Ageing society

As Asia ages rapidly, society must focus on health and wellness from an early age

Derek Goldberg says continuous efforts at better health practices across citizens’ lifetimes are necessary to prepare for an ageing society in Asia, where the populace is growing old especially fast

PUBLISHED : Sunday, 10 December, 2017, 2:01pm
UPDATED : Sunday, 10 December, 2017, 3:36pm

Studies show that Asia’s population is ageing faster than anywhere else. Japan is forecast to become the first “ultra-aged” country, meaning 28 per cent of the population is 65 years or over, while one-fifth of the people in South Korea are expected to be 65 by 2030. China is now ageing more rapidly than almost any country in recent history and its dependency ratio for retirees could rise as high as 44 per cent by 2050. The impact of these shifting demographics is wide-ranging, from the strain on health systems to wider economic impacts.

Christine Lagarde, managing director of the International Monetary Fund, recently urged policymakers in the region to step up their response – calling out markets like China, Japan, Korea and Thailand – and warning of a drag on growth as shrinking workforces in key Asian economies lower productivity. And, of course, an ageing population also presents an added cost burden in rising health care costs – the Singapore-based Asia Pacific Risk Centre has predicted the swelling ranks of the elderly will cost the region US$20 trillion in health care by 2030.

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The time bomb began ticking generations ago. In 2002, the journal Science published a paper that showed a steady increase in lifespans beginning in 1840. When researchers charted average female life expectancy in record-holding countries, they found an increase of almost three months per year; a child born in any given year is likely to live three months longer than a child born the year before.

In 1840, Swedish women lived the longest: an average of just over 45 years. By 2000, Japanese women held the record and were living almost 85 years on average. Men’s life expectancy also grew linearly, just not as rapidly.

The World Health Organisation says that, by 2050, the number of people 65 or older is expected to reach 1.5 billion, triple the number in 2010.

So is 70 the new 60? With a greater “lifespan”, do people have a longer “healthspan”? The evidence is not yet conclusive.

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But clearly non-communicable diseases, like heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for almost 70 per cent of all deaths worldwide and are some of the top causes of death among people over 60. The key risk factors in each case are age and lifestyle. Their rise has been driven primarily by four things: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets – all of which can be managed and mitigated by the individual.

Not surprisingly, medical costs increase with age, and data shows that medical expenses in the 70-plus bracket are almost three times that of the 50-59 group. However, what is most noteworthy is that, among those in their 40s, major chronic conditions really appear on the radar, suggesting the need for prevention-based intervention for those as young as in their 30s.

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Today, one of the biggest opportunities to address Asia’s ageing population lies in better health education and wellness support at an early age. We must engage the active, healthy, 30-something working population on the impact their lifestyle choices will have in another 30 years.

Disease and disability need not be the natural consequences of ageing. Decisions across one’s life have a profound impact on our health status in later years. Among Mexican women, for example, going to bed hungry as a child has been associated with a nearly 90 per cent increase in adult diabetes.

Disease and disability need not be the natural consequences of ageing

We must shift from a focus on episodic, reactive care to continuous, proactive care. Without this fundamental change, health care systems risk becoming obsolete in the face of the silver tsunami and the rising tide of non-communicable diseases.

More community-based care models and holistic, preventive approaches can be supported by increasing access to advanced technology and data analytics (both clinical and financial) allowing greater identification of individuals’ needs and delivery of proper support, ranging from one-on-one nurse support and clinical engagement to self-learning and empowering digital tools designed for early prevention of disease and disability.

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Japan presents a strong case for such a shift in approach to health care. By the 2030s, one in three Japanese will be 65 or older, making it imperative that the country rethinks the way it delivers health services. In 2015, Prime Minister Shinzo Abe called for a 10 per cent reduction in the number of hospital beds in the country and a stepped-up effort to care for patients at home or in nursing care facilities. The country has also unveiled a vision for 2035 that calls for transforming health care into an integrated system that emphasises quality over quantity, value over inputs, autonomy over regulation, care over cure and integration over fragmentation.

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Rather than fragmented, provider-centric systems focused on treating sickness, we should be planning and adjusting for integrated, people-centric systems focused on wellness.

Beyond addressing structural issues in its health care system, Japan is also reassessing its attitude towards older workers. As of 2025, the mandatory retirement age will be 65, up from 60 today. And the country’s Silver Human Resources Centres are expanding their efforts to connect older residents with paid, often part-time, employment, which keeps them engaged in society and ensures that their skills and experience aren’t wasted. One such worker, 80-year-old Nenosuke Yamamoto, reconditions abandoned bicycles, continuing his lifelong love of cycling. In a recent interview, he explained: “I feel that if I keep on working, I might not age as much. I might not have dementia or other sorts of ageing issues.”

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It seems inevitable that most of us are going to live at least a little bit longer than our parents, but will we be fit and healthy in our old age? Will we be fixing bicycles at 80 like Nenosuke Yamamoto? That’s partially up to us. While no one has the power to stop ageing, we all have the power to improve our odds of living long, healthy lives. Moreover, we can all play a role in creating a universal health system that is better structured to support healthy ageing, something even the youngest among us will one day need.

Derek Goldberg is managing director, Asia Pacific, for Aetna International