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Testimony on The Graying of Nations" by Jeanette C. Takamura
Assistant Secretary for Aging
U.S. Department of Health and Human Services

Before the Senate Special Committee on Aging
June 8, 1998

Mr. Chairman, and Members of the Senate Special Committee on Aging, I appreciate the opportunity to testify before you today on "the Graying of Nations" and the international challenges that it presents to policymakers around the world. I would like to commend you for calling this hearing. It is especially important because it brings much needed attention to the world wide phenomenon of aging; it sets the stage for 1999, which has been designated by the UN General Assembly as the International Year of Older Persons; and it focuses on active aging.

As I mentioned, 1999 is the International Year of Older Persons, when longevity will be celebrated on a global scale. It will be an ideal time for all of us to reflect on these swiftly changing world demographics and to envision how differently our world will look in the next millennium. It will also be an opportunity for us to consider both the triumphs and challenges that lie before us.

In this century alone, we have seen a more dramatic extension of longevity than humankind has witnessed in more than 4,000 years. It is quite a gift and is quite a miracle. You will hear today from a number of speakers about the aging of the populations in various nations; how aging in third world countries differs from aging in more developed nations; and why focusing on the issues of international aging is important. I would like to share with the Committee how the Administration on Aging (AoA) at the US Department of Health and Human Services, the agency which I head, is helping to assure that the United States is prepared for its own longevity; what we can share with other countries, and discuss some of the international efforts in which we are already involved.

The demographics of longevity

America is among a growing number of nations blessed with the gift of longevity. As you know, May was Older Americans Month, and we, along with your Committee and others around the country saluted this year's theme, "Living Longer, Growing Stronger in America." This theme highlights the fact that many of us are living longer, fuller, more satisfying lives and that we are growing stronger in many ways in the process. Indeed, there is a growing recognition that aging can and should be a positive experience, and that we can take charge as we prepare for our own longevity, regardless of our age today. Certainly there are numerous examples of older Americans who have remained active long past their point of retirement. I know many of you will remember meeting or hearing about Milt Garland, America's oldest worker, who at 102 was concerned about the time it would take from his job to come get his award in Washington D.C. last March! No doubt advances in medicine, science and technology, as well as health promotion and disease prevention, employment, volunteer and continuing education opportunities will continue to enable older Americans to make a difference in communities across the nation.

Approximately 46 million Americans are age 60 and over, with persons 100 years of age and older the fastest growing segment in our country. Since 1900, the percentages of Americans 65 and over has more than tripled (4.1% in 1900 to 12.8% in 1996), and the number has increased nearly eleven times (from 3.1 million to 33.9 million). About 1 in 5 Americans will be over the age of 65 by 2030. That is approximately 70 million older persons, more than twice their numbers in 1996. The oldest old, 3.5 million persons in 1994, represented just over 1 percent of the population. By 2030, the size of the population age 85 and over is projected to reach 8.5 million. In less than 13 years, the vast majority of the 76 million baby boomers born between 1946 and 1964 will begin to join the ranks of our older Americans. According to the Census Bureau, 1 of every 9 baby boomers will survive to at least 90 years of age. As a result, the programs we run and the policies we make must be designed for a longer living community of older persons.

The Administration on Aging and the Older Americans Act (the Act)

Through the Older Americans Act, a system is in place to enable millions of older Americans to maintain their dignity; live as independently as possible; to be free from fear of abuse, neglect and exploitation; to avoid the pain of hunger, social isolation, and loneliness; to be assisted and cared for in their own homes if they are vulnerable and frail; and to have their families receive support as they provide care. The Act is the vehicle through which social, nutritional, and other services to older people have been organized and delivered for the past 33 years. Its programs address the needs of older adults, as they are understood at the national level and based upon needs assessments conducted by state and area agencies and tribal organizations across the country. Since the Act was enacted, it has generated the national infrastructure for an entire network of home and community-based programs and activities which exist in every community across the nation.

Recognizing that longevity has become a way of life in America, and that its ramifications will permeate and touch every aspect of our society -- from its work force to its transportation systems, to our health care systems and our families -- we are reorienting our work within the Administration on Aging to address the current and emergent needs of multi-generational cohorts of older Americans in the next century. Our focus is on health, long-term care, consumer protection, economic security, and on modernizing our core Older Americans Act programs to make the services and service delivery structure more relevant to emerging needs of the 21st century.

What we can learn from each other

Our aging network, the Older Americans Act, our programs for older people and their families, and our use of volunteers to assist in delivery of services have been of great interest to other nations. America's older citizens are not only living longer but they are remaining active. Their continued involvement in learning and in their communities offers us the opportunity to shift our thinking in what it means to be an older person. Our many foreign visitors are particularly interested in and impressed with the Older Americans Act. In fact, at last summer's International Forum of the Americas held in Uruguay, organized by the Pan American Health Organization, the Administration on Aging was asked to speak on the Older Americans Act and the "basic elements of a comprehensive system of support for older adults." In addition to the numerous requests for information we receive from other governments, and the many foreign visitors we receive, AoA has entered into several long term, bilateral relationships which we believe will be of benefit to both countries.

Japan

For the past few years, AoA has been hosting officials from the Japanese Ministry of Health and Welfare. Our current guest is spending a year with us, learning about the Older American Act programs and long-term care policies. He is most interested in the OAA ombudsman program as a model to protect the rights of the elderly. One of my staff members will be embarking on a Washington-Tokyo Public Service Fellowship through the American-Japan Society of Tokyo and the Japan-America Society of Washington. She will be hosted by the Ministry of Health and Welfare in their division that oversees aging issues. Of particular interest will be comparing Japan's Golden Plan and the Older Americans Act programs and service delivery system, and how the Ministry will be adapting its aging policies to the growing older population.

China

AoA is working with the China National Committee on Aging to develop joint programs and activities. We have assisted China's Deputy Director of the International Department to gain a Hubert Humphrey Fellowship to the United States. He is currently completing a professional affiliation with the Administration on Aging to learn about our programs for older people. Our Chinese colleague is quite impressed by our volunteer programs.

China has some unique aging problems and unique solutions which we should look at closely. Currently, one-fifth of the world's elderly population is Chinese, or about half the elderly in Asia and the percentage is growing rapidly. In the year 2020, over 230.6 million people will be over the age of 60, or about 15.6% of the Chinese. Their "baby boomers" generation came in bunches, when the economy was good. At the end of the 1970's, the "one child" family planning policy began to take effect. While there will be fewer children available to support their parents, the Chinese constitution specifically states that "adult children have the responsibility to support their elderly parents." China also has a "Family Support Agreement," most often used in rural areas, which specifies exactly how children will look after their parents.

Mexico

We are working with the Mexican Ministry of Health, as part of the Health Workgroup of the US-Mexico Binational Commission. The commission is a forum established by the two nations to allow for regular exchanges at the cabinet level on a range of issues critical to the United States and Mexico. Together with our colleagues in the Mexican Ministry of Health, we have established an Aging Coregroup. This group focuses on shared issues of our aging populations and exploring opportunities to expand bilateral, collaborative efforts to better address the special health needs of older Mexicans and Americans. We hope to work with the Mexican Ministry of Health in putting on a binational conference on aging in 1999, during the International Year.

Sister Cities Partnership

I wish we had a way of supporting the exchange of expertise at the local, service delivery level so our front line providers could learn first hand how other nations are preparing for longevity. We have a good start in the direction of "thinking globally, acting locally." In 1996, we entered into an agreement with Sister Cities International, to bring together the expertise of our aging network and the expertise of Sister Cities International in developing binational programs. We continue to look for ways to expand the number of pilot projects across the country that would join with their sister cities around the world. Our enthusiasm at the national level has already been transferred into action in a number of cities. We have stimulated the development of aging projects in Las Cruces, New Mexico and have encouraged the newly formed Durban, South Africa and Chicago, Illinois sister cities to develop aging projects.

Our Rio Grande Area Agency on Aging in El Paso, Texas has been working closely with nursing homes and health centers in its Sister City of Juarez, Mexico, right across the border. I think the most important message to convey to you is how enormously enriching this experience is for both parties. If I may quote a statement made by an El Paso nursing home administrator participating in this project, "we thought we would be good helpers but they (the Mexican counterparts) reminded us of the true spirit of service." One of the school age American volunteers who worked in the Mexican nursing home remarked "I will never forget this for someday I will be old."

Another example of a sister city aging project is Yamanashi Prefecture, Japan, which has been in a sister state relationship with the State of Iowa for approximately 15 years. Recently they developed an Aging Consortium Committee to jointly study aging issues and to share knowledge about elder care and services in their respective communities. I had an opportunity to visit with several representatives of the Yamanashi Prefecture when I was in Des Moines recently, and most impressive to me is their technology which Yamanashi elders have available to assist in their care in the community.

The International Year of Older Persons - 1999

As we know, 1999 is the International Year of Older Persons when world wide attention will focus on aging. This will be a unique opportunity to celebrate the achievements and contributions of older people, to bring attention to the needs of older persons around the world, and to prepare nations for longevity. We greatly value the support this Committee and its staff are giving to help us prepare for the International Year. The Administration on Aging is taking the lead in the federal government in planning for the International Year, which actually begins on October 1, the International Day of Older Persons. Our activities will focus on preparing departments and agencies government wide for population longevity. We have formed a federal committee. I must tell you that we have been pleasantly surprised and gratified by the very enthusiastic response from all those who are working together for the International Year. Our major goals will be, in part, to highlight for the world the U.S. government's leadership and commitment to addressing the needs of older people and to highlight the contributions of older adults themselves. We also want to use the opportunity provided by the International Year to move agency aging agendas forward, to embrace the reality of longevity in all federal agencies, and to prepare the country for our own dramatic aging.

Our work at the federal level will be reinforced by other efforts/activities which will take place across the country at the state and community level. One of our major activities for the International Year will be a large, federal-wide conference, which we hope to hold in Washington, D.C. during Older Americans Month in 1999. Once again, I am very pleased that the Senate Special Committee on Aging is actively participating in the preparations for the International Year, and for this conference in particular. We plan on inviting our colleagues in other nations to this conference.

But that is not all we are doing for the International Year. In January, we added an International web site to our Administration on Aging homepage. The International Year of Older Persons is prominently featured and contains links to other International Year web sites, resource information and ides for celebrating the year. We continue to receive inquiries from all over the world about our plans for the International Year, and just last week were visited by a delegation from the Netherlands interested in our plans. Our international coordinator recently attended a multi-national meeting organized by the German Ministry for Family Affairs, Senior Citizens, Women and Youth to discuss plans for the International Year. She shared our plans with 18 participating countries.

The Denver Summit of the Eight

Last summer the Denver Summit of the Eight (consisting of the United States, Canada, France, Germany, Italy, Japan, Russia and the United Kingdom) for the first time addressed the issue of aging. Our Department, including the Administration on Aging, was heavily involved in preparing the communique issued by the leaders of the G-8 nations. This communique is of special importance because it begins to shift the focus from aging as a "dependent" stage of life to a new definition of "active aging" defined as the "desire and ability of many older people to continue work or other socially productive activities well into their later years and to dispel the stereotypes of older people as dependent." The Summit of Eight communique stressed the importance of learning "from one another how our policies and programs can promote active aging and advance structural reforms to preserve and strengthen our pension, health and long term care systems. Governments pledged to work together, within the OECD and with other international organizations, to promote active aging through information exchanges and cross-national research." The theme of active aging was reiterated in the 1998 Summit of the Eight, held last month in Birmingham, England. I look forward to our continued participation in this valuable effort.