Impacts on health and social care of an ageing population in Asia : policy initiatives in Hong Kong

Population ageing strikes Asia at a speed and a scale unprecedented in history. Not only the size of the older population (i.e. over 65) is going to be the largest, older people in Japan and Hong Kong are the longest living (with an average life expectancy at birth exceeding 86 years of age at present). Women also outlive (therefore outnumber) men four to five years, leaving them as the largest group in poverty as most are not covered by contributive pensions. The change to an elderly-focused (i.e. with chronic illnesses) healthcare system also requires a shift from acute curative operation to one that encourages health promotion and illness prevention at an early age, supported in parallel with a firm system of community rehabilitation care. In the personal care service front, winning back the family to share the care, in particular to replace institutional care, is almost impossible with the many faces of the new families (e.g. increasing single parents, divorce and re-marriage rates) and the lack of caring commitments as a result of individualism. The need for more women to enter and stay in the workforce also argues against family care. What is needed first and foremost is a change of mindset at the service delivery front — a thinking and an acceptance that the many-helping-hands approach (e.g. cross disciplines and cross sectors collaborations) is the only way possible for seamless health and social care, as well that ordinary people including our relatives and neighbours (so called informal care givers) could provide certain level of care in complement to the highly skilled, expensive and limited professional care givers (e.g. social workers, nurses, occupational therapists, physiotherapists). Hong Kong shares all the above, both in questions and answers. Putting these ideas in practice would require innovative policy-making, funding for research and political will. With the encouragement from the Elderly Commission (EC), Hong Kong has piloted several initiatives in this regard. EC and policy officers from the Labour and Welfare Bureau came up with an initial policy idea and thought of a through-train implementation plan first, fundings were then obtained for small scale pilots for non-governmental organisations (NGOs) to operate. When the experience was successful, pilots then became policies. Examples include the Elder Academies (students teaching older persons self-care and computer skills using primary and secondary schools as platforms); and the Good Neighbours series, notably: (1) Linking NGOs to faith-based organisations such as churches to train older volunteers; (2) linking NGOs to trained volunteers for prevention of abuses; and (3) linking specialist medical teams to NGOs and their trained volunteers for suicide prevention, as well as for hospital discharge planning. Policy drivers of the projects and implementation will be briefly discussed.