 Thank you, Mazda, for really shedding a light on stress as an outcome of a mental health, post-physical health, which we've been talking about more, and also clarifying some of the mediating, complicating factors, regardless of the similar microenvironment, individual-level attributes can also play into differentiating different kinds of mental outcomes. Before we open it up to questions, I'd like to maybe call on Professor Guo from Fudan University in Shanghai, because Professor Chou, in talking about the rapid decline of fertility and rapid aging of the population, I think Shanghai is going through that as well. In fact, the total fertility rate in Shanghai probably had dropped below one, even lower than Singapore today, and you wrote an essay on the leading causes of death as a result of modernization, good lifestyle, and better eating, but dietary problems. Would you like to comment a little bit from the research you've done, the data that you have looked at in response to what the Singapore example might point to? Thank you, Chairman. I am not ready to this Singapore case, but I want to say something about my essay. You mentioned about the leading killers in Shanghai. I focus my research on trying to find the association between the leading cause and urbanization. You can see in the conference compendium, it's on the page 13 to page 14. I want to show that I provide some statistics about the urbanization in Shanghai and the city development, and also the trend of the leading causes. I found actually the leading cause is very stable, and also I found in most cases Shanghai is also almost the same as many industrialized nations. The pattern changed from communicable diseases into non-communicable diseases. I think it's very interesting, but I'm not sure how to link this to the policy options, because it's very difficult to... Thank you. I think you summarized very well in terms of the findings. I really see similarities there. I'd like to turn to Dettler if you have a light to illustrate the points that you didn't get to make earlier today or yesterday. I thought it might be helpful. We have been hearing so much yesterday and today on how do we live in cities, what we call civilization, density and consequence of density and architecture and environment. We are hearing a lot about health and about biology and health and disease and how do we cope with it. I thought perhaps it might be helpful to try to get an overarching idea, how can we combine it and how can we develop a new science. There's a new science and the architects, certainly I would blame them if they're not aware of it. There's a new science and that's the new science of evolution. Everybody has heard, especially our friend from the UK, of Da Vincian evolution. This was descriptive, fantastic hypotheses, but it's only in the last five years that we have the methodology to sequence actually what is down here on the slide, the spiral of evolution starting 3.5 billion years ago with archaebacteria unicellular organisms They're actually still alive, they're not dead. They're still reproducing in some areas in the world. And then from these unicellular organisms, two fish and two amphibia and reptiles and then primates and men, took 3.5 billion years and we know the sequence. Actually it's being sequenced every day, especially in China. Fast, fast rate. Every model organism is being sequenced. So we understand the molecular biology of evolution. And we know that the patents of biology, the patents we live with are very old. Some of the patents are 3.5 billion years old. The way our cells divide essentially and are regulated are essentially still the same as discovered 3.5 billion years ago in evolution. And the brain works very similar to parts of the brain of fish and amphibia and reptiles. We think we are extremely advanced, but we are not. We are working on very old patents. So evolution, that's the consequence, is very, very old. And the more important mechanisms are, the older they are, the better they're conserved. Civilization, urbanization, as we have heard, is extremely fast. And the smithmatch is causing diseases of civilization. We are discussing now diabetes, cardiovascular diseases, mental health, and so on. And I think what we have to do is develop a new science, combining very precise science of evolution, getting more and more precise. And the complexity of civilization and all sociology, socioeconomic, and what combined that. I think this will be the avenue to go and I hope that this will make other people as enthusiastic as I am and many of my colleagues are. Well, thank you for adding that insight. Now the floor is truly open. Comments and questions for any of the four panelists or the general issues of the focus of this panel? Yes, Professor Fu from Fudan. Yes, thank you. I'm from Fudan School of Public Health. And I have a question to Professor Chai. When you look at your prevalence of the diabetes from, for example, in the 1990, 80% and the instant 9%. And in the 2004, it's 8.2%. But in the 2010, now increase very fast. It's in the different, the six years, why they change so much? Yes, they saw that you are the food out of physical inactivity. So do you have some evidences so that, for example, in these two relations, it means to have the food consumption is a greater change or not? Keep your questions and answers brief. Yeah, apart from looking at the prevalence of diabetes, we also have in terms of prevalence, for example, of physical activity, dietary habits, and so forth. And it actually does correlate with the change, of course, given a certain lack period. So yes, the physical activity has decreased over the years and unhealthy consumption has gone up over the years. Yeah, Professor Rahman. I want to thank the panelists for what I thought was a first rate set of presentations, which I guess are so well integrated because of the organizers. But I see two themes and perhaps they reflect my own interests. That cut across suicide, lifestyle, and obesity, frailty, and stress, and the way they were presented. And they have to do with policy interventions. First, does one target the high risk areas according to the analyses that have been made, where these problems are most severe? Or to use the extraordinary image of, yep, the iceberg, the tip of the iceberg, should one do something to improve the whole way of living in the city and shift that curve to the left? I would love to hear the panelists address how they would deal with that in relation to the city. Dr. Yi. I think when we do suicide prevention, there are always the most three phases of intervention, have a primary level, secondary level, and territory level. Now, usually the territory level only has a small population. But when you like to do make any changes, it will be very expensive. For example, when you deal with the mental health patients. Now, for the primary level is supposed to be that is the measure which affects the whole population. That is what we mean. We like to change the population. So for the policymaking, if I was given one dollar, where should I spend my debt dollar? I will spend on the primary care. And I think that would be the one who would have some chance to shift the whole population because suicide itself is still a rare event. In order to target them, it is difficult, but you can manage to enhance the mental health of the whole population. And then there will be a chance to make the difference. Dr. Wu, would you like to take a stab at that? I agree with Paul. I mean, it always makes sense to benefit the maximum number of people. And to do that, you have to take the primary care approach. What is striking is that all governments know that. But no government actually does it. They all focus on the high risk bit. And the question is, why is that? OK, a question from Stephen first and then Richard. A request for some practical assistance from the last four panelists. In East London, there is a rapidly growing involvement of young Bengali men and girls with addiction to alcohol and drugs. Do we think this is largely to do with a breakdown of family structure, depression, or migration, or something else? What could we do about it? Any of the four panels want to take that? We'll be brief. My question would be, what do you mean by primary care? My answer would be to the question of what can we do? I think we have to go to the basics. And I come back to what I said. Why are people committing suicide? Why are they being stressed? We have to ask the question, why? Not how and how can we apply primary care and get a denser care system? Why are they depressed? Because evolutionary, if anxiety is a normal phenomenon and is helpful, actually, you run away. In our society, by education and by density, you cannot run away. If the traffic light is red, then you are killed by a car. OK? So you are educated the wrong way. Against the way our evolution would just to react. And this is, I think, we have to go back to basic science and then try to create a new type of therapy and not just increasing the number of hospitals and primary care doctors. Mars, how would you respond to that question? Well, I think we need to know much more about the value of the urban stressors. We're talking about the urban environments, about the value of the urban stressors. I think the density stress is a good example. What density might mean in Hong Kong might not be true in Berlin. As far as its stress impact is regarded and as far as its mental health impact is regarded. So we urgently need to know more about this. And we, as I said earlier, need a sort of metrics to do this. And we have some examples, and I think but we need to put our brains together, the neuroscientists and the urban planners. And then to draw the consequences. But no, as far as we do not have the information about when stress starts, in which area of this world and in which city of this world, and where the boundaries are and how the degrees and the ranges of stress are, we can't do anything specific about it to, for example, prevent people with a high risk for mental health or mental ill health or depression. Thank you. Richard. Just to follow up your comment. I mean, the positive side of certain kind of stress is that we feel anxiety. We're also paying attention. And complex urban environments are environments that they, I'm not talking about at the psychiatric end of it, but stresses of urban life are also, at that end, ways of focusing attention, paying attention, not taking things for granted and so on. And that's also a natural, I mean, that kind of uncertainty is also, you know, biologically natural to us. The issue I'd raise for you about this for planners is that we're constantly told that we have to remove that kind of anxiety, attention making in the environment. When we make a playground, for instance, we have to make a playground in such a way that it's entirely safe. That we reduce, this is in Britain called health and safety regulations, modeled on the notion that people feel best in an environment where they're destimulated, where they don't have to worry about their safety. It contrasts, for instance, the kinds of playgrounds that the great Dutch architect Aldo van Eyck made, which had no fences at the edge of them, which were next to traffic. And he said, this is a good thing. Children should learn to pay attention to the world beyond their pleasure. Now, that's stressful. It has anxiety, but it also has a very positive side to it. So I have to confess that when I listen to you talk about this, I worry a little that something which is the genius of cities, which is it makes people out of a certain anxiety, worry and so on, pay attention to where they are, is diminished, a low stress environment would be a very deadly, dull environment. Now, I know you're not talking at that end about it, but it impacts on our freedom to create what I think of our living urban spaces. Well, thank you. Well, you have to maybe think about the response. Sharon. Thank you. I suppose I have a comment and a question to our colleague talking about obesity and the food system. A comment, really, which was in relation to Victor's question of is it about the targeted or is it about the universal approach, which I think is very different as to whether it's primary, secondary or tertiary. Because if you think it's a targeted or a universal approach, that's a political question. And there is a movement to think about you in terms of shifting the curve. I moved to thinking about proportionate universalism, which I'll come to later. But a question, a reflection of your work. To me, we live within a globalised food system. And some of the images that you showed were the traditional approaches of behaviour change, trying to get people to put different foods into their mouth and telling them that that's what you should be doing and it's going to be better for your health, which has failed everywhere around the world, in and of itself. So it's a question of where is Singapore in terms of thinking from a policy perspective? How is it thinking about the interaction with the food industry and particularly the food processing industry? If you're talking about the obesogenic environment, you're talking about ultra-processed foods, whether it's the soda or the sorts of foods you spoke about. How is Singapore tackling that in the context of much greater foreign direct investment coming into your country, which is all highly salted, highly sugared, high fat foods? What are you doing as a country? Because of course the uptake of that is always in the cities. That response, Master Yumanda, get back in the shirt. Yeah, thanks for your comment, which is extremely important. What I would like to respond is stress is not harmful per se and would never mean to say something like that and the response to what I showed should never be the creation of a low stress or risk-free environment. That wouldn't be the right consequence, but stress can be harmful under some conditions and we need to know more about these specific conditions in the urban environment. That's an important difference. What I would like to make. Thank you. Dr. Cha, you wanna respond to Erin's question? Yeah, I think there's a difference between tackling obesity and say tackling lung cancer due to smoking. In lung cancer, you can villainize smoking. In obesity, you cannot villainize eating. Perhaps you can villainize sugar in soda, excessive sugar, excessive salt. So I think the strategy is that you need to work with the industry. The difficulty is of course, do we have sufficient science, sufficient knowledge to be able to, especially in food sciences, to be able to work with industry. So take for example, we talk about glycemic index. So in Singapore, noodles, for example, is a well-known dish similar to your pasta, for example. How do you decrease the glycemic index of noodles, for example? So there have been some work with the food industry to come up with different versions of noodle that has lower glycemic index. Substituting the types of oil, for example, at the hawker centers and so forth. So again, working with the industry and to come up with the idea that healthy food is good for business. Can we move towards that kind of better time? Healthy food is good for business. Healthy food is tasty. Thank you, yes. Question from the lashes later. My question is really to Paul Yip. If I look at his chart of suicide rate there, I wonder whether there is a correlation there with property prices and property, and in 2003, property prices read an all-time low when I see suicide rates at all-time high in your chart. And I see recently your suicide rates going up again and everybody from Hong Kong is complaining about property prices shooting through the roof. So really there's kind of a frustration of people's ability to afford a reasonable lifestyle, reasonable being what we are induced to believe is reasonable in the city. Paul. I think that the people commit suicide is usually not from one single causes, right? I think it will be a multiple causes. And I don't think the housing price is a good indicator. The stock prices could be better. But I think what I see, I think in Hong Kong, I think what we need to do, I think since the historical high, it is coming down, it is leveling off now. As I remember in 2008, I think the late, the final quarter of the 2008, we have a financial tsunami, a small financial tsunami in Hong Kong, but the tsunami actually is staying there. It doesn't go up. So I think it is very much due to the, I think the contribution from a lot of people who are working very hard in the community who really do raise the awareness of the depression and re-engaging those wonderful group of people now. I think I don't see any more hands. I'd like to use the last four minutes or so to have each of the panelists maybe give a one minute summary on what you didn't get to say. You know, you packed in a lot of information. I think it would be interesting to hear one more time from the four presenters. If you have things to say. Dr. Wu, you went through very quickly what you were. Yeah, I have a very broad perspective, but since nobody is plugging for the older sector, I will do so because I think in my presentation, I didn't make it clear enough. I don't think we ought to focus on diseases. We always think about aging population diseases. We want to talk about social support caring the impact of disease on the person in terms of dependency, whether they can look after themselves. I think we ought to change all our discussion if we're talking about aging population into designing environments to cater for this very rapidly increasing population both from the urban planner, the policies and health and social policies. I think they ought to work together to deal with that because these people are going to increase dramatically in cities. Thank you, Dr. Wu. Do you have anything else to add? Dr. Cha, anything from Singapore? I think we have talked about different diseases. What I would like to highlight is perhaps the last point on my slide that perhaps what is needed to handle all this complex issue is some form of integrative modeling and simulation. It is done a lot in other sectors but not so much in health sectors. How do you bring about different kind of models from epidemiological models, cause effectiveness models, system dynamics models and bring them all together, including even genomics data? Can I have a virtual population, for example, that correspond to say Singapore in terms of demographics, epidemiological risk factors as well as even genetic risk factors and then simulate what would happen? Because I think policy makers now have very short, or I mean all the time they have very short attention span but they are under pressure to say that how do I make the decision? Perhaps modeling and simulation is a way to go. Thank you. I'll give the last word to Master. My last word. Now that urbanity is becoming more the norm for the seven billion people on this world, it's high time for a good exchange between our different sectors. What we know about the health aspects of urban living is old information, it's old data from decades back and largely collected in the northern hemisphere. I don't know how we can extrapolate from this information on today's urban living and that I think should be a new territory of joint research. Thank you. I think my last word is that we've learned so much from these four experts. Let's give them one more round of applause and no questions.