Action Plan to PromoteHealthy Diet Physical Activity · As Chairman of the Working Group on Diet...
Transcript of Action Plan to PromoteHealthy Diet Physical Activity · As Chairman of the Working Group on Diet...
Action Plan to Promote Healthy Diet and Physical Activity Participation in Hong Kong
Printed by the Government Logistics Department May 2010
Action Plan to Promote Healthy Diet and Physical Activity Participation in Hong Kong
Action Plan to Prom
ote Healthy D
iet and Physical Activity Participation in H
ong Kong
Action Plan to Promote Healthy Diet and
Physical Activity Participation in Hong Kong
Contents
Preface by Professor Alfred CHAN Cheung-ming, Chairman of the
Working Group on Diet and Physical Activity iv
Abbreviations vi
1. Introduction 1
Global situation of non-communicable diseases and
their risk factors 2
Prevalence of non-communicable diseases and their
risk factors in Hong Kong 3
Strategic framework for prevention and control
of non-communicable diseases in Hong Kong 4
Implementation of the strategic framework and
establishment of Working Groups 5
2. Diet, physical activity and health: Hong Kong situation 7
Local situation of dietary habit, physical activity
participation and overweight/obesity 8
Local health promotion activities to promote healthy
lifestyles 13
Analysis 19
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3. Actions to promote healthy diet and physical activity
participation 23
Preamble 24
Goals 25
Details of 30 specific actions 25
Table 1 – List of detailed actions with targets and timeframe 45
4. Making it happen 57
Annexes
1. Membership of Working Group on Diet and Physical Activity 60
2. Terms of reference of Working Group on Diet and
Physical Activity 61
3. Discussion topics of Working Group on Diet and
Physical Activity meetings 62
4. Summary of Members’ input on local health promotion
activities 63
5. Health promotion: concepts and practice 69
iiiii
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Preface
Globally, we are facing a rising threat imposed by chronic non-communicable
diseases or chronic diseases. Evidence shows that the risk of disease is mainly
attributable to unhealthy lifestyle practices. The World Health Organization
estimated that, worldwide, low fruit and vegetable intake and physical inactivity
account for 2.7 million and 1.9 million deaths respectively. Increasing amounts
of evidence are telling us that the earlier an individual adopts healthy lifestyle
habits, the lower his or her risk of contracting non-communicable diseases during
adulthood and beyond.
Hong Kong is in a process of change. As urbanization and economic growth
are generally welcome, unsatisfactory diet and physical activity patterns have
become more common in our population. People nowadays are more vulnerable
to affluent diets than ever. Besides, many lead sedentary lives. As a result,
increasing numbers of people are becoming overweight or obese. They in turn
experience a higher risk of potentially lethal non-communicable diseases, such as
diabetes mellitus, heart diseases and cancer. If the situation does not improve, the
cost and impact of lifestyle-related diseases on our healthcare system, as well as
society at large, will increase and eventually prove catastrophic.
To avert this from happening, we must work in a coordinated manner and
aim to promote healthy eating and physical activity participation from all sides and
at all levels: the individual, family, organization and the wider community. This
responds to the call made in the Government’s strategic framework document
“Promoting Health in Hong Kong: A Strategic Framework for Prevention
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and Control of Non-communicable Diseases” published in 2008.
As Chairman of the Working Group on Diet and Physical Activity, I would
like to thank all who helped in drawing up this Action Plan. The objective of
this is to outline the framework of actions that will take place in the coming
few years to support, and help set the direction for, the delivery of effective
health promotion programmes.
This document is a critical step in what must be a broader process to
promote healthy diet and physical activity participation in Hong Kong. It is
a product of collaboration among stakeholders from different sectors of our
society. Every individual and organization has a role to play. The actions
set out here represent a start, not an end. With dedication, partnership,
and coordinated effort called for in this Action Plan, we are better placed to
empower individuals to take responsibility for their health as well as that of
others, and to create a caring community that opens up a wider range of
healthy choices for all. One will agree that, eventually, wellbeing and quality
of life are choices that individuals and communities have to make. Make that
choice today by playing your part in the Action Plan!
Professor Alfred CM CHAN, BBS, JP
Chairman
Working Group on Diet and Physical Activity
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Abbreviations
Abbreviations Full name
BRFS Behavioural Risk Factor SurveyCHEU Central Health Education UnitCSC Community Sports CommitteeCUHK Chinese University of Hong KongDH Department of HealthEDB Education BureauEHS Elderly Health ServiceEMACs Estate Management Advisory CommitteesFEHD Food and Environmental Hygiene DepartmentFHB Food and Health BureauFHS Family Health ServiceHA Hospital AuthorityHAD Home Affairs DepartmentHBM Health Belief ModelHD Housing DepartmentLCSD Leisure and Cultural Services DepartmentMCHCs Maternal and Child Health CentresNCD Non-communicable diseasesNCDD Non-communicable Disease DivisionNGOs Non-governmental organizationsPHS Population Health Survey PRH Public rental housingSC Steering Committee on Prevention and Control of
Non-communicable Diseases SCT Social Cognitive Theory SHS Student Health ServiceSTEPS STEPwise approach to SurveillanceSWD Social Welfare DepartmentTDS Total Diet Study
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Full name
Behavioural Risk Factor SurveyCentral Health Education UnitCommunity Sports CommitteeChinese University of Hong KongDepartment of HealthEducation BureauElderly Health ServiceEstate Management Advisory CommitteesFood and Environmental Hygiene DepartmentFood and Health BureauFamily Health ServiceHospital AuthorityHome Affairs DepartmentHealth Belief ModelHousing DepartmentLeisure and Cultural Services DepartmentMaternal and Child Health CentresNon-communicable diseasesNon-communicable Disease DivisionNon-governmental organizationsPopulation Health Survey Public rental housingSteering Committee on Prevention and Control of Non-communicable Diseases Social Cognitive Theory Student Health ServiceSTEPwise approach to SurveillanceSocial Welfare DepartmentTotal Diet Study
Abbreviations Full name
VHTs Visiting Health TeamsWG Working GroupWGDPA Working Group on Diet and Physical ActivityWGPC Working Group on Primary CareWHO World Health Organization Y-HBSS Youth-Health Behaviour Surveillance System
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1. Introduction
Introduction1
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1Global situation of non-communicable diseases and their risk factors
1.1 Withgrowingaffluence,theworld’spopulation is living longer intermsof lifeexpectanciesingeneral.Atthesametime,thereisanincreasingnumberofpeoplesuffering fromnon-communicablediseases(NCD),suchascancer,strokeand ischaemicheartdiseases,whichcause ill-health,disabilityandprematuredeaths. TheWorldHealthOrganization(WHO)estimatedthatofthe58milliondeathsin2005,approximately35million(60.3%)werecausedbyNCD.
1.2 NCDareclosely related to the lifestylepractices,andmanyNCDsharecommonbehavioural risk factorssuchasunhealthydiet,physical inactivityandbeingoverweight/obese.Thepresenceofthesebehaviouralriskfactorscan lead to thedevelopmentofbiomedical risk factors,notablyexcessivebodyweight,highbloodpressure,adversebloodsugarand lipid levels thatare thekeyrisk factors formostNCD. TheWHOestimatedthatbyhavinghealthylifestylesincludinghealthierdiet,increasingphysicalactivityandstopsmoking,atleast80%ofheartdiseasesandtype2diabetesaswellasone-thirdofcancerscanbeprevented. Therefore, to improve thecommunity’shealthprofilethroughpreventionofNCD,highpriorityshouldbegiventothoseinterventions that tackleunhealthydiet,physical inactivity,overweightandobesity,andsmoking.
1.3 Recognising that the rapid riseofNCDwould representoneof themajorhealthchallenges in thecomingcentury, theWHOdeveloped theGlobal Strategy for the Prevention and Control of NCDin2000,theWHO Framework Convention on Tobacco Controlin2003,theGlobal Strategy on Diet, Physical Activity and Health in2004,and the2008-2013 Action Plan for the Global Strategy for the Prevention and Control of NCD in2008andcalledon itsMemberStatestodevelopnationalpolicyframeworkandimplementactionstotackletheissue.
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1. Introduction
Prevalence of NCD and their risk factors in Hong Kong
1.4 HongKong’shealth indices rankamong thebest in theworld. Likemanyplaces,however,anincreasingdiseaseburdenfromNCDisevidentowingtothechanges inhealthriskprofilewiththeexpandingandageingpopulation,socialchangesandglobalisation. Forexample, theproportionofregistereddeathsattributed tocancer,heartdiseasesandstrokehad increased from12.2%,9.4%and7.5% in1961 to30.0%,16.3%and8.9%respectively in2008.
1.5 Among41530registereddeaths in2008,over three-fifthswereattributedtosixmajorbutpreventableNCD, includingcancer(30.0%),heartdiseases(16.3%),stroke(8.9%),chronic lowerrespiratorydiseases(5.1%), injuryandpoisoning(4.3%)anddiabetes(1.3%). The importanceof thesesixmajorNCDisalsounderlinedintermsofhospitaldischargesanddeaths.Altogether,theyaccountedfor21.5%(orabout351438episodes)ofallhospitalinpatientdischargesanddeathsin2008.
1.6 Regarding thebehavioural risk factorssuchasoverweightandobesity,inadequate intakeof fruitandvegetables,physical inactivity,andalcoholmisuse,theBehaviouralRiskFactorSurvey(BRFS)April2009reportedthatabouttwo-fifths(38.7%)ofpeopleaged18-64wereoverweight/obese;aboutfour-fifths(79.0%)failedtomeettheWHOrecommendationofhavingatleastfiveservingsof fruitandvegetablesperday;aboutone-fifth (21.0%)wereclassifiedashaving “low” levelofphysicalactivity (basedon InternationalPhysicalActivityQuestionnaireclassification);andaroundoneintwelve(8.4%)hadbingedrinking. Theabovefindingshaverevealedthat thebehaviouralriskfactorsofNCDarecommoninthelocaladultpopulation.
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Strategic framework for prevention and control of NCD in Hong Kong
1.7 There is convincingevidence that significanteconomicbenefits canbeachievedbypreventingNCDin thecommunity throughhealthpromotion toaddressthemajorriskfactorsofNCD.TohaltandreversethetrendinNCD,astrategicapproachwithconcertedeffortsandeffectivemeansisrequired.
1.8 In thisconnection, theDepartmentofHealth (DH)published thestrategicframeworkdocumententitled “Promoting Health in Hong Kong: A Strategic Framework for Prevention and Control of Non-communicable Diseases” on 28October2008.Theoverallgoalof thestrategicframework is to increasethepositivehealthandqualityoflifeofthepeopleinHongKong.Tooptimisehealthgains,thestrategicframeworkfocusesonthemajorriskfactorsthatarepotentiallymodifiableandhavesignificant impactonthehealthof theHongKongpopulation.
1.9 Six strategicdirectionshavebeen identified for focusing theattention,resourcesandactionswithaviewtoachievingtheoverallgoalofthestrategicframework.Theseinclude:
(i) Support newandstrengthenexistinghealthpromotionandNCD preventioninitiativesoractivitiesthatareinlinewiththisstrategy;(ii) Generateaneffective informationbaseandsystem toguideaction acrossthediseasepathway;(iii) Strengthen partnership and foster engagement of all relevant stakeholders;(iv) BuildupthecapacityandcapabilitytocombatNCD;(v) EnsureahealthsectorthatisresponsivetotheNCDchallengesandto improvethesystemofcare;and(vi) Strengthenanddevelopsupportivehealthpromotinglegislation.
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1. Introduction
Implementation of the strategic framework and establishment of Working Groups
1.10 Tosteerand take thematter forward,ahigh-levelSteeringCommitteeonPreventionandControlofNCD(SC)wasestablished todeliberateonandoverseetheoverallroadmapandstrategy,includingthesettingupofWorkingGroups(WG) toadviseonspecificpriorityareas. TheSC,chairedby theSecretaryforFoodandHealth,comprisesrepresentativesoftheGovernment,publicandprivatesectors,academiaandprofessionalbodies, industryandotherkeypartners.
1.11 TheSCrecognises that the issuesof tobaccocontrolhavebeenactivelytackledbytheTobaccoControlOfficeof theDH,theHongKongCouncilonSmokingandHealthandotherorganizations. Thus theSCconsiders thatWGshouldbesetuptotackleotherimportantbehaviouralriskfactorsofNCD.UnderthesteeringoftheSC,thefirstWGwasestablishedinDecember2008totackletheimminentproblemscausedbyunhealthydietaryhabits,physicalinactivityandobesity.ThesecondWGwassetupinJune2009totackletheproblemsrelatedtoalcoholmisuse.AnotherWGwillbesetuptotackletheproblemsrelatedtoinjuries.
1.12 UnderthechairmanshipofProfessorAlfredCHANCheung-ming,theWorkingGrouponDietandPhysicalActivity (WGDPA)hasbeensetupwith17membersrepresentingthekeystakeholdersinthepublicandprivatesectorsincluding theacademia,districtcouncil,educationsector,businesssector,food industry,healthcareprofessionals,socialservicessectorandrelevantgovernmentdepartments.ThemembershipoftheWGDPAislistedinAnnex1.
1.13 TheWGDPAadvisesonthepriorityareasforaction,anddrawsuptargetsandactionplansrelatedtoissuesofdiet,physicalactivityandobesityfortheSC’sconsideration.ThetermsofreferenceoftheWGDPAislistedinAnnex2.
1.14 Since itsestablishment inDecember2008,WGDPAhadmetfour timesandthetopicsdiscussedarelistedinAnnex3.
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2.Diet,physicalactivityandhealth:HongKongsituation
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2 Diet, physical activity and health: Hong Kong situation
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22.1 Weightgain isaconsequenceof the imbalancebetweenenergygained
fromfoodorbeveragesandenergyexpended innormalbodyfunctioningordailyactivities. Therising trendofoverweightandobesityhas largelybeenattributed tounhealthydietaryhabits,wideavailabilityofhigh fatandsugary foods, lackofphysicalactivityandengagement insedentarylifestyles. Inthefollowingparagraphs, the localprevalenceofmajorNCDriskfactors includingdietaryhabit,physicalactivityandoverweight/obesityarereviewed.Furthermore,thelocalhealthpromotionactivitiesconductedbydifferentgovernmentdepartmentsandnon-governmentalorganizations(NGOs)arealsopresented.AlltheseinformationisessentialforidentifyingthepriorityareasforactionandguidingtheinterventionsonNCDpreventionandcontrolinfuture.
Local situation of dietary habit, physical activity participation and overweight/obesity
Dietaryhabit
2.2 For infant and toddlers, there is growing evidence suggesting thatbreastfeedingcanpreventsubsequentchildhoodoverweightandthatlongerbreastfeedingperiodgivesgreaterprotectionforchildren.Itwasestimatedthat thepercentagesof newbornsever breastfedondischarge fromhospitalsrosefromabout10%in1981toaround76.9%in2009.Theeverbreastfeedingrateincreasedfrom50%forbabiesbornin1997to73.7%forthoseborn in2008.Theexclusivebreastfeedingrateforover4-6monthsincreasedfrom6%forbabiesbornin1997to12.7%forthosebornin2008.However,forotherdietaryhabitsamonginfantandyoungchildren,thereislimitedinformationavailable.
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2.3 According to the“AssessmentofDietaryPattern inPrimarySchools2008”conductedby theCentralHealthEducationUnit (CHEU)of theDHin2008toassess thedietaryhabitofP4andP5students, therewasadefiniteknowledge-attitudegapwhere healthy eating is concerned. Studentspossessedgoodknowledgeofhealthier foodoptionsdidnotnecessarilysynchronisewithwhattheychoseinfoodpreference.Onlyabouthalfhadahabitofeatingfruit(57.5%atetwiceormoreperday).Besides,only9.8%to25.6%ofthestudentsdidnotconsumefooditemssuchasdrinkswithaddedsugar,deep-fried food, foodhigh in fat/sugar/salt in theweekprior to thesurvey. Furthermore,studentsshowedpreferencefor food itemsthatwereusuallyhighinsalt,sugarorfat,suchasburgerandfries,ice-creamandhotdog.
2.4 TheWHOrecommends400g intakesof fruitandvegetables foradultsperdayfor thepreventionofchronicdiseases. TheBRFSApril2009of theDHrevealedthataboutfour-fifths(79.0%)ofpeopleaged18-64failedtomeettheWHO’srecommendation in2009. Males(85.3%),youngadultsaged18-24(85.6%)andclerks(84.4%)hadthehighestprevalenceofinadequatefruitandvegetableconsumption.
2.5 TheBRFSApril2007also revealed thatasubstantialproportionof localpopulationateout forbreakfast (30.2%), lunch(51.5%)anddinner(10.8%)fiveormoretimesaweekin2007.AccordingtotheBaselineSurveyforthe"[email protected]"Campaignof theDH in2007,84.5%and53.9%ofpeopleaged12andaboverespectivelyperceivedthat fruitandvegetableingredientswere too little in foodprovidedby foodpremises. Ontheotherhand,60.1%,40.9%and27.2%respectivelyperceived that fat/oil,saltandsugaringredientsweretoomuchinfoodprovidedbyfoodpremises.
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2.6 The“BetterHealthforBetterHongKong”Campaignwasaterritory-wideheathpromotioncampaign launchedfrom2000to2006bytheHealthInfoWorldofHospitalAuthority(HA).Healthcheck-upwasalsoprovidedtotheparticipantstoassesstheirgeneralhealthstatus.From2000to2002,over4500subjectswererecruited fromtwo local labourunions toattend thehealthcheck-up,and thedatawereanalysedandpublished inseveralstudies. Fordietaryhabit,overhalfoftheparticipantshadatleastoneofthesixunhealthydietaryhabits(nodailyfruitintake,nodailyvegetableintake,lowfluidintake,havingirregularmeals, frequentsugarydrinksandfrequentdiningout)andaround20%hadmore thanoneunhealthydietaryhabit. Overall,menhad lessdesirabledietaryhabitthanwomen.1
2.7 Forelderlypopulation, thePopulationHealthSurvey (PHS)2003/2004showedthat79.5%and76.5%ofpeopleaged65-74andaged75andaboveconsumedlessthanfiveservingsoffruitandvegetablesperdayrespectively.
Physicalactivityparticipation
2.8 Thesurveysof theEducationBureau (EDB)onstudents’physical fitnessshowed thatother thanPhysicalEducation lessons, less thanhalfof thestudentsengagedinmoderateexerciseforatleastthreetimesperweekwith20minutesormorepersession(i.e.48.1%forP1-3and50.0%forP4-6 in2003/04;40.1%forS1-3and30.1%forS4-7in2004/05;and40.8%forP1-3and42.2%forP4-6 in2005/06). The2004/05studyalsofoundthat46.4%of juniorsecondaryand40.5%ofseniorsecondarystudentsspentoverfourhoursdailywatching television,videos,using thecomputerorplayingcomputergames.
2.9 In theStudyontheParticipationPatternsofHongKongPeople inPhysicalActivitiesof theCommunitySportsCommittee(CSC),61.2%ofrespondentsaged7-12(i.e.mostlyprimarystudents)and57.4%ofrespondentsaged13-19(mostlysecondarystudents)engagedinthreedaysormoreof30minutesofmoderatetovigorousactivityweekly,excludingPhysicalEducationlessons.Althoughthe figuresarehigher than those inparagraph2.8, there ismuchroomforimprovement.
1KoGT,etal.AssociationsbetweendietaryhabitsandriskfactorsforcardiovasculardiseasesinaHongKongChineseworkingpopulation-the"BetterHealthforBetterHongKong"(BHBHK)healthpromotioncampaign.AsiaPacificJournalofClinicalNutrition2007;16:757-65.
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2.10 According to theBRFS in2009,around85.9%ofpeopleaged18-64didnothavevigorousphysicalactivity for threedaysormoreperweek;about75.5%didnothavemoderatephysicalactivity for threedaysormoreperweek;around29.0%didnotwalk for10minutesdaily. Overall,aboutone-fifth(21.0%)wereclassifiedashaving“low” levelofphysicalactivity(basedonInternationalPhysicalActivityQuestionnaireclassification). Clerksweremorecommon tobeclassifiedashaving “low” levelofphysicalactivity.Furthermore, fromPHS2003/2004 findings,20.9%ofpeopleaged15andabovesatat least10hoursdailyandpeople inyoungeragegroup(15-34)spentmoretimeonsitting.
2.11 Accordingto theSportsParticipationSurvey2001of theHongKongSportsDevelopmentBoard,48%ofpeopleaged15andabovehadparticipatedinatleastonesportsactivityinthepastthreemonths.Peopleaged15-24(65%)had thehighestparticipation rate,while thoseaged55-64had the lowest(31%).
2.12 Forelderlypopulation,8.3%and16.6%ofpeopleaged65-74andaged75andaboverespectivelydidnotwalk for10minutesdailyaccording toPHS2003/2004.Furthermore,18.7%and30.9%ofpeopleaged65-74andaged75andaboverespectivelywereclassifiedashaving“low” levelofphysicalactivity. FromtheSportsParticipationSurvey2001,49%ofpeopleaged65andabovehadparticipated inat leastonesportsactivity in thepast threemonths.
Overweight/obesity
2.13 Accordingtostatisticsof theStudentHealthService(SHS), theprevalenceofoverweight includingobesity(definedasmorethan120%medianweightforheight)amongprimaryschoolstudents rose from16.4% in1997/1998schoolyearto22.2%in2008/2009schoolyear. Similarly, theprevalenceofoverweight includingobesityamongsecondaryschoolstudents rose from13.6%to17.7%in thesameperiod. Overall, theprevalenceofoverweightincludingobesityamongstudentsrosefrom15.7%in1997/1998to20.4%in2008/2009.Theprevalenceremainedhigheramongboyswiththedifferencebetweenboysandgirlswideningslightlyover theyears. It isclear that thecohortwithahigherbaselineprevalenceofobesitywillendupwithahigherprevalenceofobesitywhentheyleaveschools(bothprimaryandsecondary).
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2.14 From2003to2004,theChineseUniversityofHongKong(CUHK)conductedacross-sectionalstudy toexamine theprevalenceofoverweight/obesityamong local studentsaged11-18.2 Theweight andheight of around
2100studentsfrom14schoolsweremeasured.Thestudyrevealedthattheprevalenceofadolescentoverweight/obesityrangedfromabout10%to14%basedondifferent internationalclassification. Theproblemofoverweight/obesitywasmorecommonamongboysthangirls(boys:14%-20%;girls:7%-10%).
2.15 Another cross-sectional studyofCUHK,whichexaminedaround2600childrenaged6-13,revealedthatabout13%ofboysand11%ofgirlswereobese.3 Furthermore,about10%and3%ofthechildrenwereclassifiedashavingthreeormoreandfourormoreof thesixcardiovascularrisk factors(highsystolicbloodpressure/diastolicbloodpressure,highbloodtriglyceride,lowbloodhigh-density lipoprotein,highblood low-density lipoprotein,highbloodglucoseandhighbloodinsulin)respectively.
2.16 Foradultpopulation, theBRFS revealed that38.7%ofpeopleaged18-64wereoverweight/obese(definedasbodymass indexgreater than22.9)in2009. Weightproblemwasmorecommonamongmales than females(male:49.3%; female:29.7%). Peopleaged35oraboveandbluecollarworkershadthehighestprevalenceofoverweight/obesity.Overallspeaking,theprevalenceofoverweight/obesity remainedstable from2004 to2009.However,anincreasingtrend(46.0%in2004to49.3%in2009)ofoverweight/obesitywasobservedamongthemalepopulation.
2.17 Analysingthedatafromthe“BetterHealthforBetterHongKong”Campaign,itwasrevealedthattheage-standardisedpercentageofoverweight/obesityandcentralobesityamongtheparticipatingworkingpopulationwererespectivelyaround60%and27%inmen,and32%and27%inwomen.Comparedtothedatacollectedfromalocalprevalencesurveyforglucoseintoleranceandlipidabnormalityin19904,thepercentageofcentralobesitydoubledinmen(12%to27%)butremainedsimilarinwomen.5
2KoGT,etal.Theproblemofobesityamongadolescents inHongKong:acomparisonusingvariousdiagnosticcriteria.BMCPediatrics2008;8:10.3SungRYT,etal.WaistcircumferenceandbodymassindexinChinesechildren:cutoffvaluesforpredictingcardiovascularriskfactors.InternationalJournalofObesity2007;31(3):550-8.4CockramCS,etal.Theprevalenceofdiabetesmellitusand impairedglucosetoleranceamongHongKongChineseadultsofworkingage.DiabetesResearchandClinicalPractice1993;21:67-73.5KoTC,etal.Doublingover tenyearsof centralobesity inHongKongChineseworkingmen.ChineseMedical Journal2007;120(13):1151-4.
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2.18 Furthermore,overaquarterofthesubjectshadmorethanonecardiovascularr isk factor (smoking, being obese, having hypertension, havinghypercholesterolaemia,havingdiabetesmellitus,pasthistoryofcardiovasculardiseases). Despite thishighprevalenceofmultiplerisk factors,most(83%)perceivedtheirhealthassatisfactory.6
2.19 Forelderlypopulation, thePHS2003/2004revealed that theprevalenceofoverweight/obesitywas49.4%and41.9%forpeopleaged65-74andaged75andaboverespectively.
Local health promotion activities to promote healthy lifestyles
HealthpromotionprogrammesbytheDepartmentofHealth
2.20 TheDHhascommittedtosafeguardingthehealthof thecommunitythroughpromotive,preventive,curativeandrehabilitativeservices.TheDHpromoteshealthy livingto thegeneralpublic throughvariouschannels. Thefollowingparagraphssummarisetheseactivities.
2.21 TheNCDDivisionof theDH is responsible forsurveillanceandcontrolofNCDofpublichealth importanceinHongKongandformulationofstrategiesinrelationtoNCDprevention.ThroughBehaviouralRiskFactorSurveillanceSystem,PublicHealth InformationSystemandotherhealthsurveys, theDivisionregularlycollects,collates,analysesanddisseminatessurveillancedataonNCDandtheirrelatedriskfactors.Theinformationcollectedisusefulforplanning, implementingandevaluatinghealthpromotionprogrammes,for development ofNCDpreventionand control activities, and for riskcommunicationthroughamonthlypublication“NCDWatch”.
6KoGT,etal.Lowlevelsofawarenessofsuboptimalhealthconditionsinahigh-riskworkingpopulation:the"BetterHealthforBetterHongKong"healthpromotioncampaign.InternationalJournalofBehaviouralMedicine2007;14:63-9.
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2.22 TheCHEUof theDHpromotes the health of the community throughcollaboratingwithvariousagencies inhealthpromotion. Topromotehealthyeatinghabit, theCHEUhasallalongcommittedtoraisingpublicawarenessof the importanceofhealthyeating throughvarious large-scalecampaignssuchas“2Plus3ADay”Campaign,“[email protected]”Campaignand“[email protected]”Campaign.The“[email protected]”Campaignwas launched in2006-2007academicyear to raisepublicawarenessandconcernabouthealthydietamongchildren,andcreateanenvironment thatisconducive tohealthydiet inschoolsand thecommunity. In2007, the“[email protected]”Campaignwasalso launchedtopromotehealthyeating inrestaurantsaspartof theeffortstoaddressNCDandobesity;alsoto formulateand implementstrategies toempower thepublic tomakeandrequesthealthierchoiceswheneatingout.Forpromotingphysicalactivity,theCHEUcollaboratedwithdifferentgovernmentdepartments,non-governmentorganizationsandprofessionalbodies to launchvarious initiativessuchas“HealthyExerciseforAllCampaign”,“ExercisePrescriptionProject”and“StairClimbingtoHealth”.
2.23 Through theCommunity LiaisonDivision, theDH establishes closepartnershipswithDistrictCouncils,HealthyCityProjects,communitygroupsand thepublic toorganizehealthpromotionprogrammesandpromotepopulationhealth.
2.24 TheFamilyHealthService(FHS),SHSandElderlyHealthService(EHS)oftheDHprovideavarietyofhealthpromotionanddiseasepreventionactivitiesforpeopleindifferentlifestages.
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2.25 TheFHSprovidesacomprehensiverangeofhealthpromotionanddiseasepreventionservices for children frombirth to5yearsandwomenbelow65yearsofage. Theseservicesareprovided throughanetworkof31MaternalandChildHealthCentres(MCHCs)and3WomanHealthCentres.Furthermore, theFHShasbeenactively involved inpromoting,protectingandsupportingbreastfeeding. Since2000,abreastfeedingpolicyhasbeen implemented in theFHS to facilitateasupportiveenvironment inallMCHCs.AllmedicalandnursingstaffofFHSweregivenstructuredtraininginbreastfeedingcounselling. SinceAugust2002, theDHhas implementedadepartmentalpolicy topromotebreastfeedingamongallstaffandsupportbreastfeeding in theworkplace. Information kits onbreastfeedingareproducedanddistributedtopregnantwomeninantenatalclinicsofhospitalsandMCHCs. Everyyear, theFHS joinsupwithothercommunitypartnersin launchingpublicitycampaignsaround theWorldBreastfeedingWeek toraisepublicawarenessonbreastfeeding.TheFHSalsomonitorsthetrendoflocalbreastfeedingratethroughcollectingmonthlyreportsfromallpublicandprivatematernityunitsandconductingregularsurveysintheMCHCs.
2.26 TheSHSaims tosafeguardboth thephysicalandpsychologicalhealthofschoolchildren throughcomprehensive,promotiveandpreventivehealthprogrammestoenablethemtogainthemaximumbenefitfromtheeducationsystemanddevelop their fullpotentials. TheSHSoperates12StudentHealthServiceCentres,whichprovidesservicessuchashealthassessment(e.g.weightstatusmeasurement),healtheducation(e.g.onhealthyeating,physicalactivityparticipation)andindividualhealthcounsellingforallprimaryandsecondaryschoolstudents.
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2.27 TheEHSprovidesprimaryhealthcare to theelderlysoas to improvetheirself-careability,encouragehealthy livingandstrengthen familysupport inorder tominimise illnessanddisability. Itoffers integratedhealthservicesincludinghealth riskassessment,physicalcheck-ups,counselling,curativetreatmentandhealtheducationtoelderlypeopleaged65andabovethroughits18ElderlyHealthCentres. Tailoredhealtheducationwillbegiven tothosewithhealthrisks,suchasoverweight,sedentary lifestyleorunhealthydiets,whicharedetectedthroughhealthriskassessment.Collaboratingwithvariouselderlycareproviders, the18VisitingHealthTeams(VHTs) reachintothecommunityandprovidehealtheducationforeldersandtheircarers.TheVHTsconducteducationaloutreachvisits toresidentialcarehomesfortheelderly toprovideskill trainingfor theirstaffontopicssuchasdesigninghealthymenus forelders,enhancing fiber intakeof residents,assessingresidents’nutritionalstatus.TheEHSactivelydisseminateshealthinformationtothegeneralpublic,includingtopicsondietandexercise,throughpamphlets,internetwebpages, telephone informationhotlines,mediaprogrammesandinterviews,andcontributedarticlestonewspapers.Topromotehealthyeatingandexercisesforall, theEHShasproducedvariousVCDssuchas“HealthySnacks”,“ShoppingSmart”,“ExerciseforHealthyAgeing”and“MaintenanceExercisefortheFrailElders”.TheEHShasalsopublishedaseriesofbooksincluding “CookbookofHealthyRecipes”and “OnHealthyEating:TheScienceandLoveofFoodandEating”,whichfurtherpromulgatetheprincipleofhealthyeating.
Health promotion programmes by other government departments and localorganizations
2.28 Apart fromtheDH,othergovernmentdepartmentssuchastheLeisureandCulturalServicesDepartment (LCSD)andEDBalsoplayamajor role inpromotinghealthy lifestyles. Many localNGOsalsoactivelyparticipate inpromotinghealthy living. Basedonthe input fromWGDPAMembers,some50localhealthpromotionprogrammeswereidentifiedandlistedinAnnex4.
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2.29 In accordancewith theOttawaCharter forHealthPromotion, healthpromotion isdefinedas“theprocessofenablingpeople to increasecontroloverand to improve theirhealth”. For thisprocess tomakean impactonpopulationhealth, thesixelementsofPEOPLE,namelyPartnership,Environment,Outcome-focused,Population-based,Life-courseapproachandEmpowerment,areconsideredasthecoretoplanningandimplementationofthehealthpromotionprogramme.Usingthesesixcriteria,someexamplesofhealthpromotiongoodpracticesareidentifiedandoutlinedbelow.
JumpRopeforHeartProgram
2.30 TheHongKongCollegeofCardiologyhaslaunchedthe“JumpRopeforHeartProgram”in1999tomotivateyoungpeopletoadoptahearthealthy lifestylethroughhavingphysicalactivity, thusreducingtheriskofheartdiseasesandstroke.Theprogrammecomprisesfourcomponents:-• Teachingskippingskillsthroughprovisionofasetofteachingkitwithguide
books,ropes,DVDs,andposterstoparticipatingschools;• ProvidingHeartHealthEducation throughhealth talksbycardiologists,
distribution of health educationmaterials, slogan/poster designcompetitions,etc;
• FundRaisingwhich isused foroperating the “JumpRope forHeartProgram”andorganizinghearthealthpromotionalactivities. 15%of thefund raisedwillbeallocated toparticipatingschools for theexpensesoforganizing the “JumpOffDay”andotherhealth-relatedactivities.Furthermore,studentscanhelptodisseminatethehearthealthmessageto their relativesand friendsduring fund raising. Besides, the fundraisingmechanismof the “JumpRope forHeartProgram”assures itssustainability;and
• Organizing“JumpOffDay”byparticipatingschools for theirstudents toperformskippingskillssothatmorestudentswillbemotivatedto jointheprogramme.
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HongKongHealthySchoolsAwardScheme
2.31 TheCentre forHealthEducation andHealthPromotion ofCUHKhaslaunched theHongKongHealthySchoolsAwardScheme forprimaryandsecondaryschoolssince2001. TheScheme followsclosely theHealthySchoolsProgrammepromotedby theWHO. TheSchemecoverssixkeyareas, includinghealthpolicies,health services,personalhealth skills,socialenvironment,community relationshipsandphysicalenvironment. Itbuildson theconceptofhealthpromotingschool toencourageeducationalachievement,betterhealthandemotionalwell-being; therebysupportingstudents in improvingtheirqualityof life. Itprovidesastructuredframeworkfor the development and implementation of healthy schools. A set ofguidelinesandstandardswithindicatorsformonitoringschools’progressandrecognitionofachievementareadopted.TheorganizerhasrecentlylaunchedtheHongKongHealthyPre-SchoolsAwardSchemetopromotehealthamongpre-schoolchildren. TheSchemehasobtainedpartof its funding fromtheQualityEducationFund.
2.32 Theaboveprogrammescomprise thesixkeyelements for implementationofhealthpromotionprogramme. Theorganizerscloselycollaboratewithvariouspartiessuchas theEDB,DHandparticipatingschools tocarryouttheprogrammes.Thisdrawstogetherthestrengthsofpeoplefromdifferentsectorswithdiverseknowledgeandskills.Theprogrammesadoptthesettingapproachandpromotehealthy living inschools, thuscreatingasupportiveenvironmentwhichenablesstudents tocultivate thehabitofhealthy living.Clearguidelinesandmeasurable indicatorsareestablishedtogaugeschooldevelopmentandmonitortheprogress.Theyareterritory-wideprogrammestargetedforallschoolsinHongKong.TheprogrammespromotehealthylivinginchildrenwhichmayhelptoreducetheriskofhavingNCDintheiradulthood.Furthermore, theprogrammesalsoempowerstudentswithpersonalhealthskills,andequiptheschoolmanagementswithskillstocreateanenvironmentthatisconducivetostudents’health.
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Analysis
Unhealthydietaryhabit,physicalinactivityandoverweight/obesityareprevalentinthelocalpopulation
2.33 Datafromvarioussourceshaverevealedthatunhealthydietaryhabit,physicalinactivity,andoverweight/obesityarecommonatdifferent lifestagesof thelocalpopulationstartingfromschoolage.
2.34 Fordietaryhabit, theWHOrecommendsexclusivebreastfeedingup to6months fornewborns. Althoughmany infants inHongKonghavebeenbreastfedondischargefromhospital,theexclusivebreastfeedingrateremainslow. Unhealthydietaryhabit isalsocommonamongchildrenandadults.Manychildrenshowpreferenceandconsumeunhealthyfoodsuchassugarydrinksanddeep-friedfood.Similarly,majorityofadultshavecertainunhealthydietaryhabitssuchas inadequate fruitandvegetablesconsumption,andfrequentsugarydrinks. Overall,unhealthydietaryhabit ismorecommonamongmales.
2.35 Physical inactivity isprevalent in the territory. Localstudiesshowed thatabouthalfofthestudentsdidnotexerciseenough.Ontheotherhand,theyspentasignificantproportionoftimeonsedentaryactivitiessuchaswatchingtelevisionandsurfing internet. Foradultpopulation,aboutone-fifthareclassifiedashaving“low” levelofphysicalactivityandoverhalfof themdidnotparticipate inanysportsactivity inthepast threemonths. Similar tothechildrenpopulation,adultsspendalotoftimeonsedentaryactivitiessuchassitting.Ingeneral,femalesarelessactivethanmales.
2.36 Theprevalenceofoverweight/obesity isontherisingtrendinHongKongforbothchildrenandadults. Asunhealthydietaryhabitandphysical inactivityare risk factors foroverweight/obesity, it isnotdifficult tounderstand thereasonbehind. Overall,overweight/obesity ismorecommonamongmales.Furthermore, thepresenceofcardiovascularrisk factorssuchashighbloodpressureandadverselipidprofilearenotuncommonamongbothchildrenandadultpopulation.
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Informationgapon localepidemiologyofunhealthydietaryhabitandphysicalinactivity
2.37 It isclear that theunhealthy lifestylespracticesarecommon in the localpopulation.However,information on the prevalence of unhealthy dietary habit and participation in physical activity among children, especially infants and young children, remains inadequate.
2.38 Severalgovernmentdepartmentsareconductingpopulation-basedsurveysrelated to thedietaryhabitandphysicalactivityparticipationof the localpopulation. Forexample, theStudyon theParticipationPatternsofHongKongPeople inPhysicalActivities isbeingconductedby theCSCof theSportsCommissiontoexaminethepatternsofphysicalactivityparticipationbythelocalpopulationagedsevenandabove.TheFoodConsumptionSurvey2005-2007and theTotalDietStudy(TDS)of theFoodandEnvironmentalHygieneDepartment (FEHD)arebeingconducted tocollect informationonthefoodconsumptionpatternsofthelocaladultpopulation.Whiletheabovestudiesareexpected toshed lighton thebehaviouralandbiomedical riskfactorsaffecting thepopulationat large, information focusingon infantandyoungchildrenremainslimited.
2.39 On theotherhand, theDHhasconducted the firstpopulation-basedChildHealthSurvey tocollecthealth informationof localchildrenaged14andbelow,suchashealth-relatedbehaviours,healthstatusandparentingissues.While theChildHealthSurveyof theDHmayaddtothecurrentknowledgeonhealthstatusof infantsandyoungchildren, thesurveyhasnotbeenspecificallydesignedforcollectingdataondietaryhabitandphysicalactivity,andtheinformationgeneratedfromthesurveymaynotbecomprehensivetoguideinterventionsthatfocusonchildren’sdietaryhabitandphysicalactivity.Moreinformationonthisareaisrequiredtobetterdefinetheirhealthneeds.
2.40 Besides,majorityof local studies focuson revealing theprevalenceofunhealthydietaryhabit,physical inactivityoroverweight/obese. Information on the knowledge, attitude and practice, as well as incentives and barriers to people’s adoption of healthy lifestyles is limited. Thus, it isdifficulttoidentifypeople’srootreasonsofhavingtheseriskfactors.
2.Diet,physicalactivityandhealth:HongKongsituation
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Gaponlocalhealthpromotionactivities
2.41 As canbe seen fromAnnex4, local health promotion activities are varied in nature and majority are organized independently by various organizations with minimal coordination among them. Activities tendtopromotehealthy living,withschoolchildrenandadultsasthemaintargetgroups.Furthermore,despitethelackofdetailedinformation,the small scale and short-term nature of some of the local health promotion activities might imply a limited impact on improving population health.
2.42 Besides,health promotion activity targeting at young children is apparently scanty. Individualsare influencedby factorsactingat allstagesof lifeand the risksofdevelopingNCDaccumulatewithage. Agoodandhealthystart in lifecreatesastrongplatform for thehealthoflater life. Byutilisingopportunitiesatearly lifestages, itmaybepossibletoachievereduction inprematuredeathsand fewerdisabilities inadulthood.Furthermore, it is fareasier toestablishgoodpatternsofactivityandeatinghabit than tochangeunhealthyhabits thathavebecome ingrained. Thus,interventionthatpromoteshealthinearlylifeisimportantinreducingtheriskofNCDinlateryears.
2.43 According to theWHO, theworkplacehasbeenestablishedasoneof theprioritysettings forhealthpromotion into the21stcentury. Theworkplaceisnotonlyoneof theplaceswheremostof thetimeisspent; italsodirectlyinfluencesthephysical,mentalandsocialwell-beingofworkersandinturnthehealthof their familiesandcommunities. TherearemorethanthreemillionpeopleworkinginHongKongandworkplaceoffersanidealsettingtopromotehealthy lifestyles fora largeaudience. However,activities to promote healthy living in workplace for the working population are also limited.
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TheroleofNGOsandbusinesssectorinpromotinghealth
2.44 TheOttawaCharter forHealth Promotion presented by theWHO in1986 recommended thathealthpromotion liesbeyond thehealthsector,emphasisingthat individualshavetotakegreaterresponsibility for theirownhealth. The importanceofpartnership forhealthpromotionwasreiteratedinWHO’sThe Bangkok Charter for Health Promotion in a Globalized World issuedin2005(informationontheconceptsandpracticeofhealthpromotionasanapproachand tool to improvingpeople’shealth isattached inAnnex5).IntheWestern Pacific Regional Action Plan for NCD,theRegionalOfficefor theWesternPacificofWHOalsourgedMemberStates toencourageandpromotecommunityparticipationandgrassrootsmobilisationsoas toestablishabroadbaseofsupport forpreventionandcontrolofNCDandtoensureacceptabilityandeffectivenessofpolicyandpopulation-basedinterventions. Thepublichealth issueofoverweight/obesity inHongKongthuscannotbe tackledsolelyby thehealthcaresystem,governmentorhealthcareworkers.Jointparticipationofallsectorsisthekeytosuccess.
2.45 ManyNGOsworkfor thewelfareof thecitizensand long-termsustainabilityof thesociety. Theyvaluesocial justiceandequality,andthe intrinsicrightsofevery individual. Whilesociety isobliged toprovide individualswith thebasicsocialandeconomicresourcestodeveloptheirpotentials,manyNGOsencourageindividualstocarryout theirresponsibilitiestowardstheir familiesandsociety,tobeself-reliantandtoachieveself-actualisation.Infact,manyNGOssharecommonvaluesinhealthpromotionbymotivatingthecommunitytotakeresponsibilitiesforhealthandempoweringindividualswithknowledgeandskills tomakehealthierdecisions forhealth,whilebeingmindfulof theneed tominimise thehealthequitygap. Thuson topof theeffortsby theGovernment,NGOs’participationandsupportinhealthpromotionisessentialtoenhanceitseffectiveness.
2.46 InHongKong,about52%ofthepopulationisinthelabourforceandpeoplespendmore thanone-thirdof thedaily lifeatwork. At individual level,promotinghealth inworkplacecan improvethewell-beingof theemployeeswhichwillenhance theirproductivity. Assuch,ahealthyworkplacewillbeimportant forsustainablesocialandeconomicdevelopment. On theotherhand,unhealthyworkforceresults ineconomic lossesthroughabsenteeism,injuryanddisease,directand indirecthealthexpenditures,andsignificantsocialcoststofamilies,communitiesandsociety.Therefore,thecommitmentandcontributionfromthebusinesssector is indispensable in improvingandprotectingpopulationhealth.
3.Actionstopromotehealthydietandphysicalactivityparticipation
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3Actions to promote healthy diet and physical activity participation
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3Preamble
3.1 It isenvisioned thatwith thesuccessful implementationof theStrategicFramework forNCDPreventionandControl,HongKongwillhaveawell-informedpopulation that isable to takeresponsibility for theirownhealth,acaringcommunity that integrates thepublicandprivatesectors toensurehealthychoicesfor thepublic,acompetenthealthcareprofessionthatviewshealthpromotionandpreventivemedicineaspriorities,andasustainablehealthcaresystem that incorporatesstrongelementsofhealthpromotion,diseasepreventionandcurativecare forourpeople, therebysignificantlyreducingthetollofdiseaseburdenrelatedtoNCD.
3.2 Toachievetheabovevision,WGDPArecognisestheimportanceofconcertedeffortsof theGovernmentanddifferentsectors in thecommunity inorder tocreateasustainableenvironmentconducive topromotinghealthydietandphysicalactivityparticipation.Itisofequalimportancethatindividualcitizensshould takeresponsibility for theirownhealth,aswellas thehealthof theirfamiliesandthecommunities,bymakinginformedandhealthierchoiceswithregardtodiet,physicalactivityandotherlifestyles.
3.3 AlthoughWGDPA ismainly tasked to recommendactions to promotehealthyeatingandphysicalactivityparticipation inHongKong,WGDPAalso recognises thesynergistichealthbenefits thatcanbebroughtaboutbymodifyingothermajorbehavioural risk factors includingsmokingandexcessivedrinkingatonego.Therefore,WGDPAwishestocallforcontinuingactionsfortobaccocontrolandavoidanceofexcessivedrinking,inadditiontoadoptionofhealthydietandactiveliving.
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Goals
3.4 Inmakingrecommendationstopromotehealthyeatingandphysicalactivityparticipation,WGDPAaims tohalt therising tideofoverweight/obesityandachievetheultimategoalofpreventingNCDandenhancingthequalityoflifeofthepopulation.Aftercarefulreviewandin-depthdiscussionregardingthelocalsituationonNCDandthemajorriskfactors includingunhealthydietaryhabit,physical inactivityandoverweight/obese,aswellas the localhealthpromotionactivitiesconductedbygovernmentdepartmentsandvariousorganizations inHongKong,WGDPAhasdrawnup thisAction Plan to Promote Healthy Diet and Physical Activity Participation in Hong Kong(ActionPlan).InthisActionPlan,WGDPAsetsoutpriorityareasforaction,anddrawsupalistofproposedactionswithtargetsandtimeframeswhereapplicable.
3.5 Indeveloping thisdetailedActionPlan,WGDPAconsulteddifferent keystakeholders in thepublic andprivate sectors including theacademia,districtcouncils,educationsector,businesssector, food industry,healthcareprofessionals,socialservicessectorandrelevantgovernmentdepartments.Itisintendedtooutlinetheframeworkofactionsthatwillbetakentosupport,andhelpsetthedirectionfor,thedeliveryofhealthpromotionprogrammes.
3.6 Togetherwith thecontinuingactions for tobaccocontrolandavoidanceofexcessivedrinking, thisActionPlanaims tobringaboutsynergistichealthbenefitsbymodifyingmajorbehaviouralriskfactorsandeventuallyreducetheprevalenceandmortalityratesfromNCDsuchasheartdiseases,strokeandcancersinthelongrun.
Details of 30 specific actions
3.7 Toachieve thesetgoalsand in linewith theNCDpreventionandcontrolstrategy, theSCMembershaveendorsedfourpriorityareas foractionwitha totalof11recommendations. Another threerecommendationsaremaderegardingsecuringof resources for theproposedhealthpromotionactions.This section setsout the30 specific actionswesuggest to implementto support people tomake healthier choices in their daily lives. Ourrecommendationshavebeenmadeafterconsultingstakeholdersfromacrosssectors,disciplinesandorganizations,andmost importantlysoliciting theirsupport for implementing therecommendations. The listof recommendedactionsaresummarisedinTable1.
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Priority area 1: Generate an effective information base and system on dietary habit and physical activity participation to guide actions
(Recommendation1A)StrengthensurveillanceofNCDandbehaviouralriskfactors
3.8 ResearchandsurveillanceofNCDandtheirrelatedriskfactorshelpgenerateevidence-basedinformationandinformactions.WGDPArecognisesthatthereisinformationgapregardingthedietaryhabitandphysicalactivityparticipationamong infantsandyoungchildrenand theirsignificantothers. Besides,WGDPArecognisesinadequacyininformationrelatedtotheunderstandingoftrends inunhealthybehaviours, thereasonsfor these,andeffectivewaysofpromotinghealthylivinginthepopulation.
3.9 In thisconnection,WGDPA recommends strengthening surveillance of NCD and tracking changes in the behavioural risk factor profiles of unhealthy dietary habit, physical inactivity and overweight/obesity of the population.Thesurveillancedatawillbeusefulformonitoringthetrendsofhealth-relatedbehaviours,planning, implementingandevaluatinghealthpromotionprogrammes.Currently, theBehaviouralRiskFactorSurveillanceSystemof theDHsystematicallyandregularlymonitorsthetrendsofhealthrisk factors in the localpopulation. The followingparagraphsdescribe thethreespecificactionstargetingthisrecommendation.
Action 1:Conduct a pi lot study on a web-basedYouth-Health BehaviourSurveillanceSystem(Y-HBSS)
3.10 Recognising the importanceofsoundsurveillance information for trackingchanges inhealthbehavioursof theyouth, theDHhasconductedapilotstudy to assess the feasibility andacceptability of usingaweb-basedsurveyquestionnaire tocollecthealthbehaviour informationfromsecondaryschoolstudents.Morethan1300studentsstudyingin8secondaryschoolsindifferentdistricts inHongKonghavebeen invited. Thestudywill becompletedinthesecondquarterof2010.Thestudyresultswillprovideusefulinformationonthefeasibilityofdevelopingaterritory-wideweb-basedY-HBSStomonitorthepriorityhealthbehavioursamongthelocalyouth.SupportfromtheEDBwillbesolicitedtoenhancetheacceptancebythestakeholders.
3.Actionstopromotehealthydietandphysicalactivityparticipation
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Action 2:Explore theuseofgrowthparametersmeasured inschools to trackchangesofobesity
3.11 Atpresent, there isa lackof comprehensivemechanism tocapture theanthropometricmeasurements of students. Noting that schools havebeenmeasuring theheight andweight of their studentsperiodically ineachacademicyear, theDHandEDBwillwork together toexplore thearrangements toallowtheuseofgrowthparametermeasured inschools tomonitorthelongtermtrendofoverweight/obesityinchildrenandadolescentssuchasby issuingguidelines toschoolsandstandardising the instrumentsusedandmethodsofmeasurement.
Action 3:ConductTotalDietStudytoassessdietaryintakeofthepopulation
3.12 Healthyeating isan importantdeterminantofhealth. Imbalanceddiet isassociatedwithsomechronicdiseasesandconditions includingobesity,heartdiseases,hypertension,diabetesandcancers. In thisconnection, theFEHDhascommissionedtheFoodConsumptionSurvey2005-2007,whichisa territory-wideandpopulation-basedstudytocollect informationonfoodconsumptionpatternsof thegeneralpublic. TheFEHDplans to reviewthe findingsof theFoodConsumptionSurvey2005-07 in2010. To furtherassessthedietary intakeof thepopulation,aTaskForceonTDSconsistingofmembersfromvariousgovernmentdepartmentshasbeenestablishedbytheFEHDtodevelopaTDSinHongKong.TheTDSmeasurestheamountofnutrients ingestedbypeopleofdifferentageandsexgroups. Itenablestheidentificationofthepopulationgroupsthataremostatriskandfacilitatestheformulationofactionplanstailor-madeforthespecificgroups.Theactualfieldworkwillbeconducted in2010-11andthe findingsof thestudywillbepublishedinphasesbetween2011-14.
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(Recommendation1B)Conductpopulation-basedhealthsurveyswithreferencetoWHO’s‘STEPS’
3.13 Apart fromstrengtheningsurveillanceofNCD,WGDPA recommends that population-based health surveys with measurement of biomedical risk factors should also be conducted regularly to monitor the health status of local population. Furthermore,NCD and risk factor surveillance should follow the “STEPwise approach to Surveillance (STEPS)” as recommended by the WHO. In the longterm, it is important todevelopamechanismtointegratealllocallyavailablehealthdatafromdifferentsourcesand to facilitatedatasharingamonggovernmentdepartments,academia,healthcareprofessionalsandotherstakeholders.
Action 4:ConductthesecondPopulationHealthSurvey
3.14 TheSTEPSinstruments,asrecommendedbyWHOtomonitor thetrendofchronicdiseaseriskfactors,coverthreedifferentlevelsof“steps”ofriskfactorassessment,includingquestionnaire,physicalmeasurementandbiochemicalmeasurements,e.g.bloodglucoseandbloodlipidprofiles. Inyear2003/04,theDHhascollaboratedwiththeDepartmentofCommunityMedicineof theUniversityofHongKong toconduct its firstPHS to report thepatternsofhealthstatusandhealth-relatedissuesofthegeneralpopulationinHongKongforadultsaged15orabove. It isenvisaged that the informationcollectedevery10yearswouldfacilitateplanning,managementandevaluationofhealthpromotionprogrammes. Hence, theDHplans toconduct thesecondPHSbasedontheWHOSTEPwiseapproach incollaborationwiththeacademia,whichwill takefiveyears tocomplete(from2011to2015). Commissioningofthestudywillstartin2011whilethepilotstudyandtheactualfieldworkwillbeconductedin2012and2013/14respectively.Areportwillbepublishedin2014/15.
3.Actionstopromotehealthydietandphysicalactivityparticipation
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(Recommendation 1C)Promote and support research related to risk factormodificationandeffectiveinterventions
3.15 Todeepen theunderstandingofcausesandconsequencesof the rise inunhealthyeatingandphysical inactivity,andwhatworkstopromotehealthyliving,WGDPA recommends promoting and supporting research in areas related to the behavioural risk factor modification and the effective interventions in promoting healthy eating and physical activity participation. The research resultswill be valuable forguiding futureevidence-basedinterventionsinpromotinghealthyeatingandphysicalactivityparticipationininfantsandyoungchildren.
Action 5: Conductaseriesofsurveyson infantsandyoungchildrenand theirparents
3.16 Lifestylehabitsintheearlyyearsplayacrucialroleinshapinganindividual’seatingandphysicalactivitypatterns. To fill theexisting informationgapsregardingthe lifestylehabitsof infantsandyoungchildren, theDHwill takethe leadtoconductaseriesofsurveysonparentalknowledge,attitudeandpracticeof feeding infantsandyoungchildren,milkconsumptionof infantsandyoungchildren, levelofphysicalactivityof infantsandyoungchildren,andfoodandnutrient intakesof infantsandyoungchildren. DatacollectionandanalysisoftheabovesurveysareexpectedtobecompletedbytheendofDecember2010.TheresultsofthesurveyswillbepublishedinMarch2011.
Action 6:Conduct reviewon theexistingprovisionof recreationand sportsprogrammes
3.17 ProvisionofawidevarietyoforganizedrecreationandsportsprogrammesisakeymeasureoftheLCSDtopromotesportstothecommunityatlarge.Theseprogrammesserve theobjectivesof fosteringastrongersportingculture,arousingpublicawarenessof thebenefitof regularparticipation inphysicalactivities,enhancingourqualityoflifeaswellassocialsolidarity.Inordertoenhancetheprogrammemixandtodesignmorenewprogrammestocaterfortheneedofdifferenttargetgroups,theLCSDplanstoconductareviewontheexistingprovisionofrecreationandsportsprogrammesin2010-14withaviewtoprovidingmoreattractiveprogrammesforfamilymembers,adultsandpeopleintheworkforce.
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Action 7: Conduct reviewon theexistingprovisionof leisure facilities,bookingarrangementsandchargesofvenues
3.18 TheLCSDpledges toprovide,manageandmaintainsafeandhigh-qualityrecreationandsportsfacilitiestofosterpublicparticipationinrecreationalandsportsactivitiesatanaffordablecost. Guidelinesontheprioritiesandquotafor individualandgroupusesare inplacetoenablethevenuemanagementtoprocessapplications for these facilities fromdifferentusers. Inorder tomeettheforeseeable increaseinthepublic’sdemandfor leisurefacilitiesasaresultof theenhancedpublicityof“Sport forAll” innear future, theLCSDplanstoconductareviewontheexistingprovisionofleisurefacilities,bookingarrangementsandchargesofvenuesin2010-14,whichaimstoenableafairallocationoffacilitiesamongdifferentusers.
Priority area 2: Support new and strengthen existing health promotion activities on healthy eating and physical activity participation
(Recommendation2A)Supportnewhealthpromotionprogrammes
3.19 WGDPAagrees thatahealthystart in life is fundamental for thehealthofadult life. WGDPAalsonoted that theworkplacehasbeenrecognisedasan importantsettingforhealthpromotion internationally,suchastheOttawaCharter forHealthPromotionandtheBangkokCharter forHealthPromotioninaGlobalizedWorld.Atpresent,therearelimitedhealthpromotionactivitiesonhealthydietandphysicalactivityparticipation for infantsandyoungchildrenaswellasforpeopleintheworkplace.Toaddresstheissue,WGDPA recommends supporting new health promotion programmes on healthy eating and physical activity participation targeting at young children and their parents, and people in the workplace.Thefollowingparagraphsdetailthehealthpromotionprogrammestobelaunchedintheyearsahead.
3.Actionstopromotehealthydietandphysicalactivityparticipation
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Action 8: DevelopandlaunchanewparentingprogrammeonweaningtargetingallinfantsandyoungchildreninMCHCs
3.20 Weaning is thestageduringwhichababychangesfromapurely fluiddiettoasemi-soliddietwhichcontainsallvarietiesof foodtypicalof thefamily’sdiet. It isan importantstagebecause it influences thedevelopmentof thedietaryhabitsofachild.Hence,theDHwilldevelopandlaunchaparentingprogrammeonweaninginHongKong.Beforerollingoutoftheprogramme,all relevantmedicalandnursingstaffof theDHwillbetrainedin2010.Theimplementationof theprogrammewill takeplace inthethirdquarterof2011withongoingevaluation.
Action 9: DevelopaHongKongCodeofMarketingofBreastmilkSubstitutes
3.21 Breastfeedingprovidesidealnutrientsforthehealthygrowthanddevelopmentofinfants.Theanti-infectivepropertiesofbreastmilkalsohelpprotectinfantsagainstcertaindiseases.Nevertheless,variousfactors/barriersmayinfluencethemothers to feed their infantwithbreastmilksubstitutes,suchas infantformula. In thisconnection, theWHOInternationalCodeofMarketingofBreast-milkSubstituteswasdeveloped in1981 to recommendrestrictionson themarketingofbreastmilk substitutes, toensure thatmothersarenotdiscouraged frombreastfeedingand thatsubstitutesareusedsafely ifneeded.Sincethemarketingofformulamilkiswide-spreadandaggressive,theDHaimstosetupataskforcetodevelopaHongKongCodeofMarketingofBreastmilkSubstitutesby thesecondquarterof2010witha view todevelopingandpromotingtheCodebythefourthquarterof2011.
Action 10: Exploremodelstopromotehealthydietandphysicalactivityinworkplace
3.22 Theworkplaceisanidealsettingforreachingthemajorityofadults.However,whilestudiesinNorthAmericaandEuroperevealedthathealthpromotioninworkplacehavebeeneffective,workplacesaregenerallyunder-utilisedasasetting forpromotinghealthandwell-being inHongKong. To thisend, theDHaimstodevelopandpilotsuitablemodel(s)topromotehealthyeatingandphysicalactivityinworkplaceinHongKongby2010-11.
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Action 11:Expandthe“IdealBMI”DiseasePreventionProject
3.23 The“IdealBMI”DiseasePreventionProject isahealthprogrammelaunchedbytheHAincollaborationwithdifferentcorporatesandorganizationstoraisetheemployees’awarenessofobesityandrelatedhealthproblems,encouragethemtoadopthealthy lifestylesandpromoteacultureofhealthy living fordiseaseprevention. Byyear2010-11, theHAaims toengagearound20businessenterprisesandpublicorganizationsaspartners. Through thisprogramme,employeesmayexperience thebenefitsofhavinghealthierlifestylesandprovisionofhealthyworkingenvironment.Ontheotherhand,theemployersmayalsobenefitfromanimprovementinproductivity,increasestaffmorale,andhelppromotetheircorporateimages.
(Recommendation2B)StrengthentheEatSmartprogrammeoftheDH
3.24 For theexisting territory-widehealthpromotionactivitiesonhealthydietandphysical activity,WGDPA recognises the successof theEatSmartprogrammes(i.e.“[email protected]”Campaignand“[email protected]”Campaign)of theDH in termsof theactiveparticipationofschoolsandrestaurants,andwideacceptancebystudents/parentsandstaff/customers.Buildingon theearly successof thecampaigns,WGDPA recommends strengthening the existing EatSmart programme and broadening its coverage, and may consider extending the EatSmart programme to cover all walks of lifeinfuture.
Action 12: BroadenthecoverageoftheEatSmartSchoolAccreditationScheme
3.25 Schoolsoffer important support for childrenandyoungpeople tomakeinformedchoicesabout theirdietsandprovidethemwithaccesstohealthierfoods.AnidealEatSmartSchoolshouldcontinuouslyimplementadministrativemeasures, provide healthy lunchand snacks, carry out education andpublicity, andshoulder the responsibility of advocatingahealthyeatingenvironmentintheschoolsector.TheEatSmartSchoolAccreditationSchemeorganizedbytheDHin2009aimstomotivateandassistallprimaryschoolsinHongKongto formulateand implementhealthyeatingpolicy,establishafavourable learningenvironment forpromotinghealthyeating,andcultivateandstrengthenthegoodeatinghabitofthestudents.WiththesupportoftheEDB, theAccreditationSchemeisanongoingprojectwhichencouragesthefamily,theschoolandthecommunitytojointlyformulatespecificschoolpolicyandmeasuressothattheschoolwillultimatelyachievethestandardof ‘idealEatSmartschool’.
3.Actionstopromotehealthydietandphysicalactivityparticipation
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(Recommendation2C)Strengthenpubliceducationonnutrition informationonfoodlabelsandenergyimbalance
3.26 Nutrition informationon food labels isan importantpublichealth tool topromoteabalanceddiet,henceenhancingpublichealth. This informationenablesconsumerstocomparenutritionalvaluesofsimilarfoodproductsandthenmakehealthy foodchoices. For thosewhorequirespecialdiets,e.g.peoplewithdiabetesorhighblood lipid,nutrition informationonfood labelsenablesthemtoselectsuitablefoodandhelpmanagetheirhealthconditions.Therefore,WGDPA recommends strengthening the public education on nutrition information on food labels,withaviewtoempoweringmembersofthepublicwiththeabilitytomakehealthyfoodchoices.
3.27 Apart fromstrengtheningpubliceducationonnutrition labelling,WGDPArecognises the importanceofdisseminating informationon thecauseofoverweight/obesityinhealthpromotionprogrammes.Atheart,excessweightiscausedbyenergy imbalance. Eatinghealthier toreduceenergy intakeorbeingmoreactiveto increaseenergyexpenditurealonemaynotbeabletooptimizethebodyweight. Achievingenergybalancethroughhealthyeatingandregularphysicalactivity is thekey tomaintainingoptimalbodyweight.In thisconnection,WGDPA also recommends strengthening the public education on energy imbalance from unhealthy eating and physical inactivity as the cause of overweight/obesity. Besides, importanthealthmessagesshouldbedisseminatedinthecommunitythroughmassmediasothatavery largeaudiencecouldbereachedforraisingthe issuesforpublicattention.
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Action 13: Continuepubliceducationonnutritioninformationonfoodlabels
3.28 Providingnutrition informationon food labelshasbeenrecognisedasoneofthemeanstopromotehealthyeating.ATaskForceonNutritionLabellingEducationcomprisingrepresentativesfromprofessionalorganizations, trade,consumers,academiaandgovernmentdepartmentshasbeen formed tooverseethepublicityandeducationcampaignonnutritionlabelling.Totieinwiththeimplementationofthemandatorynutritionlabellingscheme,theFEHDconductsathree-yearNutritionLabellingPublicityandEducationCampaign,whichaims todrivehometheadvantagesof thenutrition labellingschemeandenhancepublicunderstandingonhowtoreadnutrition labelsandmakeuseofsuch informationtomaintainahealthydiet. Thiscampaign includes,amongothers, theAnnouncementofPublic Interest inTVandradio,releaseof resultsofvariousstudiesonnutrients in food,productionofavarietyofpublicityandeducationalmaterialssuchasthematicvideo,posters,booklets,andsouvenirs,andorganizationofrovingexhibitionsandhealthtalks.
Action 14: ContinuepubliceducationthroughEatSmartprogrammes
3.29 Enablingpeopletomakeinformedchoicesthataffecthealthisimportant.Tothisend, theEatSmartProgrammes(i.e. “[email protected]”Campaignand“[email protected]”Campaign)oftheDHaimtoeducate,empowerandenablethecommunity tohaveeasieraccesstohealthierdiet. Buildingonthesuccessofthesecampaigns,theDHwillcontinueitspubliceducationthrough theEatSmartprogrammes toempowerschoolpersonnel,parents,foodsuppliers,mediaandthepublicwithhealthyeatingtips.
Action 15: Educatepublicontheimportanceandbenefitsofregularparticipationinsportandotherphysicalactivities
3.30 Tomeet thegoalofpromoting the levelofphysicalactivity inHongKong,people’sawarenessandknowledgeofthebenefitsofbeingactiveshouldbeenhancedas thefirststep. In thisconnection, theLCSDplanstoorganizelarge-scalesportspromotionalprogrammeswithaview toeducating thegeneralpublicon the importanceandbenefitsof regularparticipation insportandotherphysicalactivities. Membersof thepublicandcommunitystakeholderswillbeinvitedtojointheseevents.Furthermore,variouspublicitymaterialswillbeproducedanddisseminated through themedia,schools,hospitalsandleisurevenuesoftheLCSD.
3.Actionstopromotehealthydietandphysicalactivityparticipation
35
Priority area 3: Strengthen partnership and foster engagement of all relevant stakeholders
3.31 Thehealthdeterminantsare sopervasive that healthpromotionanddiseaseprevention requireswholecommunity involvementandextendsbeyond thescopeof thehealthsector. Working inpartnershipwithallrelevantstakeholdersat community level is crucial for thesuccessofhealthpromotionwork.Bydrawingpeoplewithdifferentbackgroundsandexpertise, ithelpsmaximisethestrengthsandcreatesynergy. Giventhecomplexityofhumanbehavioursandthechallenges in tacklingunhealthybehaviours,WGDPA recognises the importance thathealthauthority,healthcareprofessionals,governmentdepartmentsandotherNGOstoworkcloselytogetherinamorecoordinatedapproachinordertoaddressthesecomplexissues.
(Recommendation3A)Intra-governmentalpartnership
3.32 Close cooperationwith all government departments responsible forhealth improvementandprotection, food,physicalexercise,environment,transport, employmentand community development canensure thatrelevanthealth-relatedstrategy iseffectively integratedand implemented.In thisconnection,WGDPA recommends government departments/bureaux working together to develop and implement policies that are sensitive to the needs of the public in achieving healthy eating and physical activity participation, and to create an environment, including the built-environment, that facilitate people in making healthier choices.
3.33 Forinstance,provisionofsafeexercisefacilities,walkingpaths,alongwithothertownplanningdesignsthatareconducivetogoodhealth,canincreasetheopportunitiesfor,andreducebarrierstophysicalactivity.Introductionofhealthyeatingpolicyinschoolscanalsohelppromotehealthyeatingatanearlyage.TheDH,LCSDandEDBareworkingcloselytopromotephysicalactivityandhealthyeating inschoolsand/orcommunitysettings. Suchcollaborativenetworkswillstrengthentheplatformtoharnesscommunitysupportandoptimisesynergisticeffect through intersectoralaction. Thefollowingparagraphshighlightourworkplanintheyearstofollow.
36
Action 16:Solicitsupport fromrelevantgovernmentbureauxanddepartments indevelopingandimplementinghealthypublicpolicies
3.34 Commitment and coordinated efforts from government bureaux anddepartmentsarecrucial to facilitatepromotionofhealthydietandphysicalactivityparticipation in thepopulation. In thisconnection,officials fromrelevantbureauxanddepartmentswillbeinvitedtoattendWGDPAmeetingsandbriefmembersregardingtheirworkonpromotionofhealthyeatingandphysicalactivityparticipationin2010.ThiswillalsoenhancecommunicationbetweentheDHandothergovernmentbureauxanddepartmentsregardingtheNCDframeworkandstrategies,andsolicit theirparticipation inbuildinghealthypublicpoliciesinyear2010-11.
Action 17: Solicit support from theEstateManagementAdvisoryCommittees(EMACs)topromotehealthydietandphysicalactivities/healtheducationatestatelevel
3.35 EMACsworkasaneffectivecommunicationchannelbetween theHousingAuthorityandtenantsofpublicrentalhousing(PRH)estates. The leverageandoperationofEMACsalsoserveasausefulplatformforNGOstointroduceawiderangeofservices,includingpromotionofcommunityhealthandfitnesssuchas thepilotneighbourhoodactiveageingproject. Hence, theDHwillworkwiththeHousingDepartment(HD)topromotehealthydietandphysicalactivities/healtheducationat theestate level,e.g.arrangevisits toEMACsto introducetheActionPlan. Moreover,withtherecentendorsementbytheHousingAuthority,EMACscanprovidefundingforNGOs(about$30,000to$50,000perprogramme) to runcommunitybuilding functionsand the likeinPRHestates. NGOsare invited touseEMAC fund toorganizehealthpromotionactivitiesattheestatelevel.
3.Actionstopromotehealthydietandphysicalactivityparticipation
37
(Recommendation3B)Workingwithotherhealthpromotionpartnerstodevelopandimplementpoliciesandpractices
3.36 Furthermore,successfulimplementationofanyhealthpromotionprogrammeswouldnotbepossiblewithout theactivesupportandparticipationof thecommunity. WGDPA recommends other health promotion partners to develop and implement policies and practices that are supportive of healthy eating and physical activity promotion for members of the public.Forexample,HealthyCityandSafeCommunityAssociationssetupindifferentdistrictscanhelpcultivateahealthylivinglifestyleinthecommunitythroughclosecollaborationwiththeGovernment, localorganizationsandthepublic.TheDHcouldalsoexploreopportunitiesintheworkplacetopromotehealthyeatingandphysicalactivityamongtheworkforce.
Action 18: Promulgatetheactionplantootherhealthpromotionpartners
3.37 Changing lifestylehabitsmaybeginat the individualor family level,butmaintaining thedesirablechanges requires thepresenceofaconduciveenvironment for reinforcementat thecommunity level. Healthpromotionprogrammes/policiesneedtofocusonthecommunityasawhole,making itsupportiveandenablingsothatallcommunitymemberscanplayanactiverole inchanging thebehavioural risk factors. Therefore,whendevelopingandimplementinghealthpolicies,participationofcommunityhealthpromotionpartnersisimportantsoastounderstandtheirviewsandsolicittheirsupport.Inthisconnection,theDHmetwithchairmen/representativesofHealthyCitiesProjectsCommittees inDecember2009andwillcontinue toworkwith theHomeAffairsDepartment(HAD)topromulgatetheactionplanatdistrictlevelincludingvarioushealthpromotionpartners.
Action 19:Assisttradetoproducefoodthataresupportiveofhealthyeating
3.38 TheFEHDplans todevelop tradeguidelineson reducingsodium,sugarsandothernutrientsthatexcessiveintakeisnotadvisableinfoodsin2012.Itprovidesguidancetothefoodtradetomodify themanufacturingprocesssoastolowerunhealthycontentsinfoods,whichinturnenablesthecommunitytohaveeasieraccessofhealthier foodcommodities topreventdiet relateddiseaseslikecancers,highbloodpressure,heartdiseasesandstroke.
38
Action 20: Promotehealthylifestyleandself-managementthroughenhancementofprimarycareservices
3.39 Agoodprimary care systemwhichprovides thepublicwith access tocontinuous,comprehensiveandholisticcareisimportantforpromotinghealthandpreventionandcontrolofdiseases. ToenhanceprimarycareservicesinHongKong, theWorkingGrouponPrimaryCare(WGPC)chairedbytheSecretary forFoodandHealthhas formulatedasetof recommendations.Amongst themarestrategiestostrengthenthepreventionandmanagementofNCD,startingwithhypertension (HT)anddiabetesmellitus (DM), thetwocommonestNCD inHongKong. Assetout in the2009-10PolicyAgenda,conceptualmodelsandclinicalprotocols forHTandDMarebeingdevelopedby theWGPCforuseascommonreference to facilitatecross-sectoralcollaborationamongdifferenthealthcareprofessionals inbothpublicandprivatehealthcaresectors. Lifestylemodificationsandenhancedself-management for thepreventionandbetter control of thesemajorNCDareemphasised in theseclinicalprotocols,aswellas in thepilotprojectsunderwaytostrengthenprimarycareservicedelivery.
Action 21:Enlistsupportofstakeholdersinthecommunitytoencourageandsupportphysicalactivity
3.40 TheCSCof theLCSD iscommitted to lowering the ratioof the inactivepopulation,thusachievingtheultimategoalof“SportforAll”inthecommunity.Assuch,theLCSDwilldisseminatethefindingsandrecommendationsoftheStudyof“Sport forAll” tovariousmajorstakeholders in thecommunity,e.g.governmentdepartments,DistrictCouncils,NationalSportsAssociations,DistrictSportsAssociations,businessorganizations,schools,etc., throughletters andother channels. TheLCSDwill also continue to enlist thestakeholders’supporttopromotephysicalactivityparticipationtotheirservicecustomersandstaff.
3.Actionstopromotehealthydietandphysicalactivityparticipation
39
Action 22: Solicitsupporttostrengthentrainingonsportandotherphysicalactivitiesforkindergarten
3.41 Beingphysicallyactiveinchildhoodlaysthefoundationforactiveparticipationinphysicalandsportsactivitiesinadulthood.Thehealthmessageonregularparticipation inphysicalandsportactivitieshavebeendisseminated tostudents,parentsandteachersthroughprimaryandsecondaryschools. Tointegratephysicalandsportactivitiesintoearlychildhood,theLCSDwillworkwiththeEDBfrom2010onwardstostrengthentrainingonphysicalandsportactivities forkindergarten teachersandpre-schoolstudentsbyorganizingworkshopstoenhancetheirknowledgeinthisaspect.
Priority area 4: Build the capacity and capability to promote healthy eating and physical activity participation
(Recommendation4A)Reviewoverseasand local literatureonhealthpromotioninterventions
3.42 Fromthepublichealthperspective,healthpromotionisanimportantstrategyinprimarypreventiontoimprovethehealthofthepopulationasawhole.Ashealthbehavioursareintricatelyconnectedwiththelivingenvironmentinmanyways,healthpromotionneedstobeevidence-basedandoutcome-focused.Conventionalmeansofhealth informationdisseminationsingly throughdistributionofhealtheducationmaterialsandorganizingpublicitycampaignsarenotaseffectiveasonewouldhavethought.Inplanninghealthpromotionprogrammes,organizersshouldtakereferencefromeffectivehealthpromotionintervention,andshouldconsider factors thatwillenhancethesustainabilityofeffectiveprogrammes.Thus,WGDPA recommends reviewing overseas and local literature of health promotion interventions on healthy eating and physical activity participation, so as to identify elements of success and factors which enhance programme sustainability.
40
Action 23: Review,summariseandcommunicate findingswithstakeholdersonregularbasis
3.43 TheDHiscommittedtobuildingtheevidencebasefortheeffectivenessandcost-effectivenessofpublichealth interventions, including thoserelated todietandphysicalactivity.TheDHhasbeenconductingongoingreviewsandsummarising important findings fromevidence-based literatures,aiming todevelopevidence-baseddata forsharingwithhealthpromotionpartnersonregularbasisusingthematicwebsitesinyear2010-11soastoleadactiontoimprovethehealthofthepeopleinHongKong.OtherserviceunitsintheDHwillalsoconductongoingreviewsrelated tootherareasof interestandwillcommunicateusefuldata/information tohealthpromotionpartners throughvariousmeans.
(Recommendation4B)Organize forumsandworkshops for fosteringpartnerships,bettercoordinationofeffortsandcapacitybuilding
3.44 Itisimportanttoempowerthepartnersandstakeholderswiththeknowledgeandskills inaddressingtheproblemsofunhealthydietaryhabitandphysicalinactivity. In thisconnection,WGDPArecommendsorganizing forumsandworkshops for fosteringpartnerships,better coordinationofeffortsandcapacitybuildingamonghealthpromotionpartners. TheDHhasorganizedcapacity buildingprogrammes for its staff andNGOs toenhance theirknowledgeandskills inhealthpromotion. Basichealthpromotionconceptsand theoriesaswellasgoodpracticesareshared in thesesettings. Moretrainingopportunitiesshouldbeconsideredtoequiphealthpromotionpartnersin thecommunitywith theskills inorganizingeffectiveandevidence-basedhealthpromotionprogrammestocomplementgovernment’srole.
Action 24:OrganizeaconferenceonNCDprevention
3.45 InordertoeffectivelyraisetheawarenessofNCDpreventionandcontrolandbringabout thesynergistichealthbenefitsofmodifyingmajorbehaviouralriskfactors, theDHplanstohostaconferenceinearly2012,puttingspecialemphasisonthepromotionofhealthydietandphysicalactivity,preventionofalcoholmisuseandinjuries,aswellascommunityparticipationandcapacitybuilding.Throughthisevent,weaimtobringtogethermajorlocalaswellasinternationalhealthpromotionpartnerstosharetheirexperienceonsuccessfulhealthpromotionapproachesandbestpractices.
3.Actionstopromotehealthydietandphysicalactivityparticipation
41
Action 25:Identifyhealthpromotionagenciesthroughvariousforums
3.46 Successful communityprojectsacknowledgeand involve thegroupsorindividualswhohaveastake in the issue. Isolatedactionwillonlybringlimitedimpact,andapartnershipapproachisdesirableatthecommunitylevel.In thisconnection, theDHwillorganizedifferent forums inyear2010-12toidentifyasmanyhealthpromotionagenciesaspossible,andengagethemforcollaborationinfutureinrelationtopromotinghealthydietandphysicalactivityparticipation inHongKong. Buildingcoalitionsandpotentialpartnershipamong thestakeholderscan furtherchampion theeffort inpromoting thehealthofourcitizensinHongKong.
Action 26:Developeducationkitsonbreastfeeding forhealthprofessionalsandorganizeworkshops
3.47 Good nutrition in early years of life is amajor determinant of growthanddevelopmentandwilldirectly influence thehealth inadulthood. Asbreastfeedingprovidesclearshortand long termhealthbenefits forbothinfantsandmothers,breastfeeding isrecommendedasthebestnutritionforinfantsinthefirstsixmonthsoflife.Inviewofthelowexclusivebreastfeedingrate inHongKong,WGDPAurgeshealthprofessionals tosupportwomeninchoosingbreastfeeding for their infants. TheDHthusplans todevelopaneducationkitonbreastfeeding forhealthprofessionalsandorganizeworkshops to teach themthenecessaryskills tosupportandempower themothersandtheirfamiliestoachievetheirbreastfeedinggoals.Theeducationkitswillbe launchedinthesecondquarterof2010whiletrainingworkshopswillbeorganizedin2011.
(Recommendation4C)Applytheories,concepts,evidenceandskillsinplanningandorganizationofactivities
3.48 Inadditiontoappraisingevidenceonsuccessfulelementsforhealthpromotionprogrammes, it isalso important to incorporate thesesuccess factors intotheprogrammes. Likewise,elementsdemonstrated tobenoteffectiveshouldnotbe introducedagain,henceavoidingreinventingthewheel. Thisisanessentialway toachievebetteroutcomegiven limited resources.Therefore,WGDPA recommends the health promotion agencies to apply health promotion theories, concepts, evidence and skills in planning and organization of healthy eating and physical activity promotional activities, which could take the form of ‘demonstration projects’.
42
Action 27: Arrangetrainingworkshopsforhealthpromotionpartnerstobuilduptheirskillsonorganizinghealthpromotionprogrammes
3.49 Puttingresearch findings intopractice is importantwhenorganizinghealthpromotionprogrammes. Toequip thehealthpromotionpartnerswith thenecessary knowledgeandskills in applyinghealthpromotion theories,concepts and evidence in planning and organizing health promotionprogrammes, theDHwillarrangeat least four trainingworkshopsfor thesetargetaudienceinyear2010-12.
Priority area 5: Secure resources for health promotion on healthy eating and physical activity participation
(Recommendation5A)Sharethevisionandplanswithstakeholdersandcommunitymembers
3.50 WGDPAbelieves that the small-scaleand short-termhealthpromotionactivitiesmaynotgeneratesignificantimpactonimprovingpopulationhealth.Resourcesshouldbepooled together tobetterutilise the fundingavailableaswellas tomaximise the impactofhealthpromotionactivities. In thisregard,WGDPA recommends the Government to share the vision and plans of the Strategic Framework for NCD Prevention and Control with stakeholders and community members.
Action 28: Organize forumforhealthpromotionpartners topromulgate theNCDStrategicFrameworkandtheActionPlan
3.51 WGDPA recognises that in order tomake healthier choices easier,interdepartmentalcollaborationandpartnershipwithkeystakeholdersandcommunitysectorsareofvitalimportance.Thus,theDHwillorganizeatleastfourforums/workshopsinyear2010-12fordifferenthealthpromotionpartnerstopromulgatetheStrategicFrameworkforNCDPreventionandControlandtheActionPlan,aimingtoenlisttheirsupportforactivitiesandpoliciesthatwillcontributedirectlyandindirectlytothepromotionofhealthofthepopulation.
3.Actionstopromotehealthydietandphysicalactivityparticipation
43
(Recommendation5B)Applicationsforfunds
3.52 NGOs and academic institutions should also be encouraged to submit applications for funds provided by the Administration and other sources to conduct research studies relating to health promotion. SuchfundingsourcesincludetheHealthCareandPromotionFund,theHealthandHealthServicesResearchFund,ResearchGrantsCouncilof theUniversityGrantsCommittee, theCommunity InvestmentandInclusionFund, theHongKongJockeyClubCharitiesTrust,theSKYEEMedicalFoundation,andtheBoardofManagementoftheChinesePermanentCemeteries,etc.
Action 29: ConductworkshopsforNGOstoenhancetheirunderstandingofvariousfundingsourcesandapplications
3.53 InHongKong, fundingsourcesareavailable forvarious research/projectthemes, includinghealthpromotion initiatives. However,many fundingsourcesmay impose various requirements, and understanding suchrequirements is fundamental forNGOstosecuremoreresourcesforhealthpromotionprogrammesonhealthydietandphysicalactivityparticipation. Inthisconnection, theDHplanstoorganizeat least four forums/workshops inyear2010-12forNGOsandotherhealthpromotionpartnerstoenhancetheirunderstandingonvariousfundingsourcesandapplications.
(Recommendation5C)Encouragehealthpromotionpartners toexplore innovativemeansoffunding
3.54 It is important to findwaystomobilize local resources topromotehealth inthecommunitythroughbuildingpartnershipbetweenpublic,privateandnon-governmentalorganizations. In this regard,WGDPAencourageshealthpromotionpartnerstoexploreinnovativemeansoffundingsuchascharitabletrusts(setupbybusinesscorporationswithemphasisonsocialresponsibility),matchingfundsandseedinggrants.
44
Action 30: Explore thepossibilityofsecuringdifferentsourcesof funding fromestablishedchannelstopromotehealthyeatingandphysicalactivity
3.55 WGDPArecognises thatdiversifiedsourcesof funding forhealthpromotioncanattract theparticipationofcommunitypartnersandNGOs inpromotinghealthyeatingandphysicalactivityparticipation. Thus,various fundingsources, including innovativemeansof fundingsuchascharitable trusts,matchingfundsandseedinggrants,wouldbeexploredregularlywithaviewtopoolingtogetherexistingresourcesfromdifferentchannelsforbetterutilisationandtocreatesynergy.
3.Actionstopromotehealthydietandphysicalactivityparticipation
45
Tabl
e 1
Lis
t of d
etai
led
actio
ns w
ith ta
rget
s an
d tim
efra
me
Prio
rity
Are
asR
ecom
men
datio
ns A
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
)Ti
mef
ram
e
fective
ef and
habit
an
Generate base
dietary
on
physicalactivity
guide
to
1) information
system
and
participation
actions
surveillance
factor
risk
changes
dietary and
Strengthen track
NCDand unhealthy
of physicalinactivity the
of
behavioural
(1A
) the
of in profile
habit,
overweight/obesity
population.
,
Surveillance
obesity
outh-Health factors,
for
identify
risk
those school
to [Act
ion
1]
YBehaviour
Pilot
System
behavioural
including
secondary
in students
•DH
EDB
• •
study
the
Com
plete
Q22010
by Com
pletethereview
Q42010
by
• •
2010
of
grow
th
in
of
use
the
Explore
parametermeasured
trackchanges
to
schools [A
ctio
n 2]
obesity
••
EDB
•DH
•Developlogistics
tomonitorthe
prevalenceofobesity
inschoolchildren
2010
46
Prio
rity
Are
asR
ecom
men
datio
ns A
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
)Ti
mef
ram
e
•ConductTotalDietS
tudyto
assessthedietaryintakeof
thepopulation
[Act
ion
3]•
FEHD
•Reviewthefindings
oftheFood
ConsumptionSurvey
in2010
•Conductfieldw
orkof
TotalD
ietS
tudyin
2010-2011
•Publishreportsof
TotalD
ietS
tudyin
phasesfrom
2011to
2014
2010-14
(1B
)Conductpopulation-
basedhealthsurveys
withbiomedicalriskfactor
measurementregularlyto
monitorthehealthprofileof
thepopulationwithreference
toW
HO’s‘STE
PS’.
•Conductthesecond
PopulationHealthSurvey
foradultsaged15or
abovewithbiochem
ical
measurementse.g.
anthropometric
measurements,blood
glucoseandbloodlipid
profiles
[Act
ion
4]
•DH
•Academia
•Com
missionthe
studyin2011
•Conductpilotstudy
in2012
•Conductfieldw
orkin
2013/14
•Publishthereportin
2014/15
2011-15
3.Actionstopromotehealthydietandphysicalactivityparticipation
47
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
) T
imef
ram
e
(1C
)Promoteandsupport
researchinareasrelatedto
thebehaviouralriskfactor
modificationandtheeffective
interventionsinpromoting
healthyeatingandphysical
activityparticipation,e.g.
researchonparental
know
ledge,attitudeand
practiceoffeedinginfants
andyoungchildren,
includingbreastfeedingand
weaning;foodandnutrient
intakesofinfantsandyoung
children.
•Conductasurveyon
parentalknowledge,
attitudeandpracticeof
feedinginfantsandyoung
children(6-month-oldto
2-year-oldand4-year-old)
•Conductasurveyonmilk
consum
ptionofinfantsand
youngchildren(12-month-
oldto2-year-oldand
4-year-old)
•Conductadietarysurvey
oninfantsandyoung
children(6-month-oldto
2-year-oldand4-year-old)
•Conductasurveyon
physicalactivityofyoung
children(2-year-oldand
4-year-old)
[Act
ion
5]
•DH
•Academia
•Com
pletedata
collection&analysis
byendofD
ecem
ber
2010
•Publishreportby
March2011
2010-11
48
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
)Ti
mef
ram
e
•Conductreview
onthe
existingprovisionof
recreationandsports
programmessoasto
providemoreattractive
programmesforfam
ily
mem
bers,adultandpeople
intheworkforce
[Act
ion
6]
•LC
SD
•Toenhancethe
programmemix
andtodesignsome
newprogram
mes
cateringfortheneed
ofdifferenttargets
2010-14
•Conductreview
onthe
existingprovisionof
leisurefacilities,booking
arrangem
entsandcharges
ofvenues,etc.tocopewith
theprom
otionofsportfor
all [
Act
ion
7]
•LC
SD
•Toenhancethe
provisionofleisure
facilities
2010-14
2)Supportnewand
strengthenexistinghea
prom
otionactivities
onhealthyeating
andphysicalactivity
participation
(2A
)Providesupportfor
lthnew
healthpromotion
programmesonhealthy
eatingandphysicalactivity
participationtargetingyoung
childrenandtheirparents,
andpeopleinworkplace.
•Developandlauncha
newparentingprogramme
onweaningtargetingall
infantsandyoungchildren
(6-month-oldto2-year-
old)inMaternalandChild
HealthCentres
[Act
ion
8]
•DH
•Trainrelevant
medical&nursing
staffofD
Hin2010
•Implem
entthe
programmeinQ3
2011
•Ongoingevaluation
oftheprogramme
2010-12
3.Actionstopromotehealthydietandphysicalactivityparticipation
49
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
npa
rty
Ta
rget
(s)/I
ndic
ator
(s)
Tim
efra
me
•DevelopaHongKong
CodeofMarketingof
BreastmilkSubstitutes
[Act
ion
9]
•DH
•Setupataskforce
byQ22010
•Codedevelopedby
Q42011
2010-11
•Exploremodelstopromote
healthydietandphysical
activityinworkplace
[Act
ion
10]
•DH
•Developsuitable
model(s)tobe
consideredforpilot
testing
2010-11
•Expandtheworkplace
healthpromotion
programme,nam
ely
“IdealBMI”Disease
PreventionProject,w
hich
aimstoim
provehealthat
individualandorganization
levelsincollaboration
withcom
munitypartners
[Act
ion
11]
•HA
•Engagearound20
commercialand
publicorganizations
tojointheproject
andencourage/
supportthe
organizationsto
provideasupportive
environm
entforthe
healthoftheirstaff
2010-11
(2B
)Strengthenthe
EatSmartprogram
meofDH
andbroadenitscoverage
inschoolsandconsider
extendingtheprogrammeto
othersettings.
•Broadenthecoverage
oftheEatSmartS
chool
AccreditationSchem
e
[Act
ion
12]
•DH
•EDB
•Engageallprim
ary
schools
2010-15
50
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
) T
imef
ram
e
(2C
)Strengthenpublic
educationonnutrition
informationonfoodlabels
andenergyim
balanceasthe
causeofoverweight/obesity.
•Continuepubliceducation
onnutritioninformationon
foodlabels[A
ctio
n 13
]
•FE
HD
•Conducta3-year
NutritionLabelling
Publicityand
EducationCam
paign
with3phases
2010-12
•Continuepubliceducation
throughEatSmart
programmes
[Act
ion
14]
•DH
•EDB
•Empowerschool
personnel,parents,
foodsuppliers,m
edia
andthepublicwith
healthyeatingtips
Ongoing
•Educatepubliconthe
importanceandbenefits
ofregularparticipationin
sportandotherphysical
activities[A
ctio
n 15
]
•LC
SD
•Organizelarge-scale
sportspromotional
programmesand
invitepublicand
stakeholderstojoin
•Producevarious
publicitymaterials,
suchasDVDand
broadcastthroughTV,
Roadshow,schools,
hospitalsandleisure
venuesofLCSD
2010
3.Actionstopromotehealthydietandphysicalactivityparticipation
51
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
) T
imef
ram
e
3)Strengthenpartnership
andfosterengagem
entof
allrelevantstakeholders
(3A
)Governm
ent
departm
ents/bureauxwork
togethertodevelopand
implem
entpoliciesthatare
sensitivetotheneedsofthe
publicinachievinghealthy
eatingandphysicalactivity
participation,andcreate
anenvironm
ent,including
thebuilt-environm
ent,that
facilitatepeopleinmaking
healthierchoices,e.g.
provideaccesstosafe
exercisefacilities,walking
paths,alongwithothertown
planningdesignsthatare
conducivetogoodhealth;
introducehealthyeating
policyinschools,etc.
•So
licitsupportfromrelevant
governmentbureauxand
departm
entsindeveloping
andimplem
entinghealthy
publicpolicies
[Act
ion
16]
•
WGDPA
•DH
•Inviterelevant
bureauxand
departm
entstobrief
WGDPA
mem
bers
andintroducetheir
workonpromotion
ofhealthyeating
andphysicalactivity
participation
2010-11
52
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
) T
imef
ram
e
•SolicitsupportfromEMACs
topromotehealthydietand
physicalactivities/health
educationatestatelevel
[Act
ion
17]
•DH
•HD
•Arrangevisitsto
EMACstopromote
healthydietand
physicalactivities/
healtheducation
•InviteNGOstouse
EMACfundfor
organizinghealth
education/prom
otion
activitiesatestate
level
2010-11
(3B
)Otherhealthpromotion
partnerstodevelopand
implem
entpoliciesand
practicesthataresupportive
ofhealthyeatingand
physicalactivitypromotion
form
embersofthepublic.
•PromulgatetheActionPlan
tootherhealthpromotion
partners,e.g.through
meetingwithHealthyCities
Projects[A
ctio
n 18
]
•DH
•HAD
•Briefm
embersof
theHealthyCities
ProjectsCom
mittees
in18districtsonthe
ActionPlan
2010
•Assisttradetoproduce
foodthataresupportiveof
healthyeating
[Act
ion
19]
•FE
HD
•Developtrade
guidelineson
reducingsodium,
sugarsandother
nutrientsthat
excessiveintakeis
notadvisableinfoods
2012
3.Actionstopromotehealthydietandphysicalactivityparticipation
53
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
)Ti
mef
ram
e
•Promotehealthylifestyle
andself-managem
ent
throughenhancem
ent
ofprim
arycareservices
[Act
ion
20]
•DH
•Consultandliaise
withhealthcare
professionals
2010
•Enlistsupportof
stakeholdersinthe
community,suchas
DistrictCouncils,N
ational
SportsAssociations,
schools,corporations,etc.
[Act
ion
21]
•LC
SD
•Letterstovarious
stakeholdersto
introducethe
findingsand
recommendationof
the"StudyofS
port
forA
ll"•
Enlisttheirsupport
topromotephysical
activityparticipation
totheirservice
custom
ersandstaff
2010
•So
licitsupporttostrengthen
theirtrainingonsportand
otherphysicalactivitiesfor
kindergarten
[Act
ion
22]
•LC
SD
•EDB
•Providetrainingplan
forkindergarten
teachersandpre-
schoolstudents
2010
onwards
54
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
)Ti
mef
ram
e
4)Buildthecapacity
andcapabilityto
prom
otehealthyeating
andphysicalactivity
participation
(4A
) Reviewoverseasand
localliteratureofhealth
prom
otioninterventionson
healthyeatingandphysical
activityparticipationto
identifyelem
entsofsuccess
andfactorswhichenhance
programmesustainability.
•Review,sum
mariseand
communicatefindingswith
stakeholdersonregular
basis
[Act
ion
23]
•DH
•Developevidence-
baseddatafor
sharingwithhealth
prom
otionpartners
onthem
aticwebsites
•Com
municateuseful
data/information
throughvarious
means
2010-11
Ongoing
(4B
)Organizeforumsand
workshopsforfostering
partnerships,better
coordinationofeffortsand
capacitybuildingam
ong
healthpromotionpartners.
•Organizeaconference
onNCDprevention
emphasisingonpromotion
ofhealthydietandphysical
activity,preventionof
alcoholm
isuseandinjuries,
aswellascommunity
participationandcapacity
building
[Act
ion
24]
•DH
•Involvemajorkey
healthpromotion
agenciesinthe
conference
Early2012
•Identifyhealthpromotion
agenciesthroughvarious
forums
[Act
ion
25]
•DH
•Identifyasmanykey
healthpromotion
agenciesaspossible
forcollaboration
2010-12
3.Actionstopromotehealthydietandphysicalactivityparticipation
55
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
) T
imef
ram
e
•Developeducationkitson
breastfeedingforhealth
professionalsandorganize
workshops[A
ctio
n 26
]
•DH
•Launcheducation
kitsinQ22010
•Organizeworkshops
in2011
2010-11
(4C
)Healthpromotion
agenciestoapplyhealth
prom
otiontheories,
concepts,evidenceandskills
inplanningandorganization
ofhealthyeatingand
physicalactivitypromotional
activitieswhichcouldtake
theformof‘demonstration
projects’.
•Arrangetrainingworkshops
forhealthpromotion
partnerstobuilduptheir
skillsonorganizinghealth
prom
otionprogrammes
[Act
ion
27]
•
DH
•Organizeatleast
fourforums/
workshops
2010-12
56
Prio
rity
Are
asR
ecom
men
datio
nsA
ctio
nsLe
ad a
ctio
n pa
rty
Targ
et(s
)/Ind
icat
or(s
)Ti
mef
ram
e
5)Secureresources
forhealthpromotion
onhealthyeating
andphysicalactivity
participation
(5A
)Sharethevisionand
plansoftheStrategic
Fram
eworkforN
CD
PreventionandControlw
ith
stakeholdersandcom
munity
mem
bers.
•Organizeforumforhealth
prom
otionpartnersto
prom
ulgatetheNCD
StrategicFram
eworkand
theActionPlantoPromote
HealthyDietandPhysical
ActivityParticipationin
HongKong
[Act
ion
28]
•DH
•Organizeatleast
fourforums/
workshops
2010-12
(5B
) EncourageNGOs
andacadem
icinstitutions
tosubmitapplications
forfundsprovidedbythe
Adm
inistrationandother
sourcestoconductresearch
studiesrelatingtohealth
prom
otion.
•Conductworkshopsfor
NGOstoenhancetheir
understandingonvarious
fundingsourcesand
applications[A
ctio
n 29
]
•DH
•Organizeatleast
fourforums/
workshops
2010-12
(5C
) Encouragehealth
prom
otionpartnersto
exploreinnovativemeansof
fund
ing.
•Explorethepossibilityof
securingdifferentsources
offundingfromestablished
channelstopromote
healthyeatingandphysical
activity
[Act
ion
30]
•DH
•Topooltogether
existingresources
fromdifferent
channelsforbetter
utilisationandto
createsynergy
Ongoing
4.Makingithappen
57
Making it happen 4
58
44.1 Totakeforththeproposedintersectoralcollaborationasrecommendedinthis
ActionPlan,consultationwithlocalNGOsandothercommunitystakeholderswillbeconducted toseek theirviewson theactionsand their interests toparticipate. Inorder toensurethatpeople inallpartsof thesocietywillgetinvolvedandact together, the implementationof theActionPlanwill bepublicisedthroughvariousmeans.
4.2 ThecurrentNCDchallengeHongKong faces isgreater thanpreviouslyrealised. Intheactual implementationof theActionPlantopromotehealthydiet and physical activity participation inHongKong, there aremanyforeseeablebarriersthatneedtobeovercomeinordertoachievethevisionandgoalassetout in theNCDpreventionandcontrolstrategy. Moreover,WGDPArecognisesthattheactiveparticipationbyeveryoneinthecommunityisthekeytosuccess.
4.3 Witha leadershiprole incombatingthechallengeofNCD, theGovernmentcouldprovide thepeoplewith informationonnutritionandphysicalactivitypertainingtohealthyliving,andworkcloselywiththestakeholdersinboththepublicandprivatesectors tocreateasupportiveenvironment forpeople tomaketherightchoicesforthemselvesandtheirfamilies.Itistimetocallforindividualsinthesocietytotaketheirownresponsibilityfortheirhealth,andtomaketheirownchoicesofhealthbehaviours.Relevantstakeholdersalsoplayanimportantrole inhealthpromotionactivities, forexample, foodindustrytosupplyhealthierchoicesoffood,andemployerstoprovideahealthyworkingenvironmentfortheirstaff.
4.4 ItistimeforeveryoneinthecommunitytoacttogetherincombatingtheNCDbattle.Byworkinginpartnership,everyonecanmakeHongKongahealthierplacetolive.
Annexes
59
Annexes
60
Annex1Membership of Working Group on Diet and Physical Activity
ChairmanProfAlfredCHANCheung-ming,BBS,JP
ViceChairman DrLAMPing-yan,JP Members ProfJulianaCHANChung-ngor MrCHAUHow-chen,GBS,JP DrCHEUNGWai-lun,JP MrMichaelLAIKam-cheung,MH,JP MsCatherineLEEOi-wa DrLoboLOUIEHung-tak MrJamesNGChi-ming DrMarySCHOOLING MrTANGKwai-tai DrJoyceTANGShao-fen DrTSEHung-hing MrWONGKa-wo,JP DrWONGMan-sau Ex-officioMembers MsOliviaCHANYeuk-oi MrTonyLIUKing-leung DrThomasTSANGHo-fai,JP MrBenjaminYUNGPo-shu
Secretary DrLEUNGTing-hung,JP
Annexes
61
Annex2Terms of reference of Working Group on Diet and Physical Activity
(a) Toassesstheepidemiology,riskfactorsandsocioeconomicdeterminantsofspecificNCDwithreferencetodietandphysicalactivityoflocalpopulation;
(b) Tomakerecommendationsonthehealthandhealth improvementneedsofthelocalpopulationinrelationtohealthydietandphysicalactivity;
(c) Toreviewlocalandinternationalgoodpracticesandinterventionstrategiestopromotehealthydietandphysicalactivity;and
(d) Tomake recommendations on the development, implementation andevaluationofaplanofactionforpromotionofhealthydietandphysicalactivityinHongKong.
62
Annex3D
iscu
ssio
n to
pics
of W
orki
ng G
roup
on
Die
t and
Phy
sica
l Act
ivity
mee
tings
Dat
eTo
pics
FirstM
eeting
16Decem
ber2008
•HighlightsoftheStrategicFram
eworkforP
reventionandControlofN
on-Com
municable
Diseases
• •Diet,PhysicalActivityandHealth:H
ongKongSituation(W
GDPA
PaperNo.01/2008)
HealthPromotionProgram
mesbytheDepartmentofH
ealth(W
GDPA
PaperNo.
02/2008)
SecondMeeting
23February2009
• • •
Environm
entalScanningofInformation,ResearchandHealthPromotionActivityon
DietandPhysicalActivityinHongKong(W
GDPA
PaperNo.01/2009)
HealthPromotion:ConceptsandPractice(W
GDPA
PaperNo.02/2009)
PresentationonHealthandHealthServicesResearchFundandHealthCareand
PromotionFund
ThirdMeeting
27April2009
•DiscussiononthedraftR
eporton
andPhysicalActivityParticipationRecom
mended
inHongKong
ActionstoPromoteHealthyEating
FourthMeeting
9Novem
ber2009
•DiscussiononthedraftA
ction
ParticipationinHongKong
PlantoPromoteHealthyEatingandPhysicalActivity
Annexes
63
Annex4Su
mm
ary
of M
embe
rs’ i
nput
on
loca
l hea
lth p
rom
otio
n ac
tiviti
es
(The
title
s of
som
e pr
ogra
mm
es a
re in
Chi
nese
onl
y)
Org
aniz
atio
nD
iet
Phys
ical
act
ivity
Hea
lthy
lifes
tyle
Infa
nt a
nd y
oung
chi
ldre
nPlayrightChildren’sPlay
Association
•Outreachservices,playsafety
inspectionservice
HongKongChildhealth
Foundation
•Pre-schoolM
otor
PerformanceAwardSchem
eCentreforH
ealthEducationand
HealthPromotionoftheCUHK
•HealthySchools(P
re-School)
AwardSchem
eWatchdogEarlyLearningand
DevelopmentC
entre
•InnovationsinHealthand
Wellness:aFitnessand
NutritionProgram
ForSpecial
NeedsChildrenproject
Scho
ol c
hild
ren
and
adol
esce
ntTheCUHK
•HealthyUniversity
Program
mes
•HealthyUniversity
Program
mes
•HealthyUniversity
Program
mes
HongKongCouncilofEarly
ChildhoodEducation&Services
•BuildingHealthyTuckShop–
HealthyPrim
arySchoolTuck
ShopProgram
YangMem
orialM
ethodistSocial
ServiceShatinIntegratedCentre
forYouthDevelopment
•Healthyeatingclassessuch
as 親
子美
食DIY
64
Org
aniz
atio
nD
iet
Phys
ical
act
ivity
Hea
lthy
lifes
tyle
UnitedChristianNethersole
Com
munityHealthService
•Healthyeatingeventssuch
as“B
reakfastClub”,“Healthy
SnackW
orkshop”
•Com
munitynutrition
placem
entandcareertalkfor
tertiarystudents
•SchoolandHom
eInvolvem
ent,Nutrition
andExercise(SHINE)
programmeforhealthy
lifestyleproject
•HealthPromotingSchool
Project
EducationBureau
•OutdoorEducationCam
p
EducationBureau&HongKong
SchoolsDanceAssociation
•SchoolsDanceFestival
EducationBureau,HongKong
ChildhealthFoundation,Physical
FitnessAssociationofHong
Kong,China
•SchoolPhysicalFitness
AwardSchem
e
LeisureandCulturalServices
DepartmentandEducation
Bureau
•SchoolSportsProgram
me
A.S.W
atsonGroup
•A.S.W
atsonGroupHong
KongStudentSportsAwards
HongKo
ngCollegeofC
ardiology
•JumpRopeforH
eartProgram
HongKongSchoolsSports
Federations
•Inter-school,inter-district,
inter-portandinternational
studentsportscom
petitions
Annexes
65
Org
aniz
atio
nD
iet
Phys
ical
act
ivity
Hea
lthy
lifes
tyle
TheBoys’&Girls’Clubs
AssociationofHongKong,
Departmentofpaediatricsand
adolescentmedicineofthe
UnitedChristianHospital
•IntegratedandSustainable
Com
munityPioneerProject
forO
besechildren
CentreforH
ealthEducationand
HealthPromotionoftheCUHK
•HongKongHealthySchools
AwardSchem
e•
“Hom
e-SchoolJointVentureto
Com
batC
hildhoodObesity”
HavenofH
opeChristianService
• 「
真」
健美
大行
動–
身心
健康
區
校推
廣教
育計
劃
HongKongEvangelicalChurch
BradburySheungShuiFam
ily
Center
• 「
健康
活力
小種
子」
計劃
HongKongPlaygroundAssociation
• 「
健康
新營
人」
計劃
Pam
elaYoudeNethersoleEastern
HospitalandtheHongKongCenter
forH
ealthPromotionandDisease
PreventionoftheHongKong
Tuberculosis,C
hestandHeart
DiseasesAssociation
•SchoolH
ealthPromotion,Hong
KongEastC
lusterproject
66
Org
aniz
atio
nD
iet
Phys
ical
act
ivity
Hea
lthy
lifes
tyle
TheSalvationArmyYaum
atei
I ntegratedServiceForYoungPeople
•Ed
ucateyoungpeopleonreading
nutritionallabel,promotehealthy
eatingandactiveliving
St.James’Settlement
• 「
叻營
仔女
全攻
略」
計劃
Adu
ltHongKongNutritionAssociation
•Ea
tSmartforTotalHealthRecipe
Design&CookingCom
petition
UnitedChristianNethersole
Com
munityHealthService
•Foodlabellingandfuncooking
class
•Com
munityNutritionService
•Healthycookingclasses
•WeightM
anagem
entC
lasses
•Healthpromotionprogrammefor
professionaldriversandSouth
Asiancom
munity
DepartmentofO
rthopaedicsand
TraumatologyoftheCUHKandthe
FamilyPlanningAssociationofHong
Kong
•Post-m
enopausalw
omenwalk
towardsahealthylife
Caritas–HongKong
•PromotionofW
ellnessin
WorkplacewithanEast-M
eet-
WestApproach
CareForY
ourH
eart
•Eathealthyandgetactive:a
lifestyletostartandkeep!
Annexes
67
Org
aniz
atio
nD
iet
Phys
ical
act
ivity
Hea
lthy
lifes
tyle
Elde
rly
UnitedChristianNethersole
Com
munityHealthService
•OutreachNutritionConsultation
Servicesforelderlycentres
•TaiC
hiclasses
CastlePeakHospital
•LifeStyleRedesignProgram
Who
le c
omm
unity
AssociationofGreenOrganic@
Living
•Cookingclasses
•Healthfoodrecipes
•Healthsem
inars
HealthyCitiesProjectsinvarious
districts
•Healthpromotionevents
•Healthpromotionevents
•Healthpromotionevents
UnitedChristianNethersole
Com
munityHealthService
•Publicnutritioneducationvia
magazine 「
健康
動力
」
•Healthtalks
•Regularmediainterview
•TaiC
hiandfolkdanceclasses
forpatientswithchronic
diseasesthrough“Good
NeighbourNetwork”
•
SchoolandHom
eInvolvem
ent,Nutritionand
Exercise(SHINE)@
the
community
•Masscommunityhealth
prom
otionevents
LeisureandCulturalServices
Department
•HealthyExerciseforA
llCam
paign
DistrictSportsAssociationof
Hom
eAffairsDepartment
•Organizerecreationand
sportsactivitiesatdistrictlevel
HongKongMedicalAssociation
•Healthy8,000Steps
Cam
paign
•ExercisePrescriptionProject
NationalSportsAssociation
•Organizesportstraining
programmes
68
Org
aniz
atio
nD
iet
Phys
ical
act
ivity
Hea
lthy
lifes
tyle
HealthInfoWorldoftheHospital
Authority
•“BetterH
ealthforaBetter
HongKong”healthpromotion
campaign
•“IdealBMI”Disease
PreventionProject
AberdeenKai-fongW
elfare
Association
• 「
運動
保方
- 糖
尿篇
」計
劃
HongKongEvangelicalChurch
BradburySheungShuiFam
ily
Center
• 「
健樂
每一
步」
計劃
HongKongRedCross
• 「
五星
健康
五星
家」
之「
健
康生
活模
式」
推廣
HKSKHLadyMacLehoseCentre
• 「
營養
身心
,健
康人
生」
計劃
Annexes
69
Annex5Health promotion: concepts and practice
1. Applicationof ‘healthpromotion’ to improvepopulationhealthdatedbackto itsembryonicbeginnings in the latesixtieswhichblossomed intoaninternationaldiscipline in theeighties. At the firstGlobalConferenceonHealthPromotionorganizedby theWHO in1986, theOttawaCharter7
waspresented. Health promotionbecame recognisedas theprocessofenablingpeople to increasecontrolover,and to improve, theirhealth.To reachastateof completephysical,mentalandsocialwellbeing (i.e.healthasdefinedby theWHO),an individualorgroupmustbeable toidentify and to realise aspirations, to satisfy needs, and to changeorcopewith theenvironment. Health is therefore, seenasa resource foreveryday life,andnot theobjectiveof living. Health isapositiveconceptemphasisingsocialandpersonal resources,aswellasphysicalcapacities.
2 Clearly,healthpromotionisnotonlytheresponsibilityofthehealthsector,butgoesbeyond to includeactionsdirectedatchangingsocial,environmentalandeconomicconditions,strengtheningskillsandcapabilitiesof individuals,aswellascausinghealthychoiceseasier tomake. The fivekeyactionareas foreffectivehealthpromotionare tobuildhealthypublicpolicy, tocreatesupportiveenvironments forhealth, tostrengthencommunityactionfor health, to developpersonal skills, and to re-orient health services.
3 In today’sglobalisedworld, increasing inequalitieswithinandbetweencountries and communities are seen,making vulnerable groups suchaswomen,children,elderly,disabled,poor,unemployed, immigrantsatparticularlyhighriskofunhealthylifestylepracticesandillhealth.Recognisingtheenjoymentof thehighestattainablestandardofhealthasafundamentalrightofhumanrace,itremainsforeverygovernment,community,civilsocietyandcorporate toplacehealthat thecentreof itsdevelopmentagenda. Inessence,eachsectorhasitsuniqueroletoplaytocontributetoimprovementsinpublichealth,andpartnershipswillprovideexcitingandrewardingwaystobringthemtogether. Buildingonthevalues,principlesandactionstrategiesof theOttawaCharter, theBangkokCharter8 in 2005 reaffirmed thatpoliciesandpartnerships toempowercommunitiesand to improvehealthandhealthequalityshouldbecentral toglobalandnationaldevelopment.
7OttawaCharter.WHO,19868TheBangkokCharterforHealthPromotioninaGlobalizedWorld.WHO,2006
70
Whenishealthpromotioneffective?
4 The ultimate goal of health promotion is to improve an individual’sphysiologicaland/orsocialaspectsofhealth. Forhealthpromotionactiontobeeffective,onemustdotherightthinganddoitwell.Thisunderscorestheneedtobuildcapacity in thehealthpromotionworkforce,be it in thepublic,privateornon-governmentalsector, inorder that limitedresourcescouldbeput tobestuse. Goodhealthpromotion followsaplanningandevaluationcycle9(seeFigure1).
Figure 1. Health promotion planning and evaluation cycle9
Theoryhelpsidentifywhataretargetsfor
intervention
Theoryhelpstoclarifyhowand
whenchangecanbeachievedintargetsforintervention
Theoryindicateshowtoachieve
organizationchange,andraisecommunity
awareness
Theoryprovidesabenchmarkagainstwhichactualcanbecomparedwithidealprogram
Theorydefinesoutcomesand
measurementsforuseinevaluation
Problem definition (redefinition)
1
Impact assessment
5
4
3
2Solution
generation Outcome assessment
Implementation
Resource mobilisation
7
Intermediate outcome
assessment
6
9TheoryinaNutshell,AGuidetoHealthPromotionTheory.NutbeamDandHarrisE,McGraw-Hill,2002(reprinted)
Annexes
71
5 Nutbeam10proposedaSixStageDevelopmentalModelforhealthpromotionresearch,planningandevaluation,pointingout thestrategic relationshipbetweencause, target population, content andmethodof intervention.That is tosay,everyproject inhealthpromotionmustbeginwithproblemdefinition (understandingwhat theproblem is,whyandhow it arose),followedbysolutiongeneration(how itmaybesolved), intervention testing(whether thesolutionworked), interventiondemonstration (how theactioncouldberepeatedandrefined),dissemination(if theactioncouldbewidelyreproduced)and finallyprogrammemonitoring (whether theprogrammecouldbesustained).Onceahealthpromotionprogrammehasreachedstagesix,emphasisshouldbeonsupportingprojectmanagementandassessingcostandbenefits for thesakeofmaximisingprogrammecost-effectiveness.
6 Intheeffort todemonstrateeffectivenessofahealthpromotion intervention,onemustdistinguishbetween thedifferent typesofoutcome inorder tocommunicatewhatconstitutessuccess.Threelevelsofoutcomeexist. Thefirst level comprises ‘healthpromotionoutcomes’ representing themoreimmediate resultofactions.Examplesarehealth literacy,social influence,publicpolicyandorganizationalpracticesthataffectan individual'sability tomakehealthychoices.Thenextlevelis‘intermediatehealthoutcomes’suchashealthy lifestyles,effectivehealthservicesandhealthyenvironmentsthatdetermine thehealthof individuals thereby impactingon thehighest levelof ‘healthoutcome’, typicallydescribedbymortality,morbidity,disability,qualityof life,andsoon. Implicit in this three-levelconstruct is thenotionthatchangesgeneratedinthedifferentlevelsofoutcomewilloccuraccordingtodifferent timescales,dependingon the interventionandtypeofproblembeingaddressed.Forthisreason,itisnotunusualtotakeadecadetoprovecertain interventionsareeffectiveat thehealthoutcomelevel,andeventhismaybedifficultgiventhepresenceofconfoundingfactorsduringtheinterim.
10NutbeamD.EvaluatingHealthPromotion:Progress,ProblemsandSolutions.HealthPromotionInternational1998;13(1):27-44.
72
7 Forahealthpromotionprogrammetosucceed,theremust,firstandforemost,beaneffective intervention. Formativeevaluationwillexaminehowwell theinterventionhasachievedtheplannedchangesorsetobjectives.Then,everyaspectoftheinterventionmustbecarriedoutproperlytoachievetheexpectedresults. Processevaluationwillprovidethe informationthat theprogrammehasindeedbeenimplementedasplanned.Forsomeprogrammes,outcomeevaluationmay not be required so long as the programmehas beenconductedasplanned,andtheexpectedresultswill follow. Forexample, itwillnotbenecessary toevaluatesuccessofa tobaccocontrolprogrammesinceinevitablyfewerpeoplewilldiefromlungcancerifthereisareductioninsmokinguptakeandprevalence.Forotherprogrammes,impactevaluationtoexamineknowledge,skill,attitudinal,behavioural,serviceuse,environmentalorpolicychangeswillberequired.
Findinganinterventionthatfits
8 Experienceshowsthatprogrammesaremore likely tobesuccessfulwhenthedeterminantsofthehealthproblemarewellunderstood,wheretheneedsandmotivationsof the targetpopulationareaddressed,and thecontext inwhichtheprogrammeisimplementedhasbeentakenintoaccount.Theuseoftheories11 thatexplainandpredicthealthbehaviourandbehaviourchangecanhelp in theunderstandingof thenatureof theproblem, theneedsandmotivationsof thetargetpopulationandthecontext, thuspromotingabetterfitbetweenproblemandprogramme.Healthpromotiontheoriesarebroadlycategorisedaccording to the levelof intervention– individual, interpersonalandcommunitylevel.
11TheoryataGlance,AGuideforHealthPromotionPractice(secondedition).NationalCancerInstituteUSDHHS,2005
Annexes
73
9 Notableexamplesof theories thatexplainbehaviouralchange in individualsinclude the Health BeliefModel (HBM) and the Stages of Change(Transtheoretical)Model. TheHBMaddressesan individual’sperceptionsofthethreat(suchassusceptibilityandseverity)posedbyahealthproblem,thebenefitsofavoidingthethreatandfactors influencingthedecisiontoact(barriers,cuestoactandself-efficacy).Sincehealthmotivationisthecentralfocus, theHBMisagoodfit foraddressingproblembehaviours thatevokehealthconcerns,e.g.HIV infection. TheStagesofChangeModel,on theotherhand,arguesthatbehaviourchangeisaprocessratherthananevent.Peoplegothroughfivestagesofbehaviouralchangefrompre-contemplation,contemplation,preparation,actiontomaintenance.Thoseatdifferentstagesofchangehavedifferent informationalneedsandbenefit frominterventionsdesignedspecifically for thatstage. Themodel iscircularsincepeopledonotsystematicallyprogressfromonestagetothenext,butenterthechangeprocessatanystage, relapse toanearlierstage,andbegin theprocessagain,untilthemodelstopsatsomepoint.Atypicalexampleisquitsmokingbehaviour.
10 Theoriesat the interpersonal levelassume individualsexistwithin,andareinfluencedby,thesocialenvironmentconsistingoffamily,friends,coworkers,professionals,andsoon. SocialCognitiveTheory (SCT) isa frequentlyusedtheory.SCTdescribestheongoingdynamicprocessinwhichpersonalfactors,environmental factorsandhumanbehaviourexert influenceononeanother. If individualshaveasenseofself-efficacy, theycanchangebehavioursevenwhenfacedwithobstacles.Iftheylackthesenseofcontrol,theyarenotmotivatedtoactandcannotpersistthroughchallenge.SCThasbeenusedsuccessfullyinareasrangingfromdietarychangetopaincontrol.
11 Community levelmodelsexplorehowsocialsystems functionandhow tomobilisecommunitymembersandorganizations. Theyofferstrategies thatwork inavarietyofsettingssuchasschools,worksites,communitygroups,andsoon.Awell-knownexampleistheDiffusionofInnovationsTheorywhichstates thatpublichealthpractitionersmustattend to the reach,adoption,implementationandmaintenanceofprogrammestooptimisetheirefficiency.Forexample,cancercontrolprogrammeswillnotrealisetheirfullpotentialforimprovingpopulationhealthuntiltheyarebroadlydiffusedanddisseminated.Diffusionof innovationsthatpreventdiseaseandpromotehealthrequiresamultilevelchangeprocesstakingplace indiversesettings. This theoryhasbeenused in thepromotionofcondomuse,smokingcessationanduseofnewtestsandtechnologiesbyhealthprofessionals.
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12 Inpractice,nosingletheorydominateshealtheducationandhealthpromotion,norshould it. Adequatelyaddressingan issuemayrequiremore thanonetheory,andnoonetheoryissuitableforallcases.
Healtheducationisnothealthpromotion
13 A distinction needs to bemadebetweenhealth education and healthpromotion.Healtheducation,according to theGlossaryofPublicHealthTechnicalTerms12, represents consciously constructedopportunities forlearning, for individuals,groups,organizationsandcommunitieswhicharedesigned to facilitatechanges inbehaviour towardsapre-determinedgoalandsoas to improvehealthstatus. Commonmodalities includemediapublicity,pamphletdistribution,posterexhibitionsandhealth talks. Healtheducationhasalonghistoryindiseasepreventioncharacterisedbyemphasisontransmissionof information,baseduponasimplisticunderstandingof therelationshipbetweencommunicationandbehaviourchange. It isclear thatinformationtransmissionalonecannotachieveimpactsonbehaviourchangeas itdoesnot take intoaccountsocialandeconomiccircumstancesof thetargetgroup.Onlytheeducatedandeconomicallyadvantagedbenefitastheypossesspersonalskillsandeconomicmeanstoreceiveandrespondtohealthmessagescommunicatedthroughconventionalmeans.Despitestrengtheningofhealtheducationby thedevelopmentanduseofbehavioural theories intheeighties,health interventions relyingoncommunicationof informationhavemostly failedtoachievesubstantialandsustainableresults in termsofbehaviouralchange,andhavemadelittleimpactintermsofclosingthegapinhealthstatusbetweensocialandeconomicgroupsinsociety.Tobeeffectiveinimprovinghealth,morepersonalformsofcommunication,andcommunity-basededucationaloutreach,focusedonbetterequippingpeopletoovercomestructuralbarrierstohealthareneeded.
12GlossaryofPublicHealthTechnicalTerms.EuropeanCommission,1996
Annexes
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Effectivehealthpromotioninaction
14 Oneof themostsuccessfulhealthpromotionstoriescanbefound inNorthKarelia. Kareliaused tobea lowsocio-economicarea in theeasternpartofFinlandinthe1970swhichreliedondairyfarmingasthemajorsourceoflivelihood. Peoplesmokedheavilyandconsumedahigh-fatdietwith lowfruitandvegetable intake. Finlandhadtheworld'shighestdeathrate fromcardiovasculardiseasesasaresultofwidespreadandheavysmoking,highfatdiet(e.g.heavyconsumptionofdairyproducts)andlowvegetableintake.NorthKareliahadaheart-diseaseratetwicethatofFinlandasawholeatthattime.
15 TheNorthKareliaProjectwas launchedwithassistance from localandinternationalexperts. Itwasa large-scalecommunity-based intervention,involvingNGOs,consumers,schools, food industry,supermarkets,massmedia,agricultureandsocialandhealthservices. It included legislationbanningtobaccoadvertising, the introductionof low-fatdairyandvegetableoilproducts,changesinfarmers’paymentschemes(linkingpaymentformilktoproteinrather thanfatcontent),and incentivesforcommunitiesachievingthegreatestcholesterol reduction. Doctorsandnurseswereaskedtohelpmodify risk factorsof theirpatientsandclients. Opinion leaders invariousvillageshavebecomeprojectassistantsandmanyhealthpromotionactivitiestookplaceatworkplaces. Peopleunderstood theirhealth riskand tookresponsibilityfortheirownhealth,whetherbywatchingtheirdietorexercising.
16 Theprojectcausedsignificant reductions inrisk factorsandcardiovasculardiseasemortalityby73%. Success factors includeda focusonrisk factorreduction,multisectoralcollaboration,population-basedapproach,communitysupportandstronggovernmentcommitment.
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Partofthephotographsonthecoverwasprovidedthroughthecourtesyof
EducationBureauLeisureandCulturalServicesDepartmentKowloonTongSchool(PrimarySection)
St.Paul’sCollegePrimarySchoolMrJustinLAWKai-chun
MsLAUKa-yeeMrCliffLUI