2017-05-08 HIA submission to LegCo’s Subcom on Rights of Ethnic Minorities on Use of healthcare services (public hearing)

HIA consolidated our frontline experience and stakeholder’s feedback into 6 main concerns and corresponding suggestions (please see here for details).

At the Legislative Council’s public hearing on 2017-04-10, we particularly emphasized the importance of timely professional medical interpretation to ensure patient’s quality of care, as well as the need to collect ethnicity health data in order to identify health disparities.

Submission:
http://www.legco.gov.hk/yr16-17/chinese/hc/sub_com/hs52/papers/hs5220170508cb2-1315-5-ec.pdf

Meeting replay:
http://webcast.legco.gov.hk/public/zh-hk/SearchResult?MeetingID=M17050012

 

Submission:

The Legislative Council Subcommittee on Rights of Ethnic Minorities
8 May 2017 Meeting on
“Difficulties encountered by ethnic minorities in gaining access to housing and healthcare services, and views on services provided by Support Service Centres for Ethnic Minorities”

Submission from Health In Action

Follow up regarding Subcommittee’s 10 April 2017 meeting on “issues relating to the use of healthcare services by ethnic minorities”

  1. Health In Action has previously submitted in writing six major concerns and corresponding suggestions relating to the use of healthcare services by ethnic minorities for the Subcommittee’s meeting on 10 April 2017 (please see Appendix).
  2. Upon questioning by Subcommittee members at that meeting, we welcome Hospital Authority’s and Department of Health’s verbal replies to consider some of the proposed suggestions to ensure equal access to healthcare services by ethnic minorities, particularly on adding a language needs option in the clinical system, enhancing language sensitivity of GOPC telephone booking system, unifying service standards of medical interpretation between Hospital Authority and Department of Health, and strengthening language support during drug collection at the pharmacy. We look forward to seeing the implementation of such language enhancement measures.
  3. However, we observed from the meeting that there is an urgent fundamental need to address the lack of data regarding ethnic minorities in the health sector, since such data gap tramples any effort of service evaluation or planning. Despite repeated requests from multiple Subcommittee members, it is regrettable that the authority refused to collect statistics about the number of ethnic minorities accessing public services. In response to the authority’s reply that there is no basis for ethnicity to be included in routine health data collection, we hereby explicate the need for such data based on arguments of public policy, public health, and social justice.

Making the case for including ethnicity in routine health data collection

  1. The public policy rationale
    In line with the Government’s Administrative Guidelines on Promotion of Racial Equality, we are pleased that the Food and Health Bureau, Department of Health, and Hospital Authority have drawn up a checklist of measures to facilitate ethnic minorities to access public healthcare services. Yet, the lack of ethnic minorities patient data in the public sector provides no means of evaluating the appropriateness or effectiveness of such measures, such as the adequacy of medical interpretation services, cultural competence training for frontline staff, and patient information materials. From the policy point of view, collecting ethnicity information in the health sector enables the Government to identify and address racial discrimination and inequalities in all public policy aspects. The inclusion of ethnicity as part of routine health data collection allows the respective authorities to design and deliver better health policies, services, and programmes to ensure equal access for people of different ethnicities.
  2. The public health rationale
    At the individual patient level, information on ethnicity can guide clinical decisions and improve patient-centred care through evidence based medicine (EBM), for example latest research in pharmacogenomics have shown that certain drugs have a higher effectiveness in some ethnic groups than others. On the other hand, at the population level, it is as important to collect information on patients’ ethnicity in order to identify health needs and measure disparities in care in order to improve the health status of different ethnic populations. It is a well known finding in the public health field that around the world, ethnic minority groups experience higher rates of disease and poorer health related outcomes compared to non-ethnic minority groups. In Hong Kong, there is a lack of relevant public data, but our frontline experience clearly indicated that such health disparities exist, for example South Asian females have more than triple the rate of obesity than Chinese females (50% VS 14%), and the Nepalese elderly have much lower influenza vaccination rates than their Chinese counterparts due to lack of awareness of the Government Vaccination Program. Hence, collecting ethnicity-specific health data is a public health imperative in order to identify health needs and disparities that are amenable to interventions.
  3. The social justice rationale
    The right to health is a fundamental part of human rights and health is a valuable resource for each person to attain his or her life aspirations. Fulfilling the right to health requires equitable access to healthcare services for all in Hong Kong, and any unequal access due to modifiable factors is a form of health inequity and social injustice. It is important to highlight the difference between health inequality and health inequity. Health inequalities are differences in health status or in the distribution of health determinants between different population groups; where as health inequities are avoidable inequalities in health between groups of people within countries and between countries. In Hong Kong, ethnic minorities face barriers in accessing healthcare services and health information, which in turn place them at higher risk of poor health. Collecting ethnicity information helps ensure that the Government can monitor health trends by ethnicity to reduce health inequities.
  4. Examples of overseas practice
    In view of the importance of collecting ethnicity information on health, many countries have already implemented such measures for many years.
  • In the UK, recording ethnicity information was made mandatory across the National Health Service in 1991 alongside with the national census.
  • In the USA, the Department of Health and Human Services Committee on the Collection of Race and Ethnicity Data recommended in 2004 that measures of ethnicity be obtained in all healthcare data systems whenever possible.
  • In Australia, since 1992 the government has established health database containing information on ethnicity.
  • In New Zealand, the Ethnicity Data Protocols for the Health and Disability Sector were developed for the standardized collection, recording, and output of ethnicity data for the health sector.In summary, based on the above three rationales and examples from overseas, we hope that the authorities would reconsider including ethnicity information in routine health data collection in Hong Kong.

 

27 April 2017