In January 1996, I suffered from a constriction of my chest. A stress test followed by a Sestamibi scan showed 90% stenosis or blockage of my left circumflex coronary artery. A team of cardiologists at the National Heart Centre led then by Dr Arthur Tan, performed an angioplasty. Unfortunately after 8 weeks, it re-stenosed. Thanks to medical science, when the second angioplasty was done, Dr Richard Schatz inserted a stent named after him. He happened to be lecturing in the region.

Since then, a team of cardiologists, including the chairman of the Singapore Heart Association, Dr Low Lip Ping, has been reviewing my case at regular intervals to make sure that all is well, and all has been well. Had I not promptly seen my doctors, I may not be your guest speaker.

Coronary heart disease in Singapore accounts for about 1 in every 4 deaths and the figure is going up. Singapore has the dubious honour of the highest rate of coronary heart disease among Asian countries. We must therefore take heart disease seriously.

Let me say a few words on the treatment of heart disease, an issue I take an interest in, because of my personal experience.

Cardiovascular diseases – which comprise coronary heart disease and cerebrovascular disease – account for about 9% of hospital admissions in Singapore. This means about 32,000 admissions every year. Not all of these cases will require surgical or other interventional procedures. In 1997, 2,200 patients required balloon angioplasty and 1,900 had open heart surgery.

Singapore is a small country. Even though heart problems rate highly in our disease profile, in absolute numbers they are small compared to those of other countries, especially at the tertiary level. The more complex diagnostic methods and procedures usually require sophisticated equipment, and highly skilled specialist teams, and a minimum number of cases to remain viable. Cardiologists and heart surgeons must have enough practice to be good at certain procedures. The more cases they do, the better their skills become. And patients will have greater confidence in them. When I had to consider the insertion of a stent, my cardiologist, Dr Arthur Tan advised me to get Dr Richard Schatz who happened to be in Singapore, to do it. At that time, Arthur Tan had done several hundreds. Dr Schatz had done several thousands. In the event, Arthur Tan performed the procedure but with Schatz standing next to him to lend him Schatz’s experience and expertise. He gave Arthur Tan the confidence to balloon the stenosed coronary artery wider than it originally was and more than he would normally have done. Only then did he place the stent into position.

We could have left the hospitals to develop tertiary services at will. But this would have run the risk of duplicating services unnecessarily. Worse, it would have seriously diluted the level of expertise, the treatment outcomes, and the cost-effectiveness of each of the service providers.

We therefore decided on the National Heart Centre to concentrate the nation’s clinical expertise and training at the tertiary level, and equip the Centre with the latest and most sophisticated equipment for tertiary diagnosis and treatment. As we have limited talents, all cardiologists and cardiac surgeons, from the university and hospitals in both the private and public sectors, should have access to the Centre.

We cannot afford to be parochial. Just as we welcome foreign talent at the national level, so the Centre must look beyond its institutional associates and include the private sector. Qualified heart specialists, no matter where they practise, must be brought in as part of the National Heart Centre system. Private sector specialists who are willing to contribute alongside their public sector colleagues, will be made welcome. The Centre will have dual appointment arrangements, so that specialists practising in other hospitals can still be involved at the national centre level. The university must also regard the National Heart Centre as an integral part of its academic system. This will ensure that we can achieve excellence in the quality of cardiac treatment and practice.

Such a broad all inclusive approach will strengthen our system and enable us to deliver excellent health care to the nation.

The Centre must be discriminating in what it does. According to the World Health Organisation, coronary heart disease, which is globally the 5th most important cause of disability, will become the leading cause by the year 2020. Not surprisingly, this upward trend has spawned an explosion of research in diagnosing and treating heart disease. Many of the resulting innovations involve advanced technology. They have caught the imagination of the public, and this has stimulated consumer demand and rapidly driven up the cost of medical care. In some cases, it has led to escalating and heavy costs to governments or patients.

Every decision has to weigh the cost-benefit analysis. We face the ethical dilemma of how to allocate limited resources to derive the greatest benefit. The cost side of the equation is straightforward. We can calculate how much a bypass operation or a heart transplant cost. But assessing the benefit or effectiveness is far more complex. How does one measure it? It could be number of lives saved, or physical disability prevented, or quality of life improved. Then we face the more sensitive issue of weighing the worth of one life over another.

These concerns involve value judgements about where the most benefit would be. Spending more does not necessarily mean achieving better results. For example, the US spends 15% of its GDP on health care, Japan spends about 6%, and Singapore 3%. Yet life expectancy is highest in Japan, followed by Singapore, and then the US.

A significantly-higher proportion of US health care costs go to high technology and tertiary care compared to Japan and Singapore. The US model is not suitable for Singapore. We must find more cost-effective strategies when we anticipate a surge in cardiovascular diseases.

Prevention is more cost-effective than cure in the long run. Epidemiology studies abound which identify many of the principal risk factors of coronary heart disease. We know now that many of the risk factors are linked to modern lifestyles - diet, overweight, sedentary habits and smoking. Public health programmes targeted at reducing the incidence of these risk factors must be the cornerstone of every country’s health policy. Thus Singapore places great emphasis on anti-smoking campaigns and healthy lifestyle programmes.

At the opening of this conference the Minister of Health, Mr Yeo Cheow Tong, unveiled the Healthier Choice symbol that the Singapore National Heart Association will administer. This symbol will help consumers make informed choices when purchasing food. Together the government, community organisations, and the medical profession, can promote the health of our citizens.

The organisers of this 3rd International Heart Health Conference have put together a programme which focuses attention on the public health aspects of heart health. The objective of "Forging the Will for Heart Health" is an important one, and I hope the conclusions and recommendations from this conference will contribute towards that end.

A final word: At my opening, I mentioned the angioplasty procedures I underwent nearly three years ago when I was 72. In my case had I not had a healthy lifestyle, no smoking, daily aerobic exercise, good diet, I would have been in trouble much earlier. My mother, her sister and her brother died of heart disease. Simple food precautions and lifestyle changes can avoid or mitigate heart disease problems, at little cost.

Avoid fatty or polysaturated, high cholesterol meats in favour of high fibre and low fat, vegetables, fruits, fish, and lean meats; cut down on salt intake to minimise risk of high blood pressure. And absolutely no smoking. Do aerobic exercise regularly, at least 3 times a week, and for at least 15 minutes each time, excluding warm-ups. And finally, learn how to manage stress. I do it by regular cycling and meditation. But to each his choice of aerobic exercise and his favourite release from stress.