Co-operative Response to the Ageing Society in Japan (1997)

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This document has been made available in electronic format
by the International Co-operative Alliance (ICA)
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April, 1997
(Source: ICA Review, Vol.90 No.1, 1997, pp.18-24)


The Co-operative Response to the Ageing Society in Japan
by Akira Kurimoto*
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The Co-operative Solution
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The ageing society is one of the typical phenomena associated with  longer 
ife expectancy and lower birth rates. The increased costs for maintaining a
social security system for the elderly have become serious problems facing a
lot of industrialized countries: a smaller number of the working population
has to shoulder the burden of caring for an increasing ageing population.
There exists a widening gap between what the elderly expect and what the
society can offer. In this regard, the mobilisation of  financial and human
resources to cope with the rapidly ageing society is one of the most crucial
domestic problems to be solved. 

Methods of coping with an ageing society are investigated in many parts of
the world. They vary largely from one country to another based on the
different historical and socio-economic backgrounds. The key issues are:
who provides social services, who receives such services, and how are the
costs borne. There are three types of players in the provision of services; the
public sector, the private sector and the third sector, which includes co
operatives and non-profit organisations. The question of where co-ops
stand between the State and the Market needs to be addressed. 

The welfare state model has been established in the northern and western
parts of Europe and has been admired for decades as the ideal solution. It is
characterized by the strong and overall involvement of states in the
provision of services, by high level of services accompanied by higher
taxation and by universal services covering the entire population. But  it is
becoming  increasingly less attractive owing to high costs and inevitable
high taxation, the lack of choice and the inevitable bureaucracy. 

On the other hand, the market solution has been  mainstream in the United
States, where there is neither public health insurance nor pension schemes
covering all the nation, while  the commercialized provision of social
services, privately-run insurance and nursing homes has been highly
developed. It has been effective in promoting self help and voluntary work,
but has proven to be a failure in many cases especially when catering to the
poorer social strata. The freedom of choice may benefit those who can
afford to pay for quality but expensive services often exclude many groups.
The State's involvement has been limited to a minimum.

So, it can be suggested there should be a co-operative solution in addition to
public assistance  and mere self help. The co-operative is based on mutual
help of persons united voluntarily to meet their common economic, social
and cultural needs and aspirations (ICA Statement on Co-operative
Identity).  It occupies the middle ground between the public and private
sectors, aiming to adopt  the most desirable features from both (Laidlaw,
1980).  In the context of social services it could be used by the ordinary
people but without entailing loss of freedom of choice. But it can go further
- the co-operative solution may have the following potentials which differ
from others.

Firstly, it is based on the owner-worker or owner-user identity. The
members can be the workers/employees who provide the  social services
(workers co-ops) or beneficiaries/clients who use the services (consumer
co-ops) or both (hybrid co-op). This feature may give the co-ops an
advantage over investor-owned companies in providing services.

Secondly, it is a democratic, participatory organization owned and
controlled by its members. It can offer more responsive and better services
if it  properly involves the members in decision making and day-to-day
operations. 

Thirdly, it is based on the community in which it operates. It could cater to
the specific needs of the people in collaboration with the community
organizations and help enhance the overall welfare standard of the
community.

Out of these characteristics, it could enrich work life by promoting self
management, improve work environments by providing staff with greater
control and enduring interactions with clients, empower citizens as co-
producers, promote greater staff engagement, higher service quality often at
a lower cost, and finally develop civil democracy (Pestoff, 1996).

The co-operative solution should be intensively and extensively studied as
an effective supplement or a viable alternative to the public and private
sectors in coping with the problems associated with the ageing society.
There exists a number of good examples of co-operative contribution to
these problems both in urban and rural areas, in the welfare states and in the
laisser-faire societies. The co-operative service houses in Sweden and the
social co-operatives in Italy are well known examples, but hereafter I'd like
to present some cases being practised in Japan.

Medical Co-ops
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The medical co-ops are organized as consumer co-ops based on the four
principles; membership mainly consisting of healthy consumers, emphasis
on activities to maintain health, running of medical institutions guaranteeing
patients' participation, members' participation through Han groups. 

They emphasize the members' involvement in their own health maintenance
and co-operative administration in collaboration with the medical care
experts (doctors, nurses and other technicians). In the medical care
characterized by asymmetric information or disproportionate knowledge
between specialists and laymen, the member's voice has an important role to
play. Therefore, even in the choice of highly professional treatment
methods, they promote patients' self-determination based on the information
and consultation given by doctors so as  to raise the patients' understanding
and satisfaction, which may lead to better collaboration between them  and
the medical team in combating diseases. To promote such practices based on
"informed  consent" they have adopted and implemented "Charter on
Patients' Rights" since 1991.

They have been serving the health/social care needs of the aged population
which constitutes the main core of the membership. Preventive medicine has
been emphasized to avoid illnesses characteristic of the aged such as
hypertension, diabetes and cancer, so as to enable them to lead healthy
lives. To this end, consumer education and information is of crucial
importance. Members periodically undergo physical examinations  but also
carry out checks on  blood pressure and urine at home or in Han meetings,
using simple devices, initially with the assistance of specialists. They also
monitor both eating habits and  living environment,  both of which have a
strong impact on health. Courses and lectures on health promotion, social
security, co-operative administration and voluntary activities are organized
to train leading members. Thus co-ops are empowering consumers/patients
to look after their own health.

On the professional side, the medical co-ops provide medical services
including rehabilitation at co-operative hospitals and clinics. At the same
time, they extend their services to cater to the social care needs since the
integration between medicine and social care becomes more important in
dealing with the elderly. The visiting nurses  play an important function by
providing services to the patients in their own homes. Thirty-two co-ops
run visiting nurse centers and another thirty-six plan to open centers in the
near future. Baths on wheels is another service catering for  bedridden
patients.  In addition, five elderly home-care support centers and an elderly
health/social care house are run by medical co-ops and another 18 facilities
are currently being planned.

Home Help and Goods
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Consumer co-ops have promoted a variety of member activities ranging
from a consumer movement for food safety to peace campaigns. In the
1990s the members interests have concentrated on environmental
conservation and the social welfare of the elderly. Women in their thirties
and forties constitute the bulk of membership, and it is natural for them to
have the greater concern about social services since they are facing the
problems of how to take care of their ageing parents.  So, a great number of
consumer co-ops have made a positive response to the members' needs and
aspirations by starting to commit themselves to social services both in
members' activities and in business operations.

The members' activities for elderly care are making steady progress these
years. The most popular one is  the home help services conducted among
members based on the idea of mutual help. Both the helpers and the helped
are registered at co-ops; the former does  the household chores including
cooking, shopping, washing and cleaning, or just chatting, while the latter,
mainly the elderly and handicapped, pays a small amount as compensation.
In some cases the time deposit system is adopted instead of monetary
remuneration. It is hoped that the participating members can learn from each
other across the generations and enrich their quality of life through personal
communication. The home help groups were formed in Co-op Kobe in
1983 and now spread to forty co-ops. The registered members reached
25,000 and the aggregated servicing time exceeded 1.2 million hours (See
Chart 4). To encourage these groups, training sessions for coordinators or
more professional helpers have been organized; the nationwide network of
the groups was established in June last year by JCCU (Japanese Consumers' 
Co-operative Union). Of course, these activities are carried out
because of the good will of the members and co-ops support such voluntary
efforts. But this is an area in which the government expects the  co
operatives to make a great contribution as the supplier of human resources.

In addition, luncheon parties or meal deliveries (meals on wheels) are
organized in 30 co-ops to help the aged, mostly those living alone at home.
In both cases volunteers cook hot meals and maintain  communication with
the isolated elderly. Members are also taking active part in study groups,
exchange meetings and training courses to raise their knowledge and skills.
Out of these activities, specialized welfare service co-ops or workers
collectives have been spun off. 

The great earthquake in Kobe in January 1995 caused serious damage to
human lives, houses and buildings and the infrastructure of the city, but at
the same time awakened a huge wave of volunteerism. Thousands of people
rushed to the devastated areas to help the survivors, especially the aged,
living in temporary shelters. To encourage such volunteerism on a durable
basis, Co-op Kobe set up eight volunteer centers in February 1995 where
about 4,000 members are registered, and last year it established special
funds to support volunteer activities.

Consumer co-ops have also launched business operations to cater to the
ageing population, constituting an ever growing market in years to come.
Store facilities are being improved so as to enable aged and handicapped
people with wheelchairs to have easy access. Some co-ops started home
delivery services of daily necessities and/or meals for those who have
difficulties in shopping. The size of food packages are redesigned for
households consuming small amounts and the contents are also reviewed to
meet the specific requirements of the aged consumers. Members give
feedback on these initiatives.

Clearing houses for information on welfare facilities/ services have been set
up by eight co-ops to help members' access to the public and co-op
resources. They aim to grasp the specific needs of members who require
services, provide the welfare information to members, monitor the services
provided, encourage members' participation and collect the data. Co-op
Hiroshima and Nagoya Co-op are undertaking "the model project for in
house welfare services information network" sponsored by the
Social/Medical Care Foundation.

In 1994, in collaboration with 2 primary co-ops, JCCU started an
experimental catalogue selling instruments and supplies for the aged
consumers. This business has expanded nationwide to thirty co-ops with
estimated sales of \100 million in 1996. It is intended to be a bridge between
manufacturers who do not grasp the market and consumers who do not
have information on these products, as consumer co-ops have the potential
to identify the members in need and to send catalogues, reflecting  users
voices in product development and linking with mutual help activities of
members.
  
Although it will take some time for this business to become profitable, co-
ops have started it with long-term perspectives. Some co-ops run
specialized stores for such products and in November 1996 Co-op Kobe
opened Heart Land, an in-store shop with sales space of 1,650 $B-V(B, the
largest of its kind. In addition, nursing homes with day care facilities were
established by Seikatsu Club Co-op in 1994 and by Co-op Kobe in 1995.

Elder Citizens' Co-op
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In Japan the workers co-operatives are quite young and therefore small in
both membership and business volume. There are two origins: one has
emerged from unemployed workers' unions and the other has spun off from
consumer co-ops. The former has been promoting the employment of the
unemployed, mainly aged workers, since 1979 and formed Jigyodan
(Japanese Workers' Co-operative Union) in 1993. The latter was organized
by consumer co-op members in the field of care to the elderly , providing a
cafeteria and other specialist services.

The latest development is the formation of elder citizens' co-ops as hybrid,
multi-purpose co-ops organized under the initiatives of Jigyodan. They are
composed of the elderly who wish to live worthwhile lives as workers and
beneficiaries.  

Family members and supporters can become associate members. There are
ten co-ops already operating and others are being set up shortly. They aim
to help the elderly to lead independent lives as much as possible. 

To this end they plan to create job opportunities in such fields as road
cleaning, gardening, house repairing, recycling etc. and to carry out joint
purchases of daily necessities. They also promote activities to encourage
mutual support through culture, sports, recreation, learning and
communication. They seek to work closely with existing consumer and
worker co-ops. It is too early to evaluate the current status and predict the
future, but they seem to be making steady progress as mutual help
organizations of the elderly themselves.

Conclusion
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The ageing society with fewer children will inevitably weaken the traditional
capacity of family care for the elderly and necessitate the creation of a social
system in which senior citizens can lead their lives without anxiety,
supported by social services they can afford. At the same time it is
necessary to create social systems and cultures which facilitate self
fulfillment  by the creation of job opportunities, involvement in the
community lives, promotion of collaboration among generations and gender
integration. In this regard the ageing society in the 21st century will
intensify people's interests in co-operation and will require a greater spirit of
co-operation.

Co-operatives can and should make pioneering works to support elderly
people's lives and their self-fulfillment, thus creating new values in the
ageing society. They are requested to give priority to them as one of the key
policies, developing members activities and business operations, new
products and services to meet the ever increasing needs, thus contributing to
the creation of a real welfare society.

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*	Mr. Kurimoto is the Manager of the International Department of
JCCU and the Executive Director of the Japanese Society for Co-operative
Studies.