Impact of Exposure to Haze

6 Mr Leon Perera asked the Minister for Health (a) whether he can provide data on the long-term impact of Singaporean children's exposure to haze in terms of the likelihood of developing respiratory illnesses, including chronic conditions such as asthma, later in life; and (b) what is the estimated healthcare cost of this impact.

The Minister of State for Health (Dr Lam Pin Min) (for the Minister for Health): Mdm Speaker, in Singapore, transboundary haze is a short-term, episodic, recurrent event with varying severity every year. There is currently no data both locally or internationally, that looks into the long-term health effect of short-term, episodic exposure to the haze.

Researching this would be highly challenging as any results would be based on observational studies only which would not be able to show a definite cause-and-effect relationship. Hence, it would be difficult to ascertain the direct long-term health effects due to the episodic exposure to haze as there could be many contributing factors to the long-term health outcome we are measuring. For example, it would be difficult to determine that intermittent exposure to haze 20 years ago would have caused the chronic obstructive airways disease in a person, since it could also have been caused by other factors such as smoking, previous lung infection, or existing lung diseases.

However, overseas studies on long-term health impact have been based on long-term exposures, which are different from the pattern of exposure here. These studies showed that continuous, long-term exposure to air pollutants over several years may result in lung function abnormalities in children and subsequently, in adulthood. This could lead to greater susceptibility to the effects of ageing, infection and other pollutants, such as tobacco and smoke in adults.

Nevertheless, I appreciate that as parents, we are concerned about the impact of haze on our school-going children. The short-term health impact of haze is well documented for children and adults alike. Short-term exposure to high levels of haze particles may cause irritation of the eyes, throat and nose. Such irritation usually resolves on its own. In individuals with pre-existing chronic heart or lung diseases, short-term exposure may trigger an episode or exacerbate the underlying diseases, such as an asthma attack.

Besides widely publicised health advisories, we have put in place several measures to protect and enhance the health and well-being of Singaporeans.

First, the Haze Subsidy Scheme (HSS) assists children, the elderly and the lower- to middle-income Singaporeans with their outpatient haze-related medical treatments. We provided subsidies of more than $3.3 million in 2015 which helped with over 77,000 haze-related attendances.

Second, my Ministry has also worked with community partners to distribute we-care packs and masks to the needy, ensuring there are adequate supplies of protective masks in the market, educating the public and raising awareness of the health effects of the haze. In addition, my Ministry also welcomed the efforts by ST Dynamics to develop N95-equivalent masks that can fit children's faces. We note that preliminary data from ST Dynamics indicate that the mask should pose no safety concerns when used with the micro-ventilator. To ensure that it is safe for children to wear the masks even without the micro-ventilator, there are plans for clinical trials locally. In the meantime, we have stockpiled these smaller sized masks to ensure that there would be sufficient supply available to the general public.

Third, the Ministry of Education (MOE) has school continuity plans in place to take appropriate haze management measures.

Two days ago, my colleague from MOE outlined the move to provide air purifiers to all primary and secondary schools to further enhance the well-being of our schoolchildren. Most importantly, we want to prevent haze from occurring in the first place. To this end, Singapore is working closely with neighbouring countries to tackle the haze issue, which is largely caused by irresponsible business practices. The ASEAN Agreement on Transboundary Haze Pollution is the key framework for ASEAN Member States to work collectively and take concerted action against haze. Singapore has also led the development of the ASEAN Haze Monitoring System which would help to increase transparency and accountability of errant companies that are responsible for the forest fires.

Mr Leon Perera (Non-Constituency Member): I thank the Minister of State for his comprehensive and helpful reply. Notwithstanding the difficulty of predicting longer term health outcomes, would the Ministry consider developing an estimate for what the long-term health impact would be in terms of the healthcare cost that would have to be borne by the Singapore Healthcare System, both Government and consumers and companies in the long term, from our children suffering exposure to haze so that we can use that dollar figure, even if it is an estimate, derived from other international studies that have been done – as the Minister of State acknowledged – so that we can use that estimate as a planning parameter to decide how much to invest in haze-proofing our schools and ensuring our children are better protected against haze? This approach to policymaking and decision making may be helpful to assess the future impact, so as to decide investment today.

Dr Lam Pin Min: I would like to thank the Member for the suggestion. As I have mentioned in my reply, it is indeed rather difficult to ascertain the long-term health effects of short-term exposures like those that we have encountered in Singapore. Having said that, I think, we will continue to look at what the other countries have done; the studies that they have conducted. And whatever information that we can get from these studies, we will definitely put them into our planning norms.