Following is the speech (English only) by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, in response to the debate on Policy Address in the Legislative Council today (February 5):
Hong Kong is going through a period of restructuring - in both the economic and social arena. The pace of change has escalated and the movements in business and people have increased. More individuals and families are facing varying degree of changes: with uncertainties in terms of the relevance of skills and qualifications, in terms of security of employment and in terms of stabilities in their family relationships. In rising up to these renewed challenges, it is timely for us to reflect on our policy directions.
Members have expressed their views on how Hong Kong should position ourselves in the light of new challenges. I wish to thank Members for some of their valuable advice. Our Mission in the policy areas of health, welfare and food is to build a 'Caring and Healthy Society', a society with rich diversity recognising the strengths of differently endowed individuals. We seek to build a community that celebrates family solidarity and a network of mutual care, trust, support and reciprocity that embraces all individuals, nurtures their healthy development, and enable them to participate in economic and social life with dignity and self-reliance.
We are all born with different abilities and potentials and acquire capabilities and skills as we develop. In encountering different circumstances at different stages in our lives, the life skills that we have acquired would either enable us to meet life challenges or create vulnerabilities. We therefore need to act today to preserve tomorrow. Our policies and programmes should be directed at enhancing physical and psychological well-being by strengthening preparedness and building resilience. In this regard, capacity building, of both an individual and the community, is the key.
We invest heavily in the health and well-being of our people. The figures speak for themselves. Currently over 30 per cent of our budget (amounting to $69.4 billion) is invested in our public health care system, social services, providing a safety net for the needy and ensuring food safety and hygiene. This level of investment, made on the basis of a low tax regime, is substantial both on its own and in relative terms when compared with other developed economies which have a much higher rate of taxation. Our challenge remains to ensure the effectiveness and efficiency of such investment and in this regard, our policies need to be fair within generations, equitable between generations and sustainable across generations.
We recognise that we must take on an approach which adopts social investment perspective in order to build the capacity of individuals, families and the community to meet the evolving challenges and to build a more inclusive and participatory society. Each person can aspire to fulfill his or her life goal and contribute to a mutually supportive community. Such an approach enables us to cover human, social natural and physical dimensions of our society. A broader partnership base is required. Individuals, families and communities, as well as professional and business sectors must all be engaged in exercising our social responsibilities for strengthening the health and social fabric of our society.
On the health front, we will ensure quality, equitable, efficient, cost-effective and accessible health care systems and to organise the infrastructure for coordinated health care delivery through an interface of public and private systems. We have already said that we will target subsidies to ensure that we will offer protection to the community from significant financial risks that may arise from catastrophic or prolonged illnesses and avail affordable quality care to the disadvantaged in our community. We will strengthen the community mode of health care delivery so as to provide better quality and more cost effective care to the elderly and the chronically ill as well as the population at large and at the same time this will reduce the reliance on hospital care and reduce the need for hospital beds. We will continue our work to address the long-term financial sustainability of our public health care system. With the SARS outbreak last year and the threat of avian flu this year, it is inevitable that one of our major emphasis will be on strengthening our infectious diseases prevention control systems and infrastructure.
Infectious Diseases Prevention and Control
In the wake of the SARS epidemic last year, we have implemented a comprehensive package of cross-sectoral measures to prevent and control SARS and other infectious diseases. We will further enhance our preparedness against outbreaks of communicable diseases on a number of fronts.
First, we are drawing up a major disease outbreak control plan using existing contingency plans as building blocks, drawing on the advice of international experts as necessary.
Second, we have already established a notification mechanism for infectious disease and public health incidents with the Guangdong Province and Macao. The three places will explore the development of a common information system, start exchange programmes for public health officers and undertake joint research projects for the Pearl River Delta Region.
Third, to build up hospital surge capacity for infectious disease control, we will provide over 1 300 additional isolation beds by early 2004, including intensive care unit (ICU) beds, in 14 public acute hospitals, and we intend to construct a new infectious disease centre at Princess Margaret Hospital with the necessary facilities.
Fourth, we will review the adequacy of existing publicity and educational avenues in a bid to reach out more to vulnerable populations and to engage more the community in fighting communicable diseases.
Fifth, we will recruit experts in public health and hospital infection control to run training programmes and second staff to international institutions.
Sixth, we will support research on prevention, treatment and control of infectious diseases through a dedicated research fund of $450M. Applications for funding research projects have already been invited and are in the process of approval.
Establishing a Centre for Health Protection
The SARS Expert Committee has recommended that a Centre for Health Protection (CHP) with responsibility, authority and accountability for the prevention and control of communicable diseases be established in Hong Kong. We are pressing ahead with the establishment of this new public health infrastructure. Our interim target is to set up the CHP under Department of Health with two functional branches, namely, Surveillance and Epidemiology Branch & Infection Control Branch, starting to operate by the middle of 2004. We expect the CHP with six functional branches to be fully operational by 2005.
Ensuring the long-term financial sustainability of the public health care system
Members have commented on the long-term financial sustainability of our health care system. We will continue to follow a four-pronged approach to address the issue of long-term financial sustainability of our healthcare system. First, we will work with the HA to identify further means to improve productivity and efficiency in the fulfillment of our plans and objectives. Second, we will continue to explore areas where resource-sharing arrangements between the public and private sectors can be gainfully pursued. Third, we will keep reviewing the need for further fee restructuring to ensure that public subsidies are channeled to service areas with the greatest need. Fourth, we are conducting studies on the relevance and suitability of various healthcare financing options to Hong Kong. Upon completion of these studies this year, we will consult Members on the way forward.
Food Safety and Environmental Hygiene
Health and food safety are inextricably linked. On the safe food and clean environment fronts, public health protection should always take precedence. We will ensure a comprehensive and integrated approach in food chain management (i.e. from feed to table) by putting in place the necessary infrastructure; a coherent, effective and dynamic food policy on the basis of scientific evidence and risk analysis and enhancing private-public partnership and participation by stakeholders during the process. While legal and regulatory frameworks are necessary instruments of last resort to ensure and raise standards and provide necessary safeguards, effective protection for public health can only be achieved to the concerted actions from all parties, collaboration across sectors and shared responsibilities between the sectors and the general public. I can assure Members that in the consultation exercise, we will certainly take into consideration the views of trade and the anxieties of the public before we make any decisions. We will certainly take in view all these considerations before a decision is made.
*Prevention against avian influenza
The unprecedented outbreaks of avian influenza in poultry currently occurring in the region have aroused grave concerns over the potential health risk of avian influenza posed to humans. I would like to assure Members once again that we have done all we can to prevent an outbreak situation in Hong Kong and will continue to monitor closely the outbreak situation in the region and review the relevance of further control and preventive measures.
Although events in the past few days have led us to take unusual, drastic and decisive actions, it would be useful for me to give an overview of what we have done in the past few years and put in the perspective the current risk to Hong Kong. We have taken a number of effective measures to reduce the risk of recurrence of avian influenza outbreaks in Hong Kong. We introduced a vaccination programme for all our chicken farms in June last year and we also secured the Mainland's agreement and co-operation to vaccinate all chickens intended for export to Hong Kong. At present, all the chickens available in the market have been vaccinated against H5 avian influenza and we have been most vigilant in our efforts to monitor both local and imported chickens to ensure that their immunity status is maintained at a satisfactory level. In the farms, we have imposed tightened biosecurity measures to prevent the introduction of avian influenza viruses to farms. At the wholesale level, our wholesale market is thoroughly cleansed and disinfected on a daily basis to maintain good hygiene standards. The Agriculture, Fisheries and Conservation Department (AFCD) has also put in place a demerit point system to ensure that all wholesalers and transporters working at the wholesale market must thoroughly cleanse and disinfect their vehicles after unloading. At the retail level, we are implementing two rest days per month to reduce the viral load there, if any. The Food and Environmental Hygiene Department (FEHD) has also stepped up inspection of the retail outlets to ensure that all hygienic conditions relating to the sale of live poultry are being observed.
We have presented these strategies at the meeting in Thailand. The World Health Organisation has commented that this is one of the most advanced systems that they have seen. And they doubt whether this system can be transposed to other countries in the region.
However, we fully understand that we must, in the light of the rapidly changing circumstances, review our strategies regularly to ensure that it continues to be effective in addressing and anticipating the problems. To this end, we will maintain our avian influenza surveillance programme to cover all poultry from the farm to the retail level, wild birds, waterfowls in recreational parks and pet birds available in the market.
Members will be aware that in the past few days, we have introduced a number of additional precautionary measures in response to the outbreak situation in the neighbouring countries. These measures included:-
- the temporary suspension of all imports of live poultry including pet birds and poultry meat from the Mainland;
- the stepping of our monitoring programme for travellers at the border control points;
- the addition of avian influenza to the schedule of diseases under the Quarantine and Infectious Disease Ordinance requiring medical practitioners to notify the Department of Health of the existence of avian influenza cases;
- the closure of the Mai Po marshes and walk-in aviaries in recreational parks to minimise the contacts between the public and wild birds;
- enhancing the surveillance programme of wild birds and birds at recreational parks, increasing the collection of faeces from wild birds for laboratory testing and stepping up inspections of pet bird shops;
- testing by the Hospital Authority on influenza viruses for patients to check if the case is related to avian influenza;
- the issuance of advisories and warning notices to schools and nurseries to take measures to prevent children from coming into contact with live birds
- establishment of a formal liaison mechanism with the Mainland for the exchange of information on animal diseases;
- the temporary suspension of processing applications for the importation of pet birds pending the development of avian influenza in the region;;
- the compulsory requirement for all workers in the poultry and bird trades (including those operators in the Bird Garden in Mong Kok ) to wear protective clothing through the appropriate licensing and management authorities;
- the offer of free vaccination to all poultry and bird workers as well as those who work in the related trades;
- increasing and enhancing the inspections by AFCD and FEHD staff on farms, wholesale markets and retail outlets;
- enhancing our surveillance programme by increasing the number of swab tests on chickens to detect the presence of the virus.
In addition, we have also developed contingency plans for various case scenarios and we will be sharing this with Members of this Council at a very early date when it is ready.
Obviously, I think all these measures and the comments made by other members do not, in fact, collaborate with the allegations made by the Hon Michael Mak that the Government has not learned its lessons in dealing with infectious diseases. Certainly, I would beg to defer with Mr Mak's views and opinions.
The outbreaks in the region have also led to recent discussions in the community as to whether central slaughtering should be introduced to further address the avian influenza problem. In this regard, we have been studying various possible options to reduce the contact between the public and live poultry. We will soon start the consultation process and we will certainly listen to the views of the trades and the relevant stakeholders and the public and sustain dialogues with the various sectors throughout the whole consultation exercise.
In this regard, relating to the comments made by the Hon Tsang Yuk-shing, in fact, in Thailand last week, I did share with the ministers our experience with avian influenza and did offer to share our experiences we have had. Certainly, some of the member countries and ministers are expressing interest to come to Hong Kong to learn from our experiences and we certainly welcome them.
In fact, we will send a team from Hong Kong to Vietnam on February 8 to help the Vietnamese government deal with the avian influenza problem from the human side. This team has been sent by the Department of Health and comprises members from the University of Hong Kong, Chinese University of Hong Kong and the Hospital Authority.
I completely concur with them that to deal with avian influenza problem and the potential threat to human lives, we need to have an international collaboration and we are certainly working very closely with the World Health Organisation to deal with these problems. Can I also assure the Hon Dr Lo Wing-lok that we are working out on the contingency plans in case there is a large pandemic of influenza in Hong Kong. We already have a pandemic plan for influenza and this is being updated in the light of current threat of the avian influenza.
So, certainly, the concerns expressed by the members are being dealt with. Obviously, the Members may not be completely aware of the work that we are doing but we certainly share with members at the early possible time.
*Support to the agriculture and fisheries industries
We are committed to promoting the sustainable development of the agriculture and fisheries industries. By providing technical advice and offering credit facilities, the AFCD assists the industries to improve their productivity and upgrade their production.
The department supports and facilities the local development of organic farming through provision of infrastructural and technical support to the agriculture industry. The department and the Vegetable Marketing Organisation have entered into partnership with a number of non-governmental organisations to establish the Hong Kong Organic Resource Centre to develop local organic vegetable standards and a certification and inspection protocol to ensure that the food produced through organic farming is properly recognised. Four local farming areas have already been converted for organic farming. The department also promotes controlled-environment greenhouse farming to the local agriculture industry for the production of high-end crops.
As regards fisheries, considerable resources and efforts have also been committed to the protection of our fisheries resources. We have implemented a number of measures to protect our fish stock and help it to recover to a sustainable level. These measures include a habitat enhancement and restoration programme which entails the deployment of artificial reefs in selected waters to provide shelter and spawning grounds for our fish stock, and a fish fry release trial scheme to help enrich our marine resources.
I would like to assure the Hon Wong Yung-kan that we are committed to continue to provide this support.
Welfare and Rehabilitation
In the social welfare arena, we must shift from the 'service provision' orientation to the 'social investment' and approach in our services. We need to ensure that the services that we are supporting are in fact investing in individuals, families and the community to enhance their capacity to cope with changes and adversities, and seek to maximise individual's strength, promote self-reliance and self-betterment. Our social programmes will need to be re-orientated to ensure that we are not encouraging passive recipients of resources and services and that involve people in active learning and problem solving, we should help to instill in them self-esteem, self-respect and a sense of control.
In this connection, I note that there are calls by Members of this Council and by the welfare sector to introduce and resurrect the planning mechanism and develop this blueprint for Hong Kong. Obviously the old rigid planning mechanism which sought to match service provision with population level has already served its useful purpose. As resources are finite, we need to look beyond the conventional approach. I recognise the need to develop new strategic directions to achieve the paradigm shifts from 'service provision' to 'social investment', and I certainly agree that we should not develop such strategic directions in a vacuum. I've already started the work to communicate with my NGO welfare partners to revisit the philosophical basis and the values of our social welfare system as suggested by the Hon Law Chi-kwong and assess our efforts in focusing on the 'social investment' approach in our services. At the end of the process, I look forward to enhancing the sustainability of our social investment strategies and develop priority investment areas that would best serve the interest of our community. I certainly look forward to working with the sector to developing the so-called blueprint.
Partnership with Third and Business Sectors
Life in this millennium is complex and intense. Regardless of one's disposition, we would all face vulnerabilities in one form or another at some stage in our lives. Of course none of us is immune to this. I cannot over emphasise the need to enhance our overall capacity to cope with such situations. Individual efforts alone at times may not be sufficient and naturally, people look to Government for support. Our investment in human development caters for the different endowments of individuals as far as possible. We also provide a safety net of basic support for the needy and a mechanism exists to help able-bodied recipients to gain self-reliance and re-join the labour market and be economically active. Nonetheless, while Government offers opportunity to all, we also look for responsibility from all. I therefore see the need for a multi-pronged approach of drawing the best out of our community resources, with Government, the third sector and the business sector working together in close tripartite partnership. By resources, I am looking beyond the narrow monetary definition to include mutual help, sharing of innovative ideas, operational experience and management skills and volunteerism, just to quote a few. I see such resources working at two levels. At the community level, cross fertilisation of skills and expertise between government, the third and business sectors would work to the benefit of all. Mobilizing the efforts of all three sectors would tremendously enhance the community's capacity to cope with changes and challenges. At the individual level, through the new and effective modes of capacity building programmes the community can provide, they would be better positioned to tackle life's challenges and stand a better chance to return as active and participating members of our society instead of descending into a downward adversity cycle.
The Chief Executive's Policy Address states that the seeds of tripartite partnership between government, the business community and the third sector was sown when we established the Community Investment and Inclusion Fund in 2002. We now need to explore more effective means to further entrench this cross-sectoral partnership concept at the local community level at a faster pace. I have exchanged initial ideas with the Community Investment and Inclusion Fund Committee and the Social Welfare Advisory Community, and in the coming months, we will be working hard with the relevant Committees, the third sector as well as the business community to devise effective measures in this regard.
I am conscious of Members' interest in how to help the poor elevate themselves and to improve their economic situation. Obviously the problem of poverty is a very complex one, not least of which is a definition. We have entered into debates at this Council for many times and too many hours. And I don't believe that we have a common definition of what poverty is. I do agree with the Hon Law Chi-kwong that whatever the definition of poverty, it is a very complex issue and there are multiple causes. Unless we are able to identify them, it is going to be very difficult to have a comprehensive policy that will be sustainable. I've already undertaken to research the problem in the next six months. We will share with Members on the welfare side how we intend to take this forward. I am of the view that capacity building remains the key in this regard. We are obviously conscious of the importance of ensuring the effectiveness of the social investments we have made in relation to those in vulnerable situations. Members are aware that The Director of Social Welfare will conduct a study on the effectiveness of the Department's Active Employment Assistance (AEA) scheme and 'Intensified Employment Assistance Projects' with a view to help the recipients to elevate themselves and become more self-reliant. The Director would involve our NGO partners in this study and that would throw some light as to how we should approach the problem of poverty and help the more vulnerable in a more positive manner.
We remain committed to implement an effective and sustainable safety net, particularly through the Comprehensive Social Security Assistance (CSSA) Scheme, to look after those least able to help themselves, such as needy elders and the disabled. I would also wish to clarify the adjustment of the CSSA were on the basis of the deflationary adjustment and there were no cuts to the basic rates. In 2003-04, estimated social security spending of $22.38 billion has increased by 4.5 percent, accounting for 10.8 per cent of Government's recurrent expenditure.
As over 30 percent of CSSA cases involve able-bodied adults, we will ensure CSSA can serve as a springboard to self-reliance for these individuals. In this connection, we have intensified our Support for Self Reliance measures since June 2003 to help those able-bodied recipients to go back into the workforce. We will continue with our effort to help them to become self-reliant.
Against an ageing population, we will continue to work with the Elderly Commission (EC) to promote active and healthy ageing in the community. We will work with the EC to network with different sectors to promote work in these areas, and assist the EC with research on ageing issues to support its work. The EC has identified four priority areas for consideration, namely, lifelong learning; financial security, retirement and work practices; intergenerational solidarity; and transport and building environment.
In respect of promoting women's well-being, we shall continue to tap the advice of the Women's Commission on implementing the three-pronged strategy of gender mainstreaming, empowerment of women and public education.
Madam President, I hope that in this very brief presentation, I have been able to demonstrate to Members that we will continue with our policy to build a caring and healthy society and we have substantial and substantive strategies and measures to take this forward. Thank you very much.
Ends/Thursday, February 5, 2004