The commentary "People in Hong Kong Have the Longest Life Expectancy in the World: Some Possible Explanations" written by Prof. Roger Yat-Nork CHUNG and Prof. Sir Michael MARMOT has been selected as “Top 10 Most Read Perspectives of 2020” by National Academy of Medicine.
Key points are highlighted as follows:
The success of Hong Kong’s economic development must be considered an important factor in its success in achieving long life expectancy but factors other than the general population-level wealth are at play. It can be illustrated by comparison with the United States. The GDP for the United States per capita is higher than Hong Kong, but its life expectancy is more than 6 years lower.
As compared with the United Kingdom and the United States, Hong Kong consistently edges them out in terms of social indicators (e.g. youth involvement in education or employment) and health indicators (e.g. life expectancy and infant mortality rate). In particular, Hong Kong’s infant mortality rate is among the lowest in the world. These strongly indicate good quality health care and positive social conditions in Hong Kong. Other factors that have been hypothesized to contribute to health advantage include the geographical location with subtropical climate that does not give rise to frequent extreme weather; and the existence of a public health care system that does not deny people of adequate health care due to lack of means.
Life expectancy is calculated using current age-specific mortality rates of the particular year of interest. In Hong Kong, the majority of the older people migrated to Hong Kong during the post-WWII and Civil War period. Thus, they might tend to be healthy and resilient. Hong Kong adults below age 60 are also generally healthy and adult mortality rates for both sexes are among the lowest in the world (67/1,000 for men and 36/1,000 for women). There is probably no strong cohort effect that will upset the life expectancy of these future older generations.
However, studies have shown clearly that health inequality exists in Hong Kong. Disadvantaged and marginalized groups may face health inequity—including but not limited to ethnic minority, foreign domestic workers, people with long-term serious illness, and others. It can be explained by socioeconomic position (SEP) and low SEP are found to be linked to poorer health. Another study also found that lower neighborhood-level SEP predicted higher age-standardized mortality rates over the past few decades. We should be vigilant as to whether the inequality that currently exist in Hong Kong are storing up problems for the future and will affect the life expectancy of future generations of older people.