Singapore

Section 1: Country Introduction

Map

Figure 1. Map of Singapore outlining the country with a scale bar.

Singapore is a rather unique country. As an island city-state in Southeast Asia, located off the southern tip of the Malay peninsula, Singapore’s capital city is Singapore. The country is made up of 63 islands including the main island Pulau Ujong, which are organized into the five regions seen in the map below.

Figure 2. Map of Singapore displaying the five urban districts. These district lines were drawn by the Ministry of National Development in Singapore in their 1991 Concept Plan.

Developed for urban planning and general administrative purposes, this five-region system allows for the country to be further divided for governance by councils and mayors–of course, under the leadership of the executive branches of its parliamentary republic. The populations and areas of these regions are denoted in the table below.

Figure 3. Tabulated data of the populations and areas of the five urban regions of Singapore based on 2020 values. Data has been arranged in terms of current population, from least to greatest.

Urban vs Rural Population

The urban population of Singapore has been reported at 100% from 1960 until the most recent data collected in 2020, according to the World Bank’s collection of development indicators; the entirety of the country is essentially one large urban center. Per the criteria outlined by the United Nations, any town or city with 20,000 people+ living within its established boundaries is considered to be urban. Thus, in the case of Singapore, this means that 100% urbanization has been achieved. The general population of Singapore has continued to grow during this same time, as can be seen in the plot below. There has been an overall increase in the Singaporean population, other than two small dips in the mid-1980s, during the country’s two-child policy, and in 2003, due to a SARS outbreak in the country.

Figure 4. General Population Growth in Singapore from 1960-2020. Data obtained from Singapore Department of Statistics.

As can be seen, Singapore has been experiencing a steady population growth since 1960. In 2020, its population was 5.686 million people. It is predicted that the country’s population will continue growing, put into context of current migration and fertility trends.

Urban vs Rural Population Density

According to the United Nations Department of Economic and Social Affairs, Singapore is the second most densely populated country in the world, with 8,019 residents per kilometer squared, or 18,645 residents per mile squared. This can be primarily attributed to Singapore’s highly urbanized nature, with the entire country being one large urban center.

Climatic and Geographical Analysis

As mentioned above, Singapore is a sovereign city-state that consists of one large island (mainland Singapore or Pulao Ujong), and 62 smaller islands. Most of Singapore is flat, with more than half of mainland Singapore situated only 50 feet above sea level. Bukit Timah Hill, the highest point of Singapore at 545 feet above sea level, is located in the middle of the island. Because Singapore is near the equator, it has a tropical climate, uniform temperatures, high humidity, and lots of rainfall throughout the year. Similar to other countries in the region, Singapore experiences monsoon season from November to February.

When considering Singapore’s geography and natural landscape, it is important to keep in mind that the country is 100% urbanized, which has had serious repercussions. Over time, about 95% of Singapore’s forests have been lost to industrailization and urbanization. Currently, the government is putting its efforts to setting aside specific bits of land across the island to be used for parks, nature reserves, and other green spaces.

Section 2: Demography

Crude Mortality Rate

Figure 5. Mortality Rate in Singapore, Malaysia, and Thailand from 1960-2020. Data obtained from World Bank Open Data.

According to data posted by the World Bank, the mortality rate in Singapore was 5 per 1000 people in 2020. Its neighboring countries, Malaysia and Thailand, had mortality rates of 5.2 and 7.8 per 1000 people in 2020 respectively, which were both higher than that of Singapore.

Crude Fertility Rate

Figure 6. Fertility Rate in Singapore, Malaysia, and Thailand from 1960-2020. Data obtained from World Bank Open Data.

According to data posted by the World Bank, the fertility rate in Singapore was 1.14 births per woman in 2020. Its neighboring countries, Malaysia and Thailand, had fertility rate of 1.98 and 1.51 births per woman respectively, which were both slightly higher than that of Singapore.

Life Expectancy

Figure 7. Life Expectancy at Birth in Singapore from 2000-2019. Male values are denoted in blue while female values are denoted in red. Data obtained from World Bank Open Data.

Overall, the life expectancy for both sexes has risen since the turn of the century, going from 80 to 85 for females, and 76 to 81 for males. Females consistently had a life expectancy during this time period.

Median Age

Figure 8. Median Age in Singapore from 1955-2050. Graph includes predictions for the next three decades. Data obtained from Worldometer and United Nations collaboration.

Median age data from 2021-2050 are based on estimates from Worldometer through an elaboration of data from the United Nations, Department of Economic and Social Affairs, Population Division. The median age in Singapore is currently 42.2 years, which is a considerable increase since the mid-20th century. Predictions, located to the right side of the dashed line, estimate the median age to continue increasing and reach 53.4 years by 2050.

Infant Mortality Rate

Figure 9. Infant Mortality Rate in Singapore from 1950-2020.

There has been an overall decrease in infant mortality rate (measured in the number of deaths in every 1,000 live births) since 1950. The decrease can be split into three general phases, as can be seen in the graph above: 1950-1965, 1965-1990, 1990-2020. With more recent developments, especially within the realms of health and healthcare, the infant morality rate of Singapore has continually decreased since 1950. Currently, the country experiences an average of 2 infant deaths per 1,000 live births, ranking fourth in lowest rates among other countries across the globe.

Percent of Population that is Working-Age

Figure 10. Percent of Working Age Population between 15-64 Years Old between 2010-2020. Data obtained from World Bank Open Data.

According to data and articles posted by the Singapore Manpower Research and Statistics Department, the working age population is described as anyone aged 15 and older. Young people aged 15 can work in both industrial and non-industrial settings, though some conditions apply when working in the latter.

Population

Figure 11. Age Distribution of Singapore Population in 2021. Data obtained from Singapore Department of Statistics.

Figure 12. Age distribution of the Singaporean population, divided by sex, based on reported figures from 2019. Data obtained from https://www.populationpyramid.net.

“Jumps” in Age Structures: Contributing Events

There are a few things to consider when looking at the age structure of Singapore society. The first major discontinuity is seen when moving from the 65-69 age range to the 70-74 age range. Prior to this category, there had been a steady decline in the population numbers.Yet, this is where that decline drops much more significantly and in a way that looks different between male and female populations.Women’s age structure seems to decline in a much more consistent way, showing a sharp decline, but one that is much steadier compared to the male population. Men in this age range see a much more significant drop in population, suggesting that women tend to live longer on average compared to their male counterparts given social and biological factors that contribute to lifespan differences between the sexes. Moreover, the population structure shows a significant portion of the population is within the 20-24 to 60-64 age range, with the highest being 45-49 for women and 55-59 for men in Singapore. This is interesting for a few reasons. First, the high numbers of those between 20 and 40 years old reflect social policy moves that were made in Singapore in the 1980s. After years of a two-child policy within the country to help curb population growth after World War II, Singapore had reversed its policy approach in the 1980s (BBC, 2021). During this period, the country actually encouraged citizens to have bigger families to increase the size of the shrinking population. Thus, the largest age categories tend to fit around this period, with the exception of the highest population group of men being 50-59.

Section 3:Cultural-Linguistic Information

Linguistic landscape

Before diving into the details, it is important to review the general linguistic landscape in Singapore. Due to the diversity of the country, there are a variety of languages used for different purposes. The country has four official languages: English, Mandarin, Malay, and Tamil. Malay is the national language of the country, related to the Singapore’s previous status as a state of Malaysia. English is the lingua franca of Singapore, with academic, professional, and governmental affairs being in this language.

In addition to these more common language, there are a plethora of minority languages spoken in Singapore. These include, but in no way are limited to, Indonesian, Korean, Japanese, and Punjabi.

Top three languages

Figure 13. Most Common Languages Spoken in Singaporen Homes. Data obtained from Singapore Department of Statistics.

English stands as the most commonly spoken language in Singaporean homes, with over 1.3 million speakers. Mandarin Chinese is a close second, with 1.23 million Singaporeans speaking it in their homes. Other Chinese dialects grouped together come in third at around 430,000 speakers.

Geographic Distribution of Languages

Singapore is a very unique country, both in its governmental structure and its demographics. As outlined above, Singapore is divided into five regions, which are all incredibly diverse in terms of their demographic makeup. Migration to the country from countries such as China, Indonesia, and India, among many more, have resulted in great variety of languages. Given that there is little homogeneity in these communities, both geographically and linguistically, it is very difficult to determine what the geographic distribution of the languages is.

According to the Singapore Department of Statistics, more than 40% of the Chinese folks living in the country come from the Chinese province of Fujian, 25% originate from the Chinese province of Guangdong, and the others come from a multitude of other Chinese provinces. This very assorted community (a) speaks mutually incomprehensible dialects of Mandarin and (b) lives all across Singapore. The Indonesian community in Singapore is rather similar to the Chinese one, speaking Javanese, Boyanese, among many more dialects and living throughout the country. The Indian group living in Singapore is actually the most diverse of the three main ethnic groups in the country, consisting primarily of Tamils, Malayalis, and Sikhs. In addition to all of this, there are also relatively large Pakistani and Sinhalese commnunities in Singapore, further contributing to the linguistic diversity of the country.

Section 4: Economic Information

Largest Industries

Figure 14. Top 5 Industries per Revenue Generated in 2020. Data obtained from GuideMeSingapore, Hawksford.

The five largest industries in Singapore include manufacturing, wholesale & retail trade, business services, finance & insurance, and service. These industries were the top contributors of Singapore’s $376 billion GDP in 2018. According to Hawksford (2020), these have been the industries at the top five as of 2018. The 2018 data showed manufacturing at a worth of $21,635,200,000. This was actually the top of the gross producing industries, as well as the top industry nationwide. Next was wholesale & retail trade, which in 2018 was valued at $18,535,800,00 (Hawksford, 2020). These top two industries are interconnected with international and domestic trading. Third was business services, valued at $15,957,500,000 in 2018. Then finance & insurance was valued at $15,080,500,000. Finally, the service industry in Singapore was listed in 2018 at being valued at $11,683,800,000 (Hawksford, 2020). These last three industries also demonstrate how Singapore has a healthy internal economic structure as well. Looking at the top industries, Singapore has a wide variety of lucrative areas that contribute to its overall GDP.

Food Production

Figure 15. Food Produced Internally in Singapore.

With little farming land, Singapore imports most of the food consumed in the country. The food at our local markets mainly comes from overseas. Accroding to the research paper, Singapore has only five million crammed on a landmass of just 715 square kilometres in 2018.

Figure 16. Singapore’s Food Imports.

According to the data, Singapore’s food consumption is highly depends on food import from other countries. Especially vegetable, meat and seafood. Singapore spends twice as much on imported food as it does on produced internally.

Unemployment Rates

Figure 17. Unemployment Rates in Singapore from 1991-2020. Data obtained from Macrotrends.

Median Adult Income

Figure 18. Median Income per Household Member in Singapore from 2000-2020. Data obtained from Singapore Department of Statistics.

As can be noted in the graph above, median income per household memebr rose from $916 in 2000 to $1369 in 2010, and finally hit $2138 in 2020.

Important Exports

Figure 19. Top 5 Exports (in billions of USD) in 2020. Data obtained from Department of Statistics, Singapore.

Trade is a critical part of Singapore’s economy. Its primary export is machiner and equipment, accounting for 43%. Other important exports include petroleum (19%), chemical products (13%), miscellaneous manufactured articles (8%), and oil bunkers (7%). At the moment, Singapore’s main trade partners are China, Hong Kong, Malaysia, Indonesia, Japan, and the US. For us here in the US, Singapore is currently our 17th largest goods trading partner with over $57 billion in two-way goods trade during 2020.

Important US Imports from Singapore

Figure 20. Top 5 Imports According to USD in Billions in 2020. Data obtained from Office of US Trade.

Section 5: Education

Average Years of Schooling

Figure 21. Average Years of Schooling among Singaporean Adults. Data is of individuals 25 years and older in Singapore. Data obtained from Our World in Data.

University Education Among Adults 25+

Figure 22. Percent of Population Above 25 Years Old with University Education, stratified by age. Data obtained from Trading Economics.

Singapore boasts a relatively high percentage of its population ages 25 and older who hold a bachelor’s degree or equivalent. In 2015, 30.47% of men aged 25 years and older had completed a bachelor’s degree or equivalent in Singapore (Trading Economics, 2021). This number increased in 2016 and has been steadily increasing year by year. The World Bank (2021) also had even more pertinent data regarding this population in the country. In 2019, an average 32.4% of the population aged 25 or older had received a bachelor’s degree or equivalent (World Bank, 2021). Still, there were some slight differences when looking at the population based on gender categories. In 2019, 30.8% of women aged 25 or higher had a university degree, showing slightly less than their male counterparts who were at a rate of 34.1% (World Bank, 2021). While this is lower than men’s rates, it is still significantly higher than many other countries, especially many countries in Asia. In fact, Singapore’s percentage of the population with a bachelor’s degree over the age of 25 is high looking at global numbers. Still, it was less than the United States’ percentage of 37.3% of people 25 and older who held bachelor’s degrees in 2019 (World Bank, 2021).

Yearly University Tuition

Figure 23. Average Tuition of the Six Autonomous Universities in Singapore, reported in Singaporean Dollars. Data obtained from Ministry of Education.

As a percent of the median adult income of the country, reported at 83,400 SD in 2021, National University of Singapore (NUS) was 23.6%, Nanyang Technological University (NTU) was 23.3%, Singapore Management University (SMU) was 30.4%, Singapore University of Technology and Design (SUTD) was 35.3%, Singapore University of Social Sciences (SUSS) was 28.7%, and Singapore Institute of Technology (SIT) was 29.0%.

Section 6: Population Trends

Age Structure (Jade)

Next, it is important to explore Singapore’s population profile in order to extrapolate additional patterns within the country. In 2021, the population of the state was 5.45 million, representing a population decline of 4.1% compared to the year 2020 (Department of Statistics, 2021). The total number of residents, citizens and permanent residents, in Singapore was 3.9 million, representing a 1.4% decline in size. The country has a 4.0 Old Age Support Ratio, which reflects the number of residents from twenty to sixty-four per residents over the age of sixty-five. There was a small decline of the Old Age Support Ratio from 2020, which was 4.3 (Department of Statistics, 2021). This means that the older population’s percent of the population is shrinking, while the working age remains strong. This leads us into a further detailed discussion of the age structure within Singapore, which reflects larger demographic trends. The age structure in Singapore demonstrates a large portion of the population is within the working range, which strengthens the country’s labor force capabilities. Currently, there are 2,565,700 people within the 20-64 age category (Department of Statistics, 2021). The average age is listed by government statistics as 40.8 years old (Department of Statistics, 2021). This reflects the largest age group, which is also within the working age range. Individuals under 20 years old are the second largest age category, making up 782,100 people. This is encouraging because it suggests a continuation of a strong labor force in the future. As the younger population ages, it will also enter into the labor force and provide a fresh new source of working capital as fewer individuals age out of the workforce. It is beneficial to have the largest age classification within working age to ensure the health of the economy and nation. The smallest category is above 65 years old, which shows that the country has a relatively young population with fewer older adults that have been removed from the labor force. This population is actually declining, as seen by the drop in old-age support ratio from 4.3 in 2020 to 4.0 in 2021 (Department of Statistics, 2021). That helps the state free up resources that would have otherwise been spent on caring for a large ageing population, like the Baby Boomers we see here in the United States. Still, a study from Chan (2005) demonstrated that the old age category is changing. Due to increasing life span expectations, there has been a growth of the oldest-old category, which are those individuals 75+. This means that the above 65 category is greatly diversifying, with different age groups in that larger category reflecting different trends and needs. As life expectancies increase, there is a need to treat older age categories with greater detail, as not everyone over the age of 65 represents a single position within the age profile. Many are still working into their 70s and often individuals are showing vastly different health needs within this later age range classification.

Migration (Jade)

Immigration to Singapore has followed key socio political trends. Taking a look at the net migration data provided by the UN’s World Population Prospects, Macrotrends (2021) provides insight as to how those socio political trends are resulting in real data. During the middle of the twentieth century, Singapore saw a growth in industrialization, which requires unskilled labor forces. This often results in a state encouraging migration to help serve growing labor needs. For example, in the 1950s, the large net migration rate was filled with Malay nationals. This culminated in a high spike of net migration in 1967, which hit a 566.6% growth rate (Macrotrends, 2021). However, the massive influx prompted stricter immigration policies, which resulted in a significant drop in the net migration rate in the late 1960s and into the 70s and 80s. This started with the sharp drop seen in 1969. Macrotrends (2021) recorded a drop of 313.51% in net migration. That is a truly stunning decline, considering the net migration rate was up above 500% just two years earlier in 1967. Another economic wave would again hit Singapore, encouraging more migration to fill labor demands. As globalization spread throughout the 1990s, the net migration rate once again began to climb. Singapore encouraged the immigration of “foreign talent” to help bolster business and tech industries (Hudson, 2017). Yet, there was also a large influx of unskilled immigrants from surrounding nations. Around 2000, the rate of new immigrants had outgrown the natural birth rate of the native population of Singapore, meaning that the population growth was more due to incoming immigrants. By 2010, almost 40% of the population in Singapore represented foreign born immigrants (Macrotrends, 2021). Many of these immigrants were unskilled laborers from Malaysia, China, Myanmar, Indonesia, and Macau (Hudson, 2017). They helped boost infrastructure projects as there was a ready supply of labor for construction projects. There were also large numbers of female immigrants that entered into the Singapore domestic industry. By 2015, 230,000 female migrants worked in the domestic industry (Hudson, 2017). Since 2017, the net migration rate in Singapore has dropped significantly. This reflects the same type of ebb and flow scenario seen in the late 1960s and 70s. The drop seen in 2017 regarding the net migration rate is again due to changing and tightening immigration policies in Singapore. In 2017, the government increased income requirements for immigrants looking to migrate into the country. The graph below this paragraph highlights a sharp and then continual decline in the migration rate. In 2020, there was a further decline in this migration trend. In fact, the net migration rate dropped 0.83%, signifying the impact of the COVID-19 pandemic and its restrictions on travel (Macrotrends, 2021). In July of 2021, the net migration rate was 4.26 migrants for every 1,000 native population. This was a 0.82% reduction in the migration rate from 2020 (Macrotrends, 2021). Given the current sociopolitical environment, it can be assumed that Singapore’s net migration rate will continue to be on the decline for the immediate future.

Income Equality (Amalina)

According to the government report Key Household Income Trends (2020), median monthly household income from work had risen over the last 5 years, but fell by 2.5% in 2020. Additionally, median monthly income per household member dropped by 1.3% in 2020, though employed households across all income groups experienced an incline in average monthly income per household member from 2015 to 2020. The declines seen in 2020 could be attributed to financial difficulties caused due to the Covid-19 pandemic. The government reportedly attempted to assist families in mitigating these troubles, and reduce subsequent financial inequalities. Households (including those within which there were no employed members) received $6308 per household member through government schemes, an amount higher than the one given out in 2020. Residents living in smaller (1 or 2 room) HDB flats received higher amounts than those living in 3 room HDB flats (HDB flats are subsidized public housing for Singaporeans). Ultimately, the Gini coefficient was reduced from 0.52 to 0.37 in 2020, which could be attributed to government transfers provided to mitigate covid-related financial troubles.

Peng (2019) writes that historically, the Gini coefficient* hit a peak of 0.48 in 2007, stabilized at around 0.45 from 2016 to 2018 and plateaued at about 0.40 in 2019.

Lee (2004) explored how income inequality in Singapore differed between different ethnic groups. On reviewing data regarding ethnic income inequality through the lenses of human capital and labour market segmentation, he found the main predictor of income equality to be discrimination rather than educational differences. Chinese people were found to dominate high paying jobs in the fields of economics and politics while Indians and Malays occupied lower-paying jobs across various sectors.

Singapore, like several other countries, also has a gender pay gap. A new study conducted by the Ministry of Manpower (2020) found that Singaporean women were earning 6% less than male counterparts. The adjusted 6% gap factored in details like age, industry and education. It was found that difference in occupation was the biggest contributor towards age gap, with men being over-represented in higher-paying occupations, compared to women. The gap has narrowed from 2002, when women earned 8.8% less than their male counterparts. According to data published by the World Inequality Database (2021), in 2021, the pre-tax income share held by the top 10% of Singaporean earners was 46% of the total national income, while the the pre-tax income share held by the bottom 50% of earners was 17.6% of the total. These figures have stayed relatively stable since 2014. In 2000, the pre-tax income share held by the top 10% of Singaporean earners was 42% of the total national income, while the pre-tax income share held by the bottom 50% of earners was 16.7% of the total.

*The Gini coefficient is a summary measure of inequality that ranges from 0 to 1. 0 indicates total income equality while 1 indicates total inequality.

Climate Change (Amalina)

According to the IPCC, mean global temperatures are likely to reach 1.5 degrees celsius towards the end of the century, which indicates that glaciers will continue to melt. Due to rapidly advancing climate change, sea levels have been rising in coastal areas in Singapore for the last few decades. Since Singapore is a low-lying country, it is particularly vulnerable to global warming-induced sea level rise. The National Climate Change Secretariat of Singapore (2021) states 30% of the island is less than 5m above Singapore Height Datum (a term used to indicate mean sea level), meaning that sea level rise is an immediate threat.

Since the 1970s, the Sultan Shoal, Sembawang and Raffles Lighthouse have shown sea level rise rates of 2.78mm/yr, 2.12mm/yr and 3.55 mm/yr respectively. This indicates that the average sea level in Singapore today is about 140mm compared to pre-1970 levels (“Annual Climate Assessment Singapore”, 2019). In the future, sea levels are projected to rise by up to about 1mm by 2100. Low-lying coastal areas could experience flooding during severe storms, or also become completely submerged over time (“A climate-resilient Singapore for a sustainable future”, 2019 ).

Additionally, research shows that sea level rise in Singapore resulting from melting ice sheets and glaciers was projected to be 10-15% higher than the global average. Projected sea level rise in Singapore was found to be higher than global estimates (Cannaby et. al, 2016).

Recent research conducted by Chua et al. (2021) attempted to uncover sea level rise trends going back 10,000 years ago hoping that it would lead to better future predictions. The last natural period of global warming took place about 10,000-7000 years ago and was called the Holocene, which is when global sea levels had risen. The researchers stated that sea levels had been stable in Singapore for about the last 3000 years, and recently have started rising again in the 20th century due to current climate change.

Fertility (Michelle)

From a macro perspective, Singapore’s fertility rate has shown a downward trend over the years. The issue of a continuous fertility decline lies at the core of these policy challenges. The fertility rate has been declining rapidly since the late 1960s owing in part to the vigorous anti-natalist policies of the government as part of its economic growth policies. By the mid-1970s, the total fertility rate had reached below replacement levels. Since 1984, the Singaporean government has adopted a pro- natalist approach, introducing several policies and programs to encourage procreation and marriage. Aggregate trends show that the fertility decline, standing at an alarming level of 1.2. Basically, the researchers argued that the low fertility of Singapore is related to demographic structure, economic situation and social structure. Much of the work in the studies on fertility in Singapore has largely been descriptive of the consequences of low fertility and the effectiveness of pro-natalist policies. These factors affect the marriage market in Singapore. Firstly, there are increasingly more opportunities for women in the workplace. Therefore, women are more independent and prefer to focus more on career and get married later than before. Second, Singapore has a high quality of labor capital, which results from high quality education of children. However, it requires the parents to contribute a lot in high tuition fees to curricular and extracurricular exercises, and requires kids to achieve a great academic score. This puts too much pressure on parents. Third, the adults in Singapore take marriage more and more seriously. Rising divorce rates in Singapore also lead to increasing caution in marriage. All of these factors lead to late marriage and low fertility rates in Singapore, and long-run effects of these variables on fertility will take a negative sign while female labor participation is positive.

Mortality (Michelle)

Overall, the mortality rate in Singapore has shown a downward trend over the years. Adult mortality, which refers to the risk of dying after the 15th birthday but before the 60th birthday for men and women. Over the past 4 decades, Singapore has made significant progress in reducing adult mortality over this period. Study found that adult mortality in Singapore has dropped by 64% from 24.0% in 1970 to 8.7% in 2010 for men, and by 68% from 14.5% in 1970 to 4.7% in 2010 for women. has fallen by about 64% and 68% respectively between 1970 and 2010. In terms of ranking of lowest adult mortality across countries, Singapore has moved up in position from 72nd for men and 62nd for women in 1970 to 16th for men and 14th for women in 2010. On the other hand, There is a trend that the population in Singapore is aging at a very fast speed, and this puts a lot of stress on the medical health system. Within Singapore residents, the proportion of those aged sixty-five and above has increased from 6% to 11.8% between 1990 and 2015. Moreover, the number of elders who were sent into the hospital has grown from 28.1% to 28.7% for male and from 26.8% to 28.7% for females from 2012 to 2014. For a great proportion of older people, hospitalization in an acute care geriatric unit will lead to prolonged length of stay, functional decline, readmissions and even death. Therefore, although Singapore has made tremendous improvement in reducing our adult mortality over the 40-year period, we cannot afford to be complacent. Singapore needs to continue with our effort to combat the associated risk factors of cancers and heart diseases as these lifestyle diseases are the main cause of early deaths among adults between 15 and 60 years of age in Singapore today.

Respiratory Illnesses (Parwana)

There are a variety of different perspectives that can be explored with regard to the ongoing COVID-19 pandemic in Singapore. However, one of the most interesting trends that Singapore has been experiencing since its beginnings in late-2019 and early-2020 is decreased rates of other infectious viral respiratory diseases. In February 2020, Singapore implemented a set of epidemiological measures in response to the COVID-19 pandemic that prohibited non-essential large-scale events, instated daily temperature and health checks at schools and workplaces, and encouraged and/or required masks in public spaces and around others. Obviously, these measures were a direct result of the ongoing COVID-19 pandemic. However, it ended up having widespread impacts on a multitude of other infectious viral respiratory diseases. As can be seen in the graph below, the general rates of acute viral respiratory infections noticeably decreased throughout 2020, specifically after the aforementioned epidemiologic measures were put in place in epidemiologic week 5.

However, to truly understand this trend in a more holistic manner, we must delve into greater detail and look not only at 2020, but also informed by and in context of 2019. That brings us to this multi-panel graph from Wan et al. (2021) that displays some fascinating information. The most common viruses in Singapore in 2019 that were responsible for various infectious respiratory diseases included influenza A/B, enterovirus/rhinovirus, respiratory syncytial virus (RSV), and adenovirus.

As can be seen in panel A, the country was experiencing a peak of influenza A/B activity late-2019 and early-2020, with it peaking at more than 35% positivity during week 5. Positivity rates dropped to 12.6% in two weeks, 5.3% in five week, and reached near 0% shortly after. Panel B shows us that enterovirus/rhinovirus positivity rates increased during the second half of 2019, dipped for a bit between May and August 2020, and then increased again. In Panel C, we can see that RSV activity was considerably higher in 2019 compared to 2020. It is important to note that its early-2020 decrease occurs with the implementation of Singapore’s epidemiologic measures. Last but not least, adenovirus activity, as shown in Panel D, also drastically decreased in 2020 when compared to 2019, following a similar timeline to influenza A/B and RSV.

Interestingly, influenza A/B activity noticeably decreased with the prelockdown measures that Singapore’s Ministry of Health implemented, as mentioned above. However, enterovirus/rhinovirus and adenovirus rates were a bit more stubborn, with their reduction happening during lockdown. The rates remained quite low throughout this period, as people remained at home, masked up, and away from potential illness transmission spaces. When Singapore reopened in April, positivity rates for these four categories of viruses remained relatively consistent for a few months. However, there was a reemergence of enterovirus/rhinovirus in September and of adenovirus in October. Despite this, the country saw historically low levels of infectious respiratory diseases caused by these four viral groups throughout the year.

Given this, it seems that COVID-19 responses in Singapore were effective in addressing the global pandemic, but also reducing the rates of other viral diseases, which are often spread through similar respiratory and contact mechanisms.

Cancer (Parwana)

According to Singapore’s Ministry of Health, cancer has been and continues to be the leading cause of death among the Singaporean population, accounting for 28.4% of deaths in 2019. To put this into context, this means that cancer was the underlying issue in about 1 in every 3 deaths in the country. Unfortunately, the incidence rates for it continue to increase with the aging population as outlined in previous sections, overlaid with the compounded consequences of the highly industrialized environment and urbanized lifestyle in Singapore.

However, despite this increase, the overall mortality rate for cancer has declined in both males and females, resulting in an increased rate of cancer survival in more recent decades. However, it is important to note here that if we compare the 1970 mortality rate to the 2015 one, it has decreased for males but has remained relatively constant for females, as can be seen below.

Cancer is an incredibly broad term, with the illness itself being a prime example of nuance and heterogeneity in the world of science and medicine. As can be seen in the pie chart below, breast cancer is the most prevalent type of cancer in Singapore, at 15.5% of all cancer cases. Due to its inherent biological mechanisms, this condition is disproportionately represented among women in the Singaporean population. Following breast cancer, the most common types of cancer in Singapore are colorectal, lung, and prostate.

The incidence and mortality statistics for common cancer types in Singapore can be seen in the graph below, displaying numbers from 2018 (World Health Organization 2019).

Considering this particular trend through the lens of Singapore’s incredibly diverse population, it is fascinating to explore ethnic variance in cancer incidence and mortality in the country, which will be done here using data from Singapore’s National Registry of Diseases Office. Between the three most common ethnicities in the country (Chinese, Malay, and Indian), there are different subtrends in the rates. Among males, the incidence rate among the Chinese has decreased while this same measure has increased from 1970 to 2015 for Malays and Indians. On the other hand, the mortality rate has decreased for Chinese males, increased rather drastically for Malay males, and remained relatively stable for Indian males during this same time frame. Among females, the incidence rate among the Chinese and Malays has increased from 1970 to 2015 while this same measure has remained relatively stable for Indians. On the other hand, the mortality rate has increased for Malay females but remained relatively stable for Chinese and Indian females. There are not many studies that dive into potential explanations for these noted differences. However, there is clearly an intricate interplay between biological, behavioral, clinical, and social factors that are resulting in the outlined statistics. Studies indicate that Chinese folks in Singapore, on average, have higher socioeconomic statuses whereas Malays and Indians may face more inequalities in healthcare provision due to more challenges, barriers, and limitations arising from this (Visscher 2007).

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