Hong Kong scored very poorly amongst almost all surveys conducted last year about the quality of life and the health of its citizens. Survey after survey depicted Hong Kong as an expensive, pollution-shrouded city of stressed-out, obese workaholics whose only recreation is shopping.

Reports showing that pollution in Hong Kong is worsening, and that shopping is the territory's number-one pastime came as no surprise to most people. Data highlighting that the physical and mental well-being of Hongkongers has deteriorated dramatically over the past decade, however, surprised many, but not those in the health industry who have been saying this for years.

"The overall health of people is not very good," said Dr Juliana Chan, associate professor in the department of medicine and therapeutics at the Chinese University of Hong Kong.

"There has been a rapid change of lifestyle over past 10 to 20 years. These include changes in how we eat, exercise, stress ... and I think all these factors added together are causing some hormonal changes which are giving rise to some silent conditions such as high blood pressure, heart disease and obesity."

Cancer, stroke and heart disease are the top three causes of death in Hong Kong. Some progress on preventing cancer and strokes is being made, but heart disease is becoming a losing a battle.

In 1981, the number of heart patients in Hong Kong stood at 4,383. That number more than doubled to 9,221 in 1991, and again in 1999, when the number stood at 19,698, according to statistics compiled by the Hospital Authority Statistical Report. Alarming as these figures are, what is more worrying is that the number of people in strikes in the 40 to 44-year-old band has tripled.

But in many cases people are unaware that they are at risk. Research by Hong Kong University found that 89 per cent of the 1,200 people who dropped dead in Hong Kong without warning had undiagnosed coronary heart disease.

An advisor of the Health InfoWorld, Dr Gary Ko, said overseas data have indicated that the incidence rate of a person having two or more high risk factors of heart diseases would be two to three times higher than that of a healthy person. These include being overweight, high cholesterol, hypertension and smoking.

A survey by the Hospital Authority's Health InfoWorld found that 40.4 per cent of people polled were over-weight. A total of 38.3 per cent of respondents had high cholesterol and 26.6 per cent suffered from hypertension.

As many as 20 per cent of respondents with two or more of these conditions will die or have a stroke or heart attack within 10 years time if they don't change their lifestyle.

"Most people in Hong Kong are not aware of their own health condition and also not health conscious as well as lacking in health knowledge in general," Dr Ko said. "This group of people that we polled are at a high productivity age -- the median age is 44.7 -- and are a cornerstone of Hong Kong's economy. Their illnesses would not only have a detrimental effect on themselves and their family, but also on the productivity of Hong Kong."

However, all these condition are reversible if people change their lifestyle to include eating a healthy diet and exercising regularly, he added.

The most effective way to fight heart disease is prevention, because even though Hong Kong has some of the best hospitals and health care in the world, heart disease kills 60 per cent of people who have a heart attack before they reach the hospital.

"That is why we have to educate people -- through programmes such as the Heart Health at Work programme that the Chamber supports at Health InfoWorld -- to take care of themselves before it is too late," said Amy Chan, senior manager for public affairs at the Hospital Authority and spokesperson for the self-funded centre for health education, Health InfoWorld.

Even though the pace of our lives today is faster than at any point in history, our activity level is much lower, she said. Most jobs in Hong Kong now involve sitting at a desk or counter, compared to blue-collar jobs that require a lot of physical activity and were the norm a decade ago.

"We have also neglected the importance of exercise and we are eating too much meat and junk food, and fewer fruits and vegetables than ever before," she said. "Also, people work very hard in Hong Kong and feel if they don't put in enough overtime they will be jeopardising their jobs. So naturally when they go home they just want to put up their feet and relax.

"But society has to wake up. This is not something that should be the responsibility of the government or employers. It is individuals' who need to help themselves," she said.

Obesity is a major culprit for many chronic disabling conditions, and people who are overweight are also more likely to develop diabetes, said Dr Chan. And she is not talking about the dictionary definition of obese, which is "grossly overweight," but rather those people who carry a spare tyre around their waist.

She estimates that about 500,000 people in Hong Kong have diabetes, and that 40 per cent of admissions on a medical ward relate to diabetics.

"A very worrying trend is the increasingly young people who develop diabetes. In Hong Kong, about one in ten people have diabetes. It used to be age related, so as you grow older your chances of developing diabetes increases," Dr Chan said.

The percentage of obese primary school children jumped from 11.2 per cent in 1996 to 14.2 per cent in 2000.

Because diabetes progresses very slowly, regular check ups can catch the early warning signs. But its slow development also means a person does not realise they are at risk until five to 10 years down the road when a life-threatening condition occurs.

"If people don't change their lifestyle, one in every four persons in Hong Kong will develop diabetes by the time they reach 60," she said. "It is getting so serious that if the situation does not improve, the health system is not going to be able to cope."

It costs about HK$4,000 a day to hospitalise a patient. Those who suffered from a stroke, or heart attack may need an operation to unblock their arteries, which costs about HK$120,000. About 40 per cent of the 4,000 people who are on dialysis in Hong Kong are diabetics, which costs about HK$100,000 a year to keep each person alive, about half of which will die within five years, she said.

It seems very inhumane to balance a person's life against a hospital's account books, but much of these costs could be avoided if people would take better care of themselves, she said.

"What we are concerned about is the middle-class group of people. These are the ones that are so busy making a living that they forget about their health. If they have a cough they will go to see the doctor. But if they are in this high risk group they will not do anything until it gets so bad in five to ten years time when it will be too late," Dr Chan said.

"Hong Kong people are very money conscious. They work hard and save hard for their retirement. But they should also invest in their health by looking after themselves so that they can be healthy enough to enjoy their retirement."

Not only has the physical health of people deteriorated in the past decade, but so to has their mental health, which has contributed to the rise in the number of stroke victims in Hong Kong. In 1981, the Hospital Authority Statistical Report shows that 11,062 people suffered a stroke. This jumped to 15,577 in 1991, and to 24,982 in 1999.

Chiu Chi-yue, associate professor and head of the University of Hong Kong's Department of Psychology, said the social well-being of Hong Kong people, compared to other Asian nations, is very low.

He believes the importance Hong Kong people place on wealth as a barometer to gauge their well-being is one of the main reasons behind this, which has been exasperated by the prolonged economic slump, unemployment and job insecurity.

"In Hong Kong there is a strong association with social well-being to economic well-being," he said.

Between June and September 1998, a survey of 545 respondents showed that daily changes in Hong Kong people's psychological health during the height of the Asian economic crisis were associated with the daily performance of the Hong Kong Stock Exchange (see graph).

"Hong Kong people's sense of well-being went hand in hand with the Hang Seng Index. When the market was up, people were happy. When it was down they were depressed. The findings are quite incredible," Prof Chiu said.

He attributes this to Hong Kong people's association of self worth -- and how they feel other people perceive them -- being narrowly focused on monetary and material wealth.

By having no other way to judge how they are doing, he says people are putting all their emotional eggs in one basket. If the basket gets dropped -- the economy goes down, their pay is cut or they lose their job -- they become depressed.

"People need to diversify their investment in themselves by broadening their interests and expectations," he said.

Job insecurity is negatively impacting not only the well-being of workers, but he also believes that of companies and the Hong Kong economy as a whole, which could have long-term consequences.

Excessive cost cutting measures, such as slashing head-count and trying to motivate employees to do more with less through instilling fear of layoffs, result in only short-term increases in efficiency. If people are constantly under stress and under a lot of anxiety in the workplace, their performance would be affected.

"People under stress or anxiety are not as creative or innovative as when they have a secure position," Prof Chiu said. "They tend not to take risks and just do what they know is safe, but not very innovative."

If Hong Kong is to position itself as a knowledge-based economy driven by innovation, it is vital that workers are able to be creative.

"In university we see this happening. In the old days when the economy was doing well, students were willing to take risks. Now they only want to take degree programmes that will guarantee them a secure job when they graduate," he said.

Just how this will affect Hong Kong's long-term development and the entrepreneurial spirit that has been one of the cornerstones of the territory's success is hard to say.