Singapore built a nation underpinned by public health, but new threats loom

Sixty years after independence, Singapore has come a long way from the time it battled malnutrition and poor hygiene. Very different enemies lurk in the future.

- Teo Yik Ying

The year is 1965. You wake to the clatter of metal buckets, as night soil collectors begin their rounds to empty the outdoor latrine shared by four households. The stench is overwhelming, mingling with the acrid smoke from nearby charcoal fires where a street food vendor fries dough fritters in reused oil. You send your barefoot child off to school with a coin for lunch—likely a bowl of watery porridge or cheap fried noodles. At the school tuckshop, there is little green in sight, mostly fried snacks and sugary drinks. Most of the children in school do not own a toothbrush, and many already suffer from significant tooth decay by the time they are seven.

Passing your neighbour on her way to the "death houses" in Sago Lane—shophouses where the terminally ill are taken to die—you learn that her mother has tuberculosis. Her daily visits provide her mother essential sustenance, as there is otherwise little food offered to the occupants.

At the shipyard where you work, news circulates that a night-shift worker has lost a finger in a drilling accident—the third such incident in a month. Workplace safety is minimal, with no established protocols or protective gear.

This was the public health reality for the average Singaporean at independence. Singapore in the 1960s faced the full weight of post-colonial neglect. Malnutrition and poor sanitation were widespread, and infectious diseases such as typhoid, tuberculosis and gastroenteritis were common causes of death.

The healthcare system was under-resourced, with insufficient doctors, nurses and clinics. It also lacked coordination across public services.