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Why Hong Kong women are living longest at 87.658 years

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Elderly Hong Kong women. PHOTO: SCMP

According to latest figures from the 2019 World Population Review, Hong Kong women are expected to live longest at 87.658 years against 81.876 for their men but an average of 84.762 years.

Other countries in the first ten with highest average life expectancy include: Japan average life expectancy of 84.55 years; Macau with 84.168 years; Switzerland with 83.698 years; Singapore with 83.526 years; Spain with 83.486 years; Italy with 83.424 years; Australia with 83.348 years; Channel Island with 82.992 years; and Iceland with 82.92 years.

This is not the first time Hong Kong was declared the longest-lived. According to the United Nations Vital Statistics Summary and Life Expectancy at Birth for 2016 – the most recent data available – Hong Kong women live, on average, to 87.3 years of age and men to 81.3, beating such places as Japan and Italy, which are renowned for longevity.

Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age and other demographic factors including gender. The most commonly used measure is life expectancy at birth (LEB), which can be defined in two ways. Cohort LEB is the mean length of life of an actual birth cohort (all individuals born a given year) and can be computed only for cohorts born many decades ago, so that all their members have died. Period LEB is the mean length of life of a hypothetical cohort assumed to be exposed, from birth through death, to the mortality rates observed at a given year.

However, an average Nigerian is not expected to live beyond his or her 55th birthday.

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The new report showed that the average life expectancy of Nigerians was 54.494 years. But a breakdown showed that women are expected to live longer than their male counterparts at 55.414 years against 53.6 years for men.

The 2019 World Population Review ranked Nigeria 198th out of 202 countries studied. Nigeria has better life expectancy than only Sierra Leone (199th), Chad (200th), Lesotho (201th) and Central African Republic as the least ranked nation at 202th position.

The report showed that residents in Nigeria are liable to die of sicknesses and diseases, as well as other causes.

Causes of death listed in the report are influenza, pneumonia, tuberculosis, diarrhoeal diseases, stroke, Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), coronary heart disease, liver disease, prostate cancer, diabetes mellitus, maternal conditions, malaria, breast cancer, meningitis, cervical cancer, lung disease and low birth weight.

Other causes include accident, road traffic and birth trauma among others.

Meanwhile, why are people in Hong Kong living the longest despite persistent social unrest, growing financial inequality and choking urban density?

According to a study published recently in the International Journal of
Environmental Research and Public Health, over the past three decades, life expectancy in Hong Kong has increased from 74.1 years in 1986 to 81.4 years in 2015 in males, and from 79.4 years to 87.3 years in females. In recent decades, several studies have been conducted to explore the life expectancy of the Hong Kong population.

The study is titled “Understanding the Increase in Life Expectancy in Hong Kong: Contributions of Changes in Age- and Cause-Specific Mortality.”

The results indicated that the improvement in health in both the adult and old age groups played a significant role in the increase in life expectancy for both males and females in Hong Kong over the period under study. However, in the latter years of the study period, it was observed that the contribution rate of the adult age groups dropped significantly, and the life expectancy advantage for both genders was then mainly driven by a decline in the mortality of the older population.

The researchers noted: “Our findings concerning Hong Kong were consistent with existing studies in other countries such as Italy and Germany, where the primary contributions were also derived from the elderly.

“The reason for the limited contribution of younger ages to the increase in life expectancy is related to the ‘rectangularisation of the survival curve’. In the first half of the 20th century, mortality reduction in the younger age groups greatly increased life expectancy. Since the 1950s, however, a reduction in mortality among old people became the major contributor. The transformation of the survival curve strengthened the role of the elderly population in recent decades.

“Besides, the ‘compensation law’—which has been mentioned in previous studies and states that a reduction in early mortality is compensated with a higher rate of change of mortality with age—also explains why the increase in life expectancy had less magnitude than the mortality decline.

“In addition, the contribution pattern varied across genders. In terms of age-specific contribution, the contributions of females at older ages were even more substantial than those of males, which was in line with the results of previous research. On the other hand, the different contribution patterns for males and females resulted in different gains in their life expectancies over the distinct periods.”

Meanwhile, Harvard Health Publishing has recommended tips for a longer life:

No matter what your age, you have the power to change many of the variables that influence how long you live, and how active and vital you feel in your later years.

Actions you can take to increase your odds of a longer and more satisfying life span are really quite simple: do not smoke; enjoy physical and mental activities every day; eat a healthy diet rich in whole grains, vegetables, and fruits, and substitute healthier monounsaturated and polyunsaturated fats for unhealthy saturated fats and trans fats; take a daily multivitamin, and be sure to get enough calcium and vitamin D; maintain a healthy weight and body shape; challenge your mind- Keep learning and trying new activities; build a strong social network; follow preventive care and screening guidelines; floss, brush, and see a dentist regularly; and ask your doctor if medication can help you control the potential long-term side effects of chronic conditions such as high blood pressure, osteoporosis, or high cholesterol.

The International Journal of Environmental Research and Public Health findings showed that the decline in mortality from chronic diseases, such as malignant neoplasms, cerebrovascular diseases and heart diseases, made substantial positive contributions to the total improvement in life expectancy in Hong Kong between 1986 and 2015. A similar trend was observed in other countries, such as Italy and Germany, where the reduction in mortality from cardiovascular diseases and malignant neoplasms exerted important positive influence on their life expectancy gains. In Japan, a rapid decline in mortality from cerebrovascular diseases also played a primary role in the improvement in Japanese life expectancy. Therefore, the increase in life expectancy in Hong Kong over the past decades could partly be attributed to the reduction in mortality from those chronic diseases, especially among the older population.

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Improvement in health in Hong Kong during the past decades is likely to be related to several factors. First, the well-established, accessible and affordable medical health system has played a crucial role in enhancing the health conditions of population in Hong Kong. Besides, an increase in government expenditure in health care has promoted the development of medical and health services in Hong Kong. Moreover, strategies, which have focused on preventing chronic diseases, may have further contributed to an effective control of chronic diseases. For instance, since 2008, the Hong Kong government has launched a strategic framework to prevent and control non-communicable diseases and has also formed a guiding committee to supervise its practical implementation, providing effective direction for prevention of chronic diseases in Hong Kong.

Furthermore, it should be pointed out that among older adults, especially among those at advanced ages, pneumonia was still noticeable in halting the increase in life expectancy in Hong Kong. Pneumonia can affect people of any age, but older people with a weak immune system tend to have a higher risk of developing the disease. According to Li et al., during the period 2011–2015, old people aged 65 and over accounted for more than 75 percent of pneumonia-related hospitalizations in Hong Kong, which certainly caused a huge health and economic burden. With a rapidly accelerated ageing population in the coming decades, it is absolutely worth paying attention to the prevention of pneumonia in Hong Kong.

According to the present study, in the past few years, increasing prevalence of some chronic diseases among younger age groups has halted the improvement in life expectancy in Hong Kong, even though the influence was limited. Non-communicable diseases (NCDs) were principle health challenges around the world, and almost half of the deaths were among people younger than 70 years. Compared with the elderly, those premature deaths that were primarily attributable to NCDs were within the most effective years of their work, thus causing substantial stress to both families and the national economy. Adult mortality from NCDs and injury has also been discussed in previous research. These studies mentioned the premature death from NCDs in Japan, the US and central and eastern European countries. Therefore, the health status of younger age groups should also be noted in Hong Kong.

This study has important implications for practical health interventions. The results reflect that secondary preventive strategies are still meaningful for the further reduction in mortality from chronic diseases in older age groups, as well as in younger age groups. It is generally accepted that dietary and behavioral factors, such as smoking and a lack of physical activity, are major factors for chronic diseases; thus, a healthier lifestyle will play an important role in the prevention of chronic diseases.

Precautionary measures are also crucial for the prevention of pneumonia or secondary bacterial infections. For example, the use of vaccination against influenza viruses was a fundamental means to reduce deaths from pneumonia caused by influenza infection. On the other hand, since the elderly—especially those at advanced ages—have become healthier, with an increase in the number of elderly residents in Hong Kong in the future, medical treatment and health care needs will be big challenges to the health system.

Nevertheless, this study has some shortcomings. For instance, owing to the limitation of the available data, the last age group was 85 years and above. Since the health conditions of the older population (example, the 85–99 years) and even centenarians (the 100+ years) could be very different, it is necessary to further explore the health status of these additional specific age groups.

The researchers from the Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China, were led by Yan Zheng, Qingsong Chang and Paul Siu Fai Yip concluded: “This study reveals the growth mechanism of life expectancy in Hong Kong over the past decades. The results showed that, during the observed period from 1986 to 2015, the major contribution to the improvement in life expectancy in Hong Kong for both males and females was mainly attributable to the older population. The reduction in mortality from malignant neoplasms and circulatory diseases (example, cerebrovascular diseases and heart diseases) made substantial positive contributions to the increase in life expectancy, with the age groups making the greatest contributions shifting to the older ages in more recent years. However, these positive contributions were partly offset by a negative contribution of pneumonia, especially among those at advanced ages. Therefore, although Hong Kong has achieved a remarkable feat in improving the overall life expectancy, further measures can and should be taken to sustain its continuous improvement.

“It is well known that the trend in life expectancy can be affected by multiple factors, such as socioeconomic state and availability of public health services. Due to limitations in the data, we did not explore such issues here. In the future, this study could be further developed to explain the influence of such factors on the changing life expectancy.”

A professor of gerontology and geriatrics at Chinese University, Jean Woo, said: “It was surprising. The whole world had looked to Japan; what is their secret?”

Regions dubbed “blue zones” by Dan Buettner, author of books about places conducive to old age, such as the province of Ogliastra, in Sardinia, and the centenarian-riddled Nicoya Peninsula, in Costa Rica, conjure up images of bucolic villages sitting alongside cerulean waters. Hong Kong, however, benefits from many aspects of its urban density, and Woo suggests the legacy of British colonial rule has left many well-designed Hong Kong neighbourhoods.

“Sha Tin is an example of good design,” says Woo. “It was just swamps before and was purpose-built – they had a blank sheet of paper to design it. There is a river and every­one walks by it, there are green spaces, parks and the public housing is very good.

“Our green space is not empty like a football field, there are things in it. You can socialise, do physical activity and you can rest your eyes. It isn’t just buildings higgledy-piggledy like a maze. It affects air quality as there is good airflow.”

Meanwhile, Harvard Health Publishing recommends:

Smoking: An enemy of longevity
If you want to live a long, healthy life, make sure you’re among the nonsmokers. Smoking contributes to heart disease, osteoporosis, emphysema and other chronic lung problems, and stroke. It makes breathing during exercise much harder and thus can make activity less enticing. It appears to compromise memory, too.

The news does get better. People who quit smoking can repair some, if not all, of the damage done. After a smoker quits, the risk of heart disease begins to drop within a few months, and in five years, it matches that of someone who never smoked. Stroke risk drops to equal that of a nonsmoker within two to four years after a smoker quits, according to one study. The death rate from colorectal cancer also decreases each year after quitting. At any age, quitting progressively cuts your risk of dying from cancer related to smoking, although this drop is most marked in those who quit before age 50.

Diet and aging: Gaining a nutritional edge
Plenty of research suggests that eating healthy foods can help extend your life and improve your health. Studies reveal that a healthy diet can help you sidestep ailments that plague people more as they age, including heart disease, hypertension, cancer, and cataracts.

There is no shortage of new and conflicting advice on diet and nutrition. Stick to the basics with more broad-based changes, such as cutting back on meat; eating more vegetables, fruits, and whole grains; and striking a healthy balance between calories in and calories out.

Choose fruits and vegetables wisely
Get at least five servings of fruits and vegetables a day. When filling your plate with fruits and vegetables, choose from a full color palette. For even more health benefits, aim for nine servings a day. To get there, choose vegetable soups and vegetable or fruit salads. Sprinkle fruit on breakfast cereal, and select it for snacks or as a sweet end note after meals.

Choose fats wisely
Whenever possible, use monounsaturated and polyunsaturated oils. Avoid trans fats entirely. Limit saturated fats to less than seven per cent of daily calories and total fat to 20 per cent to 30 per cent of daily calories.

If you don’t have coronary artery disease, the American Heart Association recommends eating foods rich in omega-3 fatty acids, such as salmon, trout, or mackerel, twice weekly. If you have documented coronary artery disease, consume roughly one gram a day of EPA or DHA from oily fish and supplements if your doctor advises this.

Choose carbohydrates wisely
Choose whole-grain foods over those made with refined grains, such as white bread. Look beyond popular choices like whole oats and brown rice to lesser-known whole grains like barley, bulgur, kasha, and quinoa. Limit your intake of white potatoes.

Choosing protein wisely
Emphasise plant sources of protein, such as beans, nuts, and grains, to help you bypass unhealthy fats predominant in animal sources. Enjoying a wide variety of vegetables and eating beans and grains helps you get a full complement of amino acids over the course of a week. Shy away from protein sources high in saturated fat. Favor fish and well-trimmed poultry. If you do eat beef, pick lean cuts.

Don’t char or overcook meat, poultry, or fish — it causes a buildup of carcinogens. Cutting off fat, which causes flames to flare on the grill, can help avoid charring; try gently sautéing, steaming, or braising these foods in liquid instead. Grilling vegetables is safe, however.

Turning the tide on weight gain
Turning the tide to lose weight — or just holding the line at your current weight — can be difficult. The following tips may help:

Line up support. Work with your doctor and, possibly, a nutritionist or personal trainer. Ask for help in setting a reasonable goal and taking small steps that make success more likely. Tell friends and family about your goal, too.

Shut down the kitchen. Make your kitchen off-limits after dinner — even if you need to run a strip of crime tape across the door to do so.

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Aim for a small change. Trimming five per cent to 10 per cent of your starting weight is a realistic goal with excellent health benefits, including reducing blood pressure and cholesterol levels and lowering the risk for diabetes.

Eat well. Focus on vegetables and whole grains, which are digested slowly. Limit refined carbohydrates. Enjoy moderate amounts of monounsaturated and polyunsaturated fats in your diet. Cut down on saturated fats and avoid trans fats.

Watch the balance. Taking in more calories than you burn off adds extra pounds. Burning off more calories than you take in shaves pounds. A moderately active person who gets about 30 minutes of exercise a day needs 15 calories of food for each pound of body weight. To lose a pound a week, you need to lop off about 500 calories a day by becoming more active and eating less.

Step up activity. If you are struggling to maintain a healthy weight or need to lose weight, the 2005 Dietary Guidelines for Americans recommend 60 to 90 minutes a day of moderate activity. You can work out in one daily session or shorter bouts at least 10 minutes long. Walking is safe for practically everyone. Talk to your doctor if you’d like to include more vigorous activities, which give you twice the bang for your exercise buck — that is, one minute of vigorous activity equals roughly two minutes of moderate activity.

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