Agetech World podcast: The age-old lessons we can learn from Japan

With governments across the globe facing a ticking timebomb when it comes to funding the care needs of their ageing populations, a leading social and medical anthropologist has told the latest Agetech World podcast that there is much Japan can teach policymakers.

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Among Dr Iza Kavedžija’s main research interests is exploring the lived experience of ageing in urban Japan.

The Assistant Professor of Medical Anthropology in Cambridge University’s Department of Social Anthropology has lived in Japan and conducted extensive ethnographic fieldwork with two distinct groups of people in the Kansai region.

This led to her first in-depth study, Making Meaningful Lives: Tales from an Ageing Japan, and has underpinned a series of journal articles addressing a broad range of topics including care, hope and hopelessness, and happiness and gratitude.

In conversation with Agetech World, Dr Kavedžija said Japan had long been known for its widespread respect for the older population and its sense of obligation to caring for them.

The country has one of the world’s oldest populations, with nearly 30% of its 125m inhabitants aged over 65. This age group is expected to account for 34.8% of the populace by 2040.

Whilst this is inevitably putting a strain on Japan’s long-term care system, the country’s politicians and wider society are continuing to learn, evolve, and devise radical solutions to meeting this growing demographic challenge.

Japan has always had a strong tradition of family caring for its older citizens. But to this has been added a Long-Term Care Insurance (LCT) scheme, a complete package for the over-65s covering both the financing and the implementation of social care according to needs, supported by mandatory premiums levied on those aged 40-plus and co-payments from users.

Further responding to the nation’s ageing society, Japan is preparing to introduce a new Community-based Integrated Care System by 2025, with the aim of ensuring the comprehensive provision of health and nursing care, housing, and livelihood support.

Japan has also been working on developing robots to automate care for older adults, and other innovations include government investment in non-medical activities that can help prevent age-related illnesses; helping the over-65s flourish by working with them in their homes and communities rather than expecting them to conform to current societal norms or live in neglect; and making their towns and cities easier to navigate so seniors can still participate in everyday life whether for pleasure or work.

The number of residential homes is restricted with the emphasis on community care

Dr Iza Kavedžija

Asked what Japan can teach the likes of the UK – which is facing a soaring health and care crisis – Dr Kavedžijan said: “I think there are many things that Japan has paid close attention to.

“I think the Long-Term Care Insurance is one of a kind… that allows for the drawing on services from various sectors, so it is possible to create a mix of forms of support, whether it be home care, whether it be various forms of assisted living…so a lot of interventions that are in the community and a lot of providers that range from non-governmental to the state sector to the private sector, where one can create a plan of care and support with a care manager that’s tailored to the needs (of the individual) drawing from the broad range of services.

“It isn’t always the same sort of story where the plan has led towards institutional living.

“In this sense I think Japan has been particularly successful. Of course, as the proportion of older people is so high in the population, this system is somewhat coming under strain. I don’t want to represent it as a particularly rosy situation. It isn’t. There are challenges to it.

“But I think nonetheless that this very, very well thought out system of support is important and it also cultivates these various forms of dependence, or interdependence, where one can draw on different types of assistance.”

Dr Kavedžija added: “It actually also allows people to continue living relatively independent lives….it doesn’t necessarily mean they have to move in with their children.

“So, they think of older people as the ones who continue the tradition and social changes as something that is brought on by younger people.

“In this case, I think we have seen very clearly that it is older people themselves that have often been the active leaders in social change. They have been the ones often saying, ‘I know there is an expectation for me to depend on my older son, but I don’t want to be a burden on my children.’

“So, they cultivate various forms of care in the community and they themselves become very involved in a huge range of activities, volunteer activities, that foster support in the community and create these communities of care.

“That is, I think another lesson that would translate well elsewhere.”

But Dr Kavedžijan also gave a note of caution. “I don’t want to paint too much of a positive picture because certainly challenges are there. That is something that again is perhaps an important lesson, and that is to do with the circulation of care, as I like to call it, where we need to think of care in systemic ways.

“For instance, elder care largely depends on a volunteer workforce, and that had for many years often consisted of women.

“In order to support better care for elders I think it is necessary to consider in which ways we can perhaps support childcare. So, to think about these flows of care in a much broader way and try and foster support across the board rather than thinking of them as separate units…that are not intertwined.”