Primary care is better than cure?
The social determinants of health are the conditions in which people live in, including housing, food, education, political system, social support and more. Professor Samuel Yeung-shan Wong pointed out that many research studies have found that lower social classes spend less time on healthcare services and that doctors generally do not prefer seeing patients from such classes; health equity for the lower social class is indeed an issue neglected by the society. Here, primary care can play a critical role. With respect to the current 10% public healthcare spending on primary care only, Professor Wong thought that this reflected the government’s lack of attention to health promotion and protection. “Efforts related to prevention and primary care is truly insufficient. Currently the private market constitutes 70% of all primary care services, even with healthcare vouchers it is still unsatisfactory.”
Health In Action also believes that the government healthcare policies and resource allocation have misled Hong Kong residents to overlook the value and practical importance of family medicine and primary care, and instead blindly seek for specialist services. This creates a vicious cycle, including contracting family medicine services, distorting the health culture, inappropriately increasing the healthcare expenditure on both society and individual levels, and confusing health messages due to incomplete information.
The fundamentals of primary care, and the future of community health promotion
Professor Wong explained that the system of family medicine and community service is well developed in the UK, Australia and Canada. With complete registration systems, it is easy to locate and access service providers, and the systematic training and regulations enhanced the societal recognition of such services and appropriately meets the markets needs. In comparison, Hong Kong fares much worse. He pointed out that there are currently only around 400 family medicine doctors in Hong Kong, far from adequate. However, even more importantly, according to Professor Wong, is the limited range of services provided. He said Tin Shui Wai’s Community Health Centre is an example of “an ideal and practical” model.
“Tin Shui Wai’s Community Health Centre is a good initiative, but it is too distant from most local residents, accessibility is certainly an issue. In addition, I hope that these type of centres are not merely general out-patient clinics, but offers services or activities that directly help the community to prevent different types of diseases, from vaccinations to health talks etc, various kinds of health activities. Also, there has to be work focusing on driving healthy behavioural change, as well as a range of social services. Only then is this the ideal community health centre I have in mind. I believe HIA also has a similar vision. Only such institutions truly care for the people, which is indispensable among local community groups.” Professor Wong understood that many low-income individuals find it difficult to attend appointments on time or to comply with health service arrangements. If there is someone who takes the initiative to follow up with them or assist them in attending appointments regularly, why not? “If a mother is unable to go see a doctor because there is no one to help her take care of her child, why can’t arrangements be made to facilitate that? This should be something a community health centre can do…”
Humanitarian work is a vaccine that “reminds you why you entered the health profession”
Professor Wong expressed his support towards HIA’s involvement of medical students from both medical schools in our local and overseas humanitarian work. “Entering the medical profession itself can be said as a form of sacrifice, and also a life vocation. Although different individuals have different interests, and in spite of the pressure and workload as a medical practitioner, we must remember that we are working for the elimination or alleviation of people’s suffering caused by illness. To be able to join your work is as if taking a booster dose!” exclaimed Professor Wong. He suggested HIA to encourage greater participation of medical students on case follow up and management. Currently our asylum seeker/refugee escort service and Nepal school health promotion project have created platforms for the younger generation to learn about health inequity through first hand experience serving underprivileged groups.