World Cancer Research Fund Hong Kong (WCRF HK)

Diet, Lifestyle and Cancer Prevention:

Getting the message across

Delegate Pack

Saturday 18 June 2005

JW Marriott, Hong Kong

Saturday 18 June 2005

Dear Delegate,
Welcome to World Cancer Research Fund Hong Kongs third annual conference for health
professionals.
For more than 20 years, members of the World Cancer Research Fund global network have been
committed to funding scientic research into the relationship between food, nutrition and cancer,
and to raising awareness that cancer risk can be reduced through healthy diet and lifestyle choices.
Our landmark expert report: Food, Nutrition and the Prevention of Cancer: a global perspective (1997)
remains the most authoritative and recognised report on the topic.
Nevertheless, we know that lifestyle changes are not always easy to achieve as they involve altering
habits that have built up over a period of time, often many years. Research and education alone are
not necessarily enough to trigger a change in behaviour. As well as presenting people with the facts,
we need to work with you, the health professional, to affect behavioural change at a community level.
Todays conference will bring together local and international speakers who will share with you their
experience of the psychology behind behavioural change; how foods work in our body to affect our
mind; advice on how to achieve behavioural change with your clients; as well as specic examples of
successful health promotion initiatives in the workplace, schools and wider community.
World Cancer Research Fund Hong Kong (WCRF HK) aims to facilitate lifestyle change here in Hong
Kong and around the world, but we can only do so successfully with your collaboration. Together we
can provide practical solutions to everyday lifestyle challenges faced by the general public. Together
we can work to help prevent cancer in Hong Kong.
We hope you enjoy the conference and look forward to working with you now and in the years to
come.

Marilyn Gentry
Chief Executive,
World Cancer Research Fund global network

Karen Sadler
Development Director, Asia

02

Diet, Lifestyle and Cancer Prevention - Getting the message across

Saturday 18th June 2005
Conference objectives
The objectives of this conference are to:
g

Share the experience and expertise of the World Cancer Research Fund global network as pioneers in cancer
prevention.

Examine the predicted trends in cancer incidence in Hong Kong and its related causes.

Work towards an understanding of the psychological basis of food choice and how it can be affected by social, cultural
and economic factors.

Outline the psychological factors for behaviour change looking closely at established approaches and techniques.

Investigate the effects of eating and drinking on mood, challenge common assumptions and show how recent research
is helping to reveal more about the relationships between our diet and our state of mind.

Illustrate how healthy lifestyle choices can be made more straightforward and appealing within the community.

Present the Department of Health plans for health promotion in the community with particular reference to primary
cancer prevention following the recent launch of the report produced by the Cancer Expert Working Group.

Educational Objectives
At the conclusion of this conference, delegates will have an understanding of:
g

The current and future direction of cancer prevention through diet and lifestyle factors.

The psychology behind behaviour change.

Key tools to help facilitate lifestyle change amongst clients, families and individuals.

Effective health promotion activities, which may be transferable to other communities.

Local and international initiatives, which have successfully applied health promotion activities in various settings.

Accreditation
The following organisations have awarded CME/CNE/CDE accreditation points to this conference:
HK College of Family Physicians (4 points)
HK College of Community Medicine (5 points)
HK College of Physicians (2 points)
MCHK CME Programme - Accredited by HKAM (5 points)
HK Dietitians Association (3.5 Core and 2 Non-Core points)
HK College of Nursing (3.5 points)
HK College of Paediatricians (5 points)

04

Conference ProgrammeSaturday 18th June 2005

10.00 11.00am

Registration and Refreshments

11.00 11.05am

Welcome and Conference Arrangements

Professor Tai-Hing Lam, Chair Professor and Head of Department of Community Medicine, the
University of Hong Kong. Chair, Cancer Expert Working Group, Department of Health

11.05 11.15am

Diet & Cancer Prevention Setting the Scene

Karen Sadler Development Director Asia, World Cancer Research Fund Hong Kong

11.15 11.30am

Predicted Trends in Cancer Incidence by 2020

Dr CK Law, Director of Hong Kong Cancer Registry. Chief of Service, Department of Clinical
Oncology, Queen Elizabeth Hospital, Hospital Authority, Hong Kong

Behavioural Change
11.30 12.15pm

Psychological Basis of Food Choice

Professor Peter Rogers, Department of Experimental Psychology, University of Bristol, UK

12.15 1.00pm

Facilitating Lifestyle Change What Works?

Dympna Pearson, State Registered Dietitian, DipADP, UK

1.00 2.15pm

Sit-down lunch (with guest lunchtime speaker)

Food and Mood Challenging Common Assumptions
Professor Peter Rogers

2.15 3.00pm

Health Promotion - Making Healthy Choices Easy, Early and ExcitingEverywhere

Dr Linda Milan, Director, Building Healthy Communities & Populations, WHO Western Pacic
Region, Philippines

3.00 3.30pm

Working Together for Change

Dr Ray Choy, Head of Central Health Education Unit, Hong Kong Department of Health

3.30 3.45pm

Nutrition Break
Case Studies Getting the message across
Examples of local and international health promotion initiatives in the workplace, schools
and wider community

3.45 4.05pm

The Healthy Exercise for All Campaign A Stair Climbing Programme

Dr Eliza Sha, Medical and Health Ofcer, Central Health Education Unit, Department of Health,
Hong Kong

4.05 4.25pm

Workplace Health Promotion Programme

Dr Yang Huang Koh, Manager, Workplace Health Promotion, Health Promotion Board, Singapore

4.25 4.45pm

Childhood Obesity - A Practical Approach

Dympna Pearson, State Registered Dietitian, DipADP, UK

4.45 5.00pm

Closing Remarks
Prof Tai-Hing Lam

06

Professor TH Lam, MD, FFPHM, FFOM, FHKCCM, FHKAM, FRCP

Chair Professor and Head of Department
DEPARTMENT OF COMMUNITY MEDICINE, UNIVERSITY OF HONG KONG

Chairmans Opening Remarks

Abstract
More and more people are becoming aware that most cancers are preventable. Unfortunately, such a
simple message has not yet been adequately delivered to all members of the public, and where it has
been delivered, it has sometimes been forgotten or even distorted.
Nowadays, many health care professionals are treating more cancer patients and they, along with the
media and members of the public, have the impression that cancer is increasing. The perceived increase
is largely due to: there being more people in the population; the population living longer; more sensitive
methods of diagnosis; earlier diagnosis; and, more surviving cancer patients. In Hong Kong, when
increasing population and ageing is controlled for, the age-standardised incidence and mortality of some
types of cancer have been decreasing in the past 10-20 years. However, this is largely due to a reduction
in smoking and other lifestyle changes.

The Report by the Expert Working Group on Cancer Prevention and Screening of the Government Cancer
Coordinating Committee was published by the Department of Health in early 2005. This report, like the
1997 World Cancer Research Fund Expert Report Food, Nutrition and the Prevention of Cancer: a global
perspective, contains detailed reviews of current literature and evidence-based recommendations for
cancer prevention.
The theme of todays conference Diet, Lifestyle and Cancer Prevention getting the message across, is
most relevant. It is extremely difcult for health professionals to get the cancer prevention message
across to their patients, and, more importantly, to actually change their behaviour. We are very fortunate
to have World Cancer Research Fund Hong Kong (WCRF HK) established here in Hong Kong, and today, to
have world-renowned experts to share their wealth of knowledge and experience on the subject of cancer
prevention and lifestyle change with us.
On behalf of all participants, I would like to thank World Cancer Research Fund Hong Kong and all the
speakers for their valuable contributions. On behalf of World Cancer Research Fund Hong Kong, I extend
our warmest welcome to you all.

Professor TH Lam

We have a long way to go, not only to get the right messages across to our patients, but to correct the
misleading messages too. Let us all work together, to prevent cancer here in Hong Kong and throughout
the world.

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CHAIRMANS OPENING REMARKS

Some cancers show a real increase in incidence, such as breast cancer, colorectal cancer and prostate
cancer, and the main reasons for the increase in the former two can be found in lifestyle factors, whereas
the increase in prostate cancer is mainly due to increase in screening. Unfortunately, there have been
many more advocates for early detection screening and early medical consultation for those who have
some symptoms of cancer than there has been for real primary prevention.

Karen Sadler
Development Director, Asia
WORLD CANCER RESEARCH FUND HONG KONG (WCRF HK)

Diet & Cancer Prevention Setting the Scene

This expert report had a powerful impact on cancer prevention and control. Governments and international
agencies around the world use it to shape public health policy. Indeed, the Cancer Expert Working Group,
under the HK Department of Health, cited this report as a major reference as it drafted cancer prevention
strategies for Hong Kong. And directly or indirectly, the expert report continues to guide communities,
families and individuals on all continents as they make choices about food, physical activity and weight
management that may save their lives.
In the same way that our diet affects our daily health, it also affects our long-term risk of developing
disease, such as cancer. Scientic research shows that up to 40% of cancers could be prevented through
healthy diet and lifestyle choices.
In order to make informed decisions about our health, we need not just the most recent or most highly
publicised studies, but the complete picture an objective, educated and independent view of all the
scientic literature. This is precisely the mission of the World Cancer Research Fund global network, and
locally, World Cancer Research Fund Hong Kong. We are committed to evaluating the evidence on nutrition
and cancer and to providing you with the results to enable you to work with your clients and help them to
make informed choices about reducing cancer risk.
Since 1997, a great deal of new evidence has accumulated and the World Cancer Research Fund global
network is currently working on the production of a second report, due to be published in 2007. The report
will review all the available science relating to cancer prevention. It will act as the most authoritative global
report ever to be published on the subject of food, nutrition, physical activity and the prevention of cancer
and will form the basis of the agenda for science in this area for years to come.
Biography
Karen Sadler is Development Director, Asia for World Cancer Research Fund Hong Kong and was
instrumental in setting up the charitys activities and programmes in 2002. Ms Sadler was a member of
the Cancer Expert Working Group (CEWG) on Cancer Prevention and Screening (the Working Group) which
was established under the Cancer Co-ordinating Committee chaired by the Secretary for Health, Welfare
and Food. The tasks of the Working Group included reviewing the local and international scientic evidence
of primary prevention and screening, formulating guidelines for cancer prevention and recommending
strategies for implementation.
Since joining the World Cancer Research Fund global network in 1997, Ms Sadler has worked for
the organisations UK charity; the networks strategic headquarters - World Cancer Research Fund
International; and, more recently, as the most senior member of staff at World Cancer Research Fund
Hong Kong. Her main areas of interest include developing health promotion programmes and activities
for cancer prevention; building collaborative links with like-minded organisations; and fundraising
management. Ms Sadler has gained a broad range of experience within the charity sector over the
past 15 years, the last ve of which have been within an international environment in the cancer
prevention arena.

Karen Sadler

DIET & CANCER PREVENTION SETTING THE SCENE

Abstract
This year, 10 million people worldwide will develop cancer, and the gure is expected to reach 15 million
by 2020. This global estimate is alarming, but much is being done to reverse this upward trend. Not least
among these achievements was the publication by the World Cancer Research Fund global network in
1997 of the Expert Report: Food, Nutrition and the Prevention of Cancer: a global perspective.

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Dr CK Law
Director of Hong Kong Cancer Registry, Chief of Service, Department of Clinical Oncology
QUEEN ELIZABETH HOSPITAL, HOSPITAL AUTHORITY, HONG KONG

Predicted Trends in Cancer Incidence by 2020

Based on the trends in the age-sex-specic incidence rates of different age groups from 1983 to 2002,
the cancer incidence in 2020 can be projected using the method of least square regression. Briey, the
extrapolated incidence rates were multiplied by the 2020 population estimate for the corresponding agesex groups to make the forecast.
Overall, it is predicted that an annual increase of 500 new cancer cases is expected in the next two
decades. The number will increase by 45% to over 31,000 by 2020 despite a steady decline in the
age-standardised rates in most cancers. Colorectal cancer will come rst, followed by lung, female
breast, prostate and liver. The biggest climbers will be lung, colorectum and prostate in men, and breast,
colorectum and ovary in women. Stomach, nasopharyngeal and cervical cancers are predicted to decline
steadily.
Most of the predicted increase is attributed to an ageing population. The population aged 60 or above
doubles every two decades: from half a million in 1981 to one million in 2001, and to nearly two million
in 2020. It accounts for 15% of the whole population in 2001, rising to 25% in 2020. As the rise is more
obvious in the female population, the gap in cancer incidence between the genders will decrease.
Another major cause of rising cancer incidence is diet. The Governments household survey has shown a
diet shift from one dominated by rice to one with increasing consumption of beef, pork and poultry. Meal
consumption and preparation patterns have also changed from home cooking to eating outside the home.
These observed changes in dietary lifestyle are usually characterised by a change to a more highly caloric
diet, rich in fat and animal protein. Combined with low physical activity, diet imbalance may result. This
could partly explain the rising trend in those cancers such as breast, colorectum and prostate that are
closely related to lifestyle inuences.
Assuming a genetically stable population, the changing patterns of cancers such as breast, colorectum
and prostate should reect changes in environmental factors such as diet or lifestyle. Modication of
these factors, public education and health policies such as anti-smoking, would be effective and benecial.
Biography
Dr Law graduated from the University of Hong Kong in 1981 and joined the Department of Clinical
Oncology, Queen Elizabeth Hospital in 1982 under Professor John HC Ho and Dr YF Poon. He obtained
his FRCR in 1987 and undertook general Clinical Oncology training in the UK in 1988. During 1994-95 he
received training in stereotatic radiotherapy under Dr Michael Brada at the Royal Marsden Hospital, UK and
Dr Jay Loefer at JCRT, Boston, USA; and in 3D conformal RT under Prof Mitsuyuki Abe in Kyoto, Japan. He
has been a Consultant since 1995 and became the Chief of Service in 2003.
Dr Law is also the Director of the Hong Kong Cancer Registry, Hospital Authority since 2004, Senior VicePresident of the Hong Kong College of Radiologists since 2004 and the President of Hong Kong Head
and Neck Society (2005-2006). He also took up honorary posts as Honorary Clinical Associate Professor
in the Department of Clinical Oncology, University of Hong Kong; and Honorary
Consultant in the Radiation Therapy Center of Kiang Wu Hospital, Macau.
Dr Law is active in patient education, being the Executive Council Member of the
Hong Kong Anti-Cancer Society.
Dr Law is an Honorary Advisor of the Tai Shan Charitable Association, Hong
Kong, and Cancer Patients Group in Macau. Dr Laws main interests lie in
intracavitary mould brachytherapy and IMRT for nasopharyngeal carcinoma,
radioiodine treatment for thyroid cancer and thyrotoxicosis, and chemotherapyradiotherapy as well as traditional Chinese medicine for lung and head & neck
cancers.

Dr CK Law

PREDICTED TRENDS IN CANCER INCIDENCE BY 2020

Abstract
Cancer has emerged as a major health problem. In 2002, about 12,000 men and 9,900 women were
diagnosed with cancer and 11,600 died from the disease in Hong Kong. The ve most common cancers
were lung, colorectum, female breast, liver and stomach.

10

Professor Peter Rogers

Department of Experimental Psychology
UNIVERSITY OF BRISTOL, UK

Abstract
There is no doubt that food choice and consumption are affected strongly by social, cultural and economic
factors. It is sometimes argued that these factors can override basic psychological and biological
inuences, but a more accurate view is that food choice (i.e. the foods that are selected and consumed
by an individual at a given point in time) is determined by an interaction of inuences. Economic, industrial
and socio-cultural settings provide opportunities and place constraints on food choice behaviour within
which psychobiological inuences operate. The latter inuences are the subject of this presentation. For
omnivorous species, such as ourselves, they are shaped by key biological priorities, including the need
to: (1) obtain sufcient food energy to meet requirements for maintenance, growth and activity, (2) obtain
sufcient quantities of the essential macronutrients and micronutrients, and (3) avoid ingesting harmful
substances. From this perspective the adaptive value of various, largely automatic inuences become
apparent. These include:
g
g
g
g
g
g
g

Neophobia (Ive never tried it, I dont like it).

Innate responses to basic tastes (e.g. liking for sweetness, rejection of bitter tastes).
Temporary shifts or alternation in preferences with eating (e.g. sensory-specic satiety).
Appetites reecting physiological need states, namely hunger and thirst (and salt appetite).
Learned preferences and aversions.
Effects of external, eating-related cues (learned specic appetites).
Physiological controls on appetite that are permissive to weight gain (and weight loss).

For example, strong and specic food aversions can develop when consumption of a food is followed
by nausea and vomiting. Such conditioned aversions are a dramatic example of how responses to food
can be modied according to the effects of the food on the body. They involve association of the smell,
taste and avour of the food with the after-effects of eating. Conversely, association of a taste or avour
paired with positive nutritional consequences can result in increased preference for that specic taste
or avour. A feature of these learned preferences and aversions is that they appear to involve, at least
in part, changes in liking (i.e. a change in hedonic/affective response to the taste, avour, etc. of the
food). In other words, there is a change in how good the food tastes to the individual corresponding to the
benet or harm resulting from earlier experiences of that food. The same process appears to be involved
in inuencing the development of preferences for drinks. For example, liking for caffeine containing drinks
such as tea and coffee is reinforced by the psychopharmacological consequences (changes in mood/
affective state) of caffeine ingestion. Similarly, liking for the taste of beer and cigarettes is probably
reinforced by the effects of alcohol and nicotine, respectively.
A consequence of these many inuences is that individual dietary habits tend to be self-perpetuating,
making dietary changes hard to achieve. Nevertheless, persistence with a change can be expected to reap
the benet of the eventual stamping in of the new habit, whether it be increased liking for healthier food
choices, avoidance of high fat snacks, or reduced meal size (or all of these!). At the same time, initiation
and maintenance of dietary change also requires appropriate knowledge, motivation and opportunity, and
short-term benets provide stronger motives for change than long-term benets. Interventions for effecting
dietary changes need to take into account fully these multiple inuences on food choice. A recent,
comprehensive review of such interventions and their effectiveness can be found at:
http://www.nutrition.org.uk/upload/Food%20Choice(2).pdf
Biography
After doing degrees in biology (BSc) and experimental psychology (MSc) at
the University of Sussex (1972-1976), Professor Rogers worked in teaching
and research at the Universities of Leeds and Manchester (1976-1990). He
completed a PhD on eating behaviour at the University of Leeds in 1983,
and between 1990 and 1998 was Head of Psychobiology in the Consumer
Sciences Department, Institute of Food Research, Reading. During part of his
last year with the Institute of Food Research he worked at CSIRO Division of
Human Nutrition, Adelaide, Australia. Professor Rogers joined the Department
of Experimental Psychology, University of Bristol as Senior Lecturer in 1999. He
was Head of Department during 2001 to 2004 and was promoted to Professor
of Biological Psychology in 2003. Professor Rogers is a Chartered Psychologist,
a Fellow of the British Psychological Society, and a Registered Nutritionist.

Professor Peter Rogers

PSYCHOLOGICAL BASIS OF FOOD CHOICE

Psychological Basis of Food Choice

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Dympna Pearson
State Registered Dietitian, DipADP
UK

Facilitating Lifestyle Change What Works?

This presentation will outline the key elements of a behavioural approach, as well as the evidence
to support its use. A behavioural approach relies heavily on the use of good interpersonal skills and
the health professionals possession of strong interpersonal skills has been identied as the single
most important factor in inuencing change. (Najavitis 1994, Miller & Rollnick 2002, Stewart 1995).
The acquisition and use of effective behaviour change skills raises a number of issues for healthcare
professionals.
Motivation is often viewed as the elusive magic ingredient required for successful lifestyle change.
This presentation will endeavour to unravel the complexity of this topic. Motivation is not an all or
nothing phenomenon it needs to be present throughout the change process.
Motivation needs to come from within the individual. It is not something we can do to people, although
it is inuenced by the helping style of the practitioner. It is not a set of techniques, neatly packaged, to
be delivered to the person who is trying to lose weight, like a dose of medicine.
Practitioners working with people to facilitate weight loss and maintenance need to be able to tap into
the individuals intrinsic motivation for change. This means using a behavioural approach, which is based
on a client-centered approach (Stewart et al 1995), through the use of skilful listening in a constructive
discussion about lifestyle change (Rollnick et al 1999).
Biography
Ms Pearson is a State Registered Dietitian with extensive experience of working in different clinical
settings and providing training for healthcare professionals
She has played a key role in developing Behaviour Change Skills training for healthcare professionals. This
training is geared towards brief interventions and focuses on the development of interpersonal skills as
well as the more advanced motivational and cognitive behavioural approaches. These courses run at a
national level and as in-house courses.
Ms Pearson has completed the Miller & Rollnick international Train the Trainers course on Motivational
Interviewing and is part of the motivational interviewing network of trainers. She has written a number of
articles for healthcare journals on facilitating health behaviour change. She has lectured extensively on
the subject, both in the UK and at international meetings.
Ms Pearsons interest in obesity management is reected in her recent work as Chair of Dietitians working
in Obesity Management (UK) [DOM (UK)], a board member of the National Obesity Forum (NOF), and a
member of the editorial board of Obesity in Practice. She currently works as a Freelance Trainer and
Consultant Dietitian.

Dympna Pearson

FACILITATING LIFESTYLE CHANGE WHAT WORKS?

Abstract
The importance of psychological factors are increasingly recognised as paramount in setting the scene
for behaviour change (Brownell 1995) and it is well recognised that knowledge alone doesnt necessarily
lead to a change in behaviour (Glanz 1985, Shepherd 1987, Thomas 1994). Recent reviews have shown
that a combination of diet and exercise supported by behavioural therapy is likely to be more effective in
achieving lifestyle change (Thorogood 2001, HDA 2003).

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Reading List:
Motivational Interviewing Preparing People for Change (2002)
William Miller & Stephen Rollnick
Pub: The Guildford Press
ISBN: 1-57230-563-0
Health Behaviour Change: A Guide for Practitioners (1999)
Stephen Rollnick, Pip Mason & Chris Butler
Pub: Churchill Livingstone
ISBN: 0-443-05850-4

Changing Eating & Exercise Behaviour: A Handbook for Professionals (1996)

Paula Hunt & Melvyn Hillsdon
Pub: Blackwell Science
ISBN: 0-632-03927-2
Counselling Skills for Dietitians (1997)
Judy Gable
Pub: Blackwell Science
ISBN: 0-632-04261-3
Changing for Good (1994)
James Prochaska, John Norcross & Carlo DiClemente
Pub: Avon
ISBN: 0-380-72572-X

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FACILITATING LIFESTYLE CHANGE WHAT WORKS?

Patient-Centered Medicine Transforming the Clinical Method (1995)

Stewart, Brown, Weston, McWhinney, McWilliams, Freeman.
Pub: Sage
ISBN: 0-8039-5689-4

Lunchtime presentation:
Food and Mood Challenging Common Assumptions
Abstract
It is not hard to think of the effects of eating and drinking on mood a cup of strong coffee is alerting,
a large lunch can leave us feeling contented, relaxed and even sleepy, and eating chocolate may relieve
tension perhaps followed, for the dieter, by feelings of guilt. Some of these inuences are related to the
eaters attitudes towards particular foods (e.g. naughty but nice), whereas other effects are mediated
by oro-sensory, pre-digestive and post-absorptive actions of dietary constituents, such as carbohydrates,
amino acids, caffeine and alcohol. Nevertheless, mood and behaviour (and the brain) may be less
vulnerable to short-term variations in nutrient intake and status than is often assumed.
This presentation will use coffee (caffeine) and chocolate as case studies to show how recent research
is helping to reveal more about the relationships between diet and mood.

Professor Peter Rogers

LUNCHTIME PRESENTATION: FOOD AND MOOD CHALLENGING COMMON ASSUMPTIONS

Professor Peter Rogers

Department of Experimental Psychology
UNIVERSITY OF BRISTOL, UK

16

Dr Linda Milan
Director, Building Healthy Communities & Populations
WHO WESTERN PACIFIC REGION, PHILIPPINES

Abstract
A recent review estimated the current and projected burden for the top eight cancers in the Asian Pacic
Rim region. In 2000, the region had over 3 million new cancer cases, over 2 million cancer deaths, and
5.4 million people living with cancer. By 2050, it is estimated that the number of cases and deaths will
double.
Cancer, taken as a whole, leads the mortality league tables of the Western Pacic Region. As with other
chronic and non-communicable diseases (NCDs), cancer is growing at epidemic proportions. Closely
associated with lifestyle change, urbanisation, industrialisation and population ageing, these NCDs have
become a major challenge for the World Health Organization (WHO) in the Region.
The response to this epidemic links neatly with the strategic direction of promoting healthy lifestyles and
reducing risk factors to human health that arise from environmental, economic, social and behavioural
causes. Many of the programmes being advocated and supported by the WHO contribute to its efforts to
develop healthy communities and populations. These linkages are reviewed in this presentation.
The development of health promotion as a public health intervention, composed of a series of actions that
seek to foster conditions that allow populations to be healthy and to make healthy choices, has evolved
in recent years. In the Region, strategies for health promotion revolve around three main tracks: settings
(such as cities, schools and workplaces); risk factors (physical inactivity, smoking, unhealthy diet); and
populations of different ages (life cycle approach).
Making healthy choices easy, early and exciting everywhere emphasises the importance of healthy lifestyles
within the context of healthy supportive environments where healthy choices can be just as compelling
as unhealthy ones. Thus, health promotion involves the creation of environments that support healthy
choices, choices that:
g
g
g

should be made early in the life course and maintained through life;
should be easy to adopt because they are accessible and affordable;
should be everywhere in the environment, in all the settings where people live, work, learn and play.

Cancer prevention requires much environmental support, and it can be an important component of
developing healthy workplaces. A healthy workplace is a place where everyone works together to achieve
an agreed vision for the health and well-being of workers and the surrounding community. Such workplaces
would have at least the following components. They are listed here with examples of cancer prevention
programmes that could be integrated:
1. Workplace Policies: Would ensure that non-smoking is the norm and remove exposure to environmental
tobacco smoke.
2. Lifestyles and Personal Health Skills: Workplace canteens would provide ample fruits and vegetables.
Work schedules and environments would facilitate and enhance physical activity. Weight maintenance
and smoking cessation would be important general measures, but also training in personal safety
measures would be important.
3. Physical Environment: Compliance with national standards and regulatory requirement is enforced.
Occupational particulates would be minimised or eliminated.
4. Health Services: An occupational health and safety programme would
remove all carcinogenic hazards and minimise exposure and risk of
accidents. A workplace health service would provide opportunity for
screening for cervical cancer and for breast cancer. An enlightened
occupational health might, where appropriate, support screening for
colon and rectal cancer.
Dr Linda Milan

HEALTH PROMOTION MAKING HEALTHY CHOICES EASIER,

EARLY AND EXCITINGEVERYWHERE

Health Promotion Making Healthy Choices Easier,

Early and ExcitingEverywhere

18

Biography
Dr Linda Milan is the Director of the Division of Building Healthy Communities and Populations (DHP),
World Health Organization Regional Ofce for the Western Pacic (WPRO). The Division facilitates the
sustainable development of healthy communities and populations by promoting healthy environments
and reducing the impact of diseases; and encouraging healthy lifestyles to prevent disease and disability
through integrated intersectoral approaches that recognise and stress the links between development, the
environment and health. The work of the Division covers a broad range of WHOs programmes in the areas
of the environment, health promotion, non-communicable diseases, mental health, reproductive health,
child and adolescent health and development, nutrition and food safety, and tobacco.

Before joining WHO in 1995, Dr Milan was Acting Undersecretary (or Vice Minister) of Health for
Management Services at the Department of Health, Philippines. She was Assistant Secretary of Health
for International Health and External Relations and was responsible for promoting, coordinating, and
facilitating multilateral and bilateral programmes of the Department of Health.
From 1988 to 1995, she was actively involved in the work of WHO, a member of the Philippine delegation
to both the Regional Committee and the World Health Assembly, and was a member of the Executive Board
of WHO from 1993 to 1994.
Dr Milan is a graduate of medicine at the University of the East Ramon Magsaysay Memorial Medical
Center. She obtained her Masters of Public Health degree at the UP College of Public Health. She studied
international health (MCH) at the Graduate School in Public Health, San Diego State University, USA, and
epidemiology (Public Health Administration) at the Ben Gurion University, Israel.

19

HEALTH PROMOTION MAKING HEALTHY CHOICES EASIER,

EARLY AND EXCITING...EVERYWHERE

Dr Milan also served as Acting WHO Representative in the Philippines, in a concurrent capacity, from
September 1998 to August 2002; and from March 1996 to May 1999, as the Regional Adviser in
Occupational Health in charge of the programmes on occupational health, ageing and health, rehabilitation
and prevention of blindness and deafness.

Dr Ray Choy
Head of Central Health Education Unit
HONG KONG DEPARTMENT OF HEALTH, HONG KONG

Working Together for Change

Physical activity, nutrition and tobacco control are priority action areas for the CHEU. The presentation will
briey discuss the multi-media health promotion activities of these priority areas highlighting intersectoral
collaboration within and beyond the DH. The CHEU strives to work together with the government and the
public sector, the academia, non-governmental organisations, professional bodies, the private sector and
members of the community to achieve the desired goals.
Biography
Dr Choy is currently the Head of Central Health Education Unit, Department of Health. His research
interests include health promotion, cultural and social determinants of health, mental health, migration
studies and developmental disabilities.

Dr Ray Choy

WORKING TOGETHER FOR CHANGE

Abstract
The aim of this presentation is to give an overview on how the Department of Health (DH), HKSAR,
is committed to supporting health promotion in the community, with particular reference to primary
prevention of cancer. It will introduce the policy of the DH, and the background of the newly-established
Centre for Health Protection (CHP). As a health promotion unit of the CHP, the Central Health Education
Unit (CHEU) plays a vital role in formulating a health promotion strategy and organising health promotion
programmes and campaigns for prevention of communicable and non-communicable diseases in Hong
Kong.

20

OF

HEALTH, HONG KONG

Case Study: The Healthy Exercise for All Campaign A Stair

Climbing Programme
Abstract
The mortality and morbidity of many major chronic diseases in the world are attributable to physical
inactivity. However, about 60% of the worlds population lacks sufcient physical activity to keep
themselves healthy. In Hong Kong, we are facing the same problem. The Healthy Living Survey conducted
in 1999 showed that less than half of the respondents had done some form of exercise within the month
before the survey was carried out. Most of the respondents cited that work commitment and lack of time
were their major barriers to doing exercise. To tackle these factors, we launched a pilot programme to
promote stair use in 36 public housing blocks in 2003. Three activities were implemented in the estates,
including the display of posters and stickers in the staircases and elevators of the blocks, the distribution
of health education materials to the households, and the organisation of promotional activities near the
selected blocks.
An evaluation, composed of an observational study and a survey, was conducted between November 2003
and January 2004. Data was collected in Three phases, namely the pre-intervention phase (three weeks
before the programme), the post-intervention phase One (one day after its implementation) and the postintervention phase Two (three weeks after its implementation). Twelve blocks were evaluated; in which nine
blocks were the intervention group and three blocks were the control group.
At each phase, the number of pedestrians entering the block, leaving the block and using the stairs were
counted in the observational study. Children, people with physical disabilities, or people carrying large
luggage and their companions were excluded from data analysis. The percentage of pedestrians using the
stairs in the block during the observation period, were computed accordingly. Questionnaires were mailed
to all households of the blocks to assess the knowledge, attitudes and behaviour of the residents on
stair climbing/physical activity. Their perceived enabling and disabling factors of stair climbing and their
comments on the programme were also explored.
In the observational study, 609,960 pedestrian counts were recorded. The programme effectively
increased stair utility by 20% in public housing estates at the intervals of one day and three weeks after
its implementation. Further analysis revealed that the stair utilities of the intervention group increased
signicantly across both genders, on different days of travel and directions of travel at the Post-intervention
Phase One.
As for the survey, 7,246 questionnaires were distributed at each phase. Though the response rate was
relatively low (9-10%), we received some qualitative feedback, which was valuable for us to improve our
programme in the future. Both environmental and personal factors were cited as the major enabling and
disabling factors for the respondents to use the stairs.
In view of the favourable results, we adopted a multisectoral approach to extend the programme in the
community. Firstly, we collaborated with the Hong Kong Housing Authority to implement the programme to
other suitable public housing blocks. We also put up the point-of-decision prompt in different settings of
government buildings, e.g. health centres, dental clinics, etc. Furthermore, we encouraged and supported
community groups, including non-governmental organisations and property management companies, to
promote stair use in their own suitable settings. An information kit and a mini-website were produced for
this purpose.
Considering the limitations of the evaluation, we are conducting two studies to
assess the long-term effectiveness of the point-of-decision prompt intervention
in public housing estates and are exploring the possibility of extending the
programme to other public venues, e.g. libraries, sports centres, etc. It is hoped
that the programme will encourage more people to become physically active.

Dr Eliza Sha

THE HEALTHY EXERCISE FOR ALL CAMPAIGN A STAIR CLIMBING PROGRAMME

Dr Eliza Sha
Medical and Health Ofcer
CENTRAL HEALTH EDUCATION UNIT, DEPARTMENT

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At CHEU, she has the opportunities to acquire knowledge on various disciplines in health education,
including social marketing, research and evaluation, development of health education resources as well
as programme management. She was involved in the planning, implementation and evaluation of health
promotion projects, and her eld of interest is physical activity promotion.
Dr Sha is currently a member of the working group of the Healthy Exercise for All Campaign which is a
territory-wide campaign co-organised by the Department of Health and the Leisure and Cultural Services
Department and supported by the National Sport Associations as well as various professional bodies and
community groups.

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THE HEALTHY EXERCISE FOR ALL CAMPAIGN A STAIR CLIMBING PROGRAMME

Biography
Dr Eliza Sha graduated with a degree in medicine and surgery from the Chinese University of Hong Kong.
Upon completion of her internship in 1997, Dr Sha joined the Department of Health of the Hong Kong SAR
Government and served as a Medical and Health Ofcer in an outpatient clinic during her rst ve years of
service. She then joined the Central Health Education Unit (CHEU) of the Department of Health.

Case Study: Workplace Health Promotion Programme Diet & Physical Activity
Abstract
Singapore has a total population of 4.19 million and a local resident population of 3.44 million. The
population is ageing and the number of elderly aged 65 years and above comprises 7.7% of the total local
resident population. The median age of Singapores workforce has increased from 34.7 years in 1993 to
38.5 years in 2003. The proportion of the workforce aged 30 to 59 years has also increased from 64.8%
to 74.4% over the same period. The major causes of death in Singapore are cancer, heart disease and
cerebrovascular disease and they account for over 70% of all deaths among Singaporeans.
In Singapore, the Occupational Health and Safety Department under the Ministry of Manpower was
established in 1970 to prevent and control health hazards at workplaces and reduce the incidence of
occupational diseases. It was not until 1984 that workplaces began to take an interest in promoting the
health and well-being of their employees other than that required by legislation. A small team of one doctor
and two nurses was set up under the then Training & Health Education Department to oversee workplace
health promotion (WHP) in Singapore. Even then it was conned to activities such as talks and exhibitions.
Today, WHP in Singapore embraces a holistic and integrated approach, with the Health Promotion Board
(HPB) working with the Singapore National Employers Federation, Association of Small and Medium Sized
Enterprises, Singapore Sports Council and Food Caterers Association to achieve healthy employees in
healthy organisations.
With 64% of Singaporeans aged 18 to 65 years working and spending long hours at their workplace
(workers in Singapore spend a minimum of 8-10 hours at work everyday), it makes sense to promote the
physical, emotional and social well-being of our workers. With an annual programme expenditure budget of
S$1million, the HPB has implemented several key WHP initiatives over the years (note: budget excludes
mass media outreach, production of educational resources and manpower cost).
Key Initiatives
The prestigious Singapore H.E.A.L.T.H. (Helping Employees Achieve Life-Time Health) Award was started
in 1999 to give national recognition to companies with commendable WHP programmes. Starting this
year, the Award will introduce the Corporate Fitness and Corporate Nutrition Award which honours
companies with innovative and sustainable worksite exercise and healthy nutrition programmes that have
shown results.
Funding in the form of a matching WHP Grant is given to help companies jumpstart and sustain their
WHP programmes. The Grant ranges from S$5,000 to S$10,000 per project. Exercise classes, gym
membership, canteen food analysis and worksite nutrition programmes are fundable under this WHP Grant
Scheme.
HPB organises A.C.T.I.V.E. (All Companies Together In Various Exercises) Day for all companies. Every
year companies are encouraged to dedicate one day in September (which is our National Healthy Lifestyle
Campaign Month) to this national event where employees and their CEOs gather together to perform a
physical activity. Fitness instructors and T-Shirts are provided free to participating companies. Companies
are encouraged to use the services of HPBs list of approved food caterers for their corporate functions.
For those with canteens and staff cafeteria, HPB offers free training to help their chefs and cooks prepare
healthier food menus. Employees also have access to an on-line dietary practices survey.
They get immediate feedback on their eating habits, and receive regular on-line
health tips.
How do we get small and medium sized companies to adopt WHP? How do we
get real buy-in from top management? How do we get workers to participate in
WHP activities? How can we help companies sustain their programme year after
year? How do we justify continued funding for our national WHP programme?
These are but some of the challenges faced by WHP in Singapore.

Dr Yang Huang Koh

WORKPLACE HEALTH PROMOTION PROGRAMME - DIET & PHYSICAL ACTIVITY

Dr Yang Huang Koh

Manager, Workplace Health Promotion
HEALTH PROMOTION BOARD, SINGAPORE

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Biography
Dr Yang Huang Koh is currently the Manager of Workplace Health Promotion in the Health Promotion Board
of Singapore.

Her team has spearheaded several national strategies such as the prestigious Singapore H.E.A.L.T.H.
(Helping Employees Achieve Life-Time Health) Award, the Workplace Health Promotion Grant and the more
recent HealthPRO (Programme to Promote and Protect health). In addition, her department has introduced
extensive training for workplace health promotion facilitators ranging from seminars and forums to
intensive two and a half day workshops.
Dr Koh was instrumental in the content design and development of the `IN HEALTHY COMPANY package,
a highly successful self-learning programme. The package makes use of interactive classes, home
assignments, audiocassettes and videos to teach workers skills on how to practise healthy lifestyles.
Dr Koh has more than 15 years of experience in workplace health from both the government and private
sector. She spent ve years running a private workplace health promotion consultancy with the National
Healthcare Group. During that time she consulted for organisations such as UBS, Abacus International,
Pzer, Apple Computers and Singapore Police Force. She provides training, delivers motivational talks to
companies, designs corporate health education programmes and contributes papers and articles related
to health education and promotion. She also lectures to post-graduate students and teaches part-time at
the Singapore Institute of Management.

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WORKPLACE HEALTH PROMOTION PROGRAMME - DIET & PHYSICAL ACTIVITY

Her department is responsible for conceptualising and implementing national strategies and policies that
will encourage companies in Singapore to adopt workplace health promotion.

DIET AND HEALTH RECOMMENDATIONS FOR THE PREVENTION OF CANCER

Diet and Health Recommendations for the Prevention of Cancer

The following World Cancer Research Fund Hong Kong diet and health recommendations will help us to
balance the foods and drinks we consume each day and make simple lifestyle changes that will help
prevent cancer. The more of these recommendations we follow, the lower our overall cancer risk is likely to
be. Remember that cancer prevention is about getting the balance right. These should be seen as targets,
not rules
Note: The World Cancer Research Fund Hong Kong recommendations are global. Some local adaptations
have been made and are noted below the appropriate recommendation.
1.

Food supply and eating: Choose predominantly plant-based diets rich in a variety of vegetables and
fruits, pulses (legumes) and minimally processed, starchy staple foods.

2.

Maintaining body weight: Avoid being underweight or overweight and limit weight gain during
adulthood to less than 5kg (11 pounds).

3.

Maintaining physical activity: If occupational activity is low or moderate, take and hours brisk walk
or similar exercise daily, and also exercise vigorously for a total of at least one hour in a week.
If you are just starting out, try to get some moderate physical activity, at least 30 minutes daily.
Moderate activity could include activities such as brisk walking, cycling, gardening or dancing.

4.

Vegetables and fruits: Eat 400 800 grams (15 30 ounces) or ve or more portions (servings) a
day of a variety of vegetables and fruits, all year round.
In Hong Kong 400 800 grams is about 10 20 taels.

5.

Other plant foods: Eat 600 800 grams (20 30 ounces) or more than seven portions (servings)
a day of a variety of cereals (grains), pulses (legumes), roots, tubers and plantains. Prefer minimally
processed foods. Limit consumption of rened sugar.
Locally, 600 800 grams is roughly 15 20 taels. A medium sized bowl of rice in Hong Kong is typically
200 grams.

6.

Alcoholic drinks: Alcohol consumption is not recommended. If consumed at all, limit alcoholic drinks
to less than two drinks a day for men and one for women.
One drink is equal to 250ml (one small glass) of standard strength beer, a small glass of wine or
25ml (one measure) of spirits, or equivalent.

7.

Meat: If eaten at all, limit intake of red meat (for example beef) to less than 80 grams (3 ounces)
daily. It is preferable to choose sh or poultry in place of red meat.
In Hong Kong, 80 grams is the equivalent of 2 taels.

34

8.

Total fats and oils: Limit consumption of fatty foods, particularly those of animal origin. Choose
modest amounts of appropriate vegetable oils.

9.

Salt and salting: Limit consumption of salted foods and use of cooking and table salt. Use herbs and
spices to season food.
Also limit your consumption of Chinese sauces such as soy and oyster sauce. Try using garlic, ginger and
far jiu bak kok (peppercorn and star anise) to season foods instead.

10. Storage: Do not eat food which, as a result of prolonged storage at ambient temperatures, is liable to
fungal contamination.

11. Preservation: Use refrigeration and other appropriate methods to preserve perishable food as
purchased and at home.

12. Additives and residues: When levels of additives, contaminants and other residues are properly
regulated, their presence in food and drink is not known to be harmful. However, unregulated or
improper use can be a health hazard; this applies particularly to food supplies in economically
developing countries.

13. Preparation: Do not eat charred food. For meat and sh eaters, avoid burning of meat juices.
Consume the following only occasionally: meat and sh grilled (broiled) in direct ame; cured and
smoked meats.

14. Dietary supplements: For those who follow the recommendations presented here, dietary
supplements are probably unnecessary, and possibly unhelpful, for reducing cancer risk.
And always remember...
Do not smoke or use tobacco in any form.

35

DIET AND HEALTH RECOMMENDATIONS FOR THE PREVENTION OF CANCER

Fatty foods include fried and deep fried foods. Corn, sesame, sh and peanut oils are healthy
alternatives to animal fats.

World Cancer Research Fund Hong Kong

World Cancer Research Fund Hong Kong (WCRF HK)
is a registered charity dedicated to the prevention
of cancer by means of healthy food and nutrition,
physical activity and weight management.
Vision
To prevent cancer in Hong Kong and worldwide.
Mission
To raise awareness that the risk of cancer is
reduced by healthy food and nutrition, physical
activity and weight management.
To develop and strengthen scientic knowledge of
the relation of food and nutrition, physical activity
and weight management to cancer prevention.
Work
To encourage people to choose and enjoy healthy
diets and lifestyles.
To inform health professionals about the prevention
of cancer by means of healthy diets.
To support innovative scientic research into the
relationships between food, nutrition and cancer.
To ensure that diet and health recommendations
for reducing the risk of cancer are based on current
science.
To work with other organisations committed to
health promotion and prevention of disease.
World Cancer Research Fund Hong Kong (WCRF HK)
Room 1706
Beverly House
93-107 Lockhart Road
Wanchai, Hong Kong
Tel: (852) 2529 5025
Fax: (852) 2520 5202
Email: info-hk@wcrf.org
Website: www.wcrf-hk.org

Stopping cancer before it starts

World Cancer Research Fund Limited is the registered
company name of World Cancer Research Fund Hong Kong
(WCRF HK). Registration number: 596724
2005 World Cancer Research Fund

World Cancer Research Fund Hong Kong

Health Professional Conference 2006
Saturday 18th June 2005
Building upon the success of this years World Cancer Research
Fund Hong Kong health professional conference, plans are already
underway for our next conference in 2006.
To register your interest and to be kept informed of next years
conference, please send us an e-mail or visit our website at
www.wcrf-hk.org for more information.