AXA Group employee and presenter of Next Stop Noel Eyres visited AXA Life Japan as part of his world-travelling video series Next Stop, to find out about the business challenges in the aging land of the rising sun.
Kawaii* kids and podgy pyramids
Shimbashi station, Tokyo, 8.30 am: As I watched the well-behaved school children with their identical satchels and distinctive blue or yellow bonnets – for greater visibility and safety on the streets –, calmly board the subway train with the other morning commuters, I pondered on whether Japan actually felt older. The fact is, the Eastern Asian archipelago has the oldest population on the planet, with a third of its inhabitants over the age of 60. When you look at world population graphs – a perfect pyramid for emerging countries with their swathes of under 15s, or a chubby blob for Europe with its large middle-aged population – Japan’s graph looks decidedly top-heavy. By 2055, the projections are that it will have inversed itself from its 1960 version: imagine a wobbly version of Giza’s great Pyramid balancing precariously on its tip.
The population is not just aging, it’s declining. This is a result of a lower birthrate due to a smaller population of women of childbearing age combined with a tendency to have less babies, typical of most developed country but even more pronounced in Japan, as well as local social factors (women are often still expected to be homebound and dedicated to rearing children once they’re mums, so motherhood tends to get put off), and more basely economic reasons. And a declining population means less people of working age inputting into the economy. By 2060, if nothing changes, it’s expected that there will be only 1.19 workers for each pensioner (versus 2.59 today). Each worker will need to support one pensioner financially – and what will be left for rearing kids?
Other developed countries are heading that way, but Japan is in the lead. This population decline and its associated workforce shrinkage, added to the economic slowdown over the last 20 years or so, is having very real and worrying impacts on Japan’s ability to sustain itself in the long term. So other nations have their eyes on Japan to see how it can cope before they too trudge down that same path in a not-too-distant future.
All in this together
So as I exited the subway to get my first view Tokyo life, even if I wasn’t exactly expecting a five-day immersion in a city-sized old folk’s home, I was aware of the stress that this demographic change is having on the country’s economy and social services. That was the reason for my visit: understand the societal effects and associated healthcare implications of this trend and, thanks to my contacts at AXA Life Japan, get an idea of what role AXA can play in this context.
With such a wide-reaching, long-term problem, it is up to the economy, society and the government together to find the solutions to attenuate this situation, failing the capacity to reverse it. The government has been busy and has proposed and is implementing various measures. The focus is on the notion of “extension of healthy life expectancy” and supplementing its national pension plan with long-term-care insurance. This comprehensive programme provides people who have been paying into the system a customized service, depending on their needs as assessed by the health services, offered by a choice of competing institutions to provide the services.
AXA in JapanKey figures
Lifestyle diseases and bone and joint-related diseases, for example, account for one-third of medical expenses borne by the government, and a number of local governments are promoting initiatives to prevent aggravation of these diseases. Hence, the need to start treatment from the onset of early symptoms.
This is an opportunity for AXA to move from its role as payer to partner by accompanying an aging population to live their old age better. In September 2016 it launched “Prevention Care Support”. This insurance product supports early medical treatment, preventing the aggravation of minor diseases in addition to the coverage of conventional medical insurance, thereby reducing financial loads but also improving the quality of life of customers. This is a first in the industry to broaden the treatment options of patients with refractory diseases.
SMEs: the (aging) backbone of the Japanese economy
Another drive to tackle the economic repercussions of an aging population is to target the pillar of the Japanese economy: Small and Medium-sized Enterprises (SMEs). As a significant contributor to the local economy – accounting for a large proportion of economic output and employing the vast majority of the working population locally – SMEs are the backbone of its economy and one of the primary keys to the Japanese recovery.
Weight of SMEs in Japan’s economy
I was put in contact with Yoshinori Kasahara, from AXA Life Japan’s Health & Productivity Management Promotion Office to find out how AXA is working with SMEs as a partner in health. I joined him at a work-sharing space in the heart of the student district. Upstairs from the café area, serving an array of trendy organic coffee-based beverages, we sat down amidst a jumbled array of 3D printers, a robot, studious designers and an earnest American hipster pitching a business venture to a group of Japanese suits. As we sat down, coffee in hand, Kasahara-san explained the burden of Japan’s aging workforce and their waning health on a company and of the knock-on effects on the economy. This includes the cost of Presenteeism: employees who will come to work out of a sense of duty, but whose poor health and subsequent lack in productivity have an impact on the company’s financial health.
This is where Health Productivity Management (HPM) comes in. This central government initiative aims to promote better living to SME owners and their staff and thereby reduce the longevity-related strain on the governmental coffers and the social welfare system.
AXA Life Japan contributes to the national promotion of HPM and positions itself as a leading-edge support company of this initiative by cooperating with public entities such as the central or local governments. AXA’s HPM advisors provide SMEs owners with training and material to raise awareness of and provide tips for healthier living, such as eating better, more balanced meals, exercising regularly and avoiding unhealthy life choices, and also providing life planning consultations to alleviate employees’ concerns for their future. In a country with a strong civic sense an emphasis on returns in productivity, profitability and sustainability encourages people to change their behaviour.
Kasahara-san summarized the benefits of the initiative thus: “HPM is mutually highly beneficial for AXA Life Japan, our clients and our society. These are WIN-WIN-WIN relationships. That’s why we can create strong relationship with stakeholders and expand our business.” With Japan as the precursor on the subject, he added: “I believe AXA Group can use this business model globally because aging societies are everywhere in this planet.”
These examples are inroads into prevention and alleviating the economic aspects, but what about care for this fragile community? With an elderly population outstripping the caregivers’ ability to deal with them and an immigration policy that doesn’t encourage an imported foreign population to compensate, what are the options?
Domo arigato** Mister Roboto
If there aren’t enough health-carers to support such a significant proportion of the population, maybe technology can fill certain gaps. That’s what brought me to the Robo Care centre, an hour’s train ride from the centre of Tokyo, showcasing various types of robotically assisted solutions catering to the needs of the elderly or those with reduced mobility.
At first I was not particularly overwhelmed by what was on display in the showroom: an array of robotic toys, Segways, electrically assisted shopping trollies and motion sensor games adapted to senior citizens to induce physical activity. Apart from what appeared to be a bionic exoskeleton in one corner of the showroom, it didn’t look too different from a Christmas display in any big toy store.
We were then given a demo of two exoskeletons. Plugged directly onto the nervous system via a few stick-on captors which relayed the intention to make a particular movement: walk, squat, or simply raise a leg, the exoskeletons enhanced that intention mechanically. The demonstrator would not allow me to try it out myself so I remained sceptical of its efficacy until we ascended a floor to what can be described a rehabilitation ward: half a dozen people of all ages with very reduced mobility – normally wheelchair-bound –, were walking on treadmills with these hi-tech contraptions. It was uplifting to see these grandmothers – and kids – a steely glaze of concentration on their faces, recovering their ability to get around and finding some independence in their movements. A few small steps for an individual, a great leap forward for the mobility-reduced in a country where more than five million elderly people live alone?
With this in mind I headed to Jizo Dori – a shopping district catering specifically for the elderly – where I met Bunya Usui, from AXA Life Japan’s distribution department, who is the brains behind “Are you OK”. This app and service was designed to enable family members to care for their elderly kin from afar. The tool, installed on the elderly person’s mobile phone, can geolocalise and monitor their location, ensuring their safety. The idea came to Bunya-san in response to his mother’s Alzheimer’s condition and her tendency to get lost. She can now quickly and easily contact her son or activate a panic button which connects her directly with AXA Assistance, who will offer her support.
After my visit to the Robocare centre and amble through Jizo Dori, in answer to my initial question: No, in Tokyo at any rate the population didn’t feel older. The capital is still an active, bustling city, with an average age marginally lower than the national average. The streets are lively with Japanese youth in many districts, but the truth is, the national population crested in 2010 and has since lost 900,000 residents, and the countryside is emptying at an alarming pace. So there is still a lot to do for the public and private sector to overcome this challenge.