Goals for child health in Hong Kong in the 21st century – from the medical perspective (a 10-min talk)TF FokFaculty of MedicineThe Chinese University of Hong Kong

Millennium Development Goals: progress towards the health-related Millennium Development Goals

Fact sheet N°290May 2011

• September 2000: 189 heads of state adopted the UN Millennium Declaration

• They established eight Millennium Development Goals (MDGs), with targets set for 2015

• The Declaration commits world leaders to combat • Poverty• Hunger• Disease• illiteracy• environmental degradation• discrimination against women

The MDGsGoal 1: Eradicate extreme poverty and hunger

Goal 2: Achieve universal primary education

Goal 3: Promote gender equality and empower women

Goal 4: Reduce child mortality

Goal 5: Improve maternal health

Goal 6: Combat HIV/AIDS, malaria and other diseases

Goal 7: Ensure environmental sustainability

Goal 8: Develop a global partnership for development

Public Health & Epidemiology Bulletin, DH; Aug 2011 issue

NEWBORN SURVIVAL IN BANGLADESH

NEWBORN SURVIVAL IN NEPAL

NEWBORN SURVIVAL IN UGANDA

NEWBORN SURVIVAL IN PAKISTAN

Source: NEWBORNNEWS express highlights in newborn health | June 20, 2012

MDG 1: Eradicate extreme poverty and hunger

HK Goal: Minimise relative poverty and social gradient

Not only absolute poverty adversely affects healthIncome inequality also plays a role, via its links to psychosocial pathways associated with relative disadvantage

Marmot M, Wilkinson R. 2001. Psychosocial and Material Pathways in the Relation Between Income and Health: A Response to Lynch et al. British Medical Journal 322(19 May) 1233-36.

The associations between income inequality and health are not inevitable, but rather are contingent on the level of public infrastructure and resources availableThe lack of material resources (e.g. differentials in access to adequate nutrition, housing and healthcare), coupled with a systematic underinvestment in human, physical, health and social infrastructure (e.g. the types and quality of education, health services, transportation, recreational facilities and public housing available) are most damaging to the health of the disadvantaged

Lynch J, Davey Smith G, Kaplan G, et al. 2000. Income inequality and mortality: Importance to health of individual income, psychosocial environment or material conditions. British Medical Journal 320(29 April) 1200-04.

Current New Zealand Children’s Social Health Monitor Indicators

Comprises 5 economic and 3 health and wellbeing indicators: Economic Indicators:

Gross Domestic Product (GDP) Income InequalityChild Poverty and Living StandardsUnemployment Rates Children Reliant on Benefit Recipients

Health and Wellbeing Indicators: Hospital Admissions and Mortality with a Social Gradient Infant MortalityInjuries Arising from the Assault, Neglect or Maltreatment of Children

THE NEW ZEALAND CHILDREN’S SOCIAL HEALTH MONITOR 2010 UPDATE

The Paediatric Society of New Zealand, the Population Child Health Special Interest Group of the Royal Australasian College of Physicians, the New Zealand Child and Youth Epidemiology Service, TAHA (the Well Pacific Mother and Infant Service), the Maori SIDS Program, the Kia Mataara Well Child Consortium, the New Zealand Council of Christian Social Services, and academics from the Universities of Auckland and Otago

Kiwi

Source: Numerator: National Minimum Dataset (Neonates Removed); Denominator: Statistics NZ Estimated Resident Population. Medical Conditions: Acute and Arranged Admissions only; Injury Admissions: Emergency Department Cases removed. Rates are per 1,000, Rate Ratios are unadjusted; Ethnicity is Level 1 Prioritised.

Risk Factors for Hospital Admissions with a Social Gradient in Children Aged 0-14 Years, New Zealand 2005-2009

Medical Conditions Injuries

Neonatal Mortality

Post-Neonatal Mortality

Sudden Unexpected Death in Infancy (SUDI)

Risk Factors for Neonatal and Post Neonatal Mortality, and Sudden

Unexpected Death in Infancy (SUDI), New Zealand 2003–2007

Source: Numerator: National Mortality Collection; Denominator: Birth Registration Dataset; Rates are

per 100,000, Rate Ratios are Unadjusted, Ethnicity is Level 1 Prioritised. SUDI is neonatal AND post

neonatal.

Distribution of Hospital Admissions due to Injuries Arising from the Assault, Neglect or Maltreatment of Children 0-14 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2005-2009

Source: Numerator: National Minimum Dataset; Denominator: Statistics NZ Estimated Resident Population. Rate is per 100,000 per year; Ethnicity is Level 1 Prioritised; RR: Rate Ratios are unadjusted

MDG7 and HK Goal:

Ensure environmental sustainability

SCMP 2012-03-26:Dirtiest financial hub is Tsang's legacy

Why may children be at greater risk than adults from air pollution?More rapid breathing, increasing their exposure to air pollutants Mouth breathing more common - bypassing filtering effect of the nose and allowing more pollutants to be inhaled Spend significantly more time outdoorsImmature immune systems and developing organs - more susceptible to the health effects of air pollution. For example:

inhaled lead more easily deposited in the fast-growing bones Inflammation caused by air pollution is more likely to obstruct their narrower airways Take less exposure to a pollutant to trigger an asthma attack due to the sensitivity of a child's developing respiratory system Early exposure to toxic air contaminants could affect the development of the respiratory, nervous, endocrine and immune systems, and could increase the risk of cancer later in life

Air Pollution and Children's Health: A fact sheet by Cal/EPA's Office of Environmental Health Hazard Assessment and the American Lung Association of California [02/28/02] [revised 11/26/03]

• Melamine Milk scandal (2008): 6 babies were killed and 300,000 were left sickened…• Toxic Bean-sprouts (2006): treated with sodium nitrite, urea, antibiotics and a plant

hormone 6-benzyladenine• Pesticide-drenched ‘yard-long’ beans (2010): contaminated with banned pesticide

isocarbophos• Leather milk (2011): this time using leather-hydrolyzed protein which, like melamine,

appears to boost the protein-content of milk• ‘Aluminium’ dumplings: food made with flour, including dumplings and steamed buns.

had aluminium levels above national standards• Glow-in-the-dark pork: pork that glowed an eerie, iridescent blue: Shanghai Health

Department said the pork has been contaminated by a phosphorescent bacteria…• ‘Lean meat powder’ pork: using a β2 agonist clenbuterol, known as ‘lean meat powder’,

which can cause dizziness, palpitations, diarrhoea and profuse sweating• Toxic take-away boxes (2010): foam-boxes release toxic elements when warmed by food:

potential damage to livers, kidneys and reproductive organs• ‘Sewer’ oil (2010): one in 10 of all meals in China were cooked using recycled oil, often

scavenged from the drains beneath restaurants• ‘Cadmium’ rice (2012): Research claimed that up to 10% of rice sold in China was

contaminated with heavy metals, including cadmium. In some areas 60% of samples were contaminated, some with up to 5 times the legal limit.

Top 10 Chinese Food Scandals

MDG 4 and HK Goal:

Reduce child mortality (& morbidity)

Following is a question by the Hon Frederick Fung and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (November 26, 2008):

Question:

A recent study by the Chinese University of Hong Kong has revealed that the problem of childhood obesity in Hong Kong is getting worse, and it has projected that by 2013, every one of four teenagers aged between 6 and 18 would be obese…….

Reply:

According to statistics provided by the Student Health Service of the Department of Health (DH), the obesity rate among primary school students rose from 16.4% in 1997-98 to 21.3% in 2007-08. To promote healthy eating habit, DH has all along committed to raising public awareness of the importance of healthy eating through various large-scale campaigns such as "EatSmart@school.hk" and "EatSmart@restaurant.hk". It has also launched a "Strategic Framework for Prevention and Control of Non-communicable Diseases" to promote public health and healthy living.

LCQ17: Childhood obesity

Current Efforts to Address Obesity: 1.Health Promoting Policies2.Promoting Supportive Environments through Social Programs3.Collaborating with Partners to Promote Healthy Behavior4.Empowering Partners and Individuals5.Raising Awareness through Health Education and Communication

HK Goal: To provide supporting environment/infrastructure /policies to facilitate health initiatives

LCQ8: Breastfeeding

Following is a question by the Hon Fred Li and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (February 23, 2011):

Reply:

….The Government has all along endeavoured to promote, protect and support breastfeeding…. Healthcare professionals provide counselling service for breastfeeding mothers, and help post-natal women acquire breastfeeding skills and tackle the problemsthey may encounter during breastfeeding.

(a) The DH carries out regular breastfeeding surveys in its maternal and child health centres (MCHCs)…….

(b) The DH has recently conducted a survey to gauge the knowledge, attitude and behaviour of about 1,000 parents…. The DH will continue to publicise positive health information to enhance parents' understanding….

(c) The Government will put in place a Hong Kong Code of Marketing of Breast-milk Substitutes (the Hong Kong Code)……….

More babycare rooms in public places encouraged to promote breastfeeding2 Aug 2008

The Government spared no efforts in promoting breastfeeding and strived to create a supportive environment in the community, including the formulation of advisory guidelines to encourage more private and public organisations to provide babycare facilities in their premises.The Permanent Secretary for Health and Food (Health), Ms Sandra Lee, made this remark today (August 2).

The breastfeeding surveys conducted in the DH's Maternal and Child Health Centre (MCHCs) indicated the same rising trend……. Ms Lee said these bore testimony to the fruitful efforts of DH, HA and non-governmental organisations. Yet, the provision of a supportive environment is of paramount importance in motivating more mothers to choose and sustain breastfeeding.

To this end, the Government is providing more babycare rooms in public places to facilitate breastfeeding. There are currently 106 government and public premises with babycare rooms, showing an increase of 14% as compared to 91 in 2006. The number will be further raised to about 146 in 2012.

Department of Health, HKSAR Government

Breastfeeding and weaning practices among Hong Kong mothers: a prospective studyMarie Tarrant1*, Daniel YT Fong1, Kendra M Wu2, Irene LY Lee3, Emmy MY Wong4, Alice Sham5, Christine Lam6 and Joan E Dodgson7

BMC Pregnancy and Childbirth 2010, 10:27

The proportion of mothers still providing any breastfeeding and exclusively breastfeeding at monthly time intervals.

• Lack of support during antenatal and postpartum period

• Returning to work early• Lack of public (or even private)

facilities for nursing mothers

HK Goal:

To improve care of children with special needs

• Early detection• Timely intervention/placement• One-stop/coordinated services• Easy accessibility• Social/family support• Long term placement

MDG 3: Promote gender equality

HK Goal: Promote racial / local-Mainland harmony

Goals for Childhealth in Hong Kong –from the Medical Perspective

Sustainable environment that is conducive to child healthClear air and clean water – allergyAllows safe outdoor activitiesClean food (melamine, artificial colouring)

Eradicate not hunger but imbalanced diet and overfeedingObesity and metabolic syndrome

Promote gender equalityEspecially for the new immigrants

Provide Pui To for healthy child rearing and growthBreast feeding and infant bonding – maternity leave, paternity leave, housing, privacy, day care centre, workplace child care

The MDGsGoal 1: Eradicate extreme poverty and hunger

Halve, between 1990 and 2015, the proportion of people whose income is <US$1Achieve full and productive employment and decent work for all,Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Goal 2: Achieve universal primary education

Goal 3: Promote gender equality and empower womenEliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015

Goal 4: Reduce child mortalityReduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Goal 5: Improve maternal healthReduce by three quarters, between 1990 and 2015, the maternal mortality ratioAchieve, by 2015, universal access to reproductive health

Goal 6: Combat HIV/AIDS, malaria and other diseasesHave halted by 2015 and begun to reverse the spread of HIV/AIDSAchieve, by 2010, universal access to treatment for HIV/AIDS for all those who need itHave halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Goal 7: Ensure environmental sustainabilityIntegrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resourcesReduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of lossHalve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitationBy 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers

Goal 8: Develop a global partnership for development

In New Zealand, children who are reliant on benefit recipients are a particularly vulnerable group. During 2009, 75% of all households (including those with and without children) relying on income-tested benefits as their main source of income were living below the poverty line (housing adjusted equivalent disposable income <60% of 2007 median) [32]. This proportion has increased over the past two decades, rising from 39% of benefit dependent households in 1990, to a peak of 76% in 1994, and then remaining in the low-mid 70s ever since [32], with these trends being attributed to three main factors: cuts in the level in income support during 1991, growth in unemployment (which peaked at 11% in 1991) and escalating housing costs, particularly for those in rental accommodation [13]. The vulnerability of benefit dependent children was further highlighted by the 2000 Living Standards Survey, which noted that even once the level of family income was taken into account, families whose main source of income was Government benefits were more likely to be living in severe or significant hardship and as a consequence, more likely to buy cheaper cuts of meat, go without fruit and vegetables, put up with feeling cold to save on heating costs, make do without enough bedrooms, have children share a bed, postpone a child’s visit to the doctor or dentist, go without a computer or internet access and limit their child’s involvement in school trips, sports and extracurricular activities [13]. The 2004 Living Standards Survey suggested that the picture may have worsened between 2000 and 2004, with the proportion of benefit dependent families living in severe or significant hardship increasing from 39% in 2000 to 58% in 2004 [

Current Efforts to Address Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . 8 I. Health Promoting Policies II. Promoting Supportive Environments through Social Programs III. Collaborating with Partners to Promote Healthy Behavior IV. Empowering Partners and Individuals V. Raising Awareness through Health Education and Communication