In 2019, Beyond Social Services was commissioned by the Health Promotion Board (HPB) to conduct a qualitative research study on the health competencies of low-income earning residents living in public rental housing. The study aimed to understand residents’ notions of health and their health-related concerns. Involving residents in the process was important, and a key objective was to activate local response and form community action teams to address health concerns identified from the research.
However, in 2020, the spread of COVID-19 severely impacted the livelihoods of low-income residents. As a study elsewhere by Beyond had shown, median household income among residents who applied for our financial assistance fund fell by 69%. In addition, 35% of applicants saw their household income from work fall to zero. The study also showed, based on data from 1,231 applicants, that the fall in work income was higher among those with lower income before COVID-19, signalling deepening inequality.
With this in mind, Beyond collaborated with South Central Community Family Service Centre (SCCFSC) to embark on this study. The organisations conducted in-depth semi-structured interviews, covering health issues, with 50 residents from families with youth and children in Lengkok Bahru, a neighbourhood comprising six blocks of public rental flats. These interviews were organised and conducted by trained residents, students and volunteers. Beyond also interviewed several medical practitioners to gather their perspectives and insights.
Based on the responses of interviewees, residents were generally aware of healthy lifestyles—e.g. the need for adequate rest, a healthy diet and regular exercise— but are limited in actualising them due to their constrained individual capacities. Ensuring mental well-being, improving immunity from chronic illnesses, and positive healthcare seeking behaviour were limited by residents’ employment conditions, caregiving stresses, as well as access to and the quality of the healthcare system. The decline in residents’ income from work during the pandemic, therefore, created additional constraints that limited their capacity to ensure that their health needs were met. Low-income non-Singaporean residents were especially disadvantaged in accessing adequate healthcare due to their ineligibility for government subsidies.
Households in Lengkok Bahru generally have the will and knowledge but lack the capacity to adopt healthier lifestyles and positive health-seeking behaviour. Community interventions or public policies to improve healthcare outcomes of low-income residents therefore need to be directed at increasing their capacities at work and the household, as well as improving the accessibility and quality of the public healthcare system for more vulnerable groups. It is also important to ensure that policies do not create further stressors on the livelihoods and wellbeing of families already living under financial strain.
The findings from this report were first shared with residents of Lengkok Bahru, from which an action team of residents convened. The team now meets regularly to discuss how to increase the healthcare capacity of the community as a whole. Strategies include networking with relevant medical practitioners and organisations, making care arrangements when residents need to go for medical appointments, pairing up to check in on the health status of one another, and facilitating mutual aid when healthcare costs become insurmountable. Effectively, these residents are training themselves to serve as health ambassadors in the community. These community interventions can help low-income residents cope with and manage the difficulties they experience in the healthcare system. They are also integral in building solidarity and relationships among residents in the community. However, such community interventions, in themselves, remain limited in addressing the root cause(s) of their difficulties—namely, employment conditions, caregiving constraints, and the limitations of the healthcare system. These structural issues require public policy interventions and multi-stakeholder involvement and action.