This article highlights the role of the “insurantial imaginary”, defined as a social context in which profitable, useful and necessary uses can be found for insurance technology, as a condition that shaped the articulation of the sickly, idle and risky racial minorities within Singapore’s public health discourse on diabetes. Focusing on parliamentary speeches relating to diabetes between 1965 to 2020 as well as healthcare financing policy documents, I argue that the narrative of sickly, idle and risky minorities bodies tied to broader notions of racialized responsibility and accountability emerged sharply under a universal national health insurance system. Where parliamentary discussions on diabetes as a public health issue before the institution of universal health insurance circa 2014 utilized racial categories in the classificatory or administrative sense, these very categories became endowed with new meanings and moral imperatives, where Malays and Indians were urged to lead healthier lifestyles to reduce the national insurantial burden. This study builds on the literature on race in medicine by underlining the role of healthcare financing as a technology of racial biopolitics.
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Many Malays are active when they are young—in athletics, football and all. But once they work and have a family, they neglect all these, they don’t bother about proper eating.
While diabetes is a national issue, the Prime Minister said the disease is a “health crisis” for the Indian and Malay communities during the National Day Rally on Aug 20, given the statistics. Among those above 60 years old, 60 per cent of Indians and 50 per cent of Malays have the disease.
The ethnic differences are mainly for Type 2 diabetes, the more common type, which has risk factors that include family history and ethnicity, age and environmental influences, and obesity, said Dr Kevin Tan, consultant diabetologist and endocrinologist at Mount Elizabeth Hospital … A higher prevalence of diabetes in these ethnic groups translates to a heavier healthcare burden for individuals, families, the community and the nation, he added.
(Abu Baker 30 Aug. Citation2017)
Diabetes mellitus as a disease entity has existed in the public radar from as early as the 1980s, but not necessarily in the way described above. Between 1965 when Singapore gained independence, and the year 2000, public health discourse on diabetes centered on making changes to lifestyle, with politicians calling for Singaporeans to avoid “excessive eating and drinking” (Ministry of Culture 28 Mar. Citation1982), and to adopt a more active lifestyle (Ministry of Culture 6 Aug. Citation1993; Ministry of Information and the Arts 26 Nov. 2000). In a 2003 parliamentary sitting, the Minister of State for health, Dr Balaji Sadasivan presented a breakdown of statistics for disease prevalence based on the three main racial groups (Chinese, Malay and Indian) in Singapore and explained that vernacular media platforms were being tapped to deliver health-promoting messages to the high-risk Malay and Indian racial groups in Singapore (Parliament of Singapore 18 Mar. Citation2003). The tone of the diabetes discourse would shift around 2014, as speeches and reports begin to emphasize racialized responsibility and accountability in the national effort to reduce the prevalence of Type 2 diabetes.
