SINGAPORE: Gina clasped her hands into a tight fist, fighting her emotions, as she recounted her experience after being diagnosed with Type 1 diabetes in Secondary 4.
Then just as she was getting used to her condition, her family was dealt another blow. Her mother Madam Low, a store assistant who earns about S$1,000 a month, was diagnosed with Type 2 diabetes at the end of last year.
Today, the 18-year-old and her family, which includes her mother and an older sister, struggle to make ends meet. And this even after receiving help in the form of medical supplies, such as test strips and pen needles, from Touch Community Services’ diabetes support arm.
“She already could not afford food and transport expenses for us and imagine having additional costs for her diabetes. There are times when my mother does not have enough money and she needs to borrow from my relatives,” Gina said.
Madam Low's diabetes diagnosis was another blow to the family, which survives on S$1,000 a month. (Photo: Monica Kotwani)
A NATIONAL EPIDEMIC
The condition has authorities so concerned that in April, the Government took the unprecedented step of announcing a "war on diabetes". With more than 400,000 people affected, the International Diabetes Federation has estimated that Singapore has the second-highest proportion of diabetics among developed countries, after the United States. And numbers could rise to 1 million by 2050.
To tackle the epidemic, Singapore authorities have set up a taskforce to look into the prevention and care of diabetes. With obesity and hypertension among the risk factors for the more common Type 2 diabetes, one of the areas of focus is encouraging people to eat more healthily.
But getting that message across to people on a tighter budget may prove a challenge, as families grapple with balancing value for money and healthier food options.
LOW INCOME AND DIABETES
While the link between socioeconomic factors and chronic diseases like diabetes has not been well-studied in Singapore, experts say there are indications of a correlation between the two.
For example, obesity is one of the risk factors in developing diabetes. “These days, we also see rising rates of obesity among the low-income group,” said Dr Kalpana Bhaskaran, head of Temasek Polytechnic’s Glycemic Index Research Unit.
The National Health Survey conducted by the Health Ministry in 2010 revealed a "modest" link. The report said households earning less than S$2,000 a month had the highest prevalence of obese individuals, compared to those earning S$6,000 or more. It said findings were similar when taking into consideration housing type.
In the case of Madam Low, who is not obese, it is difficult to establish what could have caused her to develop Type 2 diabetes. For now, she knows that eating healthily is important in managing the disease, but this can sometimes be easier said than done when every cent counts.
“SOMETIMES SHE MIXES BROWN RICE AND WHITE RICE”
Eating more vegetables and switching from white rice to brown rice could mean managing blood sugar levels better. Indeed, after Gina was diagnosed, Madam Low tried to change the way the family ate. She was worried Gina would face more complications as she gets older.
“Outside food is more oily and salty, so she tries to cook more at home so we can have a healthier choice of food,” Gina said.
But eating healthily can come at a price. During a trip to the supermarket with Channel NewsAsia, Gina and her mother spent time surveying the different types of rice and their cost. “My mum always chooses cheaper food items,” Gina said. “She doesn’t always buy brown rice because it’s too expensive for us. Sometimes she mixes brown rice and white rice so she will not use too much.”
For low-income families like Gina's, affording healthier options on a strict budget is challenging. (Photo: Monica Kotwani)
Gina said her mother also buys brown rice in smaller packs. Dr Bhaskaran, who is also Vice-President of the Diabetic Society of Singapore, said this is a common practice among low-income families.
“Brown rice is one to 1.5 times more expensive than white or polished rice. When you have more disposable income, you can make a bulk purchase, which is cheaper. But the lower socioeconomic group may not have the money to do bulk purchase. They buy in smaller quantities which can be more expensive,” Dr Bhaskaran said.
THE FLIPSIDE OF GENEROSITY: FOOD DONATIONS ARE MOSTLY PROCESSED
Depending on their needs, low-income households could also receive food rations from voluntary welfare organisations or Family Service Centres (FSCs). Regular items in food packs provided include instant noodles and canned food - most of which are high in salt and fat content.
“Maybe when groups give away things, they have to bear in mind that rations should be thought through and there should be healthier choice products and some vegetables,” said Dr Bhaskaran.
Food Bank Singapore currently supplies food items donated by the public to more than 180 voluntary welfare organisations and FSCs, which in turn distribute the items to low-income households that include the elderly and those living in rental units.
Food Bank staff Jo-an and Margarita distributing food items to one of their beneficiaries. (Photo: Monica Kotwani)
The organisation recently started encouraging the groups they work with to distribute healthier substitutes such as oats, brown rice and olive oil. But its management associate, Jo-an Choo, said the drive has faced some challenges.
“Donors are not that keen on donating perishables like vegetables and fruits. For distribution, most of the centres are unable to store fresh produce, which is why they are not requesting this,” she said.
“The awareness to consume healthier products is not there either. Once we were distributing healthier food products, and there were beneficiaries that returned the olive oil asking if it was for massage,” Ms Choo said.
Still, the organisation is pressing on. Twice a month, it has been distributing healthier food bundles, which contain items such as brown rice vermicelli, oats, as well as a fruit and vegetable pack. It is also aiming to launch a cookbook that will teach beneficiaries to cook healthier meals with the donated items.
“We wouldn’t want to have canned food every day, which is really unhealthy, and in the long run, will have an impact on the health of the beneficiaries,” said Ms Choo.
HEALTHY OPTIONS ON A TIGHT BUDGET
Dr Bhaskaran said it is still possible to have healthy meals on a tight budget, but educating vulnerable households needs to be stepped up. First, they need to be informed on how to read the nutritional values on food labels, and be able to identify the "Healthier Choice" symbol.
Second, it is about making behavioural and perceptional changes. "Low-income households may eat less vegetables and fruits - there is a perception that fruits and vegetables are expensive but it’s not true. You can make a simple meal for between S$2 and S$3, if you know how to choose right."
For example, she said some supermarkets offer discounts on house brand items such as brown rice. Families can also look out for vegetables and fruits on discount. Finally, supermarkets can also play a part in putting together bundled meal options at a low cost and have cooking demonstrations using those items.