Sociological Solution to the Super-Aged Society
Japan is at the forefront of a super-aging society. An "aging society" should be a social success. However, more and more people think that it is a failure because the burden of medical care and welfare. Isn't this a "spell" that makes us think so? We need “sociological imagination” to transcend these views.
This interview has been edited for clarity
Fukuoka, Japan - Professor Kiyoshi Adachi had his last lecture at Kyushu University this February entering an age-specified retirement. He believes the welfare system implemented after WWII was so successful that is why now, it is a failure. It created the lop-sided population demographic where a new paradigm is necessary to overcome what economics only forecasts as ‘pessimistic,’ lacking funds and workers. Here, Professor Adachi speaks on themes he has covered during his career as a sociologist.
What do you specialize in?
I am a sociologist specializing in welfare sociology. Many people need help understanding sociology and how it differs from the social studies classes they took in school. I believe the difference is best described by the "home and away" concept in sports. For example, during the World Cup qualifiers, two countries will play matches in their respective venues. This is because you cannot know a team's true strength by having them play in their home country. Only when you see them play outside regular conditions can you truly understand their qualities.
Social studies observe society from the point of view of a home game. Social studies will tell you what kind of country it is, the society, the legal system, its values, its history, and the characteristics of people. The purpose is so that everyone understands the structure of the society that they live in so that they are good citizens.
In contrast, sociology is about looking at a country's society from an "away" perspective. Sociology is about trying to see things from a third party's point of view, with a sense of incongruity in the structure of a country's society, values, behavior patterns, implicit norms, consciousness, and behavior.
Munesuke Mita was one of my college professors who ran away from home during high school because he didn't fit in with his family. Even after he moved from Osaka to Tokyo and became a university professor, he felt uncomfortable with academia imported from the West and tried to understand a different value system by learning from people in Mexico, Peru, India and Southeast Asia. I am also someone who feels uncomfortable with Japanese society. Part of this is with the idea of a "super-aged society."
How did you come to specialize in welfare sociology?
In 1994 I went to the United States to volunteer and research non-profit organizations in Los Angeles. I have been participating in volunteer and research activities all over Japan to support the elderly living alone since the 1980s. I began to think about the differences between Japanese-style welfare volunteer organizations and American non-profit organizations from a comparative sociological point of view. Unlike Japan's volunteer organizations, the American NPO system was matter-of-fact, rational and taught me a lot. I learned that in the United States, there is a large national organization for the elderly, formally known as the American Association of Retired Persons, now called the AARP. Through this organization and others, society has come to understand that the "retirement system" is unconstitutional in the United States and deemed as ageist. In the United States, the 1960s and 1970s brought on three major social movements that protested against discrimination based on race, sex, and age. The movements considerably changed society.
I began to conduct surveys upon returning to Japan with members of the Japanese elderly movement. The senior citizens' clubs in Japan differ from AARP in the United States. I thought that problems such as the "retirement system" would not be solved without a movement by the elderly. Despite being called a "super-aged society," the elderly movement has not been very active in Japan, and the issue of age discrimination has not become a major social or political issue.
I hear in the news how a significant portion of the population in Japan is over the age of 65. What have you learned about the super-aged society?
In Japan, there is a great deal of interest in the issues of an aging society, perhaps the highest interest in the world. However, I think that this interest is misguided. That is one of the reasons why I wrote the book, "How to Overcome the Super-Aged Society." The first thing that comes to my mind is that we are forced to dance to the words "aging" and an "aging society." The people themselves are not accounted for; they are not discussed as humans. We only look at age, population numbers, population structure, rates, and ratios. Humans are reduced to data. Even though each and every person is different, we don't look at individuals. They are no longer seen as people. This is why the future becomes pessimistic. The data only shows that the aging society will become a super-aged society. In the capitalist paradigm, they are not producers, just consumers.
It is often said that in modern medicine, doctors look at test results and do not look at the patient in front of them. Doctors are often criticized for looking only at the disease data on the computer display without looking at the patient. The same thing is happening. We look at the data, not the people. If we only think about disease based on test data, we may end up saying, "We were able to treat the disease, but the patient died."
In the book, I pointed out that this is precisely the "spell" of the word "super-aged society." We assume that we are thinking and observing by looking at data, but in reality, we are being put under a "spell" by data and are being brainwashed by the associated words. Given the terms "aging" and "aging society," it seems that society is moving in such a pessimistic direction and that something needs to be done to stop it. We are manipulated by words, our thoughts are formed by words, and we are moved to act by such words. The problem is that smart, highly educated people are easily put under this "spell." Even among the national and regional governments, people who think earnestly about the future are the first to be put under this "spell."
In your book, “How to Overcome a Super-Aged Society,” you state that the “kaigo hoken”, the long-term welfare care insurance was so successful that it failed.
In sociology, there is an interesting theory of the self-fulfilling prophecy. When everyone thinks that something is inevitable or thinks it is true, it does begin to become true. This can be seen in the stock market or fashion. A big trend can start with a small trigger, and when many believe, they act accordingly. I saw this mechanism in the evaluation of long-term care insurance. Initially, long-term care insurance was a policy breakthrough of relegating long-term and elderly care to society rather than entrusting care to families.
It was an advanced achievement unique to Japan, which now has one of the world's oldest populations. With industrialization, Japanese families rapidly became smaller, nuclear families while both husband and wife work and grown children live separately. Under these circumstances of the extended families living apart, the family cannot take care of the elderly. Therefore, the Ministry of Health, Labor and Welfare launched the public long-term care insurance system after considerable review and preparation. It should be considered a big success.
How can we best translate the word “kaigo”?
"Kaigo" is a concept developed for the Japanese system, and I don't think it exists in other countries. It's not in Chinese; you can't find it in Korea or overseas. In English, it would be "Long term care," but it differs from "nursing care." It is an administrative policy term since the service provided by long-term care insurance is "kaigo." Other countries have similar words and concepts, but Japan's "nursing care" is different. It is said that the three major forms of nursing care are "meal assistance, toilet assistance, and bathing assistance." For example, the Japanese bathing culture is different from China, so the service itself is different. In English, the nursing home is a system where a nurse plays a central role in supporting long-term care. In Japan's system of "kaigo", nurses are not central. National qualifications for "kaigo" welfare care workers were created around the same time as long-term care insurance. With the introduction of long-term care insurance, various qualifications and systems were established in a hurry.
From the perspective of the Ministry of Health, Labor and Welfare, long-term care insurance seems to have been necessary to reduce medical expenses. Rather than support for families, there was a need to reduce costs due to "social hospitalizations," a phenomenon of elderly people being hospitalized to receive feeding and toilet care because no one was home to care for them. Many elderly people were hospitalized because they had nowhere to go. As a result, the expenses were piling up.
Many citizens, especially those within the women's movement emerged strongly to support and promote the long-term care insurance system because wives were expected to stay home to perform care duties. Entrusting care to women is a division of labor by gender and greatly hinders women's independence. So, women were the driving force behind the movement to realize long-term care insurance. The incentive was also to create jobs for women. Many community-participatory home welfare service activity groups were volunteer groups led by women. The 1998 Act on Specified Non-Profit Activities allowed volunteer organizations to become non-profit corporations. Women's volunteer groups became NPOs and became long-term care providers under the long-term care insurance system, enabling them to have paid work. What used to be "unpaid volunteer work" became "paid work." This was groundbreaking. From a sociological point of view, this can be seen as a decisive step forward against sexism in Japanese society.
However, from the government's point of view, this is "too much success and failure." The policy allowed to support so many elderly for so long. However, with welfare and health insurance, more government finances are no longer in their control. I think this split in evaluating "success but failure" is somewhat gender-related. Women evaluate from the perspective of reducing the burden on women and providing a social safety net. The men's point of view critically evaluates from the viewpoint of fiscal pressure and the system's sustainability. In addition, I think there are various points of contention, such as conflicts from the perspective of medical care, nursing, and welfare.
Japan still has places named “obasuteyama” or throw-away grandma mountains. Are there similar customs overseas?
Obasuteyama – or throw-away-grandma-mountains are found in folktales and lore all over Japan. Kunio Yanagita's "Tono Monogatari" and Shichirō Fukasawa's "Narayama Betsuko" are famous. However, this is from a pre-modern period, and when thinking about the "super-aging society," I think it is more appropriate to think of it as "triage." Triage is a system that prioritizes the lifesaving of victims for emergency rescue in the event of a disaster. Medical personnel says that it is a rational system that tries to save as much life as possible with limited resources, such as in the case of a disaster by helping those who are likely to be saved. During the Covid-19 crisis, people with underlying medical conditions and the elderly were said to be risk groups. This is also a data-centric way of looking at people, but more than that, the problem is that this leads to triage.
Triage started as a medical system for the French army during the Napoleonic Wars. Among the soldiers wounded in the war, those who could be sent back to the front line as soon as possible were selected to invest medical resources first. Therefore, this system began as a system of war, for maximally rationalize the use of limited care in the extreme conditions of war. It's reasonable in war, but what about ordinary life? It is inherently inhumane. If misused, it is a dangerous sorting method. In the corona misfortune, age was used to sort populations. It was used to prioritize vaccinations but we don't know how it will be used in the future. It turns into a dangerous thought. There is the danger that it will lead to a selective mindset that the elderly have no choice but to be sacrificed because it is difficult to sustain them.
You have a book coming out to propose a solution to the super-aged society through re-examining the possibility of non-profits and volunteerism. You propose the idea of “paid volunteer work” as a solution to capitalist societies.
Japan is now at a standstill. The economy is in a long-term slump and the world has become chaotic. At this rate, what is the vision in economics and political science? This is where sociology comes in. There is a third way of "society" that is neither political nor economic. That is why I wrote "Imagined Communities in the 21st Century: The Principle of Volunteerism: The Possibilities of Non-profits", to address those issues. I would like to think of an 'imagined community' that is neither economic nor political. That would require imagination for a vision of volunteerism and non-profit.
We think that we can only live by "labor." We are put under this curse or "spell." In one of the most memorable scenes in the movie "Spirited Away," a film by Hayao Miyazaki of Ghibli Studios are the words, "please let me work here," which are replaced by the phrase "I want you to give me a job, please." The words are capitalist. The central figure, Chihiro, a girl of ten, is thrown into the world of slave labor in the bathhouse, like global capitalism. We must restore a way of life that is not "labor". Therefore, I want to aim for "non-labor work" and go beyond "unpaid volunteer work" to "paid volunteer work." In this book, I wrote about work that goes beyond labor.
In the movie Spirited Away, the central figure Chihiro can leave the indentured-servitude operation of the bathhouse when the evil Yubaba gives her a riddle. She says if she can spot her parents, who were turned into pigs, she will let her leave. However, she realizes her parents are not there. The answer was not within the realm of possibilities or the available options. She realizes that the answer is to leave.
I consider war and welfare in the new book "Origin of Welfare" (Genshobo), published at the beginning of March 2023. Why do wars break out even though welfare is gradually scaled-down because finances are tight? War becomes more and more possible while welfare becomes impossible. If you think about it simply, the logic is reversed, but now the world is going in this direction. We can only assume that we are under a "spell." Being caught in the process of self-fulfilling prophecies is the danger of such "spells."
Welfare does not come naturally. It did not evolve naturally out of charity or goodwill. It was because there was war. Welfare became necessary because of the destruction and misery of war. The 20th-century "welfare state" was born after World War II. This is clear. There was no "welfare" in pre-war Japan. There may have been hospitality based on status systems, but no universal "welfare." After Japan was defeated in the war, the GHQ instructed the Japanese government to help the people and create a social security law. "Welfare" did not come naturally from within.
The world of Ghibli to connect to a wider audience
Ghibli movies often appear in lectures or when writing an academic book, because most people under 40 have seen the stories. This allows for substance to be given to sociological thinking and find points of contact with the issues in our lives. Considering characters and storylines serve as an important bridge that connects the world of sociology with the rest of the world.
Sociology in Japan grew from the Faculty of Letters. It was originally considered a branch of philosophy. Eventually, it came to be thought of as social science, and gradually moved away from literature and philosophy. However, the fusion of literature, philosophy, and empirical science is the strength of sociology. Sociologists Mr. Sousuke Mita and Mr. Masayuki Osawa do the same. They valued the reality of people's lives rather than empirical or factual data. Sousuke Mita pursued and discussed a young man named Norio Nagayama, who committed murder. There is a book called "Manazashi no Jigoku", or the "Hell of the Gaze." Sociologist Masayuki Osawa also discusses NHK's morning drama "Ama-chan" in detail and finds a number of post-earthquake issues in Japan. I want to follow the methodology of these scholars, and I am doing so with a sense of adventure.