Replies to LegCo questions
LCQ21: Prevention of diabetes
Following is a question by the Hon Paul Tse and a written reply by the Secretary
for Food and Health, Dr Ko Wing-man, in the Legislative Council today (December
14):
Question:
According to the information of the Department of Health (DH), one out of every
10 people in Hong Kong suffers from diabetes. One out of every five patients
with diabetes is diagnosed at a young age (i.e. diagnosed before turning 40).
Patients with diabetes have become increasingly younger. In 2007, 2.6 out of
every 100 000 children under the age of 19 suffered from the disease, with
12-fold increase in the number of such type of children with diabetes in a
period as short as 10 years between 1997 and 2007, which is a shocking rate of
increase. Close to 36% of the members of the public have soft or sugary drinks
at least once or more a day. Drinks available in the market have a very high
sugar content, e.g. a glass of red bean icy drink and a glass of iced lemon tea
contain eight and four teaspoons of sugar respectively. To avoid children's
exposure to a higher risk of diabetes due to excessive consumption of drinks
with a sugar content, some countries have imposed a sugar levy on drinks with a
sugar content. In this connection, will the Government inform this Council:
(1) given that patients with diabetes have become increasingly younger, whether
the Government will review the effectiveness of the current practice of health
education alone for raising the awareness of diabetes prevention among parents,
adolescents and children, in the hope that they will consume less drinks with a
high sugar content; if it will, of the details;
(2) given that the number of people with diabetes seeking consultation from the
Hospital Authority in recent years has risen from 296 000 in 2009-2010 to 390
000 in 2014-2015, whether the Government has projected, on the basis of this
rate of increase, the additional manpower and resources required in the public
healthcare system in the current financial year as well as each of the next five
years to cope with the situation in which the number of diabetic patients keeps
increasing;
(3) whether it will, from the perspective of "prevention is better than cure",
consider following the practice of countries such as France, the United Kingdom,
Denmark, Norway, etc. to introduce a sugar levy to raise the prices of drinks
with a sugar content, so as to dampen the public's desire (especially that of
children) to buy such drinks, and subsidise public healthcare expenditure with
the revenue from the sugar levy;
(4) as a number of people with diabetes have relayed that it is often difficult
for them to find suitable food with a low sugar content when dining out, whether
DH has reviewed the effectiveness of the EatSmart@restaurant.hk Campaign, which
has been implemented for years; whether it will formulate a policy to encourage
restaurants to include in their menus dishes that are suitable for people with
diabetes; and
(5) of the effectiveness of the work at the present stage of the Committee on
Reduction of Salt and Sugar in Food established by the Government last year, as
well as its work progress?
Reply:
President,
Like other non-communicable diseases, the risk of diabetes can be significantly
reduced by maintaining healthy body weight through regular physical activity and
a healthy diet. We have been implementing strategies to prevent non-communicable
diseases in Hong Kong. In October 2008, the Government published a strategic
framework document to prevent and control non-communicable diseases titled
Promoting Health in Hong Kong: A Strategic Framework for Prevention and Control
of Non-communicable Diseases. The document tackles unhealthy lifestyle habits
which have significant impact on the health of Hong Kong people but are
preventable or modifiable. A cross-sectoral and multi-disciplinary steering
committee chaired by the Secretary for Food and Health was set up to monitor the
development direction and implementation progress of the strategy.
Successful implementation of the strategy depends on close collaboration among
the Government, the public and private sectors, the community and the public in
fostering an environment which promotes healthy lifestyles.
Regarding relevant parts of the question, we provide our response as follows:
(1) The Department of Health (DH) has been sparing no efforts in employing
different methods to raise public awareness of the prevention and management of
diabetes. Among others, for people who are aged 45 or above, or whose immediate
relative(s) has/have diabetes, overweight (body mass index (BMI) 23 to 24.9),
obese (BMI 25 or above) or centrally obese (with a waist circumference of 90
centimetres or above for males, or 80 centimetres or above for females), the DH
advises them to have regular body checks for diabetes. Diabetic patients should
follow the medical advice of doctors, including taking prescribed drugs
properly, controlling blood pressure and refraining from smoking. The World
Health Organization (WHO) selects an important public health topic as the theme
for the World Health Day on April 7 every year, and this year's theme is
diabetes. Echoing the theme of World Health Day 2016, the DH has launched a
series of publicity and public education campaigns since April this year, in
collaboration with various bureaux/departments and supporting organisations, to
increase public awareness of the prevention and management of diabetes. In
particular, with a view to encouraging the general public to engage in regular
physical activity, the DH has invited the Physical Fitness Association of Hong
Kong, China to design the Ten-minute Exercise, a moderate-intensity physical
activity suitable to be done at the workplace and at home. Through websites and
booklets, the DH also promotes to the public 39 diabetes-friendly recipes
designed by dietitians. A booklet named Managing Diabetes Made Easy was
published in collaboration with Diabetes Hongkong to help new diabetic patients
to better understand their body condition, enrich their knowledge of diabetes,
and monitor and control the disease in order to prevent complications. Moreover,
the DH published two books titled Living at Ease with Diabetes and Healthy
Dining with Diabetes. Written by a multi-disciplinary team of health
professionals, the two books explain the proper management of diabetes and offer
practical advice on diet modification, exercises, travelling, life skills and
psychological adjustment. They also encourage patients to manage their condition
and delay complications by optimising blood sugar control so as to enjoy years
of healthy life.
In addition to the above promotional activities, the DH has also been
encouraging and supporting, through a life-course and setting-based approach,
people of all ages to have a healthy diet, engage in regular physical activity
and maintain normal body weight in family, school, workplace and community
settings. Specific measures include:
(i) The DH endeavours to promote, protect and support breastfeeding to prevent
childhood obesity. The Family Health Service (FHS) under the DH assists parents
in choosing the appropriate food for their infants, young and pre-school
children through various means, including leaflets on healthy eating, on-line
health education information and individual guidance by healthcare personnel in
Maternal and Child Health Centres. In particular, parents are encouraged not to
provide sugar-added drinks and snacks for their children. The FHS also advocates
maintaining an adequate amount of physical activity among children, and
cultivating a healthy diet and lifestyle in young children to prevent childhood
obesity.
(ii) An EatSmart@school.hk Campaign with emphasis on the promotion of healthy
eating was launched in primary schools in the 2006/07 school year. Under the
campaign, primary schools developed policies and implemented measures on healthy
diets through home-school co-operation, with a view to effectively implementing
the nutritional requirements laid down by the DH in supplying lunches and
snacks. This serves to ensure that school children can learn and are nurtured in
a "nutrition friendly" environment. Riding on the success of the campaign, the
DH launched the StartSmart@school.hk Campaign in January 2012 to promote healthy
eating and physical activity among preschoolers across the territory with a view
to preventing childhood obesity.
(iii) The workplace is also an ideal setting for developing a healthy lifestyle.
The DH launched the Health@work.hk Pilot Project in 2010 and the second phase of
the Health@work.hk Project in 2012. In August this year, the DH launched the
Joyful@Healthy Workplace Programme in collaboration with the Occupational Safety
and Health Council. The programme enables employers and employees to create a
healthy and joyful working environment together through a series of activities.
It focuses on three main areas, namely healthy eating, physical activity and
mental well-being.
(iv) At the community level, the DH launched the "I'm So Smart" Community Health
Promotion Programme in June 2012 to mobilise community partners to promote
healthy eating and physical activity in the community.
Apart from the above health promotion measures, the Student Health Service of
the DH checks enrolled students' body weight during annual health assessments,
counsels students with sub-optimal weight, and makes referrals to specialists if
further management is considered necessary. The DH has also developed, updated
and promoted the use of a reference framework for diabetes care to provide an
evidence-based reference for healthcare professionals in primary care settings
so that they are in a better position to provide continuous and comprehensive
care for patients with diabetes. Given that the age of patients with diabetes is
getting younger, the DH will continue to review the effectiveness and directions
of the measures to further enhance public awareness of prevention of diabetes.
(2) In planning for its services, the Hospital Authority (HA) will take into
account a number of factors, including population growth, demographic changes,
growth rate and projected demand for specialist services, as well as the HA's
long-term objectives and strategies for its overall service development. The aim
is to work out the directions for the overall healthcare development in the
future so as to meet the demand for healthcare services and manpower in the next
10 to 20 years. The HA will not make assessment of manpower and resource
requirements regarding individual diseases. It will, however, continue to
monitor the development of different disease areas and the service demand to
ensure that the provision of services meets the needs of patients.
(3) and (5) As regards the encouragement and promotion of healthy eating, one of
the key policies of the Government is to encourage and facilitate the public to
reduce the intake of salt and sugar in food on an ongoing basis. The Government
has made reference to measures taken by different countries and regions in
facilitating, encouraging healthy eating and preventing diabetes. These measures
include enhancing public education, heightening health awareness, encouraging
the industry to offer healthy food options, enhancing nutrition information for
food items, and introducing fiscal or regulatory measures. The Government notes
that there are divergent views held by various local and overseas stakeholders
on the effectiveness of introducing fiscal measures as a means to reduce the
intake of sugar from food among the general public.
The Government has been working closely with the Committee on Reduction of Salt
and Sugar in Food (CRSS) established last year. Considering the actual
circumstances of Hong Kong, both the Government and CRSS are of the view that a
step-by-step approach should be adopted, starting from aspects which are more
achievable first before tackling the more difficult ones. We consider that,
through the industry's voluntary participation to progressively lower the
content of salt and sugar in food, the public will gradually adapt to the
changes in flavour and be receptive to a relatively healthier diet. This will
also allow time for the industry to make adjustment accordingly, thus reducing
the impact of the measures on their actual operation.
The CRSS has convened many meetings and focused discussions to solicit the views
of relevant stakeholders including food manufacturers and the catering industry.
Building on existing measures and policies, the CRSS recommends the Government
to further implement pragmatic measures on salt and sugar reduction that are
appropriate to Hong Kong's situation.
To draw up specific proposals for reducing salt and sugar intake, the CRSS
focuses on two main directions, namely "starting from an early age" and
"starting from information transparency", with the view to building up a culture
of low-salt-and-sugar diets, and making use of consumers' influence to expedite
the pace of the industry in reducing the salt and sugar content in food.
On "starting from an early age", the CRSS proposes to capitalise on the DH's
StartSmart@school.hk Campaign targeting at pre-primary institutions, to organise
more training courses for chefs of the institutions to teach them ways to
prepare tasty low-salt-and-sugar meals; to strengthen the understanding and
training for teachers on salt and sugar; and to provide more low-salt-and-sugar
recipes for the institutions, while encouraging them to share their recipes
among themselves and encouraging parents and children to cook low-salt-and-sugar
dishes or snacks together.
As regards "starting from information transparency", the CRSS is considering a
front-of-pack low-salt-and-sugar labeling scheme for pre-packaged food, which
will help consumers identify low-salt-and-sugar products easily. It is also
hoped that the scheme will serve as a catalyst for the industry to provide more
varieties of low-salt-and-sugar products for consumers. The CRSS and the Centre
for Food Safety will liaise with the industry to work out the guidelines and
details of the scheme, with a view to ensuring that the industry's concerns for
operational and technical matters are taken into account.
Besides, in response to the CRSS's recommendations and with the support and
concerted efforts of the HA, more than 80% of the staff canteens of public
hospitals, i.e. 20 canteens, have implemented the "calorie" indication pilot
scheme and indicated the calorie of selective dishes on their menus.
Implementing the "calorie" indication scheme in the staff canteens of public
hospitals in the first place has the positive effect of encouraging other
restaurants to join the scheme as some operators of these canteens are leading
restaurant chain groups. These restaurant chain groups may leverage on the
experience from the staff canteens which they operate and implement similar
measures in the other restaurants. This will lay the foundation for further
expansion of the "calorie" indication pilot scheme.
The Government will continue to make reference to the recommendations of the
CRSS and the WHO, as well as the relevant measures and experience relating to
reduction of salt and sugar in food in other places (including the effectiveness
of the measures, the response from the industry and consumers' receptiveness),
and give full and thorough consideration to the local situation in order to
explore and formulate salt and sugar reduction measures that are suitable for
Hong Kong.
(4) The DH launched the EatSmart@restaurant.hk Campaign in April 2008 to
encourage and assist restaurants to provide dishes with more fruit and
vegetables or with less oil, salt and sugar.The Task Force on
EatSmart@restaurant.hk Campaign comprises representatives from the catering
industry, academia, professional groups and government departments. It reviews
the directions, operation and promotional strategies of the campaign and
provides recommendations accordingly. To enhance the effectiveness of the
campaign, the DH launched a free EatSmart Restaurant mobile application in 2015
to facilitate the public to locate the EatSmart Restaurants in Hong Kong.
Moreover, the "EatSmart Restaurants" e-Coupon Promotional Activity was launched
in June this year to allow the public to enjoy promotional offers when ordering
EatSmart dishes at participating EatSmart Restaurants.
Each diabetic patient has his/her own dietary needs depending on the type of
diabetes he/she suffers and his/her physical condition. It would be difficult
for restaurants to provide dishes that cater for the needs of all patients with
diabetes. We need to explore the feasibility of such an idea carefully.
Ends/Wednesday, December 14, 2016
Issued at HKT 19:15
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