Bauhinia Foundation Research Centre P. 0

Transcription

1 Policy Recommendation Highlights 15 September 2010 P. 0

2 Focus on livelihood issues Focus on 3 livelihood issues 1.Development of primary care 2.Columbarium policy 3.Anti-drugs issue P. 1

3 Issue 1: Development of Primary Care Emphases: (1) prevention is better than cure; (2) behavioral change Findings obtained from the territory-wide telephone survey y( (N = 720) : Many Hong Kong people are physically inactive Over 63% of respondents seldom engage g in sports activity on a weekly basis 37.3% (268) respondents did NOT engage in sports activity; 26.6% (192) engage in sports activity once or twice a week 40% of EU citizens play sports at least once a week; 65% get some form of physical exercise at least once a week Doctor shopping behavior Only 24.2% (175) of respondents frequented the same GP or family doctor when in need; 31.8% (229) rarely did so & 15.6% (112) never did so 28.7% (274) regarded proximity of the clinic (close to home/ workplace) as the most important consideration for doctor visit P. 2

4 Behavioural change is imperative Increasing burden of lifestyle diseases ~ In Hong Kong, 2 / 3 of deaths are attributable to chronic diseases e.g. hypertension (HT), heart disease, diabetes (DM) & chronic respiratory problems > 25% of Hong Kong people aged 15 years or above suffered from HT; about 10% of the Hong Kong adult population had DM - Physical inactivity, it tobacco use & unhealthy diets are major causes of chronic non-communicable diseases - WHO: physical activity is the most important modifiable risk factor for chronic diseases Our 12 policy recommendations target 3 areas: 1. Promote evidence-based health screening & health assessment 2. Set up more interactive healthcare service platform (manned by nurses) 3. Promote healthy lifestyle P. 3

5 Policy recommendation: health assessment & health screening (1) Unlike the UK, New Zealand and Australia, Hong Kong has no territorywide health screening or health assessment policy. We therefore recommend: 1. Compiling an age-specific health screening schedule based on medical evidence and professional consensus (e.g. Australia) 2. Drafting a population based screening framework to provide guidance to decision i makers when assessing potential ti screening programs for the population (e.g. there must be evidence showing that the screening does more good than harm) 3. Introducing health screening program(s) targeting specific group(s) of the population and illnesses of high incidence E.g. free / subsidized (a) cervical cancer screening: regular pap smears test for women; (b) test for prostate cancer for men (yet, harms of PSA may outweigh the benefits) P. 4

6 Policy recommendation: health assessment & health screening (2) 4. Providing free/ subsidized health assessment(s) E.g. blood pressure; cholesterol level; eye health; the body mass index & a brief consultation session with a trained nurse Vital statistics collected can also provide an update to the person s electronic Health Record (ehr) 5. Offering incentives for the private and non-governmental sectorsto incorporate health assessment and health screening into their staff medical policies (e.g. annual checkups offered by some Japanese companies) E.g. time-off for health check; coverage by company s insurance policies; government subsidy given via vouchers P. 5

7 Policy recommendation: interactive healthcare service platform o E.g. NHS Direct, the NHS Direct website, Healthdirect Australia, Telehealth Ontario, the Growing Up Healthy Hotline in New York o More first-contact care are being offered round-the-clock, outside of clinics - on electronic platforms; therefore, we recommend: 6T 6. To set up a 24-hour 24h health h advice hotline, step by step (manned by registered nurses) & 7. Building an interactive health website alongside the hotline Provide users with more options for first-contact care Faster referral to appropriate follow-up health and medical services Anonymous nature protects user privacy and individual rights As self-management support to patients, in non-urgent cases Professional health advice given at the comfort of users own home Telecare as an ideal service delivery mode for the aged and the chronically ill P. 6

8 Policy recommendation: nurture a sports culture (1) An effective way to induce health seeking behavior, such as regular engagement in sports, is to build a conducive environment. To this end, we recommend: 8. Promotion of exercise prescription Studies showed written prescription increased physical activity level and improved quality of life of patients for over 12 months Exercise prescription & verbal advice from GPs are effective e ways to drive behavioral change for preventive care (E.g. Australia, the USA, the UK and New Zealand) Further promote the Exercise Prescription Project co-organized by the Department of Health and the Hong Kong Medical Association since M 9. More venues &if infrastrutural t support tf for community sports E.g. increase of community sports and recreational facilities, & public parks Success cases: Holland d(hague Sports Park; cyclist-friendly fi road-network); Taiwan (island-wide cyclist-friendly infrastructure) P. 7

9 Policy recommendation: nurture a sports culture (2) 10. More physical activity in schools Primary and econdary schools may consider extending the time of physical education, and broaden the PE curriculum to include information i on healthy h diet, and the health benefits of physical activity 11. More physical activity at the workplace and amongst the work force Adults spend at least half of their waking hours at the workplace A 3-year study involving 1,600 employees in 16 worksites of the Home Depot, Inc, across the US and Canada, confirmed that workplace fitness programs were highly cost-effective Reduced employers cost for insurance premiums, disability benefits and medical expenses; improved workplace morale, perceived organizational commitment, lowered turnover intentions, absenteeism & work fatigue Government may take the lead to encourage regular exercises at office Incentivizing sports activities amongst the workforce e.g. free public sports club membership & gym subsidy P. 8

10 Policy recommendation: promote healthy lifestyle 12. More health and fitness TV and radio programs The government may consider requiring free-to-air television and radio service providers to devote some of their airtime for health and fitness programs (e.g. phone-in health programs, healthy cooking programs, aerobics, yoga programs), making reliable and comprehensive health advice readily available to members of the public Q&A P. 9

11 Issue 2: Columbarium Policy Surging demand & supply gap A total of 495, 932 niches have been allotted on a permanent basis to 22 non-profit making columbaria (8 managed by FEHD; 14 by religious or ethnic organizations) ~ 300 re-used public niches are available each year for allotment; 13,000 applications on the waiting list (waiting time: 2 years or more) From now till 2012, some 135, 000 newly built niches will be made available Estimated average annual numbers of cremations is 49,200 in the next 20 years (i.e ) (> 93% of the 52,600 total death) Additional supply in the pipeline pp will be insufficient to meet surging g demand in 3 years time (excluding the 12 new sites being proposed in the latest consultation document) P. 10

12 Background Situations worsened by the Not-in-my-backyard (NIMBY) effect Columbarium projects involving > 240,000 niches have been shelved after consultation with residents and District Councils, in the past few years Proliferation of unauthorized private columbaria Consumer rights of those who have purchased/ plan to purchase such niches must be protected The need to introduce a licensing scheme to regulate private columbarium development Long-term cultural changes for handling cremains Need to step up efforts in promoting more sustainable and environmentally friendly ways of handling cremains P. 11

13 Research findings: shared responsibilities Do you support developing columbarium facilities in all the 18 districts of Hong Kong? Percentage by views (%) Strongly support 4.9 Support Oppose Percentage by views (%) Strongly oppose don't know/ not sure Respondents who supported the development of columbarium facilities in all 18 districts i t are only slightly (i.e. 7%) more than those opposing it (49.7% VS 42.7%) P. 12

14 Research findings: district-based priority allocation If priority allocation in local niches can be given to passed-away away local residents, do you support building columbarium facilities in your district? Percentage by views (%) Strongly support Support Oppose Percentage by views (%) Strongly oppose 2.5 don't know/ not sure On the condition that passed-away local residents are given priority allocation to local niches, respondents who supported the development of columbarium facilities in their own district increased by 11.9% (61.6% 6% %); and those opposing it decreased by 14.9% ( 42.7% %) P. 13

15 Research findings: public facilities as compensation If public recreational facilities such as swimming pool and library, can be built in exchange, do you support building columbarium facilities in your district? Percentage by views (%) Strongly support 3.5 Support Oppose Percentage by views (%) Strongly oppose 2.5 don't know/ not sure On the condition that public recreational facilities can be built in exchange, respondents who supported the development of columbarium facilities in their own district increased by 2.5% (52.2% %), and those opposing it decreased by 9.1% (42.7% %) P. 14

16 Research findings: who to decide columbarium location (1) If columbarium facility is to be developed in all 18 districts, after public consultation, which of the followings should be given the right to decide its exact location? Percentage by options (%) Gov't department 37 Legislative Council DC of respective constituency Percentage by options (%) Others 2.4 Don't know/ not sure Many respondents (41.6%) regarded that the respective DC should be given the right to decide the exact columbarium location in their own district after consultation P. 15

17 Research findings: who to decide columbarium location (2) If columbarium facility is to be developed in all 18 districts, after public consultation, which of the followings should be given the right to decide its exact location? Percentage by Age Groups *N = 709 * Significant at 99% C.I. Over half (51.4%) of the year-old respondents & close to half (49.8%) of the year-old respondents regarded that the respective DC should be given the right to decide the exact columbarium location in their own district after consultation P. 16

18 Policy recommendations: increase supply & empower DC 1. Consider building underground, multi-storey columbarium on existing cemeteries to expedite provisions of public/ non-profit making niches Below sight-line Proven technical feasibility (land use, planning, infrastructural support & transport capacity etc.) 2. District columbarium facilities to give priority allocation to passed-away away local residents Equal rights & shared responsibility 3. After feasibility studies by relevant government departments, exact location/ design of new district columbarium is to be decided by the respective District Council through community consultation & engagement To decide whether/ what kind of compensatory public facility is needed P. 17

19 Research findings: means of handling cremains (1) You are in support of which of the following ways to deal with the shortage of columbarium niches in Hong Kong? Percentage by options (%) Gov't to increase supply of 36.1 Cremains at own home 5.8 Cremains at FEHD's GoRs 17 Cremains at sea 22.9 Industrial build'g conversion 14.2 Others (e.g. mainland, tree Don't know/ not sure 2.2 Percentage by options (%) *N = % of the respondents supported the gov t to increase columbarium supply, 22.9% supported scattering of cremains at sea, & 17% supported scattering of cremains in the FEHD-managed Gardens of Remembrance (GoR), as a means to deal with columbarium niche shortage P. 18

20 Research findings: means of handling cremains (2) You are in support of which of the following ways to deal with the shortage of columbarium niches in Hong Kong? Percentage by Age Groups *N = 709 As a means to deal with columbarium shortage, 39.4% of the year-old respondents supported scattering of cremains at sea, while 31.7% of the year-old respondents supported scattering of cremains in GoRs, as a means to deal with columbarium niche shortage P. 19

21 Research findings: means of handling cremains (3) You are in support of which of the following ways to deal with the shortage of columbarium niches in Hong Kong? Percentage by Education Background Industrial build'g conversion Cremains at sea Cremains at FEHD's GoRs Cremains at own home Gov't to increase supply of columbaria Primary or below Secondary Tertiary or above * N = % of respondents who had tertiary education or above supported scattering of cremains at sea, 31.8% with tertiary education or above supported scattering of cremains at GoRs, as a means to deal with columbarium shortage P. 20

22 Policy recommendations: more ways to handle cremains 4. Further promote scattering of cremains at sea by increasing the current provisions by FEHD, NGOs & private enterprises 5. Further promote scattering of cremains in the 8 Garden of Remembrance (GoRs) managed by the FEHG Environmentally friendly Increasing gpublic acceptance Sea burials : 44 app as at 07, but ~ 1, 000 app between 07-10; GoRs: < 30 applications/ year pre-2007; 650 applications in Consider converting industrial buildings into properly designed multi-storey columbarium blocks (e.g. Japan) Convenient location Minimal visual impact P. 21

23 Research findings: regulating private columbaria (1) Do you support the government to regulate private columbaria through a licensing scheme? Strongly support 14.7 No ancestral cremains in Hong Kong Ancestral cremains in public columbaria Ancestral cremains in private columbaria Support Oppose Strongly Support/ Support 83.6% 85.5% 83.5% pp (219) (206) (106) Strongly oppose 1.6 * N = Percentage by views Strongly Oppose/ 16.4% Oppose (43) 16.4% 14.5% 16.5% (43) (35) (21) 79.7% of the respondents either supported or strongly supported the gov t to regulate private columbaria through a licensing scheme. A majority of respondents who had no ancestral cremains in HK, or who had ancestral cremains in public/ private columbaria also supported regulation through licensing (83.6%, 85.5%, 83.5%) P. 22

24 Research findings: regulating private columbaria (2) For existing private columbaria that cannot meet the licensing conditions (to be introduced), how long should they be temporarily exempted? 3 years+ 2-3years 1-2 years No ancestral cremains in Hong Kong yrs+ 8.2% Ancestral cremains in public columbaria Ancestral cremains in private columbaria 8.2% 7.7% 12.7% within 1 year no exemption don't know/ns >2 to <3 17.2% 19% 13.6% >2 to <3 yrs >1 to <2 years 42.2% 36.7% 39.8% * N = % by option Within 1 yr 25.8% 27.6% 22% 35.4% of the respondents regarded a temporary exemption period between 1 to 2 years should be given to pre-existing private columbaria that cannot meet the licensing conditions. 1-to-2- year exemption period is also the most popular choice amongst respondents who had no ancestral cremains in HK, or who had ancestral cremains in public/ private columbaria (42.2%, 36.7%, 39.8%) P. 23

25 Policy recommendations: a licensing scheme 7. FEHD to introduce a licensing scheme to regulate non-fehd operated private columbaria 8. A temporary exemption period of no more than 2 years is to be given to pre-existing existing columbaria, which fail to meet the license requirements Q &A P. 24

26 Emphases Issue 3: Ways to Combat Drugs 1. Using drug tests to combat drugs 2. Prevention, treatment & counseling as priorities, prosecution as a last resort Drug test has often been an indispensable part of most anti-drugs programs / campaigns e.g. USA since 2002; UK since 2004; Singapore Monitoring & deterrence An effective way to deal with the problem of hidden drug abusers Early intervention A tool of law enforcement (enable evidence collection) P. 25

27 Research findings: drug tests in schools Trial Drug Testing Scheme in Tai Po Schools (the Scheme) Launched in December 2009 and has been completed Successfully raised awareness amongst the public esp. the youth Do you know about the Trial Drug Testing Scheme in Tai Po Schools? (N = 710) * The age effect is statistically significant at 99% confidence level Yes No Overall Most respondents aged between 18 and 29 knew about the Scheme (95.7%), while only 71.5% of respondents aged 50 or above knew about it. P. 26

28 Research findings: extending the school drug testing scheme The respondents who knew about the Scheme were asked, Do you support extending the Tai Po Schools Trial Drug Testing Scheme to cover all 18 districts i t in Hong Kong? (N = 608) Percentage by Age Groups Strongly gysupport / support Strongly oppose / oppose Overall (Weighted) Amongst all age groups, respondents aged between 18 and 29 had the highest rate of support (76.9%) for extending the scheme to different parts of Hong Kong P. 27

29 Policy recommendation: school drug tests Recommendation 1. Extending the Trail Drug Tests Scheme in Tai-po to all secondary schools in Hong Kong - Schools to apply the Beat Drugs Fund on a voluntary basis - Government to provide expertise & necessary backup e.g. treatment & rehabilitation provisions - Parents & students consent obtained through an opting out mechanism, instead of the current opting in mechanism - Deterrence, health protection, early identification & early intervention as the main objectives P. 28

30 Research findings: drug driving When asked, Do you support authorizing the police to conduct compulsory drug test, on drivers, given reasonable grounds,? (N= 720) Percentage by Views Don't know / not sure 5.2 Strongly oppose 0.3 Oppose 7.7 Percentage % Support 59.2 Strongly support % of respondents supported authorizing the police to conduct compulsory drug test on drivers, given reasonable grounds (59.2 supported; 27.6 strongly supported) P. 29

31 Policy recommendation: to combat drug driving Recommendation 2. Authorize the police to conduct compulsory drug test on drivers, given reasonable grounds - Presence of more than one policeman, during the collection of body sample, as a safeguard against possible abuse of power by law enforcement agency - Reasonable suspicion must be based on suspect s behavior - Urinalysis or blood tests are more appropriate - Test tfor recent tdrug abuse - Intimate sample are generally of higher evidential value than non-intimate samples (e.g. hair) in court P. 30

32 Research findings: inside entertainment premise When asked, Do you support authorizing the police to conduct compulsory drug test on people inside entertainment premise during police checks, given reasonable grounds? (N=720) 89.1% of respondents supported authorizing the police to conduct compulsory drug test on people inside entertainment premise, given reasonable grounds (68% supported & 21.1% strongly supported) P. 31

33 Policy recommendation: to combat drug abuse inside entertainment premise Recommendation 3. Authorize the police to conduct compulsory drug test during raids/ patrols, given reasonable grounds (such as on people inside entertainment premise) -Applies to people p of all ages (i.e. below and above 18 / 21) - Fairness - Avoid loopholes - Presence of more than one policemen - Reasonable suspicion based on suspect s behavior - Urinalysis or blood test P. 32

34 Policy recommendation: a tiered intervention structure Objectives 1. Welfare protection as the first priority 2. Prosecution as a last resort Recommendation 4. Introduce a tiered intervention structure & set up a central database of person tested positive First-timer: Warning & voluntary treatment / rehab programs (e.g. info & assistance provided by social workers or GPs) Second-timer (at risk group): Mandatory treatment / rehab programs Third-timer & beyond (abusers): Prosecution & the positive drug test results would be admissible evidence in court P. 33

35 More on treatment & counseling support Peer group therapy & family counseling are crucial for drug abuse treatment. While the government has used these elements in its efforts to combat drug abuse, we call for further enhancement of the two Peer group influence as the main reason for drug abuse - in 2009, while 53.2% (7,019) of all reported drug abusers cited peer influence/ to identify with peers as their reason for drug use, the rate amongst below-21 young drug abusers was 67.7% (2, 131) One s own home/ friend s home have become the most popular pp locality of drug abuse - as at the first quarter of 2010, 75.7 % of reported drug abusers took drugs at home/ friend s home P. 34

36 Q &A Thank You! P. 35