From Clinic to Community: Transforming Health for Singapore's Minority Women

There is also a particular kind of invisible burden that does not always make it into a consultation room – the emotional and relational labour involved in prioritising one’s own health amid family responsibilities, household demands, and the need to maintain harmony within the family. For some women, seeking help is not an individual decision, but one that is weighed against family and cultural expectations.

I recall an elderly woman who repeatedly declined free mammogram screenings to avoid conflicts with her husband, particularly in relation to his traditional views on preventive care. I’ve seen a daughter who defaulted her medical appointments because she was holding down a full-time job, then steps right into the grind of looking after her elderly mother’s needs at home, with little to no help. I see the same fierce devotion in a mother who, despite managing multiple complex medical conditions of her own, spends her days shuttling between her home, her daughter’s house, and the nursing home where her husband resides. She gives every ounce of her energy to her loved ones while trying to find time for her own doctor’s visits. Because of this, booking a doctor's visit isn't simply a calendar entry; it is a heartfelt balancing act of trying to keep the daily peace and ensuring the people they love never feel left behind.

Beyond the clinic, the picture was no different. I observed how these women were largely absent from mainstream health promotion activities — not through indifference, but through cultural mismatch and language barriers. The social determinants sitting underneath all of this – such as income insecurity, limited social mobility, inadequate or limited access to culturally relevant care, and the weight of misinformation passing through informal community networks – are not background factors. For ethnic-minority communities, however, they sit at the foreground of health, more visibly and more heavily than in other groups⁴. These blind spots dictate their well-being every day, shaping real-world outcomes more significantly than clinical charts and manifesting directly as chronic conditions like diabetes and obesity⁵. While diagnosing a symptom may be simple, addressing these deep-seated social determinants is something that cannot be resolved in a ten-minute consultation.

Why I Built This Programme: The Gap I Could Not Ignore

Singapore has no shortage of health programmes. The Health Promotion Board runs population-level campaigns that offer affordable, if not free, chronic disease management and health screening. And yet, uptake among ethnic-minority women remains consistently low⁶. The programmes existed — but the fit did not.

So I thought: What if we built something from the inside? What if, instead of asking these women to adapt to a programme, the programme adapted to them and their needs?

Lifestyle medicine provided me with a framework that felt accustomed to this population because its pillars are not merely abstract clinical constructs but also considers the daily lived realities that interact constantly. A woman who is financially stressed sleeps poorly. A woman who sleeps poorly struggles to make sound nutritional choices. A woman who feels socially isolated is less likely to sustain any healthy behaviour independently.

I also knew, for this community, there was a sixth dimension that could not be ignored: financial wellbeing. Financial stress and health are deeply entangled — and in lower-income households, that entanglement is particularly tight⁷. Thus, not addressing economic literacy felt incomplete.

What We Found

The pilot ran with thirteen participants and we saw promising results. Health literacy improved and behavioural changes were sustained at three months post-programme. Participants engaged and kept engaging not because they were obligated to, but because something in the experience resonated deeply enough to keep them showing up. The findings are modest in scale but meaningful in signal.

The qualitative data is where the real story lives. Participants described a sense of community, of being understood, of health feeling accessible and relevant, rather than prescriptive and alienating. A participant mentioned how the suggested home exercises proved to be beneficial amidst a constrained lifestyle juggling between multiple responsibilities. This highlights how the individualised regimen made participants feel understood.

As a lifestyle medicine physician, this is precisely the mechanism I wanted to activate: social support as a behaviour change lever. The research literature is clear in showing that group-based interventions outperform individual counselling for most lifestyle outcomes⁸ — and this effect is magnified in collectivist cultures, such as Asian cultures, where the "we" is often more motivating than the "I”⁹. Women did not just learn about nutrition or exercise in BayFit; they learned alongside people who understood their lives. That distinction mattered enormously.

Admittedly, however, sustaining that change beyond three months after the programme remained challenging. Time constraints and work commitments eroded gains for some participants. This was a clear reflection of the structural conditions these women are navigating. Health behaviour does not exist in a vacuum. When the environment is not designed to support it, sustaining change takes an extraordinary amount of effort, and that burden should not rest on individuals alone.

Where I Hope We Go From Here — Together

I share these reflections as an invitation into the questions this pilot has opened up. With thirteen participants, what we have is the beginning of a rich and meaningful future. Imagine what we can uncover if this work were extended beyond the thirteen women who participated in this pilot. By engaging a larger and more diverse group of women across different age groups and life circumstances and following them over a longer period such as six months or a year, we could gain a richer understanding of how knowledge, behaviours, and health outcomes evolve over time. This opens possibilities for capturing not just knowledge and behaviour, but possibly, clinical markers such as blood pressure, glycosylated haemoglobin (HbA1c), and metabolic health among ethnic-minority women. These data will allow meaningful comparison with broader, national benchmarks that can strengthen the evidence base.

I often find myself reflecting on the question of sustainability. What would it look like to keep this community going after the eight weeks — a monthly gathering, a peer network, or a simple digital thread that keeps people gently connected and accountable to the commitments they made to themselves? The social infrastructure built during the programme is its most powerful asset; it should not dissipate the moment the formal sessions end. These are ideas worth exploring together with the community, not just for them.

There is also something important in how we hold the stories that emerge from this work. The voices of these women and their experiences of being represented in a health space are precisely the kind of evidence often missing from the literature on ethnic-minority communities, especially in Singapore. Every story we gather and document with care is a small act of filling that gap. Over time, that body of evidence — grounded in the lived experiences of real women in real communities — has the power to quietly, steadily shift how health is understood and designed on a much larger scale.

On Belonging to the Community We Serve

As an ethnic-minority woman, I, too, carry a version of the same social determinants I study. I have had to carve out space for my own health amid competing demands, felt the pull of putting others first, and consciously resist the familiar narrative that putting yourself first is somehow selfish. I understand, in a way that goes beyond the clinical, the psychological weight these women carry privately. And perhaps that is precisely why this programme was built from the inside and not from a distance — because I believe it matters that the people building health programmes for our communities are sometimes also from those communities. It changes what questions you ask. It changes what you are willing to hear.

Programmes like BayFit are necessary but not sufficient. They work best as part of a broader ecosystem — one that includes employer-level support for working women, primary care systems that can match patients to community resources that are relevant to them, and health policies that explicitly address ethnicity-based disparities. Such policies acknowledge that health gaps among minority groups stem from varying exposure to everyday risks and resources—such as financial constraints, housing, and social mobility—rather than innate ethnic differences. By shifting focus partially away from universally affordable healthcare (such as Healthier SG initiatives), we actively identify who risks being left behind and can design targeted interventions rather than assuming that a rising tide lifts all boats. Thus, I hope this research contributes to making that case within Singapore's broader health system.

A Closing Thought

Thirteen women came through eight weeks and left feeling that their health mattered — not as a clinical imperative, but as something worth nurturing and investing in. In communities where women frequently prioritise the needs of others before their own, creating a space where health becomes a collective, joyful, culturally grounded act is exactly the kind of shift community physicians like myself are trying to make. That is where every health programme should begin — and where this one will continue to grow.