“Diversity is an indispensable value that promotes a healthy development of a society. Yet, it is something that we are missing right now in Hong Kong,” commented Dr Ning Fan, Chairman of Health In Action (HIA), a humanitarian organization with the vision to eliminate health inequity in societies.

Fan observed a worrying trend in recent years that people tend to define the identity of Hongkongers based on skin colours. “What is more disturbing is they tend to accept or even welcome the Westerners to be Hongkongers, while rejecting the ethnic minorities from Southeast Asia or Middle East,” said Fan.

Although Hong Kong is often depicted as an affluent and international city, ethnic minorities, as well as asylum seekers and refugees (ASRs), still encounter all forms of health inequities in accessing healthcare services.

“We understand empathy is a prerequisite for being a healthcare professional. However, if empathy has a limit to certain races, it is no longer genuine,” expressed Fan.

In this exclusive interview with MIMS, Dr Ning Fan, Chairman of Health In Action (HIA), a humanitarian organization with the vision to eliminate health inequity in societies, illustrated the health care disparities amongst ethnic minorities and ASRs in Hong Kong, and the vision of HIA in reaffirming the principle which the WHO also proclaims: Health is a fundamental human right that every human being shall enjoy.

Patient-doctor communication remains the primary hurdle

Health care disparities arise from all kinds of systemic barriers. Language barrier is one of them.

According to a letter submitted by the Hospital Authority (HA) to the Legislative Council (LegCo) in 2014, interpretation services are provided in public hospitals and clinics of the HA through Hong Kong TransLingual Services (HKTS), part-time court interpreters, volunteers and consulate offices. However, as pointed out by Fan and HIA’s NGO partners, many of the ethnic minorities and ASRs are not aware of their rights to request these services.

“We have noticed some people wandering in hospitals and clinics, asking some ethnic minorities if they need interpretation services. Some of them have unknowingly paid these unqualified personnel as interpreters,” shared Fan.

Even though healthcare professionals know they can help patients request interpretation services, some of them ask patients to bring their own relatives or friends as interpreters instead, in order to save time and efforts.

“There was a case when a husband acted as the interpreter for his wife. Later, we found out the woman had been suffering from domestic violence and the husband had been hiding the truth,” recalled Fan. “Medical interpretation is a professional service. Even though patients’ relatives or friends can communicate in Chinese, it doesn’t mean that they fully understand the medical terms. Healthcare professionals should understand that the role of a professional interpreter cannot be replaced,” Fan emphasized.

The language barriers also exist before and after the medical consultation. Prior to consultation, ethnic minorities and ASRs face difficulties in booking appointments. The telephone system for booking general out-patient clinic (GOPC) appointment is only available in Cantonese and English. After patients receive medications after the consultation, they also find it difficult to follow the correct administration since the drug labels are printed in either Chinese or English.

Pharmacist delivering talk on appropriate medication use for Nepalese elderlies.
Pharmacist delivering talk on appropriate medication use for Nepalese elderlies.

Additionally, since interpretation services cannot be made available within 24 hours, it means ethnic minorities and ASRs can only visit GOPC without the help from interpreters. In view of this, HIA suggests HA to establish medical interpretation as standard service – such as setting as default in the Alert Box of its Clinical Management System (CMS) and stationing in-house medical interpreters in clusters with high ethnic minorities patient load.

HIA also organises trainings for the interpreters under HKTS. “Same as any other healthcare professionals, these interpreters also need to refresh and update their medical knowledge. That’s why we organise training for them every half year,” explained Fan.

Cultural difference affects health care quality and patient outcomes

Apart from language barriers, cultural difference is another factor contributing to healthcare disparities. Although HA provides trainings to enhance cultural sensitivity, these trainings are not compulsory, and not many healthcare professionals are aware of these trainings.

The challenge in promoting healthy diets for ethnic minorities and ASRs is one example resulting from cultural difference. “Most of them prefer to adhere to their traditional styles of food preparation. If we stick to our usual way to simply advise them not to consume ingredients that are high in fat, cholesterol, salt or sugar, they would have nothing to eat,” explained Fan.

Nutritionist delivering healthy cooking workshop for working poor family ladies in Kwai Tsing District.
Nutritionist delivering healthy cooking workshop for working poor family ladies in Kwai Tsing District.

Cultural difference may even affect clinical judgement. “The Nepalese community believes and accepts a wide variety of religions, ranging from Hinduism, Buddhism, Tantrism to Islam and Christianity. In their practice, it is normal for them to communicate with the gods. However, in our practice, if we don’t understand their beliefs, we may diagnose them as patients with schizophrenia,” said Fan.

Discrimination due to misunderstanding

Besides affecting patient outcomes, misunderstanding may also lead to discrimination. “To assist ASRs in accessing medical care in public hospitals and outpatient clinics, we have recruited and trained a team of university students to provide escort service. During the escort, we received feedback from some healthcare professionals that ASRs were wasting taxpayers’ resources. Some members of the public even suggested us to prioritize Hong Kong citizens over these people,” Fan shared.

On the contrary, Fan pointed out taxpayers will ultimately suffer if underprivileged populations suffer from poorer health outcomes due to our lack of care and attention. “The local ethnic minorities are holders of Hong Kong identity card. They should have equal access to healthcare just as we do, since they are also one of us,” he emphasized.

On the other hand, according to the Operations Circular No. 10 / 2013 issued by HA, ASRs are entitled to the government’s medical services on a case-by-case basis.

“Some healthcare professionals do not know the government does offer ASRs medical care as long as they remain in Hong Kong, regardless of the status of their applications or claims. Sometimes, on top of the supporting documents to verify their status as ASRs, we also need to present the HA’s Operations Circular to prove that ASRs have these rights,” explained Fan.

ASRs in need of mental health support

Since ASRs often have to flee their homeland due to fear of lives or persecution within a short period of time, their psychological well-being is extremely fragile. In particular, for asylum seekers, even when they have arrived a safe destination, they still live under the uncertainties that one day they might be returned to their country of origin.

Psychiatric nurses delivering holistic health workshop for asylum seekers and refugees.
Psychiatric nurses delivering holistic health workshop for asylum seekers and refugees.

This situation deteriorated when the so-called “bogus refugees” made headlines in recent years. Fuelled by the sensational media coverage, ASRs in Hong Kong are usually isolated and excluded from the local community. “I believe there are ‘bogus refugees’ in Hong Kong, as in anywhere else around the world. This doesn’t mean there are no ‘real’ ones, nor does it mean we can stop caring for the ASRs,” commented Fan.



HIA conducted a mental health needs assessment on 37 ASRs in 2013. Results showed that over 50 percent of ASRs scored mild to extremely severe in each of the mental health categories, namely depression, anxiety and stress. Another study conducted jointly by HIA and the Chinese University of Hong Kong in 2016 also showed similar results. Of the 129 survey participants, around 90 percent were found to have mild to severe depression.



In 2015, HIA launched a Women Empowerment Programme and organized health and wellness workshops for female ASRs. Even though the sample size was small, the significant reduction in risk of depression highlighted the importance of social inclusion and involvement as a crucial factor in improving mental health. 

Continuous efforts to achieve equal healthcare for all

Apart from its own projects, HIA has also submitted their suggestions to LegCo’s Subcommittee on Rights of Ethnic Minorities on the use of healthcare services earlier this year.

“Many of the symptoms we see nowadays arise from social issues, such as stress due to long working hours and poor living conditions,” said Fan. “I believe knowledge is power. Healthcare professionals like us possess the power to not just treat patients’ diseases, but also initiate institutional improvement and cure the society as a whole.” MIMS

About Health In Action (HIA):

HIA is a humanitarian organization established in 2011 in Hong Kong. Apart from ethnic minorities and ASRs, HIA also focuses on the health inequities faced by local working poor families, who often prioritise generating income to attain household livelihood over pursuing sustainable and healthy body-mind functions. Their work is rooted in the core belief that every human being has the right to health. They offer support to people based on health needs, irrespective of race, religion, gender or political affiliation. HIA wishes to drive social change through cycles of service, research, and advocacy. HIA is also active in advocating for community-based primary care in health policies through channels such as the Hong Kong Council of Social Service (HKCSS) and social media. HIA is a registered charity in Hong Kong and is a member of the Hong Kong Council of Social Service.

For more information, please visit HIA’s website or their Facebook page.

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Sources:
http://www.info.gov.hk/gia/general/201410/15/P201410150649.htm
http://www.legco.gov.hk/yr16-17/chinese/hc/sub_com/hs52/papers/hs5220170508cb2-1315-5-ec.pdf