//vol.15-1 Overview

Lakshmi Jacota

Health is not simply the absence of disease, but encompasses the gamut of physical, mental and social wellbeing. Hong Kong has one of the highest ranked health indices in the world, but there are challenges, not only as a consequence of an aging population, but because of other factors as well. What are the determinants that we need to consider when we speak about a health gap?

 

We live in what many call the golden age of health care. We are now quite used to hearing about constant advancements is medical technology along with cutting edge research and experimentation that heals and cures, extends life expectancy and reduces infant mortality. It is not unfamiliar to read about common diseases – and new pandemics – that can be vaccinated against. So then, what do we mean when we talk about disparities in health equality and equity, otherwise known as a health gap?

Perhaps the best starting point is to clear up the distinction between health inequality and health inequity. According The Lancet, the former “simply describes a difference between two measurements of the same indicator” [for example, maternal health, mortality or prevalence of diseases], while the World Health Organisation defines health inequity as “a systematic difference in the health status of different population groups.” 2

In other words, these definitions force us to look at the issue of a health gap as one based on advantage and disadvantage; those who have and can access health care and who can afford it, vis-à-vis those who cannot. Inequity clearly suggests that there are social, economic and sometimes even political features that can impact overall health, whether physical, emotional or mental. These factors can include, but are not exclusive to, the availability of safe housing, clean water, healthy food, education and medical care. Health inequity, as many have argued, goes beyond health management exclusively, but which requires changes in government policy to become more holistic in order to balance out potential and avoidable differences in order to overhaul a country’s or city’s health status.

 

Look at the issue of a health gap as one based on advantage and disadvantage

 

In fact, there is a stark reminder that health inequity is not something unique to low income countries, but is very apparent within communities as well, with Hong Kong being no exception. As The Chinese University of Hong Kong (CUHK) Institute of Health Equity (IHE) pointed out, data from as early as the Department of Health’s own Population Health Survey 2014/15 indicated, there has been “a gradient of self-rated health among different groups of household income … [meaning] that households with higher income are more likely to consider their health good or excellent than as poor or fair.” 3

The Institute specifically points out the inequality of particular factors in Hong Kong that have aggravated measures of health inequity. These include: education; one of the lowest minimum wages among many developed countries; a high Gini coefficient which measures income distribution; unaffordable housing; an aging population and, most obviously, the long waiting time for publicly funded out-patient services, leaving “those who are poor and deprived … less likely to have regular sources of primary [health] care, irrespective of the number of chronic diseases or other sociodemographic factors.” 4

While COVID might have exacerbated health inequities, the global pandemic cannot be used as the sole reason for the worsening health gap, both in Hong Kong and around the world. So, given this grim scenario, what can be done to rectify this situation?

In January this year, the World Economic Forum put out a report 5, in which it was argued that for broader outcomes across health and wellness to be obtained, innovations and investment in healthcare must be done in combination by addressing cross industry collaboration and public-private partnerships. This is because health care relies also on the maintenance of healthy lifestyles, while also reducing risk factors that are very often explicitly ‘non-medical’.

As the CUHK IHE clearly states, the government must work with other sectors, “including academia, social care and healthcare, professional bodies, businesses, charities and voluntary organisations, in developing policies across the board to mitigate the social determinants of health inequalities and alleviate the burden of disease on disadvantaged groups.” 6 This is not a new strategy, but one that certainly has to gain more traction if we are to deal with health inequities seriously. Therefore, to advocate for the concerted efforts of a diversified inter-sectoral approach – not only in treatment, but in prevention and control as well – becomes something that a youth organisation like the Federation can readily commit.

 

The global pandemic cannot be used as the sole reason for the worsening health gap

 

One current initiative of the Federation, for example, is the HKFYG Health PLUS (H+). This health and wellness complex, obtained after renovating a kindergarten premises in a rather disadvantaged district in Hong Kong, Sham Shui Po, now serves as a platform to engage young people, as it encourages positive behaviour and empowers them to contribute to primary health care in the community. H+ extends the services to all-rounded health through lifestyle modifications, which include interventions on nutrition, physical activity, stress management, sleep quality, risky behaviour and making social connections. What the creation of Health PLUS has done is establish a new service foundation for the Federation, focusing on Health and Wellness, making a very tangible effort at addressing health inequity through its contribution to creating a healthy society in a deprived community with all-round wellness.

Similarly, global digital investments reached nearly US$57 billion in 2021, particularly in tele-health and mental health, two areas in which the Federation not only has services, but encourages young people to get involved. What tele-health does is alleviate pressure on health care systems by offering on-demand primary health care, allowing a greater access to a greater number of people. This global effort must be both embraced and celebrated.

There are many other ways and initiatives, ongoing and to be launched. What we all know is that not one single person on earth is immune from health issues. But what makes the closing of the health gap a real possibility is when every organisation, civil society, government and business can play to its strengths to generate equitable standards for the overall health of a population Only by prioritising “actions, products, programmes and policies that promotes wellbeing” 7 can the journey of closing the health gap begin.

 

References:

  1. “Bridging the global health gap”, The Lancet, editorial, Vol.4 Issue 9 es579, September 2016. Available at https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30190-5/fulltext
  2. Health inequities and their causes. World Health Organisation, 22 February 2018. Available at https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes
  3. Explainer on Health Equity. CUHK Institute of Health Equity, Available at https://www.ihe.cuhk.edu.hk/explainer-on-health-equity/
  4. ibid
  5. Global Health and Healthcare Strategic Outlook: Shaping the Future of Health and Healthcare. World Economic Forum, January 2023. Available at https://www.weforum.org/reports/global-health-and-healthcare-strategic-outlook-shaping-the-future-of-health-and-healthcare
  6. Build back Fairer: Reducing Socioeconomic Inequalities in Health in Hong Kong. CUHK Institute of Health Equity. Available at https://www.ihe.cuhk.edu.hk/wp-content/uploads/Health-Equity-Report-01-1-1.pdf
  7. Shaping a more equitable world for health and wellbeing. World Economic Forum. Available at https://initiatives.weforum.org/global-health-equity-network/home