Growing old in China: WHO interview

34 World Health • SOth Year, No. 4, July-August 1997 WHO Interview Growing old in China Dr Zhu Han-Min, Head of the WHO Collaborating Centre for Community Health Care for the Elderly in Shanghai, was interviewed by Christopher Powell of WHO's Health Communications and Public Relations Unit. World Health: Can you tell us what the work of your Institute involves? Dr Zhu: The Shanghai Geriatric Institute is, among other things, a WHO Collaborating Centre for community health care for the el- derly. It depends directly on the Shanghai Health Bureau, which in turn is an arm of the Ministry of Health. I am also Vice-President of Hua Dong Hospital in Shanghai, where I take a particular interest in the health of the elderly. The Institute itself was founded in 1987 and its main purpose is to undertake research into the mechanics of ageing, to find out how the process of ageing can be delayed. We are trying to determine approaches to the prevention of sickness in the elderly that are suited to our eco- nomic level and our domestic customs. WH: Why do we need new approaches? Dr Zhu: The fact is that the popula- tion of Shanghai is ageing very rapidly. The percentage of people aged 65 and over is more than four times as large now as it was in the 1950s. In China, the family has always traditionally cared for the elderly, and in former times 90% would stay with their family, in an environment with which they were familiar. Now our society is chang- ing and, with the development of nuclear families, a: gap is forming between the generations . Old people Maintaining the family bonds. Keeping active and well integrated in society is a source of fulfilment and good health. Photo Panos Pictures/ C. Stowers© themselves are less ready to stay with the family while the younger generation are finding it difficult to accept older people in their homes. This is why the social sector is strengthening education efforts to try to counter this gap, not least by encouraging the "young elderly" to care for the "old elderly" in the community. WH: What practical measures are there in place to help the elderly? Dr Zhu: The two main approaches are to develop education, especially in the fields of lifestyles and nutri- tion, and to encourage older people to have regular check-ups, at least once or twice a year, so as to identify diseases and treat them early. These approaches are adopted at all three levels of the health services - munic- ipal, district and community. The staff at all levels go to visit the elderly in their community, since hospital consultations are costly and most old people cannot afford them. The health services are trying to develop home care as much as possible. Our staff also do social work, arranging activities for the elderly such as exercise, short jour- neys, lectures, gardening and paint- ing, as well as helping them to acquire self-help health skills. WH: Is the situation the same for elderly women as for elderly men ? Dr Zhu: The proportion of elderly women is always higher than that of men. A very interesting thing is that, in our cities, the average life ex- pectancy is longer in females than in males, but the active life expectancy is shorter in females than in males. For different reasons the women World Health • SOth Year, No. 4, Ju ly-August 1997 suffer more from chronic diseases and a loss of ability to manage the tasks of daily living; this seems to be due to the traditional cultural back- ground. The man who is retired at home tends to have a less stressful life while the women continue to be exposed to many demands, and this affects their active life expectancy. WH: Do the elderly have a prefer- ence for traditional treatment and traditional medicine? Dr Zhu: Many doctors prefer to offer traditional therapy because it's not expensive, while Western medi- cine is very dear. Older people tend to be poor and the cost of living always seems to be rising after retirement, so they prefer traditional medicine. If the simple way has a good effect we use it; you don't always need modem pharmaceutical treatment to bring about improve- ments. WH: What can you do to maintain the psychological health of older people ? Dr Zhu: This is very important in elderly health care. When men and women are retired, there is often an imbalance in some area, especially in the male. This might show itself in depression, or anger with other family members. We are trying to establish a new approach in primary prevention to correct such imbal- ances. For instance, we organize the old people for education, for visits or for forms of entertainment. Again, these activities are organized at the municipal and community level. And they are all free. Of course, health care itself and medical ser- vices are free, at any of the four types of medical facilities - those run by the government, by the work- place from which they have retired, by the cooperative in the countryside or by the insurance scheme. The community or district hospital is available if there should be a health crisis. WH: Does the effect of the one-child family policy pose a problem, since there will be fewer younger people to care for the elderly? Dr Zhu: Yes, there will be a big problem. We have always expected younger persons to care for the older ones. In the 1950s and 1960s, fertil- ity was encouraged and this resulted in a "baby boom." After that, fertil- ity was restricted through the one- child family principle and fell to a low level; there was no longer the replacement factor. In about 80% of Fascination of ploy in Chino. Developing social networks is essential for sustaining autonomy in old age. Photo Keystone/ M. Rutschi © 35 families , the elderly live at home with the younger generation. Furthermore, the nuclear family is rapidly growing in our cities. In the next century there will be a situation where one son or one daughter may have to care for four or even six elderly people. The older ones may stay at home but the younger ones cannot stand it! WH: So what is going to be the solution ? Dr Zhu: We believe that the best way is to develop health care based on the community, so each and every community will create a community service centre capable of catering for old people who may have lost the ability to cope with daily living. When the younger persons go out to work, there will be nobody left at home to offer care, so the commu- nity centre will be able to arrange the necessary care. WH: ls the government doing enough to help the older generation? Dr Zhu: Certainly. There is a real political commitment on the part of the government. In Shanghai, we have two policies to deal with the problems of ageing. Firstly, we have to protect older people's rights. Secondly, we have to convince the younger generation that they must assume their responsibilities as carers for the previous genera- tions. • Dr Zhu Hon-Min , Professor of Geriatrics, is Vice-President, Hua Dong Hospital, Shanghai Geriatric Institute, Shanghai Municipality, No. 22 1, Yon An West Road, Jin An District, Shanghai, Chino.