Hong Kong’s Director of Health Ronald Lam Man-kin is with us, sharing the status of health care for Hong Kong's public, and how we can prepare for the future with stronger regulation and better innovation, so that Hong Kong people can continue to be among the healthiest in the world.
Check out the full transcript of TVB’s Straight Talk host Dr Eugene Chan’s interview with Dr Ronald Lam:
Chan: Good evening! I'm Eugene Chan, and welcome to Straight Talk. Our guest is the Director of Health, Dr Ronald Lam. Dr Lam is a specialist in public health medicine and has championed important initiatives, including setting up the new Centre for Medical Products Regulations to strengthen regulation and foster medical research. Dr Lam was the founding director of the World Health Organization’s Collaborating Centre for Traditional Medicine, and has represented Hong Kong in global tobacco control and health workforce regulation. Here at home, he also serves in key leadership roles across various statutory boards and health councils. Welcome, Director Ronald!
Lam: Hi, Eugene!
Health statistics and status
Chan: You know, Hong Kong has always been very proud to have one of the longest life expectancies in the world – 82.5 for males and 87.9 for females – a really outstanding achievement for Hong Kong people. I must congratulate the Department of Health. What factors have actually contributed to this trend of a very high life expectancy for the Hong Kong people?
Lam: Yes, Eugene. Indeed, Hong Kong is one of the healthiest places in the world. And as you said, over the past decade, we are seeing a rising trend of the life expectancies at birth, which is now among the best in the world. And attributing to this most importantly is our policy commitment, that no one should be denied adequate healthcare because of a lack of means, which also means that the residents of Hong Kong can have accessible as well as affordable healthcare. And as you may also know, we have a very efficient and effective healthcare system. And Bloomberg has just ranked us as the second best in the world as well. Added to that, we also have a very strong focus and commitment on the public health preventive as well as disease control services as well. So, on the public health front, we have focused on three strategic areas – one is health regulation, the other is disease prevention and control, and the third is health promotion and innovation as well.
Chan: Right. So, Director, when you say having a long life, I'm sure everybody wants to have a long life, and I remember all the emperors in the world always looking for medicine to have a long life. But then long life doesn't mean that you have a healthy life, right? So, in your opinion, as your director of health perspective, how healthy are Hong Kong people in 2025?
Lam: Apart from that, we have one of the best life expectancies at birth. If you look at the age-standardized death rate, we are now having a record low age-standardized death rate, which is 2.5 per thousand standard population. And this is against the background of a rising aging population. So, you can see how effective and high-quality our healthcare system is. And of this, one of the most important areas is disease prevention and control. We are seeing that there are several NCD (non-communicable diseases), which will affect the population at large. And those main causes of death will include those NCDs like cancers, heart diseases, diabetes, and so forth. But all of these diseases are, in a way, preventable. So, if we adopt healthy lifestyles, like having a good balanced diet, providing good nutrition for, you know, the pregnant women and also having regular exercise, as well as avoiding excessive drinking and smoking. Then it would help us to have a much happier and healthier lifespan. Alluding to these, the government put in a lot of initiatives in promoting healthy lifestyles. And as you know, we have a very stringent and also comprehensive set of tobacco control measures. An indirect indicator that can reflect this is that we have one of the lowest smoking preferences in the world, now reaching as low as 9.1 percent of the population. And if we do healthy lifestyle in the right way, then we can see that the NCDs, especially cancers, the number one killer, would drop significantly. And this is also reflected in the significantly lower cancer death rates all these years.
Chan: Right, director. It is very encouraging to hear. I mean, we have a good medical system. We are preventing diseases. I mean, we are doing well. However, you just mentioned a very good point that, as we know, by 2039, one in three Hong Kong people will be 65 years old, or older, which means we're getting a really ageing population. Are we, in terms of health, ready for the social and healthcare challenges that are sort of coming up? Are we ready?
Lam: Yes, we are undergoing these healthcare reforms as stipulated in the chief executive's Policy Address. These include not only the health regulation, but, most importantly, disease prevention and control. So, that means we are putting a lot of effort and new initiatives, not only in amendments of law related to health, but also the services of several major public health programs. Let me give you an example. Cancers are the number one killers. We have lung cancer, breast cancer, and so forth. So, based on the best available scientific evidence, we have launched a number of territory-wide, population-based cancer screening programs to enable us to have early detection and then early identification of the causes and then early treatment for these patients. So, an example is the colorectal cancer screening program, and through this colorectal screening program, we are able to achieve identifying several precancerous stage cases that allow us to institute certain treatments such as the colectomy removing the colorectal adenoma, and then in such cases, such early intervention can enable us to have early follow up and then let them to have less fatalities as well.
Chan: Right. Director, I'm sure all our viewers will agree that prevention is better than cure. We all know that all the time, but in Hong Kong, we always felt that you only go to see a doctor when you are actually unwell. Compared to dentistry, it is slightly better. You go there for a very regular check-up. So, what more can be done to shift the actual focus from hospital treatment to actual prevention and primary healthcare in the community? What are your efforts?
Lam: Structurally, right now, we have set up a new department under the Health Bureau that is the Primary Care Commission. And the focus, one of which is to have the reform, to place focus … to shift the focus from secondary care to primary care. To drive on this from the Department of Health perspective, we have to reinforce mainly two initiatives – one is maternal and child healthcare, and the second is to encourage the population, especially those elderly, to use more primary care services, instead of going to the A&Es or going to the hospitals seeking help. So, in the first part, the maternal and child health centers under the Department of Health are the major players in this, because they are providing prenatal care and also immunization programs, as well as child development programs in collaboration with various stakeholders like the Hospital Authority and other departments as well.
Chan: Right.
Lam: An example would be the comprehensive childhood immunization program because of the high coverage of the vaccine targeting different infectious diseases. We are seeing that previously those diseases, like ferroptosis and polio, have been brought under control, and polio has been eliminated as well. And over the past few years, we are able to achieve, through vaccination, a total control or elimination of the local transmission of measles and rubella. So, these are very shining examples. Apart from immunization programs, our maternal and child health or family health as a whole also provides sorts of screening in collaboration with the social welfare sector for those pregnancies at risk and also those families with newborns. We not only identify their health needs, but also if there are any additional social or mental needs, like postnatal depression, like if there are any social needs, we need to refer them to the appropriate organizations to follow up. Let me give you an example. Out of the over 36,000 attendances to the maternal and child health centers, we have identified 3,500 postnatal depression cases last year. So, this highlighted the effectiveness of the program. And also, we have worked closely with the Social Welfare Department and the Hospital Authority to institute childcare … a comprehensive childcare development scheme. And through this scheme, we have screened over 6,000 families, and one third of them, we identified that they have the mental needs that need to be taken care of by these psychiatric departments. So, you can see that these highlight the necessary intervention at the very early stage of life.
Chan: Right, let's have a short break now, and, viewers, we will be right back with more Straight Talk.
Infectious diseases and preparedness
Chan: Thank you for staying with us. Director of Health Dr Ronald Lam is sharing with us the latest statistics on how healthy Hong Kong people are. So, Director, in the first half, you have told us that prevention is better than cure, and the Hong Kong medical system is one of the best in the world, and Hong Kong people should be very assured. One area that we must touch on tonight is talking about all these infectious diseases and how prepared we are. I mean, we had SARS some 20-odd years ago, and we just went through COVID-19. What lessons, when you look back, have we learned from SARS, such that we did reasonably well with COVID-19?
Lam: After SARS in 2003, we set up the Centre for Health Protection, a dedicated agency to deal with disease infection, and also the control of the spread. So, we focus on three major areas. One is to have real-time surveillance; the second is rapid intervention; and the third is responsive risk communication. So, these are what we call the 3Rs. And based on the 3Rs, over the past decade, we have developed a very robust disease prevention and control system. We have instituted various contingency plans, and have emergency preparedness with exercise and drills conducted every year on different infectious diseases of public health significance. And so, you can see that with such preparedness and response, we are able to deal with, in the past decade, significant outbreaks, like the swine flu.
Chan: Right.
Lam: And so, when COVID hit us in 2020, we were ready, in fact, to adapt the preparedness plans, to adopt a cross-disciplinary and also multi-departmental approach, to work together against this. And most importantly, during the COVID-19, we employed several very important innovative technologies, building up IT systems and so forth, to assist us in the responses. So, in terms of risk communication, in terms of use of latest technologies, and also adopting a cross-disciplinary and inter-departmental approach would be of critical importance that we use during the COVID-19 fight.
Chan: Right. Director, one of the things I am sure all of us remember is that we all had to do vaccinations, right? And I am sure that we all agree that it will help to prevent such infectious diseases. So, how would you assess the vaccination culture today in Hong Kong, given all that has happened? And one term that has come up most recently is there is sort of a growing challenge, as which we call the ‘vaccine hesitancy’. So, can you address these two issues for the viewers?
Lam: Vaccination is a critical, I would say, silver bullet against infectious diseases because it confers not only immunity to those vaccinated, but also because of the herd immunity, it also protects those unvaccinated groups, like those newborns, those immunocompromised as well. So, it is very important. But unfortunately, there are some myths and also misunderstandings about the vaccines. People sometimes would be hesitant to take up that because of allergies or other concerns, or unknowns. So, we tackle that, first of all, by the evidence because vaccination programs, their effectiveness, their outcomes are very obvious. And over the years, you can show the effectiveness, like we are able to reduce the hepatitis carrier status in the population by introducing the hepatitis vaccination program to the newborns. And so to reduce the hesitancy, we also need to rely on the health promotion part as well to get our messages very transparent. In the COVID era, we tried to make the population to adopt the use of COVID vaccine, not only by science, by clear messages as well. And we are able to promulgate that the different effects and different spectrums of different types of COVID vaccines, as choices for the public to choose. So, this is very important.
Chan: You are quite happy with the culture that has been developed over the last few years in Hong Kong?
Lam: Yes, we are seeing an increase in the flu vaccination as well. Compared to last year, the recent season's vaccine coverage has increased by 12 percent. And it is very clear from science and from our health statistics that we have seen reduction in the severe influenza cases by overall 20 percent in the pediatric and adult population. So, it is very crystal clear that flu vaccination is effective. And this is also reflected in the increase in uptake rate to a new height.
Chan: This is definitely very encouraging news because if more people are protected, the whole community is better in terms of health. Maybe we all read in the news recently about those mosquito-borne diseases like the Chikungunya Fever. I mean what is the latest now? I mean, do we have to be really concerned because we have a lot of traveling between Hong Kong and other places, especially Guangdong for Hong Kong people, and should we be concerned?
Lam: We have over a dozen Chikungunya cases reported (as of last week). And globally, there is an upsurge in the Chikungunya Fever outbreaks. So, all these imported cases right now in Hong Kong, they came from different places, from Guangdong, from Bangladesh, Sri Lanka, Indonesia, and so forth. So, this reflects, first of all, a global warming phenomenon. As you rightly put it, we have increased travel, especially during the summer break. And also the heavy rainfalls and the increase in high temperatures, all these would predispose an area to the breeding grounds of the vectors because Chikungunya is transmitted not from person to person, but through the mosquito vector, which is present in Hong Kong as well, the Aedes albopictus.
Chan: Right.
Lam: So, to prevent this, we need, on a personal level, not only when going to travel or to outings, you have to put on the insect repellent, wearing dress with long sleeves and so forth, but also remember that in homes or any places, remove the breeding grounds, like small potted plants, and you have to clean those collections of water.
Chan: Right. As you just said, Hong Kong as an international hub, I mean, we want more people to come with all these mega events. How can Hong Kong be the best guard against all these importations of new diseases that we just discussed? Anything we can do?
Lam: Yeah. On the border level, we have the health measures in place, including temperature screening and allowing the travelers to have declarations. So, whenever we encounter cases of subspecies with fever, we will have a brief assessment and then refer to hospitals if necessary. So, this is from the government's part. From the travelers' perspectives, I would advise they have to take cautious precautions. They have to know the places where they are going to, what the situation is in terms of epidemics, like if there is an outbreak of dengue fever or other vaccine-preventable diseases, like measles, then they have to check if they are vaccinated or not to go there. And then to put on the mosquito prevention measures as well. And when back from other places, they have to watch out, like if you have been to the places with Chikungunya case outbreaks, then better you still apply insect repellent for 14 days to avoid coming back to Hong Kong and getting bitten by the vector mosquito, and then lead to further transmission. So, all these measures, you have a host of measures to pay attention to.
The role of regulation
Chan: Right. We are covering a lot of areas tonight. Director, one more area I would like to talk about is the role of regulations. I mean, one of the roles of the Department of Health is to regulate healthcare professionals, and also the healthcare premises, which is coming very soon in October. Can you share with the viewers why it is so important to have regulation of the healthcare workers? I mean, how does that ensure the safety and the quality of care to the patients? How will that happen?
Lam: Health regulations are fundamental to an effective and high-quality healthcare system because it guarantees the standard of the professionals, as well as patient safety in the premises. So, one part would be the health professionals, because for patients, they are in a disadvantaged position in that they have sort of an information asymmetry because they could not understand if the doctors they are seeing are good or not, the professional competency, whether they are following the ethics properly, and so forth. So, all the medical practitioners, dentists, and other healthcare professionals they have to be registered with the Medical Council, the Dental Council, or the Supplementary Medical Professions Council, and so forth. This is to ensure that there is a statutory body to give the code of practice for them to follow, and then, through the stipulations in the code of practice, they ensure their professional competence is up to standards. But the sort of health professional regulation is not a one-go exercise. It does not stop at that – when you finish the registration, then you let it go. So, the professional councils or the government would monitor closely to ensure that they have continuous professional development, learning as a lifelong process, as far as they are registered.
Chan: Right. One area I just mentioned earlier is about the PHFO, the Private Healthcare Facilities Ordinance. How is that going to help the safety of patients?
Lam: In Hong Kong, we have a dual-track healthcare system. So, all the public hospitals and clinics are under the purview of the Hospital Authority. But for the private sector, we have to ensure the premises where the patients consult their healthcare professionals they have to be set up in a very safe and hygienic way, in terms of hardware and software, for patient safety’s sake. So, this is why the Private Healthcare Facilities Ordinance comes in. And there are four types – one is the private hospitals, then the daycare procedure centers, and the others are clinics and health service establishments. So, on a risk-based approach, we have already licensed the private hospitals, as well as daycare procedure centers. Now, in October, we will start licensing all the private clinics. We estimate that there are around 5,000 in Hong Kong.
Chan: Wow!
Lam: So, starting from Oct 13 this year, until 13th of April next year, we will accept the applications. There are provisions in the ordinance that allow those clinics that have been established before November 2018 they have a transitional arrangement, which means that we provide the transitional license to them to allow them to have renovations or changes to their facilities to comply with the code of practice.
Chan: Right. Director, we have to leave it there for now. And thank you very much for sharing your insights with us.
As Dr Lam has highlighted, the Department of Health is preparing us for the future with stronger regulation and better innovation, so that Hong Kong people can continue to be among the healthiest in the world.
Thank you for joining us on Straight Talk, and have a good evening!
