Who are we trading off? Considerations for Singapore’s post-pandemic social compact

Academic Views, Coronavirus / Thursday, April 23rd, 2020

Chong Ja Ian, Harvard-Yenching Institute Visiting Scholar 2019-2020, argues that the pandemic reveals the need for Singapore to reconsider how it makes decisions about national directions and policy trade-offs. (Banner photo credit: Sumita Thiagarajan)

Singapore’s state-affiliated mainstream media has lately been publishing pieces relating to inequality. Undoubtedly, this has to do with the disproportionate economic pressure and public health consequences of the ongoing pandemic borne by the vulnerable. This includes low-wage migrant workers currently bearing the brunt of coronavirus infections, many of whom live in crowded, squalid conditions. The reality now made apparent has led to calls to be “kinder” to each other. Even if this plea is timely and appropriate, there remains the question of how our society got to its present sorry state. This may have to do with a collective willingness to close our eyes to the many “trade-offs” we have come to accept.

Before we speak of kindness, it may be useful to consider some of the decisions we have either made, or delegated others to make, on our collective behalf. Perhaps this is a first step to appreciating how Singapore ended up where it is. This may prove helpful for thinking through not just the outcomes we prefer (and those we wish to avoid) after the pandemic, but also ways to improve the processes through which our community makes choices that affect everyone. The 11 deaths and 9,125 infections from COVID-19 as of April 21, along with the quasi-lockdown conditions of the Circuit Breaker, should at least prompt us to improve how Singapore goes about its business.

Invisible among us

The concentration of COVID-19 infections among migrant workers should highlight their importance to not just Singapore’s economy but also its society. For a long time, many of us who enjoy the outcomes of migrant workers’ labor—fancy buildings, clean streets, shipyards, just to name a few—have had the luxury of seeing them as invisible. Recent comments about how they allegedly still have it better in Singapore than elsewhere are sad reminders that many still hold these views. But migrant workers live with and among us, sharing medical facilities, infrastructure, and food supplies. Their health, welfare, and security are part of everyone else’s. Truly, nobody is safe until everyone is.

If Singapore continues to have an economy that requires a low-wage migrant labor component, then we must take the treatment of this segment of society more seriously than before. This means integrating migrant worker participation, voice, and concerns in decisions that affect them, in a more active way than has been the case.

Moreover, Singapore must recognize that it ignores civil society groups and independent media at its peril. Together with workers, these groups consistently highlighted the risks facing migrant workers for more than decade—and as recently as March 2020—but were largely treated by Singaporeans as nuisances, if not ungrateful miscreants and malcontents.

International organizations, too, warned the Singapore authorities repeatedly about the risks of overcrowding and poor living conditions facing migrant workers, even getting official commitments to improve. Alerts came from the UN Special Rapporteur on Contemporary Forms of Racism, Racial Discrimination, Xenophobia, and Related Intolerance in 2011 as well as the 2011 and 2016 rounds of the UN Human Rights Commission’s Universal Periodic Review (UPR) to name a few. Singapore responded by highlighting positive migrant worker satisfaction surveys, legal instruments, and promises to rectify outstanding problems. In these public, external settings, the Singapore state is also interestingly amenable to acknowledging the role and contributions of non-state actors more positively.

The NGO coalition ALMOS (Alliance of Like-Minded CSOs in Singapore) raised the issue of migrant workers’ rights—among other human rights concerns—as part of the 2016 UPR process. (Photo: ALMOS)

An official reaction to the 2016 UPR on Singapore, for instance, indicated:

Surveys showed most migrant workers were happy with their work conditions, and would recommend to their families and friends to work in Singapore. Laws such as the Employment Act provided them the same avenues of justice as locals. Additional safeguards were provided through the Employment of Foreign Manpower Act and the Employment Agencies Act… Singapore noted that all types of foreign worker housing must adhere to rules on safety and well-being. The longer-term direction was to improve workers’ living conditions toward larger dormitories with full facilities. (p.12)

The 2018 UN UPR Mid-Term Report stated that, ‘The Singapore government accepted, albeit partially, the recommendation that it would “improve the situation of work migrants by enabling them to easily switch employers and to have access to decent housing.”’ (Emphasis added) Changes in this vein include legislation regulating migrant worker living conditions as well as new online reporting and feedback channels. Judging by COVID-19 infections among migrant workers, interventions based on limited acceptance of recommendations seem insufficient to address key health and welfare concerns. Such avoidable conditions put everybody in Singapore in a riskier, more precarious position.

Cost of “efficiency”

As cases of COVID-19 spike, concerns are rising over whether Singapore’s healthcare system can cope with the numbers and how to avoid it being overwhelmed. Wuhan and Italy provide indication that the overrunning of medical systems can have disastrous and deadly results, given the demands of both COVID-19 patients and others who require care. Even though Singapore has excellent medical services, resources are limited. Singapore’s doctors, nurses, and hospital beds per 1,000 population does not compare as strongly to other developed economies, including some where COVID-19 has overwhelmed medical systems. Such considerations have led even Singapore’s main state-backed broadsheet to publish concerns about the possibility of the health system being heavily strained.

The limitations of Singapore’s healthcare system are a known issue. In 2014, both Singapore’s state-affiliated mainstream media and its small independent media published stories about bed shortages at local hospitals. Patients were placed in hallways and temporary shelters awaiting bed space. The situation was particularly worrying given the ageing population that will demand more healthcare services. The matter sparked debate in Parliament and the administration at the time made sought to rectify the situation with new procedures and community hospitals. Yet even this increase was insufficient for a crisis, as it turns out.

The circumstances surrounding healthcare appear to be a consequence of an approach to healthcare—and, indeed, other social services—that emphasizes the reduction of redundancy and cost. A 1993 White Paper from Singapore’s Ministry of Health captures this mindset, stating:

Factors like an ageing population or more intensive practice of medicine can raise demand for health care, but to a significant extent health services are supply driven. Studies have shown that countries with more doctors, especially specialists, tend to spend more on health care. Therefore [sic] we must continue to control the number of doctors trained and the type of training they receive…

MOH should control the provision of hospital beds in Singapore, including the number of Intensive Care Unit (ICU) beds, the most expensive service in any hospital. MOH should also coordinate the introduction of new medical technology in subvented hospitals to avoid unnecessary proliferation and duplication of expensive facilities. (p.4)

(Source: Singapore Ministry of Health)

Under regular circumstances, the effort to control apparent key drivers of cost seems  reasonable. Yet such a position limits the ability respond to massive and sudden surges in demand during emergencies—such as the current pandemic. Running a system so lean makes fiscal sense, but it comes at the expense of opening society to other, less common but nonetheless real, risks. When searching for extra resources in a crisis, Singaporeans may discover that they have little left to spare.

Many make the point that foreseeing every contingency is impossible. I am sympathetic to the limitations of human capacity, but it is also difficult to claim that Singapore was blindsided regarding the potential for large-scale medical crises. Before the current spike in infections, many in Singapore touted how experience with SARS enhanced preparedness for COVID-19. But why did lessons from 2003 not extend further? Hong Kong, South Korea, and Taiwan so far appear to have drawn more successfully from similar experiences.

From my time working in Washington, DC in the early 2000s, I recall Singaporean officials at briefings about anthrax attacks on the United States and a simulated biological attack by a US think-tank. Those sessions discussed the necessity of enhanced preparedness—including the maintenance of spare medical capacityto cope with the public health, social, economic, and security implications from the very real possibility of large numbers of people falling seriously ill. The lessons learned and precautions needed remain the same regardless of the origins of a pandemic. Like the US Government, Singapore cannot have things both ways, by claiming experience and expertise while also citing the unavailability of information and the inability to fully anticipate pandemic responses.

Inequality in reality

The pandemic and its consequences also lay bare inequality in Singapore and its implications for society. Low-wage migrant workers as a group systematically do least well within our population, in terms of income and wealth. Others particularly hard hit by the economic slowdown include people living below or near the poverty line, many of whom provide basic services. It is little surprise that pawn shops have permission to open despite not explicitly featuring on the list of essential businesses. They are a source of loans for people without the credit other financial institutions demand.

(Source: Human Development Report 2019, UNDP)

This state of affairs is unsurprising. Many have been writing about Singapore’s struggle to address inequality in recent years, sometimes facing criticisms of inaccuracy or cherry-picking cases. Skepticism notwithstanding, comparative global measures suggest that Singapore looks more like laissez faire economies than developed social democracies, after adjusting for achievements like health and education for inequality. This is despite claims that our system is more communitarian and compassionate. Progress on inequality clearly exists, but this pandemic reveals the fragility of such advances and the ease of backsliding.

About the neighbors

Finally, the current public health crisis has uncovered Singapore’s symbiotic relationship with Malaysia, our closest neighbor. Malaysia is a major trading partner, destination for Singapore investment, and labor source. Many Singaporeans also have family ties there. The panic food purchases and efforts to accommodate Malaysian essential workers in Singapore following Malaysia’s Restriction of Movement Order shows the degree to which our well-being is mutually tied. This suggests a need for better cross-border coordination over policies that affect both our countries, including a degree of care toward each other’s citizens when they are in our respective jurisdictions.

Many Singaporeans view Malaysia with a degree of condescension, suspicion, and even disdain. Some Malaysians hold similar sentiments about Singapore. These attitudes are unhelpful for the long-term cooperative ties that persist regardless of the parties holding political office on either side of the causeway. Neighbors inevitably have differences, but it is critical to have these debates in ways that are peaceable, professional, and insulated from other aspects of the relationship. Amicable resolution of the Pedra Branca dispute shows that mutual respect is possible. Given our mutual dependence, there are overriding bilateral incentives to learn to disagree without being disagreeable.

It shouldn’t take a pandemic, but here we are…

Protests and dissenting voices in Singapore have not often been welcomed in Singapore, drawing police investigations or even prosecutions for assembly-related offences. (Photo: Jolovan Wham)

One key takeaways for Singapore from the pandemic is that, like China, Singapore needs to learn to better account the range of cacophonous voices at home and abroad, even if these are sometimes inconvenient for the rich, powerful, and privileged. This means improving our collective ability to evaluate differing perspectives on their merits, rather than being quick to denigrate and dismiss out of dislike for a source or point of view. Likewise, if Singapore wishes to collaborate with and bolster international institutions, rather than simply seek external validation and accolades, then more seriousness and transparency regarding compliance with international commitments is a good place to start.

Another lesson is a need for greater introspection, participation, and debate. Directly or indirectly, the consequences from choices of commission and omission that affect our society come to rest on us all. People in Singapore bear responsibility for legislation and policies, as well as their oversight and implementation. Some may take issue with the necessity of such action during a crisis, or mischaracterize it as unnecessary finger-pointing. Yet the circuit breaker may provide the opportunity of time and distance to reflect on how to better and more effectively take on our citizenship and social duties. Carelessly accepting existing trade-offs as given and inevitable means that Singapore risks waking up one day to find that we have traded ourselves away.

Note: Edit made on 24 April 2020 to include information on legislative changes and reporting channels.

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