My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Hong Kong, May day weekend – Sunday

Filed Under (China, Health Policy, Mexican 'flu, Public Health, SARS) by Paul on 04-05-2009

I have been watching how a very different society deals with a public health scare.

The health of the public is a very different activity from running a health care system. Many health care systems including the NHS and the system in Hong Kong is primarily organised by the state. We develop policies, set up the architecture of the system create and maintain institutions and try and implement a state run system. That’s the way in which health care is usually organised and thought through.

The health of the public is a different issue. It depends almost totally not on the state and on social policy but how individuals and families interact with civil society. The state matters, but it can very easily look impotent and a bit stupid if it tries to pretend that the health of the public -public health- actually belongs to the state.

A pandemic scare tests the strength of civil society and tests how well the state understands that civil society. Each state and each civil society has a close eye on its history and lessons from successes and failures of the past.

Six years ago Hong Kong suffered a major pandemic scare around SARS. This was a respiratory disease that in that pandemic killed 229 people in Hong Kong and about a thousand throughout the world. Its epicentre was Hong Kong and China and the experience was one of failure. Hong Kong depends for its livelihood on trade. That trade involves not just the transfer of goods but also the rapid transfer of people. It is a trade and a people hub.

That means it can spread disease beyond its own small borders very quickly or it has to close itself down. The enormity of this for the lives of the 7 and a half million people who live here is considerable. Closing HONG KONG has an immediate impact on everyone’s income and many many jobs.

So 6 years ago the initial response to SARS was at best timid and at worst confused. This was because an immediate and tough response may have appeared over the top to the rest of the world and , if the illness had not spread, would have interrupted trade unnecessarily.

So in a trading nation decisions around publicity and quarantine are big decisions to make. There was a big inquest into SARS and what has been unfolding over the last few days has been the demonstration of lessons learnt.

The first time a case was confirmed – Friday May 1st a bank holiday here- there was immediate publicity and government action. The people in the hotel where the Mexican diagnosed with the flu had been staying, were all placed in 7 day quarantine, the man himself was in isolation in hospital. Within 2 days the Chinese authorities had traced everyone on the plane he had been on from Mexico to Shanghai and then the plane from Shanghai to Hong Kong. He had had two taxi rides in Hong Kong.  One driver came forward and the taxi drivers trade union gave up the other one.

The media obviously has this as the top spot on the news in fact as most of the news and I interviews at different times one of two of the guests of the hotel who are now on 7 days hotel arrest. They are mildly put out. No one tells them what is going on. No toothbrush etc. So the media plays some dissent but most people admit they were just unlucky to have been in that hotel or on that flight or driving that taxi and quarantine is what they expect.

The government seems to have learnt the lessons and acted very completely but that isn’t the purpose of this post. The people with a few days are changing aspects of their behaviour but not their whole behaviour. So when the state moves its rating of the event up to emergency what do the public do. Well given the crowded community restaurant I was in on Saturday night and given the number of people on a sunny Sunday going to Lamma island for a walk they seem to ignore it.

But that’s not quite true because we are two weeks rather than 2 days into this crisis. We are now at level six. A week ago all public and private lifts had a transparency put over the buttons with a sign saying this will be disinfected twice a day. The toilets in schools and public toilets are cleaned once an hour. The trains and the tube have messages about coughing and sneezing  and what YOU can do. A recent visit to a gents sees EVERYONE washes their hands with very great enthusiasm. At the bottom of busy escalators someone is employed to run a disinfected cloth over the handrail to stop infection being passed on from one person to another. People do things. The state does things. They interact and complement.

So people are carrying on, but they are behaving differently too. What interests me is the difference in their activity and their relationship to the different state activity. I can hear the average UK blog reader saying well that’s because they live in a communist society and are frightened into doing what they are told. But that doesn’t really fit Hong Kong which is probably one of the most capitalist place sin the world where buying and selling and markets are not just the work place of many of the public but seems to be their life blood.

And the young people round me at the moment just do not look like people who simply do what they are told. They do what they are told when they agree with it. And what is different is that they can see that the general good – not having a pandemic- has a link with the individual good – not getting ill in a strong way. They also know that their place in the world – a general issue- fits in with their own income – an individual issue.

So as they look at their individual health they feel that they are much more likely to get ill – and this is obviously true- if there is a pandemic. If they therefore change their individual behaviour then they are more than likely to do good for Hong Kong and good for themselves. The notion in this one thing if nothing else- that there is a congruence between sensible individual precautions and what they are being told to take and the collective good is one that they trust. They can see it and understand it.

That’s what feels different in the UK. By now if the Government had put a few hundred people under hotel arrest the media would have interviewed their grannies who would have said how outrageous it was to stop little Johnny from coming to my 90th birthday party. A few cats would have died because they had been unfed and there would be an enormous hue and cry. Human rights legislation would have been invoked to defend the inalienable rights of the people in the hotel to go to their grannie’s birthday party and the RSPCA would be suing the government over the cats.

The expectation in the UK is that whatever the Government would do would be bad for us. Equally so if they hadn’t quarantined it would have been an example of them not taking responsibility for the nations health.

In the UK we have a breakdown in trust between government and civil society. Looking at a society where that has not happened is really interesting.  Since I have been involved in government that breakdown of trust in the UK feels bad most of the time. However if we were to face a real pandemic, that trust would either be refound quickly or a lot of lives would be lost because it had broken down.


3 Responses to “Hong Kong, May day weekend – Sunday”

  1. Very interesting post! More thoughts on preparing for outbreaks here: Is “just-in-time” the best way for pandemic flu planning?

  2. The Chinese are nothing if not pragmatic;here business matters and what effects business effects life.

    The consequince of which is that pressure is immediatly put on the government of Hong Kong to react;they have learnt the lesson from previous complacency.

    I have lived in HK for three years and amazed at the safety stability of the place;hysteria ocasionally but only if it does not infringe on money making(my lap sap lady and I often disucss the next hot stock tip)

    Lat moth I attended a conference in Europe; each delegate was asked to explain the national characteristics of the countries in which they work.

    Mine was the Hong Kongees are “hard working. a little hysterical at times(without an umbrella I will get wet and die)but nevertheless a wonderfull place to live.

    My feeling as a heaklth profesional is that the HK goverment has taken enough steps to anticipate the impending pandemic.

    Interesting to see the ladies in Wachai with with tight short skirts and flu masks(ofcourse matching)

  3. Its a little over a month since my last posting;there are fewer masks in evidence on the strees of Hong Kong in spite of the evidence that the pandemic is evident.
    Are we simply conditioned to react and then when the situation become more settled we ease our concern? if the the situation is the same if not worse why do we react differently?

    The reason I think is that we over react and then settle simple by waiting.

    Does the flu medication make us more confortable?does it ease our concern about contracting the condition by making us believe that its at least possible to overcome the condition by medical means.

    There is an old English expression which is not easilly translated by goes something like “there is nought as queer as folk” and its not what you think it means.

    lee du ploy

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