Professor Chan’s strong research background and rich knowledge in public health serve her well in leading evidence-based strategies for health policies. Chinese medicine, for example, is an area that Professor Chan wants to allocate more resources for its further development in Hong Kong. She explained, “There are two major aspects, namely the positioning of Chinese medicine practice and the development of Chinese medicine. Chinese medicine has been incorporated into the healthcare system in Hong Kong as announced in the Chief Executive’s 2018 Policy Address. In establishing the Chinese medicine hospital, other than the building works, we also need to factor in the sufficient supply of quality manpower. The $500 million Chinese Medicine Development Fund has been launched to provide subsidies for more training and research in the field, which will help develop a bigger talent pool and facilitate more evidence-based practice in Chinese medicine. If Hong Kong is to have a world-class Chinese medicine hospital, strong support from training and research programmes is crucial.”

As with all medicine, proprietary Chinese medicines must also comply with the registration process to ensure their quality, efficacy and safety. As many local manufacturers are small and medium-sized enterprises which, unlike big pharmaceutical companies, have little manpower and resources, the Government will provide resources to facilitate them to comply with relevant regulations and requirements. A well established surveillance mechanism by the Department of Health is also in place to safeguard public health by monitoring Chinese herbal medicines and proprietary Chinese medicines on sale in market. The Government is also actively planning the establishment of a Government Chinese Medicines Testing Institute to specialise in the testing of, and scientific research on Chinese medicines, with a view to further strengthen international collaboration and technology transfer.

Professor Chan (left) met with the Vice Commissioner of the State Administration of Traditional Chinese Medicine, Mr Wang Zhiyong (right) during her visit to Beijing.

Another major initiative on Professor Chan’s plate is to strengthen Hong Kong’s secondary and tertiary medical systems, including improvements to the hardware and software used by the Hospital Authority (HA). Two 10-year Hospital Development Plans, comprising over 30 individual projects, are being funded. The first 10-year plan has been allocated a funding of around $200 billion, and the second one has set aside $270 billion. A number of existing hospitals will be redeveloped and new hospitals will be set up. For example, the Hong Kong Children’s Hospital which is the first children’s hospital in Hong Kong has commenced services in phases since December 2018.

Apart from infrastructure, Professor Chan noted that there has been general manpower shortage in the medical sector. She explained the Government’s key strategies to help address the issue, “We have taken a multi-pronged approach. Firstly, we have established a platform bringing different stakeholders together to collaboratively find solutions to alleviate the shortage of doctors. Secondly, we will adjust the funding mechanism to facilitate HA’s long-term manpower plan. Lastly, in order to attract non-locally trained doctors to Hong Kong, we have amended the legislation to allow them to work on longer contracts. Their limited registration has been extended from one year to three years, making it more attractive for them to work in Hong Kong.”

People aside, Professor Chan is also providing support to medical research on healthcare improvements. For example, the introduction of the Hong Kong Genome Project would allow scientists to study the sequence of around 40,000 to 50,000 genomes of Hong Kong population, which in turn will facilitate more accurate diagnosis and personal management of diseases, such as uncommon disorders and cancers. She added, “HA already launched the pilot of the Big Data Analytics Platform (Platform) in December 2018 to facilitate healthcare-related research. The Platform will be formally launched by end-2019 and can accommodate more projects.”

With the plethora of planned projects and initiatives, Professor Chan recognises the importance of priority setting. One of the important projects which she places great emphasis on is the establishment of District Health Centres (DHCs), “We are effecting a complete paradigm shift in this regard—turning people’s attention from treatment towards disease prevention. Currently, a lot of Accident and Emergency cases and admissions into our hospitals are in fact unwarranted, which give considerable pressure on our medical resources. Therefore, we will be setting up DHCs in each of the 18 districts to work closely with general practitioners in the communities. The DHCs will act as a hub in each district, with other satellite centres being built, to work on the Government’s disease prevention strategies for three main cohorts: i.e. (i) those who want to improve their general health; (ii) those who are at high-risk (for example, the obese or smokers); and (iii) those who need long-term health care services (for example, those who have been discharged from hospitals and need long-term medication or rehabilitation).

Professor Chan (first left) visited Phoenix Clubhouse and its clinic jointly operated by the David Trench Rehabilitation Centre and the Hospital Authority.

The DHCs will employ a range of health care professionals, such as nurses, social workers, pharmacists and dieticians, etc. The first hub was opened on 25 September 2019 in Kwai Tsing. We will proactively take forward the setting up of DHCs in all other districts of Hong Kong.”

Hong Kong’s cancer strategy is a big talking point as statistically it is the region’s topkiller. According to Professor Chan, the first Hong Kong Cancer Strategy was launched in July 2019 which spans the entire healthcare continuum. Prevention and screening, surveillance, treatment and rehabilitation will all be expanded with increased resources.

In terms of prevention, the Government’s action plan focuses on smoking, alcohol consumption, unhealthy diet and lack of physical activity, which are all factors contributing to cancer and other diseases such as diabetes and heart disease. The surveillance strategy involves improving the quality of cancer data collected by the Hong Kong Cancer Registry (HKCaR) and putting in more resources to expand the HKCaR’s role in the surveillance of cancers, looking more widely at survival rates, morbidity, and working more closely with private hospital partners.

Besides, there have been public demands on increasing screening programmes for different types of cancers. Professor Chan explained, “We are looking into the latest scientific evidence to determine the types of screening that can be implemented. For example, we have commissioned The University of Hong Kong to research the most effective ways to identify high-risk cases for breast cancer. After screening, early diagnosis and treatment can be arranged. More resources have been allocated to expanding the HA Drug Formulary to include suitable new drugs and allowing HA to upgrade and acquire medical equipment.”

Professor Chan added, “Rehabilitation and survivorship are extremely important. With advancement in treatment, cancer patients can now live longer, and it is important that we help them maintain their quality of life. We are going to set up a ‘Cancer Network of Partners’– an engagement platform involving community partners to strengthen services and support for cancer patients in the community. We would also expand family medicine and set up more nurse-led clinics so as to enhance the aftercare services to cancer patients. This all fits into our entire continuum of healthcare.”

On the area of environmental hygiene, Professor Chan admitted this as a real challenge. “The government is using technology to improve the efficiency and effectiveness of rodent and mosquito control. We are also trying to enforce, with penalties, the laws related to hygiene and combating shop-front extensions. However, the public needs to be geared up too. If restaurants continue to put their refuse out on the street, no matter what rodent control we put in place, there will still be rats. So we are enhancing public education by running community-wide campaigns to boost awareness of cleaning agents and tools. We are also using radio campaigns to reinforce to the public that it’s important to do things like clearing stagnant water to reduce mosquito breeding places.”

Professor Chan (right) visited Sheung Shui Slaughterhouse, inspecting the disinfection pool for vehicles entering and leaving the slaughterhouse.

Professor Chan acknowledges that currently, not everyone is doing their best, and is looking at enhanced enforcement against those who deliberately contravene the law such as those failing to properly dispose of refuse. The Government is adding closed-circuit televisions in the back alleys to deter such behaviour and help identify and prosecute offenders. Professor Chan noted, “Commercial entities, shops and restaurants are legally obliged to arrange collection of their own refuse. The Food and Environmental Hygiene Department will step up inspections of restaurants. The Department will also closely monitor the illegal refuse deposit black spots and strengthen enforcement actions against cleanliness offences.”

Professor Chan noted, “Recent surveys have shown that over 80% of Hong Kong people consume more salt than the World Health Organization recommends, which is a serious problem. The Government has established the Committee on Reduction of Salt and Sugar in Food (the Committee) to specifically look at measures in reducing the amount of sugar and salt in food. Besides encouraging behavioural changes of individuals, the Committee also focuses on changing mindsets in the food industry as a whole. Restaurants are encouraged to reduce their use of salt and sugar, or at least provide alternative choices to customers. This is an ongoing initiative, including a scheme to improve the labelling of prepackaged food in terms of salt and sugar content. The Food and Health Bureau is also working with condiment production companies, such as those producing traditionally salt-rich products to see whether they can change their formula to use less salt. Beverage companies are also being approached to see if they can achieve lower sugar levels in their product ranges.”

Professor Chan (second left) met with young participants of an international service leadership programme during her visit to the Hong Kong Red Cross Headquarters.

Professor Chan (right) exchanged views with the Chief Executive Officer of the Health Promotion Board of Singapore, Mr Zee Yoong-kang, on strategies to prevent and control non-communicable seases in November 2018.

When asked about how she maintained a healthy lifestyle, Professor Chan identified four modifiable risk factors that we could all take more control of, namely: smoking, drinking alcohol, exercising and eating. She said, “I am a non-smoker and non-drinker. I exercise whenever I find time. For colleagues with busy schedules like myself, I recommend engaging in ‘zero-time exercise’. For example, when you are sitting down, you can lift your legs off the ground to exercise your leg muscles. When you clap, you can clap harder—you can actually burn some energy this way. In terms of eating, I do not eat a lot of fatty or unhealthy foods. I personally enjoy healthy foods most of the time. To be restrained is also important, not just restraint in eating but also restraint in buying. Have the willpower to avoid buying something unhealthy, and if you really cannot resist something, then just buy the smallest packet of it!”

Amidst all her duties, Professor Chan does occasionally find a little time for herself. She said, “I like very simple things: meeting friends and family, shopping, listening to classical music, or thinking by myself.”