The role of public health specialists in tertiary hospitals in Singapore

INTRODUCTION As a developed country, Singapore’s health system is undergoing a fundamental shift.[1,2] Driven by a rapidly ageing population, rising chronic disease burdens, pandemic threats, rapid advances in technology and growing fiscal pressure, the country is transitioning from an acute-centric model to one centred on prevention, primary and community-based care, and population health management.[3,4,5,6] This transition started in earnest with the Ministry of Health’s 2017 articulation of the ‘Three Beyonds’ strategy for the nation:[7] Beyond Hospital to Community, Beyond Quality to Value and Beyond Healthcare to Health. These principles were a precursor to initiatives such as Healthier SG[8] and catalysed Singapore’s transformation towards a health system more focused on population health and preventive medicine. Traditionally, public health and preventive medicine in Singapore have been viewed primarily as a community or health policy function, often positioned outside hospitals.[9] Although primary care has taken on a strong public health role and continues to grow with Healthier SG, hospitals remain fairly disease-centric, focused on acute treatment, episodic care and technological excellence. Yet, with Singapore’s shift to per-capita subvention for public healthcare institutions, hospitals are further incentivised to ensure good transition of care, reduce length of stay, decentralise care and ensure that their catchment population remains healthy.[10] This commentary argues that tertiary hospitals must, therefore, move beyond healthcare to health, by shifting away from being ‘islands’ within the health systems that merely treat diseases when they occur, towards becoming jointly responsible for the health and well-being of their catchment populations. In these hospitals, public health physicians can play a transformative role: embedding preventive thinking, shaping institutional policy and aligning hospital operations with broader population health goals. WHO ARE PUBLIC HEALTH SPECIALISTS? In Singapore, public health specialists are registered medical practitioners who have completed the National Preventive Medicine Residency (NPMR).[9] The NPMR is a structured postgraduate programme that combines formal instruction in epidemiology, biostatistics, health systems and policy with supervised experiential learning in healthcare operations, population health programmes, research and clinical governance. Notably, the NPMR also trains occupational medicine specialists, whose roles are comparatively well-defined in tertiary hospitals.[11] However, this paper will focus exclusively on public health specialists and the aspects of preventive medicine that are most relevant to them. Public health is a medical speciality focused on promoting health and preventing disease, disability and premature death through evidence-based interventions at both individual and population levels. Public health specialists’ expertise spans biostatistics, epidemiology, health services planning and evaluation, healthcare management, clinical prevention, medical informatics and applied research. Crucially, they bridge clinical medicine and public health practice. By integrating knowledge from medical, social, behavioural and economic sciences, they apply systems thinking to enhance the health and quality of life of individuals, families and populations. The role of public health specialists within hospital settings in Singapore has historically been heterogeneous and less well-defined, although it is becoming increasingly important as tertiary institutions expand their mandates in population health, integrated care and system redesign. This diversity of roles has historically included contributions not only in technical and advisory capacities, but also in senior hospital leadership and administrative positions, where public health specialists have shaped institutional strategy, governance and system transformation. Therefore, this commentary focuses on carefully outlining the current emerging roles of public health specialists and, more broadly, how preventive medicine can support the advancement of tertiary hospitals. WHY THE UNIQUE SKILLSETS OF PUBLIC HEALTH SPECIALISTS MATTER IN TERTIARY HOSPITALS Tertiary hospitals typically represent the most complex, data-rich and innovation-driven environments within any health system. They bring together multidisciplinary teams, advanced analytical abilities and robust academic infrastructure—resources that, if harnessed strategically, can drive research, insight generation and prevention at scale. In these settings, public health specialists have a crucial enabling role in translating data into understanding and action. Their core competencies in epidemiology, medical informatics, implementation research and systems design enable hospitals to derive critical insights into patient and population needs. By generating meaningful intelligence from complex data, they help to inform service planning, identify gaps in care and align institutional priorities with emerging health trends. In everyday hospital operations, public health specialists add value by bringing a systems-thinking approach to clinical practice to enhance the quality of care. Their work includes supporting and leading clinical governance, patient safety and quality improvement programmes, as well as contributing to or spearheading clinical informatics and data-enabled improvement initiatives across hospital services. Through close engagement with clinicians in care model redesign, they help to reduce infections, disease recurrence, complications and avoidable readmissions while optimising outcomes and resource use. Their expertise in health technology assessment, hospital financing and appropriate, value-based care is also critical in optimising the use of hospital resources. By embedding these principles into operational and strategic decision-making, public health specialists serve as catalysts, enabling tertiary hospitals to deliver high-quality, evidence-based and financially sustainable care. Beyond the hospital walls, public health specialists extend their impact into the community through initiatives in population health, right-siting of care and preventive outreach. They are key contributors to regional health strategies, designing and evaluating programmes that strengthen continuity of care and promote health across care settings. This outward-facing role is crucial for integrating hospital-based expertise with community care to create a person-centred system. This broad and integrative skillset enables public health specialists to complement and enhance the clinical excellence of tertiary hospitals while providing the systems perspective essential for institutional leadership. They help hospitals evolve towards an end-to-end, preventive life-course approach—one that moves beyond episodic treatment to anticipate, prevent and manage health needs across the continuum of care. In doing so, they strengthen the hospital’s role not only as a centre of healing, but also as a catalyst for sustained population health improvement. PUBLIC HEALTH—A NON-TRADITIONAL, CROSS-CUTTING DISCIPLINE Unlike most traditional clinical speciality departments that operate within defined clinical boundaries, public health is intrinsically cross-cutting. Its strength lies in ‘joining the dots’ on what is often treated as separate—bridging clinical practice with management, policy and research to create a more coherent and responsive health system. In tertiary hospitals, public health specialists act as integrators. They serve as bridges between clinicians and administrators, translating bedside realities into system-level improvements and helping leadership navigate data insights through a population health lens. Equally, they function as catalysts that enhance the work of existing specialities. For example, by partnering with endocrinologists to design population-level diabetes management programmes or with renal specialists to refine chronic kidney disease screening pathways, they help to amplify preventive care and systems thinking within the clinical mainstream. BUILDING A FRAMEWORK FOR PUBLIC HEALTH SPECIALISTS AT SINGAPORE GENERAL HOSPITAL Singapore General Hospital (SGH), one of the nation’s largest tertiary centres, has begun to reimagine how public health and preventive medicine can be embedded within the fabric of hospital care. As a leading academic and clinical institution, SGH recognises that prevention must extend beyond community settings into the hospital itself, where the most complex cases, richest data and the greatest opportunities for system redesign reside. To achieve this, SGH has developed a framework specifically for integrating public health specialists and preventive medicine residents into key institutional domains aligned with its strategic priorities. The model [Figure 1] adopts a dual structure: core domains of practice, which represent the foundational pillars of hospital-based preventive medicine, and personalised sub-interests, which enable specialists to cultivate niche expertise that complements institutional goals. This framework outlines the role of public health specialists within tertiary hospitals in today’s healthcare climate. It draws inspiration from the competencies defined by the American College of Preventive Medicine,[12] but has been tailored to the realities of large tertiary academic hospitals in Singapore.Figure 1: Framework for core domains of hospital-based public health and preventive medicine practice.At its core, the model recognises three essential and overlapping domains of public health and preventive medicine within hospitals and their associated practice areas [Figure 2]:Figure 2: Core public health and preventive medicine domains and their associated practice areas. These domains and topics are not mutually exclusive. There are multiple situations in which there are roles and projects that cut across two or all domains. Clinical Preventive Medicine: This domain focuses on applying strategies within clinical settings to reduce disease risk, detect conditions early and optimise patient outcomes. It encompasses communicable disease prevention, management of non-communicable diseases, population health initiatives and the integration of preventive care into everyday clinical pathways. Health Services and Systems Management: Specialists in this domain contribute to the strategic planning, implementation and evaluation of healthcare delivery systems. Their work spans value-based healthcare, patient safety and quality improvement, crisis preparedness, care integration and operational analytics—functions that enhance both system efficiency and patient experience. Research, Epidemiology and Biostatistics: This domain grounds practice in evidence. Specialists design and conduct health services research, perform epidemiological surveillance and lead programme evaluations that inform hospital policy and strategy. In addition, they advance the institution’s academic mission through publications, grant-funded projects and translational research. In practice, these domains often intersect. For example, a single hospital-driven population health programme focused on prevention among older adults[13] may integrate population health management with strategic and systems insights, alongside data analytics, epidemiological analysis and implementation and evaluation sciences. Beyond these core pillars, public health specialists may pursue clinical or non-clinical sub-interests that align with hospital priorities [Figure 1]. Clinically oriented specialists can contribute to fields such as primary care, palliative medicine, renal medicine or endocrinology—areas in which their skillset can enhance screening, early detection and care continuity. Others may engage in system-level innovation through data science, digital health, healthcare financing or global health partnerships. This structured, yet flexible, approach recognises that public health and preventive medicine is not a stand-alone entity but a cross-cutting function within the hospital. By embedding public health specialists across diverse portfolios, SGH ensures that they collectively uplift the hospital and shift the focus towards ‘Beyond Healthcare to Health’. CONCLUSION Singapore’s health system continues to evolve, and the best is yet to come. Accordingly, the integration of public health specialists within tertiary hospitals reflects a necessary evolution in how institutions define their mission and measure success. In this regard, SGH’s framework provides a scalable model for other institutions to adopt and adapt to their own unique organisational needs. As Singapore’s health system continues to shift towards prevention, integration and value, hospitals must likewise mature into learning organisations capable of anticipating risks, improving quality and shaping healthier populations. Public health specialists bring the analytical rigour, systems perspective and translational ability to guide this transformation. Their growing presence in tertiary hospitals signals not just a change in workforce composition but a redefinition of what hospitals can and should contribute to the nation’s long-term health future. Acknowledgement We thank Prof Julian Thumboo, A/Prof Loo Chian Min, Dr Joshua Tan, Dr Teo Ken Wah and Ms Xin Xiaohui for their valuable insights and contributions to discussions that informed the development of the SGH framework for public health specialists. Their perspectives and feedback were instrumental in shaping the conceptual thinking underlying this work. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.