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AUICK Second 2006 Workshop
AUICK held
the Second 2006 Workshop
under the theme of "Population Ageing and Appropriate
Measures
for the Aged" in Kobe, Japan, from 30 October to 10 November, 2006,
with the support of
the United Nations Population Fund (UNFPA) and the Kobe City
Government. AUICK invited nine participants from nine AUICK Associated
Cities and two interpreters.
CONTENTS
1.
BACKGROUND
2. AIM
3. PARTICIPANTS
4. PROGRAM
5. REVIEW
1.
BACKGROUND
World
Population is growing rapidly, but it is aging
even more rapidly. In the last half century, the world population more
than
doubled, from 2.5 to 6.1 billion. The population of people aged 65 and
over, however,
more
than tripled, from 131 million to 417 million. Over the next half
century, the world
population may grow by about 60% to 10 billion, but the population of
people
aged 65 and over will almost triple again, from 417 to 1.5 Billion.
This accelerated
ageing process is even more dramatic in Asia.
In the last
half century, Asia’s
total population almost tripled, rising from 1.4 to
3.7 billion. Those 65 and over, however, grew by almost four times,
from 57 to
217 million. The
future will see even
greater ageing. While the total Asian population may grow from 3.7 to
6.4
billion, or 57 percent from 2000 to 2050; those 65 and over may grow
from 217
to 907 million, or an increase of more than 4 times. Moreover, the
number of
very old people in Asia - those 80
and over - has
grown from about 4 million in 1950 to 29
million in 2000. This number will grow to over 225 million by 2050.
Population aging
has a great impact on both
society and economy. It brings a shrinking of the workforce, an
increasing
social-security burden, and a major change in family structure and
medical
problems. As women represent the larger number and proportion of older
people
in almost all societies, the issue also has important gender
implications. On
the other hand, the positive aspect of ageing is that the elders have
more time
to contribute to the society with their rich experience of life and
work.
The UNFPA has been
actively involved in
aging issues for many years. It has worked with many countries to
formulate
appropriate
public policies and promote policy
dialogues to respond to the challenges posed by the social, health and
economic
consequences of population aging. It has also assisted many countries
to meet
the needs of older persons, with particular emphasis on the poor and
especially
women.
To TOP
2.
AIM
This
workshop is designed for senior
officials of AUICK Associate Cities (AACs) who are in charge of
policies and
programs directed at the aged. In view of the UNFPA Policy Guidelines
on
Aging, the Workshop is designed to help the participants improve their
knowledge of the urban policy implications of the population ageing
processes
and the social and economic impacts. It is also designed to increase
the
participants’ understanding and know-how of administrative
measures for the
aged through presentations of city reports, case studies, discussions
and field
observations. Each participant is also expected to develop a concrete
action
plan for appropriate administrative measures for the aged, which is to be
implemented upon their return to their cities.
To TOP
3.
PARTICIPANTS
The workshop was designed for the
senior-most
officials of the appropriate department, from nine selected Asian
Cities:
Chittagong (Bangladesh), Weihai (China), Chennai (India), Surabaya
(Indonesia), Kuantan (Malaysia), Faisalabad (Pakistan), Olongapo
(Philippines), Khon Kaen (Thailand), and Danang (Vietnam). Countries
are listed in alphabetical order. The participants included the
following:
Mr. Mohammed Nasim Bhuiya
Project Manager, Partnership Agreement-3, Second Urban Primary Health
Care Project, Health Department, Chittagong City Corporation, Bangladesh
Mr. Xin Jie Cai
Vice Director, Civil Administration Bureau, Weihai City, China
Mr. Shantha Kumari Paranthaman
District Family Welfare Medical Officer, District Family Welfare
Bureau, Corporation of Chennai, India
Ms. Wiwiek Widayati
Head of Cooperation Division, Surabaya City, Indonesia
Mr. Anuar Bin Che Mahmud
Deputy Director, Pahang Social Welfare Department, Kuantan Municipal
Council, Malaysia
Dr. Naseem Ahmad
Executive District Officer (Municipal Services), Engineering, Local
Council Services, City District Government,
Faisalabad, Pakistan
Mr. Fernando Moselina Magrata
Acting City Administrator and Hospital Administrator, Office of the
City Administrator, Olongapo City, The Philippines
Mrs. Nudnapa Juntavaree
Chief, Department for Promotion of Participation and
Decentralization, Khon Kaen Municipality, Thailand
Dr. An Van Nguyen
vice Director, Danang Labor, Invalids and Social Affairs Department,
Danang
People's Committee, Vietnam
Accompanying
Interpreters:
Ms. Hong Jun Cong
Chief of Passprt and Visa Section, Weihai Foreign
Affairs Office, China
Ms. Bui Thi Hong
Programme Assistant, UNFPA Vietnam Office
To TOP
4.
PROGRAM
Tuesday, 31 October
Morning Session
 The workshop
began with opening remarks by Dr.
Hirofumi Ando, President of AUICK.
He
noted that for
Japan, ageing is currently a pressing issue; and it is also an
important issue for all countries in the future.
He also
noted that the elderly should be considered a resource for a
city. Thus it
behoves
city governments to find ways to mobilize
this resource
and
use it to
improve the
quality of life for all.
He reminded the participants that AUICK workshops are an
attempt to
develop what has come to be called "South to South
development
assistance. Developing countries learn not only from the more wealthy
"North" countries, but also from one another.
Finally, he explained that the action
plan to
be
developed by each participant is a specific tactic of AUICK, to help
the
participants turn their experience in Kobe into
a plan that can be implemented at home to promote better urban planning
and to
advance the quality of life of their citizens. In a subsequent
presentation, Dr.
Ando provided some specific guidelines for the development of
action
plans.
Afternoon Session
Dr. Gayl D. Ness, Professor Emeritus,
University of Michigan, made a presentation on “Ageing in
Asia.” Professor Ness provided an overview of the
basic
demographic dynamics of aging in Asia. This begins with the
Demographic Transition, or the movement of a
society from
high to low
birth and death rates. This transition is closely associated with the
change from traditional rural-agrarian to modern
urban
industrial
society. First, the death rate declines while fertility remains
high. This gives us a period of rapid population
growth
and an
increase in
the proportion of the young population, those under 15 years
of age. At
this point, a society faces high costs in providing education for the
new young.
The second part of the transition is when fertility falls to
come into
line with the lower mortality, closing the demographic
transition. The
proportion of young people declines, reducing the burden on the society
and creating a window of opportunity where there are many
working age
people for a smaller group of young and old-age dependent people.
A few decades after fertility has fallen, the proportion of aged people
begins to rise. For example, in traditional societies the proportion of
people over 65 years of age is rarely above 5 percent. Within two or
three decades after fertility has fallen to modern levels, the
proportion over 65s may be up to 10 percent and rising. Japan
illustrates a very advanced stage of a modern urban-industrial society
with very low fertility. Its population of people over 65 years of age
is now 20 percent and is projected to rise to 35 percent by 2050. The
“very old” population - over 80 years - is now 5
percent and is projected to rise to 15 percent by 2050. This is
illustrative of what the future may hold for most if not all countries.
Along with this ageing comes a significant change in the sex ratio -
the number of males per 100 females. At birth this is typically
105-106. But the higher age specific death rates for males gradually
reduce this ratio. By ages 20-50 there are usually roughly equal
numbers of males and females. Beyond that age, there is an increasing
surplus of females, or a decline in the sex ratio. Again using Japan as
an advanced example, at age 80 today there are only about 50 males for
every 100 females. Thus an additional “problem” of
aging is the substantial increase in the proportion of women among the
aged. This will pose special problems to policy makers and program
directors.
Beyond these basic population dynamics, Professor Ness provided graphs
for each of the nine countries of the AUICK Associate Cities, showing
where they are along the lines of the development. Some, such as China,
Thailand and Malaysia, have had a rapid fertility decline and will soon
begin to see substantial rises in the number of aged. Others, such as
Bangladesh, India and Pakistan, may have a half century or more before
the proportion of their aged begins to put pressure on their societies.
Dr. Jun Matsunami, professor,
Graduate School
of International
Cooperation, National University of Kobe, delivered a
presentation on
“Local Government and Population Ageing in Japan.”
He provided an overview of the structure and functioning
of
local
government in Japan and how this affects programs for the aged.
Dr. Matsunami began his presentation by describing the
structure of
Japanese central and local governments and their functions.
The great
majority of social
services in Japan are delivered by local governments. This is because
local governments collect local taxes from various
sources,
and there
is a huge financial transfer from central government. This
equalizes
the differences between local governments, while most of them
become
less independent.
One of the advantages of local government control is
that it is closest
to the people and best understands both needs and resources
at the
local level. But local governments may also be weak in establishing and
protecting a national level of welfare.
The population of people over 65 now represents more than 20 percent of
Japan’s population, and is projected to rise to 35 percent by
2050. The rising tide of the elderly raises questions about roles of
central government and local governments, in terms of how the
medical/care
insurance system and the public pension system should be managed.
To TOP
Wednesday, 1 November
Morning Session
 Dr.
Haryono Suyono, IAC member, presented the best practice in
Surabaya.
In Surabaya, mortality fell rapidly after World War II while
fertility
remained high, producing a period of rapid population growth.
In the
1970s the country began a modern family planning program, which turned
out to be of the more successful ones in the world.
There is also now a
large influx of elderly women into the cities. This pattern shows two
important conditions. Recently the elderly population
is growing more
rapidly than the total population, and rural poverty is pushing older
people out of the villages to live with their children who
have made
some progress in the city. In Southeast Asia women typically have
longer life expectancy than men, and in Surabaya, there is a
large
influx of elderly women to live with their newly urbanized children.
This growth of the aged has gone almost unnoticed in Indonesia, where
for the past three decades we have been more concerned with reducing
fertility than caring for the aged. But now the Mayor of Surabaya has
recognized the problem and the city’s Department of Social
Welfare has begun to organize support for the aged.
They have developed some organizations, including the Gerontologi
Abiyoso, which opens and operates homes for the elderly, and Karang
Werdha, community level organizations, which promote activities for the
aged.
The city is now turning to mobilizing
community groups and Non
Government Organizations to assist in addressing the problem of the
aged.
To TOP
Wednesday, 1 November
Afternoon Session
 Mr.
Takeshi Yamamoto, Manager, Senior Citizens’
Welfare
Division, Senior Citizens’ Welfare Department, Public Health
and Welfare Bureau, Kobe City Government, made a presentation
on
“Care for the Elderly in Kobe: Problems, Progress and
the
Future.” He provided a rich and detailed account of the
city’s attempts to address the problem of the aged.
Japan’s aged population (65 years and over)
constituted only
10 percent of the population in 1950; today it is 20 percent and
by
2050 it is projected to reach more than 35 percent. Kobe has followed
the national trend closely. In 1950, recovering from
extensive war
damage, Kobe’s roughly 5 percent, or 25,000 elderly lived and
died at home with family members, usually in three-generation
families.
Today with 1.5 million people, Kobe’s aged population is
308,000, or 20 percent. Most live in a one generation family,
one third
live alone and the great majority dies in hospital or at a home for the
aged. The trend will continue - by 2014 fully one in four of
the
population will be 65 and over.
Over the past half century of
ageing, Kobe has experienced a near miraculous economic development.
Rising from the ashes of the war, it has become a city of wealth and
charm, with a standard of living and a quality of life that is enviable
throughout the world.
The services for the elderly were once limited
and largely decided by the government, but they are now extensive,
varied and
“user” oriented. They should be universal,
comprehensive, locally oriented, and affordable.
One of the varieties of the service is the Silver College with
three-year courses for people over 57. Its 4,000 graduates are now
active in a great variety of community organizations. There are senior
clubs in all the neighborhoods. A basic health service is available for
all. A city bus pass permits free travel to encourage the elderly to
get out of their homes on non-step busses. There are ward social
workers and civil affairs committees who can identify the elderly in
need and help connect them to a wide range of effective services.
This system of services has evolved over many years, and for much of
that
time, Kobe was growing wealthier year by year. Today Kobe faces a
shrinking economy and reduced revenues. And this comes at a time when
the number and proportion of the aged will only increase dramatically.
Kobe now faces the question of who will pay and how will the services
be paid for. The national elderly care insurance system now pays the
bills. Users pay some 10% of their costs, and insurance pays 90
percent. That 90% is paid for by the citizens of 40-64 years of age
(31%), the national government (25%), the Prefectural government (12.5
%) and the municipality (12.5%). At the moment this is adequate, but
the growth trends are frightening. Over the past six years the number
of people designated to receive assistance in Kobe grew from 32,000 to
60,000 and the total costs doubled from 40 to 80 billion yen. That
trend is expected to continue. The number of elderly is growing and the
proportion of those designated to receive health care is also growing.
At this moment the city is
deeply involved in a
review of the services.
When Mayor Yada met with the workshop participants,
he spoke of the
problems
of deciding how such a system can be supported; how
these services will
be paid for.
Kobe's experience is not
unique; it is only more advanced
than that of most developed countries, and it
offers an important view
of the longer term future for most Asian developing
countries as well.
All
societies are ageing. Kobe has been immensely successful in
providing
good support for the aged. But the future poses
problems that are
daunting to say the least.
To TOP
Thursday, 2 November
Morning Session
 Ms.
Akemi Fujiyama, Manager, Community Health Promotion,
Public Health Department, Public Health and Welfare
Bureau,
Kobe City
Government, made a presentation on “Measures on Maintaining
Physical and Mental Health of Elderly People in
Kobe.”
She began her presentation by explaining that the Kobe City
Government
has articulated a number of visions for a Healthy
City. The Kobe 2010
Vision sees progress through minimizing death in early life,
prolongation of a healthy life expectancy,
and
lifting up the quality
of life of the citizens.
Against this vision, the City sees three major challenges:
the low
birth rate; an increase of “lifestyle-related
diseases” and an increase of
bed-ridden
and demented older
people. Though Kobe is not immediately concerned with the low
fertility, it is important to note that
Kobe’s total
fertility rate of 1.23 children per woman is less than the national
average of 1.36. Neither will sustain the population size and
after
about 2010, Japan’s population will begin to decline.
To deal with the life-style related diseases and the problems of the
aged, the Community Public Health Division engages in a wide range of
activities. It promotes a periodic health check up of all people 40 and
over. They have also developed a series of guidelines for work among
the aged, which promotes a balanced diet, constant exercise,
participation in social activities, and so on.
Per Capita Annual Medical
Spending
The numbers of those needing medical
care, and the demented elderly are both growing substantially.
Health costs are increasing
faster than the national economy. Kobe’s per capita medical
spending in 2004
amounted to 400,000 Yen for the total, but 800,000 Yen for
the aged.
On the ground at the ward
level the
city works to promote health and care for the needy. Costs
are borne in
part by insurance and in part by the city. But the sustained
increase
in costs presents a major challenge for the city government
as well as
for the national government. This is a period of high change.
Afternoon
Session
Participants took a field trip to
facilities for the aged.
Sun
Life Uozaki
is a neighborhood elder care facility in Higashinada
ward, not far from the city center. It has four levels of care for a
total
of almost 100 people. About 40 people come for day care. They
arrive by
public transportation or special vans for those in wheelchairs. They
can shower and bathe, have meals, undertake exercise regimes and engage
in social and craft activities with one another, and they go home in
the evening. This is especially helpful for families that take care of
an aged family member at home. There is also a short stay facility
where up to 20 people can come for a few days to accommodate a special
need of the family with which they normally live.
Then
there are two facilities for people
needing greater care. A Group
Home provides comfortable quarters for
older
people who
cannot live
alone, especially for the demented elderly. Two
units accommodate 8
persons each. All 8 share a common living room, large kitchen
and
dining room; and each person has a closet and bedroom, with
balcony.
Staff are there to help with cooking, cleaning and
daily
living.
Finally, there is an Elderly
Nursing Home for as many as 30 persons
who
need
extensive nursing care; some are terminal patients.
All these facilities are light, clean
and well appointed and they are
staffed by kind young men and women. The
facility
is
supported by the
City of Kobe, by insurance payments and by additional fees
that some
users pay.
Silver
College
is
at the other end of the spectrum. It is a real three
year college with four curricula, enrolling as many as 1,260 students
(420 in each year). The minimum age for enrollment is 57 years, and the
majority of the students are in their 60s and 70s. They can study
Welfare, International Exchange and Cooperation, The Environment, and
Arts and Music. The college’s motto is Study Again and Serve
Others. Operating since 1993 the college now has an active
alumni
association of some 4,000 who engage in a variety of community
services. Faculty members are drawn from surrounding universities, and
students attend classes twice a week. This is for those elderly who are
active, fully functioning and want to keep their minds and bodies
productive in these later years.
 Shiawase-no-mura
(Happy Village) is a comprehensive welfare
complex,
which is geared mainly toward
the
physically and
mentally handicapped.
Its aim is to keep them as involved as possible
with the
normal life of
the city. The facility is located on a 205 hectare
mountainous area
about half an hour from city center,
over
the Rokko
Mountains.
There
is
extensive occupational training for the handicapped. There are
also advanced medical facilities in a hospital
dedicated
to the most
extremely disabled. Its various facilities can
accommodate
about 1,200
patients at different levels of disability. It also
has
overnight camp
sites and day picnic areas, a swimming
pool, and
other
facilities.
This
is a great assist to families with disabled members, enabling them to
sustain their home care while helping them through
the more difficult
aspects of managing their disabled members. And for those
who need more
extensive nursing and terminal care, this is also available in a
beautiful mountain setting. The facility was
planned and built in the
1970s-80s, when
Kobe’s finances were growing. Three quarters of
the costs of
the 1,000 staff and extensive grounds and facilities are
borne by the
city, only one-quarter by the users, through insurance and
fees. Today
there are pressures from the economic stagnation, and
the issues of
raising fees and reducing costs have been discussed but are
yet to be
solved.
The workshop participants remarked on
the range of services
and the
high quality of both settings and staff in this set
of facilities. Kobe
provides a model to be emulated in care for the elderly; but
it also
shows clearly how the aging of our societies places immense
strains on
our resources. The future is filled with challenges
and not many clear
answers.
To TOP
Friday, 3 November
Morning and
Afternoon Sessions
Nine participants
presented city
reports
of their respective cities.
To TOP
Monday, 6 November
Morning
Session
Participants took
a field trip to 2 facilities for the aged.
Kobe
Lifelong Learning Center, Comista Kobe was
founded to
encourage senior
citizens to participate in voluntary activities, classes, workshop,
lectures and other events so that they can deepen their
learning
in
diverse fields and enjoy opportunities that would
make their
lives even
more meaningful and worthwhile. Since its foundation on August
2000, more than 80,000 people used the center each year. The
activities range
from education and sports to hobbies, and the center also
provides a wide variety of information, consultation services
on learning and
education. This facility is located near the city center,
using
the
building of a former elementary school.
Then
they visited Kobe
Comprehensive Care Center for the Aged. The
center contains various facilities; ranging from rehabilitation, a
long- or short-stay, day care center to consultation on care. The
center was established in November 1998 by Kobe City Government.
Special
Nursing
Home “Shin-ai Home is
located on
3rd and 4th floors of the building. The home accommodates the elderly
in need of steady care who have difficulty in receiving nursing care at
home, and provides them with necessary care services. It has a capacity
of 50 people; with 6 single rooms, 10 twin rooms, and 6 quad rooms.
Shin-ai Home also operates the
Senior
Citizens’ House Higure
on the 5th and 6th floors, with 20 rooms. The House is equipped with a
Life Support Advisor in the on-site care support center for the aged,
staff members who visit residents periodically to check on their
well-being, a consultation service for living related matters and an
emergency response system. This facility is operated by a social
welfare corporation called Jesus Corps.
 The
Geriatric Health
Service
Facility “Kobe” is located on the 2nd
floor. This
facility provides in-patient care, including nursing care and
rehabilitation to people whose symptoms have stabilized and no longer
need treatment, in preparation for returning home. And on the 1st
floor, there is a Local
Rehabilitation Center, which provides training
and care guidance as necessary by physical, occupational or
speech-language-hearing therapists, either at home or in the center in
addition to consultation on welfare equipment and housing renovation to
the elderly who have difficulties in daily life. The center is fully
equipped with rehabilitation instruments and the staff, and
the elderly
people worked to rehabilitate themselves from the disease's
aftereffects.
After
the visits to 2 facilities, the
participants
enjoyed a one-hour
cruise of Kobe Port.
Afternoon
Session
AUICK
held a discussion forum on “What Elderly People can
contribute to Society,” inviting 8 elderly activists, who are
leaders in a variety of community organizations. AUICK IAC members also
participated in the forum.
Representatives
from each group presented different types of
activities, including a college for the aged, a networking system for
dispatching lecturers and teachers, mountain hiking, and a work
placement center.
The participants
had many questions and engaged in a
lively exchange with those active seniors. There was a great interest
in details of how the senior labor exchange works, and what drove these
Kobe elders to remain active and lead local organizations.
This exchange
reinforced a growing perception of a common problem
throughout the region. Everywhere governments, communities and people
are searching for new and more effective ways to care for the aged.
Kobe’s active elderly have shown one important set of
activities to address this problem.
To
TOP
Tuesday,
7
November and
Wednesday, 8
November
Morning
and
Afternoon Sessions
These
sessions were devoted to drafting and final presentation of action
plans.
To
TOP
<Thursday,
9
November
Morning
Session
To
sum up this workshop, the participants had a meeting for review and
evaluation of the overall workshop. The participants exchanged their
views and opinions frankly about the workshop. Then the closing
ceremony was held. Mr. Kazutoshi Sasayama, Special Advisor of AUICK and
Former Mayor of Kobe, honored their achievements during the workshop
and handed a certificate to each of them.
 After
the official closure of the workshop program, Mr. Sasayama hosted
lunch for the participants.
5.
REVIEW>
In
their written evaluations, the participants gave high marks to the
presentations, which they felt helped increase their knowledge of the
problems of ageing. They also appreciated the field visits, the general
organization of the workshop, and the opportunity to meet Japanese
elder community leaders. Overall, the workshop provided the three major
elements that all AUICK workshops have been designed to provide: 1.
Technical information and the high quality of services a city like Kobe
can provide; 2. An opportunity to learn from one another in
“south to south assistance”; and 3. The opportunity
and assistance to develop a plan of action to activate in their cities
upon their return home. We can elaborate on each.
- Technical knowledge and
standards.
The participants learned about
the basic demographic dynamics that produce an aging population. They
also saw where their own cities fit into those dynamics: some already
feel the pressure of the aging population while for others these
pressures are still a generation in the future. In Kobe they also found
two very important lessons. One set the standards for high quality of
care for the aged. These are standards all cities should attempt to
meet. But they also learned that even a wealthy city like Kobe faces
severe challenges in continuing to provide high quality services to the
aged. All cities will face these challenges in the future.
- South
to
South assistance.
The
participants learned much from one
another. This, in fact, brought the most innovative output from the
workshop. Cities like Weihai, Khon Kaen, Surabaya, Kuantan, Danang, and
even Chennai in India, have come through the demographic transition in
which their national family planning programs helped to reduce
fertility quickly and safely. In many cases those well developed
programs are no longer needed to the same extent. Thus participants
developed the idea to transform their family planning programs into
family welfare programs that include care for the aged.
These programs
have developed strong organizational networks for delivering services
and information throughout the country. It will be far better to
continue to use those organizations through simple adjustments rather
than to abolish them with all of the strengths they have. The
participants also came to recognize that although deep Asian traditions
enjoin families to care for the aged, urbanization and modernization
are undermining those traditions everywhere and new patterns of aged
assistance must be developed by governments everywhere.
- All
participants developed
specific
action plans that will take what
they have learned back to their own cities. In this way, they translate
what they have learned into specific and practical work plans that will
help their cities better meet the challenges of an ageing population.
Where the challenges lie far in the future, the first steps will
include obtaining better information on the number of aged, their
growth and their conditions. Where the aged now pose challenges,
participants were able to develop specific and practical steps they can
take at home to meet those challenges.
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