Tackling the crisis of care for older people: lessons from India and Japan

https://www.nature.com/articles/d41586-022-00074-x

by sohkamyung • 5 years ago

65 93 5 years ago

andi999• 5 years ago

Good article, but does anybody else feel weird about the:'what can these countries teach us'? It would be fine in a BBC article, where it is clear who is 'us', but in nature? I would feel the us vs india would be bad enough, but Japan? People from Japan publish regularily there, Japan is one of the bigger players in science.

Maybe I am overthinking this though.

dotancohen• 5 years ago

"Us" is humanity. Not every "us" is against a "them".

88840-88553• 5 years ago

My thoughts on the topic after reading the article, which made gold points, especially on the low internal migration rate and women not working, but staying at home and taking care of household and family.

The West has followed the path of freedom and free markets. The smallest unit in society is the individual, not the family (like in Asian countries). Freedom here is being celebrated, also by having the kid "finally" moving out at 18+. Those who stay are not doing it for cultural, but mostly for economical reasons.

Taking care of elderly people is not very "cool" here in Germany. My friends haven't called or visited their grandmas for many months, while my Chinese friends try to use their holidays to visit home. They are also planning longterm how to move closer together and incorporate those thoughts into the partner selection.

The Western approach is different and get often "it's me and it's my happiness".

bsder• 5 years ago

My thoughts on the topic after reading the article, which made gold points, especially on the low internal migration rate and women not working, but staying at home and taking care of household and family.

Japan is absolutely horrible to its women. Women are expected to take care of their family, their own elderly relatives and their husband's elderly relatives. It's one of the many reasons why so many Japanese women are refusing to marry and have families.

Maybe the US doesn't have it right, but, with respect to its women, Japan has it very wrong.

The biggest problem with the US is that you need a car to do anything. This includes things from basic groceries to the doctor. That's terribly limiting to the elderly.

nradov4• 5 years ago

Women in China are also increasingly refusing to get married for the same reason.

https://www.cnn.com/2021/01/29/china/china-millennials-marri...

mrkentutbabi4• 5 years ago

Really? very wrong? Have you ever talked to the average Japanese women and see how they want it?

This is why westerners will always be a gaijin.

px43• 5 years ago

Just one data-point, but my Japanese friend who lives in Japan just finished up her ONE YEAR maternity leave, so there are definitely a few things that they do much better than the US. The 6 weeks before the due date is also required by law to be protected leave as well, but most places do more.

The US simply doesn't have any protected leave at all, which is incredibly hostile to women trying to contribute to the labor force.

msh2• 5 years ago

Well the women defacto being "forced" to not work part is more, women sacrificing their freedom to make life easier for the men.

88840-88553• 5 years ago

CORRECT! And this is what perplexes me so much. I lived in Japan and saw this with my own eyes, it was such an ultra conservative society, especially in respect how women are treated.

And then you meet Western people who adore, even feteshize Japan SO heavily without reflecting anything what is going on.

People have to understand that most of the things they love in Japan (cleaness, extreme degree of quality in customer service, orderliness) is due to those ultra conservative values and norms.

Hence, I am very critical towards Japan and I find people naive who one the one hand adore Japan so much (also the super conservative government) and at the same time hate the Chinese values, system and even people.

mrkentutbabi4• 5 years ago

You must be a westerner. This is a very common westerner comment its very textbook, so textbook that Asian mindsets are tired responding to it. Please try to understand the mindset in Asia first. For example, do women in Japan really want career more vs becoming a house wife? You will be surprised at the answer.

goodpoint2• 5 years ago

having the kid "finally" moving out at 18+.

You are generalizing aspects of US to the whole "west". Statistics show the opposite: in most EU countries people don't leave home at 18 by far.

Also family is important in many EU cultures and people visit close relatives often.

jmrm• 5 years ago

In the same comment you can read: > Those who stay are not doing it for cultural, but mostly for economical reasons.

If you look statistics about young adults leaving home, and young adults who doesn't have a job (or don't earn enough to buy or rent a house), the correlation is pretty hard.

fxtentacle7• 5 years ago

The first step is to convince people who grew up with the western "individualism and freedom are the most important" culture why they should care about elderly that they are not directly related to.

Those old people who have lots of family that cares about them will be fine in any case. So the "problem" are those old people that are socially isolated and went all-in on the governments' promises of public retirement care. But now we're finding out that the old retirement system is too expensive for the young generation to handle, plus the young were taught not to care about anyone but themselves...

LatteLazy5• 5 years ago

Since the old have done nothing to help the young (quite the opposite in fact) that will be an uphill struggle.

fxtentacle7• 5 years ago

I've heard a similar sentiment recently.

"I'll start respecting the elderly when they stop bothering me with their email problems."

michaelt4• 5 years ago

Well, we western youth have certainly inherited a huge national debt, crumbling infrastructure, an upcoming climate catastrophe, a political system in deadlock, and geopolitical rivals of vast and rising power. No doubt about that.

But old people did manage to produce a first-world country as successful as any other, get their language spoken all over the globe, vastly increase college education (which they thought was doing the young a favour), build a tech sector that pays wages considered ridiculous everywhere else on the planet, create the internet and basically give it away for free, give birth to and raise us, have much less racism and sexism than there were a few generations ago (although they both remain very real problems), avoid any wars that couldn't be fought with an all-volunteer military, and avoid destroying the world with nuclear weapons - something that seemed as inevitable, in its day, as global warming is today.

Thinking the old have done _nothing_ betrays something of an ignorance of history IMHO.

pcrh3• 5 years ago

the old have done nothing to help the young

I suppose all those babies paid for their own housing, food, education, healthcare and vacations for up to 25 years before they were productive members of society?

micromacrofoot• 5 years ago

if we can’t help each other without getting something out of it then we’re doomed to be like this forever

pjc502• 5 years ago

People making this kind of comment should disclose their age.

fxtentacle7• 5 years ago

Mid 30ies. But I used to work in a government retirement home for a year just because I was curious about it. And the loneliness in there is depressing.

EDIT:

BTW, if it weren't for the fact that tech pays 20x the hourly rate, I might even have stayed working in social places.

But I have also experienced the other side, like when a restaurant refused to let us in because we came with kids. They argued that their mostly elderly customers would feel disturbed by the noisyness of kids talking to each other.

throwaway67342• 5 years ago

the young were taught not to care about anyone but themselves

as were the old.

Social Security won't have funding issues for almost a decade but there is no political will now, especially among the elderly, to find a solution to this problem

rs999gti2• 5 years ago

With current birth rates in westernized countries, I'm surprised any of these social services will still be around in two decades.

People are living longer, immigration can't solve the problem, people are relatively healthy and wealthy, etc. but there is not enough babies entering at the bottom of the pyramid to grow into tax payers to continue funding the social systems.

Dystopian me sees a world where western governments will have to institute mandatory, two child per woman births, moratoriums on birth control, huge incentives for people with children under 18, and aggressive pushes for couples to raise adopted children and/or make new ones.

mrkentutbabi4• 5 years ago

I am a non westerners relatively young person. I am in a western country to only make money. When I retire I will go back to Asia.

Western country like USA is good for competition and individualism and you can make a lot of money because of it, and then you bring the money back to Asia, and retire in Asia, where everything is cheaper and community is stronger than in western country.

refurb2• 5 years ago

As someone living in Asia, cheaper but you get what you pay for.

FooBarBizBazz5• 5 years ago

I think about this plan a lot. It feels like a way to "hack the system".

And yet, if everyone does it, then Asian countries will also end up with no community -- because all the young people will be in the West.

Already, rural parts of China and Thailand are depopulating as young people go to cities. The same in Eastern Europe. And the same, come to think of it, in the United States. What were once small towns and farming communities are now empty save for a Dollar Store and a few 50-year-olds. This would be a global-scale version of that same phenomenon.

The other issue is that this plan probably means you'll only be able to have a small family, simply because you're starting later. Over time that would also break the model. Hard for the kids to care for grandma when there are as many grandmas as kids.

But for an individual it seems like a decent plan. Except --

Well, it's a little more workable for a man, since in principle, if he's lucky, he can marry a younger woman and still have a family. But that has problems: An equal relationship is less likely, and she will be left a widow at some point. It probably just won't be as good a marriage as if you'd married your highschool sweetheart.

If you want to do geo- and cultural- arbitrage, it seems like, while harder to pull off, it might be better to do remote work and go to a traditional/low-cost country when you're younger.

decafninja6• 5 years ago

I am a Korean-American US citizen. My wife is a South Korean citizen. Initially we thought it was natural for her to gain US citizenship, but we've now decided otherwise - both for reasons similar to what you mentioned, and also because the US seems to be in a downward spiral politically.

Also I've witnessed first hand the Korean healthcare system at work via my wife, and it is by far not only less expensive, but also (maybe more importantly) less complicated. It's not perfect, but for the average person I'd greatly prefer it to the mess we have in the US.

Of course, South Korea also has its share of political issues both internally and externally. So it has also crossed our mind that perhaps we ought to think of obtaining citizenship or residency in a third country for when the "earning period" chapter of my life starts to close.

sebow• 5 years ago

"individualism and freedom are the most important" is not incompatible with caring for the elderly or your family.This is a misconception that people think of individualism as equivalent to being selfish.The best generosity and care one could provide is from his own conscience and goodwill, not doing it out of necessity or as a requirement.This was vastly pushed in EE where people would hijack Christianity or any generous aspect of a religion in order to promote their ideological umbrella of the system. The problem we have in the Europe with elderly (see Italy or other countries with similar demographics) is precisely >because< we think everyone should have at least 2-3 of their last decades of life lived in a comfortable environment where any agency is bad agency.This is overall a bad look on life and you even some young people behave like this, because "the system will provide".We put the futures of people under promises and hypotheticals.

If you want the reverse take a look at cultures that think in the opposite fashion: SK,eastern cultures,or maybe Japan(though i'm least familiar with that, and what consists as "elderly" continues to increase);Now even there you have a lot of problems, but problems are inevitable and that is precisely the argument and reason of why we should strive to behave less "civilized" - as in staying comfortable -. The reality of life is that it is constantly degrading, generations who went through war always understand this and seem "superhuman" to later generations who grew up in peace.It's not about war and conflict between people but war against the degradation of life.

decafninja6• 5 years ago

I agree with you in that the best care that can be provided is one through genuine goodwill.

However I would argue that the vast majority of people are very selfish and do not have much more than a token amount of generosity beyond themselves or at least their immediate family.

Thus while not the ideal situation, some amount of mandatory force by society is the next best, imperfect, option I can think of.

I'm Korean, and it's been traditional in Korea for children to take care of their parents when the become old. Often times this meant multigenerational households where the elderly would live together with one of their adult children. But this too is changing, and today, quite a few of the elderly are either left alone or put into nursing homes.

galfarragem2• 5 years ago

Fortune cookie: having a small family is probably the biggest mistake you can make in your life.

mattr47• 5 years ago

Or be dick parents to your children so that you have no relationship with them later on.

decafninja6• 5 years ago

Since lots of couples in wealthy, developed nations are choosing to not have kids, I wonder how this will impact things in the future.

Especially in countries where it has been traditionally implied that your children will take care of you when you grow old.

m0llusk• 5 years ago

It is really common in the gay community for people to not have children and to struggle throughout their working years. While many get help from family from childhood to early adulthood it is still common for gay people to either get kicked out of or flee from their homes and families at or before official adulthood.

It seems like punishing people for not having children and not being consistently successful in their working life is going to leave a lot of old people destitute. That is not necessarily a simple cultural issue.

2143• 5 years ago

But now we're finding out that the old retirement system is too expensive for the young generation to handle

I had read somewhere that, long long ago people who retired at, say 60 would probably eventually die by 65.

In that case the retirement system, pensions, savings etc would work because they only need to be supported for a few years.

However, as the healthcare system across the world increased, people are now living much longer lives and hence they need to be supported longer. This stresses the existing retirement mechanisms.

It's kind of ironic if that theory is true.

kgin• 5 years ago

Sometimes I have to step back and note the whiplash of future predicted problems.

When I was a kid, it was overpopulation. Then it became overpopulation combined with the prospect of automation taking all of our jobs. Now, very suddenly as it seems to me, we’re talking about declining population and a labor shortage.

lotsofpulp5• 5 years ago

Depends what you are talking about. If the topic is pollution or climate change, then total energy consumption is the problem, which inevitably leads to overpopulation being the problem.

If the topic is how much of society’s resources should be allocated to maintaining quality of life for those who cannot by themselves, perhaps due to old age, then a labor “shortage” will be the problem. More accurately, it is about which proportion of society’s resources should go towards supporting those who need assistance, changes which show up as changes in prices for labor.

I am not too fond of the idea of using society’s resources to keep people of very advanced age living longer and longer with poor quality of life. This rationing of resources will exacerbate due to reduced birth rates compared to previous decades, in conjunction with increasing lifespans and medical interventions.

galfarragem2• 5 years ago

I am not too fond of the idea of using society’s resources to keep people of very advanced age living longer and longer with poor quality of life.

Completely agree with you. The "Trillion dollar question" is what to do and how to do it, once a "solution" is not enough, "democracies" have to find ways to enforce it.

Edit: Euthanasia is a solution that is starting to be sold by some politicians. I wonder if people really understand what's behind it.

Tackling the crisis of care for older people: lessons from India and Japan

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