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We have also arrived at a stage where communicable diseases including dangerous ones which used to plague us are well under control or eradicated. Certainly, major epidemics of such diseases are now events of the past. Dreaded diseases such as smallpox and plaque are non-existent, while indigenous malaria and poliomyelitis, diphtheria and other communicable diseases of childhood are no longer the threats that they were previously. Even in the case of our old enemy, tuberculosis, the notification rate has fallen from over 315 per 100 000 population in 1966 to 175 in 1976 and further dropped to 134 in 1986. Ita mortality rate has also declined substantially and the corresponding figures are 42, 13 and 7 per 100 000 population for the years 1966, 1976 and 1986. This picture is also the more significant if we were to consider that in many parts of the world and even among our immediate neighbours many of these diseases still occur in endemic or epidemic proportions. Our success in this area has been largely due to the maintenance of constant and vigorous anti-epidemic and disease surveillance measures, development in preventive and personal health services and general improvement in the socio-economic conditions of the population over the years.

This progress is further reflected in the highly satisfactory internationally recognised health indices which are good indicators generally of socio-economic progress, improvement in the environnent and, above all and specifically, good measures of the quality of health care delivery. As it is, Hong Kong may certainly take pride in its health indices which are the envy of many in the international health fraternity.

I am pleased to report that there has been steady and significant improvement in all these health indices in the last decade. The crude death rate fell from 5.1 per 1 000 population in 1976 to 4.7 in 1986; the crude birth rate from 16.9 per 1 000 population to 13.1; maternal mortality rate from 0.18 per 1 000 total births to 0.03, and more importantly, the infant mortality rate, which is the single, most sensitive indicator of the quality of the maternal and child health services, dropped from 14.3 to 7.7 per 1 000 live births. People in Hong Kong now live longer. There has been a steady increase in life expectancy in the last decade, from 70 to 74 for men and from 76 to 80 for women,

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One of the major problems which gave me grave concern when I first took office in 1977 was the considerable overcrowding in the large acute hospitals. This is attributable in the main to the fact that Hong Kong has always been vulnerable to population pressure both chronic and acute and also the fact that hitherto most of the efforts and resources of the Medical & Health Department were directed towards the need to combat the communicable diseases which were rampant in the fifties and sixties. a consequence, the provision of hospital services lagged badly behind. In the circumstances, extraordinary efforts were obviously required if the backlog were to be cleared and any significant improvements achieved, especailly as the problem of population growth largely by immigration became more and more acute. In recognition of this need, the Department embarked on an ambitious and unprecedented plan for expansion of the hospitals and supporting facilities.

Aside from strengthening the administration in the hospital system, which aims at maximum utilisation of available beds, three major hospitals of about 1 400 beds each were brought into full operation in the short span of the last 10 years. The number of beds in end 1986 is 24 550 compared with 19 270 in end 1976, an increase of over 5 000 beds in the period under review. Further, standards of provision have also been continuously upgraded with the introduction of air-conditioning to hospital wards and the acquisition of equipment of ever-increasing level of sophistication. Plans are also in hand to build more hospitals in the next decade to provide some 13 000 additional hospital beds to meet the rising aspirations of the profession and the community.

Considerable achievement has also been attained in the provision of clinic services. The number of general and specialist clinics has increased from 65 in 1977 to 74 at present, an average increase of almost one new clinic every year in the past decade.

There has also been a considerable expansion of the work-force in the Department. As on 1st April 1987, we have an overall establishment of 26 036 with 1 589 doctors and 10 864 nurses a substantial increase over the existing strength in early 1977 when the establishment was then 15 630 with 921 doctors and 5 691 nurses. The number of both doctors and nurses in the Department have now almost doubled.

It can be seen from the above figures that much of the good work in the past decade could not have been accomplished without an adequate supply of health workers. Manpower supply has been an area to which I have always attached great importance. To this end, two new general nursing schools were commissioned in the Princess Margaret Hospital and the Prince of Wales Hospital. The training capacity of psychiatric nurses was also expanded in Castle Peak and Kwai Chung Hospitals. To address the perennial problem of shortage of doctors, a second medical school was established in the Medical Faculty of the Chinese University of Hong Kong with its teaching facilities being provided in the Prince of Wales Hospital. I am pleased to report that its first batch of medical students graduated in 1986. In order to introduce improvement on the dental service, the Prince Philip Dental Hospital was built for the Dental Faculty of the University of Hong Kong to produce our own local dentists and we had our first batch in 1985. The Dental Therapist Training School was also established to train dental therapists who are instrumental in the implementation of the School Children Dental Service, which is an important and positive step in the improvement on the dentel care of the community in Hong Kong. Further, the Hong Kong Polytechnic has taken over from the Department since the late seventies in conducting courses in paramedical sciences and has now managed to give us a steady and ample supply of medical laboratory technicians, physiotherapists, occupational therapists, radiographers and nurse tutors.

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