplaces are taught how to monitor and track the progress of their WHP programme using a set of user-friendly WHP assessment tools and indicators; (b) Club HEALTH - a peer support programme that encourages sharing and exchanging of WHP best practices and experiences among business leaders; provides updates and teaching opportunities; offers discounts and privileges on WHP services; and provides support through an on-line community platform; (c) Affordable programmes - the 2003 WHP Survey showed that the main limiting factors for workplaces to implement WHP programmes were inadequate budget (46.8%), lack of employee demand (45.1%) followed by other cost concerns such as cost of external facilities (32.0%), cost of external service providers (28.9%) and lack of government subsidies and incentives (17.3%). To address their cost concerns, HPB coordinates bulk tenders for national WHP services and passes the savings from economies of scale to them; (d) Innovative programmes – that can engage workers and encourage them to participate. An example is RESPECT, a workplace HIV/AIDS education programme that uses humour and play to engage the audience; and (e) Promotional campaigns - to encourage workers to take greater ownership of their own health by emphasizing the importance of staying healthy in the face of an increasingly competitive global market. Ultimately, the key to the sustainability of the EWH project is the extent to which health promotion is accepted as an integral part of working life. To this end, the HPB’s education and engagement efforts over the years have succeeded in developing the culture throughout Singapore.

What are the impact of your initiative and the lessons learned?
Introducing such an ambitious transformational agenda was filled with challenges. These include: • Convincing employers and employees to be active stakeholders in managing their own health. This was not easy, as there was a concern that the EWH project would increase healthcare costs and reduce productivity. To garner support, the HPB had to engage the stakeholders regularly and show evidence that workplace health promotion efforts was, ultimately, economically viable. The HPB also implemented communication programmes to get “buy-in” from the workers, and collaborated with the workers’ union to convince the employees of the importance of participating in the WHP programmes to keep healthy so as to remain employable with advancing age. • Managing concerns by the workers’ unions about having to shoulder greater proportion of healthcare costs. When WHP was first introduced to the private sector, many workers were understandably afraid that the management would use the workplace health programme initiative to shift the burden of paying for healthcare costs to the workers. We had to organize several discussion forums between the unions, employers’ federation and the relevant government agencies to allay their fears. • Balancing the need to introduce programmes that are evidence-based and scientific, and yet appealing. We adopted a customer-centric approach, conducting many focus group sessions with various organizations to obtain feedback on how to modify and improve the programmes. Instead of coming up with ‘one size fits all’ programmes, we customized our programmes and services to suit the needs of specific market segments. • Bringing smaller organizations on board. We observed that workplaces with larger workforces of more than 500 employees are more likely to have a WHP programme, compared to workplaces with less than 500 employees. As more than 50% of workplaces in Singapore have less than 500 employees and they account for slightly more than half of the workforce, the challenge was to increase the uptake of WHP by small and medium enterprises. We responded by coming up with a one-stop programme designed specially for smaller companies.


Institution Name:		Singapore Health Promotion Board
Institution Type:		Public Agency
Contact Person:		Pin Woon Lam
Title:		Chief Executive Officer
Telephone/ Fax:		+65-6435-3108
Institution's / Project's Website:		+65-6438-3848
E-mail:		lam_pin_woon@hpb.gov.sg
Address:		Number 3 Second Hospital Avenue
Postal Code:		Singapore 168937
City:		Singapore
State/Province:
Country:		Singapore

The Problem

Solution and Key Benefits

Actors and Stakeholders

(a) Strategies

(b) Implementation

(c) Overcoming Obstacles

(d) Use of Resources

Sustainability and Transferability

Lessons Learned

Contact Information