The city must strengthen public health before it is too late
This article appeared originally in the CHINADAILY on 18 June 2020.
Authors: Authors: Pamela Tin, Lead Researcher of Health Care and Aging at Our Hong Kong Foundation
Hong Kong’s efforts directed toward a COVID-19 response plan are being spearheaded by experts like Dr Yuen Kwok-yung, Dr Chuang Shuk-kwan and Professor Gabriel Leung. Before the public health crisis a few months ago, these figures were mostly only well-known within specialist medical circles. Today, they are household names. There is one commonality among these practitioners: More than their clinical practice, they are widely recognized as public health experts. But can one easily differentiate between the two professions?
The key difference between the discipline of public health and those rooted in clinical care is that the former focuses on the health of the population, while the latter focuses on the health of the individual patient.
Let’s take the example of a clinician and a public health practitioner, such as an epidemiologist. When a suspected patient is suffering from an illness, the doctor examines the patient for a diagnosis and provides treatment accordingly. Meanwhile, an epidemiologist, also known as a “disease detective”, investigates the potential cause of an illness, identifies at-risk individuals and carries out disease mapping — all in an effort to control a further spread of the disease and prevent its resurgence in defined populations.
Beyond immediate health emergencies, their expertise is equally important to emerging patterns of noncommunicable diseases such as diabetes and obesity and behavior like drug abuse.
At heart, public health is interdisciplinary and by extension requires the public health workforce to collaborate with a wide range of partners. In a recent discussion, Dr Vivian Wong, former chief executive of the Hospital Authority, highlighted the importance of diverse skills that are needed in the field of public health. It is encouraging to witness the birth of new university courses such as the University of Hong Kong’s bachelor of arts and sciences in global health and development, and the Hong Kong University of Science and Technology’s master of science in environmental health and safety. These bring together a hybrid of faculties including medicine, architecture, business and economics, law — even ocean science.
We need to vigorously increase the rigor of advocacy and recognition of equal importance to public health and medical care, without much talk
Nevertheless, the development of the public health discipline in Hong Kong has been widely acknowledged as underinvested in terms of infrastructure and workforce. In the throes of containing COVID-19 today, Professor Yeoh Eng-kiong, professor of public health, head of division of health system, policy and management at the Chinese University of Hong Kong’s the JC School of Public Health and Primary Care, categorically stated at a recent public forum: “People don’t even appreciate this group of individuals (public health practitioners). I have advocated to the government that they should invest more in public health practitioners — people with a degree in public health that can then work in the community.”
In Hong Kong, interest and priorities for public health only increased around the time of SARS and the current COVID-19 pandemic. For instance, our latest health expenditure on preventive care accounts for only 2.7 percent of the total health expenditure. The conservative spending pattern has remained unchanged since 1989-90 and only observed an all-time-high at 4.2 percent in the aftermath of SARS in 2003-04 and quickly declined in the following years. This pales in comparison to the health expenditure on curative care. This further shows that our health system has been biased to secondary and tertiary care that revolves around hospitals.
On the other hand, the trickle-down effect of a low systematic priority manifests itself in a shrinking public health workforce. The lack of sustainable funding makes the industry rather unappealing to recruit and retain talents, let alone to embark on progressive manpower planning for potential future health crises. Currently, the JC School of Public Health and Primary Care in CUHK is the only institution in Hong Kong that provides a public health undergraduate degree with a first-year intake of 32. Even including the two masters of public health programs offered by HKU and CUHK, the new blood in public health each year is still roughly less than half of our annual number of medical graduates.
We need to vigorously increase the rigor of advocacy and recognition of equal importance to public health and medical care, without much talk. This oversight must be addressed at all levels of society, especially within the government, where round-the-clock decisions are made on allocation of resources. This urgency is resonated by Professor John Bacon-Shone, associate dean (knowledge exchange) of social sciences at HKU and a former member of the government’s central policy unit. Despite the well-intended decision of the government today to provide current funding to CUHK and HKU for COVID-19 research, he said such support would be short-lived as it is directed only to the medical faculties, placing undue emphasis on doctors when the issues clearly pertain to the greater realm of public health.
While Hong Kong’s current success in the pandemic can be attributed to an interplay of factors, the government’s heightened willingness to listen to our public health experts has been palpable. COVID-19 is our last wake-up call to strengthen public health before it is too late. The imbalanced priorities between public health functions and hospital care are a pressing and intricate challenge. If this is not resolved in an apt and timely manner, our collective health will pay the ultimate price.