Imperial overreach: Singapore Health Promotion Board edition

or: How not to write a FAQ on sexual health

Singapore's Health Promotion Board released an advisory on sexuality and sexual health last year. Perhaps due to the design of the website, no one (not even LGBT activists or the self-appointed moral guardians of Singapore) took notice. Till recently. Then all hell broke loose.

Like so many, I did not think the ensuing fracas to be important, interesting, or worth investigating. The usual suspects either accused the FAQ to be a promotion of the gay lifestyle or defended the FAQ as fact based, evidence based writing. It sounded like another episode in the ongoing culture war between vocal liberals and conservatives suddenly finding their voice in a post-Papalee, internet-enabled Singapore.

Yes, having the national health body write up an entire FAQ on homosexuality is a milestone for conservative Singapore. Just that this is the wrong milestone.

Imperial overreach explained

"Trust me, I'm a doctor"

A cursory examination of the controversy and outcry against the Health Promotion Board's FAQ reveals three sets of interrelated questions or accusations, which I summarise here:

Does the FAQ highlight LGBT health issues or does it promote an LGBT social reformist agenda?
Is the HPB reaching out to LGBTs as a health board or is the HPB reaching out to mainstream society on behalf of the gay agenda?
Should the HPB be an advocate for health, an advocate for LGBTs, or an advocate for the moral majority?

We identify the public disquiet as a backlash against the HPB's imperial overreach. That is, the HPB appears to have exceeded its mandate as a health advisory board and ventured beyond their core competency in health and medicine in their advisory. This is no small matter: a public organ that is seen to promote the agenda of any one faction of the populace (liberal, conservative, or radical) will lose the trust of the entire populace, and lose its credibility and effective ability to serve the public.

The HPB seems to have forgotten the sordid history of the Family Planning and Promotion Board, a public organ that instead of offering sound advice on family planning, embarked on a crusade to sterilise women at a young age, especially targeting the poor. The HPB should note that the FPPB no longer exists, and is not remembered with fondness for its zealous social engineering.

But you can't trust a health promotion board if it's less interested in promoting health,

and more interested in social crusading

HPB vs NHS: a tale of 2 LGBT health advisories

In its defense, the Health Promotion Board claims the brochure was meant as “a one-stop resource to provide factual information on sexuality and sexually transmitted infections/HIV prevention from a public health perspective.”

In the absence of actual health practitioners and experts wading into the discussing, we therefore accept HPB's challenge to a trial by combat, and name as our champion the UK National Health Service (NHS). The choice is fair; the NHS is the direct analogue of Singapore's Health Promotion Board, and it has also published in English an advisory on LGBT issues, easily accessible online. The weapon of choice shall be their respective FAQs on LGBT health. The contest shall be determined by the accuracy and factualness of their FAQs, and whether their FAQs have been written purely from a public health perspective.

And for your reference, It's NHS's Gay health: the issues vs HPB's FAQs on sexuality. Go, open them side by side in separate browser windows. Read them, and we can discuss more.

A thorough reading of both NHS and HPB advisories shows up stark differences in their approach towards "LGBT health". The NHS tells you right from the start

If you’re gay, lesbian or bisexual, by being aware of your health risks and having relevant health checks, you can stay healthy and reduce your risk of illness... Research shows that people with same-sex partners may have a higher risk of contracting certain conditions, for instance lesbians may have a higher risk of breast cancer and gay men are at higher risk of HIV.

Unlike the HPB, the NHS doesn't tell you what homosexuality is, who's a homosexual, whether it is an identity or a behaviour, whether it can be cured, whether it's normal or not, whether it's a phase, to what extent sexuality can be fluid. That's not important from a public health point of view and that's not what the NHS as a health advisory body is interested in.

NHS simply says: if you're LGBT, here are the top issues concerning your health. If you're a sexually active gay woman, these are STDs you should screen for. If you're a sexually active gay man, here are the STDs you should screen for. Aside from HIV/AIDS. At the final 15% of its FAQ, the HPB tells you about AIDS. It says nothing else about other STDs that gay people may more prone to pick up, compared to mainstream people, nothing about the higher breast cancer risks of gay women.

Now tell me, if you were LGBT, whether you'd prefer to get your health advisory from the NHS or the HPB?

NHS tells you that depression affects LGBT people more than mainstream people, some of which is caused by bullying or homophobia, but some of it is self-inflicted because gay people can be their worst enemies. Then it tells you where to seek counselling. HPB tells you it's wrong to label people as gay and best let homosexuals come out of the closet on their own. Aside from this not being a public health issue, it's not a medical fact either. Labelling, as social scientists will tell you, occurs all the time in everyday interactions and is an integral part of social construction. You can tell people not to label others, but really... (and let's not get into the phenomenon of how people label themselves actively)

Do we need to know what homophobia is? Perhaps. Is homophobia a fact? Is it a medical fact? Is it the business of the Health Promotion Board to tell us? No.

When put side by side with the NHS advisory, the deficiencies of the HPB advisory become very apparent. As written, this is more a LGBT advocacy and education FAQ than a LGBT health advisory. As written, the HPB seems more interested in changing social opinions on LGBTs than offering a "one stop resource" of the health education and needs of LGBTs.

In contrast, the NHS advisory manages to provide timely, relevant, and appropriate health resources and advice regarding LGBT health without being contentious, controversial, or venturing out of its core competency. In contrast, the approach taken by the NHS advisory is more suited to Singapore.

Where the Health Promotion Board should provide timely, concise, and relevant health information for LGBTs, it seems to have written an advisory for the mainstream public and occasionally, parents with LGBT children, with the goal of changing public attitudes towards homosexuality. It's a good cause but one that HPB is not mandated to champion. And since it has, the public organ now reeks of institutional overreach.

As written, the HPB has let down LGBT people in Singapore, whose health needs and education are far better served by reading the NHS advisory and portal. I suspect the same for Singapore's mainstream society as well. I offer these criticisms in the hope that the HPB may take the NHS LGBT advisory portal as a working model so that it may offer what the LGBT community needs (in terms of health advice) instead of what it wants (in terms of social change).