Call to raise awareness of obesity, diabetes among Hong Kong’s South Asian ethnic minorities, but cultural sensitivity urged
- Efforts to encourage change must recognise food preferences and different attitudes towards exercise in public, experts urge
- Minority groups miss out on health messaging as city’s public drives target majority in population
Hong Kong experts who found higher levels of obesity and related health problems among the city’s South Asian ethnic minority groups have called for targeted, culturally sensitive action to help them.
Former health minister Professor Yeoh Eng-kiong, who led the Chinese University study, suggested “slightly different” approaches to improve the health of ethnic minority group members, especially those from disadvantaged and poorer backgrounds.
He noted that much of the health information and advice put out by the government, the media and the medical sector catered to most of the population.
The issue was not only the language used, but also the cultural sensitivity of the messages, said Yeoh, director of the university’s Centre for Health Systems and Policy Research.
He said ethnic minority group members had different food and lifestyle preferences, and efforts to encourage them to make the healthiest choices had to take that into account.
For example, it would be pointless to advise people to eat a healthier type of rice when they ate some other staple food, he said.
“You ask me to eat rice three times a day, and multigrain rice, when I don’t eat rice,” he argued. “Obviously I’m just disengaged. I don’t even bother to look at it any more.”
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The study covered 790 adult Pakistanis, Nepalis and Indians, who were interviewed over a year from June 2022, and found that more than three in four were obese, with a body mass index of 25 or higher.
That was more than double the obesity rate of 32.6 per cent for Hong Kong’s general population, based on the Department of Health’s Population Health Survey done from 2020 to last year.
Even among younger South Asians aged 24 or below, nearly two-fifths were obese, compared with under a fifth of those in the same age in the general population.
The study found that 12 per cent of all respondents had diabetes, above the city’s overall rate of 8.5 per cent. Diabetes rates for different age groups ranged from 2 to 32.9 per cent, higher than the overall rates of 0.6 to 19 per cent.
The researchers found that a lower level of health literacy was among the reasons explaining the poorer health of ethnic minority groups.
The study was part of the Jockey Club SATH Project for Healthy Families, a three-year pilot scheme begun in 2021 to provide culturally appropriate health information for those from ethnic minority groups. SATH stands for “Sustainability for All, Together for Health”.
Four other NGOs are partners in the project.
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Hong Kong’s ethnic minority population, including foreign domestic helpers, grew by more than a third from 2011 to reach nearly 620,000 in 2021.
The research team tried new ways to provide dietary advice, taking into account how and what South Asians eat.
Instead of using the conventional food pyramid to explain healthy choices, it presented nutritional guidance in a circle to resemble a plate, which is more commonly used by the ethnic minority groups.
Among the recommended choices were whole wheat flatbread chapatis instead of white rice, and lentils and nuts. They were also advised to use less ghee, which is clarified butter used in Indian cooking.
Indian housewife Sheela Vaswani, 67, who has diabetes, said she was told by her dietitian to eat more boiled and steamed food.
“It’s not in my diet,” Vaswani said, adding that she decided to modify her recipes to leave out spices and oil when she cooked.
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Heidi Hung Hoi-yi, the project’s executive manager, said there were cultural sensitivities to consider even when encouraging people, especially Muslim women, to exercise more.
“We will never, never suggest that they go swimming, which we understand for some women, is not culturally appropriate,” she said.
Dr Saba Asim, a public health researcher at the university, said some Pakistani women also preferred not to exercise in a gym if men were present.
“It’s their cultural norm to prefer modesty and to [exercise alone],” said Asim, who is of Pakistani origin.
Asim said Pakistani women were among the most marginalised in Hong Kong, not least because the language barrier prevented them from communicating with healthcare professionals.
Their heavy domestic duties, set by traditional gender roles, such as household chores and childcare, also meant they did not have much time for their own health.
Research leader Yeoh said the team was developing a healthcare model tailored for serving ethnic minority groups better and it fit in with the government’s emphasis on primary healthcare.
He thought it would be useful for the government and district health centres to look at what his team had come up with.
The team hoped the model could be used at district health centres across the city before being extended to all primary healthcare providers.
