Overview

Promotion of healthy lifestyle (Table 1.) is a foundational pillar in preventive care. Reducing use of tobacco and harmful use of alcohol, maintaining physical activity, consuming healthy diets, and improving air quality were recognised as important and cost-effective ways to reduce death from non-communicable diseases (NCD), namely heart diseases, stroke, cancer, diabetes and chronic lung diseases, which collectively have been responsible for 74% of all death worldwide.¹ To align with the World Health Organization’s (WHO) Global NCD Action Plan, a strategy and action plan targeting NCD prevention and control was issued by the then Food and Health Bureau and the Department of Health of Hong Kong in 2018. This plan targets four modifiable behavioural risk factors: unhealthy diet, physical inactivity, tobacco use, and harmful use of alcohol, all of which impact public health significantly.²

In addition to prevention of NCD, physical activities, dietary intervention and stress management were found to improve fertility and promote sexual health among women.³ Furthermore, a recent systematic review suggested an association between maternal lifestyle, diet and level of physical activity during pregnancy and epigenetic changes in the offspring,⁴ highlighting its potential for multi-generational positive impact.

Notably, lifestyle behaviours influence an individual’s health synergistically. Combined low-risk lifestyle behaviours (e.g. healthy diet, sufficient exercise, stress management, not smoking) was associated with 80% lower risk of type 2 diabetes (Relative Risk = 0.20, 95% Confidence Interval = 0.17-0.23).⁵ A meta-analysis demonstrated that individuals who adopted the healthiest lifestyle pattern exhibited a 29% lower risk of developing cancer and a 52% lower risk of cancer-related mortality, compared to those with the least healthy lifestyles.⁶ Conversely, among apparently healthy adults in Hong Kong, a higher number of health risk behaviours was associated with greater cardio-metabolic dysregulation.⁷

In the pursuit of a healthier lifestyle, several individual-level barriers to making sustainable changes have been identified. A major obstacle was the lack of knowledge regarding benefits of healthy lifestyle, which often left individuals unaware of the positive impacts these changes could have on their overall well-being.⁸ Time availability and competing priorities significantly limited opportunities for engaging in health-promoting activities.^8-10 Financial constraints and physical environment posed challenges on access of resources, which hindered the adoption of healthier habits.¹¹ Furthermore, personal factors such as self-worth and perceptions of one’s ability to engage in lifestyle management played a crucial role in determining an individual’s willingness to pursue healthier choices.¹²

An array of population-based interventions to reduce tobacco and alcohol use, promote healthy diet and physical activities were declared by the WHO as “Best Buys” for the prevention and control of non-communicable diseases.¹³ Meanwhile, interventions such as health coaching and motivational interviewing (MI) along with public education and health promotion efforts were proven effective to address individual-level barriers.¹⁴ To improve the overall health of the population, primary healthcare professional must routinely assess all aspects of lifestyle, and offer targeted, personalised interventions to optimise the overall wellbeing of each client.