Post on 11-Jan-2016
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic1 |
Linking Evidence to Health Policy for the Ageing:
A Social Health Atlas of Older Adults in a Major Japanese City
Megumi Kano,1 Jimpei Misawa,2 Kayo Suzuki,3 Masataka Nakagawa,3 Katsunori Kondo3
1WHO Centre for Health Development, Kobe, Japan; 2Rikkyo University, Tokyo, Japan;
3 Center for Well-being and Society, Nihon Fukushi University, Nagoya, Japan
Linking Evidence to Health Policy for the Ageing:
A Social Health Atlas of Older Adults in a Major Japanese City
Megumi Kano,1 Jimpei Misawa,2 Kayo Suzuki,3 Masataka Nakagawa,3 Katsunori Kondo3
1WHO Centre for Health Development, Kobe, Japan; 2Rikkyo University, Tokyo, Japan;
3 Center for Well-being and Society, Nihon Fukushi University, Nagoya, Japan
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic2 |
Japan’s achievements in longevityJapan’s achievements in longevity
Life expectancy at birth– 86 yrs for women, 80 yrs for men
Healthy life expectancy at age 60– 21.7 yrs for women, 17.5 yrs for men
Key contributing factors: – Health system and health services– Social and physical environment– Health behaviour– Genetics
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic3 |
The demographics of ageing in JapanThe demographics of ageing in Japan
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic4 |
RAPID ageingRAPID ageing
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic5 |
Key ChallengesKey Challenges
Ageing of the urban population
Dwindling resource base
Growing income inequalities health inequalities?
“Ageing in Place”
Lack of data to enable evidence-based policy and practice, especially at the local government level
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic6 |
Project ObjectivesProject Objectives
To establish a mechanism for integrating research into policy and programme development to promote elderly health and wellbeing in a major metropolitan area of Japan
To build the epidemiological evidence base on the broader determinants of health and wellbeing among elderly residents in rapidly ageing urban areas
To empower local stakeholders to create healthy conditions in which people live, work, and age
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic7 |
Main Project Partners Main Project Partners
City of Kobe: Public Health and Welfare Bureau, Health Division, Long Term Care Insurance Unit (Kobe, Japan)
Centre for Well-being and Society, Nihon Fukushi University (Nagoya, Japan) and the JAGES Research Group
WHO Centre for Health Development (Kobe, Japan)
Common interests in urban health, health equity assessment, social determinants of health, and evidence-based policy/programme development
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic8 |
Japan Gerontological Evaluation Study (JAGES)
Japan Gerontological Evaluation Study (JAGES)
One of the few population-based social epidemiological gerontological surveys in Japan
Conducted in 1999, 2003/4, 2006/7, 2010/11
2010/11 included 112,123 individuals across 31 municipalities in 12 prefectures
Kobe City was among the first few major metropolitan areas to join this study in 2010/11
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic9 |
Survey ItemsSurvey Items
Health status indicators: self-rated health, chronic conditions, health behavior, oral health, nutrition/diet, tobacco, alcohol, ADL/IADL, etc
Psychological indicators: depression, subjective well-being, etc
Social indicators: social support, social capital, social participation
Socioeconomic status indicators: income, education, relative deprivation, pension, etc
Environmental indicators: road safety, parks and recreation, accessibility, etc
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic10 |
JAGES Survey: KobeJAGES Survey: Kobe
Kobe City has the sixth largest population in Japan and a significant proportion of elderly residents (20% in 2005)
It is a “government-decreed city”
Representative sample of 15,000 independent, community-dwelling elderly residents aged 65 years or older
– 9,873 responses (66% response rate)– 9,328 valid responses
Self-administered mail survey conducted between December 2011 and February 2012
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic11 |
Kobe sample characteristicsKobe sample characteristics
Age (years)65-7475-8485-9495-99
56.3%37.7%5.8%0.2%
SexMale
Female45.2%54.8%
Equivalent household income groupLow (<2 million JPY)
Middle (2-4 million JPY)High (>4 million JPY)
43.6%33.9%8.4%
Household compositionLone elderly
Elderly coupleOther
23.3%44.8%31.9%
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic12 |柏市
名古屋市知多
市東浦町
大府市
半田市
西尾市
碧南市
神戸市
吉良町
美瑛町
東海市
度会町
武豊町
一色町
幡豆町
高梁市
十和田市
阿久比町常滑
市美浜町
岩沼市
中央市
東神楽町
十津川村松浦
市
南知多町東川
町南城市
今帰仁村全体
60%
65%
70%
75%
80%
85%
90%
87.2
%
83.5
%
82.8
%
82.7
%
82.1
%
81.4
%
80.8
%
80.5
%
80.3
%
80.2
%
79.7
%
79.5
%
79.4
%
78.8
%
78.2
%
78.2
%
78.2
%
78.0
%
78.0
%
77.9
%
77.6
%
77.2
%
77.1
%
76.7
%
76.1
%
75.9
%
75.2
%
74.0
%
72.8
%
67.6
%
79.2
%
Pro
po
rtio
n r
epo
rtin
g "
very
go
od
" o
r "s
om
ewh
at g
oo
d"
hea
lth
Self-rated health: “Very/Somewhat good”
Self-rated health: “Very/Somewhat good”
KobeMean
Nagoya
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic13 |
Income inequalityIncome inequality
柏市東浦町
知多市
武豊町
大府市
東海市
阿久比町神戸
市
名古屋市常滑
市岩沼市
東神楽町美瑛
町半田市
西尾市
吉良町
美浜町
中央市
東川町
松浦市
碧南市
度会町
幡豆町
十和田市一色
町南城市
十津川村高梁
市
南知多町
今帰仁村全体
0.0
0.1
0.2
0.3
0.4
0.5
0.32
9
0.34
2
0.34
9
0.35
2
0.35
6
0.35
6
0.35
9
0.36
3
0.36
5
0.37
5
0.37
5
0.38
1
0.38
3
0.38
5
0.38
8
0.39
8
0.39
8
0.40
1
0.40
5
0.40
5
0.40
5
0.40
9
0.41
1
0.41
5
0.41
7
0.41
8
0.42
1
0.42
2
0.43
8
0.47
6
0.39
4
Gin
i co
effi
cien
t
Kobe
Gini coefficient for total population = 0.329
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic14 |
Physical environment: Parks and pedestrian paths
Physical environment: Parks and pedestrian paths
名古屋市神戸
市柏市美瑛町
東海市
知多市
大府市
東川町
東浦町
碧南市
半田市
東神楽町中央
市幡豆町
阿久比町武豊
町吉良町
十和田市度会
町美浜町
岩沼市
南城市
松浦市
南知多町
今帰仁村西尾
市常滑市
高梁市
一色町
十津川村全体
20%
30%
40%
50%
60%
70%
80%
90%
100%
85.2
%
85.1
%
82.5
%
81.7
%
81.2
%
79.8
%
79.7
%
78.4
%
78.3
%
77.9
%
75.3
%
72.7
%
72.6
%
71.9
%
71.1
%
69.3
%
69.1
%
68.4
%
67.9
%
67.4
%
66.8
%
66.6
%
65.6
%
65.5
%
64.1
%
63.6
%
63.6
%
53.3
%
50.8
%
38.7
%
71.9
%
Th
ere
are
par
ks a
nd
ped
estr
ian
pat
hs
go
od
fo
r w
alki
ng
an
d e
xerc
isin
g
Kobe
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic15 |
Social-physical environment: Places to visit for a casual drop in Social-physical environment:
Places to visit for a casual drop in
今帰仁村南城
市東川町
度会町
東神楽町
十津川村美瑛
町幡豆町
碧南市
高梁市
南知多町松浦
市吉良町
東浦町
中央市
大府市
半田市柏市
十和田市西尾
市一色町
岩沼市
美浜町
東海市
知多市
武豊町
神戸市
阿久比町常滑
市
名古屋市全体
0%
10%
20%
30%
40%
50%
60%
70%
62.3
%
58.5
%
56.8
%
55.5
%
55.3
%
51.2
%
51.0
%
50.0
%
49.3
%
48.5
%
46.9
%
46.8
%
46.4
%
45.5
%
45.2
%
43.4
%
43.2
%
42.2
%
42.0
%
41.8
%
40.7
%
40.6
%
40.6
%
39.6
%
39.0
%
37.7
%
37.4
%
36.9
%
36.6
%
35.6
%
42.9
%
Th
ere
are
ho
mes
or
faci
liti
es w
her
e I
can
cas
ual
ly d
rop
in
Kobe
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic16 |
Social capital: Trust in the community
Social capital: Trust in the community
今帰仁村南城
市
十津川村松浦
市幡豆町
吉良町
一色町
西尾市
高梁市
南知多町碧南
市柏市東川町
美瑛町
知多市
常滑市
阿久比町度会
町大府市
東浦町
美浜町
東神楽町中央
市武豊町
十和田市
名古屋市東海
市岩沼市
神戸市全体
40%
50%
60%
70%
80%
90%
100%
88.3
%
78.9
%
78.8
%
78.6
%
78.4
%
78.2
%
77.5
%
76.1
%
76.1
%
75.5
%
74.6
%
73.8
%
73.7
%
73.4
%
73.3
%
72.5
%
72.2
%
72.2
%
72.1
%
71.9
%
71.7
%
71.1
%
70.9
%
69.3
%
69.0
%
68.0
%
67.9
%
67.7
%
67.4
%
72.4
%
Per
cep
tio
n t
hat
peo
ple
in
th
e co
mm
un
ity
can
be
tru
sted
(%
)
Kobe
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic17 |
Determinants of health*Ages 65-74 only
Determinants of health*Ages 65-74 only
Prevalence of low BM
I <18.5
Trust in the community Coefficient of correlation=-.539
Ecological analysis at the municipality level
0%
20%
40%
60%
80%
0% 20% 40% 60%
r=.568
この3年間で地域住民の活動や交流が衰退したと感じた人の割合
閉じこもり者の割合
Prevalence of social isolation
Multilevel analysis at the sub-municipality level
Sense of decline in community activities and relationships in past 3 years
Coefficient of correlation=.568
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic18 |
Small-area data mappingSmall-area data mappingHas not received health
check-up in the past year (%)
Goes out less than once a week(%)
Geriatric Depression Scale score
*)Only among >=75(
Had a fall in the past year(%)
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic19 |
Interactive data mappinghttp://www.doctoral.sakura.ne.jp/WebAtlas/Kihonchecklist/Single/kinki/atlas.html
Interactive data mappinghttp://www.doctoral.sakura.ne.jp/WebAtlas/Kihonchecklist/Single/kinki/atlas.html
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic20 |
ConclusionsConclusions
Older adults in large urban areas may feel healthier and benefit from better infrastructure and economy, but may experience poorer social well-being compared to smaller, more rural municipalities
Multilevel analysis confirmed some of the correlations between neighbourhood-level social factors and health indicators
Systematic collection, mapping, and analysis of social and health data by small geographic units are crucial to develop policies and programmes that are responsive to the geographically non-uniform needs of the local elderly population
Technological innovations have made interactive data mapping a feasible and effective tool for both researchers and policy-makers