Commentary: Singapore should look beyond doctors to reduce chronic disease

SINGAPORE: Is one of your New Year resolutions to follow your doctor’s advice to eat more healthily and do more exercise? The start of the year is a great time to make a change, but how long we sustain those efforts is a different story.

Educating the public about why and how we should lead a healthy lifestyle is essential to health promotion - but it isn’t enough for healthy behaviours to last. 

The recent Healthier SG White Paper outlined a proactive, preventative approach to reducing the incidence of chronic disease in Singapore. Singaporeans can also choose to enrol with one family doctor and adopt a health plan. 

It aims to shift doctor-patient relationships from being transactional and episodic to ones based on familiarity and trust. Good doctor-patient relationships play a significant role in our healthcare experience and have been shown to influence health outcomes.

Better preventive care could reduce or delay treatment needs in the long run. For example, patients with pre-diabetes can avoid long-term medication or more drastic outcomes with lifestyle changes.

But this will add to doctors’ immediate workload, with some already voicing concerns on needing more time to care for complex cases enrolled with them.

This might not be sustainable, especially when we consider the increasing rates of physician burnout and our ageing population’s healthcare needs will only increase.

But are doctors - besides friends and family - the only ones who can help drive our healthier behaviours? 

HEALTH COACHES CAN SUPPORT THE GOALS OF HEALTHIER SG

Health coaches could be that overlooked but essential part of the equation, when we consider how other roles can support and supplement doctors.

In considering behavioural change, psychologists often cite self-determination theory, a well-established framework that says goals are more likely to be achieved when they are fuelled by internal motivation rather than external pressure or coercion. 

The fulfilment of three essential psychological needs is necessary for internal motivation to flourish: Autonomy (such as voluntarily deciding to quit smoking instead of feeling forced into it by a family member), competence (feeling confident in our ability to succeed) and relatedness (feels cared for and supported by those around us). 

Research indicates that when these core needs are fulfilled, we are driven by internal motivation and tend to persist in our behaviour. 

With this in mind, we can imagine tapping on non-medical professionals to help guide and motivate us to succeed in health-related but what are ultimately lifestyle changes. In some chronic conditions, lifestyle changes have the potential to reverse disease progression, not just manage it like with medication.

When health is more than the biomedical aspects of a disease, we should not ignore the social determinants of health.