1. Healthy Ageing Initiatives, Success and Failures
The 1st ASEAN CONFERENCE ON HEALTY AGEING 2017
8:30-9:15, 11 October, Pullman Hotel in Kuching, Sarawak
Plenary Lecture
Healthy Ageing Initiatives, Success and Failures
Takeo Ogawa, Ph.D.
Professor Emeritus, Kyushu University and Yamaguchi University
President, (NPO) Asian Ageing Business Centre

2. Lessons from Japan For Prolonging Life Expectancy
For Coping with Rapid Ageing of Population.
For Shifting from Demographic Bonus to Demographic Onus.
For Sustaining Universal Health Coverage.
For Securing Health Workers.

3. Ministry of Health, Labor and Welfare
Life Expectancy
Ministry of Health, Labor and Welfare

4. Policies in Pre-ageing Era Until 1970
1959 Universal Pension Coverage (National Pension System)
1961 Universal Health Coverage (National Health Insurance)
1963 Act on Social Welfare for the Elderly
1966 National Day of Older Persons
1970 Census: 65+ =7.1% > 7% Ageing Society

5. Starting Year of Aging and Its Speed
PHILIPPINES
INDONESIA
MYANMAR
MALAYSIA
VIETNAM
THAILAND
SINGAPORE
CHINA
Arrived Year to 7% of Age 65+ Ratio
KOREA
Years
Number of Years from 7% to 14% of Age 65+ Ratio
Data Source: World Population Prospects:　2015 revision.

6. Strategies for Aged Society
Transition from Aging Society to Aged Society
Improvement of Infrastructure for Aged Society: De-hospitalization
Decentralization of Health and Social Service Programmes for Older Persons
Trial and Error of Health Policy for Older Persons
Preparation of Long-term Care Services

7. Development of Infrastructure for Long-term Care
Gold Plan
New Gold Plan
Gold Plan 21
Residential　Facilities
Nursing Home
240,000 beds
290,000 beds
360,000 Beds
Health Facilities
280,000 beds
297,000 beds
Care Houses
100,000 persons
105,000 persons
Livelihood Support Houses
400 places
1,800 places
Home Helpers
170,000 persons
350,000 persons
Short-Stay Beds
50,000 beds
60,000 beds
96,000 beds
Day Service Centres
10,000 places
17,000 places
26,000 places
Care Management Centres
Care Management Corporations (1992)
Group Home for Dementia
3,200 places

8. Health Policy for Older Persons
1963: Under the Act on Social Welfare for the Elderly, older persons take health check without fee. Its expense paid with tax.
1982: Under the Health and Medical Service Law for the Aged, the expense of health check paid with fee and health insurance.
1994: Under the Long-Term Care Insurance Act, long-term care for the elderly was differentiated from medical, health and social care.
2008: Medical Care System for Elderly in the Latter Stage of Life

9. A Tug of War between Medical and Social Services
Social Welfare
Public Health
Medicine
1973
Act on Social Welfare for the Elderly ◎
70+ older persons' medical expenses free
1983
Health and Medical Service Law for the Elderly 〇
70+ older persons pay partially medical expenses and 40+ support 70+ patients' medical cost
2000
Long-Term Care Insurance Act
65+ older persons pay 10% of LTC, and 40+ support 90% of 65+ LTC expenses
2008
Medical Care System for Elderly in the Latter Stage of Life
75+ older patients are reduced 7% of medical expenses
2012
The Social Security System Reform Bill
Comprehensive Reform of Tax and Social Security

10. A Tug of War between Medical & Social Facilities
Hospital & Health Care Facility for the Elderly Requiring Long-term Care
Day Care & Day Service Centre
Welfare Facility
1972
Geriatric Hospitals
Day Care Centre for Rehabilitation
1973
Act on Social Welfare for the Elderly
Day Service Centre for Respite Care and Reluxation
Welfare Facility for the Elderly Requiring Long-term Care
1983
Health and Medical Service Law for the Elderly
Special Designated Hospital for the Elderly & Health Care Facility for the Elderly Requiring Long-term Care
Day Care Centre & Rehabilitation Facilities with Long-term Care
2000
Long-Term Care Insurance Act
Geriatric Sanatoriums with Long-term Care & Health Care Facility for the Elderly Requiring Long-term Care
Medical Day Care Services and Social Day Services are covered under the LTC Insurance.
2005
Ammended Long-Term Care Insurance Act
Day Care & Day Service for Preventive Long-Term Care
2012
The Social Security System Reform Bill
Differentiation of Hospitals & Community-based Health
Day Care & Day Service for Preventive Long-Term Care & Community Cafe
Community-Based Preventive Long-Term Care & Livelihood Support
2017
Long-term Care Centered Hospital & Health Care Facility for the Elderly Requiring Long-term Care
Facility of Social Inclusion with the Disabled

11. Facilities for Older Persons

12. From Demographic Bonus to Onus in Asia: Changing Dependency Ratio
World Population Prospects:　2015 revision. Total Dependency Ratio.

13. Preparation to Hyper Aged Society
Transition from Aged Society to Hyper-Aged Society:
Introducing Public Long-term Care Insurance System
Universal Design of Public Spaces and Transportation
Normalization of Housing for Older Persons

14. Public Services Based on Residents’ Intention
Decentralization
National Government
National Government
Order & Prohibit
Delegation
Prefecture
Prefecture
Order & Prohibit
Delegation
Municipality
Municipality
Public Services
Public Services Based on Residents’ Intention
Residents
Residents

15. Decentralized LTC System (2000)
National Government
Grant
Guideline
Prefectures
Support Plan
Long-term Care Insurance
Municipalities
Premium
Planning & Implementation
Tax
Pension
Health Insurance
40+
65+

16. Universal Design/Barrier-Free
1994: Law for Buildings Accessible to and Usable by the Elderly and Physically Disabled Persons
2000: The Law for Promoting Easily Accessible Public Transportation Infrastructure for the Aged and the Disabled
2005: Policy Principles of Universal Design
2006: Barrier-free new law

17. Challenge to Hyper-Aged Society
After 2005-now
Looking for Healthy Life Expectancy
Establishing Integrated Community Care System
Proceeding Social Security and Tax Reform
Securing Long-term Care Workers
Promoting Preventive Care
Developing Geron-technology
Contributing Asia Human Well-being Initiative

18. Paradigm Shift Life Expectancy →Healthy Life Expectancy
High Risk Target Approach → Population Approach
Cure → Care
Professional Care → Personal Care
Age Differentiated Approach → Life Course Approach
Institutional Care → Community Care

19. Life Expectancy & Healthy Life Expectancy in Japan

20. Population Approach & High-risk Approach
Outcomes
High Risk Approach
Population Approach
Frequency
Status quo
Low
Risk
High

21. Cure & Care
Care
Cure

22. A Public-Health Framework for Healthy Ageing Life Course Approach (WHO)
High and Stable Capacity
Declining Capacity
Significant Loss of Capacity
Functional
Ability
Intrinsic Capacity
Prevent chronic conditions or ensure early detection and control
Health Service:
Manage advanced chronic conditions
Support capacity-enhancing behaviours
Long-term Care:
Ensure a dignified late life
Promote capacity-enhancing Behaviours
Environments:
Remove barriers to participation, compensate　for loss of capacity

23. Compulsory Psychiatric Care
Community Care
Pure Self Care
Responsible Individual
Pure Medical Care
Professional Responsibility
Preventive Care
Shared Care
Self-Care Continuum
Daily Choices
Self-managed
Ailments
Long-term Conditions
Compulsory Psychiatric Care
Life Style
Minor Ailments
Acute Conditions
Major Trauma
Assisted Management
In-Hospital Care
Institutional Care

24. Self-Care Continuum Community Care Preventive Care Shared Care
Nutrition, Exercise, Good-Sleep, Brain Training, Oral Hygiene, Preventive Therapy, Rehabilitation, etc.
Multi-disciplinary Cooperation
Visiting Nurse, Home Helper, Visiting Doctor, Home Hospice, etc.
Self-Care Continuum
Commission Doctor, Consultation, Education, Training, Dissemination, Capacity Building, etc.
Hospital Transfer, Referral to Specialized Hospital or to rehabilitation Hospital, Sanatorium, Hospice, etc.
Long-term Conditions
Assisted Management
In-Hospital Care
Institutional Care

25. Community Care System

26. Health Workers Doctors Nurses Pharmacist Japan 2.3 (2010) 8.0 (2010)
0.8 (2010)
Brunei
1.4 (2010)
7.0 (2010)
0.1 (2010)
Cambodia
0.2 (2008)
0.8 (2008)
0.04 (2008)
Indonesia
0.2 (2012)
1.4 (2012)
0.1 (2012)
Lao PDR
0.2 (2009)
0.8 (2009)
No data
Malaysia
1.2 (2010)
3.3 (2010)
0.4 (2010)
Myanmar
0.5 (2010)
0.9 (2010)
Philippines
1.2 (2004)
6.0 (2004)
0.9 (2011)
Singapore
1.9 (2010)
6.4 (2010)
0.4 (2004)
Thailand
0.3 (2004)
1.5 (2004)
0.1 (2004)
Vietnam
1.2 (2008) )
0.3 (2008)
Report on Public Health Administration and Services, 2014, Japan. & World Health Statistics 2014.