Transcript 投影片 1

A Gender Responsive Social ProtectionHealth Security
for the older women in the Asia-Pacific Region:
Hong Kong as an example
10th Hong Kong Sociological
Association Annual Meeting
Sociology in the 21st Century:
Prospects and Challenges
Prof. Alfred Chan Cheung Ming BBS JP PhD RSW RMN
Director, Office of Service-Learning
Director, Asia-Pacific Institute of Ageing Studies
Dr. Carol Ma Hok Ka Research Development Officer (Service-Learning), Office of Service-Learning
Lingnan University
1
Outline
• Background: A general policy framework
• Gender responsiveness for Social Protection-Health Security:
Hong Kong as an example
• The demographic profile: older women in Hong Kong
• Needs of the Older Women: Social Protection-Health Security
• Priority Areas & Key Actions for addressing the social
protection-health security issues among the older women
2
Background of
Social Protection-Health Security
• According to WHO, social protection, health security and participation are
the three main pillars of supporting the active ageing policy. (the pillars
are Interrelated)
• In an aging situation, social protection-health security are equally
important for social participation (e.g. Empowerment)
• In a status gender perspective, women in Asia-Pacific Region are largely
subordinated to men, social protection therefore is essential for a woman,
health security and social participation.
• WHO: Policy framework –Active Ageing Policy; Shanghai Implementation
Strategies (SIS)-Strategies for implementation in respond to the active
aging policy
3
Policy Framework for
Active Ageing (WHO)
Safe Environment: including
law & order
Security
Financial & income security
ACTIVE
AGEING
Participation
Economic participation
Health Maintenance
Conducive environment for
self & community -care
Elder Learning
Volunteering
© Prof. Alfred Chan, APIAS, Lingnan University
Provision of a good health care
system
4
Gender responsiveness for
Social protection-health
security for the elderly
Reasons:
1) Ageing of the elderly: Aged 75+ will increase from 23% to 38% from
2000 to 2050; In 2020, 48% of people aged 80+ will be in Asia. More than
50% of the population--Women
2) Feminization of ageing:
-- number of ageing women is increasing
-- longevity of women more women than men Women are sicker and
men die earlier-women tend to live alone, by choice, types, household
-- discriminated and experienced domestic violence in all sort of living
-- suffered from insufficient social protection-health security
-- High demand of social protection-health security needs
There is a very significant scope for protecting and improving the health of ageing
women and thus ensuring that they remain a resource for their families and
communities
5
Hong Kong as
an example
• Western model (developed economy) welfare state & privatized
market not sustainable unless increase of taxation from diminishing
labour force
• Asian model (developing economy) seek for a sustainable way on
social protection-health securities for elderly
• HK is a newly developed economy
• It has developed a hybrid model of social protection-health securities
under the heritage of colonial system
• It’s still equally under the governance of China and with the principle of
one country two systems
• HK’s model could be taken as a reference for developing a sustainable
social protection-health securities in the Asia Pacific Region
6
Ageing Population in HK
Ageing Population in HK : women come to the top
Item
1
2001
2031
Up /Down
1,004,600
（佔總人口14.9%）
2,713,000
（佔總人口31.1%）
1,709,000
(與2001年比較)(170%)
男M
女F
男M
女F
男M
女F
60+
482,100
(48%)
522,400
(52%)
1,159,000
(42.7%)
1,554,600
(57.3%)
676,900
(140.4%)
1,032,200
(197.6%)
60-74
346,600
(36.3%)
347,000
(34.5%)
782,900
(28.8%)
1,028,400
(37.9%)
436,300
(126%)
681,400
(196.4%)
75+
117,500
(11.7%) 
175,400
(17.5%) 
376,100
(13.9%)
526,200
(19.4%)
258,600
(220.1%)
350,800
(200%)
81.4歲
86歲
84.6歲
89.1歲
3.4歲
3.1歲
Ageing
population (age
60+)
2
Life expectancy
(60歲起計可達)
3
Dependency
ratio (65 or
above)
155
(65歲人口數目及以人口每
千名15-64歲人口相比)
380
225
(164.5%)
7
Education
• Women are less educated
don't know how to access
health services
2001
No Schooling
or Primary Education
Upper Secondary
or Higher Education
Male
72.8 %
Female
89.2 %
15.2 %
5.9 %
8
Financial Needs
Elderly Women lack of social security and can’t
afford to access the health care services
•
•
•
•
No employment
No savings, No MPF
Dependent on husbands/sons
Single or widowed with government support
(CSSA, OAA) at subsistence level
9
Health Conditions
& Suicide rate
•
•
•
•
•
•
Harvard Report 1999: self-accessed health status in female was poorer than
male
Common health problems include stroke, chest infection, fracture of neck and
femur, heart failure, cancer and genital prolapses
Serious illnesses: breast and cervical cancer, osteoporosis, urinary incontinence
65% of the elderly women use multi-disciplinary team approach involve doctors,
nurses, dietitians, clinical psychologists, physiotherapists, and occupational
therapists. 20-25% suffered from psychiatric illness, like dementia and
depression
The % of elderly women committed suicide is very high
Elderly women being abused is fair in HK in 2007 according to Social Welfare
Department : Reported case: 279
Aged between 60-69: 50.1%
Physical abuse: 58.1% 162 out of 279
Psychological abuse: 20.1% 56 out of 279
10
Long Term Care (LTC)
Needs
• Health Services
– Public provision , not women specific
• Social Care (Psychological / emotional + social needs)
– Informal (family, friends, volunteers, etc. ) 70% of caregivers are
women and a sizable proportion is either wives or daughters
– Formal services: 60% of the elderly women used the services
• Housing
– Sheltered homes & Residential care homes,
not women specific
11
S.I.S. 2002
(4 Priority Areas (PA) &
16 Action Areas (AA))
PA-I. Ageing &
Development
AA-1: The challenges &
mainstreaming
ageing
AA-2: Protection & security
AA-3: Alleviation of Poverty
AA-4: Older persons and
emergencies
AA-5: Positive attitudes
towards ageing
AA-6: Employability &
workability
AA-7: Gender specific
issues: The concerns
of older women
PA-II. Health &
Well-being
AA-8: Quality of life
at all ages
AA-9:Quality health
& Long-term
Care
PA-III. Enabling
supportive
Environments
AA-10: Older Persons
& the families
AA-11: Social services
& Communities
support
AA-12: Housing & Living
environment
AA-13: Care and
Support to
Caregivers
AA-14: Protection of the
rights of OPs
PA-IV.
Implementation &
Monitoring
(National Capacity)
AA-15: National
Mechanisms
AA-16: Regional & intergov’t cooperation
12
Modified Policy Framework
for Active Ageing in Hong Kong
individuals– Safe for self + others
Security
PA-I & PA-III
Physical
Financial
Environment
Government: for the needy:
Shelter + ensuring safe living
Individuals – Save for
old age when young
Government:: support
for the most needy, a safety net
ACTIVE
AGEING
PA-IV
Participation: PA-I,II,III
Health Maintenance: PA-II
Self driven, health-focused
Elder Learning
Govt facilitates
Self – healthy living
Individual
Retirement &
P-t employment
Volunteering
© Prof. Alfred Chan, APIAS, Lingnan University
Self – self + neighborhood care
Individuals :giving culture
Govt. recognized training &
facilitation
Gov’t – ensure healthy
Environment for an individual
Ensuring a
Basic
system
Gov’t – ensuring a sound 13
& accessible health service
PA-I. Ageing & Development
AA-1: The challenges & mainstreaming
ageing
AA-2: Protection & security
Social Protection & Security
•
•
•
•
•
•
•
Gender mainstreaming by Women Commission in HK, includes 1) Marriage, family
and fertility conditions; 2) education, 3) labour force, 4) employment, 5) social
welfare, 6) medical and health, 7) law and order, 8) Pattern of participation in public
affairs, 9) Time use pattern and pattern of participation in various activities
Eliminating gender discrimination, sexual harassments and Promoting positive
Image of elderly women by changing deep-rooted cultural attitudes
Active Ageing policy (especially target for women caregiver’s) by the Elderly
Commission
Increasing economic participation by elderly women. Propose to have caregiver
allowance and extend the caregiver support; training for caregivers for providing
a career ladder for experienced base qualification, i.e. Qualification Framework
Wider participation eliminates ageism is under discussion (equal opportunity
commission)
Bias makes training for older people rare (as token gesture-e,g. social enterprise)
Trend: Productive ageing & active ageing—70% are female
– E.g. older professionals maintain their skills through working or volunteering
– E.g. IT and modern skill training for older persons who want to remain working
(Hong Kong)
– E.g. 32 Elder Academy based in Secondary Schools in HK (inter-generational 14
programs)  extend to Universities
PA-II. Health & Well-being
AA-8:Quality of Life at All age
Health Securities
•
1. Preventive
–
–
–
–
–
–
and Primary Health Care
In the long run, preventive and primary health care also means
extending (free) health-care coverage to all generations
Health care system created financial burden as the cost have
soared
• E.g. China – wide disparities in health care access
Primary health care for older people
Accessible, community-based, culturally acceptable
Preventive actions are means to lessen the burden caused by
technology-intensive curative end of the medical system
Public education for women’s health: Menopause, Influenza
Vaccinations, elderly women’s centre
15
Women aged 45 or above, free scanning of the cervical cancer
(Family Planning Association or public hospitals)
PA-1: Advancing Health and
wellbeing
AA-9:Quality health & Long-term Care
Health Securities
2. Long-term Care (LTC)—Enhanced home care-Residential
care
– Home-based care service was established in 1999
– Gender mainstreaming specific for the elders on the Enhanced Home
and Community Care Services (EHCCS includes direct care services
(e.g. nursing care, restorative and maintenance rehabilitation
exercises, personal care) and support services (e.g. provision of
meals, home-making services, transportation and escort services,
carers support services, day care services, respite services, 24-hour
emergency support etc)
– From 2001-2004: 1500 (The majority users is female)
– The Elderly health centres, the community geriatric and psychogeriatric assessment schemes and a gate-keeping (need assessment
mechanism are developed in HK
– Increase the number of private homes and residential homes for
16
responding the demand of the elderly
HK’s Capacity on Ageing:
Social Protection-Health Securities
• To build a society for all ages (including a gender free policy):
follow the active ageing policy framework and the SIS
implementation plan
• Two-way participations: Top-down (government policy) + Bottomup (individual active participation) = Shared care model
• Pressure on political systems to change with the expected
emergence of ‘grey power’ over time
• Young-old partnership to improve the well-being of their parents as
an important force for social change
• ESCAP facilitates
– cooperation and experience transfer in the region
– the exchange of expertise and resources
• E.g. Developed countries’ technical and manpower aids for
developing countries
17