Why not exercise more? People need other people to sustain healthy living habits

The Straits Times, Why not exercise more? People need other people to sustain healthy living habits

By Dr Belinda Yuen, Research Director and Senior Professorial Research Fellow at LKYCIC,

Francine Chan, Research Associate at LKYCIC, and

Dr Xin Yang, Research Fellow at LKYCIC

Health programmes must move towards practical skills, coaching and follow-up that help and encourage residents to sustain healthy behaviour in daily life.

What would a healthy neighbourhood look like?

In Yio Chu Kang, an elderly resident, Lim, envisions it as a green park where her family can picnic, a place for a walk after a long day of work, and peaceful spaces to pause and clear her mind.

Much of public health messaging begins with a simple assumption: if people know what is good for them, they are more likely to do it. The Healthy Precinct Framework, conceptualised and designed by the MOH Office for Healthcare Transformation (MOHT) in partnership with agencies and community partners, takes this further and recognises that decisions are never made in isolation. Habits are shaped by whether healthy food is affordable, whether walking routes are comfortable, whether there are interesting programmes nearby, and whether someone notices when a neighbourhood friend stops showing up.

Its approach to creating a healthy neighbourhood is through neighbourhood-level collaborations that coordinate healthcare, social services, and urban design to make healthy living easier for residents.

The limits of personal responsibility
The familiar public health message starts with the individual. What does your health report say? Are you exercising enough? Is your meal option the healthier choice?

Our ongoing research project, Benchmarking Healthy Precinct Framework, in collaboration with MOHT, found that more mature health programmes move beyond information towards practical skills, coaching and follow-up that help and encourage residents to sustain healthy behaviour in daily life.

Walking is one example. Knowing that walking brings health benefits is one thing. Actually starting to walk is another. In Yio Chu Kang, residents suggested environmental enablers such as having shelter and fans in walking and exercise areas, comfortable gathering spaces, accessible transport connections and more greenery.

The same gap between intention and behaviour appears in healthy eating. A resident discussing the “Healthier Me 21-Day Challenge” said that participants saw notable improvements between their pre- and post-health screening as a positive outcome of the structured healthy eating programme. The challenge, run by the Tzu Chi Foundation, a partner of the Healthy Precinct Framework initiative, is a whole-food, plant-based diet programme to help people become healthier.

Yet, sustaining the diet afterwards was difficult. Participants wanted healthier options in hawker centres and coffee shops, beyond a time-limited intervention.

The binding constraint is often not a lack of health knowledge. It is the absence of practical conditions that make healthy behaviour easy to begin and realistic to sustain.

Health as part of the neighbourhood fabric
We often say it takes a village to raise a child. Increasingly, it takes a village to keep a person healthy too.

In our discussions in Boon Lay, residents described becoming more physically and socially active after joining Active Ageing Centre activities. They judged success not only by steps, blood pressure or class size, but also by tangible factors often missed by traditional measures of whether people returned, made friends and felt noticed by an instructor. One qigong class grew from 30 to 45 participants, with residents attributing its appeal to an instructor who engaged seniors, corrected their movements and built rapport.

The social element is not incidental. Research participants emphasised that personal invitation and trust mattered more than incentives. For many residents, it is the reason they participate in the first place and continue returning. A familiar group gives residents a reason to leave home and keep attending.

Family members, friends and neighbours can encourage a reluctant senior. Increasingly, trusted resident-volunteers play a key social role by accompanying more socially isolated members of the community to activities.

The initiative pays particular attention to residents who face greater barriers to healthy ageing and social participation, including older adults, persons with disabilities, persons living with dementia, caregivers, low-income residents and others at risk of social exclusion.

The neighbourhood itself must also invite participation. The Healthy Precinct Framework’s place-based approach combines community activation, integrated care and built-environment improvements, supported by partnerships and digital tools.

As the initiative is implemented at the precinct level, the community is directly consulted.

The framework has been implemented in 10 precincts, with Boon Lay as its first pilot, tailoring community health programmes, physical spaces, and volunteer networks directly to the public housing estate’s ageing and multi-ethnic demographic.

Yio Chu Kang took a different approach – letting residents, including older adults, help design solutions for ageing in place and dementia care from the ground up.

This framework has real-world impact when community centres, void decks, sheltered paths or community gardens are re-evaluated and transformed into part of the integrated health infrastructure. Through walk-along interviews with residents and the use of digital tools, the initiative helped identify hazards, lighting gaps, seating needs and wayfinding improvements. In Yio Chu Kang, resident feedback about buckling interlocking tiles prompted the use of a safer material across future projects in the estate to create better walking environments.

Making the framework last
The Healthy Precinct Framework is not a single intervention, screening programme or physical upgrade. Its innovation lies in activating partnerships to integrate health into daily life and neighbourhood planning. The framework moves public health from inside medical clinics into everyday community spaces.

To create healthier living environments, the framework convenes government agencies, healthcare providers, researchers and residents. Projects under its community empowerment strand have engaged more than 15,000 participants, mobilised 37 partners and supported 10 organisations to kick-start and sustain community-led health activities.

On Sept 1, the Healthy Precinct Framework received the World Health Organization Healthy Cities Recognition Award in Sydney. The award recognises the initiative as an early real-world test of how to make healthy living accessible to residents of all ages.

Even so, implementing the framework is not without challenges. There have been financial, manpower and resource constraints and community engagement gaps. Informal feedback from residents is rich, but it may not always be consistently recorded, tracked or communicated back. Residents shared that their suggestions disappear into a “black hole”.

Other stakeholders stressed that scaling a programme requires rebuilding local trust and relationships, which may be more important than simply replicating an activity in a different precinct.

The answer is not to replace local flexibility with a rigid national template. It is to strengthen what already exists: durable funding, clearer stewardship, and a way to make sure resident feedback doesn’t disappear into that “black hole”.

Singapore’s WHO award validates the ambition to localise healthy living and points to the next steps in making the model durable. Personal responsibility will always matter, but the future of health cannot remain an individual project. It takes a village not only to raise a child, but to also help all of us age well.

• Belinda Yuen is a senior professorial research fellow at the Lee Kuan Yew Centre for Innovative Cities, Singapore University of Technology and Design. Francine Chan is a research associate and Xin Yang is a research fellow at the same centre.