UNU-IAS Working Paper No. 111
Housing and Healthy Community Living for Urban Ageing Society: Case of Kobe
Junko Otani
February 2004
Abstract
Background In the course of the reconstruction after the 1995 Great Hanshin Earthquake, 400,000 households in Kobe lost their housings and experienced the repeated relocations of different types of housings. It can be said that Kobe has been conducting a massive experiment. At the post-Earthquake public housing scheme communities, 40-60 percent of the residents are aged over 65 and more than half of them are „living alone‟. This is an increasingly important population in ageing societies.
Objectives This paper addresses housing and urban community care development with ageing populations seeking healthy living, and sensitises policy makers to what can be at issue, by filling in the gaps among different measures by different actors.
Methodology Multiple-methods for Case studies including ethnography and secondary data analysis of public health survey by different types of housing schemes.
Discussion Whilst community care development is seen as a key for healthy living by most identified actors, different actors use different measures for success and setting priorities. The gaps need to be carefully identified and considered. The coordination between the public administration and local communities is the key to develop the successful community care system. What makes a difference in the process will be discussed: community dynamics, key person, volunteers, housing and other infrastructure.
Keywords
Ageing, Health, Housing, Community Care, Urbanisation, Gender, QSR Nudist Vivo
1. Introduction
This paper addresses two global trends in social change occurring concurrently: urbanisation
and population ageing, from the housing point of view by making a comparison between two
dwellings built following the 1995 Great Hanshin Earthquake in Kobe, Japan. The World
Health Organisation (WHO) stated that housing is the single most important environmental
factor associated with health. This study focuses on healthy community living and housing for
older men and women with no or non-functioning family to support their daily living in the
traditional way. They are increasingly important groups in the current social changes.
It can be said that Kobe city has been conducting a massive experiment in consequence of the
disaster. This project seeks to broaden our understanding of the significance of housing in
relation to old people‟s health in an urban setting.
Section 4-(1) introduces Housing types: temporary shelter housing. Collective home. Special
care for older people. Public reconstruction housing. High-rise. Silver housing. Then discuss
how different actors such as residents, public administrators perceive the housing; Its impact
on community care development process and health perceptions; Household structure and
family relationships; Peer relationships.
The analysis is not limited to housing type (e.g., one floor tenement or high rise) but also
includes living arrangements and environment; The size of the area; Community; Location;
Ease of access by volunteers and ability to gain the attention of public officials.
Also, Impact of media (e.g., as an information source. e.g., the language of people who watch
the TV programme.)
1 By looking at the highly age biased community of Kasetsu (temporary shelter housing: TSH) created after the Kobe Earthquake and the following stage of Fukkou Jutaku (public reconstruction housing: PRH), this research will follow the Earthquake.
The 1999 earthquakes in Turkey in August and in Taiwan in September emphasis the importance of the research and the need to generalise to other disaster. Public experiment as such can be done only in times of emergency such as natural disasters.
The general aim of this paper is to seek deeper understanding in order to identify a culturally sensitive strategies to meet the needs of ageing populations and to develop an approach that would sensitise health and welfare system policy makers to what can be at issue when a large-scale unpredicted crisis occurs in a society with rapidly ageing populations. This topic is investigated by taking the 1995 Great Hanshin Earthquake in Japan as a case study. The project will map the complexity of the experiences of old people following the Hanshin Earthquake, and explore the areas where the welfare system does not match the needs of old people, and is not adapted to deal with future trends to a society where a high proportion of older people have no or non-functioning families1.
2. Background
Background section focuses on four issues: urbanisation; population ageing in Japan; housing for ageing populations; and the 1995 Great Hanshin Earthquake. The population ageing will be discussed in the following aspects: Demographic change, Economic changes, and Family changes.
1 Campbell and Ingersoll-Dayton argues that the term, “family”, in discussing care for older people refers differently in different cultural settings with different concepts. Japaneses often mean children whereas Americans often mean spouses. [Campbell, 2000 #1]
2 ( 1 ) Urbanisation
Once people moved to urban cities, they seldom move to rural areas. As a result, city-dwellers will have more old people living in a place like high-rise apartments. Urbanisation is one thing.
In these urban apartments, space is not available for extended families. Or urban life has not required much of co-habitance of families over multi-generations. Family role changes. That will change local government roles and community care needs. This social change shares experiences with other countries, especially other Asian countries. This social change will have impacts on the housing needs for different kinds of schemes. This paper will examine the meaning of different kinds of housing schemes to old people using the Case of Kobe.
( 2 ) Population Ageing in Japan
Japan has a rapidly ageing population and the population ageing is occurring together with economic stagnation. The 1997 census announced that the number over 65 year-old surplus the number below 15 [Asahi, 1998 #3] Mar. 28. The issues related to its ageing population started to receive a increasingly great amount of attentions from the government and the public since
1970s [Campbell, 1992 #2]. The policies and programmes towards the elderly have been started. But still a lot more need to tackle. This section will introduce demographic change, economic trends and related social changes critical to the well-being of older people.
Demographic Change
Japan has the most rapidly ageing population in the world. Ageing started later than other developed countries but has been faster. Life expectancy has improved from 50 years in 1945 to the world longest of 81 years [Bentelspacher, 1994 #4]. Mortality has dropped for all ages.
The Infant Mortality Rate (IMR) has fallen particularly quickly. The Total Fertility Rate (TFR) has also dropped from 3.6 in 1950 to 1.4 in 1995, far below the replacement level of 2.1
3 [Soumucho, 1997 #5].
The proportion of those over aged 65 was 7 percent in 1970 and became 14 percent in 1995. It took Japan only 25 years to experience this demographic change whereas it took France 125 years [Soumucho, 1997 #5]. The proportion aged over 75 is increasing even more rapidly.
And it is projected that the similar rapid population ageing is to occur in other Asian countries such as China, India, Thailand, Sri Lanka.
Table 1: Population Trends and Projections for Four Age Groups (Thousands of People) 0-14 15-64 Age 65 Age 75 Total Avera years years and over and over ge age 1970 25,153(24.0%) 72,119(68.9%) 7,393 (7.1%) 2,237 (2.1%) 104,665(100%) 30.3
1995 22,387(17.5%) 87,168(68.3%) 18,009(14.1%) 6,986 (5.5%) 127,565(100%) 38.8
2000 23,591(18.0%) 86,263(65.8%) 21,338(16.3%) 8,452 (6.4%) 131,192(100%) 39.8
2025 22,075(16.4%) 81,102(60.2%) 31,465(23.4%) 17,367(12.9%) 134,642(100%) 43.3
Note: Figures are as of October 1 for each year Sources: Up to 1985: “National Census,” “Population Estimates” Statistics Bureau, Management and Coordination Agency. From 1990: Future Population Estimates for Japan, Institute for Population, Problems, Koseisho. Japanese Ministry of Health and Welfare, Kosei Hakusho (White Paper on Health and Welfare). Kosei Tokei Kyokai, 1989 [Bentelspacher, 1994 #4] [Kinoshita, 1992 #6].
Japan was the first non-Western country to industrialise and to experience rapid population ageing. Therefore, Japan‟s experience will be unique, compared to other Western industrialised countries with ageing populations, in how this major demographic transition might affect the social, cultural, and political institutions of a non-Western society.
Japan has not been an exception to the global trend of rapid urbanisation. The proportion of those who live in cities increased from 28 percent in 1945 to 77 percent in 1985 [Sonoda, 1988
#7]. This phenomenon has various implications for the family structure, living arrangements, occupations, and, therefore, social security. The houses a migrant to urban obtains tends to be
4 smaller and is unlikely appropriate for multi-generational households. Occupation engage in urban cities is not the same as occupation in rural areas. This changes the form of household income. Age distribution of migrants are not even and creates a population of unevenly distributed age-groups. Asian family values influenced by Confucianism are said to be disappearing due to the modernisation and Westernisation in line with urbanisation.
Economic Trends
Japan is in the throes of a ten-year recession: the longest and most severe recession in its post-war economic history. The common Japanese practice of full employment for life as become difficult to sustain and early retirement has already been a trend for more than a decade.
The number of unemployed and that of homeless people are increasing.
The unemployment rate in May 1998 had become 4.2 percent which is the highest since the end of the World War II. As a consequence of the recession, the jobless problem is more severe for older people in the labour force. The worst hit is workers between 45 and 54 years old. Their unemployment rate is 8.4 percent in May 1998 compared to 7.1 percent in 1997. This makes it more difficult for elderly earthquake victims to obtain a job. The number of suicide of men in
40s and 50s was increased by 50 percent to over 30,000 in 1998 from previous years of annual
20,000 cases. That in 1999 is not yet available. The causes are reported depression due to redundancy at restructuring their company. Also as another consequence of the recession, the budget for old age welfare has been reduced.
Wealth of Elderly Individuals
Japan‟s Ministry of Health and Welfare (MOHW) White Paper reports that old people are overall wealthier than younger generations. Primarily as a result of a rapid pension benefit
5 expansion since the mid-1970s, Japanese elderly people have been enjoying the fastest income gains of any age group in recent years. Over the period of 1981 to 1996, the proportion of elderly aged 60 and over who reported that their primary income source was their pension increased from 35 to 57 percent, and the proportion who reported that work was their primary income source declined from 31 to 22 percent2 [Ogawa, 1997 #8]. The expansion of the pension systems resulted in less Japanese elders reporting economic difficulty than in any other industrialised country [Palmore, 1993 #10] but this was pre-recession.
Table 2 shows that public pensions are the largest source of income for older people and that private pensions are only a small component. The Table also shows surprisingly, in view of
Japan‟s relatively high saving rate, that the proportion of the elderly people who mention savings as an income source is not higher in Japan than in the other two countries. This may be because the savings of Japanese elderly people are tied up in home ownership to greater extent than in the other two countries 3 [Ogawa, 1997 #8]. Another issue is the extent to which people are prepared to report savings.
2 The figure of 22 percent is still high by international standards, mainly because the development of social security system is a recent one and because of the comparatively large size of Japan‟s agricultural and small-business sector [Ogawa, 1997 #8]. 3 Home ownership rates are high among Japanese elderly people and they have tended to transfer home ownership in return for services from coresiding children. Due to the high price of land and housing, it is no longer possible for current younger generations to build or purchase new housing in a city without help from their parents.
6 Table 2: Income Sources for People Aged 60 and Older in Japan, United States, and Germany, 1996
Specific Income Source Percent Mentioning Percent Responding that Specific Income Source Specific Source is Main Source Japan US Germany Japan US Germany Work 35 26 7 22 16 5 Public Pensions 84 83 84 57 56 77 Private Pensions 8 33 24 2 13 10 Savings 21 24 21 2 2 2 Assets 11 34 12 3 9 2 Children 15 3 3 4 0 0 Public Assistance 1 2 1 0 0 1 Other 4 7 4 2 2 2 No Answer 0 2 0 8 4 2 Note: Results are based on self-reports. For income in general (first set columns), respondents often indicated more than one specific source, so that percentages add to more than 100 down columns. For main income source (last set columns), the percentages for particular income sources add to 100 within rounding error. The distinction between savings and assets is not clear-cut. Japanese view savings as money in a savings account. Source: Management and Coordination Agency (1996) [Ogawa, 1997 #8].
Savings, which comprise at least 21 percent of Japanese old people‟s income, have been higher than any other OECD countries. The average saving rate of Japan between 1984 and 1993 was
32.8 percent where as that of the UK was 15.9 percent. However, Japan‟s saving rate peaked around 1970 and thereafter declined rather quickly until 1984 [Hayashi, 1992 #11]. The decline is more obvious among the younger generations.
Work consists of 35 percent of Japanese old peoples‟ income sources. The data is reported by household unit. The labour force participation rate of old people in Japan is high at international standards (See Table 3). However, the employment rate of elderly people is falling even though the desire to work during later life is rising. To reduce the burden of pension coverage, the retirement age tends to increase as the pensionable age increases.
However, the recent economic recession has resulted in redundancy and firms‟ bankruptcy.
Job loss often means loss of ikigai (value of life, life enrichment) and of opportunity to develop social networks. People think they need to continue to work in order to maintain their health in
7 a daily routine. The OECD reports that the evidence suggests that those who work longer enjoy better health in their old age [OECD, 1996 #12]. It should be commented that those who are healthier may work longer. The stigma of not working is particularly severe in Japan, especially among the generation of the post-war economic growth. It is common that the loyalty to their company comes first than their family life for men.
Secondly, gender difference in labour participation is significant (See Table 4). This has direct impacts not only on wealth and income but also on benefits such as health insurance. As female labour participation in formal sectors has not been high in the post-war Japan, although it is increasing, there are significant gender differences in terms of income, access (or entitlement) to welfare services, living arrangements, and so on. Table 5 shows that more elderly women than men depend on the child‟s income as a primary source of income. This reflects the fact that the average monthly pension of man is almost double that of woman: That of man is JPY
207,000 and that of woman is JPY 119,000 (Asahi, 1997).
Table 3: The Actual Proportion of Old People Who Work over the Total Population of Old People and the Proportion Which Desires to Work for Selected Countries, 1994 (%)
Japan USA Germany Korea Thailand Current 43.6 23.5 6.8 33.6 37.1 Workers Age 60-64 63.9 44.3 17.1 56.5 54.9 65-69 44.8 29.4 7.5 42.6 39.3 70-74 38.3 18.7 1.1 26.9 23.4 75-79 20.6 7.7 0.9 19.9 19.2 80 + 13.7 2.2 1.3 10.1 11.6 Desire to 89.4 90.0 69.4 79.9 82.8 work Source: 1994 (Japanese [MOHW, 1997 #14]
8 Table 4: Labour Force Participation Rates of People Aged 65 and Older in 1985 for Selected Countries
Males Females Japan 37.0 15.5 Germany 5.1 2.1 UK 8.2 3.0 USA 15.2 6.8 Source: Labour Force Statistics, OECD [Hagemann, 1990 #15]
Table 5: Proportion of Elderly 65 to 69 Years of Age Whose Primary Source of Income Depends on Child’s Income (%)
Men with work Men without Women with Women without work work work 1980 14 37 37 52 1988 13 23 28 34 Source: [Miyajima, 1992 #9]
It is more difficult for elderly women to reconstruct their life after the loss caused by a crisis.
The chance to be a widow for a woman is in general much higher than for a man to be a widower. Female widowhood is a factor for old age poverty [Barusch, 1994 #16]. For housing, it has been more difficult for women to purchase a flat or to borrow the money to build a house.
For pensions, the Japanese system has had features of gender inequality. If married, what decides women‟s pensions is not their own contributions but their husband‟s.
As well as gender inequalities, the MOHW White Paper also reports that elderly households have a large income differential. The ratio of low-income elderly households is high compared to all households, substantiating the large differential between the haves and the have-nots.
Family Changes
Population ageing together with urbanisation has implications for changes in family structure, functions and arrangements and those family changes are intertwined with social security systems. Changes in family structure, in family occupations, and therefore, in income patterns
9 have caused changes in the expectations of older generations and the younger generations about the support system for old people [Hashimoto, 1996 #13]. Expectation between generations and being independence are important points. The ie (family, house) system was formally abolished by a new Law after the war. However, the practice remains. The eldest son inherits the properties and in return for this he and his family live with the old parents and look after them. However, the traditional value favouring coresidence with the eldest son has weakened considerably over time [Ogawa, 1997 #8] due to the high cost of housing and accommodation.
The traditional approach is that people try to be independent and not to be a burden on society and this stigmatises those who do not do so [Powell, 1990 #17]. Some people wish to be independent and not be burden to their children and maintain a good relationship and their own freedom [Hashimoto, 1996 #13] and hope to count on their children only when they become very frail. They also not wish their children to burn out taking care of old parents before they really need their children. When older people need daily assistance, deciding on what assistance to take is complex. Despite recent trends to promote formal care, cultural barriers seem to exist. One would feel shamed to receive formal care when one has a daughter-in-law
[Yamamoto, 1998 #18].
Co-residence is much higher in Japan compared to any other developed country. Although it is falling, still it is as high as 60 percent [MOHW, 1997 #14]. Table 6 shows types of household that include members over 65 years of age as a percentage. The proportion of one-person households has increased and three-generation households have decreased [Sonoda, 1988 #7].
10 Table 6: Types of Households that Include Members Over 65 Years of Age (%)
Years Total One-person Married Two-parent Households Other households couples households consisting households only and single- of three parent generations households 1975 100.0 8.6 13.1 9.6 54.4 14.4 1985 100.0 12.0 19.1 10.8 45.9 12.2 1995 100 17 24 13 33 12 Source: Annual Basic Survey of Health Administration, Ministry of Health and Welfare. [Sonoda, 1988 #7][Ogawa, 1997 #8]
The proportion of Japanese old people living with their children (married children) is exceptionally high compared to other industrialised countries. It is decreasing but the rate is less than 1 percent annually [Campbell, 1992 #2]. This seems to be a major safety net. But this might have been a major reason why the public social service programme and housing policy is behind. The programmes to provide an old people with public assistance have not been well-developed. The housing especially met old people‟s needs have not been well-developed.
This may not be just an excuse from the government side but the issues related to the culture value. Some old people, while given an easy access to some public assistance, refuse to receive but demand a daughter-in-law, especially the wife of the first son, to provide those daily assistance. They feel they lost their face otherwise in front of their neighbour and of their extended family members. It does not mean that the old parents-in-law are close with their daughter-in-law in heart.
As society has grown increasingly oriented toward nuclear families, the percentage of households where children and elderly people live under the same roof has been decreasing, and 40 percent of elderly people now live either alone or as a couple. It is becoming increasingly difficult to expect that families will provide support [MOHW, 1997 #14].
11 Co-residence is lower in a big city.4 Although the rate of children living together with their parents is declining, about half are choosing to live nearby, less than one hour away. The younger generation is beginning to think about the question of living together with their parents and the question of supporting their parents as separate issues [MOHW, 1997 #14].
Why do some people have children but are not living together? Some children cannot afford having their poor parents because they themselves are poor. Some poor parents are reluctant to come to their successful children. Because they had less opportunity due to their low education, they tried to provide their children with high education. The post-war education opportunity is relatively highly equal in Japan. The level of high school and college education varies. But they are according to the individual achievement rather than their family background. Now they feel they do not belong to the same class and society with their children.
This section has shown that Japan is a very aged society, facing a range of challenges in providing for its elderly population. Individual savings rates have fallen and family support is less strong than in the past. In the course of industrialisation and urbanisation, employment opportunities change. As a result, older people are increasingly dependent upon pension benefits and state support. The next section will briefly consider how the Japanese welfare system is facing this challenge.
( 3 ) Housing for Ageing Populations
Housing is not only a major determinant of standard of living and quality of life through material conditions, it is often a major asset to many people [Hughes, 1995 #25]. And the ownership of housing is often the determinant of the wealth and quality of life in old age. It is
4 73.2 for National and 56.2 for Tokyo [Miyajima, 1992 #9].
12 a recent phenomenon that special housings and community for older people have been built.
Various attempts have been made and it is expected to be more. It is a major concern at the ageing societies. Some studies from the USA and Europe are available on this topic [Drake,
1998 #23][Steinfeld, 1981 #24]. Highly visible segregated housing options, “special” housing for the elderly became a significant component of the urban landscape in the post-World War II
USA [Rowles, 1994 #19].
While the majority of older people continued to live in community settings, the proliferation of alternatives, particularly high-rise edifices in the central areas of large cities, began to convey an image of the elderly as somehow separate and in need of special services and housing arrangements. Although the actual number of older people involved were small, the high visibility of the elderly high-rises conveyed an image that normative pattern for the elderly was abandonment of their homes and movement into “supportive” settings where they could obtain types of assistance that were not available in their homes.
Reflecting the ethos of the time, many of the housing and long-term-care options for the elderly assumed a willingness to relocate.
The 1987 American Association of Retired Persons (AARP) survey revealed that 70 percent of older persons, especially women 80 years of age and older, agreed with the statement, “What
I‟d really like to do is stay in my own home and never move” (AARP, 1987)
Steinfeld analysed meanings of housing for old age [Steinfeld, 1981 #24]. He discussed housing from several aspects. First, Housing as a symbol of self in old age. Second, Housing as a symbol of social change. Most housing is built as a type of dwelling, for example apartments, town houses, single-family detached dwellings. Housing for the elderly, however, is built not only as a type of dwelling (usually apartments), but also exclusively for a particular group of people. And third, Housing as a shaper of identity.
Housing for old age is an important determinant of what type of health care to use. Old people‟ s home provides some function that is of a hospital. They often have health care workers such
13 as nurses to work there full-time. On the other hand, selection of housing would not be determined only by the convenience and security of access to medical care. Palmore wrote
[Palmore, 1999 #28]:
Because housing is more than a place to live, it can have many functions: a symbol of independence, a focal point for family gatherings; a source of pleasant memories; a link to the community; a focus of useful activities such as hobbies and crafts, gardening, and home improvement. Because of these many functions, age segregation in housing can have major consequences.
( 4 ) The 1995 Great Hanshin Earthquake
The Great Hanshin Earthquake, with a magnitude of 7.2 on the Richter scale, struck at 5:46 a.m. on 17 January 1995 in the Hanshin (Hyogo and Osaka) area around the city of Kobe. In the recent past this has been a rare even for a modern city, where the social and economic functions of an entire area are concentrated.
On 17 January 1995 the Earthquake devastated an area 20 km long and 1 km wide, which had
1.6 million inhabitants, causing enormous damage to Kobe and nearby cities both in Hyogo and Osaka Prefectures. A total of 400,000 houses were damaged beyond repair. On 23 January
1995, one week after the Earthquake, there were 317,000 evacuees and 1,150 shelters. The total death toll was 6,400 and more than half of them were those aged over 60 [Tanida, 1996 #20].
The damage was more comparable to a disaster in developing countries than richer ones.
According to the 1990 census, people aged over 60 years made up 17.8 percent of the population in the affected area [Tanida, 1996 #20]. The worst-affected were elderly people.
Many of the elderly victims were forced to remain in poor conditions in temporary shelters.
The aftermath of earthquake was in many ways predictable but still a great achievement in terms of rebuild and resettlement. Within one month of the Earthquake, temporary shelters for
14 10,000 households were built in Kobe and Osaka. By the end of August, free temporary shelters for 50,000 households were built. Some temporary shelters were special home with care for older people. In the following years, public reconstruction housing (modern high-rise apartment building) have been built and offered to the disaster-affected people at the heavily-subsidized low rent.
Priority was given to older people in allocation. This could be attributed to Japanese tradition and culture. It may also could be a result of influence from media coverage immediate after the
Earthquake reporting the high proportion of deaths and injuries among older. (Please see
Literature Review 3. Health impact of natural disaster.) Some of the new buildings are „Silver
Housing‟ with special facilities and care staff for older people.
Permanent housing involved new and, different kinds of living arrangement. Some elders chose to move to public reconstruction housing schemes. Some moved to private rented housing and some planned to build and move to a group house they built themselves.
Two weeks later it was reported that 4,500 people had lost their jobs as small businesses went into liquidation. The final bill for reconstruction and rehabilitation was estimated at 95 billion
US dollars in a country regularly affected by earthquakes. Medical facilities in the affected areas also suffered greatly: of 222 hospitals, 191 suffered more or less heavy damage; the buildings of 15 were completely destroyed. Similarly 2,479 clinics out of 4,578 were more or less destroyed. In addition, the earthquake damaged lifelines of the city; this included water pipes, electricity cables, communication lines, gas pipes, and roads. This type of damage further hindered rescue activities to a significant extent, thus worsening the disaster.
15 Post-Earthquake Housing Schemes
This paper looks at temporary shelter housing scheme (TSH) and public reconstruction housing scheme (PRH) as post-Earthquake communities. At the Earthquake on 17 January
1995, a total of 400,000 houses were damaged. Nearly 50,000 TSH houses were constructed by the end of August. They were relocated to 50,000 PRH over the following five years after the Earthquake. Most of TSH are tenement type housing. Most PHR are high rise modern apartment buildings. More than half of the residents at post-earthquake public reconstruction housing schemes is old women living alone. Kobe is said to be a miniature model of the future
Japan where the increasing group of older people has no family or non-functioning family in the traditional sense.
3. Research Methodology
( 1 ) Methods
I used a mix of quantitative and qualitative approaches. Although the main part of the study is qualitative research, I also used quantitative approaches. For quantitative, I use data from the main surveys of the disaster affected area. The main part of this study, however, is based on case studies using multiple-methods: ethnography, participant observation, formal and informal interviews, and the analysis of documents and records. As Media is a major actor in the policy-making process, Media analysis is also employed. The following actors were identified: volunteers, different kinds of NGOs, welfare commissioner, public health nurse, public administration, media, and residents.
( 2 ) Data collection a. Media Transcripts
As to media, in addition to the published reports and books by Media, I have prepared
16 transcripts of daily media coverage on this subject and will analyse the transcripts.
Major parts of my media data were collected at the fourth and fifth anniversaries of the
Earthquake of 17 January 1999 and 2000, respectively. I have videotaped TV coverage and prepared transcriptions of them when TV covered the Earthquake affected area for about ten days each year. First I was making transcriptions of all the data but gradually I shifted to focus on the coverage with attention to older people, housing, and health, or anything looked relevant to my research topic. I checked programmes of all TV stations on air in Kansai (Kobe and
Osaka) area, national station of NHK (Japan‟s BBC) and other private owned stations. Both
Japan-wide stations such as Asahi, Mainichi, Yomiuri, Kansai-TV, and local stations such as
Sun-TV, TV-Osaka.
I have collected a newspaper article of the time and translated into English. Mainly I collected from Asahi Shinbun (Newspaper) and Kobe Shinbun. Asahi Shinbun is a most widely read newspaper issued in all Japan. I checked the Osaka edition of Newspaper so that I was able to collect articles which appeared in the front pages which are same in all districts in Japan and articles in the back pages which deals news specific to the locality. This edition covers the
Earthquake affected area of Osaka and Kobe. The other newspaper, Kobe Shinbun, is a local newspaper. As the name says, it is a major newspaper of the locality, therefore, direct and close contacts to follow the things happening in the area.
The media data are complemented by interviews with a TV reporter and a newspaper journalist.
17 b. Hyogo Prefecture Post-Earthquake Households Health Survey
The Hyogo Prefecture conducted special health survey for the households affected by the 1995
Great Hanshin Earthquake every October for three years from 1996 to 1998. This survey were carried out by three different types of housings: Temporary shelter housings (TSH), Public
Reconstruction Housing (PRH), and General housings. In the following year of the Earthquake, which is the first year of the survey, the survey was carried out only in TSH and General housings because PRH have not yet been built. In the second year, the survey were conducted in all three types of housings. In the third year, which is the final year of the survey, they carried out only in TSH and PRH.
Table 7: The Number of Households Covered in the Survey
1996 Oct. 1997 Oct. 1998 Oct. TSH Distributed 9,315 6,451 1,769 Valid 5,315 3,644 817 PRH Distributed 4,465 10,982 Valid 3,165 6,248 General Distributed 2,714 3,772 Valid 902 1,029
Table 7 shows the sample size of the survey. The questionnaire was distributed to 20 percent of the total PRH households. And the response rate among them, was 60 percent.
c. Location of Fieldwork
Out of 76 public reconstruction housing building groups in Kobe City and more outside Kobe,
I selected three community locations by theoretical sampling (Table 1). I considered the location and the conditions if any facilities and special staff works. I considered the different types of housing schemes such as individual apartments, a group house, and silver housing, and if it was established by public or private.
18 The following approach was employed in the observation at a temporary shelter community. I have visited several different temporary shelter communities, but I have done participant observation at one temporary shelter community in suburban west Kobe. There are 250 households units. I worked as a waitress at a weekly tea shop at the community centre from
November 1998 to May 1999. I accompanied a public health nurse‟s home visit in the community in the duration from March 1998 to May 1999.
I have done major field work at two public reconstruction housing communities although I visited several others. One of the major field was a huge community which can be divided into two major groups: 11 high rise buildings of 700 household units in total with a higher proportion of older people living alone; and 3 high rise building of 500 household units for family apartments. This community is located at within the same municipal district as the temporary shelter community I have done my field work. Dept. of Health produced a few reports on these communities, which was not written on other communities.
The other major research field for public reconstruction housing community is located in central Kobe. This community is smaller than the first one, although the resident view was that they had moved to a big building. It consists of two high rise buildings of 550 household units and 220 household units of silver housings. It has one of the two silver housings Kobe city
Central Ward built as a post-Earthquake public reconstruction housing scheme.
19 Table 8: Three Research Sites of the Fieldwork
TSH PRH 1 PRH 2 Location Suburban Suburban Urban Kobe City West-ward West-ward Central-ward Building type Tenement type High rise High rise Number of 250 700 (11 buildings) + 550 (2 buildings) in household units 500 (3 buildings) total Silver housing 200 (lower levels of one of the buildings) Leader Volunteer nurse A woman who is a A male chief of the welfare commissioner self-governing body and chief of the self-governing body and of volunteer group of neighbouring community Methods Participant Shadow a community Observation at observation leader events
( 3 ) Data Analysis
I use computer qualitative analysis programme, QSR Nudist Vivo (NVivo), for content analysis of all interviews, field notes, observation data and relevant documents to show aims and objectives of reconstruction, definition of outcomes and measures of success and failure, and values to include attitudes to family and individual welfare and Japanese values.
4. Findings
( 1 ) Post-Earthquake Housing Schemes a. Temporary Shelter Housing Scheme (TSH)
A large number of residents in the area experienced the destruction of their homes and workplace. Within one month of the Earthquake, temporary shelters for 10,074 households were built in Kobe and Osaka. But many of them were located in remote or isolated areas. This is a barrier to finding a job, commuting to a job, and access health care services.
As time goes by, the proportion of the temporary shelter residents has increased. As of January
20 1998, exactly three years after the Earthquake, about 25,000 people were still living in temporary shelters [Asahi, 1998 #3]. Three years after the Earthquake, younger people had moved out. Half the residents of all temporary shelter were old people living alone. The proportion aged over 65 in temporary shelters in Hyogo prefecture was 30.3 percent in
February 1996, one year after the Earthquake. By 1998 the average age of temporary shelter communities was over 65 years old. More women were left in temporary shelters than men.
These demographic features of the post-quake population in the shelter were reported as similar to the demographic projection for the whole Japan in 40 to 50 years‟ time [Asahi, 1998
#22] 98 Apr.2).
The main features of people in shelters were not covered by pension or with little pension, elderly people living alone, no house, and alcoholic dependency among those who are late in moving out. Many have more than one of these features.
Although above common features are observed, the elderly people living alone in the shelters have different backgrounds. Some have never married. Some lost their spouse at the earthquake. Some got divorced after the earthquake or after the hard times following the earthquake. Some were widowed before the earthquake. Some have no children and others cannot afford to have parents in their homes due to the limited space and/or the possible tension or conflicts. Some children visit their old parents living in the temporally shelter regularly to come and help. Some never come.
The typical temporary shelter housing scheme was a tenement type housing of only one floor.
One building has 5-10 households with one or two rooms each. The residents see and hear their neighbours outside through windows. They drop by to share some cooked food, “I cooked too
21 much. Please help me to finish this.” “I tried to cook something new. Please try.” This is a way of making friends. Eating habits is also important for maintaining their healthy nutrition intake as it is important to maintain more balanced diet especially when living and eating alone.
TSH has negative and positive health impacts. TSH was intended to be used only for one year, but many of the residents lived for three to five years. The dwelling did not last long in the good condition but started to cause health problems. Most of TSH was built in remote area.
This was first reported as inconvenient. But later the residents started to report the improvement in their health because they lived in a clean mountain air and they had to walk for a long time to get a public transportation. This was a good exercise for them to stimulate their circulation system. As a post-Earthquake community, volunteers came in to help the residents.
With the tenement type housing, it was easier for volunteers to visit each household.
b. Public Reconstruction Housing Schemes (PRH)
Typical post-Earthquake Public Reconstruction Housing scheme (PRH) is a group of modern high-rise apartment building. It has a computerised emergency call system. They have no common space or facility in the same building. There is one assembly hall but it is not big enough to cover all the residents and is located outside the buildings to be shared by the residents of all the buildings.
Ageing populations was taken into consideration in the design of these new PRH. Housing built specially for old people is a relatively new phenomenon. They also built “silver housing”
PRHs. The program supplies an elderly resident with daily support by the provision of a specially designed dwelling and care by a “life support adviser (LSA)”. Its entrance door is a
Japanese sliding door. One LSA is in charge of as many as 60-100 old people. Silver Housing
22 programme was launched due to a joing policy effort by the Ministry of Construction (MOC) and the Ministry of Health and Welfare (MOHW) in early 1980s. Silver housing scheme is planned by the Housing Department and the Welfare Department of the local government. The concept is derived from sheltered housing in the UK.
Public administration has been trying to introduce a new system and expand the staff such as
Life Support Advisor (LSA) and Life Reconstruction Advisor making a special fund available to subsidise. Among the staff, LSA are most visible because of the staff number and the frequent media coverage and because they have an office to station at PRH. Local government entrusts LSA from Social Welfare Corporation (Shakai Fukushi Houjin). They are stationed at an office at a public reconstruction housing building or its assembly hall. They make a regular home visit and gives daily advice to old people aged over 65 living alone and those residents at
Silver housing. The LSA office has emergency system. A resident of the apartment for old people can make emergency call from their room. If a resident does not use water for more than
12 hours, it alarms. LSA can go and check. It is also linked to ambulance system.
Silver housing is a rental housing scheme for an old person or an old couple. They are linked with a special old people‟s home (Tokuyou: Tokubetsu Yougo Roujin Home). LSA works for them. It is built barrier-free. The entrance door is a sliding door, not a Western style push and pull door usual for modern apartment. It has no step. It has hand bars at the wall for safety. To apply for the silver housing, one needs to meet the requirement.
( 2 ) Media
The tone and focus of TV coverage reporting PRH was negative in 1999 but it shifted to more neutral and encourage people to think positive in the 2000 coverage.
23 Table 9: The Number of TV Programmes by Image (Positive or Negative) to Each Type of Housing (Temporary House: TH or Public Reconstruction Housing: PRH) for Year 1999 and 2000
Positive Negative 1999 2000 1999 2000 TSH 2 1 3 3 PRH 3 3 12 5 Total 5 4 15 8
Table 10: The length of TV Coverage of Positive or Negative Image about Different Types of Housing Schemes by TV Station and by Programme Types (News, Special Feature, Documentary) by Year (in January of 1999 and 2000) (Minutes)
January 1999 January 2000 TSH(+) TSH(-) PRH(+) PRH(-) TSH(+) TSH(-) PRH(+) PRH(-) NHK SF (30) SF (35) Ch.2 NHK SF (45) Edu SF (45) Ch.12 2 cases NHK SF (90) BS Satellite MBS SF (10) N (10) N (10) Mainichi 2 cases SF (30) Ch.4 ABC N (20) Asahi D (10) Ch.6 Kansai N (10) Ch.8 Yomiuri N (10) N (10) N (10) Ch.10 Collecti N (10) ve House D (30) D (30) D (30) D (30) TV D (20) Osaka Ch.19 Sun-TV N (30) N (30) N (30) Ch. 36 TSH: Temporary Shelter Housing Scheme PRH” Public Reconstruction Housing Scheme N: News SF: Special Feature D: Documentary (+) Positive (-) Negative
24 ( 3 ) Health Survey – Hyogo Prefecture Health Survey of the households affected by the Earthquake by Year 1996, 1997, 1998
Although the basic information such as demographic and social indicators were collected throughout the surveys, the questions more specific to some health issues changed over time.
The second and third year questions were modified based on the answers for the first year open-ended questions and results of other questions and overall feedback from public health nurses working in the field. Main issues identified were mental health, alcohol dependency problem, nutrition and diet, home visit programme, and other health-seeking behaviours.
These issues reflect that nutrition and daily diet is high concern for Japanese as basics to maintain one‟s health. This also reflects that they are concerned with the eating habit of those old people living alone which might affect negatively and therefore on their health status.
New questions on support and care by public administration were added to the final year questionnaires. This reflects that the public administration identifies the importance in health and welfare policy and programmes from the experience of the post-Earthquake reconstruction process and that they are concerned how to maintain the social network to form healthy community living in the new housings communities, especially at the large community of high-rise PRH apartment buildings with highly aged society.
25 Table 11: Surveyed Items in the Health Survey by Each Year
Surveyed Items FY1996 FY1997 FY1998 Demographic and social indicators: 1. Sex; 2. Age; 3. Y Y Y Address before the earthquake; 4. If has a job or not; 5. The number of family member; 6. Family compositions Earthquake impact: 1. If any deaths in kinship; 2. Home Y Y Y damage Health status: 1. Health awareness. 2. Health status Y Y Y before the earthquake and that of the past one month, 3. If any disease and its treatment situations. 4. Mental Health status (PTSS-10, GHQ30) Y Y Mental Health status (IES-R, Degree of depression) Y
Any issues in the post-Earthquake life (open-ended Y space)
The way to cope with the stress Y Y What has supported in their post-Earthquake life Y Home visit service support by public administration and Y volunteers Social support Y
Alcohol – related issue Y Y Nutrition status, Diet. Eating habit Y Y Health and Welfare needs Y Health care seeking behaviour and situation Y Habit (exercise, smoking) Y
( 4 ) Fieldwork
The determinants of the community care development dynamics include the leadership, actors, communication, collaboration, resources, size of the community, network, and housing. In this section, the discussion is made on what type of housing would enhance or discourage the community development.
Size of the community matters. It would not work well if the community is too big or too small.
If it is too big, it is difficult to reach an agreement. It is difficult to pay attention to or to reach out those who are not active or come out to community activities. If it is too small, it would be difficult to expect the dynamism big and vital enough to keep the momentum of the community
26 development going and to maintain the interesting and helpful activities that would lead to an important and reliable community network.
When the size of community is too big, it is difficult to form and manage a self-governing body.
When the self-governing body is not formed, they community will not have an official representative and difficult to collaborate with public administration and other representatives.
This is a critically negative factor in seeking a healthy community living arrangement.
Actors were identified as follows: Minsei Iin (community welfare commissioner), Jichikai
(self-governing body), Gyosei (public administration, local govt. Dept. of Health and welfare),
Jumin (residents), Volunteers, women‟s groups, NPOs, and Media (TV). In this working paper, discussions focus on volunteers, Gyousei and LSA.
The volunteers have taken a major role in the dynamism of community development at TSH communities. The housing type has significant impact of the access of volunteers. The human contacts are what most frequently reported as something missing at the life at PRH. The human contact by volunteers brought the sense that someone cares to the residents of TSH. Volunteers did not work at PRH in the same way they did in TSH for various reasons. First, the life in PRH was supposed to be no more at the stage of emergency relief after the Earthquake but back to the normal life. Therefore, the earthquake volunteers at TSH are considered no longer required at RPH. It was not only the will and policy of volunteers but the subsidies was finishing from the government for their activities from the special funding for the post-Earthquake reconstruction after three to then five years. After three years, the extension was made year by year. Secondly, it was easier for a volunteer or a neighbour to make a visit at the tenement type housing of TSH but it is not easy at the high-rise modern apartment building with heavy iron
27 door. As explained earlier, TSH is a one-story tenement type housing whereas PRH is a modern high-rise apartment building. Once the door is closed, one is shut out from the outside world.
One does not hear or feel the neighbour. Through the windows, one can see only sky at PRH whereas one used to see people passing by at TSH.
For Gyousei (public administration), there are not many choices but building high-rise apartment buildings as PRH when they need to provide this large number of housing in the short time of period. Their measure of success was the number of housing they were able to provide at the early stage of the reconstruction process after the Earthquake. The impact of the housing type on the quality of life started to receive attention from Gyousei in the later stage of the reconstruction process. This change was lead by the voices from the staff working at local level such as public health nurse and others such as the self-governing body and Minsei Iin
(community welfare commissioner). It can be said that this change was made mostly by bottom-approaches. It can also be said that Gyousei is sensitive to listen to the demand from communities.
Kose introduces the Kobe case as one of the first cases which built local government initiatives.
[Brink, 1998 #29]
Life care communities are now being constructed by several local governments. Kobe City built one of the first of these. The project contained a special nursing home and a day-care centre in the lower floors, with 31 dwelling units for independent elderly persons on the upper floors. A unit is provided for the caretaker or “life support adviser (LSA).” The floor area of the unit for a single elderly person is 35 m, with two rooms and a kitchen. The unit for a couple is 48 m, with two rooms and a dining-kitchen. The LSA checks the safety and health of the elderly resident periodically and helps in case of need. The LSA also acts as a consultant of daily living to improve the quality of life. The day-care centre provides services such as meal preparation, bathing, rehabilitation and re recreation. The nursing home can also accommodate short stay in case of need.
28 Hitorigurashi or dokkyo (living alone, solo living) is a key factor in determining and evaluating housing impacts. It is especially so when looking at the housing for old people. This research found out that it is more so in the Japanese context.
In the special reports on a TSH and PRH communities in Kobe city West ward prepared by the
Dept. of Health and Welfare of the West-ward of Kobe City, there was no distinction or attention were made on gender but on age and if living alone. Age of 65 was the line to categorise “old”. “Age over 65 and living alone” was a category described as a most vulnerable population as “The handicapped” and these population, therefore, require attentions for public support system.
Then there were some reports on the attempt of “Collective House”. There were a few arguments to encourage “Collective House”. First, they do not need young people to take care of them but the residents can take care of each other as the function left to each person is different and they can complement and help each other. This way each person will feel that they are useful to others, not only “burden”, and this becomes their Ikigai (life enrichment, value of life). Also, they do have to feel rushed to catch up with the life pace of younger people.
Second, at the collective house, the smaller number of health care workers and helpers can cover the larger number of older people than what could be when individuals are living in each home. This way, the cost of the care of ageing populations is expected to be smaller.
Although volunteers disappeared from PRH, other type of actors showed up there such as LSA.
But LSA is not necessarily working well as volunteers did, although LSA is given more official status. Various reasons for this not working well could be pointed out. First, the number of LSA is much smaller than the number of volunteers. What a LSA can reach out and cover is limited.
29 Second, some LSA are too young and inexperienced to develop trust relationship with older people. Third, when it becomes official, although it has some merits such as they have an office at PRH and the security of salary payment, there are some demerits as well. For example, there are regulations that a LSA should not do. It could be a barrier to develop human relationships more than an official level when residents want more than that. Some staff said that how to decide the distance of the relationship is something to learn. When they want to support the residents, they know they are not the residents there and they may not work there when the contracts end. It will be more difficult for the residents when the staff leaves there if the residents develop some emotional attachment to them. The regulation prohibits them to receive any gift, even a cup of tea or sweat from the residents. It is because it would encourage the residents to compete for what to serve. But when one old man gave a small gift to a staff, saying that his only daughter died at the earthquake and he has no family and he has no one to buy a souvenir for after his trip to hot spring, she could not refuse the gift.
“Loneliness” was often emphasised by media for the reason why the life at PRH is worse than the life at TSH. Brink discusses housing old people in terms of social considerations such as loneliness, isolation, and social network. The social relationships enjoyed by the individual may be affected by housing, its amenities and location. [Kose, 1998 #30] It needs to be analysed what the meanings of “loneliness” are in this context and in Japanese contexts.
Media‟s tone in January 1998 was PRH was the source of the loneliness. Their tone was to blame Gyousei for planning and providing such inhumane housing scheme. However, from the fieldwork, I learnt that the residents see it as a feeling of anxiety to uncertainty that occur at in transition time when one is leaving one place and starting a new life at another place. They admit the loneliness but they accept it as a natural process and it does not mean that they are not looking for a new life at the new house. The tone of media has shifted towards being more
30 positive in the following year of January 1999.
Some people see „old age‟ is a factor for „loneliness‟. Mr. K was happier in TSH. After moving to PRH, he feels lonely. He has no one to exchange word at PRH. He has no one to share food or eat together. It is difficult to make friends with their neighbours at PRH. Mr. K says that when one is old it is difficult to make a new friend. He sees Old Age as a factor for the difficulties of making new friends and the loneliness.
Life style difference between old age and young people is a factor in determining what kind of housing suites better. Younger people who go out to work during the day, they may feel more comfortable to live in a high-rise apartment building in an urban city. The things, however, would be different for older people who spend most of the time at home. Community life becomes more important to their life.
What is community. Some community could be made of the people who live in the same town geographically. Some could be made of the people who live far away. If one lives in the same apartment building, does it mean that they belong to the same community? It is made of the people who share the same interest and activities no matter where and how far they live from each other. Who are the people working for the community? Women or men? At what level?
This will be discussed later in this section.
Oxford Advanced Learner‟s Dictionary 2000 defined community as:
1. All the people who live in a particular area, county, etc. when talked about as a group. The local community. Health workers based in the community (= working with people in a local area). The international community (= the countries of the world as a group). 2. A group of people who share the same religion, race, job, etc. 3. The feeling in the place where you live.
31 In Kobe, after the Earthquake, people have discussed what is „community‟ (as it is in English word). There was an NGO even named “Community Support Network”. Several symposiums on Community Development have been hold in Kobe. From those above, Kobe people may use definition 3 for convenience. But they would not be satisfied only with that. They seek more than that for the community they wish to aim to develop.
5. Discussion
( 1 ) Healthy communities have strong social networks, providing opportunities for residents to pursue a social life. In the Kobe case, it would replace the losses due to the
Earthquake, such as the death of their families, friends, houses and local communities before the Earthquake. A key to a healthy community depends on how strangers could form the community to support each other quickly. Kobe case shows community support network in non-Western context where Christian is not the prevalent group.
( 2 ) Housing type is an important factor for the social network development. The community settings with particular housing environment could change the daily habits and activities of elder people. Despite the modern nice housing, the residents in PRH have reported the problem of isolation and loneliness. a. High-rise apartment building is not good to form a healthy community for old men and women. It makes not easy to have human contacts with their neighbours. It is not easy to make friends. Especially when people are living alone, it matters. There have been living alone people before the Earthquake, but they lived in a community. Like tenement houses in downtown, it was possible to live alone. b. The Kobe case, it was more difficult because all sudden massive strangers moved in.
When several high-rise apartment buildings form a community, the number of households is
32 large. Size of the housing community matters in the community development dynamics. The mammoth housing was seen as a difficult factor for community development by community leaders at my ethnographic fieldwork and by academics and media. c. Regardless of housing schemes, the difficulty in making friends with their neighbours at old age is partly because the nature of urban life style and results of urbanisation.
( 3 ) The coordination between the Gyousei (public administration) and local communities is the key to develop the successful community care system. In Japan, Minsei Iin (welfare commissioner, official volunteer) is a key person who has already established trust and respect in a community. Another important actor is Jichikai (self-governing body). It becomes an official representative to collaborate with local government and this enhances health and welfare work. Gyousei wants to go into a community to do their work but it is not always easy without Jichikai. It has been difficult to form a Jichikai at PRH, especially in such new mammoth community with high-rise buildings developed in a short period of time.
Housing has an impact on the question concerning who is responsible for the care of old men and women. The role of the government in supporting an ageing population is controversial.
Local, municipal, and Central Governments have a major role to play in assuring healthy life for the citizens. Kobe City, in the process of reconstruction from the Earthquake, became the first to show the outstanding local government initiatives to construct life care communities in cooperation with local communities.
33 ( 4 ) Why volunteers means a lot. Human contact is the key.
The most important thing that the volunteers bring the elderly is not the hot meal, but the human contact and the sense that someone cares. Volunteers can do this more convincingly than bureaucrats, public officials and civil servants [Vaughan, 1998 #26]. Housing and town planning must take into considerations what would make the activity easier and accessible and what would enhance the quality of human contacts in the daily living arrangement especially for urban ageing society.
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