Enhancing Long-term Care and Social Participation

Ryokichi HIRONO
3-4 November, 2011
Seikei University, Tokyo
Incheon, ROK
Enhancing Long-term Care and Social Participation
of Older Persons in East and North-East Asia:
Case of Japan and City of Musashino
1. Introduction
As the Concept Note by UNESCAP/SRO-ENEA for the Sub-regional Meeting on the Ageing
Population and Policies indicates, as high as 32 “percent of the world’s older persons (65 years and
over) live in the East and North-East Asian sub-region” where 60% of the Asia’s older persons live.
“East and North-East Asia is also the fastest ageing sub-region in the world,” with the aged as
percent of the total population rising from 6.1 to 9.2% during the period 1990-2008, well over the
ageing ratio for Southeast Asia (4.0 to 5.7%) and South and Southwest Asia (3.7 to 4.6%). In East
and Northeast Asia, as of 2008, Japan had the highest ratio of the aged population totaling 21.4 %,
followed by Russian Federation (13.3%), Hong Kong (12.5%), ROK (10.4%), DPRK (9.4%), China
(7.9%), Macao (7.1%) and Mongolia (3.9%). 1/
Undoubtedly. “many nations fall along a
continuum, with some countries already beginning to feel the effects of aging, and others
anticipating those effects in the coming decades.”2/ Many East Asian countries will observe in the
21st century the doubling of ageing ratio experienced in Japan during the period 1970-94 (7.04 to
14.01%), followed soon by Hong Kong (7.05-14.0１% in 1983-2014), Singapore (7.15-14.24%
during the years 2000-16), ROK (7.36-14.14% in 2000-17), Thailand (7.14-14.42% in 2002-24),
China (7.00-14.08% in 2001-26), Vietnam (7.03-14.24% in 2020-38), Myanmar (7.07-14.16% in
2018-38), Indonesia (7.08-14.27% in 2018-39), Malaysia (7.11-14.02% in 2020-43) and Brunei
(6.98-14.55% in 2024-48), 3/ “The Republic of Korea, for example, is projected to become the most
aged country in the world by 2050, with the average age of 58.6 years old. A rapid change in the
population structure, if unaccompanied by appropriate policies and programmes, will have a
------------------------------------------------------------------------------1/ UNESCAP, 2009, Statistical Yearbook for Asia and the Pacific 2009, p.9
2/ Shediac, Richard, Rainer Bernnat, Chadi N. Moujaes and Mazen Ramay Najjar, 2011, New
Demographics Shaping a Proeperous Future as Countries Age, Booz & Company. Inc. 2011, p.1.
3/ Komine, Takao, “A Long Term Forecast of Demographic Transition in Japan and Asia,”
presented at PECC’s International Workshop on Social Resilience held in Tokyo on 4-5 March,
2010.
1
far-reaching impact on people’s lives, from labour, transportation and housing issues to
social protection schemes including pension and old-age medical benefits.” 4/
In spite of the rapid pace of ageing in Asia and the Pacific region, social protection measures
have been lagging behind and highly inadequate in nearly all developing countries in the region.
Again, according to the UNESCAP survey, China, Mongolia, ROK and Russia, together with
Central Asian republics, Cook Islands, Indonesia, Sri Lanka and Vietnam, were the only developing
and transition countries in Asia whose half of the population were covered as of 2008 by some types
of social protection measures such as social insurance, e.g., sickness, workmen’s compensation,
unemployment, old age and health insurances and social assistance such as income transfers related
to poverty, health, education and employment, and the rest were not. Japan’s coverage was over 85%.
Coverage is one thing, however, and the extent and depth of coverage is another, varying
enormously not only between countries, but also between the types of social insurance and social
protection. Furthermore, the total expenditures on social protection as % of GDP has ranged between
less than 1% (PNG, Tajikistan and Vanuatu) and over 10% (Kyrgyzs Republic, Marshall Islands and
Uzbekistan), with all the developing countries of the region falling in between, including China (less
than 5%), ROK (less than 8%), Russia (less than 9%) and Mongolia (less than 10%) . Japan (16%)
had the highest percentage of GDP on social protection expenditures.5/
Under these conditions prevailing in developing countries in general, it is no small wonder why
“the United Nations adopted a comprehensive set of guidelines for action in 2002, entitled the
Madrid International Plan of Action on Ageing (MIPAA). In 2013, the second global review of
progress made in the implementation of MIPAA” is envisaged to “take place to bring into account
regional reviews which are currently in progress.” It is understood that “the present meeting will
complement the MIPAA review undertaken at the global, regional and national-levels by shedding
light on the community-level where older persons lead their everyday life, and sharing good
practices from the sub-regional countries.” The sub-regional meeting is also expected to “discuss
enhancing long-term care and active participation of older persons in the communities where their
daily life is, to share good practices (policies and initiatives) on the identified focus areas. to
formulate a sub-regional perspective based on local community-level experiences and
recommendations,” and “to build a network of sub-regional stakeholders to make available new
---------------------------------------------------------------------------------4/ UNESCAP/SRO-ENEA, 2011, Concept Note, p.1.
5/ UNESCAP, ADB and UNDP, 2010, Achieving the Millennium Development Goals in an Era of
Global Uncertainty: Asia-Pacific Regional Report 2009/10, pp. 64-65.
2
information and analysis that would help national policy makers identify gaps and
cross-cutting issues.”6/
Against this background of the rapidly changing demographic changes in Asia and an increasing
recognition of the need for formulating, before “too late,” sustainable policies for long-term care and
social participation of older persons, this paper will focus on the demographic changes of Japan, the
most aged country in Asia and various policy measures taken by the Government of Japan (GoJ)
under the changing national system of social protection and those taken by the City of Musashino,
subdivision of Tokyo Metropolis, which has long been considered as the model city in Japan for
having designed a “progressive” policy response to this critical question of ageing population.
2. Demographic Changes and Changing Needs and Requirements of the Aged Population in
Japan
Japan’s population as of 1 October, 2011 stands at 128,057,352, including 2.69 million
foreigners, according to the Population Census results recently published.7/ It represented 0.2%
increase, but a reduction of 0.3%, if confined to the Japanese nationals, as compared with the last
Population Census of 2001. This year’s population showed a decrease of 20,000 from a year earlier,
confirming the entry of a depopulation stage for the first time in its long history. While enjoying one
of the highest average life expectancy at birth in the world,8/ Japan has for some time been
experiencing a high rate of population ageing. The population of 65 years and over stood at 5.1% of
the total in 1945, but reached 23.1% in 2010, while those under 15 years old dropped from 36.8% to
13.0 % during the same period.9/ Accordingly, the dependency ratio declined during the same period
from 41.9% to 36.1%, fortunately allowing the country a greater room for providing social welfare
-----------------------------------------------------------------------6/ UNESCAP/SRO-ENEA (2011), op.cit., p.1.
7/ As reported in Asahi Newspaper’s morning edition of 27 October, 2011 on the front page.
8/ According to the White Paper on Health, Labour and Welfare (MHLW) 2011, in 2009 the average
life expectancy of men in Japan, being 79.59, is the fifth highest in the world, while that of women,
at 86.44, is the highest in the world. As compared with Japan, their corresponding figures for men
and women in the United States were 75.4 and 80.4 in 2007, in Canada 78.0 and 82.7 in 2005, in the
United Kingdom 77,4 and 81.6 in 2006-08, in France 77.8 and 84.5 in 2009, in Germany 77.17 and
82.40 in 2006-08, in Italy 78.67 and 84.04 in 2007, in Russia 61.4 and 73.9 in 2007, in China 69.63
and 73.33 in 2000, and in ROK 76.5 and 83.3 in 2008. (See Kosei Rodo Hakusho (White Paper on
Health, Labour and Welfare) 2011, Statistical Appendix, Table 1-3-3)
9/ MHLW, 2011, ibid., Statistical Appendix, Table 1-2-3.
3
benefits to the young children and the aged population.
Irrespective of the type of
households, the number of households with persons 65 years of age has seen an enormous
increase during the last two decades.
In 1965, only 276,000 households (15.4%) of the
single-person households numbering 1,795,000 had the persons 65 years old and over, but this
percentage increased to 29.6% (4,655,000 households) of the 15,707,000 households in 2010. On the
other hand, with the current depopulation trend continuing in the coming decades (from 127.18
million in 2010 to 95.15 million forecast in 2050), if the country’s immigration policy should see no
change, those aged 65 years old and over will rise from 23.1% in 2010 to 39.6% of the total
population in 2050, and those aged 14 and less will decline from 13.0% to 8.6% during the same
period, reversing the dependency ratio from a low of 36.1% to a high of 48.2%.10/ Other things
being equal, this drastic demographic change in the first half of the 21st century will be likely to
force the country to provide the young and senior dependents either with lesser level of social
protection and security benefits or with higher social insurance premium for the current and potential
beneficiaries or both, as is already being discussed by the government and the parties in power since
several years ago, and even with a totally different national system of social protection not only
covering social insurance and assistance programmes as has been practiced so far in the country
since half a century ago.
It is interesting to note that there is a wide difference in the average life expectancy at birth
between sex and between locations in Japan. For male population, Nagano Prefecture had the highest
at 78.9 years in 2006, followed by Fukui and Nara Prefectures, whereas for females Okinawa had the
highest, reaching 86.01 years, followed by those in Fukui and Nagano. Men, whether married or not,
are survived by women, and married women tend to live longer than single women.11/ These
differences of life expectancy of people between sex, locations and marital status seem to suggest,
according to some medical studies, that the sense of security and gratitude associated with married
men and women in rural communities engaged in productive activity and living in natural blessings
is an important determinant of the people’s health. One implication of the findings of these medical
studies is that it is vital for communities to provide such environments as above for the aged so that
they may live longer in peace and happiness. This is all the more important when one takes note of
the National Police Agency’s Annual Report 2005; a) that in Japan the number of those who
committed suicide in 2004 was the highest for the age group 65 years and over both for male and
female population; b) that the suicide rate among those aged 65 and over, accounting for 32.8
------------------------------------------------------------------10/ MHLW, 2011, ibid., Statistical Appendix, Table 1-3-2.
11/ Foreign Press Centre of Japan, 2006, Facts and Figures of Japan, 2006, p. 17.
4
persons out of 100,000, was the second highest, following those aged between 50 and 59
(41.0persons) in urban areas, and c) that the most important cause of suicide was found
in illness, followed by household financial difficulties.12/
Ageing is also considered to increase the incidence of people falling into illness and eventual
death. Listed in 2010 as most frequent causes of death in Japan have been among others the
incidence of cancer (31.1%), followed by heart disease (15.5%) and cerebral hemorrhage (12.5%).
These kinds of diseases were not prevalent in prewar days (4.3% for cancer, 3.4% for heart disease,
and 9.9% for cerebral hemorrhage, respectively in 1935), and even in 1947 the most prevalent causes
of death were tuberculosis, lung disease and cerebral hemorrhage.13/ Death caused especially by
cancer and heart disease has enormously increased their significance during the postwar years,
largely reflecting an increasing level of psychological stresses associated with growing urbanization,
ICT-influenced lifestyles and the pressure of long working hours and days under global competition.
In spite of such high incidence of suicide and certain types of critical illness, it is noteworthy that
aged persons with higher level of education are found to live longer than those without in Japan.
This is probably because education per se contributes to enhanced awareness among people of
the critical need for good personal healthcare. In other words, educated persons tend to take a better
care of their own health. Also, educated persons tend to have better opportunities to access to
higher-paid jobs and higher-income positions in lifetime as compared with the less educated, which
allows the better educated to have an easier access to better healthcare services and thus longer
life-span. In Japan and most other developed countries, however, there are some system of social
insurance and security benefits in place, so that even the less educated do have access to healthcare
and other public services.
This reality could be a good contrast to that in developing countries where unfortunately the
national system of social protection is still less developed or even undeveloped.14) It is not unusual
therefore that maternal mortality rates are significantly lower among the literate women than among
the illiterate and that the under-5 mortality rates with mothers receiving higher level of education are
lower as compared with those with mothers without it (e.x., 48 vs 145 in Bolivia, 53 vs 136 in
----------------------------------------------------------12/ EPCJ, 2006, ibid., p.23, quoting National Policy Agency’s Annual Report 2006.
13/ MHLW, 2011, ibid., Statistical Appendix, Table 1-3-4.
14/ Japan Institute of International Affairs, 2010, Proceedings of the Pacific Economic Cooperation
Council International Workshop on Social Resilience, pp.10-11.
5
Cambodia, 37 vs 90 in Indonesia, 25 vs 72 in Nicaragua, 91 vs 164 in Nigeria, 29 vs 105 in the
Philippines and 29 vs 66 Vietnam per 1,000 live births, all in 2000-2007).15/ It is well known by
so many evidences all over the world that “women’s education is strongly associated with having
fewer children, fewer of these children dying in infancy and childhood, better nutrition for children,
and a greater likelihood that children will be sent to school,”16/ resulting in the lower birth rate in
Japan and other developed countries than in developing countries of this region and elsewhere and a
higher longevity of both males and females among the better-to-do households than among the poor.
The role of education is also found vital not only to a longer life-span in Japan, but also to
sustained economic growth of Japan through industrialization and technological development since
Meiji Restoration of 1868. In Japan the population with at least secondary education as percent of
those aged 25 and older is higher for both males and females at 82.3% and 80.0% respectively in
2010, which compares vary favourably with any developing country in East Asia such as Indonesia
at, 31.1% and 24.2% respectively in the same year.17/ It is equally well known that other things
being equal, a higher level of human capital investment in any country contributes to higher
productivity of national economies and higher per capita GDP which in turn provides the people
including the the aged with better and wider access to healthcare services and thus resulting in a
longer life-span. Again this is substantiated by the recent survey findings in developing countries
that the under-5 mortality rate among the households in the highest wealth/income quintile tends to
be much lower as compared with that among those in the lowest quintile (e.x., 32 vs 105 in Bolivia,
43 vs 127 in Cambodia, 34 vs 101 in India, 22 vs 77 in Indonesia, 29 vs 92 in Namibia, 19 vs 64 in
Nicaragua, 79 vs 257 in Nigeria, 21 vs 66 in the Philippines, 42 vs 72 in Uzbekistan, 16 vs 53 in
Vietnam, and 37 vs 118 in Yemen).18/
In summary, ageing, though varying among countries and in-country regions, is a widespread
phenomenon in East Asia, and given the declining birth rate associated with advancing women
education, industrialization and urbanized lifestyle as well as better access to better medical and
health services, nearly all countries in the region will experience the doubling of the ageing ratio
reaching roughly 15 % of the total population between this decade and next, if not earlier. Both local
and national governments in East Asia will have to prepare themselves not only to restructure their
----------------------------------------------------------15) UNDP, 2009, Human Development Report 2009, p. 201.
16/ UNESCAP, ADB and UNDP, 2010, op.cit., p.16.
17/ UNDP, 2010, Human Development Report 2010, pp. 156 &158.
18/ UNDP, 2009, op. cit., pp.200-201.
6
respective economies and communities to provide the ageing population with both
productive employment opportunities, but also adequate system of social protection and public
services tailoring to their changing needs and requirements. In Section 3 the paper will discuss what
Japan as the most aged society now in the region has done to deal with these critical issues at the
national level and in particular what kinds of social protection and public services and how
Musashino City in the western suburb of Tokyo Metropolis, one of the more visionary communities
in the country, has already been implementing and some of the key issues facing them in enhancing
social participation of older persons in such communities.
3. Social Protection, Public Services and Social Participation of Older Persons in Japan
Social protection and public services in Japan are provided in the main both by the central and
local governments, but also by the private sector and voluntary civic organizations. Central
government is responsible for the essential legal framework under which the policies on social
security system covering both social insurance and social assistance including its financing are
formulated, implemented, monitored and evaluated. The executive branch of the central government
is required not only to administer the system but also to report to the National Diet (parliament) on
the prevailing practices and major issues facing the country in administering the system. A number
of White Papers are thus submitted by the executive branch on the conditions among others of health,
workmen’s compensation, unemployment, pension, welfare and social assistance including family
Assistance, the most important of which has been the Kosei Rodo Hakusho (White Paper on Health,
Labour and Welfare) issued every year by the Ministry of the same nomenclature. With ageing of the
population of Japan, many other White Papers on banking and finance, education, environment,
industry, national land development and security, primary industries, transport and communications
and other sectoral development contain a section on their respective policies for aged population.
The actual application of the central government’s social protection policies, however, is
administered in the main by local governments which of course are free to supplement such national
policies to strengthen their service to the public depending on the local communities’ specific needs
and requirements and subject to their financial capacity. There are therefore wide differences among
local governments in the extent, quality and range of social protection at the local community level.
Once the national system of social security and protection in place, many local governments in the
country, if not all, have in fact reinforced their public service for those in need of varied social
security programmes and in particular for enhancing social protection of older persons partly
because of the rapidly growing aged population in their respective communities and partly because
of the latter’s political demand for better services. It is no exaggeration to say therefore that the
7
provision of national social protection system including its financing thus lays the foundation for
local governments to enhance the social participation of older persons in their communities and that
some local communities are providing better public services for the social participation of their own
older persons in local community activities. As a result, it is interesting to observe since some decade
or two ago that the extent and quality of public services for both the social protection and
participation of older persons has become not only one of the major criteria for people’s choice of
communities in which to live, but also an important political agenda for the elections of local
assemblies, mayors and governors as well as for national elections where political parties are
subjected to expressing in their respective election campaigns their political commitments to the
improvement of social services to the aged population. The case of Musashino City will be taken up
later for discussion of what the so-called “progressive” local communities could do to strengthen
social protection and help encourage the social participation of older persons in local community
living and activities.
1) Japanese System of Social Protection and its Major Issues
Japanese system of government social protection is composed of both the national social
insurance systems covering the health, employment, workmen’s compensation and old-age pension
and old-age healthcare services which was transformed into the old-age medicare and
nursing-care services beginning in 2005 and the national system of social assistance including
family assistance, old age welfare, children support services and children cash allowances which
was also revised under the DPJ in accordance with their Party election platform. Family
assistance programme confined to the poor and the one-parent families with small children was
installed in prewar days, as well as the workmen’s compensation insurance system to compensate the
workmen on industrial injuries and death including permanent incapacitation resulting from working
environments. The national system of pension covering the employees in public service and their
families was also installed in prewar days. A new national system of pension and health and
unemployment insurance was installed in 1961 to cover all the employed workers and their families
in the private sector in the beginning and later further extended to cover all persons in
self-employment and their families. As of March 2009, about 34.8 million employed in small
business and their dependents are covered by the government-managed health insurance scheme,
about 30.0 million employees in larger-scale businesses and their dependent families are covered by
the corporate association-managed insurance scheme, and the self-employed and their families
totaling about 39.1 million are now covered by the municipalities and national health insurance
associations. The mutual-aid health insurance schemes covers a total of 9.1 million employed in the
central and local government services and the private schools. Those older persons aged 70 and
8
above numbering 13.9 million are covered by the special health insurance scheme specifically
designed for that age group. 19/
The old-age welfare and children support services are of the most recent origin in response to
changing population composition such as aging, declining birth rates and higher women’s labour
force participation since late 1980s.
The Gold Plan, a ten-year health and welfare service
programme for the aged population was introduced in 1991 and upgraded in 1994 (New Gold Plan)
and again in 1999 (Gold Plan 21) . Children support service programme under the name of the Angel
Plan was installed in 1994 and upgraded also in 1999 (New Angel Plan) to improve childcare
facilities including the extended day-care and holiday nurseries. In addition to enhancing these
government–financed programme, the Government of Japan (GoJ) introduced the Children and
Childcare Support Plan in 2005, urging private sector corporations to review their work rules and
improve childcare environment including employees’ parental leave. Child cash allowance
programme was introduced in 2007, and with the change in government from Liberal Democratic
Party (LDP) to Democratic Party of Japan (DPJ) regime in September 2009 it was expanded in
coverage and the amount of monthly allowance. Under the DPJ regime, not only family assistance
programme has also been improved in coverage and the amount of monthly payments, but also new
benefits programme was installed to help those fresh graduates to undergo skill training with
government financial support to their daily living and training expenses in response to higher
unemployment rates among the youth under the current economic recession and greater social
uncertainty.
There have been several changes in the national system of health insurance since 1961 when
introduced for the first time. These changes reflected on the one hand the extension of the types of
diseases and the maximum payments to be covered under medical and healthcare insurance schemes,
as well as the increases in the unit prices of a variety of pharmaceutical drugs and medical treatment
payments to be made to clinics and hospitals under the insurance scheme. On the other hand, they
also reflected a series of increases of the medical and healthcare costs to be borne by the insured
(20% in 1997 and 30% in 2003) with a view to restraining the acutely rising deficits of the national
system of health insurance. As of March, 2008, of the total national health insurance payments, the
insurance fees accounted for only 44.8%, with the breakdown of 20.4% by the employers and 28.3%
by the employees and the individual patients bore only 14.1%, with the rest totaling 37.1% financed
----------------------------------------------------------19/ MHLW, 2011, ibid., Statistical Appendix, p.26.
9
by both the central government (25.1%) and the local government (12.0%).20/ In response to the
continuing increase of the ageing population and the fact that the total medical and
healthcare expenditures for the elderly persons alone rose from ¥4.1 trillion to ¥8.9
trillion between 1985 and 1995, a special medicare insurance system for the those 70 years old
and above was installed in 2000 under which long-term public nursing-care services have been
provided for the elderly with 90% of the total cost borne by the insurance and the rest by those
individual elderly beneficiaries if below a specified annual income and, if above, 70% borne by the
insurance and the rest by the insured patients. Under this scheme, premium payments became
compulsory for those aged 40 and above to pay for the rising cost of elderly medicare services. Even
with such increase of medicare cost borne by the insured individual, the total medicare expenditures
for the elderly continued to rise to ¥11.2 trillion in 2000 and further to ¥12.0 trillion estimated for
2010. As % of the nation’s total medical and healthcare expenditures, it represented 25.4% and
33.4%, respectively.21/ There is a growing consensus in Japan that “the United States is not alone
in its healthcare conundrum” and that the Commonwealth Fund study finding that “the U.S. spends
twice as much per capita on medical care as do other industrialized nations” 22/ may also soon become
a reality in Japan, unless further reforms should be installed in the national health insurance system
particularly for the aged population.
The national system of pension has also undergone several major changes since its postwar
installation in 1961. Japan had for a long time a two tier system of the national pension (basic
pension) programme which applies to all people in the country with monthly contribution going to
the national pension fund and which applies separately to private-sector employees and the
mutual-aid pension programme which applies to public servants and those staff in teaching
institutions. In 2009 there were 70.3 million Japanese covered by the national pension scheme, of
whom 32.1 million were private sector employees, 4.7 million public sector employees, 11.1 million
full-time homekeepers and 22.4 million self-employed, in addition to 4.7 million covered by
mutual-aid pension programmes, similar to the pattern of distribution among those covered by the
national health insurance system.23/
GoJ decided in 2006 to unify the premium rate of all
mutual-aid pension programmes in 2018 to deal with inequitable imbalances in pension scheme
-------------------------------------------------------------20) MHLW. 2010, ibid., Statistical Appendix. .
21) MHLW, 2010. ibid., Statistical Appendix.
22) Choudhury, Joyjit Saha, Akshay Kapur and Sanjay B. Saxena, 2011, “Transforming Healthcare
Delivery, “ Booz & Company, Inc., 2011, p.1.
23) MHLW, 2011, ibid., Statistical Appendix, Table 3-3-1
10
between private and public sector employees in terms of both monthly contribution before and
benefits payment after retirement. To prepare the country for the coming of an aging society, a
number of policy measures have already been introduced in establishing the new
system of social protection. Both the monthly premium and pension eligibility for both
the national and employee pension schemes were raised in 2005. The monthly premium for the
national pension scheme was raised from ¥13,300 to a maximum of ¥16,000 in fiscal 2017 and
thereafter, while that of the employees’ pension scheme was raised from 13.58% of the standard
annual salary to be shared equally between employees and employers to reach the ceiling rate of
18.3% in fiscal 2017 and thereafter. The National Pension Plan revised in1994 raised the national
pension eligibility from 60 to 65 years of age, while the eligible age of 55 for the employee pension
scheme was decided to be raised to 65 for men by 2025 and for women by 2030. Also, reflecting the
difficulty of private sector corporations to cover the reserve deficiency of employee pension schemes,
they installed a Japanese version of the 401(k) defined-contribution plan under which benefits are
paid according to investment returns.
As a result of these changes in the national system of social insurance and assistance, the
national expenditures on social security have snowballed dramatically during the last few decades,
from ¥3.5 trillion in 1970 to ¥84.3 trillion in 2003 and further to ¥107.8 trillion in 2011. During the
same period, in absolute amount, the nation’s pension payments, the largest of all social security
payments, rose from ¥ 2.3 trillion through ¥12.9 trillion to ¥53.5 trillion. The medicare and
healthcare payments, was the next largest item of social security payments, rising from ¥2.5 trillion
through ¥31.5 trillion to ¥33.6 trillion, on per capita basis from ¥24,100 through ¥247,100 to
¥263,322, and as percent of GDP from 4.1% through 8.6% to 9.6%. As percent of GDP, the nation’s
social security payments have thus skyrocketed from 5.6% through 22.9% to 30.7% during the same
period,24/ with their deficits being financed by the national and local government budgetary
expenditures which in the final analysis have to be borne by the taxpayers of the current and future
generations in Japan. The deficit financing of the medicare and health insurance system, however,
has continued to rise steadily over the last thirty years, as shown by the rising percentage of the
general account expenditures from 11.7% in 1980 through 14.1% in 2000 to 17.4% in 2009.25/
The current administration under Prime Minister Noda is now under consultation with his own
DPJ and other parties if further revisions of the national system of social protection including social
-------------------------------------------------------------24) MHLW, 2011, ibid., Statistical Appendix, Table 3-1-1.
25) MHLW, 2011, ibid. Statistical Appendix ,p.37.
11
insurance and family assistance can be installed to reduce fiscal deficit financing that has been
growing since several decades ago by revising national taxation system in favour of raising
consumption tax from the current 5% to 10% within the coming five years and make the
Japanese system of social security and protection affordable and sustainable, while
meeting various inequities under the present national system. The prime minister went ahead and
announced at the G20 Summit meeting in Paris on 3-4 November this year his fiscal deficits
reduction plan targeted on the restructuring of the national taxation system including the raising of
the consumption tax to 10% during the coming five years the major part of which will be
used for
meeting
the
deficits
arising
from
the current
system
of
social protection,
in particular the health and old-age medicare insurance and pension systems. Whereas there is no
doubt that efforts must be continued with full understanding and cooperation of the people of the
country to rationalize the nation’s social protection system and reduce such huge sum of government
deficit financing, it is simultaneously to be remembered that the nation’s development policies
toward the weaker segments of the population and its commitment in particular to social protection
system catering to the needs and requirements of the aged population lay the foundation upon which
to promote the social participation of elderly persons in local communities and nation building. Had
it not been for such system, either the degree of success observed in the social participation of the
elderly persons in Japan would have been at a much lower level or the type of their social
participation would have been quite different.
Another major issue facing the Japanese system of social protection lies in the age-long problem
of the shortage of medicare and healthcare workers, particularly for the aged population requiring
such nursing and medicare services at home, in hospitals and at the old-age nursing-care homes. This
reflects partly the degree of hard work of those nursing-care workers taking care of the disabled aged
persons and partly the relatively low wages paid to those workers. The relative shortage of the
supply of such workers has been reinforced partly by the attitude especially of the female disabled
aged persons who prefer female to male workers, and partly by the mentality of the male population
in Japan who still consider nurses and nursing-care jobs as “female job.”. While it is true that in
response to a steady rise in the market demand for nursing-care workers projected in the first half of
the 21st century, a rapid expansion has been seen since early 1990s in the number of colleges and
universities for the training of such workers and that of both female and male student enrollment in
such school system, not much has been dealt with those two major problems facing the nursing-care
workers. In recognition of such perennial problems, GoJ under the DPJ regime decided in 2009 to
improve the salary scale for such workers under the national system of health and old-age
nursing-care, but not enough from the viewpoint of such workers. They have also concluded bilateral
12
agreements with Indonesia and the Philippines under which a limited number of qualified Indonesian
and Filipino nurses and nursing-care workers has been invited to work in Japanese hospitals and
nursing-care homes. Because of the linguistic requirements, this scheme has not been able to meet
fully the shortage of such workforce in the country. There is an emerging consensus in the country
that such language requirements be relaxed and the maximum stay of three years after qualification
training in the country be liberalized or dropped. An increasing number of communities have now
begun to solicit those qualified but retired for childcare and other reasons to return to these needy
jobs. They have also taken an initiative of providing free of charge some range of qualified medicare
and nursing-care training programmes for those looking for jobs, as well as for foreigners already
living in Japan and hiring them, when completing such training. It is generally agreed that the supply
shortage of qualified medicare and nursing-care workers will not be solved in the long run, unless
the two key issues of the hardship and strains demanded of such workers and the relatively low level
of wages paid to such workers are dealt with adequately.
2) Musashino Approach to Enhancing Social Participation of Older Persons
A) Brief on Musashino City
Musashino City, one of the subdivisions of the Tokyo Metropolis, covers 10.73 km2 in space
with the population of 136,133 persons (of whom 2,246 are non-Japanese) and 71,159 households as
of 1 January, 2011 and is located at half an hour train ride west of Tokyo Central Station. Human
settlements in Musashino area started around 10,000 to 20,000 year ago around a lake today called
Inokashira, gradually were expanded beyond the lake area and,, after brought into Musashi
Prefecture under the Meiji Restoration of 1868, established eventually Musashino Village in 1889
and was brought into Tokyo Metropolis in 1893 as it is today. In 1928 Musashino Village was
renamed as Musashono Township when its population reached 13,500, and became City of
Musashino in 1947 when its population reached 63,000. In 1948 Musashino City established its
school lunch preparation centres to cater to the needs of primary school children and began its
municipal garbage collection every week, the first city to do so in the country and from 1950s
onward opened its waste-water treatment centres, sports centre including swimming pools and
athletic fields, and other municipal facilities essential to healthy and comfortable living of
community people.26/
Having declared itself in 1960 as a City of World Federation and Peace, Musashino City
initiated a number of social action programmes in favour of the weaker segments of the population
-----------------------------------------------26/ Musashino City Office, 2011, Musashino Benricho (Living in Musashino)2011,
13
pp.44-45.
in local community, firmly believing in and fully supporting Mahatma Gandhi’s spirits that the
greatness of a nation is measured by what it does for the weaker population. Beginning in
1963 the City installed a series of municipal nurseries for pre-school children, in 1966
issued a special certificate of entitlement to the physically and mentally disadvantaged persons
for their skill training and civic involvement, in 1967 began to provide financial support to children
for the first time in the country, in 1972 initiated environmental education programme through
children’s experiential education in Riga Village in Toyama Prefecture facing Japan Sea (East Sea),
and proclaimed the Citizen’s Green Charter as the basic guide to community living. In an attempt to
enhance the participation of citizens in municipal decision-making processes, NGOs and other civil
society groups initiated in the 1970s a series of motions in the municipal assembly for establishing a
community centre in each block community where neighbours would get together to discuss major
issues facing them in community living, be they issues in health, education, environment, human
rights, childcare or care for the elderly. In 1981 Musashino City declared itself as a City of People’s
Welfare at the Top Priority, followed in 982 by another declaration of a Non-Nuclear City. In the
same year Musashino established a Nature and Green Education Centre in Kawakami Village and
Toyoshina Village (now Azumino City) in Nagano Prefecture in central part of Japan both of which
have been used again for experiential nature education for primary school children. A similar
experiential education programme was initiated with Tohno City in Iwate Prefecture in 1993 where
immediately after the disaster of Great East Japan Earthquake/Tsunami on 11 March 2011,
Musashino City sent its municipal staff on a long-term basis to assist the rehabilitation and
reconstruction of the disaster-affected city.
B) Musashinio Approach to Governance .
Most conspicuous of all municipal programmes for enhancing social participation of older.
persons in Musashino City has been the large number of civil society groups (CSOs) including
non-government organizations (NGOs) and community-based organizations (CBOs) that are actively
engaged in promoting their respective cause of social concerns and the closest possible partnership
between these groups and the municipal government highly receptive to a variety of citizen’s
demand and civic requests from those citizens belonging to different CSOs, CBOs and NGOs active
in each community.
On the part of Musashino citizens, they have organized themselves into city-wide CSOs/NGOs
and/or CBOs on the basis of the specific social concerns such as among others health, education,
environment, fine arts, sports, international cooperation, childcare and care for the elderly. And many
14
of these CSOs and CBOs are working in close association and cooperation with their counterpart
organizations elsewhere in Tokyo Metropolis and/or at the national level and even at the
international level. Registered in the City Office alone, there are over 400 CSOs and CBOs in
Musashino City, actively engaged in various areas of social concern, many of which are also
officially registered as not-for-profit organizations (NPOs) with Tokyo Metropolitan government
and/or the Cabinet Office of the GoJ, with secretariat office, office bearers, membership, regular
meeting schedules and financial revenues and expenditures. They not only carry out
community-level studies and eventually come out with action plans and policy recommendations to
the municipal assembly and/or the mayor of the City on their respective areas of social concern but
also go out into neighboring communities to develop and expand their concrete projects and
programmes, resulting also in action plans and policy recommendations either to Tokyo
Metropolitan Assembly and the Governor of Tokyo or to the National Diet and even to the Prime
Minister of Japan. Although none of these CSOs and CBOs are political organizations, they do keep
in touch with local assemblymen, metropolitan assemblymen and national Diet members for
knowledge and information sharing and exchange of views on certain specific issues of their own
social concern.
On the part of Musashino City, political leadership represented by the city mayor and municipal
assembly has been exemplified by their constructive engagements on a day-to-basis with these CSOs
and CBOs on all issues facing citizens as well as by their readiness to take initiatives in helping to
support the community activities of these CSOs and CBOs. The City has built over the years a
number of community centres for those citizens living in neighborhood to be able to come together
and discuss any issues of common concern to them and to present their own findings directly to
municipal assembly and the City mayor or indirectly through municipal assemblymen representing
their own respective neighborhoods. In order to facilitate group studies at community centres,
libraries well documented with relevant books, journals, magazines, newspapers and various
pamphlets issued by neighborhood and city-wide CSOs and CBOs have been set up both at the city
centre and at community centres. The City Office has also organized a number of seminars and
workshops on major issues of common concern to citizens where well-known scholars and
practitioners on those specific subjects are invited to speak, often resulting in long hours of questions
and answers. The City Office has even made it possible through financial support for active CSOs
and CBOs in the city to organize on their own a number of study seminars and workshops open to
the public, including overseas study trips to deepen their understanding of those issues of their own
concern and interest. The City Office has also made arrangements with colleges and universities
located within the city so that ordinary citizens are able to register either free of charge or at a
15
nominal fee with such authorized institutions to take up those subjects of their own interest, whether
in humanity, social, biological or natural sciences. In addition, Musashino City has been organizing a
series of joint multi-university classes on various subjects of common concern so that citizens can sit
in and audit those classes for their own learning and capacity building.
The City Office issues newsletters on a regular basis and publishes a number of findings and
reports written on the basis of their own internal studies and special pamphlets on those specific
subjects of common concern to Musashino citizens, be they on health, education, environment,
welfare, international cooperation and other issues. Bi-weekly newsletters always carry information
on which groups are meeting where and when in the City as well as what subject to be discussed,
along with information on certain festivals being organized somewhere in the city. Through these
newsletters and other publications the City Office is soliciting Musashino citizens to present their
own views and perspectives on its long- and medium-term draft development plans and programmes.
The City Office welcomes any suggestions on how to improve the City Office’s work and public
services to be rendered to citizens. The City mayor has installed a number of third-party evaluation
committees to look into the possibility of improving the efficiency and effectiveness of those
projects and programmes and reducing wasteful public expenditures. Furthermore, to help citizens to
be exposed to diverse cultural values and enrich their artistic tastes at discounted cost, the City has
invited from at home and abroad a number of famous cultural groups such as orchestras, ballet
troups, musical and other performing arts groups to perform at Musashino Cultural Hall, one of the
best in the country.
Behind the various “progressive” policies, practices and institutional reforms installed by the
City of Musashino during the last few decades in the long-term care and social participation of older
persons lies its citizens’ firm belief that, as the report on the institutional transformation for
sustainability made public by the four-member concerned international study team emphasized much
later (September, 2011), “approaches to sustainability governance based on economic values are
insufficient - and partly the cause of unsustainable development. There is a clear need to go beyond
GDP and market-value in measuring development. Human well-being and the quality of life are
important additional values, as are considerations of ecosystem services and the non-anthropocentric
values of other living beings.”27/ The same belief shared by Musashino citizens has initiated a
------------------------------------------------------------27/ Int’l Environmental Governance Architecture Research Group, the Earth System Governance
Project, IGES, UNU/IAS and Tokyo Institute of Technology, Towards a Charter Moment: Hakone
Vision on Governance for Sustainability in the 21st Century, p.1.
16
number of new programmes such as children’s education in schools and community education,
health and sanitation, environmental conservation, green growth, greenery space target setting, city
flower, garden for every block of housing scheme, urban agriculture, lifestyle changes, housing,
transportation, community centres, pregnant young women’s centres and other urban infrastructures,
disaster prevention, people participation in the municipal decision making process and the like that
were for the first time in Japan.
C)
Musashino Approach to Enhancing Long-term Care of Older Persons and their
Social Participation in Community Activities
Against the background of some measures of good governance prevailing in Musashino City
since several decades ago, it is not difficult to discover a variety of City programmes designed to
enhance social participation of older persons in community activities. In line with democratic
governance respecting the rule of law, transparency and accountability, all the city mayors have
always made it a customary practice either to draft or for some concerned assemblymen to draft
municipal laws and regulations for enhancing social participation of older persons in community
affairs for deliberation and final decision by the municipal assembly. The 1st long-term development
plan of Musashino City (1972-81) approved by the municipal assembly was inaugurated in 1971
which already incorporated a wide range of programmes for enhancing social participation of older
persons such as volunteer assistance to disabled single old-age persons at a nominal cost and the
financial assistance to disabled single aged persons living alone for the rental service of “wellbeing”
telephones and pocket bells and fire-alarm equipment connected to emergency city telephone centres.
These services including pre-cooked food delivery were made available to those disabled older
persons unable to do household chores including cooking, house-cleaning, shopping and others so
that they could interact with volunteers well versed with community affairs in care-free family
environment. Those volunteers were pre-registered with and screened intensively by the City Office
as regards their qualifications and personalities, as they had to deal by themselves with the disabled
aged persons at their households. The volunteers were reimbursed by the City Office only for their
transport charges such as bus, train and/or taxi fares. The volunteer assistance programme has been
not only in operation today, but the community needs for such services are increasing, as there has
been an increase in the number of those disabled female single old-age persons as a result of their
own longer life span and the passing of their male spouses, and as some medical studies in recent
years have shown that disabled single old-age persons felt more at ease if serviced at home rather
than at old-age homes.
There has been further improvement in various City programmes for enhancing social
17
participation of older persons in the Musashino’s second ten-year development plan (1982-91). They
included among others the remodeling and repairing of houses such as handrail installation and
barrier-free corridors for those old-aged persons living alone at one/tenth of the full cost to them, as
well as the sanitation services for cleaning and drying bed-sheets and bedcovers and the dispatching
of dentists for advices to those disabled aged persons living alone. Haircut and beauty parlour
services were also provided to the maximum of 5 times a year free of charge to those older persons
sick in bed for long time so that when feeling better they could go out into town and participate in
various community activities. Priority admission into municipal old-aged homes was also introduced
for those aged persons meeting certain qualifications.
Anti-influenza shot services also delivered at
free of charge to those persons aged 65 and above and to those aged 60 to 64 suffering from heart
diseases and respiratory sickness were effective in reducing innate worries about their health and
thus contributing to their higher social participation.
With the use of bicycles intensified in the 1980s, the City had to regulate bicycle parking near
the railway stations by designating certain public space as municipal bicycle parking lot and
arranging with the municipal association of retired persons to manage it, thus creating paid jobs, if
necessary, for those retired persons. “Silver” employment promotion centres operated by the
association of retired persons have also been engaged in repairing and refurnishing for resale those
bicycles left unused on street corners. Some of these refurnished bicycles have been sent to
municipalities in developing countries as gift of Musashino City, when requested by CSOs and
NGOs. In 1987 the first old-age centre was established in the city to provide all types of healthcare
programmes specifically designed for older persons, including a number of sports and lecture lessons,
with a view to involving them in civic and recreational activities and preventing further aging. The
mingling at the old-age centre with those persons in their respective age groups provided old-age
participants in centre programmes with a remarkable opportunity for information and knowledge
sharing and lesson learning which was also provided by “people radio and television stations”
installed for communities in and around Musashino City.
As the long-term public nursing care system was introduced in 2000, as mentioned earlier, the
Musashino’s third 10-year development plan (1992-2001) was revised in 2000 to add many more
programmes for enhancing social participation of the aged persons, in addition to those that had been
offered in the original plan. Under this new system those old-age persons certified as requiring
long-term public nursing care by the municipal committee composed of healthcare and welfare
service specialists and medical doctors are able to receive the three types of nursing care services,
enabling them to be more actively involved in community activities without being worried or less
18
worried about their impact on health. The first type of these nursing care services are rendered at
home, such as home visits by nursing care specialists, physical therapy, short-term stay at nursing
home and preventive nursing as well. The second type of services are rendered at nursing care
centres and homes including welfare, healthcare and medicare services. Several intensive nursing
care homes were installed in different parts of the city under the third development plan, catering to
the needs of those requiring such nursing care. The third type nursing services are community-based,
including night-time home visits. Also, “movus” services connecting residential areas off the main
streets were installed to encourage older persons to come into town and involve themselves in
community activities, whether going to municipal museum, art galleries, theatres, conference centres,
or even shopping and outdoor eating. The second old-age centre was established elsewhere in the
city in 1993, having been convinced that preventive healthcare through the active involvement of
older persons in various sports and recreation programmes was far more effective and less costly as
compared with medical and surgical cost associated with hospitalization.
Under the fourth 10-year development plan (2002-2011) as many as 7 “ten-million” houses have
been installed to take care of the diverse needs of older persons living in neighborhood communities,
in addition to all those services introduced in the city since 1972. They are all managed by
not-for-profit organizations approved by the City Office to provide older persons with emergency
short-stay services and day services of minimum nature such as the provision of consulting services
on healthcare and medicare and advisory services by experts on personal matters of confidential
nature. “Lemon Cap” taxi services, provided from door to door at discounted cost, have also been
introduced to encourage those disabled older persons who tend to stay home, to get out into town
and involve themselves in community activities where both the young and the old are mingling
themselves for social and recreational purposes. Musashino Development Corporation (MDC),
subsidiary of Musashino municipal government, also provides a number of welfare services for older
persons such as dispatching of social workers, nurses and other welfare experts at a nominal cost.
MDC also provides a loan of varying terms at subsidized interest charges to those older persons to
cover their daily necessities, medical expenses and repairing and remodeling of their own houses.
Activities of the two centres for the aged in Musashino City merit additional explanation, as they
have proven to be one of the most important services rendered by the City Office to encourage the
social participation of older persons in community activities. To illustrate, the October, 2011
programme at one of the centres includes among others professional lessons on chorus, paintings,
Japanese and western vocals, violin, piano and other musical instruments, lessons on Chinese chess
and marshal arts, flower arrangements, gymnastics, Indian yoga exercises, jazz and social dancing,
19
karaoke singing, magic exhibitions, poetry reading, porcelain baking, table tennis and tea ceremony.
These different topics, subject, lecturers, facilitators, time schedules, budgetary allocastion and so on
at these centres are planned by a citizen’s committee represented by those engaged in these
community activities for a long time and appointed by the annual assembly of the Musashino
Association of Older Persons (MAOP) composed of a number of voluntary groups of old-aged
participants currently registered with the centre activities. Their draft annual programmes and
budgets are presented for decision at the MAOP’s general assembly. The MAOP activities and
financial accounts are audited by a committee of auditors and presented for approval at its annual
general assembly. In addition to its annual assembly meeting, MAOP on behalf of its members, in
fiscal 2010 issued its monthly newsletters entitled “Roso (Aging)” 12 times a year, gave 12 seminars
on those subjects of common interest in cooperation with Musashino Board of Education, organized
two study trips to different parts of Japan, and presented an exhibition among others of paintings,
photographs, choreography and craftwork produced by its members. The MOAP’s annual
expenditures for fiscal 2010 amounted to ¥849,500, of which membership fees financed 66.7%, with
the rest coming from individual donations and the city grant.28/
Musashino City is now engaged in drafting its 5th 10-year development plan for the coming
years 2012-2021. A municipal committee composed of experts residing in the city has already been
drafting the Plan after intensive consultation with citizens, CSOs concerned with social actions and
CBOs concerned with community affairs as well as with the City Office, representatives of the
private sector corporations, trade union associations, agricultural cooperatives and others who tend
to represent their respective vested interests. In its draft Chapter 5, the committee has formulated
core policy plans and programmes designed to improve the living environments of different
communities in the City, followed by Chapter 6 which details cross-section plans and programmes
covering all the communities. Chapter 6 selected the six major policy areas as priority plan of
Musashino City. First, promoting and elevating the people participation in municipal policy
formulating and implementation processes and a variety of cooperation and linkage mechanisms for
the purpose, among all the stakeholders. Second, meeting the citizens-based service needs and
requirements, detailing among others possible plans and programmes for improving municipal
services for older persons in terms of healthcare, medicare/nursing, learning and welfare services.
Third, further improving the mutual flows of information and communications between
-----------------------------------------------------------28/ MAOP, 2011, Annual Report for 2011, pp.3-7
20
citizens and the municipal government with a view to better reflecting citizen’s opinions on
municipal affairs and administration. Fourth, reviewing the location of the current public facilities
owned and operated by the municipalities and improving their efficient and effective use, and fifth,
planning and executing administrative and fiscal reforms, without losing time, in
response to changing economic, social and environmental conditions within and outside the City.
Lastly but not in the least, the new draft plan stresses the need for the political leadership of the City
to encourage individual and organizational initiatives for meeting the current and future challenges
facing the municipal administration in pursuit of the government of the people, by the people and for
the people in all the communities of the City of Musashino. The total municipal expenditures for the
period 2012-2016 are estimated to amount to ¥296.7 billion, 66.4% of which are to be financed by
municipal tax revenues and cash reserves, and of which ¥42.3 billion will be allocated to investment
outlays, another good example of the model for fiscal discipline of all municipalities in Japan.
4. Conclusion and Recommendations: Enhancing the Impact of MIPAA
From the discussion above of the Musashino approach to enhancing the long-term care and
social participation of older persons in community activities and to enriching their daily living in the
community, it is now quite clear that the MIPAA’s objective “to share good practices (policies and
initiatives) on the identified focus areas” will be best met by presenting policy recommendations
based on the assessment of not only what some of the “progressive” local communities are doing in
enhancing the long-term care and social participation of older persons, but also what such
communities are doing to strengthen their local economic, social, environmental and cultural
sustainability and their local political governance, as well as what improvement is considered
essential in the national system of social protection to encourage and enable the inclusive and
sustainable long-term care and active social participation of the aged people in local
communities. Therefore, in addition to those excellent policy recommendations including
those for subregional and regional cooperation, given in the UNESCAP outcome
document entitled "Enhancing Elderly Care Services in Asia and the Pacific" made
public in January, 2011, following policy recommendations are given as useful lessons from the
perspectives of Japan and the City of Musashino, to those communities concerned with the
subject under consideration.
A.1) Long-term Care at the National Level;
1)
Improve steadily over time the national system of social protection including social insurance
and assistance programmes for older persons through constant dialogue with them in national
21
parliament, in government expert committees and/or at political rallies on their real needs and
requirements in local communities, thereby providing financial and psychological stability to
older persons in their day-to-day living. In so doing, it is vital for the government to ensure the
long-term sustainability, short- and medium-term financial viability, efficiency, effectiveness
and equity in mapping out and managing such system;
2)
Make doubly certain that all those policies and measures proposed by the
government and their respective implementation be well coordinated by the central
coordination mechanism in the Office of the Prime Minister so that there will be
minimum, if not no, duplication and less fiscal waste, let alone less confusion to the
local authorities charged with their implementation on the ground, among all the
ministries concerned with the long-term care and social participation of older
persons in the country;
3)
Delegate the authority of implementing the national system of social protection as far down as
possible to the lowest level of governments and minimize the state intervention through further
deregulation, while simultaneously not only requiring local governments and communities to
engage older persons in such implementation processes and adhere to the basic principles of
democratic governance such as the rule of law, transparency and accountability, but also
assisting those local governments and through them local communities particularly of older
persons in capacity building in terms of both human resources and institutions for strengthening
their self-governance;
4)
Decentralize the taxing authority to local governments and improve the current revenue-sharing
plan in favour of local governments and communities so as to enable the latter to supplement
and reinforce the national system of social protection and enhance the social participation of
older persons in accordance with their respective local conditions and requirements;
5)
Improve the working conditions of medicare and nursing-care workers to reduce their physical
and psychological burden associated with the care of disabled aged persons, increase their wage
levels up to that comparable to qualified nursing assistants and junior nurses and assist their
career development, including the provision of quality training and national examination for
advancing to qualified nurses; and
6)
Accelerate the negotiation and conclusion of bilateral agreements with many other countries
under which qualified medicare and nursing-care workers be invited to Japan to undergo further
training for such jobs to meet the shortage of such workers, relax language requirements,
liberalize, if not abolish, the maximum length of stay in the country and increase their salary to
the same level as any other Japanese workers on comparable jobs.
22
A.2) Social Participation of Older Persons at the National Level
1) Enact basic legislations and policies in consultation with all stakeholders in society to support
local government commitments to enhancing the social participation of olders persons and
installing and rviewing regularly the national system of social protection in response to
changing economic and social conditions of the country;
2)
Install effective mechanisms including coordination function to implement, monitor and
evaluate those policies so as to meet the changing needs and requirements of the aged
population;
B)
At the local government level;
1) Install the systematic approach in consultation with all stakeholders in the community to social
participation of older persons through long-term planning, mid-term reviews and public
awareness campaigns
3) Improve constantly and steadily the people participation in the local government
decision-making processes for all policy formulation, implementation, monitoring and
evaluation in all sectors, be they economic, industrial, health, educational, environmental,
cultural, political and administration activities including the budgetary process, by establishing
not only expert committees but also citizens’ committees involving older persons on the
formulation and evaluation of all major policies and programmes, especially those affecting the
lives of the aged population and by lowering the current restrictions on people petitions to the
City Council and on the use of citizen’s right to referendum;
2)
Monitor at the highest level the disclosure of all public information on local government
administration and on national government information relevant to the citizens, especially the
aged population in local communities, while strictly adhering to the rule on the confidentiality
of personal information and maintaining good governance at the local and community levels
which is essential to establishing mutual trust between public authorities and citizens in their
communities;
3)
Organize all local community activities in partnership with active CSOs, CBOs and other
relevant stakeholders including older persons in the community with a view partly to sharing
experiences and perspectives among them in respective activities and partly to mobilizing the
rest of the local community people, especially the groups of aged population for enhancing their
understanding, interests and cooperation on the policies and programmes under consideration;
4) Assist all groups of older persons and their voluntary associations both financially and
technically in organizing seminars, workshops, conferences, exhibitions, study tours and other
social action programmes within and outside their respective local communities in collaboration
23
with other organizations/associations;
5) Encourage older persons to go through various types of physical and medical examinations at a
regular interval such as bi-annually at registered clinics and hospitals in the community with a
view to providing them with accurate information on their mental and physical health and
administering preventive treatment at an early stage, if found necessary, thereby contributing not
only to the health of the aged persons themselves but also possible reduction in medicare and
healthcare expenditures to be borne both by the national system of medicare and health insurance
as well as by central and local governments;
6) Engage older persons in making effective utilization of their professional capabilities, expertise
and rich experiences in:
a) School programmes as special teachers, school lunch activities as volunteers ( teacher
assistants and story tellers);
b) Community programmes as lecturers in seminars and workshops on various professional
development and community education programmes;
c) Productive employment programmes as participants in “silver service” where old household
equipments and appliances are repaired and renovated for resale and supervise bicycle
parking lots for “park and ride” commuters;
d) International cooperation and disaster volunteers programmes in response to national
volunteer service programmes (ex. Great East Japan Earthquake/ Tsunami and Silver
international Cooperation Volunteers)
7) Provide older persons with a variety of community programmes where they can participate in:
a) Advancing their education and learning in subject matters ( e.g. history, fine arts, literature
and poem reading, social, biological and natural sciences;
b) Improving their skills required in daily living (e.g. cooking, sewing, safe driving etc.)
c) Maintaining their healthy lives through sports activities (e.g. gymnastics, aerobics, social
and group dancing, volleyball and basketball, table tennis and other sports clubs);
d) Disaster prevention, urban greenery and residential safety training activities; and
8) Encourage older persons and their groups and associations to get into towns to participate in
community activities, sports and cultural events for the purpose of maintaining curiosity and
spending intellectually and physically healthy lives, by installing “movus,” “ten-million houses,”
“lemon cap taxis,” “people radio and television stations,” citizen’s theatrical groups, community
parks, community centres and centres for aged persons, as operated by Musashino City, thereby
preventing old-age isolation, trauma, suicide and contributing to reducing healthcare, medicare
and nursing-care expenditures;
24
C)
At the community level;
1) Mobilize the people living around a few blocks of residential areas to come to community
centres and nearby primary or secondary schools to discuss major issues facing them in daily
community living and carry out their solutions on their own to their mutual benefits, and/or
present their findings and policy recommendations to the City Office or City Council for taking
actions, if requiring some public expenditures, thereby learning how democratic governance
works through their group decisions and actions. Older persons with governance experiences are
often found quite useful in getting consensus of opinions and actions in such communities;
2) Organize a series of seminars and workshops beneficial to community residents which would
contribute not only to cementing a sense of community and solidarity among such neighbors,
but also enhancing a sense of participation in community decision-making processes and
eventually in such processes beyond their own small community, thereby improving their
capacity for initiating new policies and negotiating for better on behalf of larger communities;
3) Invite citizens and the representatives of other communities active at respective community
centres and in a variety of community programmes to learn from each other in an effort to
improve consensus building process and join their heads, hands and hearts together for better
representation of their community demands at City Council for decisions especially beneficial to
older persons; and
4) Involve older persons as special teachers at primary and secondary schools in their own and
neighboring communities and, if necessary and useful, at colleges and universities on various
topics and subjects based on their long years of practical, technical, professional and managerial
experiences in government’s legislative, executive and judiciary branches, private sector
corporations, school system, research institutions, CSOs and CBOs and so on, thereby bringing
them into closest possible communications with younger generations who get inspirations from
older generations and from whom older persons also learn directly various issues facing them
and their perspectives.
25
References
Asahi Newspaper’s morning edition of 27 October, 2011.
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