Hong Kong Academy of Medicine Conference & Hong Kong Primary Care Conference 2019
Co-organised by the Hong Kong Academy of Medicine and the Hong Kong College of Family Physicians

平等機會委員會主席朱敏健先生致辭 (只備英文版)


Good afternoon. I would like to thank the Hong Kong Academy of Medicine for inviting me to speak at the conference today. This is a wonderful occasion for us – the Equal Opportunities Commission or EOC in short – to let you know who we are, and more importantly, why we believe there is still work to be done to promote inclusive healthcare in Hong Kong.

Indeed, the EOC cherishes every opportunity to engage in dialogue with professional sectors such as yours. After all, diversity, inclusion and equality – these are universal values, and our advocacy wouldn’t be complete without the commitment and hard work of each and every one of you. 

So without further ado, let’s dive right in and ask ourselves a fundamental question: why does the medical industry need to talk more about equality? Here I would like to show a video of Tin Shui Wai hospital, filmed in early 2018. You may begin to understand the importance of this question after watching this video. So let’s sit back and see what it is about. 

The video raises an important issue – are the healthcare facilities in Hong Kong accessible to persons with disabilities? If tactile paths at hospitals are blocked by security kiosks, and the audio signals of elevators are too weak to be detected, persons with visual impairment obviously cannot benefit from healthcare services on an equal basis with others. 

Indeed, access to healthcare services is not always equal for everyone. In 1995, when the Government announced its proposal to expand services of a clinic in Kowloon Bay to include a treatment centre for persons with HIV/AIDS, residents from the neighbouring Richland Gardens fired up in protest, putting up banners, blocking roads to the clinic, and confronting patients and healthcare workers. 

The EOC conducted an investigation in 1999 and later initiated proceedings at the District Court on behalf of the aggrieved persons. A settlement was reached in the end. Still, the incident shows clearly that stigma, prejudice and misconceptions can have a very tangible and devastating effect on access to healthcare.

The same can be said about opposition among residents to the construction of mental health facilities in their neighborhood. Buying into myths about mental illness, they associate people affected by mental health issues with violence, and spread ungrounded fears about threats to their family’s safety. This has often led to delays in the siting of mental health facilities in Hong Kong.

In 2010, a District Councillor in Tuen Mun put up banners after learning of the Government’s plan to set up an Integrated Community Centre for Mental Wellness (ICCMW) at Wu King Estate in Tuen Mun. They read, “We demand that the Centre move away from Wu King Estate.” A citizen took the case to court. It was ruled that the District Councillor had committed “vilification” under the Disability Discrimination Ordinance – by inciting hatred in public with this banner. The Defendant was ordered to pay nominal compensation of HK$1 to the Plaintiff.

Again, cases like this are a sobering reminder of the fact that the medical profession is NEVER isolated from the social, cultural and political context in which it operates. Issues like discrimination and stigmatisation affect the healthcare industry more than some may imagine, and we have to deal with them one way or the other. 

Which leads me to the role of the EOC. The EOC is a statutory body established in 1996 under the Sex Discrimination Ordinance. We are funded by the Government, but we have high autonomy over how to use our funds in implementing the anti-discrimination laws. Currently, Hong Kong has four anti-discrimination ordinances in place, namely the Sex Discrimination Ordinance (SDO), the Disability Discrimination Ordinance (DDO), the Family Status Discrimination Ordinance (FSDO), and the Race Discrimination Ordinance (RDO).

The law prescribes the functions we perform. Essentially, they are about: eliminating discrimination; promoting equal opportunities; investigating complaints; and reviewing the law on a regular basis. Underlying all these is a vision we have always held dear: to build a pluralistic and inclusive society where there is no discrimination, and no one is barred from enjoying equal opportunities in all areas of life, including receiving healthcare.

Allow me to quickly introduce how the anti-discrimination ordinances work. Discrimination is a civil offence, and it is unlawful only when it takes place in the domains stated in the law, such as provision of goods, services and facilities, employment, education, etc.

Another factor is the ground of discrimination, i.e. the characteristic on which discrimination is based. For instance, the DDO outlaws discrimination based on a disability; and the RDO covers race, colour, descent, ethnic origin and national origin.

It must be noted that “disability” is defined broadly under the DDO. Besides the obvious examples such as mobility difficulties and visual or hearing impairments, the definition covers diseases (e.g. cancer); any illness that affects a person’s emotions (e.g. depression); learning difficulties (e.g. autism); and the presence of disease-causing organisms (e.g. HIV). The DDO also outlaws discrimination based on a disability that previously existed or is perceived to exist (i.e. imputed to a person). 

Here I won’t bore you with details about what constitutes an illegal act under the ordinances. But I do want to highlight sexual harassment, as it has consistently accounted for a significant portion of the complaints we handled under the SDO. I am guessing quite a lot of you here are owners of clinics or other healthcare facilities – as employers, you do have a stake in this because under the SDO, employers may be held vicariously liable for sexual harassment committed by employees, unless you can prove that you have taken preventive measures. I shall return to this later with more details. 

One of the major functions of the EOC is to enforce the law and handle complaints lodged under the anti-discrimination ordinances. Complaints under the DDO have consistently accounted for a large portion of the cases we handled. A significant number of these cases were related to difficulties in applying for sick leave or medical leave in employment settings and access to premises in non-employment settings.

We do receive complaints directly related to medical services from time to time. And as you can see, over the past three years, the number has been on the rise. These cases involve a variety of issues, from alleged sexual harassment during medical exams and lack of sensitivity among frontline staff towards patients to dismissal of employees on the suspected ground of his or her disease. What these figures indicate is a need for medical professionals and healthcare workers alike to be more alert to discrimination and harassment in the sector. 

A good place to start is to ask yourselves the following questions:

  • As an employer, are you recruiting, managing and promoting your staff based on their merits alone, instead of their gender, marital status, pregnancy or family responsibilities? Do you appreciate the talents of people with disabilities, and the contribution they can make to the workplace?
  • As an educator, are you aware of any discriminatory practices in student admission and assessment?
  • As the owner or manager of a healthcare facility, do you know the difference between inaccessible and barrier-free designs?
  • As the provider of healthcare services, are you ensuring that all patients can use your services on an equal basis, regardless of their race or disability? 

For my presentation today, I will focus on the last two parts, as they have direct implications for how inclusive our healthcare system is.  

Let’s ponder that question from the perspective of persons with disabilities first. A longstanding concern we hear from them is that some of the healthcare facilities in Hong Kong are inaccessible, as shown in the video at the beginning.

Elevated clinic entrances that do not come with a ramp, doors to the doctor’s room that are too narrow… these are examples of the barriers that wheelchair users and other people with mobility difficulties have to face from time to time. 

People with visual impairment have their share of challenges too, e.g. the absence of tactile paths on the way to clinics and other healthcare facilities, the absence of Braille text on door and room signs inside the facility, etc. 

The problem is not limited to navigation only. Not all models of medical equipment incorporate the concept of universal design, i.e. design that suits the needs of a diverse spectrum of users, from PWDs to children and the elderly. Take dental chairs as an example – certain models are not accessible to wheelchair users. Gynaecologists, too, are not always conscious of the needs of patients with disabilities, who cannot get on to examination chairs with limited height adjustability. 

So inadequate hardware support is one problem. Another problem is the lack of sensitivity among some frontline healthcare workers towards PWDs. In 2017, a 32-year-old man with hearing impairment was mistakenly transferred from Tuen Mun Hospital to the psychiatric hospital at Castle Peak and spent six days there after a quarrel with his mother. It cost him his job – he was fired for absence from work – and it was the result of poor communication with police officers and medical staff, who apparently did not make any attempt to seek help from a sign language interpreter.  

At the EOC, we are committed to tackling this lack of accommodation and awareness through law enforcement and education. In 2010, we released a report on a Formal Investigation into the accessibility of 60 public premises owned or managed by the Government, the Housing Authority, the Hong Kong Housing Society and Link Asset Management Ltd. It prompted the Government to roll out a $1.3-billion retrofitting programme to enhance 3,500 premises and facilities.

To this day, we continue to address accessibility cases through our complaint-handling work. We also conduct sensitivity and anti-discrimination training for employers and employees in the healthcare industry, in order to inform them of practical ways to accommodate the needs of PWDs.

As I mentioned at the beginning, disinformation and stigma around mental illness are not uncommon even in today’s Hong Kong. This bears upon access to mental health support or services in at least two ways. First, employees with mental health issues sometimes have difficulty in applying for leave to attend medical appointments or sick leave when they need to rest. This is partly due to misconceptions among some employers, who may perceive depression and other mental illnesses as “character flaws” rather than genuine diseases. 

Second, while most of us may not object to the importance of mental health facilities, a “NIMBY” mindset – the idea that such facilities should be built but “not in my backyard” – remains prevalent. As I said, this has contributed to delays in the construction of Integrated Community Centres for Mental Wellness (ICCMWs) in certain districts, which is really everyone’s loss, because these centres not only serve people recovering from mental illness, but also their carers, children, people who feel they may be having mental health issues, as well as regular residents of the neighbourhood. 

To dispel myths about mental illness and champion accommodation measures in the workplace, the EOC has organised seminars targeted at employers and HR practitioners over the years. We also collaborate with NGOs every year on “Mental Health Month”, a citywide public education campaign in October featuring competitions, surveys and talks, all aimed at removing stigma and promoting the message that “mental health is everyone’s business.” 

We recently commissioned a study to further gauge the severity and different forms of stigmatisation and discrimination experienced by people with mental health issues in employment settings. We are expecting to publish our findings next year.  

Meanwhile, labelling and shaming cultures affect those living with HIV as well. The courage to seek help, the willpower needed to continue with the regimented treatment may weaken with every frown from a frontline care worker. The EOC recognises the debilitating effects stigma could bring to a person’s well-being, and so, through our Community Participation Funding Programme, we have supported different NGOs to roll out awareness campaigns over the years. In 2012, for instance, we partnered with Hong Kong AIDS Foundation on a TV promotional segment [an “API” – Announcement of Public Interest], celebrating the message that people with HIV can live a fruitful life just like anyone else. 

Another concern voiced by NGOs serving people with HIV relates to access to medication for arrested persons during their detention. I am not the medical expert here, but I do know that “cocktail” therapy only works when the medication is taken at designated times of the day with just the right dose, i.e. there is an extremely strict regimen. 

Now, here's the problem: currently, there are only three Government-run clinics offering the medication, and they usually close around 5pm. When a person with HIV is arrested and detained, he or she may face one of the following scenarios: (1) the police officer in charge does not know or believe that only three Government clinics offer the medication, and he or she insists on taking the detainee to the clinic closest to the police station; or (2) if it is past 5pm and the detainee suggests going home to pick up the medication or taking the medication that he or she has brought along before the arrest, the police officer would refuse the request in accordance with the general guideline.  

Evidently, this is a serious problem that may cause irreversible harm to people with HIV who get arrested and detained. To follow up on this issue, we have helped the NGOs establish contact with relevant units in the Police Force, and we will continue to keep in touch with these stakeholders to ensure progress is made.  

I would now like to turn to another marginalised community who also faces challenges in accessing healthcare. We all know that being able to communicate one’s health problems and understand the doctor’s diagnosis and recommendations on treatment is critical in healthcare. Yet, some members of the ethnic minority (EM) communities in Hong Kong do not speak or understand Cantonese or even English. While interpretation services are available for hospitals and out-patient clinics within the Hospital Authority network, awareness about the service and the procedure involved in asking for that service remains low.

Based on our outreach experience with EMs in Hong Kong, it appears that: relatives, children and strangers are often called upon to interpret for EM patients; requests for interpretation service are not always acceded to by frontline staff; EM patients are always at a loss for their first appointment, as staff rarely take the initiative to ask if they require interpretation service, shifting the burden of awareness onto the patient; the problem is further compounded in cases within the Accident and Emergency (A&E) unit, where the patient often arrives without an appointment and the medical staff are working under intense pressure.

What is more, poverty in Hong Kong shows a disproportionate pattern among EMs – one in every five EM households in Hong Kong lives below the poverty line, according to a Government report in 2017. This has no doubt further limited their healthcare options.  

NGOs serving asylum seekers have also pointed out a unique predicament facing this vulnerable group in our city. Frontline workers in public services are often unfamiliar with the identification documents issued by the Immigration Department to asylum seekers (called “recognizance papers”) who are awaiting decision on their claims for refugee status and non-refoulement. In consequence, asylum seekers are sometimes denied access to healthcare services, for which they are officially eligible.

Besides sensitivity training for healthcare workers – which the EOC has been conducting for years now – there is an urgent demand for professional interpreters who are fluent in Cantonese, English and languages commonly used by ethnic minority communities in Hong Kong, such as Nepali, Punjabi, Bahasa Indonesia, Tagalog and Hindi. We believe a formal list of accredited interpreters and translators, recognised by service providers across various industries, would go a long way towards helping us meet that demand and ensure equal access to services for ethnic minorities. As a first step to making that happen, we have been looking into different accreditation models in other regions, and we will soon wrap up the study. 

As for lifting EMs out of poverty and empowering them to access better healthcare, gainful employment is the key. We therefore need to make employers realise the benefits of having a diverse workforce. With that in mind, the EOC launched the Racial Diversity & Inclusion Charter for Employers in August last year. To date, close to 100 organisations have signed the Charter, pledging to adopt best practices for creating a racially diverse and inclusive workplace. Signatories are entitled to feature a special logo in their job ads and marketing collaterals.

We have also leveraged our networks to advance job-matching opportunities for EMs, such as connecting the Hospital Authority with NGOs to introduce job positions to EM students. 

When it comes to promoting inclusive and “people-centred healthcare” – the theme of the conference this year – we must not forget victims of sexual harassment and violence, specifically whether the support system currently in place might force them to relive their trauma.

A key factor is to minimise the distress caused by repetitive requests for information, which is why certain NGOs have called on the Government to set up a 24-hour, one-stop support centre at hospitals for sexual assault victims, where they can get timely treatment, report the incident to the police and allow medical examiners to collect evidence (if criminal acts are involved), and meet with counsellors in one go. 

In addition, employers in the healthcare sector also need to review their own policy and mechanism for handling sexual harassment complaints – both from their employees and service users. Is there a written, widely publicised policy? Is the contact of the complaint-handling personnel included in that policy? Is there a procedure in place to ensure all complaints are dealt with in an impartial, confidential and timely manner? Do employees know what constitutes sexual harassment under the SDO, to begin with? 

As I mentioned earlier, employers may be held vicariously liable for sexual harassment committed by employees, unless you have adopted proven preventive measures, such as formulating a comprehensive anti-sexual harassment policy and providing training to new recruits and refresher sessions to existing staff.

Indeed, over the years, the EOC has been working closely with relevant Government departments and agencies to offer tailored training for medical professionals and healthcare practitioners, to help them put together these policies and equip their staff with relevant knowledge. 

To step up our effort in safeguarding the interests of sexual harassment victims, we are also planning on setting up a dedicated unit within the Commission. Part of its work would be exploring collaboration with NGOs to establish a one-stop support platform – services may include a dedicated 24/7 hotline, referral to therapy and counselling support, and advice about the law, how and where to file a complaint, etc. 

Notwithstanding the EOC’s effort to eliminate discrimination on the grounds of sex, disability, family status and race, there are areas uncovered by the law. The four ordinances I introduced at the beginning of my presentation do not offer protection against discrimination on the grounds of sexual orientation, gender identity, intersex status, age or residency status. In other words, they do not offer an avenue for redress when, for example, LGBTI individuals, the elderly and new immigrants are refused or delayed healthcare services because of discrimination. These are protection gaps, plain and simple, and the EOC will continue to identify and advocate legislative and other measures to fill these gaps.

As you can see, the work of the EOC has always involved the medical sector one way or the other. And one of our longtime strategies in addressing discrimination and harassment in the sector is to gather data through research, so that we can come up with evidence-based recommendations for legal or policy reform. Allow me to explain this by way of a study we published back in early 2014, about sexual harassment faced by workers in service industries. We collected more than 470 questionnaires from workers from the healthcare, nursing, retail and catering industries – nearly one-fifth of the respondents had been sexually harassed in the 12 months prior to the survey. The harassers not only included co-workers, but also customers.  

The problem was, at the time the SDO did not outlaw sexual harassment by customers against service workers. There was an obvious gap in the law, which is why we recommended that the Government amend the SDO by providing protections from sexual harassment by customers against providers of goods, services or facilities. The Government listened – and they introduced the Sex Discrimination (Amendment) Bill that same year. The Bill was passed at the Legislative Council in December 2014.  

Another example of our empirical research is a study we released in May this year, about the factors behind the successful siting of ICCMWs. It consisted of an extensive review of consultation mechanisms in different jurisdictions, as well as in-depth interviews with service users, NGOs, resident representatives, District Councillors and Government officials. 

The report offered many recommendations, from setting a standard, three-phased timetable for consultation capped at 18 months and devising a clear guideline for the consultation process, to revising the Hong Kong Planning Standards and Guidelines to minimise labeling effects on mental health facilities. We recently met with the relevant Government departments, including the Social Welfare Department and Planning Department. They have agreed to further study our recommendations and explore ways to implement them.

Besides research and advocacy targeted at stakeholders, the EOC recognises that the message of inclusive healthcare needs to reach each and everyone of the local community in order to take root. And so, public education has always been an integral part of our overall strategy.  As I mentioned earlier, the EOC has a funding scheme called “Community Participation Funding Programme”. It supports projects by NGOs and community groups designed to promote equal opportunities in Hong Kong under the four anti-discrimination ordinances. Each successful applicant will receive a maximum of HK$50,000 to implement their idea. To date, close to 1,200 projects have benefitted. 

The website I am showing here – “Putting Brains in Muscles” – is one of the initiatives funded by the progrmame, and jointly organised by the Hong Kong Society of Neuromuscular Diseases and the Accessible IT Development Association. Launched recently, it positions itself as an accessible online education platform on eight common neuromuscular diseases, featuring information on diagnosis, treatment and care. People with neuromuscular diseases were also employed to assist in the design and development of the website. The platform therefore is useful not only as a source of factual information, but also as a means to promote understanding and inclusion.

In addition, the EOC has been leveraging a wide variety of media and platforms to spread the message of inclusion over the years. We have worked with RTHK in the past, for instance, to broadcast several seasons of TV drama series based on cases of discrimination and harassment, including scenarios where employees get demoted or dismissed from work after returning from medical leave.  

We have also been collaborating with Radio 1 and Radio 2 of RTHK to roll out radio promotion campaigns, featuring guest interviews and segments about the anti-discrimination ordinances. In March this year, for example, we invited Prof Eric FONG and Prof Roger CHUNG from CUHK to go on our programme “Equal Opportunities Diversity Project” on Radio 2 and talk about the findings and recommendations in their study on the health and employment conditions of foreign domestic workers in Hong Kong. 

And of course, we reach out to the community through print media, social networking platform and public events as well. 

Before I end, I would like to stress that it is essential for medical professionals and healthcare workers to constantly maintain a high level of self-awareness with regard to equality and inclusion. Throughout history, medicine, as well as other sciences, has been used and abused to rationalise oppression of minority groups, from Jews who were called an “inferior” race and persecuted in Nazi Germany, to LGBT individuals whose orientation or identity needs to be “inborn” or have a “scientific reason” in order to be justified, whereas the burden of explanation never falls on their heterosexual and cisgender counterparts. 

How you practise your knowledge can have far-reaching impact on the well-being of those living on the margins of our society. Healthcare, as a basic right and one of the most important factors of a society’s sustainable development, must be made available and equal for all.

Our vision is simple: we hope everyone can enjoy healthcare at ease. And it all comes down to having the right attitude, with all of us here making an effort, enhancing our awareness and sensitivity, and embracing all members of society.

Thank you once again for giving me the opportunity today to introduce the EOC’s work and talk about how the healthcare sector can contribute to our vision. I look forward to answering any questions you may have, and hearing your thoughts about how we can synergise our efforts to make equality a reality in Hong Kong. Thank you very much.