Defining the failure of public health
The public health function in any jurisdiction is concerned with the achievement of social justice. Modern public health is a multi-disciplinary science that aims to develop a rigorous evidence base to support policy decision-making.
In recent decades, Hong Kong's medical academics and health-care providers are recognised to have made notable contributions to the world's knowledge on the causes, treatment and prevention of many environmental hazards. The list includes those for respiratory disease, including tuberculosis, influenzas, Sars and the ubiquitous chemical agents in both indoor and outdoor pollution.
In choosing health policy directions, governments should review the strength of the evidence and the relative importance of a problem. Assessing the importance means being explicit about the value of the health gains which may result from government intervention.
Some health problems are admittedly difficult to address and resolve, such as the global epidemic of diabetes and heart disease. But much of the difficulty is created by the stance of industry in opposition to the regulation of manufacturing and aggressive marketing. Governments should recognise that they will eventually be forced into action when they recognise that the problems will bankrupt public sector health services.
However, recognition of community costs and other external consequences is often not part of the law-making process for health in Hong Kong, and even the modest proposals for essential nutritional labelling can expect a rough ride from industry representatives in the Legislative Council.
Many initiatives have foundered because of a lack of good public-health management. They include the interminably delayed central slaughtering of chickens and the refusal to act urgently and effectively on air pollution.
However, the event which will now define the failure of public health in Hong Kong in 2006 is the sickeningly cynical passage of a tobacco bill which allows establishments to apply for an exemption to the smoking ban until 2009. This effectively means they are deliberately and intensively poisoning their workers with tobacco smoke.
Over more than 20 years, we have assembled evidence to show that breathing second-hand smoke causes disease and death. The evidence of harm was accepted by Legco's Bills Committee and the principle was clearly established that workers must be protected. Yet, the government decided to breach the principle and trade away the health and life expectancy of an unlimited number of workers in the hospitality industry. A preliminary estimate is that somewhere between 40 and 200 workers' deaths will result.
I am not hopeful for a speedy reversal of this administrative evil. For the future, we need to remove public health policy from the civil service.
The autonomy of the Independent Commission Against Corruption is seen as a necessary bulwark to prevent the fabric of society being disassembled by graft.
Community health now deserves similar protection through an independent commission which will take evidence-based formulation of environmental health policy out of the hands of amateurs and vested interests.
Anthony Hedley is chair professor in community medicine at the University of Hong Kong's School Of Public Health
