NEAT Working Group on
ASEAN Plus Three Collaboration on Active Ageing: The Time to Act

Final ReportBangkok
13 July 2017

1. Introduction
On 8 September 2016, the Heads of State and Government of the Member Statesof the Association of Southeast Asian Nations (ASEAN), the People’s Republicof China, Japan, the Republic of Korea, had gathered at the 19th ASEAN Plus
Three Summit in Vientiane, Lao PDR, and declared the intention to promote
greater inclusion for active ageing in national policy making and action plans inresponse to the growing trend of ageing population in the region. It was acommitment by all states to join the global and regional movements related toactive ageing; and a follow-up to the agreement proposed in 2015 in the Kuala
Lumpur Declaration on Ageing: Empowering Older Persons in ASEAN which
was considered to be a reaffirmation of the identification of ageing as animportant post-2015 issue raised during the 6th ASEAN Plus Three Health
Ministers Meeting in Hanoi, Viet Nam in September 2014. Up to the presenttime, various strategies and directions have been formulated, and many
initiatives have been proposed by various sectors of the society in each Member
State. However, limited progress has been observed on a regional basis. Thus, it
is essential that the ASEAN Plus Three countries together with key international
partners take measures to strengthen the collaboration in order to ensuresufficient and timely response to the active ageing phenomenon in the region.
Population ageing refers to the phenomenon of increasing proportions of older
persons (aged 60 and above) in the total population. Since the middle of 20 thcentury, many countries in the world have been facing various consequences of
population ageing; and it has been increasingly clear that eventually, more andmore countries will be experiencing a similar phenomenon. It has been
estimated that by 2050, Asia would have at least one quarter of its population
aged 60 and above; and the region would have a greater number of older persons
than children under the age of 15 before the middle of the century, and nearly
60% of the world’s older people would be living in Asia.

1Experiences in some developed countries have demonstrated that population
ageing has resulted in various impact on the society as a whole. Suchexperiences have raised concerns about the social, economic and healthconsequences of population ageing which required enormous efforts andresources to address the problems. The most important priorities are (1) topromote the well-being of older persons to be healthy, active and productive,and (2) to provide essential services for the elderly who need social, economicand health support. Proper response will be difficult if the national infrastructure
is weak. Thus, learning from countries currently facing the ageing phenomenon
will be an effective guide to build the capacity of countries where the ageing
situation is still early.
Ageing has long been considered as an important global health issue. The first
World Assembly on Ageing was organized in 1982, which led to thedevelopment of the “Vienna International Plan of Action on Ageing” with theaim to strengthen the capacities of countries to deal effectively with the ageing
populations and the interaction with the rest of the society. It was recommended
to address the special concerns and needs of the elderly, and to promote an
appropriate international collaborative response to the issues of aging,particularly among developing countries. Since the 1982 event, manyconferences and meetings were organized in many regions around the world;and declarations as well as commitment resolutions were produced including theUN Principles for Older Persons (1991), the Macao Plan of Action on Ageingfor Asia and the Pacific (1999), the Madrid International Plan of Action onAgeing (2002), the Shanghai Regional Implementation Strategy on Ageing(2002), among many others. Many activities of the ASEAN Plus Threegatherings had also touched upon this issue. The significant events were the2015 Kuala Lumpur Declaration on Ageing and the recent 19 th ASEAN Plus
Three Summit in Lao PDR.
Essential recommendations in the Kuala Lumpur Declaration included:
1. Promoting a shared responsibility approach in preparation for healthy,
active and productive ageing;22. Raising public awareness on the rights, issues and challenges of oldage and ageing;
3. Eliminating all forms of maltreatment on the basis of old age andgender through equitable access of older persons to public services,income generation, health care services, and essential information, as
well as preventive measures, legal protection, and effective supportsystem;
4. Mainstreaming population ageing issues into public policies andnational development plans, and programs;
5. Promoting the development of manpower to meet the current andfuture demands for health and social services for older persons;
6. Promoting age-friendly communities/cities in the region throughsustainable and accessible infrastructure.
The statement from the 19th ASEAN Plus Three Summit provides useful
directions to address population ageing in the region. It aims to promote a
holistic approach to raise the quality of life and well-being of older persons andin addressing the multi-dimensional nature of ageing, which includes security,health, self-reliance and community participation. There are 3 broad areas ofpolicies which include:
1. Elderly Care and Health,
2. Economic Empowerment, and
3. Supportive Environment for inclusive society.
With all the commitments and declarations, it is now time to take action. TheASEAN Member States and the Plus Three countries must join hands together toensure that actual development processes take place to implement all thestrategies proposed by the Summit as well as to foster meaningful experiencesharing and closely monitor the progress so that no country will be left behind. Itis now time to act!

32. Objective
To identify areas of collaboration on Active Ageing in the ASEAN Plus Threecountries.
3. Presentations and Discussions in the Working Group Meeting
There were 13 experts from 12 ASEAN Plus Three member countries, 8
resource persons, and 10 observers, took part in a Working Group Meeting atAetas Lumpini Hotel in Bangkok on 13 July 2017 (see the name list in Annex 1).
Summaries of individual country presentations are as follows:
Cambodia
According to The National Ageing Policy 2017-2030, Ministry of Social Affairs,Veterans and Youth Rehabilitation is implementing data collection; research on
ageing population; capacity building for social workers, geriatric specialists andcaregivers; enforcing law on Older Persons on the rights, financial security, andaccess to health services; and developing the policies and action plans to beimplemented by line ministries involved in ageing issue. The role of government
under the constitution is to ensure the provision of free medical care for the poor,
the role of family in taking care of the elderly, and the role of community getting
support from Older People Association (OPA).
China
China has the largest elderly population in the world, with many elderly living
alone, longer life expectancy, and the demand for long term care. In addition, it
was significant number of elderly with dementia (with 6 times higher disability
than those without dementia). These are all the challenges with regard topopulation ageing. The Government is implementing policies to provide healthservices, and expand the scope of welfare for the elderly. The sheer size of
China, both in population and geography, present both big opportunities and bigchallenges.

4Indonesia
The critical issues are on policy and practical implementation, disparities amongareas (provinces, districts) due to decentralization implementation. Long-term
health care has not yet included in the health safety net and health insurance
system; nutrition care is still lacking. There is a need for solid evidences to build
a better policy. Multi-countries standardized surveys, field visits, more regularinter-country meetings, and high level advocacy are recommended.
Japan
Importance of active ageing has been recognized in Japan since 1970s. Elderlyemployment measures are promoted following the public pension reform. Healthpromotion has been incorporated to health care and long term care. It isrecommended that preventive long term care and daily life support underintegrated community-based care should be provided as a policy mix of health,welfare, and community development, etc. Elderly’s participation should beencouraged to enhance mutual support and social inclusion.
Laos
Currently, no social security for the elderly, only small percentage of population
got old age pension. However, the Lao government has developed policies andlegal framework to address some key issues related to the elderly as well as tosupport elderly with social protection, build benefits and promote employability
for elderly and people with disabilities, and encourage them in incomegeneration. The recommendations included promoting active ageing inemployment, local and regional actors can implement to promote employabilityof elderly through education and training initiatives.
Malaysia
By 2035 Malaysia will reach the age population, 15% will be over 50 years.
Elderly healthcare is currently provided by the government (at the publichospitals) at minimal cost. Challenges facing the care of the elderly include ashrinking role of family, lack of specialists and fragmentation of primary careservices. Economic empowerment is an important policy goal, with the elderly
only representing one of every three workers. Recommendations: Provide
5comprehensive financial assistance and increase labour force participation of theelderly. Policy goals include efforts to provide a supportive environment forinclusive society: cultural perception, and physical access.
MyanmarCurrent healthcare expenditure in Myanmar is very small at just 1%, with
out-of-pocket expenditure covering 51%. Local culture encourages extended
families with a commitment to taking care of the elderly. Policies in support ofthe elderly are not currently a priority. Recommendations: raising publicawareness and provision of community based health care for the elderly should
be promoted.
Philippines
The share of the population of elderly people continues to grow, with the elderly
females generally outnumbering the males. There are enabling laws instituted topromote the welfare of the elderly. Free health care is provided at public
hospitals and discounted at private hospitals. At present, the government
provides a social pension only for older persons aged 77 years and above whoare not receiving any other government or private pension. Challenges to thesector include the expansion of the senior citizen act, limited available data
focused on elderly, development and improvement of service infrastructure andmanagement of centers and institutions in an environment based on bothtraditional and modern institutions for future needs of aging society, and theneed of social and human services.
Republic of Korea
Korea is entering aged society where the proportion of aged people (65 yearsand over) will be over 14% in 2018 and one of the lowest birth rate in the world.
Recently, the policy uses productive and active ageing. Limitation: weakeconomic empowerment and weak pension system. Long term care system has
been introduced but the coverage is still very low (7%). The poverty of elderly is
the highest among OECD countries. Korea will take only 8 years to change fromaged to super aged society. An important lesson from Korea is how to slow
down the speed of ageing, through increasing fertility as well as international
6migration. International migration of care providers as well as retired will be theareas for future international cooperation.
Singapore
Singapore has been anticipating the challenges of population ageing since theearly 1980s and has taken steps to study its implications for various levels ofsociety and implement policies and programs so that the elderly can continue tolive in good health, enjoy opportunities for lifelong learning and employment
beyond the retirement age, and remain socially integrated in their families andcommunities. An Action Plan for Successful Ageing (2016) sets out targets forthe next 10-15 years.
ThailandThailand is in active aging now. Although, Thailand has already implemented
universal health coverage, system governance, increasing health literacy,
prevention health, expansion of intermediate care and long term care including
integration with social services are urgent needs. System design and governancefor pension system, measures to prolong retirement age, increase labor
participation and productivity are also needed. Policy measures for improvementof environment include active aging law enforcement, increasing literacy onaging friendly cities and aging friendly home.
Viet Nam
Viet Nam entered ageing phase in 2011 with over 10% of total population being
60 years old and above. It might take less than 20 years from ageing to aged
population. The National Program of Action on Older Persons 2012-20 wasapproved in 2012 to tackle this ageing challenge. The program focuses oncommunity-based care and services for the ageing population to promote theirroles in the family and community, to improve income, facilitate healthy
activities and provide care for them. In this program, Intergenerational Self-Help
Club, a volunteer-based care and counselling healthcare club for the ageing
population in the community has been chosen as the model and will be widely
replicated in the 2016-2020 period. An assessment on health insurance in 2014
showed the impressive insurance coverage of 78% and 86% for the ageing
7

population who are above 60 and 80 years old respectively.
It should be noted that, based on country presentations, definition of ageing
population is different among countries. Some presentations referred ageing aspersons aged 60 and above while the others considered people aged 65 andabove as ageing population.
4. Policy Recommendations
Recommendations for ASEAN Plus Three collaboration:
A. General recommendations
1. Develop “Active Ageing and Innovation Center” aiming for facilitating
setting standard statistics, research collaboration, regular meetings, training,and knowledge sharing;
2. Set up standard protocols for both survey and administrative data among
ASEAN Plus Three countries for comparative studies;
3. Enhance regional, multilateral, and bilateral technical cooperation for activeageing policies;
4. Establish regular meetings related to active ageing policies for ASEAN Plus
Three countries;
5. Promote technical cooperation at a high level of advocacy on active ageing toASEAN and their respective governments.
B. Elderly Care and Health
1. Technical cooperation to push active aging concept into universal healthcoverage policy of ASEAN Plus Three countries to improve health of people;
2. Promote public education to increase literacy and appropriate self-care ofageing people;
3. Advocate and promote development and provision of health promotion anddisease prevention as well as social and community services;
4. Developing appropriate policies to facilitate adequate workforce either
domestic or foreign workers for supporting elderly care in ASEAN Plus
Three countries.
8

C. Economic Empowerment
1. Expand income protection: pension, provident fund, allowance particular toself-employed and informal sector workers;
2. Promote provision of employment services (e.g., job availability, job
searching, job matching, and job counseling) as well as job training forageing population;
3. Extend retirement and pensionable age to accommodate to the extension ofhealthy life years;
4. Promote the role of ageing population associations in income generation.
D. Supportive Environment for Inclusive Society
1. Advocate for active role of ageing population to participate in labour market
and community activities;
2. Develop policy for increasing and improving elderly-friendly cities,community, housing, and transportation so that they can age-in-place;
3. Support legislation, guideline, and enforcement on non-discrimination andrights of the ageing population;
4. Promote life-long education;
5. Advocate the important role of ageing population associations in socialinclusion.

[END]9Annex 1
List of Participants
In Alphabetical Order of Country Names

NEAT Cambodia
1. Mrs. Ly Kimleang
Deputy Director of Elderly Welfare Department,
Minister of Social Welfares, Veterans and Youth Rehabilitation
NEAT China
2. Dr. WANG Zhihui
Director, Division of Elderly Health of National Center for Non-communicable Disease
Control and Prevention, Chinese Center for Disease Control and Prevention
Director, Division of Elderly Health, Chinese Center for Disease Control and Prevention
NEAT Indonesia
3. Dr. Ahmad Syafiq
Senior Lecturer,
Faculty of Public Health, Universitas Indonesia
NEAT Japan
4. Prof. ONO Taichi
National Graduate Institute for Policy Studies
NEAT Laos
5. Mr. Khamkieng CHANTHAVONG
Senior Research Fellow, Institute of Foreign Affairs
Ministry of Foreign Affairs, Laos
NEAT Malaysia
6. Dr. Muhammed bin Abdul Khalid
Chief Economist, DM Analytics Malaysia / Visiting Adjunct Fellow,
Centre for Policy Research and International Studies (CenPRIS),
Universiti Sains Malaysia
10NEAT Myanmar
7. Mr. Khin Maung Nyo
Advisor, Myanmar Institute of Strategic and International Studies (ISIS)
Address: 11191
NEAT Philippines
8. Ms. Catharine Adaro
Supervising Research Specialist,Philippine Institute for Development Studies
NEAT Korea
9. Prof. Lee Hye-kyung
Professor, Public Policy Department, Pai Chai University,
Vice President of Population Association of Korea
NEAT Singapore
10. Dr. Yap Mui Teng
Principal Research Fellow, Demography and Family
Research Cluster, Institute of Policy Studies, Lee Kuan Yew School of Public Policy
NEAT Thailand
11. Dr. Thaworn Sakulphanit
Program Director
Health Insurance System Research Office
Health Systems Research Institute
12. Dr. Wiwat Rojanapithayakorn
Director of the Center for Health Policy and Management,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, andExecutive Director of AUN - Health Promotion Network (AUN-HPN)

11

NEAT Vietnam
13.Ms PHAM Thi Tuyet Trinh
Researcher
Viet Nam Institute for Economic and Policy Research
Resource Persons
14. Prof. Ken Nakata
Graduate School of Medicine, Osaka University
Associate Member, AUN-HPN
15. Assoc. Prof. Chisa Tabata, M.D.
Vice Director, Center for Global HealthOsaka University
16. Assist. Prof. Dr. Sirintorn Chansirikarn
Assistant Dean and Acting Director
Center for Holistic Healthcare for Elderly and Hospice Care
Faculty of Medicine Ramathibodi Hospital
Mahidol University
17. Dr Vijj Kasemsup
Lecturer, Department of Community Medicine
Assistant Dean for Quality Development
Faculty of Medicine Ramathibodi Hospital, Mahidol University
18. Assist. Prof. Dr. Sirirat Panuthai
Faculty of Nursing, Chiang Mai University
19. Assist Prof. Dr. Kanittha Volrathongchai
Faculty of Nursing, Khon Kaen University
20. Assoc. Prof. Dr. Wongsa Laohasiriwong
Faculty of Public Health
Khon Kaen University
1221. Assist. Prof. Dr. Amornrat Apinunmahakul
School of Development Economics,
National Institute of Development Administration
Observers
22. Mr.Tong Terang
Deputy Bureau Chief
Ministry of Foreign Affairs and International Cooperation
23. Dr. CHEN Nahui
Research Fellow, Institute of Asian Studies,
China Foreign Affairs University
Institute of Asian Studies, China Foreign Affairs University
24. Ms. Aungsumalee Pholpark
Health Insurance System Research Office
Health Systems Research Institute
ASEAN University Network – Health Promotion Network (AUN –HPN)
25. Dr. Orasa Kovindha
AUN-HPN, Program Manager
26. Mr. Dussadee Maneesuwannarat
AUN-HPN, Program Officer
ASEAN University Network
27. Ms. Naparat Phirawattanakul
Senior Programme Officer
ASEAN University Network (AUN) Secretariat
28. Ms. Piyapat Kultanan
Programme Officer
ASEAN University Network (AUN) Secretariat
Chulalongkorn University13

Mahidol University
29. Ms. Wanpimon Senapadpakorn
Director, International Relations Division
Mahidol University30. Ms. Amara Sooknoi
International Relations Division
Mahidol University, Thailand
31. Ms. Lamdoun PluangklangInternational Relations Division
Mahidol University, Thailand

14