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Following is a speech by the Secretary for Health and Welfare, Dr E K Yeoh,at the General Meeting of the Zonta International of Hong Kong (February 28):

Vision for Health

Dr Chan, distinguished guests, ladies and gentlemen,

I am most delighted to be invited to address this distinguished gathering today and given the opportunity to meet all of you who have contributed significantly to our society through both your career as professional people and your care for the family.

What is health?

Most of you will agree that good health is a great asset to everybody and also to the society. It is a pre-requisite for an individual to achieve successes at work, contribute actively to our society and enjoy good quality of life. At the community level, health is a resource that enable productivity, prosperity and vibrancy.

When we talk about health, many people will relate health to the care and treatment that we received from doctors. In a lot of Hong Kong people's mind, health is equivalent to medical care. However, if we take a closer look at health, it actually has a much broader meaning. The World Health Organisation defines health as "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". So health is not only more than medical care, which usually comes in when people get sick, but also goes beyond health checks, which merely helps to detect diseases that have already occurred.

What is public health?

In order to stay healthy, we must first understand the factors influencing health. Then, through the systematic and evidence-based application of such knowledge on determinants of health, we can prevent disease and improve health. Let me illustrate how it works by sharing with you an old story happened in London about 150 years ago.

Cholera is a disease which spreads rapidly and can kill by the gross fluid loss that results from intense diarrhoea. Epidemics of cholera swept through London during early 19th century when the true nature of such infectious disease was still a mystery. When everybody seemed hand tied on the control of the deadly disease, Dr John Snow, by plotting the geographical locations of each case of cholera, had uncovered a cluster of cases among the people living in close proximity to the Broad Street water pump in the area of Soho. During the old days, many families had no water supply in their own home but had to resort to such communal water supply. At the same time, he found that workers from a brewery on the street seemed immune of the disease with no case detected whatsoever. These workers were not drinking water from the pump for they had something better to drink - beer. On completion of his investigation, Dr Snow concluded that the Broad Street pump as a determinant of the disease and the pump handle was subsequently removed. The cholera epidemic then came to an end.

Though, it was after nearly thirty years that the germ causing cholera was isolated, it demonstrated how knowledge on the determinants of disease can be applied to protect health of the population and prevent disease.

As with many developed countries, Hong Kong has experienced its epidemiological transition from communicable disease to chronic diseases. In parallel with such transition, the determinants of various chronic diseases and the health of the metropolitans have been unveiled. It has been observed that the key health determinants include not only the lifestyle and behaviour of an individual, but also the socio-economic and environmental factors. Health services do not have direct control over all these factors which determines health of the population. It is through implementing health promotion strategies that these sectors traditionally outside the health domain can be influenced.

How public health is applied in real life situation in a modern society like Hong Kong?

Activities to health promotion can be grouped under three main aspects. They are:

* disease prevention like activities related to health screening;

* health education like programmes that improve the public understanding on the causes of ill health and ways to maintain health; and

* health protection to create an environment conducive to health. Activities may include implementing public and fiscal policies such as controlling tobacco advertisements and imposing alcohol taxation, environmental health measures such as controlling pollution, and passage of legislation, say on motor vehicle seat belt to reduce injury in road accidents.

All along, the Department of Health has been active in promoting the health of our population. It delivers health messages to the public through a wide range of activities from organising territory-wide health education campaigns, for example the "Healthy Living Campaign" to providing health counselling to individual client at health centres. It prevents our population from getting serious diseases by providing health screening and giving immunisations. It also protects the health of the people of Hong Kong by influencing politicians in passage of legislation like in the case of creating a smoke-free environment.

What will be the new role of Department of Health and how will people of Hong Kong benefits from that?

In spite of the good work already performed, I think there are still ways to further strengthen the role of the Department of Health to achieve greater health gains. We can approach this at two levels - the individual level and the population level.

At the individual level, the Department of Health will become your lifelong partner in health. Through delivering various health services, a comprehensive health programme to provide a full range of health education and health screening specially designed to cater for the health needs of an individual at different stages of life from womb to tomb will be offered to every citizens of Hong Kong.

We will start caring for an individual when he is still in his mother's womb by giving antenatal care. At pre-school age, all infants will receive comprehensive health screening including developmental tests and vaccinations to protect them from getting various infectious diseases. When our children start school, we have student health programme and school health programme to look after these adolescents in particular their psycho-social health. It is recognised that on entering adult life, women and men will have very different disease pattern and thus health needs. So through health programme tailor-made for women, screening for important diseases like cervical cancer, breast cancer, hypertension etc are provided. We have also had plan to look after the other half of women and a men's health programme is actively under planning. We must never forget our elder population who have contributed so much to the society in their past. The Department's Elderly Health Service is providing comprehensive health care to look after not only their physical health but more importantly the psycho-social well-being of the elders. Through this life-long programme, we hope every citizen of Hong Kong will grow up, mature and age healthily.

At the population level, the Department of Health will adopt the role of an advocate for health. It have been observed that there are a full range of potentially modifiable determinants of health that are external to the traditional health domain like education, economic, social and physical environments. Health impact assessment of socio-economic variables and environmental problems should be carried out and by making use of these knowledges, the Department of Health, as an health advocate, should influence these related sectors outside the health domain to create an environment conducive to health. Besides, the Government should build up an intersectoral infrastructure covering these sectors to focus and collaborate on preventive health issues. It is through this joint effort from various sectors that the health of the population of Hong Kong can be further upgraded.

Let me illustrate how the Department can protect the health of the population by creating an environment conducive to health through its health advocate role using housing as an example. We know that the structural design of a flat and building materials can influence health as this determines several aspects of the living environment like ventilation, lighting and safety. We propose that, as a health advocate, the Department of Health should cut across the sector barrier and exert its influence to the home builders to take into consideration, among other factors, the health of the future occupants when designing structure and choosing building materials so as to ensure a safe and healthy home environment for our citizens.

Still, people will get sick in spite of the preventive care I mentioned above. And when that happens, they will need to turn to doctors for care. In order to protect the health of our population, it is vital that the standard of health services are consistently maintained. The Director of Health will take up the role as the regulator to ensure quality in the health care sector. A comprehensive review on the statutory regulations in relation to the operation of clinics, use of medical facilities and equipment, and provision of medical service in general will be carried out. Our aim is to ensure that patients will receive quality health care at all times.

You would probably agree with me that complaints can drive improvements. Factors leading to complaints vary from case to case, however, there is always something to learn. It can help identifying areas that need improvement and provide chances to give service and satisfaction to dissatisfied patients. The health care professions are committed to service improvement and we view complaints positively as opportunities to strengthen patients' support and confidence in health care services. Taking on the role as a regulator to ensure quality, I think the Department of Health is well-place to take the tasks forward to set up a complaint office to assist patients lodging complaints and conduct investigation. Moreover, the Department of Health will also be committed to ensure that the complaint process is user-friendly, transparent and fair.

In sum, taking on board the above reform measures, the Department of Health will be transformed to become a partner of your health, an advocate for health, a regulator to ensure quality and your channel to voice dissatisfaction. However, a holistic lifelong care or a living environment conducive to health alone will not promise good health without the individual's actions to take on health promoting and enabling lifestyle and behaviours. One must never forget health is also a personal responsibility.

Lastly, achieving better health requires the concerted effort from the Government and the community. A high level of community participation will provide the force of mobilisation to influence other sectors to collaborate and sustain the momentum of health promotion.

It has well been recognised that the health knowledge of women, who are the traditional care giver to a family, has great impact on the health of a community. I am, therefore, happy to see your interest in the recent consultation on health care reform. I hope you will participate actively both in this consultation exercise and implementation of the reform measures in the future.

Thank you.

End/Wednesday, February 28, 2001

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