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

• This presentation is based on collaborative work with Dr. Vanessa Yong and Dr. Yuka Minagawa.

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

Successful Aging

• The term successful aging was first introduced in 1961 in an article published in The Gerontologist.

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

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

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"

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.

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

Transition among Health States

Diseases

Conditions

Impairments

Functioning

Loss

Disability

Death

HEALTHY

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

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

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

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

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.

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

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

Definition of Successful Aging

• Definition has been revised and broadened.

– life satisfaction

– subjective well-being

– social interaction

– consider age, gender and cross-cultural differenced

Role of Government in Successful Aging

• shift focus from individual level factors to macro level factors which could help successful aging for individual

Samantha Bennett, Health Promotion Board, Singapore, presentation at Healthy Ageing in Asia, held from March 4-5, Singapore

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

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

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

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)

Healthcare

• Universal Health Insurance Coverage

• The Gold Plan

• National Long-Term Care Insurance

• Care Prevention Program

• Healthy Japan 21 and 2nd Healthy Japan 21

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)

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

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.

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

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.

Successful Aging: for WHAT?

• Successful Aging should be means to the end and not end in itself.

• Happiness?

• Satisfaction?

• Well-being?

• Feeling of Achievement?

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.