Non-Communicable Diseases Watch

October 2020

Co-occurrence of Health Risk Behaviours : An Overview

This publication is produced by the Non-communicable Disease Branch, Centre for Health Protection of the Department of Health

18/F Wu Chung House, 213 Queen’s Road East, Wan Chai, Hong Kong http://www.chp.gov.hk All rights reserved

Key Messages

※ Poor eating habit, physical inactivity, smoking, and harmful use of alcohol are significantly

associated with elevated risk of developing and dying from non-communicable diseases

(NCDs). In addition to being prevalent in the general population, unhealthy behaviours often

co-exist within individuals.

※ Among people aged 18 and above, a territory-wide household survey conducted by the

Department of Health (DH) between 2018 and 2019 observed that the prevalence of

inadequate consumption of fruit and vegetables, insufficient physical activity, current smoking

and regular drinking was 95.5%, 16.8%, 13.5% and 9.0%, respectively. Overall, 32.0% of

people aged 18 and above had two or more of the selected health risk behaviours.

※ In the fight against coronavirus disease 2019 (COVID-19), DH appeals to members of the

public to lead a healthy lifestyle, which includes eating a balanced diet, having regular physi-

cal activity, avoiding smoking and alcohol consumption, etc. Adoption of a healthy

lifestyle can also boost the immunity and thereby lower the risk of severe COVID-19.

※ For more information about healthy living, please visit the DH’s Change for Health website

at www.change4health.gov.hk. Together, we stay healthy and fight the virus.

Co-occurrence of Health Risk Behaviours: An Overview

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Non-Communicable Diseases Watch October 2020

Chronic non-communicable diseases (NCDs)

are the largest disease burden worldwide; how-

ever, most are preventable. The World Health

Organization (WHO) estimates that NCDs kill

41 million people each year, equivalent to 71%

of all deaths globally.1 Epidemiological studies

have clearly shown that poor eating habit,

physical inactivity, smoking, and harmful use

of alcohol, are significantly associated with

elevated risk of developing and dying from

NCDs, including cardiovascular diseases (such

as heart disease and stroke), cancers (such as

colorectal cancer, lung cancer and liver cancer),

type 2 diabetes, and chronic respiratory

diseases (such as chronic obstructive pulmonary

disease).1 In addition to being prevalent in

the general population, unhealthy behaviours

often co-exist within individuals.2, 3 Among adult

populations, studies on occurrence of multiple

risk behaviours reported that low fruit and

vegetable consumption and low physical activity

were the most prevalent (ranging from 47%–

54%) co-occurring pair of health risk behav-

iours, followed by low fruit and vegetable

consumption and smoking (ranging from 23%–

38%). Males, those in lower socioeconomic

status or with lower education attainment were

more likely than their counterparts to engage

in multiple unhealthy behaviours.2

The More the Health Risk Behaviours,

The Greater the Risk to Health

A study of over 4 800 adults aged 18 years

and above in England, Wales, and Scotland

examined the single and combined effects of

low fruit and vegetable consumption, low levels

of physical activity, smoking, as well as exces-

sive alcohol consumption on total and cause-

specific mortality. Compared with those without

such health risk behaviours, individuals who

exhibited all four health risk behaviours were

about 3 times as likely to die from cardiovascu-

l a r diseases and cancer, and about 4 times as

likely to die from other causes.4 For coronavirus

disease 2019 (COVID-19), a study involving

over 387 000 community-dwelling adults in

t h e U nited Kingdom assigned scores to different

levels of each lifestyle risk factors (including

p h y sical inactivity, smoking, alcohol consump-

tion and obesity) and showed a dose-dependent

increase in risk of severe COVID-19 with less

favourable lifestyle scores. Compared to persons

with the most optimal lifestyle, those with the

m o s t unfavorable lifestyle had about 4 times

the risk for severe COVID-19.5

Co-occurrence of Health Risk Behav-

iours among Hong Kong Adults

The Department of Health (DH) conducted a

territory-wide household survey between 2018

and 2019 and successfully interviewed over

5 900 Hong Kong residents aged 15 and above

(excluding foreign domestic helpers and

visitors) about their health-related behaviours

and lifestyle practices. Among adults aged

18 and above, the prevalence of inadequate

consumption of fruit and vegetables, insufficient

physical activity, current smoking and regular

drinking was 95.5%, 16.8%, 13.5% and 9.0%,

respectively (Table 1).6

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Non-Communicable Diseases Watch October 2020

Table 1: Prevalence of the health risk behaviours among adults aged 18 and above

95.5% of persons (97.2% for males; 94.0% for females) had inadequate consumption

of fruit and vegetables, i.e. less than the WHO recommended five servings of fruit

and vegetables a day.

16.8% of persons (15.2% for males; 18.3% for females) had insufficient physical

activity to be of benefit to health, i.e. not having engaged in at least 150 minutes of

moderate-intensity or 75 minutes of vigorous-intensity physical activity per week,

or an equivalent combination of moderate- and vigorous-intensity physical activity

according to WHO .

13.5% of persons (24.1% for males; 4.2% for females) reported current smoking

at the time of survey, whether smoking on a daily or less often and regardless of

what types of smoking products.

9.0% of persons (15.5% for males; 3.3% for females) drank regularly (i.e. drank

at least once a week) in the 12 months preceding the survey.

Source: Health Behaviour Survey 2018/19, Department of Health.

As shown in Figure 1, 32.0% of people aged

18 and above had two or more of the selected

health risk behaviours. The most prevalent pair

of health risk behaviours were inadequate con-

sumption of fruit and vegetables and insuffi-

c i e nt physical activity (13.9%), while the most

common trio involved inadequate consumption

of fruit and vegetables, current smoking and

regular drinking (3.8%).6

Figure 1: Distribution of numbers of health risk behaviours among adults aged 18 and above

Source: Health Behaviour Survey 2018/19, Department of Health.

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Non-Communicable Diseases Watch October 2020

Acting on NCDs

People’s lifestyles — what they eat, whether

they take regular exercise, whether they smoke

and how much they drink — would affect their

health and risk of dying early from NCDs.

In Hong Kong, cancer, cardiovascular diseases

(including heart disease and stroke), diabetes

and chronic respiratory diseases were collec-

tively accounted for 55% of all registered

deaths in 2019.7 From public health perspec-

tive, better control of the modifiable risk

factors are of particular importance in NCD

prevention and control. Intervening upstream on

a cluster of behavioural risk factors can

induce parallel reductions in the prevalence of

biological risk factors, thereby reducing the

risk of developing NCDs (Figure 2).1 Studies

have clearly shown that healthy living is

inversely associated with the risk of NCDs.8, 9

For example, daily fruit and vegetables con-

sumption and regular physical activity could

reduce the risk of developing myocardial

infarction by 40%; when smoking was also

avoided, the risk was reduced by more than

three-quarters.10 In the face of the present

COVID-19 pandemic, adoption of a healthy

l i f e s t y le can boost the immunity and thereby

lower the risk of severe COVID-19.5

The Hong Kong Government is committed to

fight against NCDs and has launched “Towards

2025: Strategy and Action Plan to Prevent and

Control Non-communicable Diseases in Hong

Kong” (SAP) in 2018 with a list of actions

and clear targets (Figure 3).11 In the fight

against COVID-19, DH appeals to members

of the public to lead a healthy lifestyle, which

includes eating a balanced diet, having regular

physical activity, avoiding smoking and alcohol

consumption, etc. DH will continue working

in close partnership with other government

bureaux and departments as well as community

partners to promote population health and

prevent NCDs.

Figure 2: Intervene upstream to reduce the risk of NCDs

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Non-Communicable Diseases Watch October 2020

For more information about healthy living or the

SAP, please visit the DH’s Change for Health

website at www.change4health.gov.hk. Together,

we stay healthy and fight the virus.

Figure 3: NCD targets by 2025

References

1. Noncommunicable Diseases,1 June

2018. Geneva: World Health Organization.

Available at www.who.int/news-room/fact-

sheets/detail/noncommunicable-diseases.

2. Noble N, Paul C, Turon H, et al. Which

modifiable health risk behaviours are relat-

ed? A systematic review of the clustering of

Smoking, Nutrition, Alcohol and Physical

activity ('SNAP') health risk factors. Pre-

ventive Medicine 2015;81:16-41.

3. Meader N, King K, Moe-Byrne T, et al.

A systematic review on the clustering and co

-occurrence of multiple risk behaviours.

BMC Public Health 2016;16:657.

4. Kvaavik E, Batty GD, Ursin G, et al.

Influence of individual and combined health

behaviors on total and cause-specific mor-

tality in men and women: the United King-

dom health and lifestyle survey. Archives of

Internal Medicine 2010;170(8):711-718.

5. Hamer M, Kivimäki M, Gale CR, et al.

Lifestyle risk factors, inflammatory mecha-

nisms, and COVID-19 hospitalization: A

community-based cohort study of 387,109

adults in UK. Brain, Behavior, and Immuni-

ty 2020;87:184-187.

6. Health Behaviour Survey 2018/19. Hong

Kong SAR: Department of Health.

7. Mortality Statistics 2019 (provisional).

Hong Kong SAR: Department of Health and

Census and Statistics Department.

8. Freisling H, Viallon V, Lennon H, et al.

Lifestyle factors and risk of multimorbidity

of cancer and cardiometabolic diseases: a

multinational cohort study. BMC Medicine

2020;18(1):5.

9. Li Y, Schoufour J, Wang DD, et al.

Healthy lifestyle and life expectancy free of

cancer, cardiovascular disease,, and type 2

diabetes: prospective cohort study. Brtish

Medical Journal 2020;368(l6669).

10. Yusuf S, Hawken S, Ounpuu S, et al.

Effect of potentially modifiable risk factors

associated with myocardial infarction in 52

countries (the INTERHEART study): case -

control study. Lancet 2004;364(9438):937-

952. 11. Towards 2025: Strategy and Action Plan

to Prevent and Control Non-communicable

Diseases in Hong Kong. Hong Kong SAR:

Food and Health Bureau and Department of

Health, May 2018.

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Non-Communicable Diseases Watch October 2020

World Stroke Day

29 October 2020

Initiated by the World Stroke Organization (WSO), World Stroke Day aims to raise awareness

of stroke and the huge burden it places on the health of people worldwide, and to highlight

the ways in which stroke can be prevented.

Most stroke cases can be prevented through leading a healthy lifestyle that includes having

a balanced diet with at least 5 servings of fruit and vegetables, no smoking, exercising regularly,

refrain from alcohol use, etc.

To know more about the World Stroke Day 2020 , please visit www.world-stroke.org/world-stroke-

day-campaign/world-stroke-day.

Non-Communicable Diseases (NCD) WATCH is dedicated to

promote public’s awareness of and disseminate health information

about non-communicable diseases and related issues, and the

importance of their prevention and control. It is also an indication of

our commitments in responsive risk communication and to address

the growing non-communicable disease threats to the health of our

community. The Editorial Board welcomes your views and comments.

Please send all comments and/or questions to so_dp3@dh.gov.hk.

Editor-in-Chief

Dr Rita HO

Members

Dr Patrick CHONG Mr Kenneth LAM

Dr Thomas CHUNG Dr Ruby LEE

Dr Cecilia FAN Dr YC LO

Dr Raymond HO Dr Eddy NG

Dr Eric LAM Dr Lilian WAN