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Background: We examined the association of housing affordability with physical and mental health in Hong Kong, where there is a lack of related research despite having the worst housing affordability problem in the world, considering potential mediating effect of deprivation., Methods: A stratified random sample of 1978 Hong Kong adults were surveyed. Housing affordability was defined using the residual-income (after housing costs) approach. Health-related quality of life was assessed by the Short-Form Health Survey version 2 (SF-12v2), from which the physical component summary (PCS) and mental component summary (MCS) measures were derived. Multivariable linear regressions were performed to assess associations of housing affordability with PCS and MCS scores, adjusting for sociodemographic, socioeconomic and lifestyle factors. Mediation analyses were also conducted to assess the mediating role of deprivation on the effect of housing affordability on PCS or MCS., Results: Dose-response relationships were observed between housing affordability and mean PCS score ( β (95% CI) compared with the highest affordable fourth quartile: -2.53 (-4.05 to -1.01), -2.23 (-3.54 to -0.92), -0.64 (-1.80 to 0.51) for the first, second and third quartiles, respectively) and mean MCS score ( β (95% CI): -3.87 (-5.30 to -2.45), -2.35 (-3.59 to -1.11), -1.28 (-2.40 to -0.17) for the first, second and third quartiles, respectively). Deprivation mediated 34.3% of the impact of housing unaffordability on PCS and 15.8% of that on MCS., Conclusions: Housing affordability affects physical and mental health, partially through deprivation, suggesting that housing policies targeting deprived individuals may help reduce health inequality in addition to targeting the housing affordability problem., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Poverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong., Methods: Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism., Results: In this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders., Conclusions: The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.

Background: Individual-level deprivation takes into account the non-monetary aspects of poverty that neither income poverty nor socio-economic factors could fully capture; however, it has rarely been considered in existing studies on social inequality in obesity. Therefore, we examined the associations of deprivation, beyond income poverty, with both general and abdominal obesity., Methods: A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed via face-to-face household interviews between 2014 and 2015. Deprivation was assessed by a Deprivation Index specific to the Hong Kong population. General obesity was defined as body mass index (BMI) ≥ 25 kg/m2, while abdominal obesity was defined as waist circumference (WC) ≥ 90 cm/80 cm for male/female. Multivariable binary logistic regressions were performed., Results: Deprivation was independently associated with abdominal obesity (odds ratios (OR) = 1.68; 95% confidence intervals (CI): 1.27-2.22); however, no significant association was found with general obesity (OR=1.03; CI: 0.77-1.38). After additional adjustment for BMI, deprivation remained strongly associated with abdominal obesity (OR=2.00; CI: 1.41-2.83); and after further adjustment for WC, deprivation had a marginal inverse association with general obesity (OR=0.72; CI: 0.51-1.01)., Conclusions: Deprivation is an important risk factor of abdominal obesity and plays a critical role in capturing the preferential abdominal fat deposition beyond income poverty., (© The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: In studying health inequality, poverty as measured by income is frequently used; however, this omits the aspects of non-monetary resources and social barriers to achieving improved living standard. Therefore, our study aimed to examine the associations of individual-level deprivation of material and social necessities with general physical and mental health beyond that of income poverty., Methods: A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed between 2014 and 2015. Income poverty and a Deprivation Index were used as the main independent variables. General health was assessed using the validated 12-item Short-Form Health Survey version 2, from which physical component summary and mental component summary were derived., Results: Our results in multivariable ordinal logistic regressions consistently showed that, after adjusting for income poverty, socio-demographic and lifestyle factors, being deprived was significantly associated with worse physical (OR 1.66; CI 1.25-2.20) and mental health (OR 1.83; CI 1.43-2.35). Being income poor was also significantly associated with worse mental health (OR 1.63; CI 1.28-2.09) but only marginally with physical health (OR 1.34; CI 1.00-1.80) after adjustments., Conclusions: Income does not capture all aspects of poverty that are associated with adverse health outcomes. Deprivation of non-monetary resources has an independent effect on general health above and beyond the effect of income poverty. Policies should move beyond endowment and take into account the multidimensionality of poverty, in order to address the problem of health inequality.

With decades of urbanization, housing and community problems (e.g., poor ventilation and lack of open public spaces) have become important social determinants of health that require increasing attention worldwide. Knowledge regarding the link between health and these problems can provide crucial evidence for building healthy communities. However, this link has heretofore not been identified in Hong Kong, and few studies have compared the health impact of housing and community conditions across different income groups. To overcome this gap, we hypothesize that the health impact of housing and community problems may vary across income groups and across health dimensions. We tested these hypotheses using cross-sectional survey data from Hong Kong. Several health outcomes, e.g., chronic diseases and the SF-12 v. 2 mental component summary scores, were correlated with a few types of housing and community problems, while other outcomes, such as the DASS-21⁻Stress scores, were sensitive to a broader range of problems. The middle- and low-income group was more severely affected by poor built environments. These results can be used to identify significant problems in the local built environment, especially amongst the middle- and low-income group.

Based on a sample survey, this paper, analyzes the impact of human capital, social capital and social exclusion on the opportunity of Hong Kong families with youth members to leave poverty. Educational attainment of the youth members and adult family members, as well as the quantity and quality of social networks were found to have significant positive impacts, while social exclusion from the labor market of the adult members was found to have significant negative impact on their opportunity to leave poverty. Among all factors, quality of social network is the most influential. The author suggests that in order to help families out of poverty and enable positive development of youth members, poverty alleviation policies or programs should be targeted to help the youth in poor families to build up a quality social network.

Based on three surveys carried out for studying living conditions of youth, women and elderly living in six remote areas (Tuen Mun, Yuen Long, Tin Shui Wai, Sheung Shui, Fan Ling and Tai Po) in the New Territories of Hong Kong, this paper reports the poverty and social exclusion of these three groups of people. The quality of life of youth, women and elderly is adversely affected by limited job opportunities, high cost of travel for employment, and poor neighbourhoods in the community. However, perceptions of reasons for their problems are different for the three groups, due to differences in bonding and bridging social capital they have, as well as the differences in perceptions on social exclusion and discrimination directed upon them.

This paper examines the changes in the quality of life of poor households in Hong Kong in the late 1990s by analyzing their levels of expenditure, income security and poverty before and after 1997. Though there have been significant increases in the levels of expenditure among CSSA recipients, the expenditure among these poorest households in Hong Kong is still below that of non-CSSA recipients. Increasing poverty in Hong Kong is the result of increasing housing costs borne by these low expenditure households, who have to squeeze their expenditure on food and other items in order to meet the rising cost of housing. De-industrialisation and mass unemployment have given capital and the state unchecked authority to restructure the economy and to deregulate the labour market. Many low-income households have been hit hard as they faced redundancy, unemployment and wage-cuts after the 1997 Asian financial crisis. What jobs have been created are mostly part-time, temporary and contract jobs, and there has thus been an erosion in both job and income security. The quality of life of poor households is devastating not only in the sense that their living standards are low, but also that they are socially excluded from the mainstream of society.

Hong Kong is a typical global city with growing levels of substandard housing and a reduction in basic living quality. The government implemented a policy of transitional social housing (TSH) in 2018 to enhance the livelihood of low-income families. Nam Cheong 220 (NC220) is the first structural steel TSH project in Hong Kong. This study aims to evaluate the social impact and effectiveness of the project, and quantitative data were collected from individuals in three stages between 2020 and 2022. The first stage (T0) involved interviewing 106 successful applicants of NC220, followed by 91 participants in the second stage (T1) and 88 in the third stage (T2). Longitudinal analysis was implemented to scrutinize the changes observed over time, namely that the living area per capita substantially increased and housing expenses per capita decreased significantly due to residents' relocation to NC220. Housing conditions and community problems also showed significant improvement. Living satisfaction, neighbour and family relationships also demonstrated positive changes. The most difficult issue for residents was finding suitable housing after staying at NC220. The findings reveal that the first TSH in Hong Kong as an intervention significantly improved the housing circumstances of residents. The social dimensions of housing for enhancing residents' well-being is worth additional attention. [ABSTRACT FROM AUTHOR]

This study aims to enrich the comprehension of the effect of living density on anxiety and stress among adults in a global city. A random sample of 1,978 Hong Kong adults was interviewed in a cross‐sectional population study in 2014–2015. Descriptive statistics and logistic regressions were used to investigate the association between housing variables and mental health indicators, namely, anxiety and stress. Logistic regression analysis results have shown that by controlling the confounding effect of demographic variables, income poverty, housing ownership and housing cost, the living density was significantly associated with anxiety and stress of residents. Compared with those living in high density of <7 m2, living in medium density of ≥7 and <13 m2 was significantly associated with lower risk of anxiety (adjusted OR 0.52, 95% CI 0.30–0.88), and the risk was less for those living in low density of ≥13 m2 (adjusted OR 0.41, 95% CI 0.23–0.72). Meanwhile, living in low density of ≥13 m2 was significantly associated with a lower risk of stress (adjusted OR 0.44, 95% CI 0.20–0.97). These results highlighted the significant impact of living density on personal anxiety and stress. Moreover, female, younger adults or those living in income poverty were also at risk of anxiety and stress. In conclusion, our findings implied that improving housing policies, such as building public housing with adequate living areas and market regulation of living density of private housing, would help enhance the mental well‐being of residents. [ABSTRACT FROM AUTHOR]

Multidimensional poverty in urban cities has become an increasing global concern. Income poverty, deprivation, social exclusion and subjective poverty have been commonly used as measurements for poverty. However, the path relationship among these various dimensions has been ignored. This study aims to fill this research gap by focusing on the impact on subjective poverty. A random sample survey of 1979 adult participants in Hong Kong was used for the analysis. Structural equation modelling was applied in studying the path relationship among the monetary, material, social and subjective dimensions of poverty. Subjective poverty was predicted through a mediated model, with deprivation and social exclusion as the mediators. The result of this structural equation modelling indicated that the impact of income on subjective poverty was partially mediated by the material and social dimensions of poverty. In an age group comparison analysis, deprivation showed a larger influence on the elderly group, whilst social exclusion had a larger mediating effect on the younger group. The implication of these results and limitations are discussed. [ABSTRACT FROM AUTHOR]

Background The life-course perspective on socioeconomic inequality in health is a burgeoning field of research. Nonetheless, the three classic life-course models (i.e. sensitive period, cumulative risk and social mobility models) have rarely been simultaneously applied to studies on obesity. Therefore, this study examined the associations of socioeconomic positions (SEPs) across life stages and their associated life-course models with both general and abdominal obesity. Methods Face-to-face interviews were conducted among 1077 community-dwelling adults aged 50 or above during 2014–15 in Hong Kong. Experiences of poverty, educational attainment and deprivation of necessities represented respondents' SEP in childhood, early adulthood and late adulthood, respectively. General and abdominal obesity were defined as body mass index ≥25 kg m−2 and waist-to-height ratio >0.5. Multivariable modified Poisson regression with a robust error variance was performed. Results Respondents with low childhood SEP tended to have reduced risk of general obesity [relative risk (RR) = 0.85; 95% confidence interval (CI) = 0.72–1.00], whereas those with low childhood SEP and low late-adulthood SEP tended to have increased risk of abdominal obesity (RR = 1.10; 95% CI = 1.00–1.21 and RR = 1.14; 95% CI = 1.03–1.26, respectively). Cumulative socioeconomic disadvantages showed a dose–response relationship with abdominal obesity. Also, those with upward socioeconomic mobility had lower risk of abdominal obesity, whereas those with downward socioeconomic mobility had greater risk. Conclusions Low SEP, especially in childhood, exerted contrasting effects on general and abdominal obesity among older Hong Kong Chinese adults. The three life-course models operated simultaneously in determining the risk of abdominal obesity, while support for cumulative risk and social mobility models was weak in general obesity. [ABSTRACT FROM AUTHOR]

In many developed countries or regions, wide income disparities increase the difficulty in reducing poverty. In their day‐to‐day lives, poor people often feel less accepted by the society. The failures in communicating with social groups and receiving social support lead to negative consequences on individual well‐being and higher level of social exclusion. Based on the debate upon alternative approaches to conceptualizing and operationalizing poverty, this study attempts to verify a mediation model with data from a household survey (N = 1,202) in Hong Kong. The results of structural equation modelling reveal that deprivation is a more powerful indicator than income poverty for specifying the negative relations of poverty with interpersonal communication, social support, and social acceptance; the negative impact of deprivation on social acceptance can be reduced by two significant mediators of interpersonal communication and social support. The results are discussed in terms of directions for future research and policy and welfare intervention. [ABSTRACT FROM AUTHOR]

Hong Kong is a typical example of a world city that faces escalating poverty and housing problems. Problems related to housing are crucial in determining deprivation. By means of hierarchical linear regression on a representative survey of Hong Kong residents in 2014, this study examines the impacts of household income and housing factors on the deprivation of residents in Hong Kong. The study indicates that income level has a crucial effect on the deprivation level of households; whereas housing cost per capita, living area per capita, and living quarter problems significantly influence deprivation. A small interacting effect exists between household income and housing factors, which do not influence the independent effects of living area per capita and living quarter problems on deprivation. For the public rental housing residents, only the effect of living quarter problem on deprivation is significant, whereas for private rental housing residents, living area per capita and living quarter problem have a significant effect. Among all the models, housing expense per capita is a significant factor only in model for overcrowded households. The study recommends that improving the maintenance and renovation schemes for public and private housing with poor living environment is a good strategy to improve housing conditions and deprivation. The study suggests that anti‐poverty policies must consider strategies and measures that can improve the housing factors, including housing expenses, living density and living quarter maintenance problems, especially for those residents with high living density, such as those living in bed spaces, cubicles, and subdivided flats. [ABSTRACT FROM AUTHOR]

A territory‐wide two‐stage stratified random sample of 2,282 community‐dwelling Hong Kong adults were surveyed between 2014 and 2015 to investigate the association between poverty and regular source of primary care utilization. Poverty was operationalized by income‐poverty and deprivation. About 94% of our sample reported having regular source of primary care (Western and/or Chinese medical practitioner) and about 69% among them were in private sector. Multivariable logistic regression showed that people who were income‐poor and deprived were less likely to have regular source of primary care (income‐poor: OR = 0.523, p =.027; deprived: OR = 0.488, p =.007) and visit private primary care doctors (income‐poor: OR = 0.445, deprived: OR = 0.222, both p <.0001). Those who had chronic diseases were more likely to have regular source of primary care (multimorbid: OR = 10.709, p <.0001), but less likely to access care in the private sector (one chronic disease: OR = 0.690, p =.019; multimorbid: OR = 0.374, p <.0001) than those without. Further, being older and less skilled were significantly associated with less likelihood of visiting a private doctor. Path analysis showed that the number of chronic diseases had significant indirect effect on having regular source of primary care with being income‐poor and deprived as the mediators (β = −.0183, p =.0016). Therefore, despite a public health‐care system that aims to deny no one from adequate health care for lack of means, regular source of primary care in Hong Kong is found to be pro‐rich. Future policies should tackle the problem of health‐care inequalities to meet the needs of the underprivileged. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the relations between poverty and social disadvantage in Hong Kong, China, the social and health status of children and youth, and the interaction between poverty and health inequalities.

Despite high and rising real incomes, the poverty rate in Hong Kong remains a cause of community concern. The government has been reluctant to set a poverty line, although the recently (re-)established Commission on Poverty has recommended that a poverty line for Hong Kong is developed. Against this background, this article reports results derived from a new deprivation study designed to shed new light on the living standards of the poorest in the community. Reflecting international studies, deprivation is identified as existing when people do not have and cannot afford items regarded by a majority in the community as being essential for all. A list of 35 basic needs items is identified as meeting this definition, the results indicating that around 30 per cent are deprived of at least two items, over 18 per cent are deprived of at least four items and 10 per cent are deprived of at least eight items. Deprivation rates are particularly high among items that meet basic health needs. A mean deprivation score index (MDIS) is then used to compare the degree of deprivation experienced by different groups, and indicates that deprivation is most pronounced amongst those receiving Comprehensive Social Security Assistance (CSSA), people affected by a disability and recent migrants. The overlap between deprivation and income poverty is also relatively low, which suggests both measures have a role to play in identifying who is most vulnerable and guiding where policy change is most urgently needed. [ABSTRACT FROM AUTHOR]

Concern over high and persistent levels of poverty and inequality have focused attention on the broader issue of social disadvantage in Hong Kong. The social exclusion framework provides a new perspective that shifts the focus away from purely economic causes to the social processes that prevent people from participating, although conceptual and definitional ambiguities present conceptual and practical challenges to empirical research on exclusion. This paper presents results from a comprehensive survey that allows the extent and nature of social exclusion in Hong Kong to be estimated for the first time. Attention focuses on examining the broad profile of exclusion, and on the association between social exclusion and a series of indicators of subjective well-being (SWB). The overlap between social exclusion and poverty is also examined, the results showing that the two are different and are associated with different levels of well-being. [ABSTRACT FROM AUTHOR]