Researchers including Dr Vladimir Canudas-Romo from the ANU School of Demography have published new findings in The Lancet, revealing reasons for the long-life residents of Hong Kong enjoy, and offering valuable lessons for developed and developing populations around the world.

A comparative study published in The Lancet offers the largest and most comprehensive assessment of Hong Kong’s world leading longevity, comparing it to 18 high-income countries. Using data from 1960 to 2020, they found that Hong Kong has developed a “substantial survival advantage”, giving it the highest life expectancy in the world. Making this even more impressive, is that Hong King has achieved this outstanding measure of population health while spending a comparatively lower portion of GDP on public health at a mere 5.9% compared to around 10% in Japan and the United Kingdom, and 17% in the United States.

Study co-author Dr Vladimir Canudas-Romo from the ANU School of Demography remarks that Hong Kong’s success is the result of fewer diseases of poverty and suppression of the diseases of affluence.

“We identified, for the first time, that Hong Kong’s survival advantage was achieved by its improved cardiovascular and smoking-attributable mortality (lowest overall smoking prevalence among high-income settings since the 1990s) compared to all high-income countries. Hong Kong’s unique combination of economic prosperity and low smoking prevalence has led to the decline of diseases of poverty, while suppressing the rise of cardiovascular diseases (i.e. the leading cause of death in high-income settings).”

The findings come at a time when life expectancies in affluent and developed countries like the United Kingdom and United States has stalled or declined. And at a time when new potential threats to life expectancy are emerging, not the least being the COVID 19 pandemic.

With smoking a significant factor in life expectancy, e-cigarettes are another factor emerging. A substantial reason for Hong Kong’s favourable health outcomes is that it has among the lowest instances of smoking in the world, and the lowest smoking attributable death rate too. The study finds countries such as Norway, Canada and Australia have also achieved significant declines in smoking, but that mortality remains higher owing to the legacy of smoking from decades past. Other countries have a way to go making such reductions says Dr Canudas-Romo.

“Smoking is the single largest cause of preventable death. However, tobacco use remains very high among men in China (42%) and South Korea (36%), and high among both sexes in France (28%), Spain (24%), UK (16%) and US (16%).”

Controlling the sale of tobacco products is well established as making a significant difference to population health, but Hong Kong offers a rare example if having achieved it so comprehensively. It has been at the forefront of policy settings affecting the sale, taxation, and use of tobacco products in public settings.

The success the study finds offers important guidance to countries both developed and developing around the world. But study also has a caveat, for while health outcomes and access to comprehensive universal healthcare are impressive achievements, they are only one measure of health. The World Health Organisation also includes mental and social well-being in the definition of health. Hong Kong has the longest working hours and lowest housing affordability in the world, and surveys shows more residents are in search for meaning in life than anywhere in the world.

The study is available here: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00208-5/fulltext