Making the Sun Shine on a Greying Nation

Singapore is a rapidly ageing nation. Half of the population is over 42 years old, and in the next eight years, nearly a quarter of Singaporeans will be at least 65 years of age and considered elderly1. Experts and the Singapore government itself have long known that a greying population poses increasingly urgent challenges to a country, particularly to its healthcare system. After all, ageing is associated with several chronic conditions, such as diabetes, osteoarthritis and various heart problems. As Singaporeans grow older, these diseases and many others will become increasingly common and pose a very real risk of overwhelming the country’s health system.

Banking on Data from 10,000 Singaporeans

By combining molecular-level genetic information with a patient’s medical history, lifestyle and family background, precision medicine could prove to be a formidable tool to prevent and treat ageing-related diseases—many of which have a genetic component.

However, such a data-intensive strategy first requires the establishment of biobanks, extensive libraries of biological samples, patient data and other information that can help researchers conduct studies that address specific needs of the local population.

Realising the potential of precision medicine to tackle the problem of ageing, Singapore’s Lee Kong Chian School of Medicine has initiated a large-scale effort, called the Health for Life in Singapore study, better known by its acronym HELIOS. By collecting data from 10,000 Singaporeans, HELIOS hopes to uncover genetic, environmental and lifestyle factors that contribute to chronic diseases and develop innovative ways to manage these conditions.

In a recent study2, Ian McGonigle, Assistant Professor at the School of Social Sciences, Nanyang Technological University, Singapore, examined HELIOS’ role in the country’s precision medicine strategy to improve its healthcare system. With his colleagues Manoj Vimal and Wairokpam Premi Devi, McGonigle found that more than just dealing with the pressing challenges of an ageing population, HELIOS also reflects important national principles and priorities.

“Respect and concern for the elderly is a very dominant cultural value in Asia, particularly in Singapore,” he said, adding that biobanks in other countries might instead focus on racial diversity or rare congenital diseases, depending on what their needs may be. “Biobanks tell us a lot about the nation’s culture.”

HELIOS sets Precision Medicine in Action

McGonigle, who has spent several years studying biobanks from an anthropological standpoint, explained that compared to some other biobanks around the world that have more fundamental and different research aims, HELIOS is more geared towards clinical and medical applications.

Aside from collecting the usual biological samples—blood, urine, saliva—HELIOS puts participants through a comprehensive battery of physical tests, from bone scans to lung assessments. HELIOS also checks participants’ cognitive status and cardiovascular health, and conducts a complete physical and laboratory work-up.

By directly linking Singaporeans’ genetic data with these clinical characteristics, HELIOS allows doctors to identify which patients would be more likely to develop arthritis or other conditions of old age.

“Ageing is unavoidable, but some diseases can be avoided,” said McGonigle. “HELIOS is looking at diseases like obesity and diabetes. Some of these conditions may have a genetic component, and work like HELIOS’s can help identify individuals most at risk before they become ill.”

In turn, recommendations could be tailored according to patient risk profiles, he noted. Those with a high propensity for diabetes, for example, could be advised to keep healthier diets, while those at risk of arthritis could follow stricter weight and exercise standards.

“This is what is so wonderful about precision medicine. Not all medical problems require a high-tech solution and much of the population can go a long way to avoid developing such diseases, just by making early-life interventions in lifestyle,” McGonigle added.

Boosting Health for Generations to Come

Beyond its practical applications, McGonigle and colleagues found that HELIOS reveals the current prevailing cultural logic in Singapore, and how the country hopes to navigate the waters of its own future.

“As an anthropologist, what was interesting to me about HELIOS was that it was focusing quite explicitly, on the social issue of ageing and on diseases of ageing,” McGonigle said. “This was interesting for me to learn about, not only in terms of understanding the medical challenges for Singapore but also in terms of how precision medicine is being marshalled for a generationally focused purpose.”

Indeed, HELIOS and similar initiatives across the country fall in step with Singapore’s concerted efforts to provide quality healthcare and promote healthy lifestyles for its rapidly ageing populace—as well as the generations that will follow it.

This foresight, combined with the unique application of precision medicine in managing the country’s population cohort as a set of generations, is what McGonigle and colleagues term “generational medicine.”

“By preparing for and anticipating the future, HELIOS can help people in Singapore extend their lives and reduce the avoidable end-of-life suffering and burden on their families. This is what we mean by generational medicine,” he said.

References:

1. National Population and Talent Division, Strategy Group, Prime Minister’s Office (September 2021). Population in Brief 2021

2. Vimal, M., Devi, W.P., McGonigle, I. Generational Medicine in Singapore: A National Biobank for a Greying Nation. East Asian Sci Technol Soc (2021).