Demographic crisis: a poverty and health perspective

People are living longer but not necessarily healthier. Research points to early life stress and adversity as an important predictor to later-life chronic illness.

Photo credit: Chris Lusher


Hong Kong is facing an unprecedented demographic crisis as the ageing population continues to rise and fertility rate declines. Although the new demographic reality is a symbol of medical and scientific success against infectious and parasitic diseases, increased longevity now presents policymakers with a new set of challenges. The global shift in disease epidemiology shows that people are now living longer but not necessarily healthier. More and more evidence confirms that the rise of non-communicable diseases such as diabetes, heart disease, and cancer is threatening the sustainability of our current healthcare system and ultimately Hong Kong’s fiscal viability. Poor health negatively affects labour force participation and productivity, and for government, a reduction in tax revenue and increase in public spending.

Per 2013 government statistics, nearly 1.4 million people were living with chronic, non-communicable diseases, which constitutes nearly 20% of the population. What’s more concerning is that nearly 72% of those chronically ill, aged 15 and over, were economically inactive. There is an undeniable and critical link between poverty and health that needs be taken under consideration when developing public health and education policies.

Chronic diseases are merely a reflection of the cumulative effects of lifestyle and environment and are consequently preventable. Furthermore, as mentioned by the Department of Health’s report on Promoting Health in Hong Kong, “the resulting disease clusters are more common amongst the poor and socially disadvantaged.” Unfortunately, the current policy focus is reactive rather than proactive. The Elderly Commission and the Steering Committee on Population Policy’s emphasis is mainly on “the promotion of Healthy Ageing as a concept and practice,” rather than addressing the root causes of chronic diseases. According to the Hospital Authority’s figures, the hospitalisation rate of an individual aged 65 or above is 4 times higher than those below the age of 65 and continues to grow at an exponential rate as age progresses. Simply promoting healthy ageing isn’t going to cut it. It must be combined with policy addressing health from early childhood and through adulthood to reduce the prevalence of age-related illness.

Research shows that individuals with low-income are at a much greater risk of developing illness. As is stands today, 1.5 million Hong Kongers live in poverty and 40% of the population lives in subsidized housing. one in four children cannot afford to have three meals a day, and one in three seniors are unable to meet basic nutritional needs. “Socioeconomic status is the most powerful predictor of disease, disorder, injury and mortality we have,” says Tom Boyce, Managing Director and chief of Division of Developmental Medicine at University of California, San Francisco (UCSF).

A report by the American Academy of Pediatrics, among others, argues that chronic illness presented later in life should be understood as a developmental disorder with roots in childhood exposure to poverty, discrimination and maltreatment. Numerous studies confirm that early exposure to stress and adversity has an impact on several systems in the body, prevents the brain from developing at an optimal level and produces dangerous levels of the cortisol hormone for extended periods of time. “Cortisol basically shuts down functions you don’t need in a moment of extreme stress, like reproduction or digestion,” Nancy Adler, PhD, director of UCSF’s Center for Health and Community. Constant exposure to early stress can permanently throw off the endocrine system putting these individuals at higher risk of developing cardiovascular and autoimmune diseases. These issues are further reinforced by the cyclical nature of poverty and poor health spanning across generations. In the medical community, there is emerging evidence that effects of poverty-related stress begin to manifest in the gestation period. Furthermore, the poor face the double-burden of increased frequency of illness and less resources to address medical concerns when they arise.

As Hong Kong’s ageing population continues to grow, and the prevalence of noncommunicable diseases increases, the impact of poverty on population health needs to be more closely addressed. A comprehensive strategy that tackles the link between early life adversity and later life health will have long-yielding effects on fiscal viability of Hong Kong’s healthcare system and a positive impact on a dwindling labour force. With the impending demographic nightmare Hong Kong is facing, addressing poverty can no longer be relegated to matters of the political left; it has become an economic necessity.

Contributing Authors

Shahnaz Mouhamou

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