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LCQ2: Promoting healthy lifestyles
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     Following is a question by the Hon Ip Kwok-him and a reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (November 11):

Question:

     On the 26th of last month, the International Agency for Research on Cancer under the World Health Organization (WHO) published an evaluation report on the carcinogenicity of the consumption of processed meat and red meat. Processed meat has been classified as "carcinogenic to humans" (i.e. Group 1) and red meat has been classified as "probably carcinogenic to humans" (i.e. Group 2A). The experts concerned have concluded that a daily consumption of 50 grams of processed meat products will increase the risk of colorectal cancer by 18 per cent. Given that quite a number of people in Hong Kong love eating red meat as well as processed meat products such as bacon, sausages and ham, WHO's research findings have undoubtedly aroused concerns. In this connection, will the Government inform this Council:

(1) as there are differences in the ingredients of processed meat products from various places and in the body constitution of people from different ethnic origins, and various types of cancers have different causes, whether the authorities have studied if WHO's aforesaid report is applicable to the situation in Hong Kong; if they have, of the details, and the authorities' corresponding measures; if not, the reasons for that;

(2) given that WHO's aforesaid report has pointed out that red meat poses cancer risks on one hand, red meat contains the nutrients essential for maintaining the normal functioning of the body (in particular the brain) on the other, whether the authorities will issue guidelines on the quantity of red meat on healthy menus and carry out publicity and educational work in this respect in order to ensure that the food supplied by institutions providing food to certain groups of people (including the Correctional Services Department, hospitals, schools and residential homes) as well as restaurants is in conformity with the principle of a balanced diet, and that members of the public will be able to make informed food choices, so as to avoid overcorrecting; if they will, of the details; and

(3) given that under some existing support schemes subsidised by the Government (such as the Short-term Food Assistance Service Projects for the poor), the food items distributed are mostly processed food such as canned food, supplemented by a few fresh food coupons, whether the authorities will require organisations operating such schemes to consider increasing the proportion of fresh food in the food items to be distributed, so as to avoid increasing the cancer risks of their service targets; if they will, of the details; if not, the reasons for that?

Reply:

President,

     As the risk factors associated with many types of cancers are closely related to lifestyles, the Department of Health (DH) has been actively promoting healthy lifestyles, such as avoiding tobacco and alcohol, having regular physical activities, maintaining a healthy body weight and waist circumference, eating more vegetables and fruits, reducing the consumption of red meat and processed meat, etc, as a major preventive strategy to reduce the effects caused by non-communicable diseases, such as cancers, to the public and society. We believe the public also understands that fresh ingredients are healthier than processed meat. However, the evaluation results on the carcinogenicity of the consumption of processed meat and red meat published by the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) on October 26, 2015 have attracted global attention. The evaluation of the IARC is mainly an epidemiological investigation into the association of cancer with the consumption of processed meat and red meat, and the classification has been made with no recommendation on the safe intake levels of the food concerned.  

     A Working Group of 22 experts from 10 countries convened by the IARC Monographs Programme has considered more than 800 studies that investigated the association of more than 10 types of cancers with the consumption of red meat or processed meat in a number of countries where people have diverse diets. Processed meat has been classified as carcinogenic to humans (Group 1), based on sufficient evidence that the consumption of processed meat causes colorectal cancer in humans; while red meat has been classified as probably carcinogenic to humans (Group 2A), based on limited evidence that the consumption of red meat causes cancer in humans and strong mechanistic evidence supporting a carcinogenic effect. The IARC announced the above results without setting any safe intake levels for processed meat or red meat.
  
     As the report published by the IARC has aroused widespread attention and concerns, the WHO made a statement on October 29, 2015 that it had released a report in 2002 to advise people to have moderate consumption of preserved meat so as to reduce the risk of cancer. The report published by the IARC does confirm the above-mentioned advice of the WHO. The report does not ask people to stop eating processed meat. Instead, it indicates that reducing the consumption of such products can reduce the risk of colorectal cancer. The WHO will continue to research into the role of processed meat and red meat within the context of a healthy diet.  

     As the contents of the IARC's report and the concepts behind the analyses are very professional and technical, they are not easy to understand. I would like to take the opportunity to explain as follows:

(1) As there is scientific evidence showing that processed meat is carcinogenic to humans, it is thus classified as Group 1, same as tobacco smoking.  However, the carcinogenicity of consumption of processed meat cannot be compared to that of tobacco smoking.  

(2) The IARC estimates that a daily consumption of 50 grams of processed meat will increase the risk of colorectal cancer by 18 per cent. According to the most recent estimates by the Global Burden of Disease Project (an independent academic research organisation), about 34 000 cancer deaths per year in the world are attributable to diets high in processed meat, while about 1 million cancer deaths per year are caused by tobacco smoking. Hence, although both processed meat and tobacco smoking are classified as Group 1, the risk of cancer deaths caused by the two can be very different.  

(3) We agree with the WHO's statement and consider that it is not necessary to ask the public to stop eating processed meat. But the public should be aware that frequent consumption of processed meat will increase the risk of colorectal cancer, and the consumption of such products should be reduced.  

     As mentioned above, the DH is committed to promoting healthy lifestyles as the major prevention strategy against cancer. Apart from promoting healthy lifestyles, the DH has specifically reminded the public that consumption of red meat and processed meat is associated with a higher risk of colorectal cancer.  For example, feature articles entitled "Red meat consumption: the Good and the Bad", "Be Cancer Aware" and "Taking Care of Your Bowels - Colorectal Cancer Prevention and Screening" are published by the Centre for Health Protection to explain the benefits and risks of eating red meat and processed meat, related health tips, as well as ways to prevent colorectal cancer.  

     In addition, the DH and the Cancer Expert Working Group on Cancer Prevention and Screening under the Cancer Coordinating Committee jointly published a booklet entitled "Prevention and Screening for Colorectal Cancer" in 2013. The booklet sets out the risk factors for colorectal cancer, which include high consumption of red meat and processed meat, and recommends the public to reduce consumption of red meat and processed meat.  

     At the same time, the DH promotes the principles of healthy eating with the use of the Food Pyramid, which include choosing food that is low in fat, salt and sugar. Consumption of processed meat is not encouraged as their fat and salt content can be relatively high.

     As for students, the DH launched the "EatSmart@school.hk" Campaign in primary schools in the 2006/07 school year and published the Nutritional Guidelines on Lunch for Students (for use in primary and secondary schools). The Guidelines suggest that given five school days in a week, lunch suppliers should not serve item(s) from the limited food group on more than two school days per week. Items from the limited food group include processed or preserved meat, such as bacon, ham, sausages and luncheon meat.

     The Nutritional Guidelines for Children Aged 2 to 6 issued by the DH recommend pre-primary institutions to use fresh and healthy ingredients and avoid processed meat.

     Moreover, the DH has been actively promoting the importance of a balanced diet, choosing nutritious, natural ingredients and avoiding processed meat in health promotion activities for elderly people, their carers and the meal service providers of elderly homes. Based on the healthy eating principle, the Elderly Health Service of the DH has published guidelines on the design of menu for elderly homes, as well as leaflets on promotion of a low sodium diet, stressing that processed food generally have a high salt content and should be avoided. It also encourages selecting a wide variety of foods from different food groups and avoiding dietary bias so as to avoid excessive consumption of red meat and processed meat.

     At the community level, the DH launched the "EatSmart@restaurant.hk" Campaign in 2008, under which restaurants are recommended to prepare dishes with healthier ingredients. It involves providing guidelines recommending not to use too much meat.

     In light of the report of the IARC and the statement of the WHO, the DH has disseminated the related health information to government bureaux and departments and its partners, explaining to them and reminding them to pay attention to the report of the IARC. In particular, government bureaux and departments are advised to reduce the use of processed meat when arranging and providing meals for staff and service targets. The government bureaux and departments are also asked to help disseminate the related health information to their stakeholders.  

     Regarding food assistance, the Social Welfare Department (SWD) has launched Short-term Food Assistance Service Projects (STFASPs) over the territory. STFASPs aim to provide short term food assistance to help individuals tide over temporary hardship in coping with daily food expenditure. During the initial implementation stage, STFASPs mainly provided dry rations like canned food. Since October 2011, STFASPs have been enhanced to allow for more food choices through provision of food/hot meal coupons to service users for them to redeem food at designated food vendors, supermarkets and meal canteens. The value of food/hot meal coupons now constitutes about 40 per cent of the food distributed to service users. Further to the release of the classification of processed meat as carcinogenic to humans (Group 1) by the IARC of the WHO on October 26, 2015, the SWD met with the service operators of STFASPs on October 28, 2015 to review the types and nutrition of food items under STFASPs. The SWD will continue to regularly liaise with service operators on the delivery of STFASPs.  

     In sum, we encourage people to start building up healthy eating habits at a young age, eat more vegetables and fruits, and less red meat and processed meat, and remember the principle of "three lows one high" when choosing food (i.e. choose food that is low in fat, sugar and salt, and high in fiber). The DH will continue to keep in view the latest research and recommendations of both local and overseas health authorities, including the WHO. It will also, in collaboration with other partners, promote healthy lifestyles as the major preventive strategy and make amendments to the relevant guidelines when necessary, so as to safeguard public health.

Ends/Wednesday, November 11, 2015
Issued at HKT 16:19

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