Because CVD and cancer had become the major causes of death in Singapore, the government adopted the National Healthy Lifestyle Program in 1992 (Cutter, Tan, and Chew 2001). This coordinated, multisectoral approach involved government ministries, health professionals, employers, unions, and community organizations. The program aimed at improving the social and physical environment so as to promote healthy living. Healthy diets, regular physical exercise, and nonsmoking were emphasized. The program used the mass media; legislative measures to discourage smoking; and widespread school, workplace, and community health promotion packages.
In a follow-up survey after six years, cigarette smoking had decreased from 34 to 27 percent among men, the proportion of adults who exercised regularly had increased from 14 to 17 percent, and the prevalence of obesity was stable. However, hypertension and high LDL cholesterol levels had increased modestly. From 1991 to 1999, the age-standardized incidence of myocardial infarction declined from 98.2 to 83.0 per 100,000 residents (Mak and others 2003) and age-standardized mortality from CAD decreased from 60.8 to 47.2 per 100,000 residents.