Health in Hong Kong: an international urban perspective

Cities, population health and health care systems Hong Kong stands out among wealthy megacities as having some of the best indicators of population health. Infant mortality is 3.0 per 1,000 births in Hong Kong compared to 6.2 in New York City and 4.0 in Paris, while life expectancy at birth is 78.0 years compared to 77.7 years in Tokyo and 76.1 years in Greater London (Table 1). Such indicators are too broad, however, to draw useful inferences about the performance of Hong Kong’s health care system, let alone the effects of Hong Kong, as a city, on its population’s health. It is difficult to disentangle the relative importance of health systems and diverse city characteristics, such as population density, levels of environmental pollution or the nature of the built environment, from the multiple determinants of health, including the sociocultural factors and the neighbourhood context of the population whose health is measured. Health is a bit like the sky. It covers everything – longevity, freedom from disease, quality of life, wellbeing – yet it touches nothing and is therefore hard to grasp. Different measures of population health are influenced by genetic and environmental factors and by what the World Health Organization (WHO) calls ‘the social determinants of health’, which range from income, educational levels, housing conditions and nutrition to social relationships, health promotion and health care services like disease prevention (vaccinations and screening). Campaigns like the WHO’s Healthy Cities highlight the importance of intersectoral strategies to health promotion. Not surprisingly, such strategies involve long lists of recommended interventions without much guidance as to the relative importance of each one. Because of these complexities, the field of urban health is dominated by studies of sub-populations within cities – migrants, ethnic minorities, IV druginjecting populations and those suffering from HIV/ AIDS or drug-resistant tuberculosis. There has been less attention to comparing health care systems among cities, and evaluating the extent to which such systems and city characteristics affect various measures of population health. An alternative approach is to describe a range of health systems among cities that share a host of key characteristics to assess their performance and to speculate about the challenges they share and the extent to which, to quote Paul Valéry, they may ‘enrich themselves with their mutual differences’. Here I focus on Hong Kong’s health system and the public health challenges faced by all megacities, as well as those specific to Hong Kong. In addition, I highlight some lessons from the experience of how three cities – New York, Greater London and Paris – have developed convergent strategies to protect their population’s health and provide their residents with access to health care services. I conclude with some questions for urban planners concerned with cities and health.