Can public health research mitigate the air pollution epidemic in Hong Kong and the Pearl River Delta?

Abstract

The deterioration of air quality in Hong Kong shows a direct relationship with the expansion of infracture development and economic growth over a period of about 20 years. The purpose and aims of the public health sciences in this context are to develop relevant research questions, assemble appropriate high quality data, test hypotheses and interpret the findings in terms of their applicability to preventive environmental health strategies. The next step is a greater challenge: the translation of quantified risks into legislation, regulations and codes of practice which will demonstrably lead to health protection and the reduction of avoidable morbidity and mortality. Studies on pollution health effects in Hong Kong by the two university medical centres since 1989 have led to a substantive database and profile of the illness, lost productivity increased health care utilisation, life years lost and the economic burden on the whole community. The exposure prevalence approximates to 100% and is a major cause of inequity in lifetime health experience. One public health viewpoint is that progress towards the adoption of mandatory measures for pollution abatement, to stem the current epidemic of cardio-pulmonary and other health problems caused by air pollution, has been obstructed and delayed because of failure to develop a comprehensive multi-sectoral strategy to reduce the hazard of air pollutants. While it is clear that the problem is regional the Hong Kong SAR is in a strong position to lead and demonstrate the value of improved air quality. This dissonance between evidence-based science and advocacy and public policy is a clear signal that the public health function is not working well in Hong Kong. Proposals to further defer action on setting air quality standards pending a two-year review of the evidence, following the World Health Organization's 2006 consensus statement on Air Quality Guidelines, adds to the uncertainty of the value placed on local research and its place in policy making. Only a very small proportion of the research on air pollution and health in Hong Kong was funded from public sources. There now needs to be an urgent review of * the scarce funding available for environmental health research in relation to its manifestly high priority, and * the process by which evidence is assessed in the policy decision-making process, in relation to social need and equity on the one hand, and the influence of vested interests on the other