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Speech by SFH at Ministerial Meeting on Universal Health Coverage (English only) (with photo)

Following is the speech by the Secretary for Food and Health, Dr Ko Wing-man, at the Ministerial Meeting on Universal Health Coverage in Singapore today (February 11):

Thank you Dr Dzau. Mr Gan, Dr Margaret Chan, excellencies and delegates,

I am delighted to have this opportunity to share with all of you Hong Kong's experience in handling public health challenges, including the impact of non-communicable diseases, the public health-care system and some of our initiatives to sustain universal health coverage.

Honestly, my colleagues have hesitation about my speaking on this subject in Singapore. Indeed, I look with envy on the 3M system in Singapore which provides strong financial infrastructure backup for universal health coverage. As a sharp contrast, universal health coverage is provided in Hong Kong through a heavily subsidised public hospital and general out-patient clinic system operated by a statutory non-government public body, the Hospital Authority.

Our public health policy ensures that no Hong Kong people are deprived of basic health care due to lack of means. With an all-inclusive daily in-patient charge of only HK$100 (or around US$13) at our public hospitals, the Government is currently paying for 97 per cent of the recurrent cost of the Hospital Authority. This is a key feature of Hong Kong's health-care system and something deeply cherished by Hong Kong people. It therefore needs no explanation why our people reject any proposals for mandatory health insurance or other contributory schemes, like the Medisave.

But we cannot hide our head against the serious challenge to the sustainability of our health-care system posed by a rapidly ageing population. The pressure on the public sector delivery system has been mounting. We will continue to strengthen the public health-care system as the cornerstone of our health-care system and provide a safety net for all. At the same time, we need to explore ways to address the current imbalance between our currently heavily government-subsidised public hospital system (which caters for some 90 per cent of hospital admissions) and private hospitals (which account for only about 10 per cent of hospital services), and maintain the long-term sustainability of the system.

We would be doing a disservice to Hong Kong if we do not act now. We are consulting the public on a Voluntary Health Insurance Scheme (VHIS) to enable us to adjust the balance between the public and private health-care sectors. The objective of VHIS is to empower those citizens who are able and willing to use private health-care services to do so. Under the system, we propose to regulate all individual indemnity hospital insurance products in the market by stipulating a set of minimum requirements. These basic requirements, including guaranteed acceptance, guaranteed renewal without re-underwriting, coverage of pre-existing conditions, and minimum benefit coverage and limits, are designed to enhance the accessibility, quality and transparency of individual hospital insurance. Consumers will have more confidence in making use of private health-care services with a choice of doctor and in a more convenient setting. Users of public health-care services can also benefit from shorter waiting time and enhanced service quality. In this way, VHIS will help promote synergy between the public and private sectors and more efficient use of public and private health-care resources. We are appealing for community acceptance of this proposal, and looking forward to implementing the Scheme through a new piece of legislation.

Hong Kong people's confidence in our public health-care system is well grounded. Hong Kong's health indices rank high consistently. With a steadily increasing life expectancy, the proportion of the population aged 65 and over is projected to increase from 13 per cent in 2011 to more than double to 30 per cent in 2041. Driven by ageing population, changing health risk profiles, and lack of attention to a healthy lifestyle, we are facing an upsurge in non-communicable diseases. In 2013, six major non-communicable diseases - cancer, diseases of the heart, stroke, chronic lower respiratory diseases, external causes of morbidity and mortality, and diabetes together accounted for more than 60 per cent of all registered deaths in Hong Kong.

How can we enable our citizens to live not only longer, but healthier? With virtually free-for-all universal health-care coverage, how to empower individuals to take care of their own health through good personal hygiene, a healthy diet, an active lifestyle and being more responsible for their own health? We need a strategy, a long-term macro and sustainable strategy on public health development which looks beyond the hospital setting and switches the focus from fire-fighting to fire prevention.

To this end, we have already launched a Strategic Framework for Prevention and Control of Non-communicable Diseases. Action is now on hand to promote a healthy diet and physical activity participation, reduce alcohol-related harm and strengthen injury prevention in Hong Kong.

A sedentary lifestyle, smoking and excessive intake of salt and sugar are known risks of developing hypertension, stroke and coronary heart diseases, obesity, dental caries and other non-communicable diseases. We need to raise public awareness and change the dietary culture of the community and the practices of the food industry. Underpinned by an International Advisory Panel on Reduction of Dietary Sodium and Sugars comprising both local and overseas experts, we have set four major strategies:

* first, reduction of salt in sauces and condiments, which accounts for 44 per cent of salt intake of the local adult population in Hong Kong;
* second, reduction of sugars in prepackaged non-alcoholic beverages;
* third, engaging chain restaurants to reduce salt and sugars content of their food; and
* fourth, involving lunchbox providers to further reduce salt and sugars content of school lunches.

Our target is to gradually reduce the intake of salt and sugars by Hong Kong citizens to the levels recommended by the World Health Organization.

Prevention and education must start early. Infant feeding practice has an important bearing on the future eating habits and the risk of non-communicable diseases in later life. Breastfeeding plays a crucial role in preventing childhood obesity. We are making a determined effort and mounting a major campaign on promoting breastfeeding. We need to change the culture not only at home but also in the workplace and we must provide an environment to encourage more mothers to choose and stay on with breastfeeding. For older infants, the introduction of complementary food is crucial for them to build up healthy eating habits. We focus on parental education to enhance parents' knowledge and skills of feeding their infants, including avoiding overfeeding and arranging adequate physical activities and a diversified diet for their young children. We are planning to issue a voluntary code to provide guidance to relevant industries and raise public awareness of the importance of ensuring the proper use of formula milk, formula milk and food products for infants and young children.

We are particularly concerned about incorrect or misleading marketing claims on formula products which seek to exert undue influence on parents' decision on breastfeeding and cause adverse long-term impact on the health of the children. We propose to tighten the regulation on nutrition and health claims on formula and food products and are consulting the community and industry on a new regulation framework.

Tobacco use is the single most preventable cause of death. In Hong Kong, tobacco control and smoking prevention have been one of the key priority areas of our public health policies. We have adopted a combination of legislation, taxation, publicity, education, enforcement, as well as smoking cessation services. Since 1982, the smoking prevalence of the population aged 15 and above has been reduced from 23 per cent to 10.7 per cent. Our target is to bring it down to a single digit. To sustain our anti-smoking policy, we must continue with our enforcement measures and take early, preventive and decisive action against new tobacco products, such as e-cigarettes, and give a clear and firm message to the tobacco industry and the community.

Another known age-related non-communicable disease is cancer. There is scientific evidence which supports that certain types of cancer are preventable and controllable. Just last week, I chaired a Cancer Coordinating Committee meeting and worked with cancer experts, academics, and public health professionals, on effective prevention and control of cancer. In going through the statistics relating to cancer incidence and mortality in Hong Kong, we noted the recent trend which shed light on priorities, treatment services standards, research and development as well as the direction on prevention and screening of cancer. For example, the meeting concluded that more research should be done to look at the rising trend of non-small cell lung cancer incidence in both male and female population in Hong Kong. Against all these, cancer education and public awareness remains the cornerstone of effective cancer prevention. Healthy eating, regular physical activity, tobacco control and alcohol avoidance must continue to be the key themes of our promotion of healthy lifestyle and cancer prevention.

An effective strategy to control non-communicable diseases is early detection, early diagnosis and early treatment. A territory-wide Cervical Screening Programme was launched in 2004 to encourage women to undergo regular cervical screening. In view of a growing and ageing population, the rising incidence of colorectal cancer and related health-care burdens, the Hong Kong Government is mounting a Colorectal Cancer Screening Pilot Programme in collaboration with multi-sectoral service providers. We aim to launch the Pilot Programme towards the end of this year. The Pilot Programme will enable us to gather local experience in colorectal cancer screening and collect relevant data to assist us in designing a more cost-effective long-term programme.

While working on this long-term preventive programme, we have not lost sight of the serious and immediate threat of new infectious diseases. Infectious diseases are no stranger to Hong Kong. As a major transportation hub, an international business centre and a popular tourist destination, Hong Kong each day receives tens of thousands of passengers coming from different parts of the world. Last year, more than 60 million travellers visited Hong Kong, more than eight times the local population figure. This presents a huge challenge to our port health and public health officers.

After the 2003 SARS epidemic, we have done a lot of work to strengthen disease surveillance, enhance laboratory diagnostic services, build up surge capacity at public hospitals, refine emergency preparedness and response plans and perform regular drills and practices to maintain and heighten the alertness of our front-line health officers. Prevention is more important than treatment. We have stepped up public campaigns to raise public awareness of personal hygiene. While we have successfully fended off the threat of H1N1 influenza in 2009, we cannot be complacent.

The experience tells us that globalisation of trade and the convenience of modern day travel mean public health officers have to constantly battle against the threat of new outbreaks - avian flu, Ebola, the Middle East Respiratory Syndrome, and other new, unknown strains of viruses lurking round the corner. Just before my departure to Singapore, we have been working strenuously against the recent surge in seasonal flu due to the antigenically shifted H3N2 strain. With the speed and convenience of modern transportation, any local public health threat can instantly become a threat against the world and all communities. We need good communication, concerted action and a global effort to mount an effective defence against these threats. I urge public health officials, infectious disease experts and front-line clinical staff to maintain the highest level of alert. We must keep in close touch with one another and share experience in disease detection and surveillance intelligence to protect ourselves and our citizens.

We will certainly continue to double my effort. As the Secretary for Food and Health, our people's health and the chickens' health are both close to my heart in the face of avian flu. In promoting healthy eating, my targets are a proper food labelling legislation as well as a strategy on healthy dietary habits. Only with all these, our work can complete in full circle.

Ladies and gentlemen, we are in a WhatsApp age with a WhatsApp population. A lot of health news or medical breakthroughs roam round the globe in split seconds. All these, however, cannot replace a good sharing and exchange session like the one we have today. I look forward to more of your enlightening views and wisdom in our ensuing discussion. Thank you.

Ends/Wednesday, February 11, 2015
Issued at HKT 18:15