Singapore, an island smaller than New York City with a 2024 population of less than six million, has come a long way in the last century. The prosperous Asian nation with the gleaming skyline currently leads the world in the average life expectancy of its residents.
The accomplishment is all the more remarkable when one considers what pre-World War II Singapore was like under British colonial rule.
Strategically located at the crossroads of major maritime routes, Singapore was a thriving trade hub before the war. However, the British colony was invaded by the Japanese army in February 1942 and occupied by Japan until the end of the war.
Prior to the war, the port city with an eclectic mix of one million residents (mostly Chinese, Malay, Indians, and some Europeans) attracted merchants from around the world, including China, India, the Middle East, and Europe.
Despite thriving commerce due to its location on the Strait of Malacca, a major maritime trade route, the city grappled with significant social problems. Those included widespread opium addiction, prostitution, and corruption.
Opium dens were widespread. Brothels were prevalent in parts of the city. Organized crime was also deeply entrenched within the Singaporean economy. Often referred to as secret societies or triads, these gangs trafficked in opium, prostitution, human trafficking including Chinese laborers and women and girls sold into the sex trade, smuggling, and protection rackets.
Moreover, the British colonial government produced and sold opium and earned substantial revenue from this enterprise. Opium farms were leased to private individuals or companies who paid the government for the exclusive right to sell opium.
Bribery and nepotism were common, fueled in part by the lucrative opium trade and other illegal activities such as smuggling.
Those conditions are a distant memory for modern-day Singaporeans, who now live far longer and far healthier than their ancestors did a mere two generations ago.
As you can see from the graph of United Nations data below, the island nation’s people now live on average an astounding 25 years longer than they did 75 years ago.
The question is why.
But before we attempt to answer this question, let’s take a quick look at how Singapore stacks up against the US in terms of the health and longevity of its citizens.
Life expectancy and health care costs: Singapore vs. USA
Though health-related comparisons of the populations of Singapore and the United States are beyond the scope of this article, it doesn’t take deep study to see how stark the differences are between the two nations in healthcare spending and life expectancy.
As of 2023 data, Singapore ranked 5th globally in average life expectancy.
The United States was 47th.
The astounding rest of the story is that the U.S. spends more per capita on healthcare than any other country in the world. In 2024, that figure will be in the $14,000 per-person range, if we extrapolate from the most recent data.
The average healthcare spending per capita among other wealthy countries is roughly half of that.
Regarding Singapore, the nation spends less than 30 percent of what the U.S. spends per person on health care for demonstrably more effective health care.
Singapore as the latest “blue zone”
Singapore is the world’s latest blue zone, according to longevity researcher and bestselling author Dan Buettner.
Though you may have heard about blue zones, a term coined by Buettner, you might be surprised to learn his definition of the phenomenon. Blue zones are places that have at least 10 times the centenarians per capita as the United States does.
More than ten times per capita the number of 100-year-olds than the richest country in the world?
Yes.
The original places crowned blue zones by Buettner are Sardinia in Italy; Ikaria, a Greek island; Loma Linda, California; the Japanese island of Okinawa, and Nicoya in Costa Rica.
Recently he has declared Singapore to be a new blue zone by his centenarian metric. However, the nation is different from the original blue zones in that achieving the status is by and large driven by steps its government has taken over the last half-century.
Singapore is an engineered longevity hotspot, Buettner argues.
Engineered by who, you might ask. The short answer is the Singapore government.
Now, it’s true that Singapore is no untroubled Shangri-La. It has its critics, as well as its share of social and political problems that generally revolve around issues of civil liberties, social policies, and laws viewed by some as harsh and overly punitive.
It also continues to battle health-related challenges in its population. Currently, it is dealing with increasing levels of hypertension and obesity among its residents, as well as an increase in mental health issues corresponding to the onset of the COVID-19 pandemic.
However, one cannot deny the government’s visionary role in bootstrapping its citizens’ health up from third-world levels after World War II to its status today as one of the healthiest countries on earth.
“Unlike the other blue zones, Singapore was no isolated region where a traditional culture evolved a lifestyle of longevity over a period of centuries,” Buettner writes in his bestseller, The Blue Zones Secrets for Living Longer: Lessons From the Healthiest Places on Earth. “Instead, it was a busy crossroads of commerce and cultures whose leaders from the start set out to create an environment of health and well-being.”
Singapore leads the world in a key life expectancy metric
But living longer in Singapore is only part of the nation’s health success story.
Singapore leads the world in another key life expectancy metric, what longevity expert Dr. Peter Attia calls healthspan.
Healthspan, or healthy life expectancy (HALE), measures the number of years a person can expect to live in good health, accounting for years lived with illness or injury. It reflects both the quantity and the quality of life and is often used to assess the overall health of a population.
HALE provides a more comprehensive understanding of a population’s health compared to traditional life expectancy measures, as it accounts for the burden of non-fatal health problems.
Attia argues that healthspan is a decidedly more important longevity health metric than life expectancy. After all, what’s the point of living long if the last decade of one’s life consists of battling serious health issues?
So, living longer in good health is the key metric we should pay attention to, he asserts.
In Singapore’s case, the nation ranks first worldwide in healthspan. In 2019, Singapore’s HALE score was 73.9 years, a substantial increase from 66.6 years in 1990. That number declined slightly to 73.6 years by 2022 but that dip can be attributed to the COVID pandemic’s impact on the nation’s health.
Why is Singapore’s life expectancy so high?
The answer to this question has many facets, similar to the multi-level approach Singapore takes to support the health of its citizens.
Singapore’s healthcare system
Singapore has a robust healthcare system with both public and private healthcare facilities. Policies that include and/or promote individual health savings accounts, government subsidies, and health-related insurance programs help ensure that Singaporeans can afford the necessary medical care without prohibitive costs.
For example, the nation has a mandatory health savings program known as Medisave. There also is a medical insurance program to help with large hospital bills and selected costly outpatient treatments. It is called Medishield Life.
Public health initiatives
The government has implemented numerous public health initiatives aimed at preventing chronic diseases and promoting healthy living. These include campaigns to reduce smoking, encourage physical activity, and promote healthy eating. Some of these initiatives are downright ingenious. For example:
National Steps Challenge
Launched in 2015 by Singapore’s Health Promotion Board (HPB), the National Steps Challenge creatively incentivizes Singaporeans to be more physically active. Participants receive free step trackers, which are linked to the Healthy 365 mobile app. This app tracks their physical activity and progress.
Participants also earn Healthpoints, which can be redeemed for vouchers and prizes. The more steps they take, the more points they earn.
The program is regularly updated with new challenges and events to keep participants engaged. These include themed challenges and corporate challenges to encourage group participation.
By providing tangible rewards and making the tracking of physical activity convenient, the program encourages long-term behavior change. It also fosters a sense of community and friendly competition, which motivates participants to stay active.
“I Quit” campaign
Another long-running initiative is the “I Quit” campaign, an anti-smoking initiative aimed at helping smokers quit the habit. It provides comprehensive resources and support for individuals trying to stop smoking.
Healthier Dining Programme
A third public health initiative that goes above and beyond is the Healthier Dining Programme, which is a government partnership with restaurants, indoor food courts, and hawker centers (a collection of open-air food stalls serving affordable local dishes) to offer meals that meet specific nutritional guidelines, such as meals that are lower in calories, saturated fats, and sodium.
To encourage the participation of food and beverage businesses, the initiative includes financial incentives and marketing support. Public promotions to highlight participating outlets and healthier menu options are part of that support.
Establishments that participate in the program can display the Healthier Choice Symbol on their menus.
Moreover, to encourage participation, the program includes financial incentives and marketing support for healthy food and beverage companies and public promotions to highlight participating outlets and healthier menu options.
Religious factors and social initiatives
A 2014 Pew Research study ranked Singapore as the most religiously diverse country in the world. Moreover, about 80% of its citizens are practicing members of a religion.
There is a growing body of evidence suggesting that individuals with a spiritual practice tend to live longer and healthier lives. This correlation is often attributed to various factors including psychological well-being, social support, and healthy behaviors encouraged by spiritual communities.
Regarding Singapore, the evidence supporting this claim includes a study published in the Singapore Medical Journal, which found that older Singaporeans who participated in religious activities had better mental health and lower levels of depression.
The study highlighted the role of religious engagement in providing social support and enhancing psychological well-being.
Singapore: a spiritual melting pot that contributes to the nation’s health
In Singapore’s multicultural and multi-religious society, spiritual practices are ingrained in daily life. Prayer, meditation, and participation in religious festivals and rituals are at the heart of Singapore’s spiritual communities, which include Buddhists, Muslims, Hindus, Christians, and Taoists.
The sense of community and belonging fostered by these spiritual practices can contribute to healthier and longer lives. Buettner found this to be the case in his blue zones research.
Singapore’s government and various community organizations recognize the importance of spiritual well-being. For instance, the Inter-Religious Organisation of Singapore promotes interfaith dialogue and cooperation, which contributes to a sense of community and social support across different religious groups.
Aging in place
Regarding community building, Singapore financially incentivizes keeping their older citizens connected to their families. Its Proximity Housing Grants provide grants to families buying a home to live with or near one’s parents or child.
According to Singapore’s Housing and Development Board: “If you are buying a resale flat to live with or near your parents/child, you may apply for the following Proximity Housing Grant:
- $30,000 to live with your parents/ child
- $20,000 to live near your parents/ child (within 4km).”
Urban planning and public cleanliness
Singapore is well-known for its rigorous urban planning and emphasis on cleanliness, which contributes to overall public health. Green spaces, sports facilities, and pedestrian-friendly infrastructure encourage active lifestyles.
Singapore’s Waste-To-Energy program
Singapore takes every effort to go the extra mile when it comes to keeping its tiny island as environmentally friendly as possible. An example of this is its state-of-the-art Waste-to-Energy (WTE) program.
Singapore has four WTE plants where the nation’s waste is taken. It is fed into large incinerators, where the waste is burned at extremely high temperatures, typically around 850°C to 1,000°C.
The heat generated from the combustion process is used to produce steam. This steam drives turbines connected to generators, producing electricity that is supplied to the national grid.
The WTE plants convert approximately 90% of the energy in the waste into usable electricity. Metals are extracted and recycled from the remaining ash, which is about 10% of the original waste volume, before the ash is landfilled.
The plants are equipped with advanced pollution control technologies to minimize emissions of pollutants and comply with Singapore’s strict environmental requirements.
Disease control
Singapore’s approach to disease control is proactive and efficient, as seen in its handling of the COVID-19 pandemic and previous outbreaks, such as the SARS virus.
It also has an ongoing, multi-pronged program to combat mosquito-borne Dengue Fever.
The government’s quick response and strict health measures often prevent widespread disease, which contributes to higher life expectancy.
COVID-19 pandemic
Singapore’s approach to COVID-19 resulted in one of the lowest fatality rates globally. The country’s excellent healthcare system, extensive testing, and strict quarantine measures helped keep the virus under control.
By the end of 2021, Singapore had reported fewer than 300 deaths related to COVID-19 out of over 200,000 confirmed cases. The country’s case fatality rate was in the 0.1% range, far lower than most industrialized nations.
Economic factors and policies
Economic factors also play a key role. Singapore’s high standard of living and low poverty rate contribute to better health outcomes for its residents. However, specific Singapore laws tip the scales further toward health benefits for its citizens, even if those benefits are an indirect result of such laws.
Take the country’s taxation of vehicle ownership, for instance, which is quite high.
Taxing driving to encourage walking
If you wish to buy a car in Singapore, be prepared to dip into your life savings, as the steps to vehicle ownership are many and the associated costs will give you an extreme case of sticker shock.
Step one is to obtain a certificate of entitlement (COE), which enables a person to own and use a vehicle in Singapore for 10 years. Getting a COE involves a bidding process that, as of 2024, tacks on roughly three times the open market value of the vehicle to the bottom-line price.
So, for a vehicle costing $30,000 USD, the COE would be in the $90,000 range (approximately $120,000 Singapore dollars).
As mentioned, that’s only step one, so keep your wallet open.
Beyond the COE cost, there is a 20% excise duty, an 8% goods and services tax, a registration fee, an Additional Registration Fee (ARF), a road tax, and the cost of insurance required to legally drive the vehicle in Singapore. The ARF alone is 100 percent of the open market value of the car, so an additional $30,000 USD in our example above.
Using Singapore’s public transportation systems, its taxis, as well as biking and walking to get around, is starting to sound better and better, isn’t it?
That’s the point. Singapore taxes driving in the extreme, which drives Singaporeans toward options that are healthier for its citizens and its island environment.
This is no accident.
In fact, incentivizing its people toward healthier behaviors has been a fundamental motive of the Singapore government and its iconic founder Lee Kuan Yew, ever since it achieved full independence in 1965.
The original leaders of Singapore were “trying to actually make sure people stayed healthy, rather than make money off of people,” author Dan Buettner has commented.
Lee Kuan Yew is widely regarded as the “Father of Singapore.” He served until 1990 as the first Prime Minister of Singapore and played a pivotal role in transforming Singapore from a British colony into a thriving, independent, and prosperous nation.
What is public transportation like in Singapore?
The nation’s rail system includes Mass Rapid Transit, which is the backbone of the public transport network, and Light Rail Transit, which serves more localized areas. The network is extensive and still expanding, aiming to have most households within a 10-minute walk of a train station by 2030.
The nation’s bus system currently serves every part of the island. Future plans include the introduction of hundreds of new buses, new bus routes, more dedicated bus lanes, and bus signal priority at traffic lights to reduce travel times.
Integrated transport hubs such as the Bukit Panjang Integrated Transport Hub and the upcoming Tampines and Woodlands hubs seamlessly connect buses with trains.
Taxis and ride-sharing services like Grab (similar to Uber) also operate throughout the country.
Singapore invests in walking
Singapore has an extensive network of covered walkways connecting residential areas to key amenities and public transportation nodes. This guarantees comfortable walking conditions regardless of weather, which is commonly scorching hot and rainy in the tropical country.
The country also prioritizes pedestrian malls and car-free zones, such as in its Orchard Road and Marina Bay areas, where cars are restricted to encourage walking and recreational activities.
Its Green and Blue Plan 2030 targets the development of more green spaces and park connectors. One of the plan’s goals is to ensure that all Singaporeans live within a 10-minute walk of a park by 2030.
Singapore’s expanding cycling infrastructure
By 2030, Singapore aims to increase its cycling path network to 1,300 kilometers, up from 460 kilometers in 2020. This plan includes the development of extensive cycling paths, parking facilities, and safety features to encourage more residents to use bicycles as their main mode of transportation.
Specific areas such as Ang Mo Kio have been transformed into model cycling towns. These areas feature extensive cycling paths that are integrated with pedestrian walkways.
Singapore has also partnered with bike-sharing services such as SG Bike and Anywheel, which provide easy access to bicycles for short trips.
The continued expansion and enhancement of cycling infrastructure are key components of Singapore’s vision to become a car-lite society.
Singapore’s growing life expectancy is no accident
Singapore’s focus on investing in and promoting healthy lifestyles reaches into many aspects of life in the country. Wellness initiatives, wise resource use, and environmentally-friendly programs have contributed significantly to the nation’s high life expectancy.
This tiny nation, poor in natural resources, has found ingenious but common-sense ways to invest in its most important resource: its people.
By learning from these strategies, other countries can improve health outcomes and achieve a higher quality of life for their own citizens.
