Looking to 2024: Health issues on the horizon – from ageing to mental well-being and digital medicine

The world marked an important milestone in 2023 – the end of COVID-19 as a global health emergency. The World Health Organization’s (WHO) announcement in May came more than three years after the coronavirus crisis, although it cautioned that the virus was here to stay. 

Progress was also made in other areas. New vaccines were approved for malaria, dengue and meningitis, while more than 120 countries signed a declaration to accelerate efforts to protect people’s health from the growing impact of climate change, the WHO’s chief noted in a year-end message.

In Singapore, the Healthier SG initiative was launched, focusing on preventive and holistic care for residents to deter chronic conditions, while the new National Mental Health and Well-being Strategy aims to enable individuals with mental health needs to seek help without stigma.  

Looking to 2024 and beyond, what public health challenges will need to be addressed? What emerging trends could shape the landscape for mental health and well-being, and how can we leverage the potential of digital medicine to improve healthcare? NUS researchers from the Saw Swee Hock School of Public Health (SSHSPH), Department of Biomedical Engineering at the College of Design and Engineering (CDE), Department of Sociology and Anthropology at the NUS Faculty of Arts and Social Sciences (FASS), as well as the Lee Kuan Yew School of Public Policy (LKYSPP) share their insights.

Ageing population, mental health and infectious disease management among Singapore’s health concerns; health equity key to complex global challenges

In 2024, Singapore will continue to face significant public health challenges related to its ageing population, mental health, and ongoing efforts to manage and prepare for infectious disease outbreaks, says Associate Professor Natasha Howard from SSHSPH. Globally, Dr Howard highlights the importance of ensuring equitable vaccine access in underserved regions, mitigating antibiotic resistance, addressing non-communicable diseases, as well as safeguarding public health in the face of climate change.

Singapore’s growing elderly will put increasing pressure on the health system, particularly for age-related illnesses and long-term care, requiring a whole-of-society approach to positive lifestyle management and healthy ageing. Mental health advocacy and support will remain important to address familial and societal stressors or more existential pressures, such as geopolitical events and climate change. Meanwhile, the aftermath of the COVID-19 pandemic will not only require managing potential variants, but also balancing economic recovery with health safety, supporting global improvements in vaccination equity, and ongoing vigilance to mitigate emerging infectious diseases and potential outbreaks.  

On the global front, health priorities are complex and require concerted efforts from both governments and civil society in healthcare innovation, with a focus on prioritising health equity.

Equitable global vaccine access – particularly against diseases such as COVID-19, measles, and polio – is crucial to save lives and reduce potential epidemics. Mitigating antibiotic resistance requires prudent national usage, robust surveillance and novel treatment research. Addressing non-communicable diseases requires preventive measures beyond the health sector to emphasise structural lifestyle changes (such as reducing the availability of ultra-processed food) and early disease detection. Meanwhile, environmental resilience will necessitate bold national and international policies to mitigate climate change's health impacts.

Role of digital medicine in delivering healthcare through personalised treatments, empowering patients and improving preventive health  

Dr Dean Ho, Provost's Chair Professor and Head of the Department of Biomedical Engineering at CDE, points to the growing applications of digital medicine in healthcare delivery. Drawing upon his work co-developing CURATE.AI, an artificial intelligence platform that provides personalised drug dosage recommendations for chemotherapy patients by studying their responses to a medication regimen, Dr Ho adds that such solutions will also play a vital role in improving population health. 

The field of digital medicine, when aligned with a broader ecosystem of disciplines that collectively understand the intended user, is poised to change the prestige of medicine at scale, sustainably. One example of how we are applying digital medicine to healthcare and health is by harnessing our CURATE.AI platform to use only a patient’s own data to dynamically adjust his or her own cancer drug dosing to optimise treatment outcomes. We are also developing a CURATE.DTx, a digital therapeutics platform that can personalise multi-tasking training for brain cancer patients, with software serving as the treatment. As cognitive decline may be a concern following brain radiation treatment for these patients, the software seeks to personalise training difficulty to optimise the cognitive performance of its users.

Moving forward, digital solutions will also be critical to address population health. At the heart of this challenge is the ability to empower long-term behavioural change in patients, an essential component of realising improved preventive health and treatment outcomes for our community. The field of digital medicine can play a critical role towards achieving this objective through holistic, user-centred innovation. Realising frameworks that drive innovation in this manner will require insights from engineers, clinicians, behavioural and implementing scientists, health economists, and beyond. Empowering these highly diverse stakeholders will ultimately accelerate our community towards actionable solutions that span key domains such as ideation, innovation, validation, implementation, and ultimately, adoption and beyond.

Impact on mental health as Singapore shifts towards smaller household sizes and more people living alone

The rising number of seniors living alone and the growing proportion of one-person households are changing Singapore’s household structures, notes Associate Professor Feng Qiushi of FASS. He adds that these shifts in living arrangements would have a bearing on the social connections and mental well-being of individuals, presenting challenges for Singapore’s mental health landscape in the coming years.

2024 marks the 30th anniversary year for the International Conference on Population and Development (ICPD), based on which the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs) were consecutively proposed to guide global development. Almost all issues mentioned by MDGs and SDGs are related to the mental health and well-being of human beings.

Specific to Singapore, it seems timely to pay special attention to the issue of household structure. Among many other countries, Singaporeans are experiencing a rapid transformation towards smaller household sizes, which is changing the dynamics of how Singaporeans are maintaining their family and social connections. Specifically, we may see more older people living without children or spouses, more youth choosing to remain single, and in particular, an increasing number of people living solo among the various age groups.

As living arrangements are indicative of the essential social interactions in daily life and thus a foundational parameter of mental health and well-being, such a demographic change may pose significant challenges to Singapore in the years ahead.

Digital well-being faces risk of rising trust deficit due to generative AI  

The growth of generative AI (artificial intelligence), along with its capacity to be used for producing deepfake videos and misinformation, will make it harder for users to discern the authenticity of content they encounter online. This erosion of trust in online interactions could have adverse effects on digital well-being, says Dr Chew Han Ei, Adjunct Senior Research Fellow at the Institute of Policy Studies, at LKYSPP.

The rise of generative AI, exemplified by tools such as ChatGPT, will exert a profound impact on digital well-being in 2024. While the benefits and opportunities are promising, the risks linked to unchecked development and application of generative AI cast a foreboding shadow over the horizon, posing a significant threat to trust in the digital realm. As an academic, I am deeply concerned about the escalating trust deficit stemming from the darker implications of unregulated AI development.

Generative AI introduces unique challenges that amplify the existing trust deficit in our digital activities. Its ability to produce highly convincing and hyper-personalised content raises concerns about misinformation, deepfakes, and manipulation. The subtle nuances of its language generation capabilities create difficulty for users in distinguishing between authentic and AI-generated content, thereby eroding trust in digital communication channels.

Preserving trust has become a pivotal factor to maintaining digital well-being. Establishing and maintaining digital trust is non-negotiable. Transparent frameworks, stringent security measures, and ethical guidelines must take precedence. Navigating the evolving terrain of technological progress in 2024 demands constant vigilance, ensuring that trust is not compromised in the face of potential pitfalls associated with generative AI.

In the ‘Looking to 2024’ series, our NUS experts weigh in on what readers can expect in the new year.