SINGAPORE needs health campaigns that are more focused on the less educated if it hopes for further gains in developing a healthier society.
A study by a Health Ministry team found that lower-educated people are more at risk because they smoke more and exercise less than the better-educated.
So while the overall number of people who exercise regularly has gone up, and smoking has gone down, the improvement appears confined largely to the better-educated.The study looked at three health-damaging factors - smoking daily, not exercising regularly, and drinking alcohol - all of which raises a person's risk of having a stroke or heart attack.
It found that someone with no more than primary education is 21 times more likely than a university graduate to engage in two or more such activities.
Compared with a graduate, someone with secondary education is 11 times more likely to engage in two or more bad habits, and someone with A levels or a polytechnic diploma is three times as likely to indulge similarly.
Men are more likely than women to smoke every day and consume alcohol regularly, but women tend to be physically inactive.
The study was based on the 2004 National Health Survey which covered more than 4,000 people, and the findings appear in this month's issue of the Singapore Medical Journal.
The six-member ministry team wanted to find out why people in lower socio-economic groups tended to suffer from more chronic diseases and die younger.
It is known that up to 70 per cent of premature deaths due to strokes and heart attacks can be prevented if people exercised more and refrained from smoking and drinking.
Yet the health messages, put out regularly for years, did not seem to be reaching the lower-educated.
The team said its findings have practical implications for public health policies and strategies and concluded that Singapore's 'generic, one-size-fits-all health promotion campaigns need to be re-assessed'.
It means coming up with ways to reach the lower-educated who do not exercise or heed health messages.
Commenting on the outcome, Professor Gavin Jones, a sociologist with the National University of Singapore, said the findings on education and bad habits were consistent with what happens in many other countries.
'Educated people tend to read a lot more and think about such issues,' he said.
Member of Parliament Halimah Yacob, who heads the Government Parliamentary Committee for Health, felt there was a need to understand why the lower-educated smoked more and exercised less.
'A pack of cigarettes costs more than $10. This is a huge amount when their take-home pay may be only $1,000. We have to ask ourselves why they are burning money this way,' she said.
She has had smokers tell her that smoking is a stress reliever or a way to bond with friends.
Professor Philip Eng, a respiratory medicine specialist, felt the anti-smoking messages have gone out differently to different groups.
'Increased cigarette taxation works to decrease access to the kids and those less well-to-do,' he said.
'The scary adverts probably do work on the faint-hearted. The pictures denoting impotence probably work on men in mid-life. The adverts on the effects on looks probably engages the young women best.'
But while the overall number of smokers dropped from 18.3 per cent in 1992 to 12.6 per cent in 2004, one in five people in the lower-education group still smokes daily compared with only one in 20 graduates.
