10 th Hong Kong Sociological Association Annual Meeting Sociology in the 21 st Century: Prospects and Challenges

1. A Gender Responsive Social Protection-Health Security for the older women in the Asia-Pacific Region:Hong Kong as an example 10th Hong Kong Sociological Association Annual MeetingSociology 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

2. 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

3. 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

4. Safe Environment: including law & order Policy Framework for Active Ageing (WHO) Security Financial & income security ACTIVE AGEING Participation Health Maintenance Economic participation Conducive environment for self & community -care Elder Learning Provision of a good health care system Volunteering © Prof. Alfred Chan, APIAS, Lingnan University

5. 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 needsThere 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

6. 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

7. Ageing Population in HK Ageing Population in HK :women come to the top

8. Education • Women are less educated don't know how to access health services

9. 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

10. 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

11. 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

12. S.I.S. 2002 (4 Priority Areas (PA) & 16 Action Areas (AA))

13. Security PA-I & PA-III Modified Policy Framework for Active Ageing in Hong Kong individuals– Safe for self + others Individuals – Save for old age when young Physical Environment Financial Government: for the needy: Shelter + ensuring safe living 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 Self – healthy living Elder Learning Individual Govt facilitates Gov’t – ensure healthy Environment for an individual Retirement & P-t employment Individuals :giving culture Self – self + neighborhood care Volunteering Ensuring a Basic system Govt. recognized training & facilitation Gov’t – ensuring a sound & accessible health service © Prof. Alfred Chan, APIAS, Lingnan University

14. PA-I. Ageing & DevelopmentAA-1: The challenges & mainstreaming ageingAA-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 programs)  extend to Universities

15. 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 peopleAccessible, 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 • Women aged 45 or above, free scanning of the cervical cancer (Family Planning Association or public hospitals)

16. 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 psycho-geriatric assessment schemes and a gate-keeping (need assessment mechanism are developed in HK • Increase the number of private homes and residential homes for responding the demand of the elderly

17. 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) + Bottom- up (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