The Hong Kong Family 10-point Healthy Living Index FAMILY: A Jockey Club Initiative for a Harmonious Society Cohort Study Press Conference December 21, 2011 1 Part 1 FAMILY Project: An Overview and 10-point Healthy Living Index Professor T. H. Lam Sir Robert Kotewall Professor in Public Health Director of School of Public Health The University of Hong Kong Principal Investigator, FAMILY Project Team 2 1
FAMILY: A Jockey Club Initiative for a Harmonious Society An Overview FAMILY: A Jockey Club Initiative for a Harmonious Society project was launched by The Hong Kong Jockey Club Charities Trust in collaboration with School of Public Health of The University of Hong Kong with a HK$250 million funding The project aims to identify the source of family problems, devise suitable preventive measures and promote family Health, Happiness and Harmony (3Hs) through a territory-wide household survey, intervention projects and public education 3 10 point Healthy Living Index Developed by the FAMILY project cohort research team Based on research findings on risk of adverse health outcomes A simple index (range 0 to 10) which everyone can understand Relevant to general physical health Can be calculated without a blood test To encourage people to maintain healthy lifestyles 4 2
10 point Healthy Living Index In 2011, the UN Summit addressed four common risk factors of noncommunicable disease 1 : Tobacco use Harmful use of alcohol Unhealthy diets Physical inactivity 10-point Healthy Living Index includes all the above risk factors to access the risk of adverse health outcomes 1 http://www.un.org/en/ga/president/65/issues/ncdiseases.shtml 5 10 point Healthy Living Index: The Score card Calculating the 10-point Healthy Living Index score 6 3
Part 1: Healthy Lifestyle Score ( max: 6 points) Ex-smoker for > 10 years, Current smoker, ex-smoker for Ex-smoker for 1 10 years non-smoker < 1 year Smoking 2 points 1 point 0 point Non-drinker or non-problem drinker 1 Problem drinker Alcohol use 1 point 0 point Physical activity Vegetables + fruits intake At least 2.5 hours of moderate-intensity physical activity (e.g., cycling, bowling, table tennis, brisk walking) per week Not enough moderate-intensity physical activity, but some moderate-intensity physical activity + some walking 2 At least 5 servings of vegetables + fruits * per day Not enough moderate-intensity physical activity and not enough walking 2 points 1 point 0 point Less than 5 servings of vegetables + fruits per day 1 point 0 point 7 footnote 1 : What is problem drinking? Defined as consuming 210mg (male) or 140mg (female) of alcohol per week 1 Approximately equals to: 12 cans (male) / 8.5 cans (female) of beer 8.5 glasses (male) / 6 glasses (female) of wine 2.5 glasses (male) / 1.5 glasses (female) of spirits 1 http://www.icap.org/table/internationaldrinkingguidelines 8 4
footnote 2: What is not enough moderate-intensity physical activity but enough moderate-intensity physical activity and walking? According to the WHO recommendation 1 : At least 2.5 hours of moderate-intensity physical activity per week (2 points) Minimally active: not enough moderate-intensity physical activity but enough moderate-intensity physical activity + walking (1 point) 8 x minutes spent per week doing vigorous physical activities + 4 x minutes spent per week doing moderate physical activity + 3.3 x minutes spent per week on walking 600 Metabolic Equivalent of Task (MET) 2 Example 1: in a week, 30 minutes of moderate-intensity physical activity, 120 minutes of walking : not enough, 0 point (4 x 30 + 3.3 x 120 = 516 < 600 ) Example 2: in a week, 240 minutes of walking : enough, 1 point ( 3.3 x 240 = 792 > 600) 1 http://whqlibdoc.who.int/publications/2010/9789241599979_eng.pdf 9 2 http://www.ipaq.ki.se/scoring.pdf Part 2: Health Status Score (max: 4 points) 18.5 < BMI < 23 (Normal) 23 BMI < 25 (Overweight) or BMI 18.5 (Underweight) BMI 25 (Obese) Body Mass Index (BMI) 1 2 points 1 point 0 point Systolic BP 120 and Diastolic BP 80 (Normal) 120 < Systolic BP 140 and/ or 80 < Diastolic BP 90 (Pre-hypertension) Systolic BP > 140 and/ or Diastolic BP > 90 (Stage-1 hypertension or above) Blood Pressure (BP) 2 2 points 1 point 0 point 1 BMI = Weight(kg) / Height(m) 2 2 For those who have been diagnosed with hypertension by a doctor or on medication, score 1 point if blood pressure is normal 10 5
10 point Healthy Living Index: A Hong Kong perspective Health of the people p of Hong Kong, as assessed by the 10-point Healthy Living Index 11 How healthy are Hong Kong people? (1) A territory-wide household survey was conducted from Mar 2009 to Apr 2011 Random selection of households in 18 districts Interviewed everyone aged 15 years or above in each household 8,481 households/families participated, with a total of 18,906 participants Age (years) Male Female Total 15-24 25-34 35-44 45-54 55-64 65 Total 1,554 1,023 1,219 1,825 1,409 1,718 8,748 (8.2%) (5.4%) (6.4%) (9.7%) (7.5%) (9.1%) (46.3%) 1,477 (7.8%) 3,031 (16.0%) 1,302 (6.9%) 2,325 (12.3%) 1,863 (9.9%) 3,082 (16.3%) 2,153 (11.4%) 3,978 (21.0%) 1,585 (8.4%) 2,994 (15.8%) 1,777 (9.4%) 3,495 (18.5%) 10,158 (53.7%) 18,906 (100%) 12 6
Prevalence How healthy are Hong Kong people? (2) 64% of Hong Kong people had 6 (pass) or above; nearly 24% of Hong Kong people had 8 (very healthy) or above 45% 40% 35% 30% 25% 20% 15% Fail 29.7% Pass 39.9% 23.2% Healthiest participants 10% 5% 0% 6.4% 0.7% 0-3 4-5 6-7 8-9 10 10 point Healthy Living Index Mean score (standard deviation): 6.11(1.73) 13 Findings of the 10 point Healthy Living Index (1) Hong Kong people do not have enough exercise and inadequate vegetable and fruit intake Lifestyle Smoking Drinking Physical activity Vegetables + fruits intake 2 points 81.5% - 29.7% - 1 point 3.9% 94.6% 59.8% 10.2% 0 point 14.7% 5.4% 10.5% 89.8% 81.5% of Hong Kong people were non-smokers or have quit smoking for over 10 years; 94.6% of Hong Kong people were non-drinkers or non-problem drinkers However, the amount of physical activity and intake of vegetables and fruits were severely inadequate: only 29.7% of Hong Kong people have moderate-intensity physical activities (2.5 hours of per week) and only 10.2% have adequate vegetable and fruit intake (5 servings per day) 14 7
Findings of the 10 point Healthy Living Index (2) Less than half of Hong Kong people have normal Body y Mass Index (BMI) and Blood Pressure (BP) Status BMI BP 2 points 41.3% 37.3% 1 point 27.8% 34.7% 0 point 30.9% 28.0% BMI: 30.9% were considered obese. 27.8% were overweight (19.7%) / or underweight (8.1%) BP: 34.7% were considered pre-hypertension and 28% were considered to be in the 1st-stage of hypertension or above 15 10 point Healthy Living Index: A Family Perspective Health of the families of Hong Kong, as assessed by the 10-point Healthy Living Index 16 8
Summary of the average 10 point Healthy Living Index for families 60% of Hong Kong families had at least 6 points (pass); less than 10% of Hong Kong families had 8 or above (very healthy) Failed Pass 60% 50% 50.4% Healthiest families Prevalence 40% 35.6% 30% 20% 10% 0% 4.6% 10 point Healthy Living Index (family mean) 9.3% 0-3.99 4-5.99 6-7.99 8-9.99 10 0.1% Mean score (standard deviation): 6.00 (1.37) 17 10 point Healthy Living Index: A family perspective Summary Everyone in the family should work together to achieve family health Do more physical activities and eat more vegetables and fruits Healthy people should also promote healthy lifestyles in their families Healthy people have a positive effect on family health 18 9
10 point Healthy Living Index: Guidelines for the Hong Kong public What should be done to improve the 10-point Healthy Living Index score? 19 How to eat enough vegetables and fruits (Part 1) Guidelines from Department of Health 1 1 serving of fruit equals: 2 small-sized fruits (e.g. plums) or 1 medium-sized fruit (e.g. orange, apple) or half large-sized fruit (e.g. banana, star fruit) or half a cup of tiny fruit (e.g. grapes) or ¾ cup of fresh fruit juices without added sugar 1 serving of fruit 1 http://2plus3.cheu.gov.hk 20 10
How to eat enough vegetables and fruits? (Part 2) Guidelines from Department of Health 1 1 serving of vegetable equals: 1 bowl of raw leafy vegetables or ½ bowl of cooked vegetables, beans, sprouts, gourds or mushrooms Tips to incorporate more vegetables and fruits in your diet: Replace snacks and desserts with fruits Choose vegetable soups instead of creamy soups Drink fresh fruit juices instead of soft drinks 1 http://2plus3.cheu.gov.hk 1 serving of vegetable 21 Comparison of fruit price in Hong Kong with that in the neighbouring regions 1 Region Price($) Hong Kong Ma acau Ja apan orth orea N Ko Orange (1 kg) 13.65 19.83 27.88 18.52 13.43 6.70 10.22 13.66 Banana (1 kg) 7.75 7.34 21.02 14.83 2.37 2.89 5.54 11.48 Apple (1 kg) 23.40 29.45 32.16 27.61 13.76 13.64 10.75 9.96 Mango (1 kg) 25.10 34.68 - - 16.00-11.87 - ppines Phili Indo onesia laysia Mal ran Ir More expensive than in Hong Kong 1 Occupational wages and hours of work and retail food prices: Statistics from the ILO October Inquiry. International Labour Organization, 2008. p.158-166 22 11
More tips to ensure eating enough vegetables and fruits Fruit prices in Hong Kong are cheaper than in other Asian countries, should purchase more Not necessarily 2 fruits + 3 vegetables, can be any combination (e.g. 3 + 2, since consuming fresh fruits such as bananas is easier than consuming vegetables) 5 servings of vegetables and fruits per day is a minimum requirement, should aim for more A diet low in sugar, fat and salt but high fiber is recommended Always prepare ready-to-eat fruits at home (e.g. bananas, apples) Eat more types of vegetables and fruits (e.g. assorted vegetable pot) For those who find it too troublesome to cook: fresh vegetable juice and/ or fruit juice is a good option 23 Winter Solstice Healthy Menu Chinese mushroom, bean vermicelli and assorted vegetable pot Salt-marinated chicken/stir-fried chicken and celery Steamed fish (tilapia/pomfret) Pork chops with tomato and onion sauce Carrot and turnip with pig elbow soup Brown rice/red rice 24 12
How to achieve 2.5 hours of moderate intensity physical activity per week? (Part 1) 30 minutes of moderate-intensity physical activity per day for 5 days - e.g., cycling, bowling, table tennis, brisk walking If no time for exercise, should try to walk more At least 8,000 steps per day is encouraged get 1 point <5,000 steps per day (steps accumulated through everyday activity): sedentary, i.e., don t walk at all Achievable by all of us: 30 minutes of walking (~100 steps per minute) every day Better to walk with family to enhance communication and harmony 25 How to achieve 2.5 hours of moderate intensity physical activity per week? (Part 2) Benefits: Energy expenditure of 300 400 kcals/day Expending 300 400 kcals/day can lead to an 10 13 lbs reduction of weight in 6 months 1 How many steps per day do Hong Kong people usually take? In a sub-study of 5,267 participants, half of them walked more than 8,000 steps per day 1 National Institutes of Health, U. S. 26 13
Five steps for a Healthy Family 1. Do more physical activities with family (e.g. hiking) 2. If no time for exercise, should at least try to walk more 3. Monitor the body mass index and blood pressure of yourself and that of your family 4. Always prepare sufficient vegetables and fruits at home 5. Promote healthy lifestyle to family members 27 Part 2 Introduction of 10-point Healthy Living Index Interactive Calculator Professor Sophia Chan Co-Investigator, FAMILY Project Team Research Director of School of Nursing The University of Hong Kong 28 14
10-point Healthy Living Index Interactive Calculator http://healthyindex.family.org.hk 29 HEALTH ( 健 康 ) HAPPINESS ( 快 樂 ) HARMONY ( 和 諧 ) End 30 15