The Chua Chu Kang (CCK) Community
History
Located in the West region, district 23, Chua Chu Kang (CCK) is 630 hectares of estate constituting of modern housing and industrial growth with a past history of rich coconut and rubber plantations farmed by Chinese immigrants who were predominantly the Teochew clan followed by the Hokkien’s who resided later and farmed pineapples, vegetables and poultry as well (Cornelius, 1999). The Singapore Housing and Development Board (http://www.hdb.gov.sg) states that Chua Chu Kang was named after ‘Kang Chu’ where ‘Kang’ meant river in the Hokkien dialect and ‘Chu’ referred to the clan name of the first headman of the plantations.
Demography
In June 2015, the Singapore Department of Statistics revealed that CCK has a total population of 174 330 residents, where 86 990 were males and 87 340 were females, whereby the female population remained higher than male for two consecutive years, with an 0.2 % increase in 2015 as shown in Graph 1 (a) and (b). In a way, this is good as Bastable (2014, p. 321) explains that females are likely to seek healthcare more often than men due to their traditional caretaker role of their children needing services in contrast to men who are influenced by sex role-expectation of society that men should be stronger. However, Annandale and Hunt (1990) found that masculinity was related with improved health in men while femininity had unfavourable health impact.
Graph 1(a). Chua Chu Kang Resident Population 2010 by Age & Gender. Data from Census of Population 2010 by Singapore Department of Statistics. Copyright 2016 by Government of Singapore
Graph 1(b). Chua Chu Kang Resident Population 2015 by Age & Gender. Data from Population Trend 2015 by Singapore Department of Statistics. Copyright 2016 by Government of Singapore
The Singapore Ministry of Social and Family Development (http://www.msf.gov.sg) defined elderly as persons aged 65 years and above. A Population Trend 2015 carried out by the Singapore Department of Statistics, displayed in Graph 1 (b) showed increase in elderly population by 2.3% within 5 years from the year 2010. In contrast, children aged below 14 years old decreased by 2.5% leading to relatively high elderly population in CCK.
A study on the type 2 diabetic epidemic found that diabetes impacts mainly those aged 65 years above (Yoon et al., 2006). Most elderly population have multiple chronic diseases like diabetes contributing to high expenditure on their treatments (Wolff, Starfield, & Anderson, 2002). Besides contributing to increased healthcare expenditure, the aging population also impacts the type of healthcare provided (Blank & Burau, 2006) increasing demands for long term geriatric care. Evidently, long term care centres such as ECON Medicare Centres and Nursing Homes and Bethany Methodist Nursing Home is built to provide professional medical and nursing cares to the elderly residents in CCK who are dependent on activities of daily living. The Singapore Ministry of Health (www.moh.gov.sg) stated their upcoming Chua Chu Kang Nursing Home planned to be located at Chua Chu Kang North 6.
Ethnicity
Besides that, there’s also traditional Chinese medicine (TCM) centres in CCK such as the Yong Kang Traditional Chinese Medicine Clinic located nearby the Chua Chu Kang MRT station. TCM is widely used by the 70% majority Chinese in CCK as shown in Table 1. This is because TCM is part of the Chinese culture and society for more than 2000 years (Men & Guo, 2010). In a study on the use of alternative medicine in Singapore, Lim, Sadarangani, Chan and Heng (2005) found that ethnicity and females are significant variables influencing the use of alternative medicine. Evidently, besides ethnicity, the female population in CCK is higher than the male as proved in Graph 1(a) and Graph 2(b), contributing to widespread use of TCM in CCK.
Table 1
Chua Chu Kang Resident Population Ethnicity & Sex in 2010
Note. Data from Census Population 2010 by Singapore Department of Statistic Copyright 2016 Government of Singapore
Religion
Furthermore, the Taoist that form 10.53% of CCK population as shown in Chart 1, are inclined towards outdoor activities to harmonize with nature and seek balance between the Yin and Yang through TCM (Chen, 2001).
Chart 1. Chua Chu Kang Religion Population of Residents Aged 15 years & Above. Data from Census of Population 2010 by Singapore Department of Statistics. Copyright 2016 by Government of Singapore
Although Rodiek (2002) proved that integration of treatment with nature by involving outdoor activities improves mood, anxiety and cortisol level in elderly, residents need to be aware as Lam (2001) believes the use of traditional medicines may lead to possible complications to other medications consumed.
In a study on Chinese immigrants in Canada, a combination of traditional Chinese medicine (TCM) and Western health services (WHS) were commonly used among elderly Chinese immigrants as WHS is the primary medical service protected by government –funded health insurance (Lai & Chappell, 2006). This relates to the local context as the provision of the Singapore government funded health insurance such as Eldershield, Medifund, MediShield Life and Drug Subsidies encourages residents to use public services such as the Chua Chu Kang National Healthgroup Polyclinic and Chua Chu Kang Family Clinic as listed by the Singapore Ministry of Health (www.moh.gov.sg). This is good as the polyclinic provides breast, colorectal, cervical and coronary risk screenings, contributing positively to residents health, as Rasmussen et al., (2007) believes that preventative health screenings increases life expectancy without affecting the healthcare cost.
Buddhism is the highest religious population in CCK corresponding to the majority of Chinese residents as shown in Chart 1. Lai and Surood (2009) describe that fate and cause-effect relationships are vital determinants of health in Buddhism. Therefore, healthcare professionals need to identify the locus of control of individual whether the individual’s sense of accountability for their actions originates from within them or influenced by others (Rotter, 1966). This affects the health of residents as individuals who believe that their state of health is controlled by external factors, like fate, may be unlikely to accept the same health education as individuals who believe that their outcomes of health is due to their own actions (Syx, 2008)
Muslim women are forbidden to expose their bodies or talk women’s health issues to a male healthcare provider (Odeh Yosef, 2008), thus prioritizing the healthcare provider’s awareness to be knowledgeable about the Muslim culture as CCK resident are 18.13% Islam. Besides that, 16.50% of residents have no religion. This decreases barriers and obstacles for residents to receive a high quality care.
Socio-economic
In relation to government subsidised services mentioned earlier, the socio-economic status of CCK residents affects how healthcare is utilized. Graph 3 indicates that majority of residents are middle income earners with a monthly income of $3000 to $3999 whereby residents could afford better goods and services with concomitant health benefits (Nwankoo, Nandy & Nwankoo, 2010) However, one-third of the majority of population earns below $1000 per month which may impact their healthcare expenditure and prevalence of diseases as proved in a study by Dinca-Panaitescu et al. (2011) that found low income groups with a higher prevalence of Type 2 diabetes.
Graph 3. Chua Chu Kang Residents Aged 15 Years & Above Gross Monthly Income from Work. Data from Census of Population 2010 by Singapore Department of Statistics. Copyright 2016 Government of Singapore
Housing
Relative to the monthly income, most CCK residents are able to afford 4- room flat and executive flats as shown in Table 2.
Table 2
Chua Chu Kang Resident Type of Dwelling in June 2015
Note. Data from Census Population 2010 by Singapore Department of Statistic Copyright 2016 by Government of Singapore
This illustrates that residents have adequate housing settings as the Chua Chu Kang Town Council (www.ccktc.org.sg) offers various services like the Handyman Service to help residents who are unable to hire a contractor for their housing repairs on their own with reasonable price maintaining sufficient housing environment in CCK as Schootman et al. (2007) found that an inadequate housing condition contributes to increased risk for diabetes. Besides that, the Census of population 2010 by Singapore Department of Statistic showed that a majority of 13 585 of CCK residents has a household size of 4 persons per home. Besides that, the statistics also showed that 63% of residents were married which is a good indicator because there is support system for each other. This social environment can provide practical and emotional support that’s beneficial to residents’ health (Hoving, Visser, Mullen & Borne, 2010). However, 3,402 residents are divorced and a whopping 5 354 residents are widowed. This affects health as Slawson (1963) found that depression and psychological impact due to broken marriages were factors for the onset of diabetes.
Facilities
The CCK Town Council also planned Cyclical and Improvement Projects for residents to upgrade existing jogging tracks along the Chua Chu Kang Park and the provision of Senior Citizen Fitness Corner that not only maintains the elderly health but also encourages exercise among residents to engage in outdoor activities. This initiative relates to Rodiek, Nejati, Bardenhagen, Lee and Senes (2014) study of the Senior Outdoor Survey Tool stating the importance to evaluate which environmental characteristics effectively supports and satisfies residents to encourage their outdoor activities. Consequently, improved sleeping pattern, mood and Vitamin D absorption can be improved by the time spent outdoors (Clare & Woods, 2008).
Besides that, the Lot 1 shopping mall located near the CCK train station is one of the Health Promoting Malls under the Health Promotion Board (www.healthhub.sg) organised by the Ministry of Health that aims to conduct mall workout exercises and provide healthier food options for CCK residents. Moreover, the Chua Chu Kang Public Library that’s located within the mall itself provides residents, particularly youngsters to spend their time reading or doing school-projects.
Community Development Team
The Resident’s Committee (RC) in CCK is a voluntary organisation run by residents for residents living in the community (www.cck.org). It serves as means of communication between the district’s community and government organisation regarding the needs of CCK residents as Bernhardt (2004) reinstates that effective public health communication is essential in promoting and protecting the public health.
Transportation
Corresponding to CCK residents level of income, most residents use car to work followed by public transportations as shown in Table 3. Reliance on motorized transportation increases inactivity leading to obesity (Bell, Ge, & Popkin, 2002). Although having a car may be convenient, the emission of harmful gas not only contributes towards a higher pollution, but health damage (Proost & Van Dender, 2001). In fact, the transportation noise from using motorized vehicles contributes to increased cardiovascular risk (Babisch, 2008). Furthermore, in an American study, transport vehicles was also found to contribute towards increased accident rates affecting the safety and health of individuals (McFarland, 1958)
Table 3
Chua Chu Kang Resident Working Persons Aged 15 Years & Above Usual Mode of Transport to Work in 2010
Note. Data from Census Population 2010 by Singapore Department of Statistic Copyright 2016 by Government of Singapore
Education
As shown in Table 4, CCK residents’ level of education in 2010 was mainly of primary followed by secondary education, indicating low educational level. Relatively, people with primary level education showed higher prevalence of type 2 diabetes (Dinca-Panaitescu et al., 2011).
Table 4
Chua Chu Kang Resident Level of Education Attending for Population Aged 5 Years & Above in 2010
Note. Data from Census Population 2010 by Singapore Department of Statistic Copyright 2016 Government of Singapore
Literacy and Language
However, a primary education level doesn’t indicate the literacy level of individual as Bass (2005) defines literacy as the ability to read, write and speak in English at level of proficiency required to function in the society and on the job. The Singapore Department of Statistics revealed in 2010 Census of Population that 137 212 of CCK population aged 15 years and above are literate with 10 707 of them only English Language literate and 99 506 of them a combined English and other language literate. Given the high literacy rate, CCK residents prefer to use their own mother-tongue language at home with mandarin language mainly conversed followed by English as shown in Table 5.
Table 5
Chua Chu Kang Resident Population Aged 5 Years & Over & Language Most Frequently Spoken at Home in 2010
Note. Data from Census Population 2010 by Singapore Department of Statistic Copyright 2016 Government of Singapore
Qualification
This high literacy rate among CCK community corresponds with university qualification being the highest attained among non-students residents aged 15 years and above as shown in Table 6. A study by DeWalt, Berkman, Sheridan, Lohr, & Pignone, (2004) defined literacy as a person’s knowledge about a particular topic. Hence, a high literacy rate equals to a high health literacy rate. Nutbeam (2008) believes that high health literacy rate increases effective management of chronic diseases like diabetes. Therefore, as Bastable (2014, p. 261) defines health literacy as the ability to identify, communicate, comprehend and use health related information to make health decisions, most CCK residents are capable to decide their healthcare choices contributing to lower health complications.
Table 6
Chua Chu Kang Non-Students Resident Aged 15 years & Over Highest Qualification Attained in 2010
Note. Data from Census Population 2010 by Singapore Department of Statistic Copyright 2016 Government of Singapore
Employment
Corresponding to their high literacy and qualification attained, 87 543 of CCK population are employed as shown in the Table 7, with most CCK
Table 7
Chua Chu Kang Resident Population Aged 15 years & Above Economic Status by Sex in 2010
Note. Data from Census Population 2010 by Singapore Department of Statistic Copyright 2016 Government of Singapore
residents working as associate professionals and technician and in fact showing an increased rate of 3.35% between 2000 and 2010 as shown in Graph 4 below. The high employment rate is good as Ross and Mirowsky (1995) found that people who work for pay reported better physical well-being than the unemployed. However, technological advancement in occupations has led to inactivity that contributes towards obesity as the sector shrinks towards service-type jobs (Bell, Ge, & Popkin, 2002). Comparatively, the rate of cleaners, labourers and related workers has also increased by 0.7%. Hence, their socio-economic factors such as low income, low educational and literacy level increases their prevalence of type 2 diabetes (Maty, 2005). However, Ramachandran, Snehalatha, Latha, Manoharan, and Vijay (1999) found that labour-intensive lifestyle involving physical activities has proved to lower the risk of diabetes.
Graph 4. Occupation of Chua Chu Kang Residents Aged 15 years & Above. Data from Census of Population 2000 and Census of Population 2010 by Singapore Department of Statistics. Copyright 2016 Government of Singapore
Food Supply
In terms of food, CCK has diverse food choices. Yet, most of them consist of hawker stalls and fast food chains like MacDonalds serving carbonated drinks and seafood. Given the rich assortment of food, oily, deep-fried and sweet beverages is associated with higher risk of type 2 diabetes among Chinese men and women in Singapore (Odegaard et al., 2011). It not only contributes to weight gain but also an increased risk for cardiovascular disease in older children and adolescents (Taveras, 2005).
Hence, a thorough analysis of the CCK community is done explaining its demography, strengths and weakness of the society in relation to community health problems, particularly diabetes.
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