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Chapter 2 / Complete chapter

Preventing Chronic Decline

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Chapter 2 editorial cartoon: A full wellness cart. An empty habit tracker. Enlarge illustration
A full wellness cart. An empty habit tracker.

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Editorial cartoon · Chapter 2A full wellness cart. An empty habit tracker.

Original illustration with Chinese lettering; the English dialogue is below. Humour is a reading aid, not evidence.

English dialogue
  • I take health seriously!
  • What does your average day look like?

Quitting smoking, the earlier the better

On average, smokers live more than 10 years less than non-smokers. Quitting before age 40 eliminates roughly 90% of the extra death risk caused by con…

Cost
It costs nothing — in fact, it saves money. A pack-a-day habit costs roughly $3–$4, which …
Benefit
One U.S. study that tracked participants without assigning them to groups found that curre…

Don’t smoke at home or in the car, and don’t let guests smoke indoors

Around 600,000 people worldwide die each year from secondhand smoke exposure; nearly 30% of those are children. Long‑term exposure to secondhand smoke…

Cost
There is no monetary cost and it takes little time. The challenge is simply having the con…
Benefit
In 2004, secondhand smoke caused 603,000 deaths globally — about 1.0% of all deaths worldw…

Pick a quit date and stop smoking on that day — don’t taper gradually

Many people try to cut back a little each day until they reach zero. Yet after six months, only 15.5% of those who gradually reduced their intake stay…

Cost
No cost at all. Just choose a date on the calendar and let family and coworkers know in ad…
Benefit
In the UK, 697 smokers were randomly assigned to two groups. One group quit on a predeterm…

Visit a smoking cessation clinic or call 12320 to find local services

Medications and regular follow-up support from professionals are two distinct components that work best together. People who take medication while rec…

Cost
A single clinic visit costs only a few to dozens of yuan. Behavioral support typically inv…
Benefit
Across 52 trials involving 19,488 participants, the combination of medication and behavior…

Only consider e‑cigarettes if you’ve already tried quitting; non‑smokers should avoid them

Switching to nicotine‑containing e‑cigarettes helps roughly 60% more people quit smoking than nicotine patches — this finding is quite reliable. Howev…

Cost
The device plus cartridges cost anywhere from a few dozen to several hundred yuan per mont…
Benefit
This up‑to‑date review includes 80 randomized trials involving 29,861 participants. Compar…

Not drinking sugary drinks — even switching to sugar-free ones doesn’t help

People who drink more than two sugary drinks per day have about a 20% higher chance of dying during the same period compared to those who rarely drink…

Cost
There’s no cost involved, nor does it take any extra time. Switching to plain water or sug…
Benefit
Two large U.S. studies followed large groups of people without any subgroup categorization…

Not chewing betel nut

People who chew betel nut have roughly a 20% higher chance of dying during the same period compared to non-chewers. Their risk of developing diabetes …

Cost
It costs nothing, takes no time, and saves money that would otherwise be spent on betel nu…
Benefit
Data from 17 Asian studies involving 388,000 participants show that chewing betel nut rais…

Switch household salt to low‑sodium (potassium‑rich) salt

For people who have had a stroke or are over 60 with hypertension, switching to low‑sodium salt can lower their chance of dying within five years by a…

Cost
One bag costs a few yuan more than regular salt. It’s easy to switch when you shop, adding…
Benefit
A randomized trial conducted in rural China enrolled 20,995 participants — all stroke surv…

Brush teeth thoroughly, clean between teeth daily, and see a dentist if you have missing teeth

People who clean between their teeth daily have roughly a 10% lower chance of dying over the same period. For elderly individuals with no natural teet…

Cost
Dental floss or interdental brushes cost just a few dozen yuan per year, while professiona…
Benefit
A Japanese study followed 9,676 participants for six years. Those who used interdental cle…

Walking 7,000–8,000 steps per day, or accumulating 150–300 minutes of brisk walking each week

People who walk roughly 7,800 steps daily have a mortality risk roughly 45% lower than those walking only 3,500 steps. The same pattern holds when mea…

Cost
It costs nothing. In terms of steps, walking 60–90 minutes daily can easily be split into …
Benefit
Fifteen studies tracking large groups of people were combined for analysis without subgrou…

Screen blood lipids regularly in adulthood (every 2 to 5 years before age 40, annually from age 40); take prescribed medication consistently for hypertension and dyslipidemia, never stopping on your own

For every 10 mmHg drop in systolic blood pressure, mortality decreases by roughly 13%, while stroke risk drops by about 27%. Each 1.0 mmol/L reduction…

Cost
Generic hypertension drugs and statins cost only a few to several dozen yuan per month. Th…
Benefit
Pooled data from multiple randomized controlled trials show that a 10 mmHg reduction in sy…

Getting about 7 hours of sleep each night with a consistent schedule

People who regularly get less than 7 hours of sleep have roughly a 10% higher chance of dying over time. The more irregular their schedule, the greate…

Cost
No cost involved. You simply need to allocate time for sleep — most people achieve this by…
Benefit
A pooled analysis of 16 longitudinal studies — involving 1.38 million participants and 113…

Playing racket sports three times a week for 45 minutes each session

People who regularly play tennis, badminton, or table tennis have about half the risk of dying during the same period compared to non-players. Their r…

Cost
The cost of court fees is typically a few dozen yuan per session. This amounts to roughly …
Benefit
A UK-based study tracking 80,300 participants compared those who engaged in racket sports …

Accumulating brief bouts of strenuous activity like stair climbing or brisk walking to total 4–5 minutes per day

For individuals who do not exercise regularly, performing just three 1–2 minute bouts of strenuous activity each day can reduce their overall risk of …

Cost
There is no cost involved, and no extra time needs to be set aside for exercise. The main …
Benefit
A study conducted by the UK Biobank involved 25,200 participants who did not engage in reg…

30–60 minutes of strength training per week

People who engage in 30–60 minutes of strength training each week have a 10–20% lower risk of dying during that period compared to those who don’t tra…

Cost
Doing bodyweight squats and push-ups costs nothing. Aim for 1–2 sessions per week, each la…
Benefit
When multiple observational studies are pooled together (without subgroup analysis), indiv…

Don’t sit for too long at a time — get up and move every now and then

People who sit the longest have a 2.6 times higher chance of dying during the same period compared to those who sit the least. Sitting continuously fo…

Cost
It costs nothing; getting up a few times doesn’t take much time at all. The hard part is t…
Benefit
One U.S. observational study used accelerometers to measure activity levels without groupi…

Eat less processed meat (ham, bacon, sausages, luncheon meat)

People who eat the most ham, bacon, sausages, and similar processed meats have a roughly 20% higher chance of dying during the same period compared to…

Cost
It costs nothing — in fact, it saves money — and doesn’t take extra time. The hard part is…
Benefit
When multiple long‑term studies are pooled together (without separating participants into …

Drink less or no alcohol

After consuming 100 g of pure alcohol per week, the more one drinks, the earlier they tend to die. 100 g of pure alcohol is roughly equivalent to 2.5 …

Cost
There is no cost at all — it saves money and time. The only difficulty is handling social …
Benefit
A combined analysis of 83 longitudinal studies involving 600,000 drinkers showed that the …

To drink less, first tally how much you drink each week, then chat briefly with a doctor.

A doctor can spend a few minutes reviewing your weekly alcohol intake, explaining the associated risks, and helping you set a realistic goal. After a …

Cost
No cost at all. Just count the number of drinks each day and jot it down. Asking your doct…
Benefit
Data from 34 randomized trials involving 15,197 participants show that individuals receivi…

Eating a small handful of nuts daily

People who regularly eat nuts have roughly 20% lower mortality rates than those who don’t. Even eating nuts just once a week yields a 10% reduction in…

Cost
Consuming 28 grams per day costs roughly 200–300 yuan annually. It’s easy to fit into your…
Benefit
Two U.S.-based longitudinal studies tracked 119,000 participants over more than 3 million …

Swapping some red meat for fish or poultry

Eating two extra servings of processed or red meat each week raises the risk of death by roughly 3% compared to normal intake. Switching to the same a…

Cost
There’s no extra cost or time involved. You’re simply substituting one type of meat for an…
Benefit
This conclusion comes from pooling data across six U.S. studies involving nearly 30,000 pa…

Swap some refined rice and flour for whole grains

People who eat an extra 90 g of whole grains daily have a roughly 17% lower risk of dying during the same period. That amount equals about three servi…

Cost
Whole grain options like brown rice, oats, and whole wheat flour cost slightly more than r…
Benefit
Pooled data from multiple observational studies (no intervention groups used) shows that a…

Drinking tea more than three times a week

People who regularly drink tea have a roughly 15% lower chance of dying during the same period. Starting at age 50, they can expect to live 1.26 years…

Cost
It costs just a few dozen to a few hundred yuan per year. Brewing a cup takes only a few m…
Benefit
A study conducted in China involving 100,900 participants, called China-PAR, tracked half …

Drinking three to four cups of coffee daily, without sugar or cream

People who drink three to four cups of coffee each day have a roughly 17% lower chance of dying during the same period compared to those who don’t dri…

Cost
Making coffee at home costs just one or two yuan per day. It takes only a few minutes to b…
Benefit
One review combined results from 201 separate studies; all of these original studies simpl…

Eating 5 servings (about 400 g) of fruits and vegetables daily

Consuming an extra 200 g of fruits and vegetables each day lowers the risk of death by roughly 10% during the same period. People who eat 5 servings d…

Cost
It costs only a few to a dozen yuan per day. You also need to spend some time washing and …
Benefit
When pooling data from multiple longitudinal studies (without subgroup analysis), an addit…

Eat fewer ultra-processed foods (chips, instant noodles, pastries, ready meals)

People who consume the most ultra-processed foods have a roughly 20% higher risk of dying during the study period compared to those who eat the least,…

Cost
There’s no direct monetary cost, but you’ll need to spend time cooking or selecting minima…
Benefit
One systematic review combined data from multiple studies, even though those original stud…

Switching from coal and wood to electricity or gas for cooking and heating

People who cook with coal or wood face roughly a 10% higher chance of dying over the same period compared to those using electricity or gas. For those…

Cost
Rural households must replace their stoves and pay higher fuel costs, resulting in an annu…
Benefit
A Chinese longitudinal study tracked 271,000 adults without cardiovascular disease, record…

Let hot drinks cool down before drinking; avoid tea, soup, and coffee that are piping hot

Drinking tea that is extremely hot raises your risk of esophageal cancer by 8 times compared to drinking lukewarm tea. Even “hot” tea doubles that ris…

Cost
There’s no monetary cost — you just need to wait two to three extra minutes each time. The…
Benefit
In a high-risk area for esophageal cancer in northern Iran, researchers compared 300 patie…

Getting some sun during the day — don’t stay out of the light all the time

Women who deliberately avoid sunlight can expect to live 0.6 to 2.1 years less than those who get the most sun exposure. Even non-smokers who avoid th…

Cost
No cost at all. Just a few minutes each day — on your commute or during lunch breaks is en…
Benefit
A Swedish study followed nearly 29,500 women for 20 years. Compared to the group getting t…

Keeping BMI between 20–25; losing weight if overweight

Mortality is lowest when BMI falls within 20–25. At BMI 27.5–30, risk rises by roughly 20%; at 30–35, it increases by about 45%; at 35–40, it nearly d…

Cost
There is no monetary cost. However, diet and exercise require daily time commitment. This …
Benefit
This analysis combined individual data from 239 longitudinal studies (no subgrouping was p…

Eating chili peppers four or more times per week

People who eat chili peppers four or more times each week have a roughly 23% lower chance of dying during the same period compared to those who rarely…

Cost
There are no costs or time commitments involved.
Benefit
A study conducted in Italy included 22,800 participants, with half of them followed for an…

Drinking one or two servings of milk or yogurt daily

People who consume two or more servings of milk or yogurt each day have a roughly 17% lower chance of dying during the same period compared to those w…

Cost
Only a few yuan per day, with no extra time required.
Benefit
The PURE study followed over 136,000 participants across 21 countries for an average of 9.…

Take baths whenever you can — don’t limit yourself to showers

People who bathe almost daily have roughly 28% lower risk of cardiovascular events and about 46% lower risk of brain hemorrhage compared to those who …

Cost
It costs a bit more in water and electricity; each bath takes about half an hour.
Benefit
A Japanese study involving 30,000 participants followed over 19 years identified 2,097 car…

Keep naps under 30 minutes—no longer than an hour. If you regularly need a one- or two-hour nap to get through the day, it’s time to see a doctor.

People who nap for less than an hour show no increase in mortality or chronic disease risk, and their mental clarity actually improves. In contrast, t…

Cost
Free. Just set an alarm before you nap; it requires very little willpower.
Benefit
One umbrella meta-analysis compiled data from 16 separate meta-analyses covering 244 healt…

Catch up on sleep the night after a sleepless night — don’t wait until the weekend

People who get less sleep than they need and fail to make it up the following night have roughly a 15% higher risk of mortality compared to those with…

Cost
No cost at all. Those extra hour or two of sleep you make up are exactly what you’d have w…
Benefit
This meta-analysis involved 85,618 participants from the UK Biobank, with an average age o…

The longer you work night shifts, the higher your cardiovascular risk — switch if you can

People who work night shifts develop cardiovascular disease about 13% more often than those who don’t, and cardiovascular deaths rise by roughly 27%. …

Cost
Switching jobs or changing shifts may mean a pay cut and loss of night-shift bonuses. Job …
Benefit
A pooled analysis of 23 studies — all observational, no subgroup adjustments — shows that …

Buy pre-packaged cooking oil with an SC code; avoid bulk, unregulated homemade peanut oil

When peanuts get damp and moldy, they produce aflatoxin, a confirmed human carcinogen that primarily harms the liver. After Guangzhou tightened regula…

Cost
The price difference isn’t huge if you shop elsewhere. Just check whether the packaging li…
Benefit
Aflatoxin is a Group 1 carcinogen per the International Agency for Research on Cancer, mea…

Replacing lard and butter with vegetable oils for cooking: you don’t need to switch oils for health reasons, nor should you expect flaxseed oil to protect your heart

Cutting back on saturated fats like lard and butter and switching to vegetable oils lowers the risk of heart disease and stroke by roughly 17%. Howeve…

Cost
It doesn’t cost much extra. Vegetable oils are already the main choice in most households;…
Benefit
A Cochrane review analyzed 15 randomized trials involving 56,675 participants, each follow…

Turn on the range hood while stir-frying and deep-frying, from the moment you light the stove until the cooking is done.

Non-smoking Chinese women who rarely or never use a range hood while cooking face roughly twice the risk of developing lung cancer compared to those w…

Cost
For households already equipped with a range hood, the extra expense is just a bit more on…
Benefit
Ten case-control studies involving non-smoking Chinese women were pooled for analysis. In …

If severe perimenopausal hot flushes and night sweats disrupt your daily life, seek clinical evaluation for hormone replacement therapy; do not endure in silence, self-medicate, or use it to prevent heart disease

Menopausal hormone therapy reduces the frequency of moderate-to-severe hot flushes by roughly 75% compared to placebo. However, it carries a small exc…

Cost
Requires a consultation at a gynecology or menopause specialty clinic. The clinician evalu…
Benefit
A Cochrane systematic review of 24 randomized controlled trials involving 3,329 women comp…

If you already plan to adopt a dog, count daily dog walking toward your physical activity goals, but do not acquire a dog solely expecting to extend lifespan

Observational studies show that dog owners have an average 24% lower risk of all-cause mortality, with even stronger associations among individuals li…

Cost
Dog ownership represents a substantial, ongoing financial commitment covering food, vaccin…
Benefit
A meta-analysis pooling 10 prospective cohort studies comprising 3.84 million participants…

If diagnosed with prediabetes (elevated blood glucose below diabetes threshold), delay progression through dietary caloric restriction, weight loss, and increased physical activity; retest glucose every six months

For individuals with elevated blood glucose who have not yet reached the diagnostic threshold for diabetes, eating less, moving more, and losing a mod…

Cost
Zero financial cost; eating less saves a little money. Accumulate at least 150 minutes of …
Benefit
The Da Qing Diabetes Prevention Study was a clinic-randomized trial conducted in Da Qing, …

If peanuts, corn, tree nuts, rice, or flour develop mold, discard the entire package rather than picking out visibly spoiled pieces; spit out bitter-tasting nuts immediately

Moldy peanuts and corn can produce aflatoxins, potent chemical carcinogens that cause liver cancer. In a long-term Shanghai prospective cohort, indivi…

Cost
Discarding a spoiled bag of peanuts, nuts, or grain costs a few to several dozen yuan. Sto…
Benefit
Aflatoxins are classified as Group 1 human carcinogens by the International Agency for Res…

Avoid eating raw or drunken freshwater fish and shrimp (including freshwater sashimi, raw fish porridge, and drunken prawns); if you have eaten them regularly, test for liver flukes and take prescribed praziquantel

Consuming raw or undercooked freshwater fish and shrimp can transmit Clonorchis sinensis (the Chinese liver fluke). It is an established biological ca…

Cost
Avoiding raw freshwater fish costs nothing; the difficulty is breaking long-standing regio…
Benefit
Clonorchis sinensis was evaluated in 2009 by the WHO International Agency for Research on …