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LCQ21: Prevention of diabetes
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     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 [email protected] 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 [email protected] 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 [email protected] 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 [email protected] Pilot Project in 2010 and the second phase of the [email protected] Project in 2012.  In August this year, the DH launched the [email protected] 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 [email protected] 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 [email protected] 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 [email protected] 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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