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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 Kondo 3 1 WHO Centre for Health Development, Kobe, Japan; 2 Rikkyo University, Tokyo, Japan; - PowerPoint PPT Presentation
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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
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic2 |
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
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic3 |
The demographics of ageing in Japan
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic4 |
RAPID ageing
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic5 |
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
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic6 |
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
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic7 |
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)
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 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: 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 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
%
Prop
ortio
n re
porti
ng "
very
goo
d" o
r "so
mew
hat g
ood"
hea
lth
Self-rated health: “Very/Somewhat good”
KobeMean
Nagoya
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic13 |
Income 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
20.43
8
0.47
6
0.39
4
Gin
i coe
ffici
ent
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
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
%
Ther
e ar
e pa
rks
and
pede
stria
n pa
ths
good
for w
alki
ng a
nd 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
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
%
Ther
e ar
e ho
mes
or f
acili
ties
whe
re I
can
casu
ally
dro
p in
Kobe
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic16 |
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
%
Perc
eptio
n th
at p
eopl
e in
the
com
mun
ity c
an b
e tru
sted
(%)
Kobe
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic17 |
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 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
IFA 11th Global Conference on Ageing | 28 May – 1 June, 2012 Prague, Czech Republic20 |
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