Lutheran Community Care Services (LCCS) episode of REALink on Wednesday (14 October) had SDP Chairman and physician Dr Paul Tambyah as its guest speaker, and he spoke about poverty in Singapore, covering issues like promoting social mobility and the structural issues of poverty here.
Dr Paul said, “I seriously think that Singapore can do better in terms of dealing with poverty and it’s not a question of doing something new or different. Maybe it’s going back to some of the values in the 50s and 60s when it seemed to be a fairer place to live in.”
During the interview Dr Paul recalled how Singapore, back in those days, had polyclinics where people could pay just S$1 to see a doctor or S$5 if they were admitted in hospital. Even with those very low charges, the country had a standard of healthcare which was “comparable to the US and the UK”, he said.
The veteran physician and infectious diseases specialist then gave an example of a patient he’s seen who did not get medication for high blood pressure because they couldn’t afford it. Unfortunately, the untreated conditional eventually led to a stroke which, of course, incurred a higher medical cost for treatment and recovery.
Noting his frustration, Dr Paul went on to draw similarities between what he sees in Singapore’s healthcare and that of the system in the United State when he was there for six years doing his postgraduate training.
“It was kind of sad that what I was seeing in Singapore was actually very similar to what happened in Chicago where a lot of poor families in Chicago made use of the emergency department in hospitals for their primary care because they didn’t have health insurance and they had no access to primary care physician,” he said.
He went on to note, “Over the years, what’s happened with the restructuring of healthcare, we are moving close and close to the US model where healthcare is seen as kind of an industry rather than as a form of social need or social service. And that is not just a philosophical thing because it affects people’s daily lives.”
“These inequalities in an area as fundamental as health disturb me,” added the physician.
How we measure poverty doesn’t tell the “whole story”
When asked on his opinion of what factors contribute to poverty in a wealthy city like Singapore, Dr Paul pointed out that “an average hides inequality” and doesn’t depict the “whole story”.
However, certain measures like the GINI Coefficient, he said, does measure inequality.
“But in Singapore, the GINI Coefficient is a bit unusual in that it doesn’t count one fifth of the people in Singapore—that’s the migrant workforce—because the published GINI Coefficient refers to Singaporeans and PRs,” he noted, adding that poverty is not a topic that well understood.
Even so, there are a few researchers who have studied this matter specifically, such as Prof Ng Kok Hoe from the National University of Singapore and Prof Teo Yu Yenn from Nanyang Technological University who have both contributed to the understanding of this issue. For example, by studying the minimum monthly income an elderly person would need to survive in Singapore—a “defacto poverty line”, as described by Dr Paul.
Addressing the structural issues of poverty
One thing Dr Paul repeatedly emphasised throughout the interview was that the structural issues of poverty must be addressed for any lasting change to happen, adding that even in a wealthy country like Singapore, there are many people who are living on the edge and are only one financial disaster away from hitting rock bottom.
“In the past, we had a welfare state in Singapore. In the 1960s and 70s, I know we were not as wealthy as we are today, but there seems to be a lot less inequality and the data also supports that,” he noted.
Moving on to education, Dr Paul also talked about how education was supposed to be a leveller, and indeed it was five decades ago when everyone had more of an equal opportunity and access to education than they do today. Education appears to have become very segregated in the last 20 years, said Dr Paul.
“Despite the rhetoric, the top schools which are the hardest to get into appear to be concentrated in the Bukit Timah and Bishan areas where the real estate is more expensive,” he pointed out, adding that private preschools tend to have teachers who are more highly trained and have more resources compared to public preschools.
This means that children whose families cannot afford private preschool will find it difficult to catch up with their peers from private preschool who have the advantage of smaller classrooms and more resources.
He also highlighted the S$1 billion tuition industry which also serves to aggravate the gap between the rich and the poor as those who cannot afford it will often be behind in terms of educational performance compared to those who can.
This is another structural issue that needs to be addressed.
Advocacy is key
As for what people can do about poverty in Singapore, Dr Paul emphasised the need for more advocacy on top of fundraising, volunteering, and charity. This is because advocacy is one of the ways to address the structural issues of poverty.
Recounting a story about his mother’s advocacy work, Dr Paul talked about how she had raised funds to buy an ambulance in order to set up a mobile clinic to delivery care to disabled children but faced a stumbling block when she realised she needed to pay for a Certificate of Entitlement (COE) for the vehicle, which cost another S$20,000.
So what she did was find a way to set up a meeting with the then-Minister for Community Development to explain the situation to him. When he heard about the problem, the minister helped them out, which eventually led to the current system where ambulances do not require a COE.
Dr Paul reiterated how this anecdote illustrates the importance of advocacy and how it can help address structural problems upstream which will eventually benefit everyone. He added that in order for this to work, people need to work together to get things done and effect change.
Watch the full interview here: