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Public Health and Healthcare Ethics


Health: A state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity
Public Health: The science and art of preventing disease, prolonging life and promoting health
through the organized efforts of society, organizations, public and private, communities and individuals.

Uses a range of inter-disciplinary approaches in its analysis of public health problems

Three Domains of Public Health:
1. Health Protection; 2. Health Improvement; 3. Health Services
Disciplines of Public Health:

Epidemiology occurrence and distribution; determinants and application; epidemic



Health administration, policy and management legislative action

Public health biology molecular and genetic bases of cellular processes

Social and behavioral sciences activities and interactions among organisms

Environmental health physical, chemical and biological agents; social economic and
cultural factors

International/Global health health concerns from global perspective

John Snow Father of Epidemiology
Greatest public health achievements in the 20th century:
*Safer and healthier food
Motor vehicle safety seat belt
Healthier mothers and babies
Family planning
Control of infectious disease
*Fluoridation of drinking water
Improvement in education and technology
Recognition of tobacco as a hazard
Leading cause of death in HK: 1) Cancer; 2) Heart disease; 3) Pneumonia; 3) Stroke
Health Indicators:
Mortality Rate (Death Rate)
An estimate of the portion of a population that dies during a specified period
Mortality rate = (No. of deaths during a specified period / No. of persons at risk of dying during the
period) x 10n

Decreasing trend in Infant & Maternal Mortality Rate in HK

Life Expectancy
Average number of years an individual of a given age is expected to live if current mortality rates
continue to apply

Increasing trend for both male and female in HK [Female>Male because male has more
alcohol consumption and smoking behavior]

Preston Curve Increase in National Income per head, increase in life expectancy

Aging population
Health Behavior Indicators:
Smoking Pattern

Decreasing trend in HK

Male > Female

Physical Activity

Physical inactivity in the general public

Four Global Public Health problems:
Climate change and health
Pollution and health
Emerging infectious disease
Non-communicable disease (NCD)

Health Ethics 1 Ethical Approaches and Decision Making Framework

Health Ethics: A set of moral principles that guide us in making medical care to solve conflicts on the
right action
Ethical Theories:
A person ought to act so as to maximize utility to product the greatest balance of good over evil,
everyone considered

Maximize benefits and happiness, reduce sufferings greatest good for the greatest

Evaluate different paths of action and foresees the consequences of each action weigh
the good against the bad, considering the impact of the action on everyone whom it is likely to

One may break the moral rule (e.g. do not kill) if it will produce greater balance of good
over evil

Confronts individuals decision based on what is best for ME

Does NOT allow consideration of special relationship during decision making (e.g. parent
to child)

Does NOT consider each individuals have right

Kantian Deontology
Do unto others, as you would have them do unto you (Treat others the same way as how you would like
others to treat you)
Categorical Imperative: supreme principles of morality which derive duties that determine what is
A. Principle of Universality act only on the maxim through which you can at the same
time will that it should become a universal law (moral low if it can be applied to everyone)
B. Principle of Humanity as an End never as a mean treat humanity with respect and
dignity; do ones duty for its own sake, not in pursuit for further ends
Four classifications of duties: Perfect duties to self/others should be considered before Imperfect
duties to self/others

Conflicts of Duties
Prima Facie Duties: the more stringent duty in conflict-of-duty situation can be regarded as
the actual duty because there are no absolute or unconditional duties

Person required to make a reflective considered decision as which of the

competing duties has the priority
Framework of Moral Norms
Respect for autonomy
Substantive rules
Authority rules
Procedural rules
Paternalism: Role of father in family and interferes with persons liberty of action (e.g. force
Autonomy: Independent self role of states without external interference (e.g. lettering patient die)

Health care professionals respect patients autonomy and are uncomfortable with
Paternalism is justified when:

Patient is incompetent to make decisions

Benefit provided or harm prevented outweighs the loss of independence and any other
benefits the patient seeks in taking the risks in question
Patients Rights: Right of information (understanding of sickness and treatment; chargers and drugs
usage etc.), refusal, confidentiality, complaints and medical reports
Informed Consent:

No medical interventions can be performed on competent adult without their informed

and voluntary consent

Agreement with the physicians recommendations after considering the risk associated
with plan of care

Mutual decision after taking initiative to discuss with patients about 1) nature of
treatment, 2) benefits, risks (Benefit-Risk Ratio) and consequences of intervention, 3)
alternative treatments
Respect patients autonomy; enhance patients well-being; fulfill legal requirements
Engage patient in his own health
Do not understand medical information
Enhance patient-doctor relationship
Might not want to make decision individually
Thorough review on treatment options
Cannot anticipate reactions to future conditions
Reduce discontent and litigation during
Might make decisions that contradict their best
Standards of Competence: Abilities to comprehend and process information and to reason about the
consequences of ones actions
Understand treatment procedures, major risks and benefits, and make a decision in light of this

Grey area exists in rival standards of incompetence
Surrogate Decision Marker: A person who will make crucial clinical decisions on behalf of the patient
when he is very sick or unable to communicate his desire about care

Substituted judgment patients preferences are known

Best interests patients own interests are not know

Advanced Directives: patients exercise his autonomy, while competent, on making decisions about
life-sustaining treatments during periods of incompetence

Living will: indicate substantive directives (e.g. MRI) in specific circumstances

Durable power of attorney: assign another person authority to perform specified actions
on behalf of himself
Protect patient against harmful outcomes
Lack of explicit instructions
Reduce stress for families and health
Restricted to terminally ill case
Prior decision may not be best in current situation
Professional Obligation
Nonmaleficence: not to inflict evil or harm others (e.g. do not kill, cause pain, incapacitate, cause
Beneficence: prevent and remove harm/evil; do or promote good
Nonmaleficence is more stringent than beneficence when there is a conflict of duties

Health Ethics 2 Justice, Privacy and Confidentiality, Fitness to Practice

Distributive Justice: Fair, equitable and appropriate allocation of health care resources

Problems arise when scarcity and competition takes place to obtain goods or avoid
Theories of Justice:
A. Libertarian
Protect rights of property and liberty, allowing persons to improve their circumstances and protect
their own health on their own initiative
B. Communitarian
Emphasize the responsibility of the community to the individual and vice versa; services will be
provided to fulfill community-endorsed social goals
C. Egalitarian
Persons should receive an equal distribution of health care but not require equal sharing of all
possible social benefits fair equality of opportunity
Loss of privacy: Others obtain information about a person that he/she wants to keep inaccessible;
enters zones of secrecy, anonymity, seclusion, or solitude to be observed, touched, or intruded
upon against his/her wishes
Confidentiality: Limits on the dissemination of information disclosed by a person

Respect for persons, build trust, and prevent harmful consequences

Six Data Protection Principles (DPP)

Personal data collected for purpose directly related to a function and

activity of data user

Lawful and fair collection of adequate data

Inform data subjects of the purpose and usage of data

Ensure accuracy of data by taking practicable steps

Delete all data upon fulfillment of purpose

Data shall be used for original stated or directly related purpose unless
prior consent given to subject

Data shall be protected against unauthorized access or processing by

taking all practicable steps

Formulate and provide polices and practices in relation to personal data

Individuals have right to access to and correction of their personal data

Data users should comply with above mentioned request within time limit
Handling of Confidential Information, Records and Property

Protect from improper or inadvertent disclosure, misuse or unauthorized use, loss,

damage or corruption

Obtain prior permission before disclosing any confidential information or records

Under no circumstances shall we use such information or records for personal gains
Exceptions to Confidentiality

Protect Patients
Child abuse
Elder abuse
Domestic violence

Protect Third Parties

Reporting to public officials
Infectious disease
Related to weapons or crimes
Warnings to persons at risk
Violence by psychiatric patients
Fidelity: Obligation to act in good faith to keep vows and promises, fulfill agreements, maintain
relationship, and discharge fiduciary responsibilities

Patient-physician relationship is founded on trust and confidence

Professional Conduct
Integrity and Accountability decisions made in the best interest of the public instead of personal
Fitness to Practice

Criminal conviction, caution, reprimand & penalty notice for disorder

Unprofessional behaviours

Drug or alcohol misuse

Physical health

Mental health

Health Ethics 3 Patient Safety & Quality of Care

Patient Safety: The absence of preventable harm to a patient during the process of health care

Every point in the process of care-giving contains a certain degree of inherent unsafety

Adverse events may result from problems in practice, products, procedures or system

A serious global public health issue

A complex system-wide effect is needed for patient safety improvements, including

performance improvement, environmental safety and risk management
Around 10% patients visiting the hospital come across with medical adverse events
First do no harm Non-maleficence
Health care will never be risk-free, but we can make these risks extremely rare rather than so
disconcertingly common
Every patient receives safe healthcare, every time, everywhere
Hand hygiene is the most essential measure
Teamwork is very important in provision of healthcare
Causes of Healthcare Errors:
Medical complexity
Human factors
*Poor team work
System failures
Training / supervision
Patient Safety and Risk Management Strategies
1. Safe Culture
Product of the individual and group values, attitudes, competencies and patterns of behavior that
determine the commitment to, and the style and proficiency of an organizations health and safety

Just, proactive, reporting and learning culture [Open Culture]

2. Safe Design and Safe Practice
Used in order to help prevent or minimize the chance of error occurring
Five areas of patient care related risks: medication, safe intervention, patients condition, patients care
process, and misidentification
Risk identification & analysis Risk reduction programmes
2D Barcode scanning system
High risk medications
Hand hygience
Know drug allergy
Safe surgery
Drug administration 3 checks
(prescription, drug, patient) 5 rights (time,
drug, dose, route, patient)
Electronic prescription of medicaiton
Rapid delivery system for dispensing
Dilution table for infusion
3. Staff Engagement and Sharing & Learning
Patient safety is everyones business
Continuous Quality Improvement (CQI) on Health Care System
Health services for individuals and populations increase the likelihood of desired health outcomes and

are consistent with current professional knowledge

Unintended patient injuries should be avoided
- Service should be provided to all who could benefit, but not to those
who are not likely to benefit, based on scientific knowledge
- Avoid under use of services as well as overuse.
Avoid waste, including waste of equipment, supplies, ideas, and energy
Reduce waits and sometimes harmful delays for those who receive care
Should not vary in quality because of a patients personal
characteristics such as gender, ethnicity, geographic location, and
socioeconomic status
Providing care that is respectful of and responsive to individual patient
preferences, needs, and values and ensuring that patient values guide
all clinical decisions.
Professionals focus on efficiency and effectively, whereas consumers focus more on satisfaction

5 Principles
Choice & empowerment
Access and support
Involvement in healthcare

Patient-Centred Healthcare
Patient Engagement
Involvement in healthcare policy
Expression of opinions (ask and be asked)
Patients complaints handling
Patients acquiring of information

Global Public Health Problem I: Climate Change and Health

Health Policy: A policy that provides all people with the opportunity to prevent sickness and to lead a
socially and economically productive life
Determinants of Health: Biological; individual lifestyle; social/community network; general social,
economical, environmental, political conditions
Climate Change
Any significant changes in measures of climate that last for an extended period of time

Causes: i) natural factors, ii) natural processes, iii) human activities

4 Dimensions


Sea level

Extreme weather

Increase in temperature level

Vector-borne infections (e.g. Malaria, Dengue
Fever) due to more vectors for transmission by 2080, 2
billion more people will be at risk of Dengue
Malnutrition, hunger and starvation crop yield in
Africa will drop by 50%
Allergies & airway diseases
Heat exhaustion & heat stroke
Less cold- related death
Changes in Rainfall
Vector-borne infections due to breeding of
microorganisms by pockets of trapped rainwater
Malnutrition, hunger and starvation
Environmental refugee
*** Rainfall flooding =/= Seawater flooding [contains salt which
may pollute drinking water]
Rise in Sea Level
*** Due to expansion of sea water surface & ice-cap
melting upon heating
Dehydration & diarrheal cases due to pollution of
drinking water and water used for farming
Mental health, conflicts and war
Environmental refugee
Injuries and death
More Disasters


Environmental refugee
Mental health conflict and war
Human insecurity
Injuries and death
*** Does NOT directly lead to earthquake or tsunami etc.

Health impacts can be classified into: i) Non-communicable, ii) communicable, iii)

environmental/context related
Greenhouse gases (CO, CH4, N2O, fluorinated gases): increases global temperature and climate
Air pollutants (Particulate Matter, O3, NO2, SO2): leads to bad health outcomes
At Risk Population
Everyone is exposed to the impact of climate changes at different levels of risk depending on
exposure to risk factors
Environmental Refugees: People who have been forced to leave their traditional habitat, temporarily
or permanently, because of a marked environmental disruption that jeopardized their existence and
seriously affected their quality of life
Urban heat island: increase in average urban temperature
Quantifying/Measuring Real Health Impacts

Discomfort & mild symptoms [greatest proportion]

Self-care & self-medicate


Hospital admission & clinic usage

Death rate [highest severity]

Displacement Effect: impacts occur a certain period of time later, not immediately

Mitigation Strategy is needed to proactively solve the problems instead of just

addressing them
5 Steps to Public Health Actions
1. Aware
2. Concern
3. Understand
4. Capable
5. Endorsed
Cobenefits: Joint primary benefits resulting from the selection of one instrument aimed at reaching
several targets and should be counted as a benefit in benefit-costs analyses in the policy selection

improve health, ii) protect the environment

Global Public Health Problem II: Air Pollution in Hong Kong

Dry air: 78% nitrogen, 21% oxygen, 0.93% argon, 0.039% carbon dioxide, ~1% water vapour
Air Pollutants: any other particles or gases not part of its normal composition

Ozone (O3), particular matter, carbon monoxide (CO), nitrogen oxides (NO x), sulphur
dioxide (SO2), lead

Causes of air pollution: i) Natural sources (e.g. volcanic eruption, forest fires, dust storm),
ii) Human activities
Coal: one of the dirtiest fuels produces large amount of ash, CO2, SO2, NOx, sulphuric acid and arsenie
Historical events that raised social awareness on air pollution:

Meuse Valley in Belgium (Dec 1930)

Donora Valley in US (Oct 1948)

London Fog in England (Dec 5-9 1952)

High concentration of SO2, High number of death
Factors leading to air pollution in China:

Industrialization urban development, power generation in factories and power plants

using fossil fuels, heavy traffic including gasoline and diesel-powered motor vehicles

Temperature inversion [temperature increases with increasing height] river valleys,

terrain or topography traps pollutants

Warm and sunny climate helps form ozone and air pollutant
Major Air Pollutant




Properties / Effects

Combustion of fossil fuel

containing sulphur

Ships, especially
in container

Highly soluble in water to

form sulphurous acid (H2SO3)




Combination of nitrogen
and oxygen in varying
proportions at high

Motor vehicles
(buses and
trucks in
roadside), power
generation and
gas cooking

Ozone (O3)

Complex reactions
involving sunlight,
hydrocarbon and NO2


[PMx, where
x = diameter
or less in

Combustion of fossil fuel

in motor vehicles

Motor vehicles

H2SO3 is a strong irritant

of respiratory mucosa bronchial

Oxidation of H2SO3 to
H2SO4 further form sulphates SO42-,
found in PM

Nitrogen oxides, rather

insoluble in water, may react with
water to form nitrous acid (HNO2),
which further oxidizes to nitric acid

NO2 used to represent

conc. of all oxides

Irritates mucus
membranes in mouth, nose and throat

Breathing difficulties, lung

damages, worsens asthma

Carbon coated with toxic

chemicals (e.g. polycyclic aromatic
hydrocarbons and toxic metals)

Fine PM: <2.5m;

ultrafine PM: 0.01m 0.1m

PM10 causes increased

respiratory illness, lung damages,
cancer and premature death

PM2.5 can be lodged in the

deepest part of lungs more

HK: 70% of PM10 is made

up of PM2.5

People who suffer most from air pollution:


Individuals with lung diseases (e.g. asthma) and heart disease

Children and adults in outdoors

Health Impacts of Air Pollution
Epidemiological Studies: studies of the health of large groups of people
Toxicological Studies: studies of the effects of air pollutants on cells or laboratory animals

Air pollution leads to deaths, illnesses of cardiovascular and respiratory system, poor
lung function and health problems in infants
Monitoring Air Quality
HK: EPD uses air quality monitoring stations routinely to monitor concentrations of air pollutants (SO 2,
NO2, O3 and PM10) based on Air Quality Objectives [Established in 1987 under Air Pollution Control

Many countries have developed ambient air quality standards for the most harmful air
pollutants (SO2, SO42-, NO2, O3, CO, PM10, PM2.5 and H2S)
Air Quality Standards: Legal limits that identify the (i) maximum concentration level and (ii) time an
air pollutant can be present in air before it begins to cause health problems
Air Quality Guidelines: Produced by WHO in 2005
Inter-disciplinary efforts are required through utilizing expertise in urban planning, technology, policies,
public health, environmental health, and political will and public awareness

Identify local sources and regional sources of problem

Local sources: implement policies in energy and transport to reduce emissions from major sources
Regional sources: implement environmental, economic and energy policies to foster regional
collaboration in air pollution monitoring and setting emission limits
Personal precautions: do not go jogging when air pollution index is high; wearing a facial mark does not
help much; air cleaner may help

Global Public Health Problem III: Emerging Infectious Disease

Transmissible Pathogens:
1. Bacteria
Single-celled organisms without a membrane-bounded nucleus
2. Fungi

Yeast: candida, cryptococcus

Dimorphic: Penicillium, histoplasma, blastomyces, sporothrix, coccidiodes, paracoccidiodes
Mold: Aspergillus, zygomycetes
3. Parasites
Protozoa: diverse group of unicellular eukaryotic organisms

Malaria, enteric amebiasis and intestinal, trypanosomiasis, leishmaniasis, toxoplasmosis,

Worms (Helminths): polyphyletic group of eukaryotic parasites

Tapeworms, flukes, roundworms

4. Virus
A small infectious agent that is cell-free
5. Prions
An infectious agent composed of protein in a misfolded form
Bacteria, Fungi, Parasites, Virus and Prions
(i) Disinfectants, (ii) antibiotics, (iii) antifungals, (iv) antivirals, (v) antiparasitics

Resistance is an inevitable evolutionary consequence of antibiotic use

Antibiotic Resistance:

Lots of germs and a few are drug resistant

Antibiotics kill bacteria causing the illness, as well as good bacteria protecting the body
from infection

Drug-resistant bacteria (possibly mutated) are now allowed to grow and take over
[survival of fittest]

Some bacteria give their drug-resistance to other bacteria, causing more problems
Antibiotics must be used correctly (right drug, dose and time)
Impact of Resistance:
Longer duration of infectiousness, greater cost of treatment, pass on resistance genes to other
vulnerable hosts
Infectious Disease: Exposure Infection Disease
Epidemiologic Triad: (i) Agent (pathogen), (ii) Host, (iii) Environment [possible vector in between]

Maintain cycle of infection

Infectious Disease
Non-Infectious Disease
Strong laboratory basis
Long-term management
Public health Rapid
Vaccination (one time intervention)
Managing multiple risk factors
Control of Infectious Disease
An intergrade response is needed through the collaboration of institutions, people, geographies and
prevention methods
1. Prevention
Primary prevention: intervention implemented before disease or injury
Secondary prevention: intervention implemented after disease began, but before it is symptomatic;
Tertiary prevention: intervention implemented after a disease established to prevent complications
2. Surveillance
Ongoing systematic collection, collation, analysis and interpretation of data, and dissemination of
information to those who need to know in order that action can be taken
Sentinel surveillance: disease specific by key locations and institutions
Passive surveillance: routine reporting
Active surveillance: going out and looking for cases, including asymptomatic and ones not previously
Syndromic surveillance: rapidly identify possible cases during epidemics using broad clinical
3. Detection
Data analysis and verification

Single case may be reportable and 2 cases are sufficient to define an epidemic; deviation
from expected threshold
4. Outbreak Investigation
Establish a case definition Active surveillance Define population at risk Formulate hypothesis for

source and spread

5. Containment

Provide early and effective treatment with quarantine if necessary

Eliminate point sources and vectors

Immunization & chemoprophylaxis, community mobilization for hygiene, health-seeking

and social distancing
Epidemic Curve
A plot of number of cases versus time

Identifying type of exposure and stage of an epidemic

Useful for developing case definition and incubation times for illness
Types of outbreaks: (i) Point source, (ii) Continuous common source (iii) Propagated person to person
Case Control Study
A group with disease compared to a group without disease

Identify important exposures demographic features and risk factors

Norovirus: a winter vomiting bug causing gastroenteritis outbreaks in closed settings
Emergency response plans should be in place before outbreak of epidemics

Global Public Health Problem IV: Non-Communicable Diseases

Rising Threat of Non-Communicable Disease
Non-Communicable Diseases (NCD): an illness that is caused by something other than a pathogen

Rarely cured completely; may have fluctuations in disease course; may need add-on
therapy with time; lifestyle factors usually play a major role

High prevalence: many leading causes of death in the world are NCDs [2/3 deaths]

7 our of 10 leading causes of death in HK are NCDs

Clustering effects: presence of one disease associated with another

Four main NCDs: (i) cardiovascular disease, (ii) cancers, (iii) diabetes, (iv) chronic lung diseases
High-income people: most died of NCDs; Low-income people: mostly died of infectious disease
Bowel cancer is catching up lung cancer in HK
Depression and Generalized anxiety disorder, Obsessive-compulsive disorder, Panic disorder,
Posttraumatic stress disorder, Social anxiety disorder, Social phobia are closely linked
Metabolic syndrome: diabetes, hypertension, obesity, gout, lipid disorder
Impact of NCDs to our Society
1. Clustering effect: presence of one disease closely related to another
2. Individual impact: physical, psychological, social and spiritual disease complications
3. Society impact: decrease in productivity, job absenteeism & turnover
4. Huge public health burden: health service utilization, health care expenditure, side
effects of drugs, advanced technological equipment and expertise sometimes required
Association between Lifestyles and NCDs

Physical inactivity, harmful use of alcohol, tobacco use, unhealthy diet lead to NCD

NCD could lead to premature deaths, mortality, morbidity and disabilities

Reduction of NCDs and controversies
Adequate amount of moderate-intensity aerobic physical activity:
%HRmax Method: (220-Age) x 64-76%
%HRR Method: (HRmax Resting heart rate) x 64-76% + RHR
Reduced smoking/e-cigarettes(vaporized nicotine)
Benefits: help smokers quit, slowly dialing down nicotine levels, no evidence,
compete with regular cigarettes
Harm: nicotine cause CVDs, birth defects, vapor contains toxicants and heavy
Decrease alcohol consumption
Consume 5 or more servings of fruits and vegetables per day
Body vibration for fat-burning
drinking low calorie soft drink -- artificial sweeteners
people rely on this are more likely to gain weight, increase appetite and calorie
surgery for obesity -- reduce size of stomach, removal of stomach portion, gastric
Benefits: recovery from diabetes, improve CV risk factors, long term weight loss
Harm: complications, gastric dumping syndrome, infections, leaking and
Challenges Forward

Aging population

Westernization and urbanization - westernization of Asian Eating Practice, increased
inflammatory bowel disease

Stress and sedentary lifestyle


people at higher risk of chronic disease are less likely to undergo health check
Strategies to control NCDs
Upstream Parable: repair the bridge before it actually falls down prevention more important than
Prevent altogether the development
- Health education (smoking
of a disease process by reducing the
cessation campaign)
risk factors
- Prophylaxis (vaccination &
- Sanitation
Early diagnosis of disease at a pre- Screening (population-based
symptomatic stage followed by
cervical cancer screening
prompt and effective treatment
- Periodic assessment of BMI
Minimize harmful effects after
More meticulous monitoring of
detecting disease
hypertension to reduce the risk of endorgan damage

Telomere: non-gene DNA at the ends of DNA strands in chromosomes, which are shortened during
DNA replication, cell division and DNA damage

Entire loss in telomere would cause the cell to stop replicating or cell death

Length determined by: level of telomerase, age and DNA damage

Adequate telomere length is vital to maintaining cells including immune system cells
Longer telomere length associated with increased resistance to disease and premature death in
prostate, breast, lung and colorectal cancers
Telomerase: an enzyme which restores telomere

Cancer cells have high level of telomerase immortal cell

Comprehensive positive lifestyle changes increase cellular telomerase activity, which reduces
oxidative stress and inflammation
Free radicals: highly reactive molecules with unpaired electrons which seek out and destroy healthy
cells and DNA

Causes oxidative stress that leads to aging

Antioxidant Enzymes: stabilizes free radicals and prevent damage to cells and tissues

Superoxide dismutase (SOD): converts free radicals to H2O2

Catalase: remove H2O2

Glutathione peroxidase: remove H2O2

Nrf2: A protein messenger that activates antioxidant enzymes & down-regulates genes that promote

History of Modern Medicine

Period One: 1821-1941
Spanish Flu
Period Two: 1945-1960
Asian flu
Immunization for Tuberculosis, Poliomyelitis
Period Three: 1960-1997
Influenza: HK flu
Viral Hepatitis B
Period Four: 1997-Present
Avian Influenza (H5N1)


Hospital Authority (HA) established in 1990 to facilitate management and distribution of hospital
Hong Kong Academy of Medicine (HKAM) established in 1993 to foster development of
postgraduate professional training and set standards

Most popular constituent colleges in HK commercial sector: Radiology, Ophthalmology,

Anesthesiology, Dermatology
Family Medicine provides continuing, comprehensive and holistic care for individuals
New challenges of modern era: (i) ageing population, (ii) degenerative diseases, (iii) ethical &
philosophical dilemmas