As articulated in my previous article, the relationship between the living and the dead in our midst has for far too long been a brutal zero-sum game. In the name of progress and development, land that was previously occupied by the dead or set aside to facilitate the management of death in Singapore has been progressively lost to cater to the residential, employment and recreational needs of Singaporeans. The pace of this displacement has greatly accelerated as the resident population increases substantially in the past three to four decades. The dead has given way to the living, displaced by modernity. They have to. It is as simple and practical as that.
The effect is the existence of an invisible ghetto between the living and the dead in Singapore, delineated by a geographical distance that sets out to ensure that the dead continues to remain out of sight and thereafter, out of mind. And so the nation continues to live in the immediate future within its own comfort zones, ill-equipped for the challenges that an ageing [dying] population would bring to Singapore.
On 20 April 2017, the Ministry of Education, in its latest response to the shrinking number of students as a result of Singapore’s declining birth rates announced that fourteen pairs of schools will be merged in 2019 – and for the first time this includes junior colleges. This announcement came only a year after the Ministry had announced that twenty-two secondary schools will be merged in 2017 and 2018 due to falling cohort sizes.
Singapore’s total fertility rate (TFR) continues to remain low while our baby boomers continue to age. Singapore is clearly not replacing itself. By 2030, the number of Singaporeans aged 65 and above is projected to double to 900,000. That means 1 in 4 Singaporeans will be in that age group, up from 1 in 8 today. The burden on a shrinking working population will only continue to increase. The pace of ageing is accelerating and the number of deaths in Singapore will only increase. By 2030 we are looking at an increase far higher than the 2 to 4% increase in absolute death numbers that we are seeing today.
Earlier in the week, the Ministry of Health announced the building of the Woodlands Health Campus (WHC), an important next part in the strategic development of the HC2020 masterplan. It will comprise a general hospital, community hospital, a nursing home as well as daycare facilities for our seniors. The WHC will form part of the National Healthcare Group (NHG), to be integrated while complementing existing health care facilities in the northern region of Singapore.
At the recent Committee of Supply (COS) debate, the Health Minister Mr Gan Kim Yong announced the expansion in the quality and accessibility of healthcare services and facilities in the years ahead. Since 2012, the healthcare workforce has expanded by some 23,000, or 33% over the past five years and another 9,000 more will be added over the next three years. By 2020, Singapore will add another 4,200 beds and 4,700 places in healthcare facilities islandwide. In doing so, he reinforced the strategic direction for health and healthcare in Singapore: (i) beyond hospital to community, (ii) beyond quality to value and (iii) beyond healthcare to health. This is indeed very comprehensive by any standards and a timely assurance for Singaporeans and their healthcare needs. In closing, Minister Gan calls for Singaporeans to “work together as one healthcare system to bring Better Health, Better Care, Better Life for all Singaporeans.”
But what about our nation’s death care needs? As it stands, clearly inadequate with short term-ism being the norm. A huge deficit exists between healthcare and death care in Singapore. The problem is we tend to see healthcare and death care as being mutually exclusive, just as we like to see life and death as polar opposites. They are not. A key component is clearly missing in Health Minister Gan’s call for “Better Health, Better Care, Better life” for all Singaporeans: Better Death.
A silver age will naturally usher in a thano-age. If the silver tsunami is the first tidal wave that will hit the shores of Singapore, then the thano-tsunami will be that second tidal wave. The gap/ deficit that we see between ageing [dying] and death in Singapore today is akin to the aftermath of a tsunami. The retreat of the first wave [the silver tsunami] may falsely imply that the tsunami has “finished”, which can lead people to return to the beach out of curiosity, only to be swept away by the next incoming and larger wave [the thano-tsunami]. Singapore is building up its defenses to meet the demands of the silver tsunami. But when it comes to our thano-defenses, we are fatally exposed. For a start, we have to seriously consider including our healthcare and death care needs in the larger Total Defence Framework. Singapore’s healthcare and death care needs should be integrated into the civil, economic and social defence of Singapore.
With the merger of fourteen pairs of schools in 2019, fourteen plots of land will be freed up for redevelopment in mature estates. What will the government do with these land parcels? More homes and more malls? No, please not. In fact, the four plots of land freed up by the merger of the junior colleges in the respective geographical parts of Singapore presents an exciting opportunity for some rethinking at the policy and strategic level in enhancing our present distorted relationship with the dead.
With the future of Mount Vernon Sanctuary very much uncertain beyond March 2018, the four plots of land freed up at 2 Tampines Avenue 9, 1033 Upper Serangoon Road, 21 Champions Way and 800 Corporation Road provides the space to develop integrated funerary infrastructure and death-related facilities that will be particularly important; essential in fact to serve the needs of residents in a mature estate and the long-term death care needs of Singaporeans, while complementing present amenities and facilities in these estates.
Violent objections will be expected. This idea is not feasible, property prices will be affected. It is unclean and unsightly. But if not here, then where? As long as it is not in my backyard! In densely populated Singapore, bringing the N-I-M-B-Y syndrome to its logical conclusion would mean that there will never be any space for the dead. Today, she is Mum. Tomorrow, she has to be kept as far away as possible. She is a number, a statistic, an offering on the altar of progress. In the face of progress, we have become barely unrecognisable.
In Singapore, the relocation and the congregation of funerary facilities away from human communities has the effect of consolidating public attitudes towards death and limit the interactions and conversations between the living and the dead. Death perceived as “illness” and “pollution” requires regulation by the state through the Environmental Public Health Act. In other words, the presence of death is eliminated through the discourse of sanitation and public health. And with the rise of medical technology, we come to accept death as an unwanted and unwelcome intrusion in our ‘natural’ way of life. And it is this ‘natural’ way of life that has been repeatedly upheld in the negotiations that takes place between the living and the dead in dense and land-scarce Singapore.
This ‘natural’ way of life has to change and Singapore urgently needs a national conversation on death in Singapore. A population white paper without a mention of our future death care needs is myopic at best. These newly freed up land parcels provides us with just that golden opportunity to address this perennial shortfall in the relationship between the living and the dead in Singapore and in a small way help us to bridge the gap between our people’s health care and death care needs.
A thano-tsunami is fast approaching. What is our strategy?