Contribution to Active Aging

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Contribution to Active Aging

Transcript Of Contribution to Active Aging

Report of the Study Group for Japan’s International Contribution to ‘Active Aging’ (Original in Japanese)
March 2014
International Affairs Division Minister’s Secretariat
Ministry of Health, Labour, and Welfare of Japan

Report of the Study Group for Japan’s International Contribution to ‘Active Aging’
Table of Contents Introduction .............................................................................................................................. 2
1. Purpose and significance of the Study Group .................................................................... 2 2. Consideration process ...................................................................................................... 2 3. Target countries of the consideration ................................................................................ 3 Chapter 1 Background and International Trends in Active Aging....................................... 5 1. Current situation of aging population in ASEAN countries................................................ 5 2. International trends in Active Aging................................................................................. 7 3. Perspectives on promoting cooperation in Active Aging................................................... 10 Chapter 2 Current Approaches and Issues Regarding Aging in ASEAN and Japan ......... 12 1. Current situation of the social security system and aging policies in ASEAN .................... 12
(1) Viet Nam ..............................................................................................................................12 (2) Thailand...............................................................................................................................14 (3) Indonesia..............................................................................................................................17 (4) Malaysia...............................................................................................................................19 2. Aging policies and Active Aging in Japan........................................................................ 21 (1) Transitions in aging policies...............................................................................................21 (2) The current framework for aging policies........................................................................24 (3) Results of field survey in Japan .........................................................................................28 Chapter 3 Recommendations for Future International Cooperation.................................. 32 1. Significance of Japan’s contribution to the area of aging policies ..................................... 32 2. International cooperation needs in ASEAN aging policies and directions for cooperation . 33 3. Japan’s approach to international cooperation................................................................ 38 4. Priority issues for each country and appropriate cooperation .......................................... 40 (a) Viet Nam................................................................................................................................40 (b) Thailand ................................................................................................................................41 (c) Indonesia................................................................................................................................41 (d) Malaysia ................................................................................................................................42 (e) Other ASEAN countries.......................................................................................................42 Conclusion................................................................................................................................. 44 Annex ....................................................................................................................................... 47 (1) Study group members (in hiragana order) ............................................................................47 (2) Discussion points ..................................................................................................................47 (3) Overview of the Study Group...............................................................................................48
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Report of the Study Group for Japan’s International Contribution to ‘Active Aging’
Introduction
1. Purpose and significance of the Study Group
 The world population is aging rapidly, and it is estimated that people aged 60 years or over will reach 2 billion by 20501. In ASEAN, aging rates in some countries will be similar to or even higher than those experienced by Japan in the past.
 Japan, which is experiencing the world’s highest rate of aging, has a long history of adapting policies and legislation for aging society. Aging policy is a part of an overarching restructuring of social infrastructure, and composed of responses to the elderly’s health, welfare and social security needs. Therefore it is essential to be undertaken from an early point. For this reason, the Study Group believes that the Japanese efforts are valuable reference for ASEAN countries, which will face actual aging society hereafter, and have to adapt their policies to aging society.
 Until now, Japan has provided to ASEAN countries training programs and technical cooperations on health and welfare, which are related to aging. However, integrated strategies of cooperation regarding aging have not been elaborated clearly, because it is a new domain within international cooperation.
 For this reason, this Study Group made clear the current situation, the challenges and needs for responding to aging process in ASEAN countries. Then the Study Group took an overview of the whole ASEAN region and defined specific recommendations for cooperation based on Japan’s experience and knowledge to the region and each country in ASEAN.
 By utilizing these recommendations and developing policy dialogues with ASEAN countries, international contributions by Japan on aging policies will be able to support each ASEAN country materialize policies and strategies on the health and welfare for the elderly and further develop a polices for Active Aging.
 Furthermore, because the capacity of elderly to live independently and actively is a common key issue to both Japan and the ASEAN countries, the concept of Active Aging2 was taken as the central theme for this Study Group’s deliberations.
2. Consideration process
 This Study Group reviewed elements of Active Aging as represented in the current international trends, and presented Japan’s future directions in the international cooperation on aging in the ASEAN region.
 In detail, the Study Group analyzed the challenges on aging in ASEAN countries and reorganized the knowledge and experience in Japan that can be utilized for cooperation to ASEAN region.
1 Since the main audience of this report is in the ASEAN countries, the Committee has used the Western calendar instead of Japanese calendar for dates in the text.
2 There are other concepts regarding the support and activities of the elderly, such as “productive aging” and “Aging in Place”.
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Report of the Study Group for Japan’s International Contribution to ‘Active Aging’

From there, the Study Group gave consideration to the possible projects and methods which Japan could contribute to ASEAN countries.  Regarding to international cooperation, a unidirectional delivery of knowledge or transfer of technology is not appropriate. It is important to cooperate on what the partner country needs. The Study Group, therefore, attempted to conduct its deliberations based on ‘user-oriented’ approach (Figure 1).

ASEAN Side

Problem Identification
Analyzing advantages and challenges in
ASEAN countries on Elderly care ・Health and Welfare services ・Poverty and Income Gap ・Difference of Urban and Rural area

Portfolio of Japan’s Experience

Reorganizing knowledge and experience applicable to Asia ・Historical Development

Japan Side

・Community based health and welfare activities

・Human Resource Development e.g. Caregivers training

Priority Setting

Solution (≒ Project )

Identifying appropriate solution for ASEAN countries

Identification of

from the viewpoint of utilizing both their potential strength and Japanese experiences.

Problems and Solutions

Strategy Setting
Cooperation Approach for Government policies
Measures for the development of elderly care/ policy ・Model projects and System development ・Capacity Development ・Technical Support for Policy making

Framework for International Cooperation
・Bilateral Approach ・Regional/ Global Approach ・Industry-academia-government Collaboration ・Open Discussion Forum

Development of “User-oriented ” Cooperation
Figure 1: Deliberation approach taken by the Study Group

3. Target countries of the consideration
 The target of the Study Group’s discussions was centered on the ASEAN countries. Because, Japan has abundant experience and a long history on international cooperation with these countries, these countries are close to Japan geographically, and are expected to continue their economic development and aging of their population rapidly. In particular, the Study Group focused on the recipient countries of Official Development Assistance (ODA), and countries with their aging speed moderate or above (Figure 2). The Study Group conducted hearings from officers and field surveys in Viet Nam, Thailand, Malaysia and Indonesia in order to collect information about the needs of international cooperation on aging policies under limited resources for the study.

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Report of the Study Group for Japan’s International Contribution to ‘Active Aging’
資料:1) UN: World Population Prospects: The 2012 Revision Population Database 2) World Bank Search 2011 (Myanmar; National Accounts Estimates of Main Aggregates, 2010, United Nations Statistics Division)
Figure 2: Classification of ASEAN+3 countries according to aging and GDP per capita
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Report of the Study Group for Japan’s International Contribution to ‘Active Aging’
Chapter 1 Background and International Trends in Active Aging 1. Current situation of aging population in ASEAN countries3  Table 1 shows indicators associated with aging in the ASEAN+3 countries (including China,
Korea and Japan).  High aging rate countries amongst ODA recipients in ASEAN+3 as of 2010 were in the order of
Thailand (12.9%), China (12.4%), Viet Nam (8.9%) and Malaysia (7.8%). Looking at prospect of aging rate in 2025, it is predicted that aging rates of Thailand and China will be 20% or over and Viet Nam will be over 15%. Furthermore, the average life expectancy is rising and life expectancy at birth is 70 years or over for both men and women in those countries.
Table1: Indicators of aging in ASEAN
Sources : 1) UN: World Population Prospects: The 2012 Revision Population Database 2) Statistical data of respective countries. 3) World Bank Search 2011 (Myanmar ; National Accounts Estimates of Main Aggregates, 2010, United Nations Statistics Division) 4) Human Development Report 2007/2008: Published for the United Nations Development Programme (UNDP)
 It is important to extend the Healthy Life Expectancy, which measures the number of years a person of certain age lives with their daily life free from health difficulties. Although Healthy Life Expectancy varies in its definition and not always comparable among countries, each country needs to pay attention to extending Healthy Life Expectancy as well as life expectancy (Table 2)
3 The definition of ‘elderly’ in ASEAN countries is usually 60 years of age and older. When not specified otherwise, the statistics and data in this report referring to ‘elderly’ and ‘aging rate’ take this 60 years and above as the criteria.
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Report of the Study Group for Japan’s International Contribution to ‘Active Aging’
Table 2: ASEAN+3 countries’ Average Life Expectancy and Healthy Life Expectancy
Source : Prepared by the Secretariat based on Global Burden of Disease Study 20104
 According to Table 3 showing Doubling Time5, while it took 25 years for the percentage of people 65 years or older in population of Japan to grow from 7% to 14%, in Viet Nam it is estimated to be 15 years, in Indonesia 17 years, in Laos 19 years and in Myanmar 20 years. This shows the aging will progress faster in those countries than in Japan. Table 3: ASEAN indicators of aging and Doubling Time
Source : Prepared by the Secretariat based on World Bank, World Development Indicators database and United Nations’ World Population Prospects, the 2010 revision.
4 The indicators shown on this figure are different from the data presented by MHLW of Japan, due to the differences in their definition.
5 The number of years required for the proportion of the aged population (65 years and older) from 7% to 14%, and it is used as an indicator of the speed at which aging is progressing.
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Report of the Study Group for Japan’s International Contribution to ‘Active Aging’
 Though aging is progressing rapidly in ASEAN region, sufficient preparation for the aging has not been seen. Figure 3 shows transformation of aging rate in ASEAN+3 together with the years when policies related to aging were implemented in Japan. According to this information, policies such as Universal Health Coverage (UHC) 6, the Elderly Welfare Act, enactment and reform of Free of Charge Health Care for the Elderly, enactment of the Elderly Health Act, “Gold Plan7”, “New Gold Plan” and Long-Term Care Insurance were all implemented in Japan before the aging rate reached 14%. In contrast to Japan, UHC has been realized in only a few of the ASEAN countries, and many countries have not established legal systems for sufficiently supporting elderly people.
14%
Source : Prepared by the Secretariat based on UN, World Population Prospects, The 2010 Revision. Figure 3: Aging rate (65 years and older) in ASEAN+3 countries and policies for Aging Society in Japan
2. International trends in Active Aging  According to the World Health Organization (WHO), “Active ageing is the process of optimizing
opportunities for health, participation and security in order to enhance quality of life as people age.”8
6 According to the WHO definition, UHC refers to the situation in which the entire population has access to basic health care services when needed and at costs that can people are able to pay.
7 Ten Year Strategy for Health and Welfare of the Elderly, which included a specific targets of doubling institutional beds and tripling special nursing homes and community-based services for older people over 10 years. This strategy was replaced by “New Gold Plan.”
8 WHO (2002) Active Ageing Policy Framework
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Report of the Study Group for Japan’s International Contribution to ‘Active Aging’
 Specifically, The Active Aging Policy Framework organized efforts to improve the quality of life of the elderly by three pillars, “Health”, “Participation”, and “Security” (Figure 4). The Study Group reviewed challenges in ASEAN region and considered potential areas for contribution from Japan based on this 3- pillared framework.
- Health: When the risk factors (both environmental and behavioural) for chronic diseases and functional decline are kept low while the protective factors are kept high, people will enjoy both a longer quantity and quality of life; they will remain healthy and able to manage their own lives as they grow older; fewer older adults will need costly medical treatment and care services. For those who do need care, they should have access to the entire range of health and social services that address the needs and rights of women and men as they age9.
- Participation: When labour market, employment, education, health and social policies and programs support their full participation in socioeconomic, cultural and productive activities, according to their basic human rights, capacities, needs and preferences, people will continue to make a productive contribution to society. Under that environment, elderly can continue in both paid and unpaid activities as they age.
- Security: When policies and programs address the social, financial and physical security needs and rights of people as they age, older people are ensured of protection, dignity and care in the event that they are no longer able to support and protect themselves. Families and communities are supported in efforts to care for their older members.
Source : WHO (2002) Active Aging: Policy Framework (http://whqlibdoc.who.int/hq/2002/who_nmh_nph_02.8.pdf)
Figure 4: Conceptual diagram of the three pillars of WHO Active Aging
 In 2012, the WHO chose “ageing and health” as the World Health Day’s theme, as a part of its efforts to increase the international momentum for aging. In that same year, Japan proposed a resolution, “Strengthening non communicable disease policies to promote active ageing”, emphasizing the importance of integrated framework including countermeasures against Non-Communicable Diseases (NCDs). The resolution was adopted at the 65th WHO General Assembly in 2012.
9 The WHO concept of ‘health’ is not limited simply to physical conditions, but includes the condition in which people are able to participate in family, as well as local, regional and national society.
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Report of the Study Group for Japan’s International Contribution to ‘Active Aging’
 In addition to this, Japan has supported policy making and technical assistance for strengthening health systems such as primary health care for the elderly, development of medical technologies for the management of health conditions of the elderly and early detection and treatment of diseases, and nurturing of human resources for health care.
 The European Union (EU) designated 2012 as the European Year for Active Aging and Solidarity between Generations 2012, promoted approaches to Active Aging at the level of the EU regional level10. In the background of this action, there are common severe economic and financial situations in current developed countries. Conventional social and economic models are found difficult to meet aging societies. Thus, how to maintain public services including pension and healthcare is a common challenge for EU countries along with the increase of aging population. The three pillars have been taken for the EU’s Active Aging efforts as follows11:
- Employment: As the age at which pension can be received has been raised in the EU, many people are unsure of whether after retirement age they will be able to continue employment until they receive their pension or whether they will be able to attain new employment. So there is a need for the labor market to provide employment.
- Social participation: The European Year seeks to ensure greater recognition of what older people bring to society and create more supportive conditions for them.
- Independent life: Active ageing also means empowering us as we age so that we can remain in charge of our own lives as long as possible.
 Furthermore, “ASEAN Strategic Framework on Social Welfare and Development (2011-2015)”12 was established by ASEAN countries to show the priorities in building a people-oriented ASEAN with special emphasis on the protection of the interests and rights, equal opportunities, high quality of life and standard of living for the elderly.
 The Framework includes plans for building capacities and understanding of social pensions, carrying out health and aging conference for government officials and other key stakeholders, and workshop to exchange views on the promotion of older people’s association, building capacity on aging policies, and ASEAN wide research network on ageing, and training caregivers.
10 EU Webpage (http://europa.eu/ey2012/) 11 European Year for Active Aging and Solidarity between Generations 2012 website
http://europa.eu/ey2012/ey2012main.jsp?catId=971&langId=en 12 ASEAN Strategic Framework on Social Welfare and Development (2011-2015)
http://www.asean.org/images/2012/publications/ASEAN%20Strategic%20Framework%20for%20Social% 20Welfare%20and%20Development%20(Nov).pdf
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