 Good morning. First of all, thank you for Taking this conference to Hong Kong. I'm so thankful to all the Alfred and house and society the LSE as well as the University of Hong Kong For organizing this It is a very important subject on urban planning particularly relating to our population demographic changes, so I'm I'd like to spend about 20 minutes to tell you a little bit about what we are doing but responding to what That I've said about Sun Yat-sen. I have to tell you the Sun Yat-sen is the first medical graduate of Hong Kong At that time, there's only 11 students he came first and There's only another pass, which is a supplementary pass The only Inequality is after he graduate he's not allowed to practice in Hong Kong because of all these British Doctors who are practicing in Hong Kong at that time, so he has to go to Macau and start his practice So I think things has changed now We have to ensure that everything is done in in coordination and able to Face the demand and also expectation of a society Okay now I Think the the topic is hell and the well-being and I don't like to Spend too much time defining these two because I believe there are other sessions who go into the look at those But it is very important that any society with hell and well-being it would lead to productivity We need to progress with little stability and if anything happens to Either of the three it would also inversely affects the Health and well-being of the whole community whole community, and this is the responsibly of governments to ensure We have a healthy and Well-balanced community in our society In Hong Kong, we always say that we are very proud to be a small government But in the recent years we find that In certain areas particularly in commercial areas that we like to have a free competition But in certain areas the government need to take a leading role as well My understanding of well-being to be very very brief is it has to be safe for everyone It's a caring society need to respect freedom human rights and needs to be a fair society That means everybody would have a equal opportunity within our society to move on to any endeavor that actually they like to do And for health, I think we are not Just concerning about physical health. We also concern about mental health We are talking about actually the perhaps even spiritual health because I think that's very important for everyone and We usually divide a government role in public health and healthcare Healthcare and public health is definitely a government's responsibility We'd never treat that as a commercial business. So this is very important that in our philosophy We need to look at the government's role in both In designing in planning and leading as well as in regulating our activities You have much better Diagrams and maps in the publication you have produced but this is the satellite picture of Hong Kong which shows that Because of our very mountainous terrain There's only limited area for development and for people who like Nature we have 40 percent of our land is country park So you can see this is perhaps one of the greenest part of the Quantum profits. In fact, if you take a satellite picture, you find that Hong Kong is actually one of the greenest area in the whole region I'll tell you a little bit about our Objective I can only mention in a macro way rather than looking at some of the missile and the Micro type of innovation that we are doing all the science we're doing But I think it's important to note that in public health We must try to maintain a low risk environment for everybody it in fact, we concentrate on the infectious diseases because like Any density populated city? It is always a very high risk For any city and Hong Kong is particularly so because not only because we have a large population of 7 million people Living in a very close area But at the same time we have a lot of people traveling back and forth and also from the mainland from the various other countries to Hong Kong and and and so on Just across the border to the mainland alone every day. We have over three hundred thousand people So you can imagine if any infectious disease occur It is hardly possible to screen everybody crossing the border every day and of course as a responsible government we need to keep health data in terms of Very vital statistics and already very timely information that we gather I Notice today that I think it is a little as I said from LSE that published We are the one of the longest living population in Hong Kong with almost 83 years Of course, that's something we are proud of it's also something we worry about In Hong Kong our statistics shows that average longevity of man is 80 and for Women is close to 86 Women's definitely a more superior Species I think in that area, but I think it's important to note that It is not just longevity that counts is the quality of life that counts And we want to make sure that our elderly folks able to enjoy life able to be productive able to maintain their well-being even they They are getting into the latest stage of their lives And of course preventive health is important and health education health information This is also a very important Responsibility of the government We over the years We have built two important centers. One is the Center for Health Protection. This follows the Believe you you all experience in some part of the world is the SARS Incidents in Hong Kong in 2003 so the center was set up in 2004 And now we are able to monitor all the infectious diseases In the region and particularly in Hong Kong and I get the report every week Regarding the incidence and also the trend of different infectious diseases on on my computer every day every week And at the same time We are able to communicate with the various Authorities in the region and also a WHO on any emerging and and we imagine diseases this is a very important part and Apart from Infectious disease. We are also moving on to non communicable diseases. We notice that the burden of NCD is much higher there is there was a United Nations high-level meeting just seen as in September Regarding this and we noticed perhaps the the most important burden in future would be on chronic diseases on Cancer and and so on so these are the things that might be need to concentrate on and now with the Progress of technology and medicine You are not talking about how to look after cancer patients and how they actually pass on with In the terminal stage many people actually have cancers that treated Recover and then you have developed a different type of cancer in the in the later years So this is very important for us to and concentrate on how to prevent and screen Certain type of cancers at the same time educate people to To know to note their own health status so that they can come off for treatment as early as possible We also have regular review of our vaccination policy in the recent few years We have increased the vaccination for influenza and also subsidizing them the elderly and also the the the young population We make sure that those people who cannot afford to have vaccination will have it free of charge And for disease surveillance as I mentioned earlier on is this very important for us to follow the disease pattern In recent years, of course because of a change of diet because of the change of lifestyle We are seeing more chronic diseases related to the cardiovascular system diabetes and so on and All population public health Authority need to regulate so we are regulating pharmaceutical products. We are regulating various things and at the moment I think what actually mentioned today. We are also looking at some of the health products like Powder milk and so on to ensure that the population were well-informed of the risks and also Perhaps sometimes the the claims of certain products so health information and information actually involves a lot of work from various sectors and for healthcare Our philosophy is we need to ensure that everybody would have an equal access for care And we should have a safety net for all so there's a common saying that that nobody should be deprived of care for lack of means and Robust public system is important And we have a very highly subsidized public system which look after a lot of patients particularly the sick and also the severely sick in Hong Kong and Because of that we need to maintain the international Healthcare standard and the medical standard this we actually relate to various professional expertise and various professions Another area that we are very concerned and we are very proud of the same time is the professional ethics of our medical carers As you know that doctor patient relationship is never equal doctors always can Advise patients to receive treatments actually when they're desperate, so it is important to to ensure The professional ethics is up to a certain standard and nobody would get inappropriate treatment or unnecessary treatment We also need to look after certain sector of the community Because the public system there always some disadvantage and those also some other associated problems like Long queues and also waiting time and so on so a public service is also One of the options for those people who can afford it So we feel that is also important for us to regulate the public sector and this initiative only started only seven years ago And I think with different types of initiatives And at the end of the day we got to make sure that our system is sustainable financially Healthcare can be a bottomless pit when it comes to financing and always you have Supply you always generate demand as well. So it is important to ensure public funding will go to the appropriate and also the Important essential services and not put to any ways. So this is a very challenging subject Which I believe every government is facing right now In the public healthcare system, we develop the hospital authority which developed in 1990 and both put into function in 1992 We set up certain priority for them because we understand that You cannot care for everybody at the same time. So we need to have some priorities So the parties is look after the poor and the needy those people who cannot afford to have private care We have no other access of care and of course also in emergency Surfaces we make sure this actually combines with the ambulance surfaces and various rescue surfaces One area I think Hong Kong is particularly keen is we need to also develop the expertise as well as the Follow the international trend of medical development. So we also invest into high risk high cost and high tech services things like Transplant things like very advanced type of research in cancer and chronic diseases and so on and the last element we very Also, we also think that is very important is the public system should be also the nurturing ground for Healthcare professionals so that they can have the good exposure of the experience of different types of patients They can also maintain a good ethical practice because in the public system Whether you see more patients or not you still being rewarded in the same way I think this is something that's very important particularly in in community like Hong Kong and at the moment I Have several level of care So this is just to tell you that the primary care side we have about 30% of public go to the public hospitals and Also 70% of them are being cared for by the private general practitioners and in hospital care We look after 90% in the public sector and private 10% and Many of the tertiary care that is very high-level care will be only done in specialized centers and also in our public hospitals Looking at the development of Hong Kong Most of the population are gravitated in around the harbour area So many of the hospitals in the past were built around those areas, but in the recent years we have Enlarge our urban area to vary A more more distant areas including the Lantau Island including the northern district including the the some of the eastern part of new territories, so Now health care service is divided into seven cluster and each cluster would have services including primary care A Q hospital of a certain standard which have an excellent emergency We have some essential specialties in emergency in medicine surgery, orthopedics, gynecology and obstetrics and so on And they also have extended care and confident care and rapid rehabilitation services as well So it is very much a self-contained design for a cluster Except a few things like specialized services What I'm talking about is like a liver transplant center and things like that is only done in one hospital We also look at mental health because mental health is not just a Healthcare done by the hospital authority alone. It requires also a lot of public support from the Welfare sector as well. So I think this is also designed a different way As I said earlier on some of the tertiary centers are designed so that it can look after special services We also planning to build Two centers one is for children one is for neuroscience because we feel that in these two areas There is a need to concentrate expertise and develop a good area for future development and research So some of the pictures of a late We developed hospitals and some of the very traditional hospital Queen Mary is one of the oldest and so is Queen Elizabeth But I think there are new buildings building on In order to expand their surfaces Rehabilitation hospitals are more spacious. They have also more facilities for people to stay longer and and develop their physical and Functional skills Cowling hospital and Typo hospital is another one More district hospitals are built in some of the satellite tanks of tranquil and always one of the latest And so it's about our hospital and we are building also two others right now one is in near the airport in Tongchong and then the other one is in tinsui way, which is in the very More distant part of the northern part and often it Western part of Yunlong And of course talking about hardware we need to also look at software and Quality and quantity is also important continuous education accreditation and professional boards and councils I Think there's no different for many of the developed communities The surface design we concentrate on would be need to be patient center We need to have a standardized facilities equipment That means anybody's go to Different acute hospitals will be more or less the same Facilities and and equipments they can get I think we invest a lot on the medical equipment so one of we are one of the most well-equipped communities in terms of medical equipment in Hong Kong We form a drug family because this is important because there's so many new drugs coming on the market and some are Very good some are not so good and some are actually not actually superior than the old ones So this is important for us to ensure with the expert advice that we've given by the various clinical experts we Try to ensure that we have the right mix of Medicine for our patients Of course, this would be reviewed rapidly and on a on at least a six month Basis so that new drugs will be added on old drug will be taken out and what I mean drug for me is something that is heavily subsidized by the government and so some new drugs they also start to have a subsidy to see whether this is actually Sustainable and we also have by a Semeritan fund and also external funds in order to ensure Some of the new drugs are made available to the appropriate patients And like all services particularly professional services, we need to have a clinical audit On a regular basis and for Hong Kong We also make a very important policy that we need to tell people what happens in a hospital Hospital is not necessary all safe. There are things happening there all day and we've got to make sure that a Event reporting system is there first of all is non punitive so that people get Wanted we will want you to report at the same time if something that's really serious We need to actually inform the public as well. So this top of transparency Policy is extremely important Another area we look at is healthcare findings financing the public system is heavily subsidized It costs us 40 billion Hong Kong dollars a year That is about 2.5 percent of our GDP and our total Healthcare expenditure in Hong Kong is roughly about 5 percent of GDP So half come from the public side our pocket insurance and half actually come from the government In the government We subsidize very high level anybody come to our clinics have to pay $45 for a general patient that's GP type of cleaning And for those who come to specialist clinic, they pay $60 and each each drug that would amount to perhaps Three months supply would cost them extra $10. So in fact, it's very highly heavily subsidized service for hospital inpatient care, they pay $100 a day and Irrespective of what they receive so they can have a liver transplant which they stay for 10 days So all they pay is 1,000 Hong Kong dollars and of course of for that Each of the transplant will cost per of the government about $800,000 so it's a very heavy subsidized service But we believe this is very important to upkeep the health standard of our citizens But despite of that we still need to have cost control and some standardization of fees and the government this term of government we have able to increase the recurrent funding on Public health and health care from 15 to 70 percent of our government expenditure The increase of the 2% roughly amounts to a recurrent expenditure of 10 billion dollars per year Okay, there are challenges of course we have a public system like that so Because we know that the capacity need to be increased at the moment. They are about 12 to 13 percent of our population is about the age of 65 and In 15 to 20 years This will amount to about 25 percent. That is from 1 8th to 1 quarter So we expect the need for health care will be much greater So we need to ensure that we have Sustainable resources to keep up with that so the demand for the capacity the long-waiting time And also the cost control is important and at the moment. Yes, I've told you earlier There's some unbalanced public and public market as well. So we do address that So our plan is to try to enhance the development also of the public market But it makes sure they also acquire the same quality and transparency as the public side. So we try to give healthcare vouchers in people in the Testing the the market. We also subsidize the vaccination program that be delivered by the private sector We also buy service from the private sector in terms of cataract operations and so on we also try to Influence the public hospitals. So now everybody agree that they would unify the hospital accreditation system and also invest into the electronic health record system Because of the demand for public and also public services I think we also would expand some of the public hospitals Build new hospitals in certain areas. But at the same time, we also putting out four pieces of land We'll be putting out four pieces of land for public hospital options So this will be something that we do in the next year The accreditation system is so important that because they would is ensure that all the public and private hospital would have the same Quality of monitoring of their standards At the moment, we are we are using the Australian Council on healthcare standards, which we developed together with the ACHS so There will be about 60 inspectors both from Locally being nurtured together with the international ones to go around to do the system accreditation scheme We expect the scheme will be completed for all hospitals within three to four years The other very important infrastructure is the electronic health record system I think we have already a very robust system within the public sector But not yet roll out to the public one in the in the recent two years We start to have sharing of information with the public sector, which has been proven quite successful But we need to move into a new platform so that it will be a patient-based type of electronic health record system So the only individuals can authorize access to his records by the But the individual himself so he can offer a certain hospital certain clinics to have access and he can also stop that We've he's not happy with that. So I think this is a New new concept, which we are having we going to be introduced and put into implementation in 2014 This will improve healthcare. This would ensure they will pop up referrals and communication and facilitate clinical audit and quality control In some way you also support research and reporting And of course with that system. We also need to ensure the privacy is well protected Talk a little bit about healthcare financing because all the time we are using taxpayers money for our public system We do not actually have any control on the private expenditure But knowing that increase in cost particularly in technology. We have to introduce a regulated insurance scheme particularly for the People who can afford it. So we decided that after two consultation in 2008 and 2010 That we need to introduce this voluntary medical insurance system We will be able to set standard and regulate it together with the support of the stakeholders There will be some subsidy so that we can sustain the coverage particularly for the elderly we enhance this would enhance the private hospital and also the regulation of public services because of All these schemes when they expect that with the 10% of inpatients now look after the Inpatients we can expect that there will be a certain growth in this percentage up to perhaps 20% to 25% in about 15 to 20 years So as a conclusion, I think time would not allow me to go into a lot of details It's only very macro approach to this subject Healthcare design is a very complex process in fact in fact involved many stakeholders But some elements we need to control particularly as the government one is the market One is the manpower and expertise And more importantly is the professional ethics Which is going to determine on the quality as well as the sustainability of a system the government need to Supply the essential and the basic surfaces and we must make sure it is sustainable financially So with that, I'd like to thank you for giving me this opportunity to share with you some of the things we are doing I'm much more looking forward to listening to many of your speakers and experts Coming today and also perhaps Participating in the discussion later on. Thank you very much Thank you very much for this very informative talk on health and well-being in Hong Kong And I think we should take time for a couple of direct questions and then enter the general discussion afterwards May I start taking up Ricky's remark? There's nothing more important than health. It's the most important law what is You're the position as secretary of health and well-being in Hong Kong with respect to all the other departments You feel you have the influence in Hong Kong to do what you need to do that to meet the challenges Is healthy priority you're what asked for? the government is Basically funding all the public systems including the public health system as well as the public Healthcare system so in a way the government actually have the authority to do that of course the We also need to have some freedom for people to innovate and the public services we allow them to be able to compete with each other, but of course the recent Demand from the public is we better make sure that they also as transparent Like the the public system and secondly the quality of care need to be monitored. I think we have the Professional system at the medical council that nursing council will look at the professions If they do something that is below the certain standard or actually in conflict with the core practice, of course, they would be Disciplined in a way But I think it's important for us to ensure that The essential elements that I mentioned earlier on the standard of care the capacity of care some of the Ethical standards we need to monitor and I think the government actually do have the Authority in the power to do so through our laws through our regulation scheme And perhaps also for a lot of peer pressure within the system and Within the government they listen to you Our government you talk about government actually our government has three parts One is the executive role, which is our responsibility The data is that the legislative council which actually monitors the government at the same time They ensure the right laws are being passed and being being being enforced and the third one of course is the judiciary which address some of the the conflicts and Try to make the right judgment Further questions, please mention your name and where you come from. Yes, please Yes, Dr. Chow, I noticed in your PowerPoint very encouragingly that you include Environmental health as part of your total package now in Hong Kong I think some areas of environmental health is not actually within your Purview and I wonder for example where the public health community as well as the environmental community have been urging That the air quality standards in Hong Kong should really come under The control of your department because that's really where you have public health expertise How do you see? How do you see what what you can do to to in a way fill out this gap in Hong Kong's public health? Well, I think we have a secretary for environment. So he has to have some work You cannot just But on the other hand I think the secretary for environment will look after a much broader perspective of the the macro environment for I think for our department our Government's role In a way, we we work with each other all the time our department of health experts also give advice to the Secretary for environment in terms of determining some of the standards and so on But it is important to to notice that In the small government at Hong Kong We actually work very closely together. There are many issues that we cause we need to cross bureau In order to come to a certain policy. So I think that there's nothing wrong with that But very importantly, we have to monitor the effects of certain environmental risk So that we can help the other bureau. So in a way, we are monitoring the The the number of people who are suffering from say respiratory diseases and Ashma and so on to see whether that is something that is Would be relevant to some of the regulation that is being enforced by the other bureaus And for that matter, I think I need to mention another thing that we are responsible. It actually is the smoking control Tobacco control and this is something that we feel that Hong Kong has done something that very drastically in the last few years and particularly able to Reduce a smoking rate from almost 20 something percent 20 years ago to down to now 11.1 So this is something that I think is related to our effort in both our bureau and department, but also in the community as a whole Okay, see three more questions. Yes Bruce Raymond Los Angeles a two quick question is professor First is most of the medicine is delivered here Eastern or Western or doesn't it make any difference and sat I know it makes a difference and secondly With what medical institutions and facilities outside of Hong Kong do you have your most serious direct and constant ties? The mainstream of medicine is western medicine So I think all our hospitals that I mentioned the 41 hospital within the hospital 40s are all practicing western medicine Chinese medicine is mainly a primary care type of setup We have at the moment 15 clinics of Chinese medicine that is sponsored or supported by the government But many of these Chinese medicine clinics are individual clinics run by the practitioners themselves We start to regulate the Chinese medicine practitioners and the Chinese medicine itself Into the year 2000. So it's almost now 11 years down the road We're able to register about 7,000 Chinese medicine practitioners, but all of them are in in in primary care In certain hospitals we introduce a mixture of Chinese and Western medicine together, but still the main carer is the western doctor But since traditionally a lot of people believe in Chinese medicine. So we allow The practice of Chinese medicine in within those those elements is important for them to communicate and also cooperate Rather than a patient going to see a western doctor and then a Chinese medicine doctor without They know each other what to give what have been given the other Areas on on our international relationship is we have a very broad relationship We most of us particularly those doctors who train in Hong Kong have opportunity to train overseas So we we went to a lot of English speaking countries for example, US, Canada Australia, UK And and many of the other areas And they're widely travel and they also have set up certain communication and partnership particularly in research so I think We host A lot of international medical conferences in Hong Kong on a yearly basis on a regular basis as well Let's take a few more short questions and answers. Yes, please What is your view professor chow on the future of primary care and the role it should have in the Hong Kong system? primary care has not been developed as as actually as As good as the hospital care in Hong Kong in the past. I'll put it this way A lot of people would try to go to a specialist if they have something here They'll go go see a cardiologist if they see something here. They go to see a neurologist and the GP system is actually Quite unregulated for many years And this is the reason why in the last few years we put a lot of emphasis in Promoting primary care as well as in the private primary care providers And this is the also something that we think is important The three three things we are doing right now one is we are setting up a primary care registry We just started earlier this year So we are registering all the primary care providers Those who claim to be public care providers Okay, so we will give them the right information on the community disease trends and so on so they get much better informed And they will give them also certain standards of care, which we think is important for the community And secondly, I think we're developing certain models of care So we'll be setting up a community health center in Well to start one in the first one in tinshui way next year But we try to make this a multi-discipline center in different districts and thirdly is We also looking at certain primary care Surface models for different age groups So for example in children, what are the important preventive medicine we need to do and in in the elderly What shall we do and what are the chronic illnesses that we can care for at the primary care level? Now too many of the so-called specialist clinics are looking after primary care at the same time I think this happened in many many countries and many other Community Can we take one more question over there? I'm Gita Mthewari from Indian Institute of Technology jelly WHO recognizes road traffic injuries as a public health problem affecting most of the young people Does that come under your purview? Um, you mean road traffic accidents and trauma. Yes one of the We developed a framework for non-communicable diseases and actually I chair the committee myself a few things that we're looking at all for the years is Some first of all something we can prevent Right something we can prevent actually if you invest even Some resources into it you can actually cut down a lot of the downstream burden of the government and prevention of injury in terms of various type of Traffic accident industrial accidents is very important. For example the the seat belts And also the the the helmet law in in in motorcycle was introduced in the 80s and the 90s This would have tremendous cut down a lot of those Traffic accidents in fact the number of mortality in traffic accidents in hong kong is actually quite low Because that might be related to our our driving speed as well But this is something that I think We are concerned with and we also working with the 18 districts in hong kong to build a healthy city scheme so that The district councillors who have a very wide network to within the community they'll be able to Through their stakeholders their supporters their voters To to actually communicate and advise people on some of the risk behavior So I think this is something that I think is very important We have the seven customers of hospitals all to get the Trail hospital with the accident emergency department So they can look after injury and the very timely basis 24 hours and they have all the specialties it requires so This would cut down the mortality of a lot of the injured patients You have to find a question. Yes. Just can I take on A little bit forward pristine those comments, which is we have done some Mapping which is pages 38 and 39 of the newspaper. We don't need to look at it now We can look at it with car which basically identifies Hot spots of areas which you would have in any city, but in this case in hong kong of high child mortality or high premature mortality Does that spatial dimension actually affect your policies in terms of care it does I think I'd like to thank you for Having such a detailed analysis of the different districts of of health says in hong kong Of course, we need to know the pathology and how it actually come about but at the same time this will help us to modify some of our Policies particularly where should we set up a clinic where should we set up a hospital? Where should we Focus on health education and what are the main risks in in certain communities and so on So this will be very helpful. So I'd like to thank you for for doing that So you will benefit in hong kong from the research at ellison. Thank you very much. Thank you very much