ISE17/20-21

• Physical inactivity, or insufficient physical activity^{1Legend symbol denoting Physical activity is defined as any form of body movement that uses energy, including activities undertaken while working, commuting, doing housework, exercising, etc.}, is on the rise in many places. The World Health Organization ("WHO") has declared physical inactivity a global public health problem, suggesting that adults should engage in at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity, or an equivalent combination of both, every week.^{2Legend symbol denoting According to WHO's recommendations for people aged 18-64, moderate activities can take the form of brisk walking and doing housework, while examples of vigorous activity include running and fast cycling. See WHO (2020b) and (2020c).} This may include work-related activity, recreational activity and physical activity during commuting. A prime reason for growing concern is that physical inactivity is a risk factor for chronic, non-communicable diseases ("NCDs"). Being physically active can reduce the risk of NCDs such as breast and colon cancers by about 21%-25%, diabetes by 27% and ischaemic heart diseases by 30%.^{3Legend symbol denoting See WHO (2020a).}
• Like any modern cosmopolitan with efficient transport and the comforts of largely sedentary lifestyles, Hong Kong is not immune to physical inactivity. According to the Centre of Health Protection ("CHP"), about one-fifth of the population aged 15 or above reported sitting or reclining for 10 hours or longer every day.^{4Legend symbol denoting This excludes the time spent on sleeping. See CHP (2020).} The outbreak of Coronavirus Disease ("COVID-19") has reportedly exacerbated the problem, owing to closure of some sports facilities and cancellation of various sports events. Although the Government has endeavoured to tackle physical inactivity, some Legislative Council Members have suggested that there should be more government-led physical activity programmes in the community.^{5Legend symbol denoting There were at least two Council Questions about the issue being raised at the Council Meetings over the past few years. See GovHK (2017) and (2020a).}
• Globally, some places in Finland, Singapore, Taiwan and the United Kingdom ("UK") have scaled up efforts to promote physical activity, which might offer insights and lessons to Hong Kong. These examples include: (a) spicing up community-wide campaigns with digital innovation; (b) adopting a multi-sectoral approach to integrate physical activity into daily settings such as schools and/or workplaces; and (c) devising physical activity programmes in response to COVID-19. This issue of Essentials reviews the overseas approaches in the above places, following an overview of relevant initiatives in Hong Kong.

Addressing physical inactivity in Hong Kong

• To align with WHO's global action plan for the prevention of NCDs, Hong Kong launched the "Towards 2025: Strategy and Action Plan to Prevent and Control NCD in Hong Kong" in 2018. Nine local targets have been set, one of which is a 10% decrease in the prevalence of physical inactivity among youth and adults by 2025. The Government has scaled up measures to achieve this goal, with a focus on promotional activities and creating a facilitative environment for doing physical activity.
• To start with, the Government has raised public awareness about physical inactivity through the launch of media campaigns and "Lazy Lion" as the new mascot. It also organizes a variety of sports programmes for people of different ages, ranging from training courses to events such as the annual Sport for All Day, in addition to pledges to enhance existing sports facilities and improve walkability and bicycle-friendliness in parts of Hong Kong.^{6Legend symbol denoting Examples are the Government's plan to promote cycling in new towns or new development areas, and the "Walk in HK" initiative to build a pedestrian-friendly environment via improvement in city planning and design.} To encourage physical activity especially among schoolchildren, the Government has funded various sports programmes at schools^{7Legend symbol denoting These include a programme hiring retired athletes to promote sports in schools, as well as a scheme encouraging schools to hire out their facilities to external organizations for holding sports activities. In return, members of the school enjoy priority enrolment for a quarter of the programme spaces.}, apart from making physical education ("PE") lessons compulsory in primary and secondary schools.^{8Legend symbol denoting Hong Kong's school curriculum states that at least 5% of the total lesson time (i.e. about 80 minutes weekly) should be allocated for PE in primary and secondary levels. In 2017, WHO's recommendation (i.e. students aged five to 17 should have at least 60 minutes of moderate- to vigorous-intensity physical activity daily) was further included as a direction for the curriculum, although schools were allowed to make adjustments based on students’ learning needs. Some schools reportedly substituted PE lessons with tutorial classes and seminars. See Education Bureau (2017) and 青年創研庫(2016).}
• While such measures may take time to yield results, regular physical activity is far from a habit for some. According to CHP, in 2018-2019, about one in six adults (17%) aged 18 or above in Hong Kong had insufficient physical activity based on WHO's recommendation, up from 13% in 2014-2015.^{9Legend symbol denoting See CHP (2017) and (2020).} The situation for youth is no better than adults. More than 90% of primary and secondary students were found not meeting WHO's recommendation of having at least 60 minutes of moderate-to vigorous-intensity physical activity daily.^{10Legend symbol denoting See CHP (2018).}
• In sum, there remain barriers to promoting a physically active culture in Hong Kong. First, long working and studying hours are often considered a cause of blame for sedentary behaviour.^{11Legend symbol denoting In 2018, employees in Hong Kong worked 42 hours per week, more than some advanced economies including South Korea, Japan and the United States, except Singapore. For primary and secondary students, the average study time is about 50 hours for a five-day school week. See Legislative Council Secretariat (2018) and (2019).} The Government has therefore acknowledged the need for a multi-sectoral approach in collaboration with various stakeholders to further integrate physical activity into daily settings, especially in schools and workplaces.^{12Legend symbol denoting See CHP (2018).} Another barrier is the lure of electronic products in after-school/work life, which results in less time and desire for exercise.^{13Legend symbol denoting A local survey showed that respondents spent an average of 48 hours per week on using electronic devices for leisure, which was 44 times the amount of time spent on exercise. See Hong Kong Baptist University (2018).} Adding to the challenge are social distancing measures and sports event cancellations amid COVID-19 that might further discourage physical activity. Nonetheless, a Hong Kong Productivity Council survey has shown a rising interest in the use of new digital technology (e.g. wearable devices and fitness apps) to monitor activity levels.^{14Legend symbol denoting See Hong Kong Productivity Council (2020).} Hence, there are views that digital innovation alongside enhanced incentives may be better utilized to encourage physical activity^{15Legend symbol denoting Ibid and 星島日報(2018).}, even in times of the pandemic, as in the case of some overseas places.

Overseas experience in promoting physical activity

Digital innovation in community-wide campaigns

• Like Hong Kong, Singapore faces the problem of physical inactivity.^{16Legend symbol denoting In 2019, about 20% of Singapore residents aged 18 to 74 had insufficient physical activity based on WHO recommendation. See Health Promotion Board (2019).} Over the past decade, the Health Promotion Board ("HPB") of the Singaporean government has more than doubled the budget for health promotion and prevention programmes to S$275 million (HK$1.6 billion) in 2019.^{17Legend symbol denoting See Singapore Budget (2020).} A prominent programme is the government's novel approach to nudge the public towards a physically active lifestyle. Known as the "National Steps Challenge", the programme has run a 5-month challenge period every year since 2015, with the following features:
  
  

  (a)	It taps into digital innovation to engage the entire adult population including citizens and foreigners aged 17 or above. Registered users receive a fitness wristband for free, although they may also use their self-purchased wearable devices. After pairing up their preferred devices with the mobile app by HPB, participants can start tracking their steps and calorie expenditure;18Legend symbol denoting Non-smartphone users may still use the fitness wristband and sync their fitness records with the help of family or friends using the "sync for friends" function via the mobile app. See Singapore Ministry of Health (2020).
  (b)	The HPB has put in place an incentive system in collaboration with businesses and industries. As participants accumulate steps, they earn Healthpoints, which can be used to redeem e-vouchers for use at partner organizations including supermarkets, shopping malls and restaurants;19Legend symbol denoting Participants with daily step counts of 5 000-7 499, 7 500-9 999 and 10 000 or above can earn 10, 25 and 40 Healthpoints, respectively. During each challenge period, up to S$35 (HK$200) in vouchers can be earned. Participants hitting 10 000 steps a day and other daily goals are also eligible for lucky draws and other bonus rewards. and
  (c)	The programme offers sub-challenge events to engage different groups in the community. These include inter-company and community challenges in which participants can take part with colleagues and neighbours to compete and earn points collectively, not just individually.

• Five seasons of the National Steps Challenge have been completed to date, with the lastest season ended in April 2020. This government-led programme has gained traction and popularity in Singapore. The fourth season in 2019 alone attracted 810 000 participants, a sixfold increase since the launch of the programme.^{20Legend symbol denoting See British Journal of Sports Medicine (2019).} The effects on physical activity level also seem to endure well beyond the programme. About two-thirds of the participants have reportedly continued to use the fitness wristband/app after the challenge period.^{21Legend symbol denoting See Smart Nation Singapore (2020).}

Multi-sectoral approach to integrate physical activity into daily settings

• In addition to organizing community-wide campaigns for all, some governments have introduced initiatives focused on targeted stakeholder groups, such as schools and businesses. Take Finland as an example. According to WHO, the Nordic state is ranked the most physically active country among 168 economies in the world.^{22Legend symbol denoting See Lancet Global Health (2018).} This may in part be attributed to the Finnish government's effort to promote physical activity from a young age and develop specific programmes for various phases of the life-course, including working adults.
• In Finnish schools, the government has implemented the "On the Move" programme to foster a physically active culture among students aged seven to 16. Schools joining the programme can make their own plans to promote physical activity in addition to compulsory PE lessons.^{23Legend symbol denoting See WHO (2015) and British Journal of Sports Medicine (2017).} These can include longer recess time to allow for physical activity and the use of physically active breaks and lessons^{24Legend symbol denoting Examples include doing star jumps while reciting multiplication table and adding movement (e.g. squats, running in place, etc.) to lessons.} to reduce sitting time. The "walking school bus" scheme has also been included as part of the programme, encouraging students to walk in groups to school along a designated route, accompanied by teachers and parent volunteers, instead of using transport. The "On the Move" programme is optional in nature and began as a pilot from 2010 to 2012, and has continued to run with positive results - nearly 90% of Finnish schools have been involved in the programme.^{25Legend symbol denoting See Schools on the Move (2020).}
• As for workplaces, Finland has used tax incentives to encourage the incorporation of physical activity into a workday. For example, it provides tax benefits for commuters using sustainable transport such as bicycles instead of using private cars.^{26Legend symbol denoting For instance, an employee cycling to work is subject to an annual tax deduction of €85 (HK$771) from his/her taxable income. Alternatively, if one drives to work in private car, the relevant expenses are not tax-deductible unless specific conditions apply (e.g. no public transport is available, walking distance to the nearest bus stop is at least three kilometres, etc.). See Verohallinto (Finnish Tax Administration) (2020).} Besides, the government has made employers' expenditure on sponsoring employees' sports and recreational activities tax deductible for up to €400 (HK$3,655) per staff every year.^{27Legend symbol denoting One way is for Finnish companies to enter into an agreement with a sports centre to pay for employees' self-selected sports activities. Employers may also issue vouchers worth up to €400 (HK$3,655) for an employee to use at a time and sports venue of his/her own choice.} Eligible physical activities can take many forms, including individual sports and those requiring rental of sports equipment and membership fees (e.g. gym).^{28Legend symbol denoting Eligible sports activities should be directly related to the employees' physical fitness and health, not someone else's (e.g. swimming class for a family member). The rental and/or membership fee should also be linked to the sports activity itself (e.g. paddle used in kayaking). See Verohallinto (2021).} Tax incentives are indeed more commonly used in Europe, probably because of their relatively higher tax rates. Yet this policy has motivated companies to help keep the workforce physically active. Finnish companies reportedly spend an average of €190 (HK$1,736) per year on an employee's physical activity.^{29Legend symbol denoting See World Economic Forum (2019).}
• Instead of using tax incentives, the UK has funded local projects to promote active travel^{30Legend symbol denoting Active travel means travelling by physically active means as opposed to more passive travel modes such as riding in motorised vehicles.} (e.g. walking and cycling) among the workforce. An example was the government's launch of a £60 million (HK$591 million) Access Fund to sponsor relevant behavioural change projects undertaken by local governments in partnership with non-profit organizations from 2017 to 2020.^{31Legend symbol denoting This fund forms part of the UK's strategy to make walking and cycling the default option for shorter journeys, or as part of a long journey, by 2040. See GovUK (2017).} For instance, with support from the Access Fund, Living Streets, a walking-promotion charity, has advised various employers how to embed a walking culture through small but rather innovative changes in the workplace, such as the use of lunchtime walking groups and walking meetings instead of traditional conference room chat.^{32Legend symbol denoting For example, Living Streets collaborated with a fashion chain by introducing a so-called travel clinic, where staff could get consultation on how to identify walking opportunities in their daily routine. Staff opting for active travel were also rewarded with a daily £1 (HK$10) travel voucher for use in the fashion chain's shops. These efforts have yielded some success. It is estimated that 30% of the fashion chain's 4 000 staff at the head office and some branches have adopted active travel options every day. See UK Department for Transport (2017).}

Physical activity initiatives in response to COVID-19

• Despite the above measures, the outbreak of COVID-19 has disrupted exercise routines and morale of some people. While the Hong Kong Government has created a series of exercise videos and online resources to promote home fitness during COVID-19^{33Legend symbol denoting For instance, the Sport for All Day in 2020 went online with the webcast of physical fitness videos on the day the event was held. See GovHK (2020b).}, the pandemic has caused several popular sports events to be cancelled or postponed, such as the Hong Kong Marathon and Hong Kong Cyclothon. Social distancing and temporary closures of sports venues have also resulted in fewer opportunities for physical activity, especially for people who are unable to exercise at home.
• As COVID-19 appeared to subdue in Taiwan, the government has encouraged the public to restart exercise routines with incentives. In July 2020, the Sports Administration under the Ministry of Education announced that it would allocate NT$2 billion (HK$553 million) to issue four million sports vouchers ("動滋券") for Taiwan citizens including their foreign spouses, by means of a lucky draw. These vouchers, worth NT$500 (HK$138) each, can be used to spend on sports-related activities, events and equipment from August 2020 to January 2021.^{34Legend symbol denoting See 臺灣教育部體育署：《國民體育季刊第203期第四十九卷第三期》，2020年.} While the amount may not be huge, this initiative has served the dual purpose of promoting physical activity and boosting the sporting economy hit hard by COVID-19 due to venue closures and event cancellations. As at end-December 2020, the vouchers have generated a transaction value of over NT$3.7 billion (HK$1 billion), involving some 7 000 participating businesses.^{35Legend symbol denoting See 臺灣教育部體育署：《運動產業紓困振興方案持續給力 拚經濟挺運動》，2020年.}
• Elsewhere, some places have supported the use of digital technology, especially virtual sports events, to rebuild the momentum for exercise amid COVID-19.^{36Legend symbol denoting Some examples are the Mt. Fuji International Marathon in Japan, Boston Marathon and other running challenges in the United States.} With the approval and support of London's authorities, the organizer of the London Marathon was able to launch its first virtual edition in October 2020. The event was divided into two tracks to avoid crowds. A small-scale elite race was held physically in an enclosed looped course in London without spectators. In the mass-participation race, participants had 24 hours to run a marathon distance from home or anywhere in the world and log their miles with aid of a mobile app developed by the organizer. The virtual race attracted some 45 000 participants from the UK and abroad^{37Legend symbol denoting See Virgin Money London Marathon (2020).}, a similar turnout as previous races.

Concluding remarks

• Physical inactivity is a mounting public health concern that has warranted growing government attention and intervention in some places. Singapore has reenergised traditional physical activity campaigns with the aid of digital innovation. Some places like Finland and the UK have adopted a multi-sectoral approach through collaboration with various stakeholder groups including schools, businesses and local charities to integrate physical activity into people's daily lives. While COVID-19 has affected exercise routines, some places have experimented with new approaches, from supporting virtual events to issuing sports vouchers, to revive public interest in physical activity. These overseas examples may offer inspirations and ideas for Hong Kong in its bid to create healthy, physically active society.

Prepared by Jennifer LO
Research Office
Information Services Division
Legislative Council Secretariat
2 February 2021