Safety - few traffic fatalities, low crime (no guns), a feeling of safety (low crime), healthy food, low obesity levels, etc…
Lots of reasons. But to be honest, what we have in Hong Kong should be what the world has.
The amazing thing is.the number for men and women both went up by about 7 months. I like living a year and getting 7 months back!
Now, a solution has been found through the work of Dr Michael Ni Yuxuan, Clinical Associate Professor in the School of Public Health and colleagues. Dr Ni conducted the largest and most comprehensive assessment of Hong Kong’s longevity to date, which has been published in The Lancet Public Health.
“Explanations for longevity in Hong Kong have included economic prosperity, our universal health coverage, and our very low maternal and infant mortality. But these things are true for many high-income regions, including in Asia. What really distinguishes us is that we have attained a low smoking prevalence for both men and women,” he said. “For the first time, we showed that successful tobacco control was the reason why Hong Kong’s life expectancy has surpassed all other populations.”
This is the real reason.
Well if that were the case, then why don’t the other countries who have even lower smoking prevalence have higher life expectancy?
And then there’s this gem of an outlier.
No. It doesn’t seem to be smoking that does it. The authors wanted a silver bullet.
However I do believe smoking is egregiously bad and a factor. It’s just not the whole story.
It seems to suggest that in Honk Kong deaths related to smoking are lower than in say USA even though the prevalence rate is similar. I wonder if they smoke different brands of cigarettes in Hong Kong meaning they are less harmful? I was watching a documentary on cigarette industry a while back and the tabaco leaves would be treated with plenty of chemicals before they were processed, which I believe makes them way more dangerous/cancerous and the documentary itself seemed to suggest same in addition to making cigarettes more addictive.
While there’s no doubt inhaling smoke (of any kind, let alone cigarettes) is bad I was raised in a farm, and I recall few people in town making their own tabaco/cigarettes and they would smoke it. None of the 5-6 of the ones who did it died young, one actually became the oldest in town, died at 97, Clearly too small a sample to mean anything but thought I’d throw it out there, and from the above table/data (alone) smoking seems to have no connection whatsoever to life acceptancy as Japan’s % of smokers is almost double that of USA, yet they have second highest life acceptancy.
AI:
DeStrider’s skepticism is a fair reminder that no single factor can explain everything. But the rigor of Dr Ni’s study lies in its comparison: it restricts the analysis to high-income regions that already share universal health coverage and very low maternal and infant mortality. Within that group, tobacco control is precisely what separates Hong Kong from the rest.
3 things would seem to matter
I think if you just look at the 2 winners - Japan and HK, smoking explains the difference. Same for Singapore.
If you compare to the US, it isn’t smoking. There are 1000 reasons why the US is bad but smoking isn’t the reason.
I’m sure no one in HK really compares to the US. They compare to Japan and Singapore.
Ok, if you are comparing only Asian countries, smoking can be the determining factor as all those countries share almost all of the other factors that I listed above - no guns, lowest crime in the world, low obesity, excellent public transport, etc…
I guess it depends on the groups you are comparing. As the article itself states:
Hong Kong’s record is best understood as a population pattern with several interacting causes, not a recipe that can be copied one ingredient at a time.
Does it really matter? Everybody agrees that smoking is bad, and I am sure that no members of a longevity forum smoke 
It’s also well known that you can’t just “transplant” findings from one country into another. The culture, habits, genetics, and behaviours of the people are also important. You’re not going to get Americans to behave like Hong Kongers or Swedes, no matter what government policy you manage to implement.
I don’t see anything special in any of these data. The biggest factors are increasing wealth, not being obese, and having access to healthcare. You can see clear examples of that within countries, such as the clear, large, life expectancy gap between poor and rich people across the USA, UK and most of Europe.
Look at the UK data (for men):
Bottom socioeconomic 10%; life expectancy 73.2y, healthy life years 49.8y
Top socioeconomic 10%; life expectancy 83.6y, healthy life years 69.2y
That is almost 20 YEARS more healthy life years, and 10 extra total years of life. So if you can raise up the poorest people in society, you make absolutely massive gains on average.
It isn’t simply a matter of universal health care. The UK system is pretty bad nowadays. But as I said earlier, culture and lifestyle have a lot to do with it. Even when the bottom 10% have just as much right to see a doctor as the top 10%, their jobs are probably shittier, worse workplaces, worse housing, worse childhood experiences and upbringing, higher psychological stresses (job insecurity, bills, debts, crime), poorer health literacy etc etc.
A much more obvious explanation IMO could simply be genetics. Hong Kong population is 92% ethnic Chinese. Japan and Korea are also highly genetically homogenous. All of those countries seem to be somewhat “protected” from negative effects of smoking compared to western populations. For lung cancer, typically smoking is a 3-5x risk enhancer in East Asia, but a 9-23x risk enhancer in the West. (pubmed.ncbi.nlm.nih.gov)
There are other situations where things like this are a major factor. For a 10mmHg increase in systolic blood pressure, a white person has a 8% higher risk of stroke, but a black person has a 24% higher risk. (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1485077)
There are also clear differences in how populations respond to certain classes of drug. Clopidogrel is an anti-coagulant given to people often after a stent placement. It needs an enzyme (CYP2C19) to activate it. Around 60% of East Asians are poor metabolisers of the drug, and so compared to a European, East Asians taking this drug have a 2x higher risk of MACE, and a 5x higher risk of stent thrombosis. If you treat with a different drug (ticagrelor) then the risk is equal between East Asians and Europeans, showing that it’s the difference in drug metabolism which is the factor.
Long story short, IMO it’s likely that genetics explain a huge amount of the difference.
Saw this on social media, not sure how accurate it is. I queried Google Gemini on the causes of the partisan mortality gap, and the answer is below.
The data visualized in “797744766_2110081750386165_5304514057814591700_n.jpeg” originates from a 2022 BMJstudy by Warraich et al.. The research indicates that while age-adjusted mortality rates fell nationwide between 2001 and 2019, they dropped by 22% in Democratic-leaning counties versus only 11% in Republican-leaning counties. This uneven decline resulted in a 541% increase in the partisan mortality gap.
The primary causes driving this demographic divergence are rooted in clinical, political, geographic, and demographic factors.
The gap is not driven by a single outlier disease but by systemic underperformance across major public health categories in conservative areas. Higher mortality in Republican counties in 2019 was observed across all major causes of death: heart disease, cancer, chronic lower respiratory disease, accidental deaths (which includes drug overdoses), and suicide.
Epidemiological researchers, including the study’s authors, suggest that the mortality gap closely tracks with the increasing polarization of state and county-level policies.
The aggregate data masks significant heterogeneity across race and geography.
It is vital to distinguish between ecological association and direct causation. As explicitly noted in the source material, the data shows an association rather than individual risk, and it does not prove that political affiliation intrinsically causes differences in mortality.
Current scholarly debate acknowledges a critical knowledge gap: the “ecological fallacy.” While diverging health policies undoubtedly play a role, the mortality gap may also be heavily influenced by demographic sorting. Healthier, highly educated, and upwardly mobile populations have increasingly migrated to economically dynamic urban and suburban centers (which vote Democratic). Meanwhile, populations remaining in economically stagnant rural areas (which vote Republican) disproportionately suffer from “deaths of despair” driven by macroeconomic trends that are arguably outside the control of local politicians.
Yet another argument for it being genetics rather than lifestyle as determinative of extreme longevity. If extreme longevity was dependent on diet/exercise/lifestyle, then there ought to be a roughly even split between men and women reaching extreme old age. It is not very likely that women are vastly, overwhelmingly, and past 116 or so, uniquely better at diet, exercise and lifestyle. Clearly, there is a structural issue at play - genes, and no amount of good diet exercise and lifestyle can prolong beyond that genetic limit, just as you can’t get a diet/exercise dependent 50 year old mouse.
In fact, as I’ve been saying since forever if you look at diet and exercise habits of centenarians, they are no different than ordinary mortals. In other words, diet/exercise/lifestyle are not significant drivers of longevity - except at the very extremes like massive substance abuse and the like.
Eat a reasonable diet, be physically active enough to avoid sedentary behaviour, and you’ll live as long as if you had fanatically optimized your diet, exercise and lifestyle. To really affect max lifespan, you need to redesign the underlying structure - your genetic code. Meanwhile, and until then, the only hope to slightly cheat that design, is through two classes of drugs: one class are ameliorative/preventative/curative, your statins and the like, which fix your weakest links, so that your life is not cut short and you can live to your full genetic pitential, and the second class of extremely rare - so far - drugs which may (crossing fingers) actually extend that life slightly beyond your genetic base - rapamycin (maybe) and other candidates.
And that, dear friends is why we are on rapamycin.news - to reach for the stars, the “beyond” genetic base. And that is - currently - drugs. Not just the ordinary medicine curative drugs - there are plenty of sites devoted to that. But to the speculative bleeding edge with a big dose of gambling risk. What it is not - and should not be - is focused on that which demonstrably does not work to EXTEND MAX LIFESPAN - diet and exercise, to which there are millions of other sites devoted and focused on.
Time to again reaffirm the truism: diet and exercise beyond the basics will not get you to the promised land - drugs is where it’s at today (genetic engineering tomorrow!).
Right - sex differences based on chromosomes. The point however is that it’s determinative, a fixed limit not susceptible to being modified by diet, exercise, and lifestyle - no matter what you eat, you’re still a man, and still dying sooner than a woman 
…
Drugs > diet + exercise.
I think it’s important to remember that what matters to most of us isn’t simply how long we live, but how many healthy years we get.
Women live longer than men, but they also spend more of those additional years in poor health. In the EU, women live about 5.3 years longer, while the gap in healthy life years is only around 0.5 years.
That’s why healthspan matters so much. Diet, exercise, maintaining muscle and cardiovascular fitness can help us spend more of our lives in good health.
And hopefully, interventions such as rapamycin will eventually go one step further — adding healthy years rather than simply adding years of poor health.
To me, that’s the real goal of longevity research: more life, but mostly more good life.
Yes, of course. We all like our healthspan to be as good as possible, everything you said is what we desire.
But here’s a thought train. Are you sure this is fully under our control? I know we assume so, but really? As you yourself said - quite rightly - women live longer, but spend more years in poor health (compared to men). What if that’s just the nature of how our bodies work? Almost all supercentenarian (110+) women have extremely poor vision, with most of them blind. It’s in the nature of the organs and their physiological journey - no matter how many carrots they ate, what sunglasses they wore and which eyedrops they used, their eyes would continue to be poor. And if it’s such a strong rule that women spend their last years in poor health compared to males, it makes me think that it’s the design they can do nothing about, it’s not likely that all of them had poor diet and exercise habits that led to poor health. Instead, just as with the limits of age, it’s a result of design that you can’t do much about with diet, exercise and lifestyle - at best you can affect things at the margin. But your health profile and how long you live, will be set so that you can’t do much about it with those interventions… unless maybe you can reach for some very powerful drugs.
So, in principle I agree with you. We all want max healthspan even more than max lifespan. But we may need to temper our expectations as to how much we can control that, and whatever we may attempt to do, is going to be down to some lucky combinations of drugs, on top of very ordinary reasonable care diet/exercise/lifestyle. YMMV.
FWIW, few people alive today 100 years old ate a robust diet their entire life.
Some of the healthspan increases may come from diet over a lifetime. All grew up in the great depression and none had berries year round (or probably fruit either).
I’m 56 and I didn’t eat berries or salmon or avocado as a child. I was exposed to lead in excess of today’s levels. A host of other ills that we didn’t yet understand. A 100 year old just compounds those less understood things. Crisco came out in 1911 and was particularly popular during the world wars and great depression.
Now, for sure, a lot of the modern world is negative. But things like air quality in the US is better I think for most people than 50 years ago before that great progressive Nixon signed the Clean Air Act.
All of this is perhaps wishful thinking for my son who eats berries, kale, salmon and avocado regularly (year round); has lived with good air and water quality; etc etc.
And I have to push back on the diet and exercise thing. For the vast majority of the population, diet and exercise will increase healthspan and lifespan. But, yes, if you won the genetic lottery, you can do fine regardless. But those 110+ weren’t exactly sedentary or obese. Just maybe not VO2 maxers. Rapamycin for an obese or sedentary person maybe the wrong answer (heck it might be for everyone) - and it certainly isn’t where the focus should be.
Well, I get your point and who knows I guess but there’s definitely other benefits to Rapa. I’ve heard longevity docs say that it fights inflammation and it is my experience that it is true. It also seems to alleviate a great deal (in my case eliminate) the aches and pains that come standard with the 50+ age. We also have an 85+ guy around these boards that says he is free of aches and pains and dedicates the result to Rapamycin. So, I for one am bullish on RAPA at least for health span and quality of life and that in itself is significant plus it should help some with longevity also.
Find it interesting and wonder why slavic nations of Europe (Serbia, Bulgaria, Russia, Ukraine etc) are all high(highest in europe), even Estonia, Latvia which neighbor them but are relatively high standard of living and pretty good health care are still very high? I wonder if there is some kind of common gene or something (that makes them susceptible to CVD, or maybe it is their love for vodka LOL)
