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LESSONS LEARNED FROM JAPAN–THE PROMOTION OF INTEGRATED, SUSTAINABLE AND LIVEABLE CITIES/COMMUNITIES

Centrally planned communities, “new towns,” have been around in Japan since the 60s. However unlike the 60s many of these “new towns” are increasingly becoming more integrated, age-friendly. They are increasingly also built with the goal of ensuring sustainability and with helping communities successfully manage the rising social challenges, in mind.

An example of one such community is Yukarigaoka. Yukarigaoka was extensively planned back in the 1970s by Yamaman, a private company. It is located in the north-central Chiba city of Sakura. However unlike some other “new towns” that were also built around the 1970s (for example, Tama New Town, which is composed of mostly elderly persons), Yukarigaoka is specifically designed to allow for the elderly to live close to their families and friends in their communities with the hope that such integration will foster opportunities for younger generations to benefit from the old and vice versa (Yukarigaoka has a balanced population aged structure, which means that it provides a living environment for residents at all stages of life).

To date, Yukarigaoka has a total land area of 245 ha. and a population of 17,000. The distance to the nearest train station is no longer than 10 minutes by foot. Doctor’s offices and child care centres are also easily accessible and close to public transport. Electric bus transportation is available for the elderly in residential areas, so the aged have direct access to residential areas and can stop where they want to. Also, Yamaman directly intervenes to help maintain the relatively balanced population structure between the young and the old. Yamaman handles the sale of both new and older housing units in Yukarigaoka so that that the transition to new accommodation can occur seamlessly within the community and the value of property does not change too much.

Kashiwa-no-ha is a new “new town” that builds on this model. It is developed with a view to the future: to pioneer solutions for social challenges. The town has a planned population of 30,000 and is situated between Tokyo and Tsukuba. Similar to Yukarigaoka, Kashiwa-no-ha is a public-private academia partnership that aims to develop a city of health and longevity, a smart city, and a new industry-creating city. The city promotes ageing-in-place, wellness and health promotion in a community setting, and allows for middle-aged residents to benefit from mutual assistance within the community. Age-friendly services provided in communities include the provision of transportation, buildings, libraries, and shopping centres, among other support structures that are specifically catered to meet elderly and youth needs.

Large investments and multiple investors are increasingly common for the development of integrated communities that can address social challenges, such as environmental sustainability and population ageing. That these communities can be sustainable and can grow are important.

Enabling the elderly to successfully age-in-place and for the youth to have connection to the old, goes down to the design of a community in Japan: of creating the appropriate physical and social environments to ensure that the appropriate interconnections exist at the local level: between the service user, informal carer and professional; between various aspects of the healthcare system and across all relevant sectors, even though such coordination may not exist at the national level. Promoting inclusiveness of elderly ensures community sustainability and growth over time. It also enables the elderly to stay in the same communities as their families as they continue to age.

With one of the highest proportions of elderly in the world, Japan undoubtedly has more structures, funding mechanisms and institutions in place to support the aged. The importance of tackling the aged society is recognised at the national level in Japan (even though local communities have their own successful initiatives targeting aged people in highly rural areas). The Ministry of Health Labour and Welfare is the agency responsible for policy making and administration of the workforce, national pension system, national healthcare system, national nursing care insurance system, etc. While most initiatives related to ageing and planning involve and have been initiated by the national government, who has the authority to secure budget and distribute it to each local government, national/state/local governments also pay. The ventures are also open to other partners. Thus, while the Japanese Government seems to take on a large burden of caring for the aged, so do the other stakeholders in Japanese society.

The benefit of multi-stakeholder engagement to create these integrated communities is that the burden of the elderly is shared among a wide variety of stakeholders. Another advantage is that elderly needs can be provided more downstream at the community level, assuming that enough support structures are present in the community and home setting to enable that to occur. This ensures that all people in society can continue to remain productive, socially engaged and age-in-place in urban settings. It also helps ensure that the communities that are built or redesigned can successfully grow to address the rising social challenges facing Japanese society in the years ahead.

Source:
Field diary: Yukarigaoka by catforehead
Notes from AAIF Conference in Singapore, April 2012
Notes from unpublished research brief.

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Pioneering information infrastructures for the aging society

The need for qualified nurses and elderly care providers is growing in Japan and one company that has realized the demand for an efficient coordination of the efforts is the SMS Company Ltd. Since its start in 2004, the company has expanded the venture portfolio to focus on building information structures for the aging society, including placement services, online job-search and community-websites for nursing-care, medical and other senior-targeted markets. The social media platforms they provide enable care givers to exchange information about challenges, solutions and opportunities on a daily basis. It also helps employers to identify new employees and to fill their vacancies faster and more efficiently.

We meet with Reiji Yamanaka and Eric Iwaya, Leaders of the Incubation Group at the SMS Co. Business Development Headquarters who explain that the company is assuming an innovative approach to collect, organize and transfer data. The current information about elderly care is scattered and the asymmetry of information is significant, so the market opportunity is vast as the nursing and medical care expenditures grow when the population ages. The SMS platforms, Nurse Jinzai-Bank, the platform for long-term placement of nurses, Nurse-senka Community, the community website for nurses and nursing-school students and Kaigo-Job, the online job-search website for nursing-care-related professionals are examples of innovative means to connect the different stakeholders in elderly care. SMS Co. also offers platforms for family care givers as well as certified care-managers. The IT solutions become market places, knowledge banks, recruitment vehicles and discussion forums.

Reiji Yamanaka and Eric Iwaya mention that the IT-literacy of the nurses is an important factor but the platforms can also be navigated through mobile phones which makes the services easy to use and accessible to a wider audience. The company has supporting call centers which help with placements and the other services provided. With its holistic approach, SMS Co. helps the ecosystem of care givers and elderly care employers come together. And Japan is not the only country in need of these services. SMS Co. has their target set on providing infrastructure for the aging societies in all Asian countries.

Japan – a country of contrasts

”There are no children on the streets. No pregnant women. Of course you notice it!” Nhat Vuong, social entrepreneur and Founder of i-kifu shakes his head. Japan is not an aging society, in many aspects it has already aged. But as Nhat points out, the elderly still have money. They get care. A report from the Japanese Research Institute, 2008, on Household Expenditures supports his statement. The household spending power is redistributed from the young to the elderly. But the question is how long the economy can cope with a hastily declining number of workers in the national work force.

As Nhat points out, people are not that engaged in giving for the cause of the well-being of the elderly. If they give to society, they prefer to look at investments for the future, supporting children, education, the environment. The elderly will need support but they are not seen as investments.

The reason to why we meet with Nhat, a social entrepreneur based out of Tokyo since 5 years back, is to learn about the mentality of the young in Japan. The mentality of the entrepreneurs, the shakers and movers. Nhat himself is the founder of the i-kifu, meaning ”I donate” in Japanese. He has been working on the crowd funding venture since 2007, to give people the opportunity to achieve a social impact through their social engagements. His venture hands out karma points that can be exchanged for rewards to people that do good; either by donations or volunteering.

Nhat’s personal story is fascinating. Following the end of the Vietnam war, Nhat’s parents fled Vietnam in a boat and he was born in a refugee camp in Malaysia. From there his family was given asylum in Switzerland, with the help of the Red Cross, and Nhat enjoyed a safe upbringing just like any other child in the stable economy of the Swiss. His parents would mention to him how lucky he was that he could just go to school, not having to work, but the concept of poverty was hard to grasp. The only comparison he had was with his Swiss peers and just like them he desired the latest toys and the nicest gadgets. It was when Nhat for the first time visited Vietnam, 15 years old, that he was confronted with social injustice and extreme poverty. It was then that he realized that he wanted to make a positive social contribution to the world.

After finalizing his studies in Switzerland Nhat moved to Japan (mostly for love), started looking for job opportunities in the digital sphere and soon saw the opportunity to connect his skills in IT, marketing and gamification (peoples’ addiction to games and the reward systems these offer) with his social impact aspirations. The idea of i-kifu was born and now, some time and a lot of hard work later, Nhat has 25 Non-for-profits that share their projects through his site. Several socially minded businesses support the platform. The traffic to the site is growing even though the concept of crowd funding and donations is much less common than in other markets. In the US, for example, there are over 1 Million Not-for-profits whereas Japan only has 60 000. After the earth quake and the Fukushima disaster this is slowly starting to change, both in the social scene and in Japan’s orientation towards entrepreneurial ventures.

”Japan is waiting for an awakening. Some people were hoping that the earth quake would have the effect but that still remains to be seen. People live in invisible prisons, entrepreneurs and innovators are held back by social expectations- you are not solely responsible for your own success or failure, your family and friends share the shame if you don’t succeed. The circle of responsibility is strong and rigid. That is why it is difficult for Japanese people to try something new. The risk is too big”.

“When you approach someone with a really great idea the first question is: Has this been done before? Not? Well, please come back when a large corporation has tried it and it became really succesful. The entrepreneur scene is not easy. There is a lack of role models and the school system still focuses on training workers for long-term positions at large corporations”. But Nhat is optimistic. And determined to work the system. He says: “If I can make it work here, then I can succeed anywhere. Plus, as we learned from Steve Jobs, if you only ask people what they want and give it to them you will never reach the really groundbreaking innovation.”

Nhat also mentions the island effect; “Everything is so easy and accessible to the Japanese, they don’t really need to travel overseas or to learn English. Even if Japan was heavily dependent on technology export for a long time, cars and electronics, they themselves did not embrace technology at the same rate. Despite high-tech innovation in some Japanese corporations, there are still offices in japan that use their fax machine actively.” A country of contrasts, as Nhat describes it.

And the vision for the future? “The era when Japan thrived is gone. There is no longer time for time-consuming, hierarchical decision-making and deeply anchored decisions. Now the speed of technical development requires that companies try, fail, succeed, iterate faster. In previous times it could take a Japanese company six months to reach a decision, now, in six months, innovators from China and India would have rolled out the product already, succeeded or failed and moved on. That’s how innovation is achieved nowadays. Trial and error. Fast. Not processes with full internal consensus. Japan needs to embrace this. Iterate faster.”

Nhat pauses and formulates his conviction: “Japan has a huge potential. The people here are extra-ordinary. I have seen people achieve here what I didn’t think was humanly possible. They can do it. They truly can. With the right support they can achieve anything.”

Aging in Japan

It is said that an era is coming in which human life is expected to last upwards of 90 years. That’s 25 years to live after retirement. 25 years of hopes, dreams, joy and sorrow. Some countries will experience this, or be hit, sooner than others. A unprescendented demographic change is happening in Japan. By 2055, 1 in 2.5 will be 65 years or older and Japan will become a hyper-aging society.

The country known for the growth of its impressive Tiger Economy and its creation of innovative high-tech firms like Sony or Hitachi needs to prepare. Many countries will soon follow and elderly care providers world-wide are wondering. What is the the land of the rising sun doing to, once again, take the lead?

Today, we are introducing a new blog series to Silverevolution: “Aging in Japan”. During the coming two weeks we will be sharing how Japan is organizing its care for the aging population, its housing, manpower, health care, transportation, and finance policies. We will visit robotics labs, learn from industry experts and speak to innovators and entrepreneurs. The world has for decades been following in the footsteps of Japan’s great innovators. Now it is time for us to learn about their forward-looking preparations for the aging world.

Reference

Country case for chronic disease: Japan and its staggeringly low cardiovascular death rates

(Yoshikazu Tsuno/AFP/Getty Images)

“Noncommunicable diseases (NCDs), primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, are responsible for 63% of all deaths worldwide (36 million out of 57 million global deaths)” – World Health Organization, 2011

Noncommunicable diseases – also referred to as chronic diseases – remain the number one global cause of deaths worldwide and cardiovascular disease (CVD) or heart disease remains at the top of the pedestal. Chronic diseases significantly concern the elderly, as 75% of 36 million global deaths attributable to chronic disease occurred beyond age 60 in 2011. In this report, we must highlight Japan – the country with the highest average elderly age yet the lowest cases of heart disease.

As early as 1981, Professor Geoffrey Rose of Epidemiology wrote an article in the British Medical Journal about taking the action of preventing CVD. He showed staggeringly low numbers of how Japan in 1968 had just over 100 deaths per 100,000 population attributable to coronary heart disease (CHD), whereas before the United States was able to drop their rates considerably over time, in 1968 they had the highest number – with over 800 deaths per 100,000 population. Sweden was around the middle, with approximately 450 deaths per 100,000 population. Further, Rose adds, “The Japanese owe their low rates not to their genes but to their way of life: when they move to America they rather quickly acquire American rates.” In addition to affirming Japan’s low death ratio, the United States and Australia had shown drops of 25% till year 1977, indicating that therapeutic advancements and prevention strategies can considerably reduce the deaths from CHD – which represent approximately half of CVD deaths (Iso, 2008). Japan has been able to keep their low CHD death ratio similar with a slight drop till 1977 (Rose, 1981) and has considerably dropped further – with over a 50% drop from this time frame to year 2000, having now around 37 deaths per 100,000 population (Iso, 2008). Dr. Hiroyasu Iso of Social and Environmental Medicine wrote in the Journal of the American Heart Association that Japan still has the lowest CHD ratio of high-income countries – between one-third and one-fifth that of the United States.

The decline of CHD deaths in Japan is attributable to the decline of mean systolic blood pressure levels and the prevalence of smoking. However, an issue is arising with a high prevalence of western fast-food diets increasing the mean serum total cholesterol and triglyceride levels (Iso, 2008). It is curious as to how Japan started with such a low ratio of deaths from CHD, and as we have heard from Professor Rose, it is due to their lifestyle. Is this lifestyle perhaps significantly affected by the practice of Complementary and Alternative Medicine (CAM) or Traditional Medicine (TM) involving the use of exercise, herbs, or other techniques? In order to explain a counterbalance for a high-fat-intake diet, I recommend collaboration with a national research organization such as the Japan Society of Oriental Medicine to investigate how the effects of Japanese Traditional Medicine, i.e. Kampo, derived from Chinese Traditional Medicine might be attributable to the low incidence of CHD deaths in Japan.

According to Dr. Johan von Schreeb of Karolinska Institute’s Public Health Sciences, approximately 1/3rd of Japan’s population is over age 60 and the country has the highest average aged population in the world – leading with 84 as the mean age of life expectancy. Prevention of chronic diseases is on the forefront of today’s world, with so many medical advances leading not only high-income countries but countries all over the world to jolt up in life expectancy. And as life expectancy rises, so does the demand for prevention of chronic disease. Is there a golden formula somewhere out in the Far East that could face this issue? As the country with the leading population of elders, perhaps there really is something about Japan that the world could need.

References

The Epoch Times. Image Retrieved April 4th, 2012: http://www.theepochtimes.com/n2/world/40000-japanese-aged-100-over-survey-says-22351.html

World Health Organization. 10 FACTS ON NONCOMMUNICABLE DISEASES. September 2011. Retrieved March 29th, 2012: http://www.who.int/features/factfiles/noncommunicable_diseases/facts/en/index.html

Schreeb, Johan von. Lecture on Disasters & Relief. January, 2012. Karolinska Institutet, Solna, Stockholm. IHCAR Department of Public Health Sciences.

Hiroyasu, Iso. 2008. Changesin Coronary Heart Disease Risk Among Japanese. Journal of the American Heart Association 118:2725-2729.

Rose, Geoffrey. 1981. Strategy of prevention: lessons from cardiovascular disease. British Medical Journal 282:1847-1851.