Healthy Ageing

Dr. Jacob Kumaresan from the World Health Organisation explains the measures taken by Japan to cope with an increasing number of elderly in urban areas. He calls for a change in mind set on how we view the role of the aged in society and the need to recognize the eldely as the guardians of our society.

Dr. Kazuo Tsubota from Keio University explains three key stages of health care. These are initial anti-ageing self-care activities like exercise and good nutrition that can slow later ageing ailments, health care systems that financially support an individual receive needed medical treatment, and the newer areas of regenerative medicine that can repair and replace body tissue that no longer functions properly.

Healthy lifespan can be increased a lot if individuals and policy-makers make combined efforts

With the concerted effort of individuals and governements, healthy lifespans have the potential to increase as much as 16 years in parts of Africa, where healthy life expectancy is as low as 29 years, and by about five years in the high income countries of Europe, the United States, Australia, New Zealand and Japan. Healthy, independent older persons actively contribute to their family and community. Their participation is an important resource for the community. These contributions can only be ensured if the elderly enjoy good health and if societies address their needs.

However, being free of illness does not necessarily ensure good quality of life as one ages. Mobility, independence, cognitive function, psychological state, and social relations and networks are also very important, and they need to be maintained—in part through good nutrition—well into old age. Actions by individuals, health workers, communities and governments in any of the determinants shown in the following chart can lead to healthier ageing:

Source: Davies AM (1998). Ageing and health: A global challenge for the 21st Century. Proceedings of a WHO symposium, Kobe, 10-13 November 1998.

Healthy ageing: who is responsible?

Indeed, the efforts of many people at different levels of society are needed for good health and quality of life in old age. Here are some steps that a healthily ageing society requires.

1. Governments and society in general: If older people are to remain healthy, the environment in which they live must help them to stay healthy. While there is much individuals can do, there are things over which they have no control. If the air is polluted with poisonous chemicals or food is poisoned with insecticides, it is difficult for an older person to keep their health. If the only food that is available or affordable is unhealthy or the lack of food labelling makes it impossible to know whether the food contains unhealthy ingredients, we cannot expect individuals to remain healthy. If the environment is noisy or the workplace unsafe, hearing as well as muscles and joints will be damaged, regardless of the lifestyle changes that people make. If the neighbourhood is unsafe and workplaces filled with tobacco smoke, or if tobacco marketing ensures that young people smoke, we can hardly expect that they will be healthy in old age. Depending on the country, national governments control the resources allocated to health ageing through health systems.

2. Communities: Communities and local governments have a wide responsibility to help people to help themselves. Older people also need access to housing that helps them to stay healthy. They need to be able to obtain healthy food locally and to be able to get around the community safely. Opportunities to mix with other people locally are vital, since becoming isolated is known to lead to poorer health. Where local governments are in charge of health, hospitals, care facilities, health workers and medication are required to assist with the health care of older people. The health of older people has to be given some priority so that there is money available to assist them.

3. Health workers: Even where individuals do all that they can to look after themselves, they will still need to receive help from health professionals. Health workers must be available, and health professionals can provide valuable advice on how to prevent illness, diagnose disease in its early stages and provide support and treatment to either cure or control the progress of the condition.

4. Older people themselves: Good health for older people also requires that individuals actively try to look after their own health. There are changes that individuals can make and steps they can take to help them enjoy a healthier old age.

For example, eating habits. As we age, nutrition requires special attention. Energy expenditure declines with age; thus, to achieve energy balance, less energy needs to be consumed. This reduction in energy intake can have an adverse effect on the nutritional status of older people unless high nutritional quality foods are eaten. Consuming foods that are rich in nutrients and other bioactive components (such as phytochemicals) may also help to protect against major age-related ailments.

Good health is imperative for older people to remain independent and continue to contribute to their families and communities.

Health promotion in Japan: from increased life expectancy to improved lifestyles

Japan has recognized since the late 1970s the importance of health prevention and has fostered numerous initiatives in the field of health promotion. In particular, national and local health authorities have launched several programmes aimed at promoting healthy lifestyles and successful ageing, improving maternal and child health and targeting various other key issues for well-being.

The plan first phase, rolling-out between 1978 and 1988, established municipal health centres as focal points for health promotion activities.

The Active 80 Health Plan, launched in 1988, marked the plan’s second phase, the aim of which was to extend the population’s lifespan to age 80. The plan aimed to encourage more people to undergo health examinations and to improve municipal health centres.

As a third phase, a national plan to encourage healthy living practices for Japanese citizens called “Healthy Japan 21″ was introduced for 2000-2010. According to the Japanese government, Healthy Japan 21 promotes national health in a comprehensive manner by reducing premature deaths and extending the healthy lifespan of citizens so that they can live without suffering dementia or being bed-ridden. It aims to achieve a society in which all nationals can live a healthy, happy and long life.

Healthy Japan 21 localized many of the priorities of Japan’s national health promotion plan, by integrating prefectures, cities, towns and villages into the planning and implementing process, with local governments becoming responsible for developing health improvement activities that support the national health priorities.

As a follow-up, the Health Promotion Law went into effect in May 2003. The law further sets out the basic national health policy and the system for health promotion in prefectures and municipalities for the upcoming years. It provides guidance on health examinations and health promotion, as well as measures to prevent passive smoking. It requires national surveys on health and nutrition and also the display of nutritional information on specific food items.

Health promotion in Kobe and Hyogo

Host governments of WHO Kobe Centre, Hyogo Prefecture and Kobe City, have developed local health plans.

In 1999, the Action Indices for Daily Life were agreed upon and became the signposts for health care policy in Hyogo Prefecture under a plan called “Healthy Hyogo 21″. To achieve the goals of this local version of Healthy Japan 21, a health promotion centre was established within the prefectural government. Together with the Hyogo Prefecture Health Promotion Association, these initiatives promote actions on seven fields for the health of Hyogo’s citizens (self-checks, exercise, eating habits, mental health, tobacco, alcohol and dental health). In addition, three lifestyle-related diseases were identified as deserving particular attention.

In parallel, Healthy Kobe 21 is part of the Kobe City Health and Medical Treatment Plan 2010, one of the city’s basic health and medical treatment programmes. The Kobe Athlete Town Plan, which aims to advance city-wide health and sports activities is closely aligned with the Healthy Kobe 21 plan. With respect to the elderly, Healthy Kobe 21 contains an extensive range of proposals. Some key examples include:

- Study of the healthy lifestyle practices of the city’s oldest old
- Promotion of exercise and walking by the use of pedometers and a points programme linked to the planting of trees
- Regional walking promotion—promotion of 10,000 walking steps a day, walking maps in neighbourhood regions, walking classes
- Cooperation with Kobe regional sport clubs (i.e. Kobe Athlete Town)
- Awareness-raising events to prevent periodontal diseases
- Promotion of “8020 movement” encouraging health practices that enable the elderly aged 80 years and over to retain at least 20 teeth
- Establishment of a pool of specialist medical health volunteers to care for the elderly

Relevant Documents and Links:

United Nations Programme on Ageing

WHO Report on Healthy Ageing – Practical Pointers on Keeping Well

WHO – Ageing and nutrition webpage

WHO – Keep fit for life: Meeting the nutritional needs of older persons

WHO Kobe Centre report on Public Health Policy and Approaches for Noncommunicable Disease Prevention and Control in Japan: A Case Study

WHO report on a Life Course Perspective on Maintaining Independence in Older Age

Dr. Kazuo Tsubota’s webpage

Japan Society of Anti-Aging Medicine