On the pale beige wall a plaque reads “2010-2014 Dr. S. P. Mak”. It was a silver plaque, with the names of past presidents of the Hong Kong College of Community Medicine, hanging under the logo of the College. Rays of sunlight projected onto the wall through the office window while the silver preserved its usual subtlety, without giving off a dazzling blaze—it seemed to echo with our featured doctor: Dr SP Mak, a humble and distinguished local leader in the field of Community Medicine.

Two months ago, you might have recognised Dr Mak in the newspaper on ‘International NO Alcohol Day’, calling on the public and the government to enhance actions to reduce alcohol-related harm.

Dr Mak is one of the founders and the Convener of the Hong Kong Alliance for Advocacy Against Alcohol (HKAAAA). Set up in July 2015, it is a non-governmental alliance affiliated with the Hong Kong College of Community Medicine. It plays an advocacy role and engages with the community to discourage alcohol consumption. Members are recruited from the academic, medical and health, social, and educational sectors. Combining expertise from these different professions, the HKAAAA conducts research, formulates evidence-based policy suggestions, and empowers the public by education. Through mass media channels and public campaigns, the HKAAAA promotes public awareness of the detrimental effects of drinking on health and socio-economics.

“While there has been much achievement in tobacco control, comparatively little has been done when it comes to alcohol,” commented Dr Mak.

She recalled that in the past, tobacco was common and popular, penetrating all social classes. With the implementation of various public health policies and regulations, including taxation and restrictions on advertising, as well as educational campaigns about the harm and carcinogenic risk of tobacco, the prevalence of smoking in Hong Kong has dropped significantly. Although alcohol is also a group 1 carcinogen with other well-established detrimental effects on health, it has not received equal attention and caution. Dr Mak believes that more vigorous actions are needed to fight alcohol, and that it requires conjoint efforts and support from the government and the community at large. Nowadays, alcohol is more a symbol of status on social occasions than a hazard. This perception is especially popular among adolescents. A survey by the Security Bureau in 2014 that targeted primary and secondary school students revealed that over 40% of the respondents consumed alcohol in that year. More recently, a telephone survey of 1000 people conducted by the HKU Public Opinion Programme, and initiated by the Hong Kong College of Community Medicine and the Hong Kong Medical Association, showed that 77% of the respondents agreed that alcohol should not be sold at retail outlets to those under 18. A similar percentage of people were in support of a mandatory health warning on containers of alcoholic beverages. Nonetheless, support from the public alone is not sufficient. Dr Mak is well aware that alcohol policies affect the vested interests of multiple parties, therefore making advocacy work in the local setting difficult. She gave the example of the lifting of alcohol import duty by Government in 2008 that she considered the single most anti–public health policy. In addition, Dr Mak reflected upon the relatively loose regulation of alcohol sales in Hong Kong compared with elsewhere. For example, those under 18 in Hong Kong can easily buy beer and wine at convenience stores or supermarkets despite a ban on selling alcohol to them in licensed restaurants; alcohol can be sold at any time as long as retail shops are open, unlike in some countries where alcohol can be sold only during restricted hours.

“These are but a few examples borrowed from overseas practices that can discourage the public to consume alcohol,” added Dr Mak.

Although HKAAAA started small, Dr Mak demonstrated to us her unwavering determination and enthusiasm for the future work of the Alliance.

The Convener of HKAAAA is only one of Dr Mak’s many active voluntary roles that she has assumed on various boards and councils since her retirement in 2008. She gives lectures and tutorials to students in the two local medical schools as an Honorary Associate Professor and an Adjunct Professor, and is involved in training younger doctors at the Hong Kong College of Community Medicine. Prior to her retirement, Dr Mak served in the Government for over 30 years, with work ranging from health policy formulation to health services planning, infectious diseases, and drug and food safety control. She is a remarkable leader in the field and served as the Vice President and President of the Hong Kong College of Community Medicine from 1997 to 2014. Clearly, Dr Mak’s impressive enthusiasm in promoting public health post-retirement stems from her long history of dedication to the betterment of people’s health. What remains enigmatic is what made her seed sprout and kept it growing in this specialty, i.e. Community Medicine, since the first day of her career.

When Dr Mak was asked about the most memorable and rewarding piece of work in her career, she recalled the planning and establishment of the first Public Health Laboratory Centre in Hong Kong in 2002. Located at Nam Cheong Street, Shek Kip Mei, it remains the only one of its kind in Hong Kong. Prior to its establishment, public health laboratories were located in scattered places in hospitals and even clinics. They were small and unable to meet the required health and safety standards, not to mention coping with public health demand should a large-scale local disease outbreak occur. Spearheaded by Dr Mak, a team of experts in microbiology, architecture, and engineering united to oversee the project. The Centre came into operation just in time to fight the SARS (severe acute respiratory syndrome) outbreak the following year, one of the hardest periods of time for Hong Kong. Looking back, Dr Mak was glad to see the facility weather such a significant health storm in Hong Kong with its enhanced capability, and the services have now won global and international acclaim.

While we were listening in awe to her story, Dr Mak tested our memory of the “Upstream River Model” that we once learnt during the junior years at medical school. She used it to explain to us her view of the role of a doctor in Community Medicine.

“Our mission is to prevent diseases of the population by acting upstream. This is a long-term goal.”

“To achieve this, we have to establish a robust doctor-community relationship, not merely a doctor-patient relationship as in other specialties.”

Perhaps a more obscure side of Dr Mak is her ‘hidden’ titles of “LLB” and “LLM”. Immediately after her retirement, she pursued two degrees in Law and Arbitration and Dispute Resolution, just for interest. We asked if she has ever wanted to change her career. She revealed that she preferred medicine to law as medicine has a warmer, people-oriented nature. She nonetheless benefitted a lot from both law programmes, especially the communication skills learnt that are most useful in establishing trusting relationships with the community at large. Reflecting on her past achievements in the field of Community Medicine and the complexities behind her work that frequently involved multiple parties within and outside the medical profession, Dr Mak’s eagerness to learn in life and her warm, loving character are perhaps her two greatest assets that have watered and nurtured the seed to fruition since the first day of her journey in Community Medicine.

On Public Health, “It promises little fame or fortune. But it does have one big thing going for it: the opportunity to make a significant—often life-saving—difference in people’s lives,” said Kathleen Sebelius, former Secretary of Health and Human Services of the United States. “To improve public health, we have to commit, we have to know the community,” summarised Dr Mak.

It might be hard to imagine working in a field where one can save somebody’s life with no acknowledgement of one’s efforts; where the greatest rewards are not easily visible. Yet this is the case with Dr Mak. After this interview, we might not remember every word of Dr Mak, but the image of the subtle silver plaque in her office will be deeply imprinted in our minds as we continue to learn to be good doctors for society.