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This paper reflects on the contemporary health policy debate in Hong Kong, and the shape assigned to particular 'problems'. Health reform discourses are identified to reveal the tensions that exist between the dominant biomedical discourse that focuses on individual responsibility, lifestyle change and health education while articulating a community development approach to health care reform. A critical review of the Consultation Document on Health Care Reform in Hong Kong, entitled Lifelong Investment in Health, will reveal a rhetorical commitment to health care reform alongside proposals that suggest little understanding of the changes required to implement such reform. In fact, the document proposes a model of health care that not only remains within the biomedical paradigm, but which if enacted may extend the influence of medicine into the psychosocial sphere. Edelman has defined policy as 'a set of shifting, diverse, and contradictory responses to a spectrum of political interests'. The starting point from this perspective is the identification of the discursive construction of policy problems and the associated 'spectrum of political interests'. It is an attempt to reveal the operation of power in places in which administrative, political and professional discourses tend to obscure it.

'Lifelong investment in health': the discursive construction of 'problems' in Hong Kong health policy