One such social group would be low-income families with member(s) suffering from long-term medial conditions. In the recent years we have often heard the saying “If you’re sick in Singapore, you better be rich, If you’re poor, you better not fall sick”. It is one thing to hear and utter statements such as these; it is quite another thing altogether to be living and experiencing poverty and sickness in Singapore. Over a period of 4 months, I had the opportunity to be connected to 12 such families through two welfare organizations; the Ang Mo Kio Family Service Centres & the Singapore Sikh Welfare Council. In an attempt to study the impact of the current welfare policies on low-income families with long-term medical conditions, I had requested the organizations to link me up to families with:

“Self-reliance” and “family as the first line of defense” might sound like foreign terms to some but they tug deeply at the hearts of all Singaporeans. These ideologies have been well internalized by Singaporeans, rich and poor alike, reflecting the success of the government in nurturing an ideological consensus amongst its citizens. However, when such ideologies move beyond political rhetoric to actively shape the states’ perspective on poverty and welfare, it spells significant consequences for social groups who are unable to live up to the dominant discourse of self-reliance.

This rather rigorous criterion was drawn out to effectively study the impact of the current welfare model and policies in Singapore on this social group. The ballpark income figure of $1,500 was chosen through a detailed study of current welfare assistance schemes such as ComCare Funds, MOE Financial Assistance etc. Those living with a combined household income of S$1500 and below, often with no regard to number of members in the family were the “state-defined poor”. This contrasted starkly with my calculations of the relative and absolute poverty line in Singapore using formulas and data provided by the Department of Statistics (DOS), which put the relative and absolute poverty lines at $2,500 and $2274.80 for a 4 persons household respectively in 2010.

By these benchmarks, based on the income figures from DOS, more than 10% of our population lives in absolute poverty and a significantly higher proportion in relative poverty. Against the background of healthy GDP growth and the lack of political attention on such a phenomenon, this discovery was rather startling. Notwithstanding, the daring netizens who endeavour to reflect the state of poverty in 5minute video clips on YouTube, poverty is made practically invisible in Singapore, hidden behind and within the aesthetic façade of HDB flats that dot the island. I say this not simply as matter of expression, but in fact, as I made my way to meet these families walking past the HDB blocks and taking the lifts up to their homes, I could never have imagined the manner in which the poor in Singapore live their daily lives.

Yet income is but one indicator, other characteristics to identify the ‘state-defined poor’ are considered via ‘means-testing’, which is not a transparent process, leaving much to be guessed as to what the state defines as sufficiently low-income to receive aid. Quite clearly poverty is conceptualized as a political concept, which can be measure both objectively and subjectively depending on which method best suits and fashions the state’s discourse on poverty.

Two main flaws emerge in the manner in which the ‘needy’ or ‘low-income’ are assessed by current schemes. Firstly there is a need to shift away from the use of combined household income, which reinforces the ‘family as first line of defense’ ideology. This ensures that those marginalized by the market are first; the responsibility of the family and any welfare towards them is secondary. I say those marginalized by the market because welfare in Singapore is predicated upon employment. The concept of ‘self-reliance’ leads to a natural inference that the state will assist you if you help yourself and in order to help yourself you need to be employed or contribute to the market. For individuals such as those with long-term medical conditions they possess characteristics of ‘unemployability’ and hence are unable to be ‘self-reliant’.

Far from understanding the structural limitations in society that disable such individuals from working which include lack of job opportunities due to inflexible labour market, inability to participate in work due to illness etc., there is an inherent tendency towards ‘blaming the victim syndrome’ (Ryam,1971) which undergirds the state’s individualist and culturalist perspective towards poverty. Such a perspective locates the cause of poverty not in structural factors such as gender, access to and level of education, housing, employment and so on but rather in an individuals attitudes and abilities which finds a tangent with the much preached ideal of ‘meritocracy’ which has become so uniquely Singaporean over the past four decades.

The second flaw is that while in more recent years that has been a progressive trend to focus on income per capita as compared to household income, this usually applies to educational assistance schemes revealing the social investment bias towards welfare policies. While social investment and economic opportunities are important in lifting families out of the poverty cycle as the government has correctly identified. This is insufficient as it ignores ‘income-maintenance’ without which such ‘activation policies’ (Esping-Andersen, 2001) are rendered meaningless. In my interaction with the families, while they maintain that they remain appreciative of the education assistance schemes available for their children, they are often unable to benefit as beyond the compulsory primary education their children have to be taken out of school so they can earn an income to support the family in their day-to-day living.

Such actions are further necessitated because as mentioned earlier, welfare assistance is contingent not only upon family support but also upon employment and income, which might be considered rather ironic but clearly in line with ‘self-reliance’ and ‘meritocracy’. Analysis of an 87-page report by NCSS on “Assistance for individuals and families in social and financial need” revealed that the only scheme dedicated to families/individuals without any source of income or subsistence was the PA scheme. The PA payouts however were even lower than the $1,500 eligibility cap for most other schemes. As of 2011, only 3,034 families received PA i.e. less than 0.1% of the population illustrating the dearth of welfare in Singapore rather than the absence of poverty which, as the numbers illustrate is clearly aive and well (Mathi & Mohammed, 2011).

So far, I have sought to illustrate how the state has systematically justified its limited intervention in both recognizing and addressing poverty by:

(1) Constructing the poor as an undefined and ambiguous category

(2) Adopting and individualist & culturalist perspective of poverty

(3) Articulating poverty as an ideological as opposed to structural problems and

(4) Situating the policy responses to poverty in terms of creating opportunities and cultivating self-reliance as opposed to redistribution and the elimination of structural barriers in the labour market

Now we turn our attention to the impact of current welfare policies on the lives of the identified social group. The characteristics of these families deserve much attention as it reveals how they are effectively misfits in both capitalist societies as well as in ‘productivist’ welfare regimes like Singapore due to their ‘unemployability’. It also reveals how the ideologies of ‘self-reliance’ and ‘family as first line of defense does little to empower these families but rather creates disappointment and frustration amongst the families as they are unable to live up to societal expectations despite their desire to do so.

All 12 families interviewed had at least one member with a chronic medical condition, 10 out of 12 had two or more family members suffering from chronic conditions. The more common conditions were hypertension, diabetes and chronic asthma. Other conditions included arthritis, AIDS, lymphoma and coronary heart disease. Often the individuals suffered a multiplicity of conditions rendering them unfit for work. At the time of interviews, two respondents were given permanent MCs, four respondents were given doctor’s letters stating they were only ‘fit for light duties’ and had to rest for 2-3 days a week. Two respondents were wheelchair bound. Another respondent whom was the sole breadwinner of her family was furnished with a doctor’s letter advising her to stop working to take care of her 16 year old daughter who was clinically depressed and suicidal. Needless to say, depression and anxiety were faced by many of my respondents.

Given the extent of their medical conditions, financing healthcare was a huge matter for these families. 11 out of 12 households in the study had one or more members funded by the Medifund at the time of interviews, with most families receiving a 100% subsidy. 10 out of the 11 qualified for Medifund after having completely wiped out their Medisave in earlier treatments for themselves or their dependents. Several families had outstanding medical debts with hospitals and polyclinic, which they were unable to service and were not waived despite their Medifund status. Medifund is awarded on a 6-mth basis-requiring applicant to reapply with updates documents every 6 months. Often once they get a job or have other sources of income the subsidy is reduced or withdrawn, as they are encouraged in be self-reliant. While this seems sound, it gives them little time to get on their feet and build any savings. Furthermore, Medifund does not cover all medical expenses. On average the families still spent about $100/mth on medical expenses. While this may not seem like much to you and me, for these families it a significant portion of their income.

All of the respondents were working and contributing to their households before their medical condition set in full swing. Several of them continue to work part-time and even full-time. Despite this, 7 out of 12 households have a combined household income of less than $1,500. 8 out of 12 have a per capita income of less than $500, with the average per capita income across the 8 families being $253. The remaining 4 families had NO income as the sole breadwinner was incapacitated or constrained by the chronic disease. Each of these 4 families received varying and often inconsistent assistance due to the disjointed structure of social welfare.

Typically the respondents were working in occupations that have seen a decline in real wages in recent year; e.g. cleaners, security guards, factory workers etc. Furthermore such jobs were characterized by inflexible working conditions and required a certain amount of physical strength, making these respondents even more “unemployable” thus explaining their “unstable work histories” (Hodson, 1982). This is as a result of our unregulated labour market, which is aligned to the neoliberal orthodoxy, espoused by the PAP government. Comparative research however has shown that countries with regulated labour markets have greater labour flexibility and occupational mobility, which facilitates rather then hinders economic growth while advancing other social objectives by increasing labour force participation (Navarro, 2006). At this point, we have to note that there is significant impetus for the government to look into intervention and regulation of the labour market in a manner that advances both social and economic objectives in the long term. Such efforts may achieve social objectives at the expense of economic objectives in the short-term but are likely to bear fruit in the long term. One such attempt to accredit and regulate security services has been a positive step but much more can be done.

Lastly, we turn to the housing situation of the families. Home ownership is touted as one of the four pillars of social security in Singapore (Workfare, 3Ms & CPF being the other three). The poor however are least able to afford homes and often turn to rental homes depriving them of this crucial pillar of security. Also do note that with the exception of Medifund in the 3Ms, all three pillars of social security are non-redistributive and dependent upon one’s income, once again emphasizing the importance of self-reliance, government as last resort and family as first line of defense. 10 out of 12 households were living in 1-2room rental flats. In Singapore, homes are stressed as a vehicle of equity accumulation, which can be liquidated in times of need by downgrading or subscribing to the lease buy-back scheme (LBS).

Such options remain irrelevant to most of my respondents. One of my respondents had purchased a 3-room flat upon getting married and was servicing his loan on times, he then had a major fall in his workplace and began suffering from cellulitis and abscess of leg, hypertension, arthritis and chronic asthma. Being unable to work full-time he applied for the LBS but qualified only after much difficulty, after he “went to see the MP” in his own words. He then appealed for a rental home, however the earnings from the LBS were deposited in his CPF and he had no access to these earnings to tide him over in time of needs. Clearly owning his home seemed to be more of a liability then an asset to him in this case. Although the CPF savings are meant to tide him over in old age, he is unsure if he would be able to live long enough to use them. Furthermore his primary concerns now are his wife and son who need his support more urgently and the CPF system locks in his money and deprives him of the much required liquidity.

Low Income families with long-term medical conditions are doubly disadvantaged firstly due to their inability to fully participate in the labour market and secondly due to the way in which social security policies are designed and dispensed. To a large extent it serves to perpetuate their poverty rather then lift them out of it, resulting in barely tolerable day-to-day living for these families, rendering social mobility a myth to them.

These families have internalized the ideologies of ‘self-reliance’ and ‘family as first line of defense’ so well that that often they do not seek for assistance until they have hit rock-bottom and even then they live with the stigma of being welfare recipients which often robs them of any form of dignity. Welfare policies that impact these families are usually:

(1) Short-term or ‘one-off’ assistance

(2) Minimal/Residual i.e. very low amounts are provided and there is no transparency as to how they are derived

(3) Only provided once applicants and their family have all their exhausted all their resources

Such form of assistance aims to drill ‘self-reliance’ and discourages dependency. On the contrary to their intention, they often create dependency on welfare and aid by disabling recipients from receiving sufficient aid and time to stand on their own feet. The concept of help once they have reached “rock-bottom” needs to be reassessed; state intervention needs to come much earlier on in order to effectively address poverty. Furthermore a basic income maintenance welfare policy should be mandatory for those social groups that are incapable of being ‘self-reliant’.

To this effect the state has to create more meaningful categories of “low-income” groups requiring assistance and design packages, which effectively meets the needs of each group. For the able-bodied a combination of social investment and income maintenance with more weightage on the former will suffice, while for my respondents, more importance needs to be placed on the latter, with the importance of each component varying over the life course depending on the circumstances of each family.

Another critique of the current model of welfare would be that are too ‘Many Helping Hands’ (MHH). The MHH approach to welfare is unique to Singapore. It entails a network of service providers, including civil society actors that fill in the gaps and provide welfare provision the state withdraws from. The government has effectively privatized social welfare on the basis of ‘shared responsibility’. The government has institutionalized the NCSS which acts as a “central enabler, to achieve economy of scales” for social services (MCYS, 2009). However the MHH results in needy families receiving varying amounts of help from different organizations and this is often perceived by my respondents as “unfair”.

The social welfare infrastructure is characterized by too many agencies with vague and diverse qualifying criteria masked in the language of ‘means-testing’. Privatizing welfare provision is ineffective due to the extent of information failure that occurs. Even social workers themselves are often unaware of the plethora of scheme available and often the onus of the extent of the help each family receives is shifted entirely on the shoulders of the social workers. Some families even felt the extent of help they received is premised upon the character of their social worker and whether he/she is willing and passionate to help or just doing their job. There is indeed a pressing need to re-haul the MHH approach and simplify the complex web of service providers by first developing transparent and consistent metrics to accredit schemes across agencies.

In conclusion, the case of low-income families with long-term medical conditions amply illustrates the weaknesses and the exclusive nature of the current model of welfare in Singapore. Such a model of welfare is unable to uphold an anti-poverty agenda due to the neoliberal orthodoxy embodied by the state through its belief that social protection guaranteed by the welfare state hinders economic growth. There is an intense need for the government to review and contextualized its much treasured ideology and discourse of self-reliance to the social realities of disadvantaged groups in Singapore. This must necessarily be done before we can make any meaningful changes in welfare policies and infrastructure.

Arvinder Kaur recently completed her Honours in Social Science and graduated with First Class Honours in Sociology. This paper was written as part of her thesis requirements for the Sociology Honours Programme in NUS. She received the Sociology Gold Medal, Cheng Heng Lay Memorial Prize for best thesis and Tan Boon Khak Gold Medal for outstanding work in Sociology for the degree of Bachelor of Arts.While she thoroughly enjoyed her years as and undergraduate pursuing Sociology her major takeaway from university was to move beyond verbal intellectual diarrhea and impressive academic writing and to use the knowledge we generate in academic papers to empower ourselves to make changes in the world around us. This paper serves as a starting point for this change-making and she hopes to be able to pursue this simultaneously with her career ambitions.