World Cancer Research Fund Hong Kong (WCRF HK)

Diet, Lifestyle and Cancer Prevention:Getting the message across

Delegate PackSaturday 18 June 2005JW 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 Karen SadlerChief Executive, Development Director, AsiaWorld Cancer Research Fund global network

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Diet, Lifestyle and Cancer Prevention - Getting the message acrossSaturday 18th June 2005

Conference objectivesThe 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.

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

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

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

g 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.

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

g 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 ObjectivesAt 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.

g The psychology behind behaviour change.

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

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

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

AccreditationThe 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)

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Conference ProgrammeSaturday 18th June 2005

10.00 11.00am Registration and Refreshments

11.00 11.05am Welcome and Conference ArrangementsProfessor 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 SceneKaren Sadler Development Director Asia, World Cancer Research Fund Hong Kong

11.15 11.30am Predicted Trends in Cancer Incidence by 2020Dr CK Law, Director of Hong Kong Cancer Registry. Chief of Service, Department of Clinical Oncology, Queen Elizabeth Hospital, Hospital Authority, Hong Kong

11.30 12.15pm

Behavioural Change

Psychological Basis of Food ChoiceProfessor 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 AssumptionsProfessor Peter Rogers

2.15 3.00pm Health Promotion - Making Healthy Choices Easy, Early and ExcitingEverywhereDr Linda Milan, Director, Building Healthy Communities & Populations, WHO Western Pacic Region, Philippines

3.00 3.30pm Working Together for ChangeDr Ray Choy, Head of Central Health Education Unit, Hong Kong Department of Health

3.30 3.45pm Nutrition Break

3.45 4.05pm

4.05 4.25pm

4.25 4.45pm

Case Studies Getting the message acrossExamples of local and international health promotion initiatives in the workplace, schools and wider community

The Healthy Exercise for All Campaign A Stair Climbing ProgrammeDr Eliza Sha, Medical and Health Ofcer, Central Health Education Unit, Department of Health, Hong Kong

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

Childhood Obesity - A Practical ApproachDympna Pearson, State Registered Dietitian, DipADP, UK

4.45 5.00pm Closing RemarksProf Tai-Hing Lam

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Karen SadlerDevelopment Director, AsiaWORLD CANCER RESEARCH FUND HONG KONG (WCRF HK)

Diet & Cancer Prevention Setting the Scene

AbstractThis 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.

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.

BiographyKaren 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.

Professor TH Lam, MD, FFPHM, FFOM, FHKCCM, FHKAM, FRCPChair Professor and Head of DepartmentDEPARTMENT OF COMMUNITY MEDICINE, UNIVERSITY OF HONG KONG

Chairmans Opening Remarks

AbstractMore 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.

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.

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.

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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Karen SadlerDevelopment Director, AsiaWORLD CANCER RESEARCH FUND HONG KONG (WCRF HK)

Diet & Cancer Prevention Setting the Scene

AbstractThis 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.

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.

BiographyKaren 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.

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Dr CK LawDirector of Hong Kong Cancer Registry, Chief of Service, Department of Clinical OncologyQUEEN ELIZABETH HOSPITAL, HOSPITAL AUTHORITY, HONG KONG

Predicted Trends in Cancer Incidence by 2020

AbstractCancer 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.

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 age-sex 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.

BiographyDr 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 Vice-President 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 chemotherapy-radiotherapy as well as traditional Chinese medicine for lung and head & neck cancers.

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Professor Peter RogersDepartment of Experimental PsychologyUNIVERSITY OF BRISTOL, UK

Psychological Basis of Food Choice

AbstractThere 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 Neophobia (Ive never tried it, I dont like it). g Innate responses to basic tastes (e.g. liking for sweetness, rejection of bitter tastes). g Temporary shifts or alternation in preferences with eating (e.g. sensory-specic satiety). g Appetites reecting physiological need states, namely hunger and thirst (and salt appetite).g Learned preferences and aversions.g Effects of external, eating-related cues (learned specic appetites).g 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

BiographyAfter 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.

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Dympna PearsonState Registered Dietitian, DipADPUK

Facilitating Lifestyle Change What Works?

AbstractThe 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).

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).

BiographyMs 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.

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Reading List:Motivational Interviewing Preparing People for Change (2002)William Miller & Stephen RollnickPub: The Guildford Press ISBN: 1-57230-563-0

Health Behaviour Change: A Guide for Practitioners (1999)Stephen Rollnick, Pip Mason & Chris ButlerPub: Churchill LivingstoneISBN: 0-443-05850-4

Patient-Centered Medicine Transforming the Clinical Method (1995)Stewart, Brown, Weston, McWhinney, McWilliams, Freeman.Pub: SageISBN: 0-8039-5689-4

Changing Eating & Exercise Behaviour: A Handbook for Professionals (1996)Paula Hunt & Melvyn HillsdonPub: Blackwell ScienceISBN: 0-632-03927-2

Counselling Skills for Dietitians (1997)Judy GablePub: Blackwell ScienceISBN: 0-632-04261-3

Changing for Good (1994)James Prochaska, John Norcross & Carlo DiClementePub: AvonISBN: 0-380-72572-X

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Professor Peter RogersDepartment of Experimental PsychologyUNIVERSITY OF BRISTOL, UK

Lunchtime presentation: Food and Mood Challenging Common Assumptions

AbstractIt 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.

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Dr Linda MilanDirector, Building Healthy Communities & PopulationsWHO WESTERN PACIFIC REGION, PHILIPPINES

Health Promotion Making Healthy Choices Easier, Early and ExcitingEverywhere

AbstractA 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 should be made early in the life course and maintained through life;g should be easy to adopt because they are accessible and affordable;g 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.

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BiographyDr 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.

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.

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.

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EDr Ray ChoyHead of Central Health Education UnitHONG KONG DEPARTMENT OF HEALTH, HONG KONG

Working Together for Change

AbstractThe 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.

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.

BiographyDr 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.

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EDr Eliza ShaMedical and Health OfcerCENTRAL HEALTH EDUCATION UNIT, DEPARTMENT OF HEALTH, HONG KONG

Case Study: The Healthy Exercise for All Campaign A Stair Climbing Programme

AbstractThe 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 post-intervention 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.

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BiographyDr 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.

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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YDr Yang Huang KohManager, Workplace Health PromotionHEALTH PROMOTION BOARD, SINGAPORE

Case Study: Workplace Health Promotion Programme - Diet & Physical Activity

AbstractSingapore 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.

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Dympna PearsonState Registered Dietitian, DipADPUK

Case Study: Childhood Obesity - A Practical Approach

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

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

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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ERDiet 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.

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

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

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.

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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 1706Beverly House93-107 Lockhart RoadWanchai, Hong Kong

Tel: (852) 2529 5025Fax: (852) 2520 5202Email: info-hk@wcrf.orgWebsite: www.wcrf-hk.org

World Cancer Research Fund Hong KongHealth Professional Conference 2006Saturday 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.

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