IFA 11 th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic 1 |1 |...

IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic1 |

Linking Evidence to Health Policy for the Ageing:

A Social Health Atlas of Older Adults in a Major Japanese City

Megumi Kano,1 Jimpei Misawa,2 Kayo Suzuki,3 Masataka Nakagawa,3 Katsunori Kondo3

1WHO Centre for Health Development, Kobe, Japan; 2Rikkyo University, Tokyo, Japan;

3 Center for Well-being and Society, Nihon Fukushi University, Nagoya, Japan

Linking Evidence to Health Policy for the Ageing:

A Social Health Atlas of Older Adults in a Major Japanese City

Megumi Kano,1 Jimpei Misawa,2 Kayo Suzuki,3 Masataka Nakagawa,3 Katsunori Kondo3

1WHO Centre for Health Development, Kobe, Japan; 2Rikkyo University, Tokyo, Japan;

3 Center for Well-being and Society, Nihon Fukushi University, Nagoya, Japan


Japan’s achievements in longevityJapan’s achievements in longevity

Life expectancy at birth– 86 yrs for women, 80 yrs for men

Healthy life expectancy at age 60– 21.7 yrs for women, 17.5 yrs for men

Key contributing factors: – Health system and health services– Social and physical environment– Health behaviour– Genetics


The demographics of ageing in JapanThe demographics of ageing in Japan


RAPID ageingRAPID ageing


Key ChallengesKey Challenges

Ageing of the urban population

Dwindling resource base

Growing income inequalities health inequalities?

“Ageing in Place”

Lack of data to enable evidence-based policy and practice, especially at the local government level


Project ObjectivesProject Objectives

To establish a mechanism for integrating research into policy and programme development to promote elderly health and wellbeing in a major metropolitan area of Japan

To build the epidemiological evidence base on the broader determinants of health and wellbeing among elderly residents in rapidly ageing urban areas

To empower local stakeholders to create healthy conditions in which people live, work, and age


Main Project Partners Main Project Partners

City of Kobe: Public Health and Welfare Bureau, Health Division, Long Term Care Insurance Unit (Kobe, Japan)

Centre for Well-being and Society, Nihon Fukushi University (Nagoya, Japan) and the JAGES Research Group

WHO Centre for Health Development (Kobe, Japan)

Common interests in urban health, health equity assessment, social determinants of health, and evidence-based policy/programme development


Japan Gerontological Evaluation Study (JAGES)

Japan Gerontological Evaluation Study (JAGES)

One of the few population-based social epidemiological gerontological surveys in Japan

Conducted in 1999, 2003/4, 2006/7, 2010/11

2010/11 included 112,123 individuals across 31 municipalities in 12 prefectures

Kobe City was among the first few major metropolitan areas to join this study in 2010/11


Survey ItemsSurvey Items

Health status indicators: self-rated health, chronic conditions, health behavior, oral health, nutrition/diet, tobacco, alcohol, ADL/IADL, etc

Psychological indicators: depression, subjective well-being, etc

Social indicators: social support, social capital, social participation

Socioeconomic status indicators: income, education, relative deprivation, pension, etc

Environmental indicators: road safety, parks and recreation, accessibility, etc


JAGES Survey: KobeJAGES Survey: Kobe

Kobe City has the sixth largest population in Japan and a significant proportion of elderly residents (20% in 2005)

It is a “government-decreed city”

Representative sample of 15,000 independent, community-dwelling elderly residents aged 65 years or older

– 9,873 responses (66% response rate)– 9,328 valid responses

Self-administered mail survey conducted between December 2011 and February 2012


Kobe sample characteristicsKobe sample characteristics

Age (years)65-7475-8485-9495-99

56.3%37.7%5.8%0.2%

SexMale

Female45.2%54.8%

Equivalent household income groupLow (<2 million JPY)

Middle (2-4 million JPY)High (>4 million JPY)

43.6%33.9%8.4%

Household compositionLone elderly

Elderly coupleOther

23.3%44.8%31.9%

IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic12 |柏市

名古屋市知多

市東浦町

大府市

半田市

西尾市

碧南市

神戸市

吉良町

美瑛町

東海市

度会町

武豊町

一色町

幡豆町

高梁市

十和田市

阿久比町常滑

市美浜町

岩沼市

中央市

東神楽町

十津川村松浦

市

南知多町東川

町南城市

今帰仁村全体

60%

65%

70%

75%

80%

85%

90%

87.2

%

83.5

%

82.8

%

82.7

%

82.1

%

81.4

%

80.8

%

80.5

%

80.3

%

80.2

%

79.7

%

79.5

%

79.4

%

78.8

%

78.2

%

78.2

%

78.2

%

78.0

%

78.0

%

77.9

%

77.6

%

77.2

%

77.1

%

76.7

%

76.1

%

75.9

%

75.2

%

74.0

%

72.8

%

67.6

%

79.2

%

Pro

po

rtio

n r

epo

rtin

g "

very

go

od

" o

r "s

om

ewh

at g

oo

d"

hea

lth

Self-rated health: “Very/Somewhat good”

Self-rated health: “Very/Somewhat good”

KobeMean

Nagoya


Income inequalityIncome inequality

柏市東浦町

知多市

武豊町

大府市

東海市

阿久比町神戸

市

名古屋市常滑

市岩沼市

東神楽町美瑛

町半田市

西尾市

吉良町

美浜町

中央市

東川町

松浦市

碧南市

度会町

幡豆町

十和田市一色

町南城市

十津川村高梁

市

南知多町

今帰仁村全体

0.0

0.1

0.2

0.3

0.4

0.5

0.32

9

0.34

2

0.34

9

0.35

2

0.35

6

0.35

6

0.35

9

0.36

3

0.36

5

0.37

5

0.37

5

0.38

1

0.38

3

0.38

5

0.38

8

0.39

8

0.39

8

0.40

1

0.40

5

0.40

5

0.40

5

0.40

9

0.41

1

0.41

5

0.41

7

0.41

8

0.42

1

0.42

2

0.43

8

0.47

6

0.39

4

Gin

i co

effi

cien

t

Kobe

Gini coefficient for total population = 0.329


Physical environment: Parks and pedestrian paths

Physical environment: Parks and pedestrian paths

名古屋市神戸

市柏市美瑛町

東海市

知多市

大府市

東川町

東浦町

碧南市

半田市

東神楽町中央

市幡豆町

阿久比町武豊

町吉良町

十和田市度会

町美浜町

岩沼市

南城市

松浦市

南知多町

今帰仁村西尾

市常滑市

高梁市

一色町

十津川村全体

20%

30%

40%

50%

60%

70%

80%

90%

100%

85.2

%

85.1

%

82.5

%

81.7

%

81.2

%

79.8

%

79.7

%

78.4

%

78.3

%

77.9

%

75.3

%

72.7

%

72.6

%

71.9

%

71.1

%

69.3

%

69.1

%

68.4

%

67.9

%

67.4

%

66.8

%

66.6

%

65.6

%

65.5

%

64.1

%

63.6

%

63.6

%

53.3

%

50.8

%

38.7

%

71.9

%

Th

ere

are

par

ks a

nd

ped

estr

ian

pat

hs

go

od

fo

r w

alki

ng

an

d e

xerc

isin

g

Kobe


Social-physical environment: Places to visit for a casual drop in Social-physical environment:

Places to visit for a casual drop in

今帰仁村南城

市東川町

度会町

東神楽町

十津川村美瑛

町幡豆町

碧南市

高梁市

南知多町松浦

市吉良町

東浦町

中央市

大府市

半田市柏市

十和田市西尾

市一色町

岩沼市

美浜町

東海市

知多市

武豊町

神戸市

阿久比町常滑

市

名古屋市全体

0%

10%

20%

30%

40%

50%

60%

70%

62.3

%

58.5

%

56.8

%

55.5

%

55.3

%

51.2

%

51.0

%

50.0

%

49.3

%

48.5

%

46.9

%

46.8

%

46.4

%

45.5

%

45.2

%

43.4

%

43.2

%

42.2

%

42.0

%

41.8

%

40.7

%

40.6

%

40.6

%

39.6

%

39.0

%

37.7

%

37.4

%

36.9

%

36.6

%

35.6

%

42.9

%

Th

ere

are

ho

mes

or

faci

liti

es w

her

e I

can

cas

ual

ly d

rop

in

Kobe


Social capital: Trust in the community

Social capital: Trust in the community

今帰仁村南城

市

十津川村松浦

市幡豆町

吉良町

一色町

西尾市

高梁市

南知多町碧南

市柏市東川町

美瑛町

知多市

常滑市

阿久比町度会

町大府市

東浦町

美浜町

東神楽町中央

市武豊町

十和田市

名古屋市東海

市岩沼市

神戸市全体

40%

50%

60%

70%

80%

90%

100%

88.3

%

78.9

%

78.8

%

78.6

%

78.4

%

78.2

%

77.5

%

76.1

%

76.1

%

75.5

%

74.6

%

73.8

%

73.7

%

73.4

%

73.3

%

72.5

%

72.2

%

72.2

%

72.1

%

71.9

%

71.7

%

71.1

%

70.9

%

69.3

%

69.0

%

68.0

%

67.9

%

67.7

%

67.4

%

72.4

%

Per

cep

tio

n t

hat

peo

ple

in

th

e co

mm

un

ity

can

be

tru

sted

(%

)

Kobe


Determinants of health*Ages 65-74 only

Determinants of health*Ages 65-74 only

Prevalence of low BM

I <18.5

Trust in the community Coefficient of correlation=-.539

Ecological analysis at the municipality level

0%

20%

40%

60%

80%

0% 20% 40% 60%

r=.568

この３年間で地域住民の活動や交流が衰退したと感じた人の割合

閉じこもり者の割合

Prevalence of social isolation

Multilevel analysis at the sub-municipality level

Sense of decline in community activities and relationships in past 3 years

Coefficient of correlation=.568


Small-area data mappingSmall-area data mappingHas not received health

check-up in the past year (%)

Goes out less than once a week(%)

Geriatric Depression Scale score

*)Only among >=75(

Had a fall in the past year(%)


Interactive data mappinghttp://www.doctoral.sakura.ne.jp/WebAtlas/Kihonchecklist/Single/kinki/atlas.html

Interactive data mappinghttp://www.doctoral.sakura.ne.jp/WebAtlas/Kihonchecklist/Single/kinki/atlas.html

http://www.doctoral.sakura.ne.jp/WebAtlas/Kihonchecklist/Single/kinki/atlas.html

http://www.doctoral.sakura.ne.jp/WebAtlas/Kihonchecklist/Single/kinki/atlas.html


ConclusionsConclusions

Older adults in large urban areas may feel healthier and benefit from better infrastructure and economy, but may experience poorer social well-being compared to smaller, more rural municipalities

Multilevel analysis confirmed some of the correlations between neighbourhood-level social factors and health indicators

Systematic collection, mapping, and analysis of social and health data by small geographic units are crucial to develop policies and programmes that are responsive to the geographically non-uniform needs of the local elderly population

Technological innovations have made interactive data mapping a feasible and effective tool for both researchers and policy-makers

IFA 11 th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic 1 |1 |...

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