11 October 2008

Key Note Address “ Successful Ageing” presented at the CADENZA Symposium 2008

The theme of the symposium is “successful ageing”. I thought I would like to kick off thediscussion by going through with you possible factors that determine successful ageing in HK basing on my experiences of coming into contact with the elderly population in the last3 years and the organizations that look after them; and perhaps, my personal experiencesas an elder myself.

In a few days time, the Chief Executive of the HKSAR will be delivering his Policy Addresswhich will determine the way he would govern HK in the years to come. Few would doubtthat issues of the elderly will be among the high priority. In the presence of inflation, and uptill now a surplus economy, the public will expectingly be demanding an increase in financial support for the seniors. While it is the responsibility of any responsible governmentto ensure a “dignify” living for those who in the past have served HK, yet few would disagreethat public money should be spent “mainly on those who need it most”; and that any form ofgovernment spending should also take into account of sustainability, especially during timesof lean. Alan Greenspan once said, “Policymakers should err on the side of prudence whenconsidering new budget entitlement initiatives. Programs can always be expanded in thefuture should the resources for them become available, but they cannot easily be cut back ifresources later fall short of commitments.” That said, is financial subsidy the all and be all to“successful living”?

Since I took up the helm of the Elderly Commission I have been moved by a fewobservations and I like to share them with you.

I was struck by some fairly healthy, and to a certain extent, able bodied elderly males idlingaway in public parks reading outdated newspapers. When asked why they did not joinprogrammes provided by elderly day care centres, their replies were that they do not want tomake plastic flowers nor watch day in and day out Chinese “golden oldies” movies. Theywant to learn something useful so that they can be part of the society.

I had the benefit of walking up 7 flights of stairs to visit an elderly couple in the old town ofKowloon City. The husband was in his mid 80’s somewhat physically disabled. The wifewas an active late 70’s, and if you think climbing 7 flights of steers is an achievement, youcan think again. This lady does it at least 4 times a day, doing the needed shopping,collecting cardboard boxes and sell them as a means of improving her daily subsistence.She refused to be put on welfare (CSSA). Her biggest enjoyment was to see volunteers from the district coming to visit her and help her with odd and ends in the flat. Every evening ayoung man in the neighborhood cafeteria would cycle around to distribute left over soup toher and her likes.

A couple of months ago I visited a singleton elderly lady in her late 80’s in a remote ruralarea of Yuen Long unapproachable by public transport. She lives alone in a corrugatedthatched hut in the company of 3 dogs. She is on welfare (CSSA) support but decline to askfor more as she would like to divert the limited public resource to those in genuine need.However, she would also like to have more home help and support from the community.

When I visit Elderly Homes, a common question that I like to ask the boarders, as a meansof assessing standard of Elderly Institutions, is whether they are happy and satisfied. Most ofthe time their answers are positive, but would always add, that they would still prefer to ageat home with or near their children and grandchildren.

On a personal basis, I am somewhat upset by the general public’s image of elderlies. Thecommon symbol of a senior citizen is a white hair, wrinkled face person partially bald, with abent back holding a walking stick being assisted on crossing a road. I think I do not need that yet. Elderlies are thus portraited as weak, frail, perhaps a burden, which by today’sstandard they are NOT.

It is on these basis that the Elderly Commission believed that some major factors forsuccessful ageing should includes:

• Proper pre-retirement preparations;

• Changing the image of the seniors;

• Promote active ageing;

• Promote an elderly friendly community;

• Promote intergeneration harmony so as to reestablish the core values of a family; and

• Involve the elderlies and not “ignore them”.

What have we done? No we have not done everything nor have we even attempted to do all. Yet we have pioneered a few areas, hopefully given time, might achieve some of theabove factors.

We have started an Elderly Academy. This is a school based learning allowing our seniorsnot only a chance to really learn but a sense of going “back to school”. Participating primaryand secondary schools will be contributing their premises after regular school hours andduring weekends. The students of these schools will become “teachers” teaching eldersenrolled either directly or through elderly institutions and non governmental welfareorganizations. The curriculae will consist of a mandatory session on health education andhealthy living. Other subjects are discussed and agreed by the ‘students” the “teacher”together. It might be a surprise to note that working with computer, personal health care arethe most commonly chosen topics. This scheme thus have achieved a few objectives.

• Ensure that our elders remain active;

• Promote their social relationship by enlarging their social circle and thus enhance their

confidence and image;

• Promote cross sectional cooperation between the education sector and welfare sector;

• Induce better understanding between the old and young – in short promote intergeneration

harmony, leading to appreciation of core family values.

Starting off with 32 schools, we have now 78 schools. The tertiary institutes have alsoshowed their enthusiasm. Some 7 out of 11 local universities are involved. They provide awide spectra of programmes ranging from specifically organized interest class to elders, toproper sub degree courses; to formally allowing the elders to sit in at regular universitydegree sessions. As of today, their should be over 10,000 elders in the primary andsecondary schools and about 1,000 who yearn to taste university life when they were youngbut were deprived are now enrolled as university students.

I am aware that the concept of the university of the 3rd Age, which is essentially a peerlearning group, has been well established in many parts of the world, in particular Australia.Ours is perhaps unique in that other there offering a university life for our elders, we havealso instilled a real sense of cooperation between the generations, where elder studentsstudy side by side with the younger regulars. This would no doubt promote inter-generationunderstanding and harmony in the long run.Nothing is more effective than peer inducement and peer support. This applies particularlyto the elderlies. It is on these understanding that the Elderly Commission has started pilotprojects in all the districts in Hong Kong – Pilot Neighborhood Active Ageing Project. Usingthe neighborhood as platforms, nongovernmental organizations enter into partnership withdifferent sectors to train up volunteers to organize activities regularly for the elderly and topay visits to singletons elders to strengthen neighborhood support and a sense of belongingin a neighborhood setting. Today we have 19 such neighbourhood projects across theterritory reaching out to every sector of the community, including private and public estates,old tenement buildings and rural areas. We have witness examples of formerly “shut offelderlies” opening up to neighbors, joining peer groups and even taking a lead to induceothers to participate. The project is extended to a “Caring for Elders” concept aiming topromote care for elders and abuse prevention through neighbor support net works. Elderlyabuse, of which we have no exact figures, are by no means rare, this project will tackle elderabuse through a three prong approach, namely education (through the Elder AcademyNetwork) prevent and support (through setting up elder caring group). 18 neighbourhoodprojects should be up and running later this month. All in all, the elders play the active roleanswering to the concept of “utilize” them and do not “ignore” than.

For those in the audience, who belong to a more mature age, the project might bring backthe nostalgia of “under the lion rock” culture where filial piety reigns supreme; where respectof the elders is a convention; where neighborhood harmony, and friendship is the norm. Asa elder myself, let me say this to you, it was this culture and spirit that bound Hong Kongtogether to emerge a winner from the doldrums of the 50’s and the 60’s to become what weare today.

Let us set the priority right, Elderly Commission is of the view that the 3 pillars for supportingelders in Hong Kong are to facilitate them – to age happily at their own home; to age activelyin their community; to age gracefully while receiving the inevitable long term care in carehomes. We need to put our act close to our mouth in all these aspects.

Ladies and gentlemen as a health care personnel I would have failed my duly if I do notstress that. “No ageing could be successful unless our elders are also healthy”. In short not only should they be taught the major personal responsibility to keep healthy theymust also be provided with proper to effective medical care when they get sick. At the risk ofbeing accused of “blowing our own trumpet” I have to proudly boast that Hong Kong hasperhaps one of the best public provided health care system where “nobody will be denied ofcare because of lack of means”. For a mere HK$100.00 a day you are offered the state ofthe art investigations and cutting edge treatment. Furthermore over 60% are either totally orpartially exempted from payment mostly amongst the elderlies. The confidence the elderlyhave on the Hong Kong public health care system makes it an impediment for those whoconsider venturing to spend their “golden age” north in the Mainland. Some who did aremaking a return.

But such social services are expensive and a strain on this public purse. As the society ages,such health care cost will increase exponentially. Elderlies have a much higher incidence ofchronic illness and when they do it is invariably multipathology. Most illnesses tends toconcertino in the last two years of ones life.

Figures and statistics in Hong Kong has shown that public health expenditure will increaseby 3.9 times between 2004 and 2033, when GDP will only grow by 1.7 times during thesame period. As a result, public health expenditure as a share of GDP will increase from2.9% in 2004 to 5.5% in 2033. Assuming that total public expenditure will be kept below20% of GDP, the share of public health expenditure as a share of total public expenditurewill increase from 14.7% in 2004 to 27.3% in 2033. Yet such social service a vital and, HongKong cannot do without.

At the beginning of my address – I did stress that any government spending and elderlyservice is an important part of it, should not lose sight of the need for sustainability. Sincehealth care service is an integral path of essential elderly care, it is obvious that the budgetfor elderly care must be phenomenal and it will need a hat-trick to make it sustain.

Ladies and Gentlemen, for the last 15 minutes or so I have posed many questions andproblems in relation to elder care, perhaps even a few time bombs. Some, the ElderlyCommission has made suggestions to tackle, many I do not know how to defuse. I will haveto defer to the experts today to share with us their wisdom.

The world is ageing, we have to find ways to face the challenge, we have no choice.For as Alan Greenspan said “Demography is Destiny”.

Thank you.