Successful Aging in Japan: The Role of the Government · PDF fileSuccessful Aging in Japan:...
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Successful Aging in Japan: The Role of the Government
Yasuhiko Saito
Nihon University, Tokyo, Japan
Presented at AASSREC Conference on
"Ageing in Asia-Pacific:
Balancing the state and the family"
held on April 4-5 in Cebu, Philippines
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• This presentation is based on collaborative work with Dr. Vanessa Yong and Dr. Yuka Minagawa.
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Overview of the Presentation
• Successful Aging
• Individual Level Determinants of Successful Aging
• Concept of Health
• Macro Level Factors for Successful Aging
– 4 Areas of Concern
• Critical view of Successful Aging
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Successful Aging
• The term successful aging was first introduced in 1961 in an article published in The Gerontologist.
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Definition of Successful Aging
• by Rowe and Kahn (The Gerontologist, 37(4):433-440, 1997)
1) avoidance of disease and disability
2) maintenance of high physical and cognitive function
3) sustained engagement in social and productive activities
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Determinants of Successful Aging
• Studies on successful aging centered around individual level determinants of healthy aging such as
–behavioral predictor of healthy aging
–psychosocial predictors of health aging
– in particular lifestyle factors • diet, exercise, smoking
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Concept of HEALTH
• Very important factor for Successful Aging
• How to define "HEALTH?"
• What is "healthy aging?"
• One way of realizing Successful Aging may be "Pin Pin Korori"
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Definition of Health
• WHO: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
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5 Aspects of Health
• Healthy
• Diseases, Conditions, and Impairments: – stroke, heart disease, pain, loss of vision
• Functioning: – walking, kneeling, grasping
• Disability: – ability to perform personal activities,
independent living, work
• Death
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Transition among Health States
Diseases
Conditions
Impairments
Functioning
Loss
Disability
Death
HEALTHY
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Pin Pin Korori
• Phrase used in a campaign in Japan to promote healthy aging about 30 years ago
• “Pin Pin” is to keep healthy, bouncing and dynamic, “Korori” is to roll over and die.
• Meaning of the phrase: to live a long life without illness and when the time is up simply die peacefully
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2 concepts to be considered
• Longer life
– For a society: aging (increase in life expectancy)
– For an individual: longevity (reaching every member of a society to maximum life span)
• Healthy life
– For a society: active aging (increase in healthy life expectancy
– For a individual: longevity without unhealthy period
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Life Expectancy
• Average length of expected life for a population
• Summary measure of age-specific mortality rates
• Life expectancy goes up if mortality rates go down
• Life expectancy can be computed at any age
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Longevity (Life Span)
• Biological limit for human being exists?
– We don’t know exactly yet.
– Probably around 120 years? (Bible, Koran)
• Longest life human being ever lived?
– French woman: Jeanne Calment
– With proof: died in August 1997, at the age of 122 years and 164 days
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Health Expectancy: Definition
Summary measure of both mortality and morbidity
Life Expectancy = Healthy Life Expectancy
+ Unhealthy Life Expectancy
86 Years of Life = 82 Years of Healthy Years
+ 4 Years of Unhealthy Years
4 years of unhealthy years do not mean the last 4 consecutive years of life.
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Survival curves for morbidity, disability, and mortality:
Percentages surviving to given age without the event
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100 110
Age
Mortality
Disability
Morbidity
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0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100 110
Age
Pin Pin Korori: Rectangularization of survival curves
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Definition of Successful Aging
• Definition has been revised and broadened.
– life satisfaction
– subjective well-being
– social interaction
– consider age, gender and cross-cultural differenced
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Role of Government in Successful Aging
• shift focus from individual level factors to macro level factors which could help successful aging for individual
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Samantha Bennett, Health Promotion Board, Singapore, presentation at Healthy Ageing in Asia, held from March 4-5, Singapore
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The Japanese Context
• Total population: 127 million
• Known for homogenous, egalitarian and cohesive society (?)
• Fertility 1.37
• Life Expectancy at Birth
– F 86.4, M 79.64 in 2010
• 2 characteristics of population aging in Japan
– speed and aging among older population
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Changes in Proportion of Aged 65+
Country 7% 14% 21% Years from
7% to 14%
Years from
14% to 21%
Japan 1970 1994 2005 24 11
France 1862 1979 2021 115 42
Sweden 1887 1972 2018 85 46
UK 1929 1976 2019 47 43
USA 1942 2014 2050 72 36
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Proportion of Aged 75+ in Aged 65+
Country 2000 2025 Difference
Japan 40.7% 59.1% 18.4
France 46.2% 48.5% 2.4
Sweden 51.3% 52.2% 0.9
UK 46.9% 48.6% 1.7
USA 47.3% 42.2% -5.1
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4 Areas of Concern
• Healthcare for Older Adults
• Employment and Re-employment of Older Workers
• Social Participation and Active Aging
• Aging-in-Place: Housing and Transportation Policies
• (Pension)
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Healthcare
• Universal Health Insurance Coverage
• The Gold Plan
• National Long-Term Care Insurance
• Care Prevention Program
• Healthy Japan 21 and 2nd Healthy Japan 21
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Employment and Re-employment
• Rising the Retirement Age and Promoting Continued Employment
• Re-employment of Older Workers
• Temporary and Short-term Employment (Silver Human Resource Centers)
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Social Participation and Active Aging
• Age-Less Life Practitioners and Groups Award
• Life-Long Learning
• Educational Supporter System
• JICA Senior Volunteer
• Senior Citizens' Clubs: Rojin Clubs
• Japan Association of Second-life Service
• Programs of Free Reduced Fare for Public Transportation
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Aging-in Place: Housing and Transportation Policies • To enable older Japanese to age-in-place and
continue to live within their community in a familiar environment rather than to move to institutional living, over the past few decades the Japanese government has formulated and implemented various housing and transportation policies for older Japanese.
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Housing
• Housing Plan for Senior Citizens in the Local Regions: This policy mandated every local government to establish a plan for housing older people.
• Housing loans at low-interest rates
• Silver Housing program: subsides for the construction of senior housing for both widowed elderly and elderly couples.
• Design Guidelines of Dwelling for an Ageing Society: universal design for all ages
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Transportation
• Transportation Accessibility Improvement Law: To ensure that older as well as disabled Japanese lead a self-reliant life to the greatest extent possible.
• The key objective is to ensure complete barrier-free accessibility at railway stations, streetcar stops, bus terminals, ferry terminals and airport passenger terminals.
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Successful Aging: for WHAT?
• Successful Aging should be means to the end and not end in itself.
• Happiness?
• Satisfaction?
• Well-being?
• Feeling of Achievement?
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IKIGAI: Japanese Word
• Successful Aging for IKIGAI (Sagaza, 2013)
• a reason for living, make life worth living, purpose of life, etc.
• Think about the work in your own language.