May 1, 2009

The Risk of Disease on a Very Crowded Little Red Dot

May 1, 2009
H1N1 outbreak
Orange alert in S'pore
Measures to fight swine flu shift into higher gear; One-week quarantine for those who return from Mexico

By Bertha Henson

EXPECT to have your temperature taken when you attend big events, and to be asked for your contact details when you enter office buildings.

Such procedures at schools, workplaces and hospitals will start now, as Singapore moves into 'orange' mode in its five-colour alert system, which progresses from green through yellow, orange, red and black.

It might well move to red soon, said Health Minister Khaw Boon Wan on Thursday, as he detailed more stringent measures to combat swine flu.

..... As for those contemplating a trip to Mexico, the epicentre of the swine flu outbreak, and affected areas in the United States such as New York, California, Texas and Kansas, the plea from Mr Khaw is: Don't.

So far, Singapore has been lucky not to have been invaded by the virus, he said, 'but I think it will not be long before patients or even deaths start to occur here'.

'In South-east Asia, we are the most globalised country, so the first cluster of cases in South-east Asia may very well emerge in Singapore.'

The problem isn't merely that we are the most globalised country in Southeast Asia. The problem is also that Singapore is the second-most crowded country in the world.

And why is Singapore the 2nd most crowded country in the world? It's mostly because of the government's hare-brained plan to deliberately bump our population up to 6.5 million (by inducing a huge influx of foreigners onto our little island).

Such a plan has numerous implications. One implication is the greatly increased risk to the health of the general public. Here's an excerpt from one of my own posts, which I had written more than a year ago:

Incidentally, I've often wondered whether the government has really considered the potential health implications of its ambitious population plan. I'm referring to the government's plan to increase Singapore's resident population to 6.5 million people (mainly by importing more foreigners).

There are plenty of reasons why we should be cautious about such a plan. One reason is that we live in a time where mankind seems to be constantly threatened by the likes of SARS and bird flu.

Squeeze 6.5 million people together on a little red dot. Make it the world's most densely populated country. Every day, pack a great number of citizens like sardines into the public transport system. What do you get?

Potentially, a great recipe for a massive epidemic .....

Unfortunately we are led by buffoons. They actually seem to believe that 6.5 million is some kind of magical number, at which Singapore's population will thrive, and below which we are doomed to failure.

This, of course, is pure nonsense. Economic success is far too complex to be reducible to a single figure, and depends instead on a wide range of other variables.

It is interesting to recall that Singapore's best economic years (when we were regularly achieving double-digit annual economic growth) all happened in those times when our population was just around 2.5 million. In other words, about half of what it is today.


John said...

It seems that the government is squeezing so many people into this island to sustain the artificially high real estate prices (so as to retain political support from the masses).

Anonymous said...

there is more to it than just health concerns. Just look at the infrastructure that can't keep pace with the influx of people. The transport network is completely insufficient as it is to cope with the current number of people here. Overall quality of life is getting worse. I can't vote so, i can't really do a thing about it, but it seems to me the policies of these days are pretty misguided.

Anonymous said...

Actually, a correction to your article, the best economic years in Spore were when China was still dormant. From the 1970's to early 1990's, Spore was a rising economic tiger just like Hong Kong. Note that China in the 1970's was still locked in a Communist regime where Deng Xiao Ping did not proclaim his "get rich is glorious" theme yet. It took a while for China to set up its economic infrastructure after Chairman Mao died in 1976, the capitalist economic plan only kicked in when Deng Xiao Ping round about 1978 made his famous get rich is glorious speech. China was still finding its export markets in the 1980s decades. China only went full steam in the 1990's, of course there is no looking back now. Hong Kong's economic rise & fall much mirrors ours.

Anonymous said...

Not that I agree with the policy of being packed like sardines but would using density of cities rather than countries be a fairer comparison?

Parka said...

John - How would overcrowding and high estate prices retain political support? No sense at all.

Anyway, I do think that the overcrowding situation is getting worse. Just like the blogger from, I try to avoid MRT trains.

Most of the time, I'll stand even if I see a seat. When I sit, I still have to give the seat up to those who need it more, so might as well stand for the whole journey. On the bus is still better because nobody will bother to squeeze to the few empty seats at the back.

Health issue is definitely a concern. Just put one swine flu victim into the train and we can shift the Singapore alert system to red. Not that I'm not confident of Singapore handling the situation, I'm just more confident of the flu spreading.

Anonymous said...

I am skeptical abt the link btw the 'magic number (6.5million)' and 'a great recipe for a massive epidemic'.

Surely there are many more places that are much more dense. Also is the calculations given in the link '' correct? e.g. what is the land area and total population used for their calculation.

Andrew Gung

tianhong said...

it's the same with japan for their transport system. i have to agree that our transport system has been pushed to the max. even with the circle line, im not sure whether it will help.

Chee Wai Lee said...

Anonymous 1/5/2009 10:39am - density of cities is definitely a better metric. Based on 2007 data, at 4 million people, Singapore stands at #29. The land area is suspiciously low at 479 sq km though, they probably counted only inhabitable areas (Reservoirs, forests etc are probably ignored).

If we pushed to 6.5 million on the same land area, we'd be at #9 (based on 2007 data). While it is fair to say the densities of other cities may also grow relative to ours, becoming *more* crowded is still ... well, *more* crowded. Besides, other world cities have the option of lowering their densities by expanding laterally ... Singapore's ability to do the same tend to be more severely restricted.

Like Mr. Wang, I had a gripe about the transportation policy 10 years to attempt to make *every* SBS bus air-conditioned. No offense, ... but a crowded and packed environment with a mostly re-cycled air system?? Someone must have given the policy a cursory glance and thought "looks good!" and stopped thinking about it. Personally, back when there were options of the AC bus and the non-AC bus and I had the luxury of making the choice, I'd always go for the non-AC. I can deal with the heat ... I'd never want to breathe the horrid smelly recycled air ...

Anonymous said...

Doesn't matter what happen lah. The most important thing is come election, the 50% walkover opposition and 66% mandate folks will still be around, and not died of swine flu or what not.

Norman said...

We are indeed crowded. Even more crowded if you take into account the fact that about 20% of our land area is forest and training areas.

Just visit Jurong East MRT in the mornings to see people literally tumble out from the North-South train after the doors open.

Seems to me that it would have been better if the MRT was built initially as a network of a few medium capacity lines, rather that 2 big heavy capacity lines. I mean - what's the point of spending 15 mins to get to the MRT station for a 30 min trip??

Chee Wai Lee said...

Andrew Gung - the numbers look about right. CIA factbook gives about the same numbers. Monaco is basically a 1 square mile hill with around 50,000 people. Singapore (according to CIA factbook) is 682 sq km which works out to about 266 sq miles (1.6km = 1 mile), so with 4.8 million people, I calculate a density of 18,045 per sq mile.

In any case, as I mentioned in my previous post, I agree that city density is a more appropriate measure.

As for a "recipe for a massive epidemic", it would depend on hygiene practice at various levels in very crowded environments. That last food poisoning case at Geylang Serai is a classic case of what happens when poor hygiene is practiced at the micro-level (individual) in combination with the macro-level (area cleaniness) in a very crowded environment. Here, we have a compounded problem: a hawker who perhaps failed to handle his fresh food properly (or lapsed) now combined with a rat infestation which he may or may not share any of the responsibility for (given a crowd of hawkers). Now, compound that again with a crowd of customers in that same environment ...

Anonymous said...

Correct me if i am wrong.. If we talk abt japan the most crowded places(cities) would be Tokyo or maybe Osaka. In kyushu or hokkaido (other areas).

Anyway, the world's population is on the rise.. more and more places would get more and more crowded. During a world wide epidemic, Would it really make a difference if singapore's population is 4.5million or 6.5 million?


Anonymous said...

Are they still sticking to the 6.5 m projection? I thought there was a change of mind when they looked at the transport situation. I do not take the MRT very often because I am a retiree, but I can definitely see the huge difference between now and about 8 years ago, in terms of train ridership, even during office hours. It definitely cannot cope with 6.5 m people.

Lost Citizen

Anonymous said...

Arguing over city or counry density is moot. In Spore there is no hinterland or countryside for you to escape to when a epidemic strikes.

Alan Wong said...

With the current population, we now have to queue and wait for at least 3~4 weeks for an appointment to see our specialist doctors at our govt restructured hospitals before we actually find out what is actually wrong with us.

With the population rising to 6.5m, it is most likely that the queueing period for treatment of serious illness at our govt hospitals would at least doubled.

However if one is prepared to pay as a private patient, our specialist doctors in govt hospitals are suddenly readily available to give immediate attention, with courtesy of our money-faced govt.

Meanwhile, those peasants who cannot afford private treatment, you can wait for your turn. Who cares if you can't wait any longer.

Anonymous said...

The crowding at mrt stations is really disgustg, one swine flu sneeze..wildfire..i too dun want to be there when sg mrt system has to support even more people~

Anonymous said...

Oh, by the way, what percentage of our scarces land was taken by golf courses for the pleasure of a select few.

Anonymous said...

There stands a good chance the figure came from drawing upon Israel's population size which is about 7.5million.

Anonymous said...

"Unfortunately we are led by buffoons. They actually seem to believe that 6.5 million is some kind of magical number."

Let us hope that whatever consequential "damages" can be undone and repaired which I doubt will happen soon. Those buffoons must be staying in not-so-crowded residential areas and not having to travel regularly on the public transport during peak hours - where inhaling vehicle exhaust while along the road or waiting for buses or breathing in a heady mix of strong perfume / hair styling spray from working commuters is getting worst and worst.

Anonymous said...

I'm more worried about being shoved off the MRT platform during peak hours, than getting SARS or swine flu in the trains...

Anonymous said...

Dear AndrewGung,

i am actually quite surprised that you did not feel that an increase from 4.5m to 6.5m is significant just because the global population is on the rise. Singapore already has quite maximised the potential of urban planning (which unfortunately is the whole island and not just some capital in some country) to the fullest extent here and yet they intend to incrase the population. and the increase of 2m is no small number given the amount of land that we have, irregardless of whether that increase of 2m is through in the flux of foreigners or through increase in local babies. There are many considerations when you want to increase the population by half, housing concerns, health and welfare concerns. No doubt our government has considered these problems when they declared this, but perhaps they have been overly optimistic of the capacity of our tiny red dot. You may say that we have the option to build upwards, but given our current technology, a sky city for 6.5m is quite out of reach, or at least given the time from now to the target year for 6.5m.

During a world wide pandemic, assuming every city averages out a certain fatality rate, singapore given it's dense population, will have quite a high number of fatalities in absolute terms.

Also, higher the population, higher opportunities that there is a lot of human traffic between singapore and other countries. that really makes the spread of a contagious disease widen much faster in a global sense.

Chee Wai Lee said...

Anonymous May 1, 2009 4:02 PM -

I had originally wanted to argue the same thing you did (that it is moot whether to consider country or city density), but that's actually not true.

If a major epidemic crisis were to hit Singapore, people *will* flee to Malaysia or Indonesia or anywhere else they can get to. At the collapse of society, refugees will go anywhere that is safe ... not simply somewhere safe in your own country.

Anonymous said...

I'm a Singaporean holidaying in Mexico for a month and was in Mexico City several days ago. Authorities considered shutting down the Metro system in this city of 22 million people. Imagine that! Public transport is one of the best ways to catch the flu, sneezing and holding the same rails, etc.

Gilbert Koh aka Mr Wang said...

Wai Lee:

If there were in a major epidemic crisis in Singapore, then in all likelihood Malaysia and Indonesia would place restrictions on the number of Singaporeans who can get in. In the worst case scenario, they would simply close their borders to Singaporeans.

Anonymous said...

How is your policy makers rewarded? Are their performance bonuses tied to GDP? Increasing population is a sure-fire way of increasing GDP.

A no-brainer.

Unfortunately we are led by buffoons.

BUffon Me said...

First, many big guys have said that our scholars must have the guts to go against popular sentiments to make decisions.

But for HDB, they shrink the size of the flats because "Singaporeans are asking for it", despite our "family friendly" policies. Heh.

And with smaller flats, but national service of having more kids, when a parent is down with say, flu. That's good luck to everyone in the small area. Not to mention, the very expensive medical care due to poor planning by some units resulting in too small a number of doctors produced from NUS.

Buffons. Indeed.

Thanks Mr Wang.

Anonymous said...

mr wang, upon reading your article for the second time, i would like to mention a basic economic principle. the production possibility frontier.

it's really is a very basic and fundamental concept to the study of economics, but it also addresses the need for a certain degree of unemployment in a country to makeup for depreciation in our capital goods. it also explains why there are "the good years" where we posted double digit growth. we (or even china and india currently) had double digit growth because there was a history of under utilization of resources and hence were not producing at the fullest potential. does a single digit growth mean that we are back sliding? not necessary so. if after a period of double digit growth, we slide to a single digit eventually for a while (unless there was some big event like the credit crisis which crippled the global economy), it is fairly normal and merely shows that we are working very closely to the borders of our current production potential.

Anonymous said...

Economic growth,there are three factors that grow economy.

1.Increase of workers-usualy limited in a country as most depend on natutal birth.

Singapore registered the highest population growth in the world during the last couple of years.

2.Increase in capital-GIC,TMK accumulated the largest capital pool in the whole world,but now possibly no more no.1 since they lost about $250 billion on paper.

3.Increase in productivity:very hard and difficult,clever guys do not do this,they want a quick fix and easy way out.

Singapore has the lowest productivity gain in the developed world,even though our wages are very low.

Singapore is not a your normal country,there is no reason why we cant enjoy double digit growth years after years.and that is where many prominent economists got that wrong,they cant imagine how PAP can pump up the workers and the capital,it normally does not happen in a democratic country.

Many economists came to the conclusion that Singapore voters have the highest IQ in this world,you read that in 154th all the time.

Anonymous said...

I used to be able to walk into any arriving trains, board them swiftly and enjoy the ride to work every morning. Even if there was no available seats, I could still flip open a book, do some readings. Its a little activity I did to make the ride a pleasurable. Zoom forward 5 years, I find it a pain taking the train to work nowadays, as its mostly cramped, and needless to say there's no longer room space for holding out a book. You stare blindly into the space, someone's back.

I would consider that as an anecdotal evidence of a downgrade in the standard of quality living. Wheres the promised Swiss standard?

BUffon Me said...

All of you should go read about Macdonald's.

On why Harry Sonneborn described Mac as a real estate company which happens to sell fast food. Then think of how this is applied to Singapore.

Except, Mac, is a business. Singapore is a country where you don't and can't just fire anyone.

Anonymous said...

I still don't understand how bumping the population to a magic number is necessary for economic growth. So far, no one in PAP has answered that clearly, they just sidetrack it all the time.

Is it really necessary? Can someone please enlighten?

Gilbert Koh aka Mr Wang said...

Anon May 2, 2009 11:59 pm:

I didn't mention the days of our double-digit growth, to make the point that we are backsliding.

I mentioned the days of our double-digit growth, to make the point that there's no obvious relationship between population size and economic growth (Singapore used to achieve much higher economic growth, when its population was much smaller).

Anonymous said...

To annon 4 May 11:05am

Building on the Macdonald's, the more people you have on a piece of limited land, the more economic transactions you can have on that land. The more "valuable" that piece of land is.

It doesn't matter you are selling burgers, toilet bowls, or night soil. It is not the selling, but the number of economic transaction you make which goes into the valuation of that land.

This, is why we have wonderous rentals even in a unprecedented recession, and the land "investors" get richer in spite of us getting poorer.

So the more people you have...

Chee Wai Lee said...

Mr Wang,

You are right. In an epidemic situation, all nations would quite rightly close their doors to Singaporeans and let it be "contained" on our island, right or wrong. Better to let 4 (or 6) million people perish/suffer than infect the rest of the 7 billion. I wonder about the subsequent consequences on relationship between the survivors and the rest of the world though ...

Anonymous said...

Make that Greedy Buffons. I have to wait six months to get an appointment for a root canal treatment at the Singapore Dental Clinic, two months for a cardiologist to see me and then four months to have a nuclear scan. I walked into a private clinic for a shoulder pain and can get an MRI done the very next morning. I am sure any foreigner can get immediate treatment when he can afford to pay for something as simple as a shoulder pain but a local have to wait months even for a life threatening condition involving the heart. It all boils down to whether one can pay or not. Perhaps our sons should adopt the same principle when they are drafted into National Service!

Anonymous said...

I'll definitely be a "quitter" before S'pore population reaches 6.5m people!

SAF should be able to take down Johor by then! So what's the problem with 6.5m people?