The good, the bad and the ugly

This is the last health page in our current format. As of May 8, we'll be expanding the section to take in more health, well-being and fitness articles and advice. To mark the end of this particular era, we decided to look at the high and low points of health in Hong Kong - the areas we are doing right and the areas that are going wrong.

In her column, Dr Rose Ong offers advice for tackling some of the biggest problems. In other words, as the old doctor joke goes - we have some good news and some bad news.

First the good news. Despite all the headlines featuring tired doctors, disillusioned nurses and medical mishaps, Hong Kong has one of the world's most effective and cheapest health systems. We still outlive most people in the other cities of the world and we enjoy one of the lowest infant mortality rates.

Professor William Hsiao, the Harvard-based health analyst who examined the SAR's system in 1997-98, sounded as if he was trying to talk himself out of a job when he pointed out that Hong Kong had a far more effective system than the much-admired American one. This is chiefly because it is available to everyone, rich and poor, if we are prepared to queue at public hospitals and clinics.

Unfortunately, too many of us have worked this out and are overwhelming the public hospitals which is why people such as Professor Hsiao have been asked to find ways to improve the system. Hopefully the solutions do not keep the people that need healthcare most away from hospitals, as happens in the US. All of us, but especially our administrators, need to remember good health depends on getting access to the right advice and treatment when needed.

During the time I have been writing about health in Hong Kong, I've often found heaven and hell, existing side by side. For instance, if you mention care for the elderly, grim images of helpless old people I have seen tied to their beds in battery farm-style 'elderly homes' spring to mind. But at the same time, peaceful, attractive homes with gardens, space and a little privacy do exist. One such place is at Wong Chuk Hang, built with government funding. I also know there are far too few places and there seems to be little government interest in building enough to provide places for more than the lucky few.

Using the ability that Hong Kong people have to transform a miserable tiny space into something useful and effective, I have seen doctors and nursing staff transform a grim psychiatric ward into an indoor garden to lighten the mood of their patients with dementia, the disease where the brain slowly deteriorates.

In that same ward at the Kwai Chung Hospital, I saw a room fitted out as a small public housing flat with all sorts of devices able to help teach someone with dementia how to cope with their disease at home. By keeping patients in their flats, the staff at Kwai Chung stop them from being tied to beds at private elderly homes and are buying their families time to find something better if they eventually need to enter an elderly home.

Another group of medical, nursing, welfare and administrative workers have decided to take health into their own hands over at Tseung Kwan O. There, the staff of the Haven of Hope Christian Service, who used to look after the people of Rennie's Mill, have started a 'Healthy Cities' movement and are involving everyone in their area, from urban services staff to schools to the police, to other health services. They have realised the fragmented approach means people spend a lot of time and energy going to different places to gain treatment. And social and environmental issues causing many of our health problems, such as polluted air or poor diet and lack of opportunities to exercise, are ignored because they are such big problems they become everybody's yet nobody's job.

This leads to what I consider the greatest threat to health in Hong Kong: pollution. The direct effects are bad enough: lung damage, ear, throat and eye damage, worsening hayfever, asthma and heart disease in those who are susceptible. But the indirect effects, the stress and discomfort of fighting your way through air pollution, the depressing effect it has when all you see is a yellow-brown haze and the effects of economic depression if the worst comes to pass and traders and tourists decide to bypass a filthy Hong Kong, can ruin all our lives.

Furthermore, when the air is unbreathable, even the healthiest cannot safely exercise. It is little wonder that the other great threat to Hong Kong's health - childhood obesity - has become so widespread a problem. We are the fat kid capital of Asia - if not the world.

While pollution affects everyone, the obesity rates among our children threaten our future. The disease could disable a generation that we will soon rely on to boost our productivity, handle our technological transformation and care for us in our old age. But it may be we who are still caring for them as they develop heart disease, high blood pressure, diabetes and other conditions brought on by long-term obesity, overfeeding and limited exercise.

Although this problem is talked about there are still grim signs that our leaders have even less idea about what needs to be done for this problem than for air pollution. Last week a senior education department policymaker was quoted as saying schools should drop sports days if teachers have too high an administrative load. In other words, sports are a trivial and unnecessary part of a child's education as far as our education policymakers are concerned.

I found those words chilling because they betrayed a complete lack of understanding of how urgent the need really is to persuade schools to put more exercise, not less, into the curriculum.

The third big threat to health in Hong Kong, and one linked to both pollution and lack of exercise, is stress. Have you noticed that if you put your car indicator on when changing lanes, vehicles beside you in the lane you are changing to will accelerate to close the gap, in order to prevent you getting in front? Why are they doing this? Because they cannot stand the thought you are getting what you want when they are not getting what they want. They are stressed and are not going to let you enjoy your happy little life! I'm convinced road rage is getting worse in Hong Kong, as is queue rage, MTR rage, street bumping rage - you name it. Hong Kong is remarkable for its relative lack of rage, given the tiny spaces and miserable conditions many people live in. But this does not mean they are not stressed. In fact the nasty driver who won't let you change lanes may be healthier than you because you may internalise your rage and let the stress damage your heart and brain arteries.

Just reading about these problems is enough to raise anyone's stress levels, but there are some practical ways of dealing with them. Dr Ong has the answers in her column, and more advice on how to cope with life in Hong Kong will appear on these pages in the future. So please read on.

Look for our new Self section, packed with great reading and advice on health and fitness, on May 8