theme 1 understanding of public health

1Public Health

DiseaseThe body or part of the body cannot function normally and affects one’s living. The common cold, influenza, the fatal heart disease and cancer, or psychological problems such as eating disorders and depression are all diseases.

EpidemicThe outbreak of an infectious disease with many people infected during the same period of time. The Black Death, which spread through Europe in the 14th century, is an example.

World Health OrganizationIn 1948, the United Nations set up the World Health Organization (WHO). Its responsibility is to guide and coordinate the health-related work of its member states so that all humans in the world can enjoy the highest standard of health.

EpidemiologyIt refers to the study of factors affecting disease distribution trends and the health status of populations to prevent and control diseases.

Family healthIt refers to the health and disease prevention of newborn babies and young children up to 5 years old and women at or below 64 years of age. Family health services are provided by the Department of Health in Hong Kong.

Community healthIt refers to the study and improvement of people’s overall health in a community.

Food safetyIt refers to the study of food processing, production and storage in order to prevent people from getting sick from consuming food with food-borne diseases.

1 The influences of outbreaks of epidemic diseases and public responses

Theme 1 Understanding of Public Health

To be used with Theme 1 of Public Health (Book 1)

Topic 1: The influences of outbreaks of epidemic diseases and public responses (pp.5 – 25)

2 Handbook for Teaching LS Module

(A) Black Death (also known as plague)

Causative agent Yersinia pestis

Mode of transmission

A bite from germ-carrying fleas from infected animals (such as rats) will transmit the disease to humans. In the case of lung-infected patients, the droplets they expel contain germs and people who inhale them will be infected. Therefore, plague is a highly infectious disease.

Symptoms Symptoms include fever, headache and topical swelling and pain of the lymph glands. The spread of germs to the lungs will cause pneumonia (pneumonic plague). Patients of pneumonic plague will have high fever, chills, bloody sputum and shortness of breath. The patient may die very soon if early treatment is not given.

Treatment The patient must be isolated and given the appropriate antibiotic treatment.

Largest outbreak in human history

In 1347, a large-scale outbreak occurred in Europe and killed 25 million people.

Outbreak in the history of Hong Kong

In 1894, plague broke out in Sheung Wan of Hong Kong Island; the number of people dead reached several thousand. Between 1894 and 1929, more than 20,000 people died of plague in Hong Kong.

Current status Plague is no longer a major threat to human health, but the World Health Organization still receives reports of about 3,000 cases from different places worldwide every year. In Hong Kong, no case of plague was recorded since 1929.

(B) Acquired immunodeficiency syndrome (AIDS)

Causative agent Human immunodeficiency virus (HIV) or AIDS virus.


AIDS viruses are mainly transmitted in the following modes:

• Sexualintercoursewiththeinfectedperson;

• Sharingneedlesandsyringeswiththeinfectedperson;

• Transfusionofcontaminatedbloodorbloodproducts;

• Transmission from infectedmother tobaby throughpregnancy, delivery or breastfeeding.

Topic 1: The influences of

outbreaks of epidemic

d i s e a s e s a n d p u b l i c

responses, Theme 1 of

Public Health (Book 1)

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Extended Information 1







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3Public Health

Symptoms AIDS patients generally lose immunity to common pathogens. They will suffer from a series of serious infections, with tumors in all parts of the body until they finally die. An infected person may show no symptoms months or even years after being infected; such a case is known as ‘HIV infection’. The affected person looks no different from an ordinary person, but he/she can transmit the virus to the other. One half of the infected person has an onset within ten years and become AIDS patient.

Treatment There is currently no treatment to cure this disease, but drugs are available to control the amount of viruses in the body. The earlier the appropriate medication is given, the higher the chance of successfully controlling the disease. In addition, medication can also prevent and cure the complications.


It is estimated that AIDS infection cases have increased from 10 million in 1993 to about 40 million globally in 2005. Of them, some 8 million infected people are found in Asia. 5 million new infection cases and 3 million deaths were recorded in 2005 alone. As of now, a total of about 25 million people have died of AIDS.


As of September 2008, a total of 3,941 HIV infection cases were recorded in Hong Kong, with 998 AIDS cases.

Current status HIV infection has become the one of the most disastrous epidemics in the world since 1981 when AIDS was confirmed as a newly discovered disease.

(C) Severe acute respiratory syndrome (SARS)

Causative agent Coronavirus


SARS is mainly transmitted through close person-to-person contact, especially when the patient coughs or sneezes to expel respiratory droplets which may deposit on the mucous membranes of the mouth, nose or eyes of nearby people. A person may be infected if he touches the surface of contaminated objects and then touches his mouth, nose or eyes.

Symptoms SARS is featured with influenza-like initial symptoms. Generally, the patient starts with a fever, and may also have chills, rigors, headache, fatigue or muscle ache, and even diarrhea in some cases. About 10% of the patients may rapidly progress to respiratory failure.

Source 1 The red ribbon is an international symbol which reminds people of the importance to fight against AIDS and show concern for HIV infected people

W h a t p r e c a u t i o n a r y

measures against SARS

did you take in 2003?

What are your feelings

and thoughts about the

SARS outbreak?

Let’s Think






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Source 2 During the SARS ou tb reak i n Hong Kong in 2003, students had to take check temperature before going to school to ensure no symptom of fever

Treatment Scientists are endeavoring to identify an effective treatment regimen. At the current stage, medical staff can take virus samples from the patient’s body to determine what therapy, and what kind and what dosage of medicine are needed.There is no vaccine currently available to prevent SARS.


On 12 March 2003, the World Health Organization issued a global alert against the new infectious disease of Severe Acute Respiratory Syndrome. The SARS spread through the world rapidly, with 8,439 cases and 809 deaths recorded in 25 countries.


During the outbreak of SARS in Hong Kong in 2003, a total of 1,755 persons were infected, of whom 299 died.

Current status No infection has been recorded since the SARS outbreak in 2003.

(D) Influenza (flu)

Causative agent Influenza viruses. There are 3 known types of them, namely A, B and C.


Influenza is mainly transmitted in crowded enclosed environments through the air or droplets. It can also be transmitted through direct contact with the infected person’s secretions.

Symptoms Symptoms include fever, headache, muscle ache, runny nose, cough and sore throat. Generally, it is not a serious disease, but people with relatively poor immunity (such as the elderly, young children and chronic patients) are susceptible to complications.

Treatment Most patients recover on their own without treatment. In serious cases of Influenza A, the antiviral drug Tamiflu can be prescribed.


In 1918, the mutated H1N1 influenza spread through the world within a year, causing the death of about 50 million people. The disease is known as the Spanish Flu. Moreover, the Influenza A (H1N1) broken out in 2009 has also become a pandemic.


In 1968, an epidemic of influenza broke out in Hong Kong, 15% of the population at the time was infected, of whom as many as 33,800 died. The Influenza A (H1N1) broken out in 2009 has also infected many people. There were even death cases.






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Teachers can ask students

to discuss whether the

Hong Kong government’s

i n f l u e n z a v a c c i n a t i o n

s c h e m e i s w o r t h

supporting.

Teaching Suggestion

5Public Health

Current status At present, scientists follow influenza mutation on an annual basis and manufacture the vaccines for its prevention. But because the influenza mutates at a very fast rate, vaccine injection into the human body only gives immunity for one year, another new vaccine injection is needed for afterward.

Source 3 A poster about the prevention of Influenza A (H1N1) from the Centre for Health Protection

(1) Comparisons between Influenza A (H1N1) and SARS

Influenza A (H1N1) SARS Comparison


Similar to general influenza, it is transmitted through air, droplets or objects.

Dispersed into the air when patients cough or sneeze.

Similar modes of transmission.

Mortality rate According to the data of WHO in May 2009, mortality rate for Influenza A (H1N1) is 0.4%.

According to the data of WHO in 2004, mortality rate for SARS is 9.6%.

The mortality rate for SARS is higher.

Incubation period

Within 7 days. Generally within 7 days. But can be as long as 10 days.

The incubation periods of the two diseases are similar.

Symptoms Fever, headache, muscle ache, running nose, cough and sore throat.

Similar to general influenza, but patients may develop symptoms of lower respiratory tract infection. The early and major symptom of SARS is fever.

SARS patients would develop the symptom of fever in an early stage.

Speed of transmission

A patient can transmit the disease to another person within 2 days.

A patient would transmit the disease to another person within 10 days on average.

The speed of transmission for Influenza A (H1N1) is 5 times quicker than that for SARS.


(E) Avian influenza

Causative agent H5N1 avian influenza virus


It is transmitted through close contact with poultry, and the chance of transmission between humans is very small.

Symptoms Avian flu H5N1 has symptoms like common influenza, but it is more likely to cause high fever, pneumonia, respiratory failure and multi-organ failure; it may even cause death.

Treatment The H5N1 avian influenza virus is more severe than the common influenza. Most patients need hospital care. Some anti-viral drugs (such as Tamiflu) may be effective in treating the condition.


H5N1 is known previously to infect birds only (such as chickens and ducks). The first human infection was documented in 1997 with 18 infected, of whom 6 died from the disease.


The world’s first human infection of Avian flu H5N1 was found in 1997 in Hong Kong, where the chickens were also found to be infected by the same type of virus. In 2003, three more cases were found in Hong Kong.

Current status The 1997 avian inf luenza case proved that direct transmission of H5N1 virus from birds to humans is possible. Not only does avian flu H5N1 cause severe complications, it also has a very high mortality rate.Scientists consider that a major outbreak of avian flu is likely. To prevent this, the Hong Kong government has implemented a series of poultry control measures, such as vaccination for local and imported live chickens, and made ‘no live chicken overnight’ a rule for live chicken vendors.

(F) Other severe infectious diseases• Cholera ( 霍亂 ): Since the 19th century, several cholera pandemics

have broken out in the world, killing several millions and causing grave economic losses. Outbreaks of cholera have occurred from time to time and even in the 21st century. For example, a cholera epidemic broke out in Zimbabwe in Africa in late 2008; it was estimated that 16,000 people were infected, of whom 800 died.

• Malaria(瘧疾 ): About 40% of the world’s population is threatened by malaria with most of them living in poor countries. Each year, over 500 million people are infected with the disease and more than 1 million people have died from it.

• Tuberculosis( 結核病 ): Despite the substantial fall in human infection since the availability of vaccines and drugs for its treatment, tuberculosis is still an infectious disease that can not be taken lightly. In 2005, tuberculosis caused 1.6 million deaths globally. In the past 20 years, 6,000 to 7,000 cases were documented in Hong Kong every year.

To prevent the outbreak

of avian influenza, the

government forbids the

sale of l ive poultry on

discovery of birds infected

with the H5N1 virus. Has it

become your habit to eat

frozen chickens instead

of f reshly s laughtered

o n e s ? W h a t d o y o u

think about the ways in

which the government’s

measures have affected

the livelihood of the live

poultry suppliers?

Let’s Think



w h a t o t h e r i n f e c t i o u s

diseases they know other

than the severe ones such

as B lack Dea th , av ian

influenza and AIDS.

Teaching Suggestion






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7Public Health

(A) How does globalization affect the spread of infectious diseases?Basically, globalization affects the spread of infectious diseases in 4

aspects: the economy, environment, population distribution and technology.

The economy:

Economic globalization refers to more frequent inter-country economic activities and inter-reliance between different economies. Instead of having the process of production in one region and exporting the products to another region for sale as in the past, various tasks are now carried out in different regions with the products exported to different places worldwide. For example, food production became industrialized and increased in scale to meet people’s huge demand for food. However, in case of food contamination during the process of production, not only are the residents in place of production likely to be affected by infectious disease, all regions where that food is sold are affected also.

The environment:

At present, humans are facing various environmental problems, which aggravate the impact of infectious diseases on human beings in two aspects. For example, global warming brings natural disasters, such as typhoons, floods and droughts more frequently to countries worldwide. Natural disasters increase the likelihood of major outbreaks of infectious diseases. Global warming has also changed the ecological system. Global warming causes organisms which can transmit diseases, such as mosquitoes, to reproduce more rapidly and thus also speed up the spread of infectious diseases.

Population distribution:

Increasingly frequent economic activities give rise to large-scale population movement as people travel around the country for work. Infectious diseases are likely to spread when throngs of people are gathered together. Forexample,China’srailwaysystemgetsverybusywiththerailwaystationsvery crowded when tens of thousands of peasant-workers travel by railway to return to their villages from the cities where they work for the Spring Festival each year (the so-called ‘spring transport crunch’). During this period, the prevention of infectious disease is one of the railway department’s most important issues of concern.

Technology:

One of the features of globalization is the substantial increase in human mobility as a result of technological advancement. We can travel across borders and reach the other end of the earth within hours. If an infected person sets off for another region before onset, the infectious disease will be spread to other regions from the source. The source of Hong Kong’s SARS epidemic in 2003 was a local hotel. A guest infected at the hotel flew





Publ ic Heal th (Book 1 )

Globalization

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Source 4 Mosquitoes can spread dengue, malaria, yellow fever, Japanese Encephalitis and other infectious diseases


elsewhereandspreadtheinfectiousdiseasetoVietnam,Singapore,Canada,Germany, the US, Ireland and other places.

The globalization of certain technologies, however, helps prevent infectious diseases from spreading. For example the popularity of the Internet enables people worldwide to have access to information about infectious diseases, which makes prevention more effective.

(B) Globalization and the World Health OrganizationWith increasingly frequent interaction between countries in various

aspects, public health is no longer a domestic issue, but a matter that may affect other places in the world anytime. For this reason, the United Nations set up the World Health Organization (WHO) in 1948. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating policy options, providing technical support to countries, and monitoring and assessing health trends. At present,theWHOhas193memberstates,includingthemainlandChinaandHong Kong.

InMayeveryyear,healthpolicyofficialsofWHOmemberstateswillattend the World Health Assembly held in Geneva of Switzerland to discuss global public health policies. In addition, the WHO has been issuing the World Health Report on an annual basis since 1995. It summarize the public health status during the previous year, releases health data of various countries and discusses selected topics. For example, the topic of the World Health Report 2007 is A safer future: global public health security in the 21st century. The setting up and operation of the WHO is one of the examples of the manifestation of globalization.

One of the important tasks of the WHO since its establishment is disease prevention. In 1967, the WHO introduced a global smallpox vaccination programme and succeeded in eradicating this highly infectious and fatal disease. The eradication of smallpox is the most successful of the WHO’s disease prevention work so far. To further control epidemics effectively, the WHO revised the International Health Regulations in June 2007. Greater transparency is required of the member states. They shall make early reports on epidemics to the WHO, so a virtual network of experts can be formed within 12 to 24 hours for assessment of the clinical, laboratory and epidemiology data collected by frontline staff before the occurrence of an outbreak. The WHO’s work is not restricted by national boundaries, and its authority is increasingly influential to all countries.

• Apart fromdiseaseprevention, theWHOisshowingconcern foranincreasingly wide range of public health topics. The followings are some of its work objectives listed in 2000:

• Tolowerchildmortalityrate• Toimprovepregnantwomen’shealth• TofightagainstAIDS,malariaandotherdiseases• Tosupplydevelopingcountrieswithbasicdrugsaffordabletotheirpeople• Toeradicateextremepovertyandhunger• Topromotegenderequality






Globalization

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Source 5 WHO’s incumbent Director-General, Dr. Margaret Chan, is the former director of Hong Kong’s Department of Health

9Public Health

Immune systemIt is one of the systems in an organism’s body. The cells and tissues of the body can form a special protective response mechanism to defend the body against pathogens (such as viruses, germs, fungi and parasites) and infection.

ObesityBodyMass Index(BMI) isameasureofbodyfat.ThecalculationmethodofBMIisasfollows:

BMI=Weight (kg)

Height2 (m2 )

Apersonisoverweightifhis/herBMIisabove25.

Ideal weight BMI = 22 (Female)BMI = 24 (Male)

Normal weight BMI between 18.5 and 24.9

Overweight BMI between 25 and 29.9

Overweight BMI between 25 and 29.9

Obese BMI between 30 and 39.9

Morbidly obese BMI is 40 and above

Mental healthMental health is also known as ‘mental hygiene’. TheWorldHealthOrganization defines mental health as: ‘not merely the absence of disease, but a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.

However, psychologists consider that apart from the absence of mental illness, a person is mentally healthy only if he/she can adapt to the environment, and is able to stay happy, be optimistic and understanding.

2 Factors affecting people’s understanding of diseases and public health

To be used with Theme 1 of ‘Public Health (Book 1)

Topic 2: Factors affecting people’s understanding of diseases and public health (pp.26 – 68)


(A) Scientific inquiry

(1) Scientific methodScientists inquire into all kinds of phenomena with scientific

methods. The steps of the scientific method are generally as follows:

(a) Design a question for interesting phenomenon observed, such as ‘What is the source of infectious disease?’

(b) Data collection. For example, reading previous study records and observing patients with infectious diseases.

(c) Form a hypothesis based on the data collected, such as ‘micro-organisms are the source of infectious disease.’

(d) Design, perform, and gather the findings of experiments.

(e) Analyze the findings of experiments.

(f) Induce the findings and draw a conclusion. In case of inconsistency between the conclusion and the hypothesis, reexamine to see if the hypothesis was based on reasonable deduction, if the experiment was designed wrong, or if errors were involved in its performance, before making a fresh inquiry. If the conclusion agrees with the hypothesis, then the hypothesis can be developed into a theory. It is only with a theory that the occurrence of the phenomenon can be predicted.

With scientific and technological developments, theories established in the past might be made obsolete by more updated and accurate evidence. Basically, scientific knowledge is generally established by the constant and repetitive inquiries of scientists.

(2) Significance of experimentsExperimentation is a very important component of scientific

inquiry. It is because an unbiased design, accurate steps and reliable results of the experiment determine the successful establishment of a hypothesis and the development of a theory. Otherwise, the conclusion drawn would be doubted and the theory could not be established.

Topic 2: Factors affecting

people’s understanding

of diseases and public

health, Theme 1 of Public Health (Book 1)

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11Public Health

(B) Background of germ theoryBefore Louis Pasteur introduced the germ theory, the scientific

community used to expalin the source of diseases with two views. The first view was ‘spontaneous generation’. According to it, organisms have their origin of life spontaneously from inanimate or non-living matter, and it is an everyday occurrence. The second view was the ‘miasma theory’. It originated intheMiddleAgeswhenpeoplebelievedthatinfectiousdiseasewascausedby bad air, which was blamed as the cause of cholera and the Black Death.

In 1668, Italian scientist Francesco Redi put chunks of meat in jars for an experiment. According to his discovery, maggots would form from the meat in the uncovered jars but not so for the covered jars. He considered that maggots formed from the meat in uncovered jar because the flies flew inside and spawned on the meat. His experiment supplanted the theory of ‘spontaneous generation’.

In 1854, a cholera epidemic broke out in London, England. Failing to explain the spread of cholera with the ‘miasma theory’, scientist John Snow traced the source of cholera and discovered that water contamination was the real cause of the outbreak. The ‘miasma theory’ of disease was therefore supplanted.

Between 1860 and 1864, French scientist Louis Pasteur experimented extensively and proved that diseases were caused by micro-organisms. The ‘germ theory’ was established and it laid the foundation for modern medical science and microbiology.

(C) Immune systemPathogens cause disease only if they enter into the human body. Basically,

the human immune system protects the body against the invading pathogens with two mechanisms. They are ‘innate immunity’ and ‘acquired immunity’.

(1) Innate immunity (Non-specific defense mechanism)Innate immunity fights against any pathogens within the body. It

mainly protects the body against invading pathogens in the following 4 ways:

(a) The skin and respiratory membranes are the first barrier to

prevent entrys of pathogens into the body.

(b) In the case of broken skin, the platelets will form blood clots

on the wound to prevent pathogens from entering the body

through it.

(c) Certain secretionsof thehumanbodycankill pathogens,

such as hydrochloric acid in the gastric juices, which is strong

enough to kill most of the pathogens in food.

(d) If the three methods mentioned above fail to stop the pathogens

from entering the body, the ‘phagocyte’, a kind of white blood

cell in the body, will consume and destroy the pathogens.






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Source 6 The process of phagocyteʼs destruction of pathogen

(2) Acquired immunity (Specific defense mechanism)Acquired immunity fights against specific pathogens within the

body. It protects the body in the following way:

‘Lymphocyte’ is a kind of white blood cell in the human body. On contact with the pathogen, it produces a kind of substance, which is known as the antibody, to fight against it. Because each kind of pathogen is featured with unique surface structure, the antibody produced by the lymphocyte can only fight against one specific kind of pathogen.

The defense mechanism of acquired immunity is shown as follows:

Antibody is produced upon the lymphocyte’s contact with pathogen.

The antibodies will not kill the pathogens, but they can:

or orNeutralize the pathogen’s toxins. This minimizes the damage to the body.

Fuse the pathogens together. This prevents the pathogens from entering the cells and make it easier for the phagocytes to destroy them.

Bind to the pathogen. This makes it easier for the phagocyte to consume it.

13Public Health

(D) Characteristics of the antibodyLymphocytes have memory. Besides producing antibody when stimulated

by the pathogen, lymphocytes will ‘remember’ that particular pathogen too. In case of an invasion by the same kind of pathogen again, the lymphocyte will produce antibody against it within an even shorter period of time. In this way, the pathogen will be destroyed before causing the disease.

Source 7 Relationship between antibody concentration in blood and the different times of pathogen invasion into the body

(E) Non-infectious diseaseIn the past, infectious disease was the greatest threat to human health.

With constant advancement in medical science, we now know relatively more about infectious disease and have developed different methods for its prevention and treatment. However, non-infectious disease will be the challenge to humans in public health at the turn of the 21st century. According to the World Health Organization, of the world’s 58 million mortalities in 2005, about 35 million died of non-infectious diseases. This was mainly due to changes in human’s lifestyle, such as unhealthy diet, lack of exercise, excessive drinking and smoking, etc; coupled with environmental pollution.

Mortality and causes of death in Hong Kong 2006/2007

Cause of death 2006 2007

1. Malignant tumour 12,093 12,630

2. Heart disease 5,619 6,100

3. Pneumonia 4,201 3,477

4. Cerebrovascular diseases 3,302 2,059

Source 8 Three of the four main causes of death in Hong Kong are non-infectious diseases, namely malignant tumour (cancer), heart disease and cerebrovascular diseases

(Source: Hong Kong Yearbook 2007, Information Services Department)





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(F) The principle of vaccineScientists have developed various kinds of vaccine to fight against

various fatal diseases. A vaccine contains modified pathogens (killed or attenuated versions) which will do no harm to the human body despite having similar surface structures to the lethal genuine ones. The lymphocytes of our body produce antibodies on contact with these modified pathogens and ‘remember’ them. In case of future invasion by the lethal genuine pathogens, antibodies can be rapidly produced to destroy them so that we will not be sick.

(G) Considerations in vaccine developmentBecause a lot of money and time is needed for vaccine development, the

medical community generally decides on the priority according to the severity of diseases. Pharmaceutical companies are the major vaccine developers. When deciding on the development of a certain vaccine, another factor they would consider is whether its production brings profits. For example, although malaria is a very lethal disease, no pharmaceutical company is willing to develop any vaccine for it because they consider that the profit from its sale would not be large enough to cover the cost of development.

(H) Significant scientific inventions which promoted medical advancement

(1) MicroscopeThe first microscope was invented in 1590. Since its invention,

the microscope has enabled people to study the microscopic world. As advancement in microscope technology improved, the magnifying power of microscopes continued to increase. Not only did it enable people to discover that an organism is a combination of cells, it also allowed people to discover all kinds of micro-organisms not visible to the naked eye, such as germs, fungi and parasites. These discoveries were highly contributive to biology and medical science. Today, the electronic microscope enables us to see the structure inside a cell, which is very important to pathological study in molecular physics and drug development.

(2) Magnetic Resonance ImagingMagneticResonanceImaging(MRI, 磁力共振素描 ) is a

technology which visualizes the tissues in the human body. When exposed to the strong magnetic field, water particles in the water-loadedhumancellswill react.TheMRIcandetect thesereactionsand turn them into images.The images formedby theMRIareuseful to the diagnosis of a tumour, tissue sclerosis, tissue infection and the early stage of a stroke.





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to think about whether the

malaria vaccine case is an

issue of ‘medical ethnics’ born from new technology.

Let’s Think

15Public Health

(I) Drug-resistant diseaseAnt ib io t ics can k i l l germs

effectively, but abusive prescriptions or patients’ failure to complete the whole course of antibiotic treatment as prescribed is likely to give rise to multiplication of the tougher germs. The antibiotics will gradually lose their effectiveness as a result. The diseases caused by these tough germs are known as ‘drug-resistant diseases’.

(J) Organ transplant in Hong KongIn Hong Kong, several thousand patients are waiting for an organ

transplant each year, but donated organs are in relatively limited supply. For example, more than 1,000 patients are waiting for a renal transplant but less than 100 kidneys are available each year.

(1) Source of organs:In Hong Kong, the organs mainly come from prospective

donors who voluntarily register their wish to donate their organs after death for removal and transplant by medical personnel.

Anyone who wishes to donate his/her organs after accidental death can fill out an organ donation card or sign up with the online CentralisedOrganDonationRegister. In thepast, theorgansofregistered donors were not donated because the deceased families did not know of the wish of the diseased. The families refused to haveorgansremovedbymedicalpersonnelbecauseoftheChinesetraditional concept of ‘keeping the remains whole’. The prospective donors should therefore discuss their decision of organ donation with their families beforehand, no matter which way they choose to express their wish.

(2) Hong Kong’s waiting mechanism for organ transplant:Due to the continual limited supply of organs in Hong Kong, a

mechanism is in force to determine whether a patient is eligible for inclusion in the waiting list of organ transplant.

A patient has to undergo various examinations before he/she can be included in the waiting list. This is done to collect sufficient data for the doctors to assess whether the patient is fit for the organ transplant surgery, and whether he/she can bear the post-transplant risks.

Source 9 Why do germs become drug-resistant?





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For example, for renal transplant, one of the conditions is that the patient can not have severe disease related to his/her condition, such as, heart disease, infection or cancer, etc. It is because the said patient would be more likely to have an onset or even die after the organ transplant if he/she had any of the diseases mentioned above. Besides, donated organs from the deceased are very precious, so they must be used in the best way to maximize the patient’s chance of survival. In a physical examination, the patient must be assessed fit for transplant and be able to benefit before approval is given for his/her inclusion on the waiting list.

(3) The principles of donated organ allocation• Thedonorandrecipientmusthavethesameorcompatibleblood

type, and those ‘with the same blood type’ have a greater chance of success.

• Thedonor’sandrecipient’sorgansmustbematchedinsize.

• Thecandidate’sageandthelengthoftimespentinwaiting,etc.,determines his/her total score. The higher the score, the higher his/her place on the waiting list will be.

(A) Globalization and obesityBefore the emergence of globalization, the food supply was affected by

regional and seasonal limitations. As trade increased, geography and time wereno longer limitationsonthe foodsupply. Forexample,Mexicancornis the staple food of Eastern and Southern Africa, whereas North America’s maincrop iswheatfromtheMiddleEast.Ontheotherhand,riceoriginatedfrom Asia is now grown all over the world. Not only does globalization have an impact on the food available for human consumption worldwide, but people’s dietary habits are also affected.

Although malnutrition continues to be one of the main diet-related problems in the world, obesity tends to become increasing severe in both developed and developing countries. According to the British Nutrition Foundation, there were about 300 million obese people in 2000. Of them, 132 million were from the developed countries, with the remaining mostly found among the poor populations of developing countries. The causes of the globalization of obesity are listed as follows:




h e a l t h , T h e m e 1 o f


Globalization

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Source 10 People in both poor and wealthy countries are threatened by obesity

17Public Health

(1) Population movementPeople are divided over the causes of globalization of obesity.

Experts think that this happened because more people have moved from the villages to the cities to live. Under the influence of city life, their dietary habits have changed to eating less traditional food and arelianceonfastfood.Forexample,inMexico,healthyfoodssuchas corn, beans, fruits and vegetables are the traditional foods, but the urban dwellers mainly eat imported fast food and processed food, which usually have a high content of animal fat and sugar. In twodecadesorso, theobesity ratesofMexicanchildrenandteenagers have soared to 30% and 45% respectively.

(2) American fast food cultureAmerican culture has always been the mainstream in

globalization. The fast food culture popular in the US has emerged worldwidealongwithglobalization.Forexample,McDonald’s, therepresentative of American fast food culture, sells food with very high calories but little nutrients, such as hamburgers, French fries and soft drinks. They were dubbed ‘junk food’ which causes obesity. However,McDonald’s isverysuccessful inbusiness.Atpresent, ithas more than 30,000 branches in 119 countries worldwide.

It is interesting to note that a study has revealed that the poorer a community, the greater the number of fast food shops opened. This study was conducted in Australia and the US. Findings show that the number of fast food shops in communities with lower per capita income is 2.5 times greater than that in communities with higher per capita income. Perhaps this explains why the poor face a greater risk of obesity than the rich.

(3) Higher price for quality foodAnother perspective on the matter points out that delicious and

calorie-high unhealthy fast food are comparatively less expensive than quality food, such as fruits and vegetables. It was shown in a study that more obese children are found in regions where fruits and vegetablesaresoldatahigherprice.Moreover,theobesityratefallswith falling fruit and vegetable prices. A study by the United States Department of Agriculture also pointed out that low-income people do not tend to spend money on fruits and vegetables. This explains why the poor may be more susceptible to obesity.

(B) Organ donation in ChinaChina is thesecond largestorgan transplantingcountry in theworld,

with 1.5 million people in need of a transplant every year. But organ transplant in the mainland has always been criticized by the international mass media because of issues involving medical ethics. They include:


to write a report on the

topic ‘Fast food causes

obesity’.

(Refer to the Assessment

Form enclosed on p.42)

Extended Activities


• Unknownsourcesoforgandonation.Somegovernmentofficialsadmitted that the organs available in the mainland mainly come from the remains of the deceased, who are mostly executed criminals.

• Chaotic registrationoforgan recipients,withpossible tradingoforgans involved.

• Noguarantee formedicalqualityandsafety,affecting theresultsoforgan transplant and the patient’s life.

A ban on human organ trading was proclaimed in the mainland on 27March2006.Atthesametime,medicalinstitutionswererequiredtoapplyfor setting up an organ transplant division before related surgeries can be performed.Asof1May2007,themainlanddulypromulgateda lawrelatedto human organ transplants – Human Organ Transplant Regulation. Under the regulation, the governance of the mainland’s organ transplants gradually keeps up with the international standard because it basically follows the internationally recognized standard of medical ethics and the World Health Organization’s principles of human organ transplant. The main points of the regulation are as follows:

1. Respect the donor’s wish in organ donation.

2. Trading of human organs is strictly forbidden.

3. The requirements for the examination procedure of the removal, application and transplant of human organs shall be strictly observed.

4. Anyone who illegally removes organs from others or engages in illegal activities involving human organ transplant shall bear legal liabilities.

Although this regulation is a major milestone in the aspect of organ transplant in the mainland, it fails to address the sensitive issue of organ removal from the remains of executed criminals.

19Public Health

3 Health concepts and public health

Body Mass IndexBodyMassIndex(BMI)wasinventedbyaBelgiancalledAdolpheQueteletinthe 19th century. It is a simple measurement that tests whether a person is overweight.ThecalculationmethodforBMIis:

BMI=Weight (kg)

Height2 (m2 )

The conditions of adults’ weight as classified by the World Health Organization withBMI:

Body Mass Index

Underweight < 18.5

Normal 18.5 – 24.9

Overweight 25 – 29.9

Obese Class I 30 – 34.9

Obese Class II 35 – 39.9

Obese Class III > 40

SinceBMIcalculatesonlytheratioofweighttoheightanddoesnot includethe ratio of fat, it is only an indicator of weight conditions under general circumstances.BMImaynotbeapplicabletomeasuretheweightconditionsof certain people, like those who are very muscular. In addition, although BMI isalsoapplicable forchildren,differentchildrenhavedifferentpacesofgrowth indifferent regions.Therefore, thereareno fixedBMI figures for theassessment of children’s weight conditions.

Food PyramidThe Department of Agriculture of the US introduced the ‘Food Pyramid’ in 1992. People are recommended to eat appropriate portions of various categories of food in order to obtain balanced nutrition. The Department of Health of Hong Kong have introduced similar ‘Food Pyramid’, recommending people to eat the most to the least according to the following order: wholegrain foods, fruit and vegetables, meat, fish, egg, beans and milk, and oil, salt and sugar.


Topic 3: Health concepts and public health (pp. 69 – 86)

Source 11 The American government updated the ‘Food Pyramid’ in 2005. Apart from the recommended portions of different kinds of food, the importance of physical exercise was also emphasized.


Anorexia Nervosa（神經性厭食症）Anorexia nervosa is a kind of mental illness. Patients would have a distorted understanding of their body image and think that they are overweight. Patients are classified into two types: restrictive and binge eating/purging type. The former type would reduce weight through voluntary dieting and vigorous physical exercises, while the latter would binge eat occasionally and then use every method possible to reduce weight. The digestive ability of chronic patients of anorexia nervosa would be affected. In the long run, conditions like low blood pressure, slower heart rate, loss of hair and osteoporosis might emerge.

(A) Different kinds of physical exercisePhysical exercise refers to any physical activity that helps enhancing or

maintaining body health and physical fitness. They can be classified into three types: flexibility exercise, aerobic exercise and anaerobic exercise. When doing physical exercise, muscles require adenosine triphosphate (ATP) to contract. ATP can be synthesized by the body through aerobic metabolism and anaerobic metabolism. Oxygen is required during aerobic metabolism for the synthesis of ATP. Generally speaking, physical exercise with ATP produced by aerobic metabolism as the major source of energy is called aerobic exercise, for example, long-distance running and swimming. Physical exercise that relies only on ATP produced by anaerobic metabolism is called anaerobic exercise. Examples of anaerobic exercise include short-distance running, weight-lifting, high jump, etc.

(B) Physical fitness and healthAccording to the definition of the World Health Organization, physical

fitness refers to a person’s adaptability that allows him/her to function effectively and efficiently without feeling tired, enjoy leisure and cope with emergencies and stress. Physical fitness can be classified into two types: ‘performance-related fitness’ and ‘health-related fitness’. The former is more about sporting skills, while the latter is about personal health. ‘Health-related fitness’ can be measured in the following four areas:

(1) Cardiorespiratory enduranceCardiorespiratoryendurance isan importantpartofphysical

fitness. It refers the ability for the heart and the lung to carry oxygen and energy to muscle cells and remove metabolic waste from them, thusenablingenduringphysicalexercise.Cardiorespiratoryendurance can be tested through maximal oxygen uptake (VO2max).Maximaloxygenuptakerefers to themaximumamountof oxygen that can be transported for the use of muscle cells.

Topic 3: Health concepts

and public health, Theme

1 of Public Health (Book 1)

Related Topic




Related Topic

21Public Health

Apart from doing laboratory testing, VO2max can be tested through methods such as one-mile running or walking, 12-minute running, 1.5-mile running and walking up and down the stairs. With good cardiorespiratory endurance, one can do physical exercise for a longer period of time and have more energy to carry out daily tasks. With poor cardiorespiratory endurance, one feels tired more easily and has higher chances of getting cardiovascular diseases. Any persistent and rhythmic aerobic exercise, such as walking, running, swimming, cycling, aerobics, rope skipping and walking up and down the stairs, can strengthen cardiorespiratory endurance. However, the less intensive the aerobic exercise is, the longer the period of time it is required to exercise.

(2) Muscle fitness: muscular strength and muscular enduranceMuscular strength refers to themaximumstrength that the

musclecanproduce.Muscularendurance is theability formusclesto sustain repeated contraction and avoid fatigue. To carry out daily tasks for a long period of time, such as moving heavy objects, climbing up the stairs and steep walk, it requires good muscle fitness so that one does not feel tired easily.

(3) FlexibilityFlexibility refers to the ability for joints and muscles to have

full range of movement. High flexibility enables more flexible body movements and avoids sports injuries. Flexibility can be measured by sit-and-reach test and can be increased by stretching exercise.

(4) Body compositionThe human body can be divided into two parts: lean body

weight (including muscles, bones, ligaments, etc) and body fat. Body composition refers to the ratio of lean body weight to body fat. A body fat percentage which is too high would result in obesity and threaten one’s health. To improve the ratio of body composition, one can do more aerobic exercise to consume the excess fat and maintain a balanced eating habit.

(C) Effects of slimming culture on human healthModernsociety is influencedby themassmedia.People’sconceptof

‘beauty’ is more and more standardized. Slim models and movie stars can be found on fashion magazines, advertisements and movies, constantly reminding people to slim up, because ‘slim is beautiful’. In recent years, slimming companies flourished in Hong Kong and slimming advertisements can be seen everywhere. Slimming culture has penetrated every corner of our society. However, such culture prevails at the cost of people’s health.

If a person is overweight, it is not a problem for him/her to shed a few kilograms so that his/her weight falls within normal standards. However, under




Related Topic


the influence of advertisements and the media, some people with normal body weight still think that they are too fat and constantly try to reduce weight through dieting. There is a chance for them to develop anorexia nervosa. This disease is especially common among adolescents. Since adolescents undergo swift changes during puberty in terms of their body and mind, they are very sensitive towards others’ comments. If they were criticized as being fat by their peers, they would be determined to slim up by dieting, thus increasing the chance of developing this disease. Apart from physiological influences like low blood pressure, loss of hair and osteoporosis, patients of anorexia nervosa may even decline friends’ invitations for meals. They may therefore have fewer friends and their psychological health may also be affected.

Research shows that curbing one’s appetite would lead to the secretion of an endocrine called endorphins. This endocrine would create a pleasure feeling that makes one feel good and keep dieting, until all body fats are consumed.Whenanadult’sBMIreaches16,allofhis/herhairwouldbelostand his/her teeth would decay and eventually fall off because the body lacks differentkindsofnutrients.WhenBMIreaches14,thepersonmayevenhavethe risk of heart failure, which would disable the normal functioning of the organs and reduce the body’s immunity. The famous Brazilian model Ana CarolinaRestonwas too thinandthereforehad insufficient immunity.Asaresult, she passed away on 14 November 2006 due to urinal tract infection.

(D) Nutritional information of food labelsGovernments from around the world would devise food labelling

systems or allow food manufacturers to decide whether they would list all the nutrition included in the food products, so that consumers can understand the nutritional values of the foods, and choose those which fit their health requirements accordingly, in order to improve their eating habits.

(1) International standard of nutrition labellingIn 1963, the Food and Agriculture Organization of United Nations

and the World Health Organization established an internationally-recognizedorganizationcalledCodexAlimentariusCommission tocoordinate the food standards around the world. Since the 1980s, theCodexAlimentariusCommissionhasdevisedsamplesofnutritionlabels and specific guidelines to be followed when making nutritional claims. This standardizes the nutrition information on food labels for the convenience of consumers.

(2) Situations around the worldManydevelopedcountrieshavedevised labelling systems

for prepackaged food. For example, countries l ike the US, Canada,Australia,NewZealandandMalaysiahave legislatedonmandatory food nutrition labels. The European Union, Japan and Singapore have set regulations that if nutritional claims are made

Are you affected by the

slimming culture and think

that ‘slim is beautiful’?

H a v e y o u e v e n t r i e d

slimming up before?

Let’s Think




Related Topic


23Public Health

onprepackagedfood,nutrition labelsmustbeattached.On1May2008, the Regulations on Food Nutrition Labelling （《食品營養標籤管理規範》）was implemented inChina. Itstatesclearlythatnutritionlabels cannot exaggerate the nutritional functions of the food and food enterprises must indicate the amount of energy and four core nutrients, namely protein, fat, carbohydrates and sodium, contained in the food products. The information on nutrition labels should be true and objective and the nutritional functions should not be exaggerated. In addition, food enterprises cannot delete, modify or add terms to existing wordings of nutritional claims. Furthermore, therapeutic indications or implications are not allowed.

(3) The situation in Hong KongThe Director of Food and Environmental Hygiene enacted

the Food and Drugs (Composition and Labelling) (Amendment: Requirements for Nutrition Labelling and Nutrition Claim) Regulation 2008on31March2008andtheamendmentregulationwaspassedby theLegislativeCouncil inMaythatyear. Itwillcome intoeffecton 1 July 2010. The amendment includes mandatory nutrition labelling system for prepackaged food items, which stipulates that all prepackaged food products should be labelled with the information about the energy and 7 core nutrients contained in the food products, including protein, carbohydrates, total fat, saturated fat, trans fat, sodium and sugar (1+7). Any nutrient content claim, nutrient comparative claim and nutrient function claim of food items must meet specific standards. Food items with nutrient function claims (e.g. calcium can build stronger bones) must be based upon solid scientific evidence, so that consumers may believe these claims.

(E) Government’s measures to promote a healthy dietApart from regulations on food nutrition labels, the government has

launched some other measures to promote a healthy diet. They aim at improving the public’s health through their diets.

(1) ‘[email protected]’ CampaignIn recent years, the number of fat and overweight people is on

the rise in Hong Kong. The ratio of fat and overweight people rose from 36% in April 2005 to 41% in April 2006. In 2005, there was as much as 57% of the death cases caused by chronic diseases related to bad eating habits. Therefore, the Department of Health launched the ‘[email protected]’Campaign,whichaimedatprovidingcitizens with better eating environment and allowing them to have healthier choices in restaurants.




Related Topic

Source 12 Participants of ‘[email protected]’ Campaign are provided with publicity materials by the Department of Health for customers’ identification.


Restaurants which participated in the ‘[email protected]’ Campaignwouldprovidecustomerswithdishesthathavemorefruitand vegetables and less oil, salt and sugar, including the choices of ‘Morefruitandvegetables’and‘3Less’.‘Morefruitandvegetables’means that either fruit and vegetables are the sole ingredients of the dish, or their portion at least doubles that of meat in the dish. ‘3 Less’ means that the dish is cooked with less fat or oil, salt and sugar. The participating restaurants would use publicity materials provided by the Department of Health and state those healthier dishes clearly on the menu and recommend them to their customers.

(2) ‘[email protected]’ CampaignApart from the attention on the nutrition of foods people

eat in restaurants, the Department of Health is also concerned with the eating habits of Hong Kong students and the trend of the increasing rate of childhood obesity. Therefore, in the 2006-2007 academic year, the Department of Health launched the ‘[email protected]’Campaignandhopedthat through this campaign, healthy eating practices could be cultivated among local students so as to let them grow healthily and enable their learning effectiveness.

The different kinds of activities in the ‘[email protected]’Campaignwere jointlyorganizedby theDepartmentof Health and related government departments, school headmasters or headmistresses, professional bodies and academic and parental organizations. The objective of the campaign is to promote healthy eating practices among primary school students and prevent them from getting different kinds of illnesses because of bad living or eating habits. Apart from promoting the benefits and importance of a healthy diet to different people in society through interesting ways, the campaign also distributes nutritional guidelines to schools, parents and food suppliers of primary schools, so that schools and parents would value more about the nutrition value of the lunch boxes they choose for students, and food suppliers would have a reference to follow.

The ‘[email protected]’Campaign iswidelyparticipated.During the first academic year after the campaign was launched, more than half of the primary schools in Hong Kong joined at least one activity of the campaign. Participating schools were from different districts in Hong Kong and this helped promote healthy eating practices to students.

Source 13 A poster of the ‘[email protected]’ Campaign promoting healthy lunch boxes to students

25Public Health

(3) ‘Two plus three every day’ website‘Twoplusthreeeveryday’websiteisestablishedbytheCentral

Health Education Unit, Department of Health. The objective of the website is to promote balanced diet, in which one eats at least two portions of fruit and three portions of vegetables on a daily basis to prevent different kinds of chronic diseases. The website contains a large amount of information about healthy diet, including the components of a balanced diet, the suggested portion of various kinds of food for people of different ages, the relationship between eating habits and obesity, etc. The website of ‘two plus three every day’ is: http://2plus3.cheu.gov.hk.

Source 14 ‘Two plus three every day’ website provides the public with a large amount of information about healthy eating practices.

(A) The ways that environmental pollution affects the health of the publicApart from personal factors like eating and exercise habits, the health

of human beings is also greatly affected by environmental factors. As human economic activities prosper, different kinds of pollution are produced, posing a great threat to human health. For example:

(1) Air pollutionAir pollution is mainly caused by the gas pollutants or suspended

particles which are released when fuels are burned. Apart from the gas pollutants produced by power plants, industrial activities, vehicles with internal combustion engines, paints or barbecue smoke are all sources of air pollution. These activities would create different gas pollutants and pose different kinds of threats on human health. For example, the burning of fossil fuels like coal and oil leads to the emission of sulphur dioxide (SO2) and nitrogen monoxide (NO), which will combine with water droplets (H2O) in the atmosphere and form




Hong Kong Today

Related Topic


t o d i s c u s s t h e m a j o r

sources of pollution in Hong

Kong and ways to prevent

t h e s e p o l l u t a n t s f r o m

affecting people’s health.

Teaching Suggestion


sulphuric acid (H2SO4) and nitric acid (HNO3). After these acidic substances are dissolved, acid rain is formed. When the poisonous metals in the acid rain are dissolved in water, they may be absorbed by fruit, vegetables or animals. When human beings eat these plants and animals, it may lead to brain damage or confusion. Besides, carbonmonoxide (CO)andhydrocarbonscandamage human’s central nervous system and cause cancer respectively. Inhaling suspended particles, however, can lead to silicosis（矽肺病）and lung cancer.

(2) Water pollutionWater pollution refers to the pollution caused by human activities

in lakes, rivers, the ocean, ground water or other water bodies. Man-inducedwaterpollution ismainlycausedbyhuman industrialactivities. For example, poisonous heavy metal or non-biodegradable chemical substances would be released during the process of industrial production or mining. When these substances flow into rivers, lakes or the ocean, they would kill organisms in the water and accumulate inside their bodies. When human beings eat these organisms, they may be poisoned.

(3) Radioactive pollutionWhen nuclear fuels are used by the nuclear power industry,

radioactive waste, wastewater and exhaust gas would be produced. Although corresponding safety and protective measures are adopted in the operation of nuclear power industries today, serious pollution problems would arise if accidents occur in nuclear power plants. Besides, the application of nuclear power in nuclear weapons, medical and technological research would also lead to a certain extent of radioactive pollution. Diarrhoea, vomiting, or even damage in the central nervous system and death would result from human exposure to such radiation.

(4) Light pollutionLight pollution is a kind of pollution that has received much

attention in recent years. It originated from the overuse of lighting system by humans. Due to the advancement of industrial development, lighting systems are widely used in advertisements, commercial products, street lamps and household lighting in cities, leading to light pollution. The impacts of light pollution on human health not only include psychological effects such as psychological stress and anxiety, but also physiological effects such as headache, fatigue and even higher chances of getting breast cancer.


A r e y o u r d a i l y l i v e s

affected by light pollution?

Did you cause any light

pollution?

Let’s Think

Source 15 The gas pollutants emitted by power plants would pose a threat to human health.

27Public Health

(B) The Minamata disease incident in JapanTheMinamatadisease incident,whichoccurred in the1950s, is a

historical incident in which human health is severely affected by environmental pollution.TheMinamatadiseasewasfirstdiscoveredinthecityofMinamatain Kumamoto prefecture of Kyushu, Japan. A disease was found in that city in 1956, the patients of which had symptoms such as a sudden drop of intelligence, abnormal eye movement, stiffness in hands and feet, convulsion, coma, etc. The patient might even die within a month. Investigation found that the cause of the disease originated from the discharge of wastewater containing mercury from factories into the bay around that area, thereby polluting the fish and shellfish in the water. When human beings eat them, the mercury would be absorbed by the intestines and the stomach, and would enter the liver and the kidney through the blood circulation system. It would then enter the brain and result in mercury poisoning. Pregnant women who suffer fromMinamatadiseasewouldevenpass themercury to the foetus,leading to inborn disability of the baby.

ChissoCorporation, the company involved in theincident, was a hydroelectric corporation which also produced chemical products. Although the development of Chisso’sbusinessbroughtaboutthedevelopmentofthecityofMinamata,peoplewerenotawareof theenvironmentalpollutioncausedbyChisso’soperation,whichwasagreatthreat to the health of the people in the region. The mercury producedbyChissoduring itsproductionprocesseshadalways been discharged directly into the bay without being processed. It was only by 1966 that the corporation stopped the discharge of mercury into the bay.

The prosperity of material life leads to increasing demand for energy. However, many pollutants would be created by the continuous consumption of energy. These pollutants would cause damage to the natural environment and ecology, as well as directly affect people’s health.




Energy Technology and the Environment

Related Topic

Source 16 The Chisso factory, which led to many cases of mercury poisoning.


4 Factors that affect people’s understanding of health and public health


Topic 4: Factors that affect people’s understanding of health and public health (pp. 87 – 119)

EuthanasiaEuthanasia is a practice of ending the life of a patient who suffered from an incurable illness ‘in a painless manner’. It is usually applied to free patients who suffer from late-stage illnesses from torture and pain. Euthanasia can be divided into ‘active euthanasia’ and ‘passive euthanasia’. The former involves the use of lethal substances or methods, such as injection, to actively end the life of patients, while the latter refers to the termination of medical treatment for patients so that they can pass away naturally, such as letting patients stop taking medications. Euthanasia can also be divided into ‘voluntary euthanasia’ and ‘involuntary euthanasia’. The former refers to the situation in which patients understand their conditions and are willing to accept euthanasia, while the latter refers to the situation in which the patients are not fully conscious or their conditions render them unable to express their wish.

Genetically modified (GM) foodGM foods are newspeciesof foods createdby isolating a gene froman organism and inserting it into another organism. Genetic engineering technology is always used to grow bigger, more delicious and more easily grown crops. For example, the anti-freeze gene is extracted from arctic fishes and inserted into tomatoes so that they became cold-resistant. Another example is the insertion of the pest-resistant gene into corns. Although there isnoevidencethatthesefooditemsareunedibleforhumans,GMfoodshavebetter adaptability to the environment and would probably put other species at a disadvantaged position or even put them at the risk of extinction, thus disturbing the balance of the ecology.



29Public Health

Risk Assessment in Public HealthRisk assessment in public health refers to the assessment of the possible consequences of certain human activities on public or personal health. The Centre forFoodSafety,DepartmentofFoodandEnvironmentalHygieneadopts an international risk analysis framework in the regulation of food, which consists of four components in risk assessment: hazard identification, hazard characterization, exposure assessment and risk characterization. Afterwards, theCentrewouldformulateappropriateriskmanagementmeasuresandriskcommunication messages to protect public health by going through these risk assessment processes.

(A) The healthcare system in Hong KongThe principle of healthcare policies in Hong Kong is that no one should

be denied adequate healthcare because of the lack of money. Therefore, the Hong Kong government allocates a large amount of public resources on public healthcare services. Healthcare services in Hong Kong can be classified into five areas: primary care services, secondary care services, tertiary care services, emergency services and extended and long-term services. Among them,about70%of theprimarycareservices (apart fromChinesemedicalservices) are provided by private practitioners, while services from the other four areas are mainly provided by the public system.

(1) Charges and costs of public healthcare services in Hong Kong

Public healthcare services in Hong Kong have high quality, which is comparable to western countries. However, the charges of public healthcare services in Hong Kong are very low. Hong Kong citizens only have to pay $45 each time they receive a treatment in public out-patient clinics, with medication, X-ray check-up and laboratorytest included.Moreover,HongKongcitizenswhostay inpublic hospitals are only charged $50 to $100 per day. Patients who cannot afford the charges can apply for medical fee exemption.

However, the cost of the operation of public hospitals is very high. In 2006, the average cost for each patient in public hospitals almost reached $20,000. With the advancement of medical technology, the cost of public healthcare services will continue to rise.Moreover,publichealthcareexpenditureisexpectedtoincreasefourfold from 2004 to 2033.

T o p i c 4 : F a c t o r s

t h a t a f f e c t p e o p l e ’ s

understanding of health



Related Topic


(2) Ratio of public and private healthcare services in Hong Kong

The ratio of public and private healthcare services in Hong Kong is severely disproportional. Over 90% of in-patient services in Hong Kong are provided by public hospitals. However, public healthcare expenditure only takes up half of the total medical expenditure in Hong Kong. This shows that the current healthcare services in Hong Kong rely too much on public hospitals, leading to a shortage of supply. For example, the current waiting time for cataract surgery（白內障手術）is almost two years and nine months in public hospitals. Seven years later, the waiting time may be as long as six years and nine months. Over-reliance of the public on the public healthcare system is a big problem faced by the healthcare system in Hong Kong.

(3) Proposals to solve the problem of the healthcare systemIn order to solve the above problem, the Food and Hygiene

Department issued the Your Health Your life: Consultation Document on Healthcare Reform inMarch2008,proposingseveral resolutions. Firstly, it is suggested that primary care services should be strengthened.Chronic diseases arebecoming more and more common in Hong Kong. Therefore, avocation of continuous nursing services and the promotion of healthy lifestyles can reduce the demand for the expensive nursingservicesinhospitals.Manyresearchessuggestthatthemore well developed primary care services are, the more cost-efficient it is to provide better healthcare services for the public.

Apart from that, fostering the partnership between the public and private sectors is also a way to solve the problems faced by the current healthcare system. As mentioned above, the current ratio of public and private healthcare services is extremely disproportional. Strengthening public-private partnership, such as co-developing hospitals, can reduce the current strains on public healthcare services.

Finally, healthcare financing can also help finance the healthcare system.

Source 17 There is a shortage of supply in public healthcare services. Patients have to wait for a longer and longer period of time.

Source 18 Your Health Your l i fe: Consultation Document on Healthcare Reform

31Public Health

(B) Healthcare financingThe current healthcare financing method in public healthcare services

in Hong Kong relies on the public expenditure allocated by the government. Because of the increasing demand for healthcare services in Hong Kong (because of ageing population) and the problem of rising medical cost (due to advancement in medical technology), the government has been considering new approaches in healthcare financing to increase income, including the following proposals:

(1) Social Health InsuranceSimilar to the current taxation model, this option deduces a

certain percentage of the monthly income from employees and employers. All the contributions would be used to subsidize a healthcare service system for all citizens. Austria, Belgium, Japan, Korea and the Netherlands currently use similar framework as the major source of medical expenditure. Facing the rising cost in medical expenditure, some countries, such as the Netherlands, cannot rely on taxation and social health insurance to solve the problem, and turn to reforms on the market structure and financing arrangements.

(2) Out-of-Pocket PaymentsThis option reduces the subsidy on public healthcare services.

Users of healthcare services would pay more or voluntarily purchase insurance to cover their medical expenses. This means of financing exists to varying extent in all economies. However, beside the Out-of-Pocket scheme, advanced economic systems would also provide safety nets for low-income and disadvantaged groups, enabling them to have access to inexpensive or free medical services.

(3) Medical Savings AccountsMedicalsavingsaccountsaremandatoryemployment-based

and income-linked individual savings accounts, which allow people to save up a healthcare reserve fund over time to pay for their future healthcare needs. Singapore has a medical savings account scheme calledMedisaveandahealthcare insurancescheme that targetscatastrophic illnesses. Premiums for the insurance are paid through theMedisave.

(4) Voluntary Private Health InsuranceThis option includes both employer-provided medical benefits

and individually-purchased medical insurance. In the US, voluntary private health insurance is the predominant means of healthcare financing. However, the rising healthcare cost has led to the escalation of insurance premium, which may be very expensive for low-income people and people with poor health conditions. In






Related Topic


to discuss the pros and

cons of the six healthcare

financing options.

Teaching Suggestion


Australia, the government strongly encouraged voluntary private health insurance and intervened in the private health insurance market by attracting citizens to purchase health insurance. This facilitates the development of the private healthcare sector.

(5) Mandatory Private Health InsuranceMandatoryprivatehealth insurance iswhereprivatehealth

insurance is mandated to be taken out by law, instead of taken out voluntarily by individuals. Premium for mandatory private health insurance is usually the same for everyone for the same insurance plan. However, the premium for low-income people or disadvantaged groups would usually be paid or subsidized by the government. The law in Switzerland and the Netherlands mandates the purchase of private health insurance of a prescribed minimum level of coverage. Insurance companies are not allowed to make profit from mandatory health insurance. However, they can do so by offering their members a variety of other insurance products.

(6) Personal Healthcare Reserve (PHR)PHR requires those above a certain income level in the working

population to deposit a fixed percentage of their income to their own PHR account. Part of the PHR deposit would be used to subscribe to a mandatory medical insurance scheme regulated by the government, while the remaining deposit would be accrued through investment in order to meet future healthcare needs. This option has the advantages of both medical savings account and private health insurance.Currently, theMedisaveandMedishieldschemesin Singapore combined both savings and insurance as the means of financing. However, different from PHR, Singapore’s schemes are voluntary inprinciple.Moreover, thepremiumdiffersaccording toone’s age and health conditions in Singapore’s scheme.

(C) The impacts of smoking on healthSmokingaffectspeople’shealth.Carcinogens incigarettesare the

causes of various kinds of cancer, such as lung cancer, liver cancer, stomach cancer, throat cancer, oesophagus cancer, etc.Currently, 19 kindsofcarcinogens are found in cigarettes. Various kinds of such substances would severely affect human health, such as polycyclic aromatic hydrocarbons and acrolein released by tar. When these substances enter the human body, they will attach to the DNA of human cells, killing the cells or causing mutation and turning them into cancer cells.

Apart from that, although nicotine found in cigarettes is not a carcinogen itself, it can be transformed into one. Nicotine would release catecholamine, which contracts smokers’ blood vessels, thus increasing their blood pressure, heartbeat pace, oxygen consumption of cardiac muscles and blood sugar.






Related Topic

33Public Health

Besides, nicotine is a strong euphoriant （興奮劑）. When nicotine enters the human body, it only takes about 10 seconds to reach the human brain, inducing a sense of euphoria and addiction.

Finally,cigaretteswouldalsoreleasecarbonmonoxide.Carbonmonoxideis a colorless and odourless toxic gas. When it enters the human body, it will reduce the oxygen level in the blood, therefore disrupting the normal functioning of the central nervous system. While the normal level of carbon monoxide in blood should be less than 1%, such level can reach as high as 15% for smokers. In the long run, carbon monoxide in the blood will block the normal blood circulation of smokers and affect their analytical and judgment abilities. It will also lead to the accumulation of fat and blockage of blood vessels, thus increasing the chance of heart attack and stroke.

In conclusion, smoking has direct or indirect effects on various parts of the human body, for example, the brain, skin, the heart, the five sense organs, the four limbs, muscles, bones, etc. If a pregnant woman smoke, the poisonous substances in the cigarettes will be passed to the foetus through the umbilical cord, hindering the growth of the foetus and increasing the risk for miscarriage. Babies born to smoking mothers usually weigh less than babies born to non-smoking mothers.

(D) The situation of tobacco control in Hong KongTobacco control campaigns in Hong Kong began in the 1970s, with a

history of more than 30 years. In 1982, the Smoking (Public Health) Ordinance was enacted, regulating the use, sale and promotion of tobacco products and designating some indoor public areas and public transport carriers as no smoking areas. It also stipulates that health warning and tar and nicotine yield should be displayed on packets of tobacco products. Tobacco control in Hong Kong was successful in the 20th century. The percentage of smokers dropped from 23% in the 1980s to 12% in 2000, putting Hong Kong among one of the regions which launched the most effective tobacco control policies.

InNovember2003,Chinaadopted theWorldHealthOrganization’sFramework Convention on Tobacco Control. The articles of this convention is therefore also applicable to Hong Kong. To put the convention into practice, the Hong Kong government enforced legislation to extend no smoking areas to parks, beaches, public transport interchanges, sports venues, etc. Since October2006,thetobaccocontrolinspectorsfromtheTobaccoControlOfficeof the Department of Health were empowered to enforce the Smoking (Public Health) Ordinance, such as prosecuting people who sell tobacco products to people under 18 years old. On 1 Janurary 2007, the amendment for Smoking (Public Health) Ordinance was put into practice in Hong Kong, clearly stating the font size and format of health warnings on packages of tobacco products. It also substantially extends the designated no smoking areas to include all






Related Topic


to discuss how to strike a

balance between enforcing

t o b a c c o c o n t r o l a n d

defending citizens’ freedom

of smoking.

Teaching Suggestion

Source 19 Smoking has great impacts on human health.


indoor public areas, workplaces and some outdoor recreational areas. In addition, the government increased the tobacco tax by 50% in February 2009 in order to strengthen tobacco control in Hong Kong.

Apart from legislation, the government also teaches citizens the impacts of smoking with various kinds of publicity and education. TheTobaccoControlOffice,establishedby theDepartmentofHealth in February 2001, not only assists in executing tobacco-related laws, but also strives to promote a smoke-free culture and ensure that the public abides by such laws through promotion and healtheducation.TheTobaccoControlOfficestartedthepublicitycampaign ‘I love smoke-free Hong Kong’ in 2005. The campaign promotes a smoke-free culture through TV and radio programmes and advertisements in outdoor billboards and public transport carriers.

(E) Food safetyFood safety is a science that examines the ways to prevent food

poisoning during the preparation, processing and storage of food. It often involves some necessary procedures in handling food so as to avoid the risk of serious illnesses.

Global food safety problems originate from two major hazards: microbiological hazard and chemical hazard. The former refers to serious hazards occurring in the food chain, such as Salmonella（沙門氏菌）and Vibrio（弧狀細菌）, while the latter refers to chemical pollution in food, such as marine toxin, mercury, lead, pesticides, etc. Other than these two hazards, foodadditives,GMfood, ingredientsof foodarealsorisks thatneedtobetaken into consideration when assessing food safety.

Over 90% of food is imported in Hong Kong and the origins of imports come from all over the world. They vary in kind and come in large quantities. In 2006, Hong Kong imported over 320,000 tonnes of rice, 178,000 tonnes ofporkandover1,300,000poultries fromcountries includingMainlandChina, theUS,Chile,NewZealand,FranceandSingapore.Therefore, thework to enhance food safety in Hong Kong is complicated. Hence, the Centre forFoodSafetywasestablished inMay2006under theFoodandHygiene Department, specializing in reinforcing the regulation of food safety, in response to the growing public concern about food safety problems like the incidents of mad cow disease and Sudan dye（蘇丹紅）.TheCentreforFoodSafety not only conducts risk assessment of the food sold in the markets in Hong Kong, but also works closely with the food industries and consumers to ensure that the food items sold in Hong Kong are safe and edible.

In thepast tenyears,otherregions,suchasCanada, Ireland,England,Singapore, Japan, France and New Zealand, have established specialist






Related Topic

Source 20 A poster of the Tobacco Control Office to promote smoke-free culture

35Public Health

departments responsible for the enhancement of food safety in response to public concern regarding food safety. The establishment of independent food safety centres has become a global trend. Other than food safety centres in respective countries, some transnational organizations also have institutions responsible for food safety, such as the European Union and the World Health Organization (WHO). Among them, WHO and the Food and Agriculture Organization of the United Nations (FAO) co-established the CodexAlimentariusCommission in1963,providingnationswithadvicesonfood nutrition labels, food additives, the use of pesticides and the appropriate procedures of food processing.

Source 21 Food in Hong Kong is imported from all over the world, posing a great challenge to food safety.

(A) Globalization and tobacco control

(1) The global network of tobaccoTobacco was first grown by American Indians and was used

for smoking in tribal conferences and religious activities. At the end ofthe15thcentury,EuropeancolonizerColumbusbroughttobaccoto Europe and tobacco was then brought into countries in Asia, likeChinaand India,andAfrica throughagraduallydevelopingglobal trading network in the 16th and 17th century. Despite the lack of large-scale global activities by that time, inter-continental and interlinked trade routes were already developed, realizing a certain degree of globalization. Therefore, we may say that tobacco was spread to every corner of the globe through an initial stage of globalization.

American Indians did not smoke for leisure initially. They were the Europeans who started smoking as a leisure activity. However, the impacts of smoking on human bodies were not widely recognized from the very beginning. When tobacco first reached Europe, it had






Globalization

Related Topic


even been used as a medicine. However, although much evidence was found regarding the impacts of smoking on human health since the 20th century, tobacco is still a legal commodity for sale in almost every country in the world (Bhutan is the only country that bans the saleof tobacconow).Amongthem,Chinahasthe largestsmokingpopulation as well as the largest scale of the growth and production of tobacco in the world, while Brazil is the country that exports the most tobacco leaves in the world.

(2) Global tobacco control measuresSmoking has great impacts on the health of humans. Tobacco

has become the number two global killer, after high blood pressure. Over 90% of the cases of lung cancer and three-fourth of the cases of chronic bronchitis（慢性支氣管炎）and emphysema（肺氣腫）are caused by smoking in the world. From 1999 to 2007, one person died because of smoking in every 6.5 seconds in the world.

Global tobacco control measures did not start just recently. The first global anti-smoking campaign had already started in the 17th century. However, these measures were only launched in a few countries. In order to solve the problem of smoking in this age of globalization, we should not only depend on the efforts of individual countries or governments, but also international collaboration. In order to deal with the globalized growth of tobacco leaves, manufacturing of cigarettes, and their trading and sales network, globalized tobacco control measures are necessary.

The discussion on the Framework Convention on Tobacco Controlkickedoff in theWorldHealthAssembly in1999. InMarch2003, the finaldraftof theConventionwaspassedandwasputinto effect in February 2005. Framework Convention on Tobacco Control is the first international convention that curbs tobacco. It is also the first global and multilateral agreement about tobacco. The aim of the convention is to provide a legal framework for controlling tobacco globally so as to protect human health. The convention set clear guidelines on issues such as the ingredients, packaging, advertisements, sales, sponsorship, pricing and taxation of tobacco and tobacco products. This provides a framework for abiding countries of the convention to formulate their own tobacco control policies.

When the convention comes into effect, abiding countries must observe all of its terms, including banning tobacco advertisements, banning or regulating tobacco companies’ sponsorship activities, tackling the smuggling of tobacco, banning the sale of tobacco to underaged people, raising the price and tax of tobacco, displaying health warnings such as ‘Smoking harms your health’ on the

37Public Health

packages of cigarettes and adopting measures to reduce smoking activities in public places, etc.

In November 2003, Wang Guangya, Permanent Representative ofthePeople’sRepublicofChinatotheUnitedNations,representedChina tosign theFramework Convention on Tobacco Control and Chinabecame the77thparticipatingcountryof theconvention.As a country with the largest scale of the growth, production and consumptionof tobacco in theworld,China’sparticipationplaysakey role in the work of international tobacco control. Hong Kong also followsthefootstepsofChinaandtightensthemeasuresoftobaccocontrol, including the amendments of the Smoking (Public Health) Ordinance, the substantial increase of tobacco tax, etc.

In 2006, abiding countries of the Framework Convention on Tobacco Controldecided tosetupaConventionSecretariatatthe headquarter of WHO in Geneva, as a global centre of tobacco control, which guides and supports the tobacco control measures of these countries.Moreover, these countries alsodecided toestablish some working groups to facilitate international cooperation in regulating advertisements of tobacco companies and tackling tobacco smuggling. A permanent and effective international network of tobacco control is gradually developed.

Despite the gradual enhancement of global collaboration of tobacco control, a report of WHO in 2008 showed that only 5% of the global population was protected by the measures of tobacco control in their countries. In addition, the tobacco taxes collected by the governments exceed their expenditure allocated to tobacco control by an average of 500 times. These showed that there is room for improvement in global tobacco control measures.

Source 22 Cover of WHO’s Framework Convent ion on Tobacco Control


Extended Information 1Yersin and plague in Hong KongAlexandre Yersin, the French scientist of Swiss descent, was Pasteur’s research partner. When plague brokeout inChina in1894,Yersinwassent toChina foranepidemicstudy. InJuneof thesameyear,plague also broke out in Hong Kong. He chose to come to Hong Kong where ‘a daily mortality rate of 40’ was documented. He worked under extremely harsh conditions and discovered the causative agent of the plague.

Extended Information 2Mode of transmission of AIDSHIV is not transmitted through usual social contact, such as shaking hands, kissing and sharing toilet facilities. AIDS also cannot be transmitted through saliva or mosquito bites.

Extended Information 3The meaning of H and NTwo kinds of protein are found on the surface of influenza virus A, they are the hemagglutinin (H) and neuraminidase (N). 15 types of hemagglutinin and 9 types of neuraminidase are known so far. The medical community identifies different types of Influenza A by different combinations of these two kinds of substances on the virus’s surface.

Extended Information 4Difference between ‘common influenza’ and ‘avian influenza’Both influenza and avian influenza are caused by influenza viruses. It is a commonplace for humans to contact ‘common influenza’. ‘Avian influenza’ was previously known to infect birds only, but human infection by the avian influenza virus has now been documented.

Common influenza Avian influenza

Period of occurrence

In Hong Kong, i t is relat ively common between January and March, and in July and August every year.

After the first human infection was discovered in Hong Kong in 1997, individual cases were documented in different regions of Asia.

CausesSeasonal outbreaks are caused by slight genetic mutations of influenza viruses.

Most patients got infected through contact with infected poultry or objects with contaminated surfaces.

SeverityHealth people generally recover on their own a few days after being infected.

An infected human possesses several influenza-like symptoms. It might progress rapidly and cause respiratory failure and multi-organ failure, and even death.

Guideline for Teachers

39Public Health

Extended Information 5The functions of Codex Alimentarius CommissionCodexAlimentariusCommission,established in1963, is responsible forcoordinating foodstandardsamong governments. There are 165 member countries from different continents at present. The objective ofCodexAlimentariusCommissionistoprotectthehealthofconsumersandensurefairtradepracticesinthe food trade through the establishment of an internationally collaborated system of food standard. The foodstandardsthattheCommissionformulatesandpromotesfortheadoptionbydifferentcountriesarecalled‘CodexAlimentarius’.Apartfromrepresentativesfromdifferentgovernments,theCommissionalsoencourages enterprises, consumers, scientists, experts and international non-governmental organizations toparticipate in theenactmentof ‘CodexAlimentarius’, inorder toestablishasystemthatcanprotecthuman health and ensure fair food trade practices through international consensus and advanced technology. ‘CodexAlimentarius’coversallkindsof food, includingprocessed,semi-processedandrawfood.Apartfromstandardsforspecificfoodproducts,‘CodexAlimentarius’alsocoverstheassessmentofpesticides used during the process of food production, the amount of residual pesticides, standards about pollutants, the assessment of food additives, the level of food hygiene, etc.

Extended Information 6The impacts of light pollution on the ecologyLight pollution would not only affect human health, but also the ecology. It would make animals difficult to distinguish day from night, thus disturbing the regular pattern of their lives. For example, lighting during the night would affect the bearings of moths and other night-active insects. As a result, flowers which rely on these insects for pollination would find it difficult to reproduce and as a result, they may even be extinct. Migratorybirdsandnewlybornturtleswouldalsolosetheirbearingsbecauseoflightpollution,leadingtotheir death.

In addition, light pollution would also speed up the reproduction of algae, resulting in red tide, which threatens the survival of marine species and pollutes the water. Although damage to the ecology does not have immediate and direct effect on human health, such damage to the natural environment would threaten the survival of human beings in the long run.

Extended Information 7Differences between ‘euthanasia’ and ‘assisted death’‘Active euthanasia’ refers to the use of lethal substances or methods by doctors to actively end the lives of patients, while ‘assisted death’ refers to the situation where doctors provide the methods of ending the patient’s life, and the patient actively execute the steps to end it. For example, the patient may operate a computer which injects certain lethal substances into his/her body. Laws in some countries allow ‘assisted death’ but not euthanasia, such as Switzerland.


Extended Information 8Differences between genetic modification and traditional cross-breedingManycenturiesago,farmersstartedtousetraditionalbreedingmethodssothatbigger,moredeliciousandmore easily cultivated crops can be grown. During the Tang dynasty, Tibetans cross-bred yaks (犛牛) on theTibetanPlateauwithcowsfromcentralChina,givingrisetopian niu (犏牛), which has a mild temper, more delicious meat and which can produce a larger amount of milk. Although these traditional cross-breeding techniques for plants and animals are similar to the modern technology of genetic modification, the two kinds differ in the following ways:

• The technologyofgeneticmodificationcan transfer individualgenesofdifferent species,whilethousands of genes are mixed simultaneously in traditional cross-breeding;

• Thetechnologyofgeneticmodificationcanextractaspecificgenetobeinsertedintoanotherbiologicalspecies, while traditional cross-breeding is limited to the same biological species.

1. 香港醫療輔助隊長官聯會編著：《戰勝傳染病 ─ 傳染病預防及控制手冊》，香港：萬里機構 ·萬里書店，2006年。

2. 黃秀如主編：《健康的時尚》，台北：網絡與書，2003年。

3. 斌仔著：《我要安樂死》，香港：三聯書店，2007年。

4. 傅浩堅主編：《運動與健康》，香港：商務印書館，2007年。

5. 潘子明著：《基因改造食品》，台北：九州圖書文物，2004年。

6. 饒忠華主編：《放眼看：醫療健康》，香港：商務印書館，2004年。

7. Richardson, Hazel: Killer Diseases, London: DK Publishing Inc., 2002.

8. Stewart, Gail B.: Understanding Diseases and Disorders: SARS,Michigan:ThomsonGale,2005.

41Public Health

1. World Health Organizationhttp://www.who.int/

2. CentreforHealthProtectionhttp://www.chp.gov.hk/

3. Hospital Authority – Severe Acute Respiratory Syndromehttp://www.ha.org.hk/sars/sars_index_e.html

4. Virtual AIDS Office of the Hong Kong Department of Healthhttp://www.info.gov.hk/aids/

5. ChineseCultureonNetFoundationLtdhttp://www.chinalane.org/life005/magicbox/index.html

6. HongKongCouncilonSmoking&Healthhttp://www.smokefree.hk/cosh/ccs/index.xml?lang=en

7. GovHK: Healthy Eatinghttp://www.gov.hk/en/residents/health/foodsafe/ healthyeating.htm

8. CodexAlimentariusCommissionhttp://www.codexalimentarius.net/web/index_en.jsp

9. CentreforFoodSafetyhttp://www.cfs.gov.hk/

10.CentralHealthEducationUnit,DepartmentofHealthhttp://www.cheu.gov.hk/


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