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Thoughts on Singapore, and FDA’s Ongoing Work to Improve Public Health

Catching Up with Califf Main Image includes photo of Dr. Califf

By: Robert M. Califf, M.D., Commissioner of Food and Drugs
Last week I wrote about my recent trip to India, a trip largely motivated by the enormous need for coordinated effort on the common imperative in the U.S. and the rest of the world for readily available, high-quality generic drugs. I also relished the chance to visit a fascinating country and renew many friendships. As part of the trip, our team also stopped by Singapore for a few days. Our trip to Singapore offered us an opportunity to think about the FDA’s global presence, strengthen ties with an FDA strategic partner, and discuss opportunities and challenges in applying technological innovation around the world. This is especially important in this era of explosive advancement in biotechnology and in digitization in health care and globalization of our society. I’d like to catch up with you today on some additional reflections about this part of the world.
Over a decade ago, I had the privilege of helping to start a U.S.-style medical school in Singapore and learned a lot in the process. Since that time, this small country (about 6 million people living on a little over 280 square miles) has continued to have a significant global impact and to play an important role in the continuously evolving Asian environment. Almost two-thirds of the worlds’ population now lives in the region including India, China and the ten ASEAN nations south of these two giant countries. We also have significant interactions with Japan and Korea, as important trading partners and major developers of technology. Despite its small size, Singapore is an important beacon of technology and developer of medical products and novel approaches to food.
Among other accomplishments, Singapore has achieved a life expectancy of almost 85 years while spending less than one-third per capita on health care compared with the U.S. In contrast, we have been experiencing a dramatic fall in life expectancy in the U.S., now 76 and still dropping. According to current models, half of Singapore’s children will live to age 100. The difference in our health profiles between the U.S. and Singapore is not uniform. Many highly educated and wealthy Americans have a life-expectancy on par with other high-income counties, while various combinations of race, ethnicity, sex, lifestyle, and education combine to produce a large part of the U.S. population with high mortality rates and poor health throughout the lifespan—from high infant mortality rates, to “deaths of despair” in mid-life, to excess deaths from chronic diseases in the elderly. An important concept in this complex picture is “healthy life expectancy ”—it’s not enough to just live a long time, but also critical to be healthy and functioning during that time.  
The core mission of the FDA appropriately causes us to focus on specific activities: to ensure safe and effective medical products; safe, nutritious, and properly labeled food; safe cosmetics and dietary supplements; and, reduced risk from tobacco products. As we do this work, I hope that we can reserve energy across the FDA to consider how our work helps to improve the public health at a time when we are experiencing a dramatic decline in health status as a country. As I’ve noted, Singapore is a strong example for us and I’m sure there is much we can learn from their approach. And we need to be strategic in our interactions with our Asian partners, as they will continue to be a source of imports, exports, and important hubs for technological development. Our wonderful team in the Office of Global Policy and Strategy, led by Associate Commissioner Mark Abdoo under Deputy Commissioner Kimberlee Trzeciak, and the FDA employees filling posts around the world, are doing a great job. I look forward to continuing our work and refining and implementing our strategies to produce mutual benefits in this increasingly interconnected and complex world.

Catch up with you next time.


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