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This book provides a significant contribution to the discussions about the future of the system. The evidence-driven content draws from the deep expertise and experience of a wide spectrum of contributors, who represent virtually all relevant areas of the health system

Purpose. Assess the effectiveness of a two-step health education program by nurses delivered through nonsmoking mothers to help fathers of sick children quit smoking. Design. Randomized, controlled trial. Setting. General pediatric wards of four major hospitals in Hong Kong. Subjects. Nonsmoking mothers who had a live-in smoking spouse were recruited when they brought sick children to the hospital. A total of 752 mothers were randomized into the intervention arm and 731 into the control arm. Intervention. The intervention group received standardized health advice, behavior modification booklets, and a 1–week telephone reminder. The control group received usual care. Measurements. The main outcome measure was the quit rate (7–day point prevalence) of smoking fathers as determined by telephone follow-up with mothers at 3 and 12 months. Quit attempts and smoking reduction were secondary outcome measures. Results. At 3 months, more fathers in the intervention group had quit smoking (7.4% vs. 4.8%; p = .03), reduced daily cigarette consumption by 50% or more (30.6% vs. 22.6%; p < .001), and reported quit attempts (6.5% vs. 3.6%; p = .01). The differences were not statistically significant by 12 months. Conclusion. A simple health education intervention provided by nurses to mothers of sick children has a short-term effect in helping smoking fathers quit, reduce consumption, and trigger quit attempts. Future studies should confirm the longer-term sustainability of the effect.

Universal health coverage (UHC) has been identified as a priority for international development by the G20, the World Health Organization, and the United Nations General Assembly. Since it was explicitly incorporated into the sustainable development goals (SDGs) as target 3.8, much effort has been expended on promoting UHC. Here we focus on four areas that, on current trajectories, are unlikely to achieve sufficient progress to meet the target. These are also areas for which G20 can provide substantial leverage: the principle of "leaving no one behind," particularly in migrant health and genuine support for primary care; reliable domestic financing, which requires enlightened leadership and deliberate dialogue between finance and health sectors; harnessing and regulating medical and technological innovation; and mutual learning and harmonised aid among donor countries. We call on G20 leaders, who will meet in Osaka in June 2019, to take concrete action on these issues. This article is based on a policy brief prepared by a working group convened by the Government of Japan as host of the Think 20 summit in Tokyo in May 2019.1 Our work has received input from a wide ranging global group of thought leaders, some of whom represent civil society, including patients and the general public.

Abstract Background Hong Kong's rapidly ageing population, characterised by one of the longest life expectancies and the lowest fertility rate in the world, is likely to drive long-term care (LTC) expenditure higher. This study aims to identify key cost drivers and derive quantitative estimates of Hong Kong's LTC expenditure to 2036. Methods We parameterised a macro actuarial simulation with data from official demographic projections, Thematic Household Survey 2004, Hong Kong's Domestic Health Accounts and other routine data from relevant government departments, Hospital Authority and other LTC service providers. Base case results were tested against a wide range of sensitivity assumptions. Results Total projected LTC expenditure as a proportion of GDP reflected secular trends in the elderly dependency ratio, showing a shallow dip between 2004 and 2011, but thereafter yielding a monotonic rise to reach 3.0% by 2036. Demographic changes would have a larger impact than changes in unit costs on overall spending. Different sensitivity scenarios resulted in a wide range of spending estimates from 2.2% to 4.9% of GDP. The availability of informal care and the setting of formal care as well as associated unit costs were important drivers of expenditure. Conclusion The "demographic window" between the present and 2011 is critical in developing policies to cope with the anticipated burgeoning LTC burden, in concert with the related issues of health care financing and retirement planning.

Abstract Background Different smoking cessation programmes have been developed in the last decade but utilization by the elderly is low. We evaluated a pilot mobile smoking cessation service for the Chinese elderly in Hong Kong and identified predictors of quitting. Methods The Mobile Smoking Cessation Programme (MSCP) targeted elderly smokers (aged 60 or above) and provided service in a place that was convenient to the elderly. Trained counsellors provided individual counselling and 4 week's free supply of nicotine replacement therapy (NRT). Follow up was arranged at 1 month by face-to-face and at 3 and 6 months by telephone plus urinary cotinine validation. A structured record sheet was used for data collection. The service was evaluated in terms of process, outcome and cost. Results 102 governmental and non-governmental social service units and private residential homes for the elderly participated in the MSCP. We held 90 health talks with 3266 elderly (1140 smokers and 2126 non-smokers) attended. Of the 1140 smokers, 365 (32%) received intensive smoking cessation service. By intention-to-treat, the validated 7 day point prevalence quit rate was 20.3% (95% confidence interval: 16.2%–24.8%). Smoking less than 11 cigarettes per day and being adherent to NRT for 4 weeks or more were significant predictors of quitting. The average cost per contact was US$54 (smokers only); per smoker with counselling: US$168; per self-reported quitter: US$594; and per cotinine validated quitter: US$827. Conclusion This mobile smoking cessation programme was acceptable to elderly Chinese smokers, with quit rate comparable to other comprehensive programmes in the West. A mobile clinic is a promising model to reach the elderly and probably other hard to reach smokers.

OBJECTIVES: This study aims to explore the attenuated impact of reported avoidance behaviours adherence on the transmission of COVID-19 through cross-sectional surveys in Hong Kong, in order to make up for the lack of research on avoidance behaviours fatigue. DESIGN: 40 cross-sectional telephone surveys. SETTING: All districts in Hong Kong. PARTICIPANTS: 31 332 Cantonese or English-speaking participants at age of 18 years or above. METHODS: We collected data on behaviours and estimated the average effective reproduction number ([Formula: see text]) among the Hong Kong adult population during the COVID-19 epidemic wave in November–December 2020 and compared with the preceding epidemic in June–July 2020. RESULTS: We observed a reduction in adherence to voluntary avoidance behaviours due to pandemic fatigue, but continued adherence to regulated avoidance behaviours. The average [Formula: see text] during the post-work from home period was higher in November–December wave with estimated [Formula: see text] of 0.81 (95% CI: 0.75 to 0.87) compared with the June–July wave with an [Formula: see text] of 0.67 (95% CI: 0.60 to 0.75). CONCLUSIONS: The declined effectiveness of social distancing interventions in reducing COVID-19 transmission was associated with fatigue with voluntary avoidance behaviours in Hong Kong population, implying a need for the government to reinvigorate the public to maintain effective pandemic control.

The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. To facilitate cross-country learning, this Health Policy paper uses an adapted framework to examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (ie, Germany, Norway, Spain, and the UK). This comparative analysis presents important lessons to be learnt from the experiences of these countries and regions. Although the future of the virus is unknown at present, countries should continue to share their experiences, shield populations who are at risk, and suppress transmission to save lives.

The article compares the incidence of public healthcare across 11 Asian countries and provinces, testing the dominance of healthcare concentration curves against an equal distribution and Lorenz curves and across countries. The analysis reveals that the distribution of public healthcare is prorich in most developing countries. That distribution is avoidable, but a propoor incidence is easier to realize at higher national incomes. The experiences of Malaysia, Sri Lanka, and Thailand suggest that increasing the incidence of propoor healthcare requires limiting the use of user fees, or protecting the poor Effectively from them, and building a wide network of health facilities. Economic growth may not only relax the government budget constraint on propoor policies but also increase propoor incidence indirectly by raising richer individuals' demand for private sector alternatives.

Human behaviour is complex and multifaceted, and is studied by a broad range of disciplines across the social and natural sciences. To mark our 5th anniversary, we asked leading scientists in some of the key disciplines that we cover to share their vision of the future of research in their disciplines. Our contributors underscore how important it is to broaden the scope of their disciplines to increase ecological validity and diversity of representation, in order to address pressing societal challenges that range from new technologies, modes of interaction and sociopolitical upheaval to disease, poverty, hunger, inequality and climate change. Taken together, these contributions highlight how achieving progress in each discipline will require incorporating insights and methods from others, breaking down disciplinary silos.