Guidelines

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
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
Japan’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
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
The demographics of ageing in Japan
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
RAPID ageing
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
Key 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
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
Project 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
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
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
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
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
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
Survey 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
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
JAGES 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, communitydwelling 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
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
Kobe sample characteristics
Age (years)
65-74
75-84
85-94
95-99
56.3%
37.7%
5.8%
0.2%
Sex
Male 45.2%
Female 54.8%
Equivalent household income group
Low (<2 million JPY) 43.6%
Middle (2-4 million JPY) 33.9%
High (>4 million JPY) 8.4%
Household composition
Lone elderly 23.3%
Elderly couple 44.8%
Other 31.9%
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
Proportion reporting "very good" or "somewhat good" health
70%
12
60% |
67.6%
75%
65%
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
Mean
85%
Kobe
83.5%
87.2%
90%
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%
80%
79.2%
Self-rated health:
“Very/Somewhat good”
Nagoya
Gini coefficient
0.3
0.2
0.1
0.0
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
0.342
0.349
0.352
0.356
0.356
0.363
0.365
0.359
0.329
Gini coefficient for total population = 0.329
0.375
0.375
0.381
0.383
0.385
0.398
0.398
0.401
0.405
0.405
0.405
0.409
0.411
0.415
0.417
0.418
0.421
Kobe
0.388
0.4
0.394
0.438
0.5
0.422
0.476
Income inequality
40%
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38.7%
60%
53.3%
50.8%
70%
80%
50%
30%
20%
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
90%
85.2%
85.1%
100%
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%
71.9%
There are parks and pedestrian paths good for walking and exercising
Physical environment:
Parks and pedestrian paths
Kobe
40%
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Kobe
30%
20%
10%
0%
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
60%
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%
50%
36.9%
36.6%
35.6%
42.9%
There are homes or facilities where I can casually drop in
Social-physical environment:
Places to visit for a casual drop in
70%
70%
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Kobe
60%
50%
40%
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
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%
80%
67.4%
72.4%
Perception that people in the community can be trusted (%)
90%
88.3%
Social capital:
Trust in the community
100%
Determinants of health
*Ages 65-74 only
Multilevel analysis at the submunicipality level
Ecological analysis at the
municipality level
Prevalence of low BMI <
Prevalence of social isolation
80%
閉 60%
じ
こ
も
り 40%
者
の
割
合 20%
.
18
5
r =.568
0%
0%
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in the
community
IFATrust
11th Global
Conference
on Ageing | 28 May – 1 June, 2012
Coefficient of correlation=-.539
20%
40%
60%
Sense
of decline in community activities and
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
in past 3 years
Prague, Czechrelationships
Republic
Coefficient of correlation=.568
Small-area data mapping
Has not received health
check-up in the past year
(%)
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Goes out less than once
a week (%)
Geriatric Depression Scale
score
(*Only among >=75)
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
Had a fall in the past
year (%)
Interactive data mapping
http://www.doctoral.sakura.ne.jp/WebAtlas/Kihonchecklist/Single/kinki/atlas.html
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic
Conclusions
 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
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IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic

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