What if your city could legally mandate a healthier you?
In parts of China, that's not a hypothetical.
Today we'll look at how new laws are turning lifestyles into legislation, from your waistline to your daily routine.
Get ready for a world where public health policy knocks on your front door.
We're live from our studios here in Beijing.
This is Roundtable.
I'm Steve.
Thank you very much for being with us today.
And for the show, I'm joined by Fei-Fei and Yushan.
First up, imagine a city where your health is not just a personal responsibility, but a shared priority backed by law.
In Hangzhou, in East China's Zhejiang province, that vision is becoming a reality.
Starting January 1st 2026 that's mere days away a new regulation will take effect in the city, aiming to reshape public health through community-based services like healthier lifestyles and a bold focus on on waste management or weight management.
Similar regulations have taken effect in several places across the country.
We'll talk about it all.
Good afternoon, Fei-Fei and Yushan.
So let's start with the new public health regulation just got approved in Hangzhou and it's going into effect just days from now.
Right.
Hangzhou, they're rolling out something really big.
And it's to be implemented just starting from January the 1st, 2026.
That's the new public health regulation that has just been approved.
And in that regulation it says residents should be more aware of health management, promoting healthy eating, regular exercise and managing their weight in a scientific way.
So this whole thing is meant for boosting community health care services and Also encourage healthier lifestyles.
So here I want you all to picture this.
An office worker reaching for a sugary drink at a convenience store.
And right on that bottle, there's a label saying, Hi, sugar.
Oh, sorry.
Delicious in the meantime, but also high sugar so that you know.
And then in another scenario, in an elementary school cafeteria, for example, every dish on the lunch tray for the kids is clearly labeled with calories and nutrition breakdown.
So that not only the kids, but also the school, the management team and the parents themselves They know what their kids are taking in on a daily basis.
That's what Hangzhou is aiming for.
So, yeah, and it's not just one specific group of people.
It's the community in general.
It's a big regulation.
It's made up of 10 chapters and 54 different articles, covering everything from health services and insurance to creating healthier environments, guiding lifestyles and conducting health impact assessments as well, which we're going to get some details on a little bit later.
But why has Hangzhou specifically taken such moves?
Well, first of all, I think Hangzhou is just one of the many cities here in China and regions here in China that are looking at to reshape their health management system.
But in Hangzhou's case in particular, the city faces a lot of challenges.
For example, an aging population, so rising rates of chronic diseases and cancers, and also a shortage of health service resources, which by that meaning that the population of Hangzhou has grown very rapidly in recent years.
It now has over 12 million residents by the end of 2024.
So the city faces challenges in public health services simply because of the growing population.
And also on top of that, the population is also aging very fastly, that over one quarter that is aged over 60 and above by the end of 2024.
That is also a big burden when it comes to health services resources.
So what should do?
And of course, the city needs to ramp up its health resources, you know, public health sector.
But when it comes to lifestyle and diets, it's something that people need to practice.
Sure.
Okay.
So, compared to Beijing's population of around what 22 23 million, Hangzhou would be considered on the smaller side, but still a huge, huge city, almost 13 million residents.
Then you've got a quarter of those residents aged 60 and above.
And of course we know it's common knowledge 60 and above, you start to deal with certain health issues.
And therefore, when you have a shortage of health service resources, that becomes an issue.
But what does that mean when you say not enough, when we say we don't have enough health service resources in the city?
One pressing issue that's been mentioned by many experts and also local residents in Hangzhou is that there's been an uneven distribution of major hospital or medical resources among the various districts in Hangzhou.
And it tends to gather in the core districts rather than surrounding areas.
So, for example, one district in Hangzhou has a population of around 1 million people, yet there are only five provincial or municipal level public hospitals serving the entire area.
For a million people.
For a million people.
And the experts there.
They explain that As our cities are getting bigger and urbanization pushes former suburban areas and rural areas to expand faster, that's kind of what the lag of catching up in speed happens between the development of urbanization and the local hospital and medical services.
So take a minor top-tier public hospital, for example.
It has to be located in an area with a large enough of population to truly function, but that also takes time.
That's why there's been a more or less of a mismatch right now, and this is also what they've been trying to tackle in the past years as well.
But Regarding the unbalanced distribution of medical services, that's just one thing, why Hangzhou is targeting this.
The other one, like you mentioned earlier Fei-Fei, is the habits and the diet that you know people kind of have.
And I believe this is not just a Hangzhou issue.
Yeah, right.
I mean, this is part of a bigger initiative, right?
The National Healthy Cities Initiative.
And I don't think that the country is picking on Hangzhou by using them as an example.
But it is a good example because of the numbers we talked about before, but also by these numbers as well.
The rates for being overweight and obese among adult residents in Hangzhou were over 30 and 8 almost 9 respectively.
And while both of those rates are lower than the provincial and national averages, the data still shows that intervention is needed.
So that's why I guess Hangzhou is a good choice to be one of these pilot cities.
And also when it comes to Hangzhou.
Well, in the eastern region of province of Zhejiang in general is that salted meat and broth is very popular, especially among the elderlies.
So that can be one of the problems concerns I would say the authorities have about this is that when you are just like eating preserved vegetables or salted meat, that will also have can cause chronic diseases in the long term.
Yeah, I mean, I'm sure it tastes amazing, which is why people love it.
Is Hangzhou's food known to be very, very good?
Does it have a cool reputation around the country?
They have their iconic dishes that the moment you mention the name of the dishes, you know immediately that they're from Hangzhou, such as Xihu vinegar fish.
Oh, that's a Hangzhou specialty.
Or more like a regional specialty because people in Zhejiang perhaps also have many of those dishes.
But in my memory I always had this stereotypical view that they eat more soup than like staple food than us in the north and their taste is relatively lighter.
I'll have to get down there and try it myself.
Let's get into the specifics of the regulations.
What are some of the highlights?
Well, one highlight is definitely the establishment and improving of health services.
That means pushing healthcare closer to where people actually live.
So it's to strengthen community clinics, expanding family doctor services and also putting real resident health management system in place.
For example, there is a medical worker at the Caihe Community Health Care Center in Hangzhou who said community health institutions are now expected to expand services such as nutritional counseling and scientific exercise guidance.
That used not to be a priority, but now it is.
So another medical worker at the Si Ji Qing Community Health Care Center also said that Hangzhou now is moving ahead with plans to establish weight management clinics or obesity treatment centers at all secondary level and above medical institutions.
So developing departments within existing institutions to tackle specific problems related to weight management.
Exactly.
And these types of things simply didn't exist before.
Well, yeah, it only mostly existed on major bigger hospitals.
But now I think they're pushing them to community level.
And also the regulation, are encouraging food producers and restaurant to offer low salt, low fat and low sugar foods.
So especially to labeling them as such, for example.
For instance, in schools or in some public canteens, that's targeting the elderly generation.
They are encouraged to offer such low salt, low fat and low sugar options for them.
When we talked about the canteens the community canteens on Roundtable before, we didn't talk about how healthy or perhaps unhealthy some of the dishes served were.
We simply said it was an amazing thing that that serves so many members of the community, including the elderly.
And we talked about the fact I talked about the fact.
When you go in there, it's kind of like a buffet style.
But what I've never seen is nutritional content in terms of what's in these dishes, how many calories per serving, or something like that.
We all know that the food is great, but now we'll just get some more details when we're heading into those places to eat.
I think this is a great move because it just gives people more information.
And when you have more information, then you can make a more informed decision about the food that you want to put in your own belly.
Exactly.
Especially if you're considering a lot of these elderly people.
They have chronic diseases like diabetes or heart conditions.
And that requires they stay on the low salt, low fat, and low sugar diet.
So by offering them and labeling them at the same time, it also helps with awareness.
I would say that they are starting to notice what's been on my plate was being put into my mouth.
And that also, I think another very interesting part of the regulation is also about fitness.
You know, the sports exercise part.
How does that work?
That it also is encouraging sports authorities like some of the public governmental agencies overseeing the sports sector can work with health departments, and they can conduct a sort of physical fitness assessment or create a database for exercise prescriptions like what we get when it comes to diet prescriptions from the governments every year.
True.
That makes sense too, because if you're going to be helping people know better how to eat healthier and safely, then knowing how to exercise better and safely is very useful information too.
Yeah.
And there's something else that they're building upon.
This is the system called the HealthPoint Reward System.
That I found really interesting.
So at the very beginning, I gave you guys a Two, actually, scenarios.
And here's the third one.
Imagine an elderly resident walking into a community fitness center scans the QR code to check in and then their health account instantly earns points, which proves in a way as if it's health points as a reward.
And these points they can later use to exchange for checkups physical checkups in the hospitals or health centers, or physical therapy for themselves.
That's also part of this whole mechanism that they're designing in Hangzhou, too.
So with such a system, the residents can earn points for participating in activities like health education fitness exercise, all kinds of that.
And then the point could also be redeemed into something tangible later on that they can use.
So you just take your phone, you go to the local gym and then you kind of sign in or whatever with your phone.
You get points for that.
Right.
That's a good system.
People are going to be cheating on that, though.
They'll just go inside it and then sit in the massage chair and play a game on their phone for an hour.
But yeah, it's still a good system to have in place for sure.
Yeah, exactly.
And also the regulations also encouraging public organizations like schools to open up their sports facilities to the public, especially during the holidays.
Also including universities and colleges, offering more spaces, more choices for people to get some of the exercises, not just inside the gym or parks.
Hangzhou is the first city in China to introduce local laws specifically for health impact programs assessments.
This new regulation is a pretty significant one.
There's a whole dedicated chapter on health impact assessments, and it's clearly outlined how they should be carried out as well, which is also important, because you can say this, you can say it out loud and you can recommend this, but if there's no clear guidelines on how to actually put this into everyday lives, then it probably wouldn't be as effective.
Exactly.
And when it comes to health impact assessment, I think it covers more sectors than we previously imagined.
For example, first of all, it's not a recommendation.
It's basically a mandated procedure, which means if someone in the society or in Hangzhou that failed to undergo the required assessment, they may face consequences.
And another thing is that it's more comprehensive meaning when it comes to policymaking, urban planning, construction projects.
Oh, the health impact assessment extends to that as well.
Yeah, you need to factor in the health impacts.
For example, if the city is planning to build on a large logistic park somewhere in the city and the traditional assessment may focus only on the economic benefits.
Traffic values, traffic volumes.
But now with the health factor in, it also needs to analyze, for example, environmental impacts.
How would that increase truck emissions, for example, emitted into the air for nearby schools and communities?
What would those heavy vehicles route increase the risk of traffic accidents in surrounding areas?
And also, what about the noise part?
So, after going through the assessment procedure, they can have measures such as adjusting those roads for the heavy trucks, installing noise barriers or creating more green zones between like parks and also between these logistic park and communities.
So the city is not just asking the residents to take better care of themselves and showing them how.
The city is asking builders infrastructure, to better take care of the environment, for the citizens of the city too.
Very responsible.
We've focused on Hangzhou so far, but China has some national level policies as well.
And they've been around for a good few years, have they not?
Yeah, ever since back in 2020.
That's when the basic medical and health promotion law came into effect and became China's first fundamental and comprehensive law in the health sector.
So it's considered as a basic law in the field of health, and health also has this significant position in the country's health policies.
This law specifically addresses health promotion.
That's outlining the measures like promoting health knowledge, improving health management, incorporating health education into the general educational system, and etc.
For example, the law also specifies that the citizens are the primary responsible party for their own health.
I think that really matters.
And we can also tell from the Hangzhou case as well that all of these efforts that China is trying to build right now, as well as what's going on in Hangzhou it's also a demonstration of what we're doing is not really making new policies on how to make people understand.
Oh, it's important that you manage your weight.
It's about building this ecosystem for this whole thing to last longer and more sustainable for even more generations to benefit from it in the future.
Yeah, I agree.
You're planting seeds, healthy seeds, if you will, in the minds of people.
You're not necessarily forcing people to do things, but at the same time, you're providing people with more information, more options.
And just spreading the word of a healthy lifestyle has to be considered a positive thing.
And we know that the more we hear about something, the more it's on the forefront of our minds and the more likely we are to take care of it.
There was something last year that stuck out as well.
It was in June, summertime of last year.
That's when the National Health Commission and also 15 other ministries they launched a three-year weight management program.
Weight management year initiative.
So three years in total.
And the aim was to raise national awareness of weight management.
Then fast forward to April of this year.
That's when they issued another document encouraging medical institutions with the necessary conditions to set up these clinics that you talked about before for healthy weight management.
Again, it's not saying that the entire city is obese.
It's not saying the entire country is obese.
It's a national attempt to. to put a healthy mindset in people's minds from the get-go.
Yeah, but also at the same time I think overweight and obesity is a more pressuring, more weighing problem now in China, because according to Lancet, I think over half of China's adults has like overweight, obesity problems.
And when it comes to children, the number of children and adolescents with high blood pressure in China is also rising.
So you can see that it's not only just about controlling weight.
It also carries with health consequences.
And that can translate into, for example, deaths caused by chronic diseases, is also one of the number one killers in China.
And then you see things popping up that you typically don't associate with young people.
Hypertension rates would be an example of that.
Hypertension is something that you hear associated with grandmas and grandpas typically, but the rate amongst Chinese teens is almost 9 for that.
So there's a bit of a juxtapose there.
Hangzhou is a great example.
We talked about the national policies, but there are other places around the country that are taking steps too.
Yeah.
Provinces and cities like central China's Henan province, Shanghai and southwest China's Sichuan provinces.
They have implemented local health promotion laws already.
And in other regions, such as east China's Jiangsu province, have included health promotion clauses by revising their former patriotic health regulations.
There's one very interesting Sichuan case.
So just not too long ago, in October this year, Sichuan Health and Health Promotion Regulation Office, they officially came into force by bringing out the weight management into their rulebook.
And it specifies that health authorities at the county level, within the province and above, are required to release weight management information and help people understand what a healthy weight actually means.
And something more practical that they're doing.
That I found really interesting is, according to a professor from Sichuan University, West China Hospital.
He said that they plan to roll out this whole series of lecture tours across regional hub cities throughout Sichuan.
And he said so in earlier March this year, I think.
And he said that this is going to roll out continuously throughout the years, which means that perhaps at this point they're still doing the lectures.
And what the lectures are about is about changing people's mindset.
People need to recognize that obesity is sort of like a disease.
It should not be overlooked.
It's not that, oh, it's just aesthetic standard.
No, it's not.
It has everything to do with your personal health.
And then on the ground.
This shift is also taking shape in Sichuan province, where they have medical institutions across Sichuan being encouraged to set up dedicated weight management clinics.
Well, this It's something that they've been doing with major hospitals but yeah, they're trying to expand that throughout the entire province as well.
And also, I think very interestingly, that a lot of communities in Sichuan they are handing out measurement tools like spoons or measuring tapes around your waist or spoons to tell you the amount of salt you should consume every day.
So they're sort of giving out this free gift to residents and sort of trying to teach them.
You know the amount.
Of you should stay on the lower sugar, lower fat, lower oil diet.
Because when it comes to Sichuan, they can eat very salty and oily dishes.
And spicy.
Yeah, spicy as well.
Yeah, if somebody hands me a tape measure, I'm going to hand it straight back to them, I would say.
Yeah.
Still, though, again, it's all part of the same initiative, right, to put it on people's minds.
Shanghai, always curious to know what's happening in Shanghai.
What are they doing there?
They also have a similar regulation, actually.
They started to implement that regulation back in 2023.
So one of the core principles of that regulation is to strengthen the management of student nutrition meals.
And they also clarify the nutrition standards for primary and secondary school students and also babies.
So they're focusing on the children's part, but also on top of that they also are pushing out, for example, a family doctor system, that among communities they have a number of family doctors inside their community level medical facilities and they all sign contracts with the residents within those communities.
And now I think the coverage rate of those family doctors' contracts among key population groups has exceeded 85.
So making it a very accessible channel for residents.
Well, I actually also have a community family doctor myself.
It's not like I call... Within the apartment complex.
Yeah, yeah, yeah.
So it's not about, you know, I call her up every...
Every time I have a question.
It's more of a regular routinely checkups, especially during my pregnancy.
She will contact me through phones or WeChat, asking me have you been to your checkups every month or every week during your pregnancy?
What problems do you have?
Where do you plan?
Which hospital are you going to?
Do you need any help?
Or are you aware of the certain basic knowledge when it comes to pregnancy and baby's health?
So they'll go through some, I think a monthly checkup on you.
But also for me, I think it was.
I'm also a bit younger than some of the residents in the community, but when it comes to the elderly generation they probably would pay them a visit door to door, especially for the those living alone.
Yeah, those um clinic doctors within the very neighborhood where my grandpa lives all knows my grandpa, everybody knows him.
Like yeah, this old man is here again, he's showing up.
I bet that's a very tight, uh knit community and everybody knows each other sort of who visits the clinic regularly.
Um, i like the part about the schools.
I've seen this type of documentary before where they were trying to change
This was in England where they were trying to change school food menus and they found it to be a very challenging thing.
The goal was to make the kids healthier meals in the school.
The challenge was that it's more expensive to make healthier meals.
That was one.
So there's the financial burden.
But then almost the bigger challenge was getting the kids to eat the food.
But the people who were the chef, who was in charge of the documentary.
He kept repeating that if you can instill this type of information, this type of knowledge, Within young people's diets and within their minds, so that they know, so that they're thinking about calories,
They're thinking about sugar They're thinking about fats.
They're thinking about what they're putting in their body, then you're creating a person who's going to be thinking about a healthier diet and a healthier version of Themselves when they grow up.
Nice, right.
It's a tough thing to do, but when you can start at that level of, It's almost more effective, I would think, than having weight management information available for people in their 60s and 70s, which is also fantastic.
But if you can start at the bottom of the age scale, if you will, then you can prevent future problems, health problems in the country.
Exactly.
I remember when I was growing up in like six or seven years old, you know, Coca-Cola was very, very popular among kids.
And we have no idea the amount of sugar we consume or the consequences come after it.
You ever watch a video of somebody boiling that down?
Yeah, this is like a ton of sugar yeah so, so we just enjoy them.
We can finish like three or five cans a day oh, my goodness.
Yes, because it's like a competition.
If my cousin grabs one, i need to grab one as well.
So if you're living with kids, you know that, but now i think among my daughter's generation they are more aware of you know, it's delicious i, i like it, but i can't drink it every day.
Let me share with you.
Um, I witnessed it firsthand.
And maybe if you're a parent listening, you can try this with your kids as well.
So my brother-in-law was eating together with his son, my nephew.
And at the end of the meal, my nephew had a small amount of dessert.
And he asked his dad, can I have some more cake?
And instead of saying no, dad said, well, do you think you need it?
And he said, no, I guess not.
He said, well, there's your answer then.
Yeah, I thought, oh.
He started just telling them no.
Effective parenting, right?
Make them think about it, which I thought was kind of cool.
Yeah, really interesting initiatives nationwide and within cities as well.
Hopefully the plans go very, very well.
