Hong Kong Children's Exercise Policy: A Public Health Analysis

Overview of the Hong Kong Health Care System

The health care system in Hong Kong is widely regarded as one of the best in the world. The majority of people there live longer than people in many other developed nations, and the infant mortality rate is also very low. These facts reflect a population committed to health and a government that enacts policies to protect its citizens and ensure full access to health care. Many countries do not offer that to their citizens, which makes Hong Kong something of a rarity — one that allows its people to enjoy a life expectancy of upwards of 80 years for both men and women. That is the second-longest life expectancy of any country in the world.

Of course, there are imperfections in Hong Kong's health care system, just as there are anywhere else. People who live there still pass away, and some die from diseases that were preventable or that went untreated or were improperly diagnosed. Such is the nature of medicine.

This paper addresses one specific policy in the Hong Kong health care system in order to examine it in depth. Addressing too many policies or too many issues at once does little for any study, because there is only space to touch the surface. When considering just one policy, there is room to examine its creation, why it was needed, what it offers, and what it lacks. No health care policy anywhere has everything that is needed — there is always something that could be improved. However, every health care policy has value because it offers something to the people subject to it. Considering both sides of the equation can genuinely help any country working on making health care policy, since each country is both similar to and different from others. The "dos" and "don'ts" of policy creation become more visible through comparison.

The Policy Focus: Physical Activity and Children

For the purposes of this paper, the Hong Kong health care policy addressed concerns exercise. This is one of the most significant public health imperatives in Hong Kong, and it emerged largely in response to trends observed in other countries. Many people in their later years become incapacitated or develop avoidable diseases because of insufficient physical activity during their early and middle-aged years. Numerous chronic — and generally preventable — diseases are brought on by a lack of physical activity. Cardiovascular disease, obesity, diabetes, and other conditions can occur in people who are too sedentary and who do not move around enough to maintain good health. One of the leading causes of death in Hong Kong is cardiovascular disease, and one of the goals of health care in that territory is to reduce the number of people struggling with that problem and developing cardiovascular conditions each year (Adab & Macfarlane, 1998).

When people regularly participate in moderate amounts of exercise, they live longer and healthier lives, on average (American College of Sports Medicine, 1975; Berlin & Colditz, 1998). However, many people in Hong Kong still do not recognize the significance of regular exercise — and that is particularly apparent in programs geared toward children. Almost 60% of the people in Hong Kong are relatively sedentary, and only a third exercise enough to see serious health benefits. The children in primary school in Hong Kong are, most likely, among the most inactive in the world. Because that creates significant risk, schoolchildren needed to be made a priority in programs designed to get them moving. In addition, they and their parents need to understand that there are consequences for sedentary behavior and that those consequences can be mitigated. The policy issue, therefore, focuses more on children than on adults.

This particular policy, which addresses the need for exercise programs for children, came about because of how sedentary the Hong Kong lifestyle is for primary schoolchildren. When children are very sedentary, they can begin developing diseases typically seen in much older people. Diabetes, heart disease, and other conditions can start to emerge, and as these children age they will begin to get sick much earlier than their parents did (Powell & Blair, 1994; Shephard, 1994). While adults should exercise too, it is vital that children move around and develop good habits from a young age. Many of those habits can be modeled at home, but learning at school is also valuable (Wong & Macfarlane, 1997).

Sedentary Lifestyles and Health Consequences

For primary schoolchildren in Hong Kong, being sedentary is simply what they are accustomed to — they do not know any other way. They see no need to move more because they have not been taught about the benefits of being more active. Once they understand the value of exercise, they will be more likely to engage in it more frequently (Adab & Macfarlane, 1998). Their parents must also learn about the importance of exercise, since anyone who exercises regularly will be healthier than someone who does not. When parents do not exercise, it is much harder to teach children to do so — and much harder to convince children to do something that their parents are not doing, since that often does not make sense to them.

Having a policy in place creates an opportunity to focus on the benefits of exercise rather than ignoring the issue. In other words, the absence of a policy makes it easier to assume exercise is unnecessary. When the government becomes involved and conducts research into an issue of public importance, recommendations can then be made about how that research should be applied (Adab & Macfarlane, 1998). That was the case in Hong Kong, where the government studies information that can help its citizens and then provides that information and sets policies based on it. Of course, no one can be forced to exercise. However, health care policies can be established that encourage exercise and make it more common. One such policy involves the amount of exercise that primary schoolchildren receive in Hong Kong (Adab & Macfarlane, 1998).

There are many benefits to exercise, especially for children. It helps decrease body fat, increase cardiac output, and keep the entire body healthy (Paffenbarger & Lee, 1996; Taylor, 1996). Starting young makes a significant difference, though a person can begin exercising at any age. While the people of Hong Kong benefit from nearly the best health care in the world, that care is largely reactive — used to prevent and treat disease once it appears. Another way to prevent disease is to encourage proactive measures that promote good health, such as regular exercise. The Hong Kong government would therefore need to become more involved in setting policies for how much exercise primary schoolchildren should receive each day, as right now they receive little to none.

Research consistently shows that deaths from chronic diseases are not limited to low-income or lower-middle-income countries. These diseases also occur in upper-middle-income and high-income countries. Wealthier countries should, in theory, be able to reduce most of these diseases, but medicine can only do so much. One reason diseases like cardiovascular disease are so difficult to completely avoid is that people often fail to do their part to stay healthy. It is vital that individuals focus on what they can do to maintain their own health — and teach that to their children — and exercise is a large part of that. Research also confirms that increased exercise directly correlates with decreased deaths from heart disease (Janus, 1997; Macfarlane, 1997), reinforcing the importance of building activity into daily life from an early age.