Severe acute respiratory syndrome: a challenge for public health practice in Hong Kong.(Evidence Based Public Health Policy And Practice)

Severe acute respiratory syndrome (SARS) is now a global challenge affecting more than 8000 patients in different continents. The dictum of public health practice especially for infectious disease is "prevention better than cure". It is especially true for SARS as the treatment strategies remain diverse and experimental. Maintaining a healthy and hygienic environment can be one of the effective public health measures to combat infectious disease. The major challenge is that some of the most important public health measures are to be taken outside the health sector. The community also needs to be strengthened and equipped with the health skills to promote better health and hygiene. There is also the need to create a supportive environment conducive to health for long term sustainability. The WHO approach of promoting health through setting approach would be one possible solution to Face the challenge. This paper will describe some of the public health initiatives in Hong Kong through "setting approach" and "community development model" in helping the society fight against SARS. With the emergence of SARS, this might be the time to globalise public health medicine as an important component of medical practice.

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Severe acute respiratory syndrome (SARS) was diagnosed in more than 1800 patients in 17 countries (including the United States and Canada) within two months (between 1 February and 31 March 2003). (1 2) At the time of writing (20 June 2003), there was a cumulative total of 8416 probable cases and 804 deaths that have been reported from 29 countries (1755 cases in Hong Kong with 296 deaths *). On 12 March the WHO issued a global alert about SARS. Case studies in Hong Kong and Canada make it quite clear that SARS is an infectious disease. (3 4) Epidemiological investigations and laboratory studies have identified the novel coronavirus playing an aetiological part of SARS. (5 6)

The impact of SARS on the world is still unclear at this stage but it is becoming a global hazard with its alarming high infectivity. SARS has spread throughout the world because people can be exposed in one place and be half a world away a day later when they become symptomatic. The outbreak has prompted the hospital authority and the department of health of Hong Kong to implement series of public health measures and hospital policies for the diagnosis and management of patients with SARS. (7) SARS is an emerging infectious disease, and treatment strategies remain diverse and experimental as inclusion of control patients is neither possible nor ethical. (8) It has been shown that the practice of droplet precaution and contact precaution is adequate in significantly reducing the risk of infection after exposure to patients with SARS. (9) Therefore good public health practice in developing similar precaution at community level would also help to reduce the risk of infection in the community.

WHAT SHOULD BE EFFECTIVE PUBLIC HEALTH PRACTICE?

Many diseases, including infectious disease can be prevented through self care and self help. Individual citizens should take the responsibility to keep the home environment and public utilities clean and healthy as a long term solution to combat against infectious diseases, and promoting better health and hygiene. The WHO launched the Ottawa Charter for Health with a strong emphasis on strengthening community action, creating a supportive environment, and developing personal skills to promote health. (10) The charter …