World’s Highest Life Expectancy

Pleasant aged man playing chess with his grandson.

Highest Life Expectancy: How Did Hong Kong Get There?

People in Hong Kong live longer than anywhere else, including Japan. Here’s why.

According to the United Nations Vital Statistics Summary and Life Expectancy at Birth for 2022, Hong Kong is rated to have one the highest life expectancy in the world, with an average of 84.3 years old for both men and women.

So how did Hong Kong manage to stay in the top #3 — considering growing social unrest, financial and housing inequality, and related range of health issues including mental health/wellbeing.

We took a look at Hong Kong’s growing elderly community to gain some insights. Will this change in the future considering the digressing changes in the city’s lifestyle habits, diets, pollution issues, medical services, and mental health?

Life expectancy depends on many factors such as income, the standard of living, access to affordable health care and health care facilities, proper nutrition, diet, as well as genetic and environmental factors.

So what makes Hong Kong different from other cities, and how might this change in the future?

Environment: easy living

Hong Kong has an environment designed to help people live healthier lives and make healthier choices. Hong Kong is a highly urbanized city with well-designed neighbourhoods, plenty of access to nature, walking trails, and outdoor activities to maintain activity levels. A convenient public transportation system and a magnitude of options on how to get around give people choices, and the compactness of the city often allows for the ability to walk to your destination.

Most of the districts in Hong Kong are members of the WHO global network of age-friendly cities. “In an age-friendly community, policies, services and structures related to the physical and social environment are designed to support and enable older people to “age actively” — that is, to live in security, enjoy good health and continue to participate fully in society.”

Some pillars of this “Active Ageing” principle include participation such as barrier-free spaces, accessible public transportation, health such as social support and outreach, activities and programmes to promote health and well-being, and security and independence such as appropriate employment opportunities and accessible, affordable housing. (Source: WHO)

Also, some experts classify the subtropical climate as an advantage for Hong Kongese siting death stats in the UK and US, for example, where extreme weather causes thousands of deaths each year. However, as climate change encroaches, what sort of stats will we face as the weather changes in the future?

Conversely, we will likely see a change in the death rates due to the notorious pollution issues Hong Kong faces. According to the last update of the WHO, over 80% of urban areas monitored for air pollution exceed the WHO air quality limits. The WHO database of nearly 3,000 monitored cities has ranked Hong Kong in the top 20% most polluted cities. (Source: Healthy Matters) Pollution is known as the silent killer causing diseases such as lung cancer, heart disease, and strokes, killing an estimated 7 million people every year. (Souce: WHO)

Diet & health

Experts claim that even though Hong Kong is seemingly unhealthy, the country, in general, consumes a diet similar to the “Mediterranean diet“. Hong Kong is uniquely surrounded by ocean and land, which enables greater access to fish, fruits, and vegetables, which are found in the local cuisine. Rice, nut oils, and a combination of meat and vegetables provide whole diets.

However, as the western diet gains popularity, more and more processed food and meat consumption have led to increases in diseases such as heart disease and high blood pressure in young people. With child obesity on the rise due to these factors, the future can only tell how the diet will affect life expectancy in the future. Furthermore, “colorectal cancer has overtaken lung cancer to become the most common cancer in Hong Kong, with 4,979 new cases of colorectal cancer diagnosed in 2014 and are often related to diet.” (Source: WCRF)

Fortunately, Hong Kong provides suitable sanitation standards and clean water, which are also urban factors that promote long life.

Access to medical care

Hong Kong continues to strive for easy access to medical care for all, providing subsidized care through its public system and alternative options through its private system. In Hong Kong, you have options. Treatments for cancer, heart disease, and strokes are available, and the city proactively aims through various schemes to promote good health in their communities. Hong Kong has taken considerable steps to curb smoking rates, for example.

However, the public system in Hong Kong is becoming increasingly unmanageable, and Hong Kong is facing shortages of doctors in ratio to the number of patients needing care, particularly the increased elderly population. Carrie Lam is taking strides to increase district health care providers, for example, but it is likely the population issues will affect the effectiveness of the healthcare system in Hong Kong now and in the future.

Mental health

Care for the elderly is a priority; easy access to quality medical care in the various districts among the city is one of Hong Kong’s positive attributes at the moment. The elderly are often never left indoors; they are active and exposed to sunlight and get exercise, allowing for less isolation. Traditional ideas of family caring for the elderly and the growing popularity of domestic helpers all help in the general happiness and wellbeing of the elderly as well.

Even with these positive factors, it is estimated that one in three older adults have symptoms of depression. Suicide rates in Hong Kong are highest among people over the age of 65. 239 of 910 suicides recorded in 2018 were of this age. (Source: HKJC Centre for Suicide Research and Prevention)

The pension system and income security in Hong Kong are lacking, and often, the elderly must rely on their children for support, which can also affect mental health negatively.

Furthermore, with increased stress levels due to the current political instability and excessive working hours standard in many industries — is Hong Kong likely to see an effect in ranking in the future due to mental health?

In Hong Kong, life expectancies at birth for both sexes have steadily increased over the past 46 years. 

In Hong Kong life expectancy there was 81.3 years for men and 87.3 years for women — topping global rankings.  Skyscrapers for as far as you can see, people walking toward you from all angles on densely packed streets, lights flashing almost everywhere and a subway that typically gets you where you want to go in under 30 minutes.

This is life with more than 7 million people living on a little over 420 square miles of land.

It’s the urban oasis of Hong Kong – that’s right, oasis.

People go about their daily routines in Causeway Bay, Hong Kong.

Meera Senthilingam/CNN

Dotted consistently through the more than 300 skyscrapers that tower over Hong Kong are well-used and -serviced city parks, quality hospitals accessible to all and restaurants filled with local cuisine that’s much healthier than its reputation suggests. Just a few miles away, there are mountains for hiking and beaches for swimming or surfing.

On Sunday afternoons, large families fill the streets, venturing out together for their weekly dim sum.

The result is a healthy, long-lived population boasting the highest life expectancy in the world.

Narrowly beating residents of Japan and other “blue zones” such as Italy, men in Hong Kong are living, on average, up to 81.3 years and women even longer, 87.3 years, as of 2016. “Over the last few decades, (Hong Kong) has caught up in a big way,” said Dr. Timothy Kwok, professor of geriatric medicine at the Chinese University of Hong Kong.

Dr. Gabriel Leung, dean of the faculty of medicine at Hong Kong University, noted that “we inched past Japan about five years ago. It’s not a position that we’ve found ourselves in for decades.”

As Hong Kong is not a country, it is not included in the Global AgeWatch Index,a measure of social and economic well-being in 96 countries, developed by HelpAge International. But Kwok’s research team used the same criteria as the index, combined with other factors, to reveal just what’s helping the population live longer.

It begins with their environment.

Easy access to everything

According to Kwok’s research, “Hong Kong ranks first for enabling environments,” he said. “That may explain our longevity.”

The streets are safe, and there is easy access to public transport, healthy food and public amenities, “enabling” people to live a healthier lifestyle.

People board one of many buses that serve them regularly in Hong Kong. 

Meera Senthilingam/CNN

The temptation to get in a car and drive is minimized by footbridges and elevators that provide easier access to walking routes and affordable taxis and public transportation: A ride on the clean, air-conditioned metro starts at just 60 US cents.

“You can easily walk to your nearest shops or shopping center … to what you need,” Kwok said. “Older people especially don’t go to the supermarket; they go to open markets.”

Hong Kong Park, located in the central region of Hong Kong.Meera Senthilingam/CNN

‘Greener than most’

“We are greener than most cities,” Kwok said, adding that in many green spaces, it’s common to see groups of elderly people doing tai chi or qi gong calisthenics in the early hours, after which they spend time together to share meals and converse.

“Tai chi morning exercises are very popular and play a role,” Leung said, but his team is studying just how big a role these factors play in life expectancy.

“We need to be designing urban spaces to facilitate that kind of activity,” said Dr. John Beard, director of the department of aging and life course at the World Health Organization.

Almost all the districts of Hong Kong are members of the WHO global network of age-friendly cities, which encourages the creation of urban spaces supportive of older people, Beard said. This includes positive images of older people, active leisure and programs for spiritual well-being.

The government also ran an initiative in which older people were invited to go around and identify problems with footpaths and other barriers to mobility, after which officials took note of the issues and addressed them in their plans, he explained.

People board one of many buses that serve them regularly in Hong Kong.

Meera Senthilingam/CNN

Good hospitals – for everyone

“Anyone can get to hospital,” Kwok said, adding that Hong Kong has universal health care for hospital treatment but not quite universal for primary care.

“The negative is that people go to (the emergency room) far too often,” he said. However, older people generally do not pay for primary care and get priority.

“When you’re sick, really sick and need to be hospitalized, it’s free at the point of care, paid for by taxation,” Leung said. “Nobody would be denied adequate medical care due to lack of means.”

Beard agreed that accessible health care contributes to longevity, as fewer people might die from conditions that would otherwise have killed them.

“It’s important that access is for everybody, not just the rich,” Beard said. “That’s when the average life expectancy will increase, as you won’t have those people at the bottom who influence the average in a negative way.”

Leung stressed that good healthcare in the earlier years of life, not just the later ones, is just as important when determining life expectancy.

This means maternal, neonatal and childhood care to prevent childhood diseases as well as efforts to prevent “the big killers” of middle age such as cancer, heart disease and stroke, he said. “These two drivers determine a population’s life expectancy at birth.”

A determined population

Leung estimates that 70% of Hong Kong residents over the age of 70 were born in mainland China and came over in search of better opportunities.

“A lot of them came as economic migrants … and were almost triathletes,” he said. “They climbed, they ran, and they swam.” Migrants also need to be psychologically fitter than their peers to have the motivation to uproot their lives.

“Physically, you need to be fit to endure the journey,” he said. “These are the people who are meant to be at the highest risk of dying now, at the rate of their peers back in their village, but they’re not dying.”

This survival advantage, combined with improved childhood health care, is what Leung believes drove Hong Kong’s “life expectancy miracle.”

Good weather

Kwok also believes that Hong Kong is well-positioned geographically, with a subtropical climate that has a part to play. “It’s not too hot and not too cold,” making life easier and more comfortable, he said.

In countries such as the UK, there are more deaths during the winter months: For example, there were an estimated 34,300 excess deaths during the winter of 2016-17. In the US, there were an estimated 108,500 excess winter deaths in 2008.

However, other parts of the world renowned for their healthy elderly populations have cooler or scorching environments at times, said Leung, who believes that this factor has less of a role in longevity.

“Japan has a very different climate than Hong Kong, and Singapore has a very different climate to Japan,” Leung said. “We are subtropical, Singapore is tropical, and Japan is temperate. “These things play a role, but they can’t be the main driver.”

A take on the Mediterranean diet: Hong Kong’s Diet – Search Images

Another geographical benefit is “access to good food,” Kwok said.

Hong Kong’s position as both a marine and land gateway to China and other parts of Asia enables greater access to fresh fish, fruit and vegetables, he said. Combined with a cuisine that includes them in most dishes, the population as a whole eats well.

“We studied the Chinese diet, and it’s quite similar to the Mediterranean diet,” he said, with meals often consisting of fish, fruits and vegetables, rice, nut oils for cooking and meat chopped up into dishes rather than eaten as whole portions.

“We mix it up,” he said.

The Hong Kong diet is known for its emphasis on stir fries that provide a great balance of high-fiber carbohydrates, brightly colored vegetables and healthy proteins like fish, tofu, or chicken1. Hong Kong is surrounded by ocean and land, which enables greater access to fish, fruits, and vegetables, which are found in the local cuisine2. Rice, nut oils, and a combination of meat and vegetables provide whole diets2.

Beard said, however, that when highlighting factors such as diet – whether in Hong Kong, the Mediterranean or Japan – it’s important to note that people have always eaten this way. “So why are they living longer now?” he asked. “There were probably also reduced stressors.”

The value of family

The close familial networks of Asian cultures in general is well-known, providing both financial and social support as people get older.

“Older people tend to have a lot of children,” Kwok said. But with decreasing family sizes and China still recovering from a one-child policy, that is likely to change for the next generation of older people. “Baby boomers had fewer children.”

Beard adds, however, that the Asian philosophy of filial piety – a virtue of respect for one’s parents, elders and ancestors – is pivotal to the happiness seen in older age, both physical and psychological.

“Older people are genuinely respected, and younger members of the family put an emphasis on ensuring the well-being of older members of the family.” said Beard.

“Confucian culture,” said Leung. “But we shouldn’t talk this up.”

He highlights Tokyo, Hong Kong and Singapore as some of the most densely packed places on Earth, where “it’s hard to fit a two-, three-generation family in the same household.”

However, Beard believes people are adapting. “The mechanisms are now changing, but there are innovative ways people are exploring, such as video connections and cash transfers, to enable this filial piety to continue,” he said.

Still room to improve

The experts agree that a country ranking at the topfor life expectancy does not mean there’s no room for improvement – far from it.

The Global AgeWatch Index also explored social care elements, such as mental health and income security, which Kwok believes is not Hong Kong’s strong point when it comes to the elderly.

“Participation in civil society is not as strong as Western countries,” he said, citing employment and volunteering among older people and highlighting that mental health is not prioritized as part of health care, with people often waiting years for a referral to a specialist.

Suicide rates in Hong Kong are highest among people over the age of 65. Of 937 suicides recorded in 2014, 241 were by people over that age, according to the HKJC Centre for Suicide Research and Prevention at Hong Kong University.

It’s also estimated that one in three elderly people there has depressive symptoms.

“We want people to live happily for longer, not just live,” he said.

Kwok highlighted that Hong Kong does not have a government pension system, with people instead relying on their children. “We do badly in income security,” he said.

Leung agreed: “There is a lot of work we should do to make sure these people live healthily and happily.”

Temporarily at the top?

Most changes at the top of the longevity listare marginal, Beard said. Japan and Hong Kong “are … world leaders, along with Germany, Italy and Australia.”

Leung agrees. “It is not a given that life expectancy only goes up,” he said, highlighting the United States, where life expectancy has fallen in recent years.

Changing diets and pollution are likely to affect patterns seen in recent years, Beard said. “Diets are not as healthy as they have previously been … and we need to do what we can to help people live longer, healthier lives. It’s never too late”

Leung’s study aims to determine the biggest factors driving high life expectancy in Hong Kong and just how big a role they play. The researchers are testing their core hypotheses that this is because of universal health care, improved childhood care, economic migration and reduced smoking rates among women compared with other parts of the world, resulting in fewer smoking-related diseases.

If these are found to be underlying factors, he hopes to use that information to inform policy measures to maintain a healthy, long-living population and keep Hong Kong at the top.

Sources:  

• Which is the Six Blue Zone in the World – Search
• Why Hong Kong has the longest life expectancy | CNN
• Hong Kong Beats The Six Blue Zones in Life Expectancy – Search
• Hong kongese eat more pork than anyone and live the longest – Search Videos
• I talked to 263 of the world’s longest-living people—their 9 ‘non-negotiables’ for a long, happy life
• Hong Kong has the highest life expectancy in the world – what is the secret behind it? – Search
• 101-year-old says she’s living the best years of her life: 8 rules I live by—don’t believe you’re ever ‘done’
• Australians outlive Americans by up to 5 years, study finds. Here are 5 things we can learn from them.