The New York Times has recently been talking a lot about the Singapore health system. Most recently here. However, in all the discussion about the amazing cost/benefit of the Singaporean system what’s lost is any consideration of a major Singaporean health initiative. Singapore’s “individual mandate,” if you will, is the enforced physical fitness of roughly 40% of the population between ages 20 and 40.
Singapore is a small city-state (population 5.6mm). Following British troop withdrawals in the 1960s, it instituted mandatory national military service for men. Two full years between high school and college. It doesn’t end there, however, those who’ve completed this full time national service are required to undergo reservist training for 10 years.
This training is no cake walk, as reservists comprise 80% of the armed forces they are required to maintain physical fitness between annual bootcamps. The Individual Physical Proficiency Test is given annually and is demanding. 70% of older reservists reportedly fail. And what happens when they fail? They go for remedial training. Essentially, months of free exercise classes.
Perhaps, this is why Singapore is the only developed country with an average BMI between 20 and 23 (i.e. ideal) or a morbid obesity rate of .1% compared with 5% in the US and 1.5% in neighboring Malaysia.
This sustained enforced physical fitness for a substantial segment of the population presumably shapes the health outcomes for these individuals, but I suspect it’s not a far leap to think it develops a fitness culture across the country which further enhances the official health policies.
The primary reason for this program is self defense, but it can also be viewed as targeted health plan. As such, it ought to be discussed on both the cost and benefit side of the equation when comparing with other global health systems.