National Population Health Survey 2023 Shows Singaporeans Are Adopting Healthier Lifestyles

The Ministry of Health's (MOH) National Population Health Survey (NPHS) 2023 shows improved trends in lifestyle and preventive health indicators among Singapore residents. Key findings from the survey highlight that there was significant increase in Singaporeans' total physical activity, reduced prevalence of smoking, improvements in the state of mental health, as well as increased vaccination rates.

2. The NPHS 2023 tracks the health, risk factors and lifestyle practices of Singapore residents aged 18 to 74 years from household interviews conducted from July 2022 to June 2023. Obesity and chronic disease prevalence from health examinations, conducted on a two-year survey cycle (NPHS 2023-2024), will be reported next year.

I) Encouraging healthier lifestyles

Prevalence of smoking continues to decline

3. The prevalence of daily smoking has decreased further from 9.2% in 2022 to 8.8% in 2023, continuing the declining trend of smoking rates over the past decade.

4. To further reduce smoking prevalence, we will continue our multipronged efforts, including a mix of policy measures, public education and provision of cessation support. The Health Promotion Board (HPB) continues to run I Quit, the national cessation programme, and QuitLine, a tele-counselling cessation service to help smokers and vapers quit the habit. Resources and content are also available on HealthHub, with tips for smokers and vapers to lead nicotine-free lifestyles. Over 6,000 participants joined the I Quit programme in 2023. We will also explore next-bound tobacco control measures to encourage a nicotine-free lifestyle.

Significant increase in sufficient total physical activity

5. The proportion of residents engaging in sufficient total physical activity¹ increased from 74.9% in 2022 to 78.5% in 2023. The largest contributor to total physical activity in 2023 was commuting (45.6%), followed by leisure-time physical activity (29.1%) and work-related physical activity (25.3%).

6. We will continue to leverage technology to provide residents with different avenues to sustain and nudge active lifestyles. The National Steps Challenge continues to encourage more Singaporeans to engage in at least 150 minutes of moderate- to vigorous-intensity physical activity per week, in line with the Singapore Physical Activity Guidelines. Sign-ups increased from close to 700,000 in February 2023 to more than 860,000 in August 2023. We will also increase residents' access to physical activity programmes through whole-of-government partner collaborations and building up of industry capability to offer more programmes. Residents can additionally access resources on HealthHub, such as online exercise videos, to engage in self-directed activities.

Improvements in the state of mental health

7. The prevalence of poor mental health decreased from 17.0% in 2022 to 15.0% in 2023. Concurrently, the proportion of Singapore residents who were willing to seek help from healthcare professionals increased significantly to 62.8% in 2023, compared to 56.6% in 2022, while 78.4% of Singapore residents were willing to seek help from informal support networks in 2023, compared to 79.7% in 2022.

8. As part of the deliverables laid out in the National Mental Health and Well-being Strategy launched in October 2023, the government will improve mental health support across all settings. We will also sustain our preventive efforts through public education to empower individuals to proactively manage their mental well-being, and encourage help-seeking and support within the community.

Improved uptake of influenza and pneumococcal vaccinations

9. Both self-reported influenza vaccination uptake among Singapore residents aged 18 to 74 years and self-reported pneumococcal vaccination uptake among Singapore residents aged 65 to 74 years increased significantly, from 18.0% in 2022 to 21.7% in 2023, and from 26.5% in 2022 to 35.0% in 2023 respectively.

10. To further encourage vaccination take-up, Singapore Citizens enrolled in Healthier SG can receive free influenza, pneumococcal and other vaccinations based on the National Adult Immunisation Schedule at their enrolled Healthier SG clinic. We will also continue our public education efforts to raise awareness and increase uptake of these vaccinations. For example, SMS reminders are sent to seniors aged 65 and above to go for flu and pneumococcal vaccinations, as well as to eligible females to make appointment for the human papillomavirus (HPV) vaccination.

Increased screening participation for chronic diseases, cervical and colorectal cancers

11. Chronic disease screening participation increased from 60.3% in 2022 to 62.6% in 2023. Screening participation for cervical and colorectal cancers increased from 43.1% in 2022 to 45.4% in 2023, and from 38.1% in 2022 to 41.7% in 2023 respectively. However, screening participation for breast cancer decreased from 37.6% in 2022 to 34.7% in 2023.

12. Under Healthier SG, eligible Singapore Citizens can receive fully-subsidised nationally recommended screening tests and the first follow-up consultation at their Healthier SG clinic. For younger adults aged 18 to 39 years old, the Diabetes Risk Assessment tool on HealthHub assesses their risk of diabetes. Those at higher risk are encouraged to go for subsidised health screening and the first follow-up consultation at a Community Health Assist Scheme General Practitioner (CHAS GP) clinic. HPB will also continue to enhance outreach efforts and work closely with partners such as the National Cancer Centre Singapore, National Cancer Institute Singapore, Singapore Cancer Society and Breast Cancer Foundation, to amplify the screening messaging during cancer awareness months and outreach events.

II) Encouraging healthier diets

13. Another key area that MOH is focusing on is encouraging healthier diets. In particular, we will take stronger action to reduce sodium and saturated fat intake among Singapore residents, with the extension of mandatory nutrition labelling and advertising prohibitions to key contributors of these nutrients.

Effectiveness of Nutri-Grade measures on beverages

14. High sugar intake is linked to an increased risk of obesity and diabetes. In Singapore, sugar-sweetened beverages are the single largest source of sugar intake. As part of efforts to reduce the population's sugar intake and continue tackling diabetes, we implemented Nutri-Grade labelling requirements and advertising prohibitions for prepacked and freshly prepared beverages in December 2022 and 2023 respectively.

15. These measures have led to reductions in the median sugar level of beverages in the market and total sugar intake among Singapore residents. Overall, the median sugar level of prepacked Nutri-Grade beverages has reduced from 7.1% in 2017 to 4.6% as of September 2023. Similarly, as of September 2023, 69% of beverages purchased were graded "A" or "B", up from 37% in 2017.

16. To complement the Nutri-Grade measures, HPB also launched the "Siu Dai by default" movement in September 2023. This initiative encourages food and beverage (F&B) establishments to offer freshly prepared drinks with less sugar as a default. Key coffeeshop associations, representing over half of coffeeshops in Singapore, as well as other beverage sectors such as bubble teas and speciality drinks, have pledged their support for the movement. About six in 10 beverage outlets across all sectors are now offering less sweet freshly prepared drink options by default.

Extension of Nutri-Grade measures to key contributors of sodium and saturated fat intake

17. Excessive intake of sodium and saturated fat are key risk factors for chronic diseases such as hypertension and hyperlipidaemia. Based on past NPHS results, the prevalence of hypertension had increased from 19.8% in 2010, to 37.0% in 2021 to 2022, and the prevalence of hyperlipidaemia remained worryingly high, with 31.9% of Singapore residents having the condition in 2021 to 2022. The National Nutrition Survey 2022 also showed that nine in 10 Singapore residents exceeded the recommended sodium limit of 2,000mg a day, and we are, on average, consuming about twice the daily limit at 3,620mg a day. Similarly, we are consuming 36% of saturated fat as a proportion of total fat, which exceeds the recommendation of no more than 30%.

18. The key sources of sodium intake among Singapore residents are from salt, sauces, seasonings and instant noodles, and the key source of saturated fat intake is cooking oil. Despite growth in the availability of healthier salt, sauces, seasonings and cooking oil in the market, adoption among consumers and F&B operators remains low. There also continues to be a lack of healthier alternatives for instant noodles. More needs to be done to increase the adoption of healthier alternatives and further spur industry reformulation in these product categories, so as to reduce Singaporeans' sodium and saturated fat intake.

19. Between April and May 2024, MOH and HPB engaged over 80 market leaders across the food supply chain on possible measures to reduce Singaporeans' sodium and saturated fat intake. Generally, the industry concurred with the need to do more to reduce Singaporeans' sodium and saturated fat intake. In the retail sector, many manufacturers have begun their reformulation journey, and are committed to doing more. In the F&B sector, tackling sodium and saturated fat content in dishes is more challenging, given the variability in added ingredients during cooking. The F&B operators also highlighted that time would be needed for consumers to adjust their palates and accept lower-sodium dishes, and for operators to adopt healthier ingredients.

20. We have carefully considered the feedback received, and reviewed the international and local evidence of measures taken. Looking at the positive impact of Nutri-Grade labelling and advertising prohibitions in lowering Singaporeans' sugar intake, we will be extending the two measures to key contributors of sodium and saturated fat in the retail setting: prepacked salt, sauces and seasonings; instant noodles; and cooking oil. These measures aim to:

a) Help consumers make more informed, healthier choices by identifying products that are higher in sodium and saturated fat;

b) Spur industry reformulation; and

c) Reduce the influence of advertising on consumer preferences.

21. We will likely retain the key features of the existing Nutri-Grade measures, and will be conducting further consultations with the industry over the coming months. The consultations will focus on the implementation details, including the nutrient thresholds underpinning the Nutri-Grade measures, to ensure that the measures are practicable and feasible. More details will be announced when ready.

22. For the F&B setting, we will focus initially on ramping up voluntary, store-front labels to help consumers identify stores that offer healthier dishes. These include dishes that use healthier ingredients or are prepared with less salt or sauces. We will also step up on public education efforts to educate consumers and F&B operators on the importance of reducing sodium in food, and strengthening our engagements across the supply chain to increase F&B operators' access to healthier ingredients.

23. Together with continued efforts to encourage the industry to offer even more healthier product offerings, we will continue to reshape consumer behaviour and choices.

24. The full NPHS 2023 report is available on the MOH website at https://go.gov.sg/nphs2023report.