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Introduction: Singapore's recent ongoing journey of health system transformation was marked by key milestones such as War on Diabetes (2016) and the Three Beyonds (2018). In 2022, there will be a new population health narrative, vision and paradigm announced that will drive Singapore's health system transformation for the next decade and beyond. The healthcare sector had been extensively planning and preparing for this tectonic change and new journey. Description: Three key planning considerations are highlighted: Developing an inclusive and shared vision - changing how we perceive health and enable every citizen to stay healthy. In this next stage of the nation's health sector developments, the national-level shared vision and values builds on the previous iterations to further the concept of healthy communities, and people as partners in health and healthcare. It will further emphasise preventive care and require that the healthcare providers include residents who do not have yet health issues or healthcare needs, as part of the population that they need to plan for and engage with. Making health and healthcare local - by engaging with and understanding the local residents' needs and building a community of care amongst providers and residents. In this new model of care, healthcare providers will have a strong mandate and responsibility to understand the health needs of their local community, build a network of integrated care providers, and pursue strong community activation for health. There will be stronger emphasis on health and social services integration - and providers will have a common digital platform to communicate and share information. System wide change for health systems, governance and leadership - starting with the healthcare sector DNA. This fundamental change in the healthcare system is centrally led by a national Population Health Steering Committee. Furthermore, we will use technology and digital health solutions to make healthcare services accessible and person-centric, improve avenues for health information and behavioural change, and make it easy for providers to connect with the patients and with one another. Payment-wise, there will be a phased transition from the traditional fee-forservice payment model, towards a progressively capitated model. These changes in the DNA of the health system will shape how we design health systems, develop programmes and consume health services in the future. Discussion: Healthcare sector leaders in the midst of this massive and long-term system change understand that we are progressing towards a healthcare system that is more people-centric, community-based and on where patients and the community are more engaged. While this engineered change takes a top-down approach and is well-planned, one observation is that the front-end strategic planning process has not been heavy on patient engagement and consultation. Conclusion: In the Singapore context, this new narrative is a big step towards a more peoplecentred health system. We expect the change to take more than a decade, but the first three years will be critical. Healthcare sector leaders will need to work closely with politicians, patients, providers and the social sector to produce long lasting and sustainable change for the system. [ABSTRACT FROM AUTHOR]

Introduction: Military forces around the world face an increased risk of the spread of communicable diseases, due to the close living quarters and congregated nature of the military camps. The Singapore Armed Forces (SAF) implemented a multi-pronged surveillance and containment strategy to reduce the risk of a coronavirus disease 2019 (COVID-19) outbreak within the local military camps. This paper details the epidemiological investigations of the COVID-19 cases in the SAF and highlights the strategies and public health measures undertaken, aligned with the national COVID-19 control strategy, to reduce the risk of COVID-19 transmission in the military camps. Materials and Methods: Medical data of our military personnel who were infected with COVID-19 during the first 180 days of the pandemic were extracted from the military electronic health records. Contact tracing and activity mapping results were obtained from unit-level epidemiological data. A review of the organization's response plans, instructions, and orders was conducted to collate the measures implemented across the same time period. Results: Prompt contact tracing and activity mapping was done for each of the 24 SAF military personnel diagnosed with COVID-19 between February 2020 and June 2020, with possible links among the cases identified and investigated. Conclusion: A combination of strategies in the formulation of public health measures based on key principles of early warning and surveillance, prompt diagnosis, and early containment were successful in preventing the formation of COVID-19 clusters within the SAF. This will provide a framework for the management of future pandemics within the military setting, driven by strong governance and leadership, to meet the military's need to maintain operational readiness in a safe manner. [ABSTRACT FROM AUTHOR]

Between 2016 and 2018, tobacco control legislation has undergone several amendments to further restrict tobacco use in Singapore. This study explored the attitudes toward these policy changes and the perceived effectiveness of legislations from the perspectives of young male adults in Singapore. Twenty-nine semi-structured telephone interviews were conducted among young male adults who have completed their National Service in 2017/18 and self-reported as a smoker at pre-enlistment screening. Young male smoker perspectives on Singapore tobacco policies including taxation, smoke-free environment, point-of-sale display ban on tobacco products, graphic health warnings, and raising the minimum legal age of smoking to 21, were evaluated. Participants held the view that cigarette pricing was a highly effective approach to control their smoking behavior because it has a direct impact on tobacco affordability, and they shared that the least effective approaches were point-of-sale display bans and graphic health warnings. Results demonstrate that participants were well aware of tobacco control policies in Singapore, but they did not always fully accept them or understand the rationale behind them. Tobacco control measures should be implemented along with public education to correct misperceptions and increase public support for tobacco control measures in Singapore. [ABSTRACT FROM AUTHOR]

Summary Background Simultaneous acute gastroenteritis (AGE) outbreaks occurred at two military camps. This study details the epidemiological findings, explores possible origins, and discusses preventive measures. Methods Investigations included attack rate surveys, symptom surveys, hygiene inspections, and the testing of water, food, and stool samples. DNA/RNA was extracted from stool samples and amplified via real-time reverse transcription PCR (RT-PCR). Partial and full-length capsid nucleotide sequences were obtained, phylogenetic relationships inferred, and homology modelling of antigenic sites performed. Results The military outbreaks involved 775 persons and were preceded by two AGE outbreaks at restaurants in the local community. The outbreak was longer and larger in the bigger camp (21 days, attack rate 15.0%) than the smaller camp (6 days, attack rate 8.3%). Of 198 stool samples, norovirus GI.2 was detected in 32.5% (larger camp) and 28.6% (smaller camp). These were essentially identical to preceding community outbreaks. Antigenic site homology modelling also showed differences between identified and more common AGE outbreak strains (norovirus GII.4). Conclusion Differences observed highlight difficulties in controlling person-to-person outbreaks among large groups in close proximity (e.g., military trainees). Distinct differences in antigenic sites may have contributed to increased immunological susceptibility of the soldiers to infection. [ABSTRACT FROM AUTHOR]