To live well

Kathy KL Tsim 詹觀蘭

HK Pract 2025;47: 90-92

In the 2024 World Index of Healthcare Innovation, Hong Kong maintains its 16th place position from 2022. The region performs well in Fiscal Sustainability and Choice, ranking 16^th and 5^th respectively.¹ To live in such a vibrant affluent city is indeed a blessing but might also be very stressful on the wellbeing of its population. A recent research study conducted between 2023 and 2024, found that 21.9%, 20.7%, and 17.4% of the Hong Kong population reported symptoms of stress, anxiety, and depression, respectively.² How to cope with everyday stressors and achieve the 3 “wells” (to eat well, sleep well and live well) is part of the art of living especially within such a metropolitan city as ours.

Insomnia is often seen in our community and medication is often used by the busy laid person for a good night’s sleep as they need to perform at work the next day. This is the case with the lady in Dr. Chan’s case report.³ The use of zolpidem is common and more acceptable by our patients especially when they perceive that it is not a “dangerous drug” as it is not listed in the Dangerous Drug ordinance. It has the added benefit of reducing anxiety as can be seen with Dr’s patient who used in it for both insomnia as well as performance anxiety during her career. This is understandable especially since this drug is recommended as an adjunct medication for both conditions, barring for short term use. Her subsequent illness came about due to her unchecked use or in this case, her misuse of medication. manner.

Everything has their benefits but even the “good” things might be bad if taken to excess as in all things. Even the humble over-the-counter Panadol (acetaminophen), with prolong daily use within the recommended dose can result in medication overuse headache (MOH). Exercise is good to destress but if taken to extremes could lead to exercise addiction. “Eating well” can lead to overeating and hence obesity with its many medical complications, e.g. diabetes, metabolic dysfunction-associated steatotic liver disease.

Hong Kong is such a metropolitan city of global travel, we have a multicultural community. As we are now in the festive season with many of our residents returning from abroad and some ex-patriate family visitations, some of our family physicians might be faced with health issues “imported” into our care circle. Issues that we might be inexperience in dealing with in our daily medical practices.

As is the case pointed out by Dr. Wong on how one should care for a cannabis user who is pregnant.⁴ Even though cannabis is illegal both for medicinal and recreational use in Hong Kong, China and our near neighbours, Taiwan and Japan; its use in other countries that Hong Kongers favour, e.g. Australia, Canada and UK, its medicinal use is legal. How do we achieve the goal of caring for such a person so that she and her unborn child can “live well” is somewhat of a challenge.

When we connect the 3 wells together, we have a glimpse of wellness and health. The famous World Health Organisation (WHO) definition of health is: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. So good health can be further defined in terms of holistic health, not as perfect health.⁵

This holistic state of complete physical, mental, and social well-being, going beyond the mere absence of disease could be what one call “wellness”. It can be said to be an active, ongoing process of making conscientious decisive choices with the goal of achieving a successful and fulfilling high quality of life.⁶ Thus it encompasses multiple interconnected dimensions, such as physical, mental, emotional, and social health. The key is taking personal responsibility for one's own health, meaning person empowerment.

So instead of making extreme health choices e.g. setting unrealistic goals of weight loss or diet control, moderation in our daily lives and our personal health practices would be a more feasible approach for the longterm success of achieving a life of balance and virtue. The practice of moderation for health cannot be a formal, singular practice of all approach but rather an implicit principle embedded within the public health services for the population. In HK, our government along with the Department of Health has formulated life-course health promotional strategies and health management plans with the view for our public to adopt and embed in their daily health journey. This practice of avoiding extremes in behaviours and opinions is essential for the health of all persons. Determining what moderation looks like for a particular behaviour or position is difficult because what is moderate for one person may be excessive or too limiting for another due to individual circumstances.

In January 2025, the Department of Health released the Report of Health Behaviour Survey 2023 which reported on the major health-related behaviours and lifestyle practices of our Hong Kong general population.⁷ It reminded our public to adopt a healthy lifestyle, avoid extremes of health seeking behaviours and practices to reduce the risk of developing major noncommunicable diseases. This is not a new concept. Our HK government via our medical community has been promoting this even in 2008 with the “Change4Health” Strategic Framework. A government initiative promoting healthy living and addressing common risk factors of non-communicable diseases, namely physical inactivity, unhealthy diet, alcohol misuse and smoking as examples. Policies were set in place to promote health and prevent disease through a combination of health promotion, early detection, and quality disease management, rather than a single health moderation framework.⁸

More recently the Primary Healthcare Blueprint, (2024) emphasise these principles further with a shift of care towards prevention-focused, community-based care. The Primary Healthcare Commission is thus formed with the goal of promoting “life course preventive care plan" in the various District Health Centres (DHC)/DHC Expresses across the 18 districts of Hong Kong. Through the pairing of family physicians and allied healthcare teams the aim is to formulate and maintain a personalised preventive care plan for the persons in our society. The emphasises is on a sustainable balance of and avoidance of extremes in behaviour, while providing specific, quantifiable guidelines to help individuals manage their health risks effectively.

Hong Kongers are very effective in what we set their minds on doing. We are known for our flexibility in our way of dealing with various situations even when we area ploughing forwards all the time. So, for our population to be inspired to take a rethink on their health is a challenge that us family physicians are being equipped to do with the help of our government’s initiatives. This challenge is made no less difficult when we journeyed with the rest of the world through the grim COVID period of modern medical history.

During this period where it seemed that the majority of services were on the acute management of this pandemic, we also have unsung heroes who worked at the background aiming to improve our basic medical community care. Audits were still be performed as we can see from Dr. Leung’s article , making recommendations for improving care of the diabetic patients under his clinic’s long-term care.⁹ The day-to-day care of patients were not forgotten especially when we know that the life expectancy at birth in Hong Kong is much longer than most other countries.

This long-life expectancy is not something that one looks forward to if it is marred with a poor quality of health. As a recap, wellness and good health is not merely the absence of disease, but a state of complete physical, mental and social well-being. We as family physicians are privileged to be entrusted with the care of the persons in our community. With the resources that are available to us through the various government policies and strategies we in turn are a valuable resource for the empowerment of our patients with their everyday health journey. As we move on and look forward to another new year with new challenges let us not forget the lessons learned but make it a foundation to build a better way forward for the health of those we care and love in our community.

References

1. Gregg G & Avik Roy. FREOPP World Index of Healthcare Innovation. https://freopp.org/whitepapers/key-findings-from-the-2024-world-index-of-healthcareinnovation/ Accessed 8 November 2025
2. Tang CS, Chow TS, Lui WK, et al. Generational analyses of prevalence, relative risks and protective factors of anxiety and depression symptoms among adult Chinese in Hong Kong. J Affect Disord. 2026 Jan 15;393(Pt A):120359. doi: 10.1016/j.jad.2025.120359. Epub 2025 Oct 6. PMID: 41062032.
3. Chan S. Z-drug and benzodiazepine abuse and withdrawal- a case report. HK Pract 2025;47:105-107.
4. Wong CYJ. Cannabis abuse in pregnancy. HK Pract 2025;47:109-112.
5. Schramme T. Health as Complete Well-Being: The WHO Definition and Beyond. Public Health Ethics. 2023 Jul 27;16(3):210-218. doi: 10.1093/phe/phad017. PMID: 38333767; PMCID: PMC10849326.)
6. Stoewen DL. Dimensions of wellness: Change your habits, change your life. Can Vet J. 2017 Aug;58(8):861-862. PMID: 28761196; PMCID: PMC5508938.)
7. Non-communicable Disease Branch, Centre for Health Protection, Department of Health 2025: Department of Health Report of Health Behaviour Survey 2023. https://www.chp.gov.hk/files/pdf/dh_hbs_2023_report_eng.pdf (Accessed 12th November 2025)
8. Department of Health HKSAR. 2008. Promoting health in Hong Kong: A strategic framework for Prevention of Non-communicable disease. https://www.change4health.gov.hk/en/strategic_framework/structure/steering_committee/promoting_health/index.html (Accessed 11th November 2025)
9. Leung N, Luk MHM, Chao VKD. An audit on management of diabetic vascular complication risk factors in general outpatient clinic during the COVID-19 pandemic. HK Pract 2025;47:94-102.