The Aging Dilemma for Asian Populations
How are countries taking care of their elderly?
Japan, the first country into extensive experience with an aging population as fertility rates decline and life expectancy increases, is far ahead of other Asian countries including Singapore, Thailand, China, India and Taiwan in taking care of its elderly.
Over the past several decades, most Asian countries have undergone astonishing shrinkage of total fertility rates, defined as the number of children born to mothers of childbearing age. Accordingly across the globe, average life expectancy has undergone an astonishing rise, increasing from 48 years in 1950 to 68 years in 2010 and is expected to reach 81 by the end of the century. Nearly 60 percent of the world’s over-60 population resides in the Asia Pacific region, a number expected to more than quadruple by 2050.
This demographic transition towards an aging society in the Asia-Pacific region brings new challenges with deep social, economic and political ramifications. With increasing age, health and well-being take their toll. Non-communicable diseases such as hypertension, diabetes and dementia are becoming more widespread. Yet, health and social security systems in the region are under-prepared to meet the needs of older persons.
Japan: At the Top of the Pyramid
Japan is a hyper-aging country, with one third of its population over 60. But it prepared well in advance to deal with it. Dr Keizo Takemi, Chairperson of the Asian Forum of Parliamentarians on Population and Development (AFPPD), told the recent HelpAge conference in Hanoi that Japan began its welfare policies for the elderly way back in 1960s when the aging rate was low at 5.7 percent. It adopted a comprehensive welfare policy, introduced universal healthcare, a universal social pension, and a plan for income redistribution, low unemployment rates and progressive taxation.
Healthcare was made free for the elderly Japanese in 1973. In 2000, Long Term Health Care Insurance System was enforced. Between 1990 and 2011 there was a 277 percent increase in the number of health facilities. All this has paid off and Japan is now not just the oldest, but also one of the healthiest and wealthiest countries, with the highest healthy life expectancy in the world.
However, Takemi cautioned that as costs of long term care benefits and premiums increase, expenditures will skyrocket. By 2025, one in five Japanese will be over 75 years old, swallowing 46 percent of the health budget. It will be important to increase healthy life expectancy, reduce the gap between healthy life expectancy and life expectancy (which currently stands at 9-12 years in Japan, but is much higher elsewhere); and create job opportunities for the healthy elderly to be economically independent. Policy makers must also develop an integrated community care system focused on home care services, moving elderly patients from hospital to home by strengthening the capacity to deliver medical as well as routine life support services. Takemi also hinted that in future Japan is very likely to use robots to care for the elderly at home.
China: Expanding Basic Health Insurance
Liu Zengrui, Director of Rights and Interests Protection, China National Committee on Aging, said the Chinese government has expanded basic health insurance to achieve complete coverage, reformed medical insurance payouts, improved nursing home care, introduced social insurance against chronic diseases, begun to emphasize fitness care for the aged, promoted social participation of older people by stipulating policies for gradually suspending the retirement age of employees and keeping older people in the workforce. It has launched a program named “Yin-Ling” to encourage and support retired scientists, experts and professors to participate in volunteer activities.
Thailand: Universal Health Care
Currently more than 10 percent of Thailand’s population is over 65 years old. Women make up 55 percent. Thailand introduced its Universal Health Coverage scheme in 2002 to provide universal access to essential health care through a tax-based financing system and paying providers on a capitation basis. As a result, only 5 percent of the elderly went for paid care in 2011.
Long Term Care has been in place since 2008. It is community based elderly care and involves both– family assistance and supporting systems of healthcare and social services. The national budget for LTC, to support the development of home based care systems, was increased to 900 million THB (USD 25 million) in 2016 from Bht600 million (US$18 million) in 2015. A pilot project (January 2013-August 2017) on Long Term Care Service Development for the frail elderly and other vulnerable people (LTOP) has been introduced in six areas. A team of doctors including nurse and physiotherapist go and see all home bound and bed bound elderly. There is also a basic universal social pension for all elderly.
Singapore: Holistic Care
Thelma Kay, former Chief of the Social Development Division, UNESCAP, and former Senior Advisor on Aging Issues, Ministry of Social and Family Development, Singapore, said Singapore has initiated many prevention and wellness programs as well as disease-specific screenings and follow-up. Healthcare is heavily subsidized. In 2014, the government introduced the Pioneer Generation Package to recognize and honor the contributions of Singapore’s Pioneer Generation towards nation-building. The S$9 billion PGP package aims to cover around 450,000 Singaporean, aged 65 years and above. It provides several healthcare benefits for all Pioneers for life, including subsidies and cash assistance.
Senior citizens have an identifier card for priority access. There is also a transport subsidy for anyone over 60. The “Aging In Place” government policy is focused for the aged to age at home as far as possible and be independent. Some community hospitals and faith-based organizations have home base care units.
India: Long Walk to Health Justice
The proportion of elderly population has increased from 5.6 percent in 1961 to 8.6 percent in 2011. In 2011, nearly 104 million persons were aged 60 or above – 53 million females and 51 million males. While there are good government schemes, implementation is poor. A Central Sector Scheme of Integrated Program for Older Persons (IPOP) is being implemented to seek to improve the elderly quality of life. But the number of beneficiaries remains small. In 2007, the Maintenance and Welfare of Parents and Senior Citizens Act was enacted to ensure need-based maintenance for the parents and senior citizens. The Rashtriya Swasthya Bima Yojana and Health Pension schemes are also steps in the right direction. The National Program of healthcare for the elderly has been implemented only in 13 of 622 districts and the uptake is painfully slow.
Mathew Cherian, Chief Executive Officer of HelpAge India and a Member of the Board of HelpAge International, said very little geriatric care is available and delivery of healthcare for the elderly is a big issue. HelpAge India provides mobile medical care through mobile vans for the poor elderly in some rural and hard to reach areas. Cardiologist Devi Shetty of Narayan Hriduyalaya has started a low cost health insurance scheme called Yashaswi in South Karnataka, through which very low cost healthcare (including heart surgery) is provided to the elderly poor. Kerala too runs a program called Vayomitram (friends of old age), wherein volunteers from rural areas are trained in healthcare, especially for older people. These are but sporadic sparks, but a lot needs to be done for proper implementation of programs nationally.
The Way Forward
As more Asian countries age, collaboration and sharing of experiences becomes important. Japan has launched the Asian Health and Human Wellbeing Initiative to make this region a society of health and longevity, by increasing healthy life expectancy and guaranteeing healthy elderly people opportunities for employment for sustainable economic growth, so that people can live their own lives based on their health.
The new post-2015 Sustainable Development Goals (SDGs) also recognize the importance of older people. Even as there is a broader commitment that all indicators should be disaggregated by age, Goal 3 (Ensure healthy lives and promote well-being for all at all ages), provides clear guidance to governments and other development agencies that older people must be taken into account.
The challenge is to ensure governments honor the commitments. Healthy aging should begin in early childhood. Greater social policy priorities, including social protection and universal health coverage, are required to create a smart, sustainable and inclusive active Aging society.
Shobha Shukla is editor of Citizen News Service. Shared under Creative Commons