Case Study: The Age-friendly Programme in Hong Kong
Age-friendliness has been the focus of attention for more than a decade in Hong Kong, with initiatives ranging from late life education opportunities and the age-friendly design of housing units and hospital wards, to priority seats on public transport and even in some fast food shops.
In 2008 the Hong Kong Council of Social Service (HKCSS) took the lead in promoting the concept of an age-friendly city by establishing the Age-Friendly Hong Kong Steering Committee. The aims were broad and inclusive: to promote public understanding, devise solutions to improve the lives of older people through consultation with elders and stakeholders, and to share information on best practice and successful initiatives.
Confirmation that the concept of age-friendly cities and communities had high level political commitment came in 2016 when the Hong Kong Chief Executive’s Policy Address featured building an age-friendly community as a specific policy focus. To date, age-friendly platforms have been established in all 18 districts, with older adults empowered to raise their concerns, advocate change, negotiate with local government departments, and report to the media to raise awareness of public concerns. The district level is seen as the key level for collaborative projects because it is at the grassroots that people know the most urgent local needs of older people.
Challenges and Strategies for Progress
Like all communities, Hong Kong faces some specific challenges as it seeks to prepare for an ageing population, in which the proportion aged 65 and over is projected to rise from 14.7% in 2014 to 30% in 2034. Overall population density is among the highest in the world, with 7.3 million inhabitants in 2017 living in a small, highly urbanised area of 2.75 km2. Property prices are high and living conditions often dense and overcrowded, with air pollution and noise detracting from older people’s quality of life.
Socio-economic factors also present obstacles to creating an age-friendly city. The Hong Kong Poverty Situation Report 2013 (1) found that the poverty rate of adults aged 65 years and over was three times higher than for those below 65; in 2016, 31.6% of older people were identified as being in poverty, even after policy interventions (2). Social exclusion is another challenge. Many of today’s older Hong Kong population spent their lives working long hours, which inevitably restricted their community and social interaction. Lacking strong personal networks, they can become less ‘socially visible’ upon retirement. Loneliness is commonly reported and encouraging active participation in community life is therefore seen as essential to building and maintaining social connectedness between older people and society.
In this context, broad stakeholder engagement has been at the heart of Hong Kong’s achievements, with age-friendly programmes being driven forward through the involvement of a number of NGOs, charitable bodies, non-profit organisations, philanthropists and agencies working in collaboration with each other and with older people at district level.
Intergenerational interaction is another successful feature of a number of projects, both through the sharing of facilities and the direct involvement of the younger generation in older people’s activities.
Age-friendly City Projects – Examples of Success
Progress towards a more age-friendly urban environment can be found across a number of different sectors.
The Elder Academy scheme, an education and social inclusion initiative, was launched in early 2007 by The Labour and Welfare Bureau and the Elderly Commission. The activities provide access to learning opportunities in schools and university campuses and are aimed primarily at older people who have had little or no education. The scheme optimizes the use of existing educational facilities and has been successful in promoting both lifelong and initial learning for older people, encouraging participation and helping to maintain physical and mental wellbeing. School and university students are engaged in the scheme, thereby also promoting civic education and intergenerational understanding. Currently, some 125 elder academies in various districts and seven tertiary institutions offer a wide variety of courses.
Another intergenerational scheme is run by the NGO Aberdeen Kai Fong Welfare Association. This focuses on community education, intergenerational learning, and volunteer development, and promoting cultural heritage. Older people interact with students of all ages in activities including: creating stories and plays with primary school children; mentoring secondary school children and helping with homework; and secondary school children organizing trips with older people to explore Hong Kong sites.
© Hong Kong, China - The Hong Kong Council of Social Service's "Stair Climbing Service"
The need for age-friendly accommodation design and development has been tackled by the Hong Kong Housing Society (HKHS), a non-profit organization that dates back to 1948. Its housing units emphasize home safety, care and support, health and wellness, so that people can grow old in their own homes. While HKHS provides only a relatively small part (just over 4%) of Hong Kong’s extensive public housing system, it is offering affordable housing in a niche position between the expensive private sector and government public rental housing.
In terms of health infrastructure one example is age-friendly hospital wards, a response to the large number of hospitalized frail older people, up to one-third of whom may have dementia. Care can be inadequate because of a lack of awareness of their needs. Currently two hospitals have adopted a principle of age awareness when refurbishing their wards (2).
Securing wider support for age-friendly policies is also important. The aims of the Hong Kong Jockey Club CADENZA Project (3) include changing the mindset and attitudes of the general public through a range of training and public education programmes as well as nurturing academic leadership in gerontology. Cross-sectional collaboration between organizations and the implementation of innovative elderly services are also encouraged in order to bring about a new mode of elderly care services to prepare for a rapidly ageing society, including planning for the needs of the “soon to be old” (Phillips et al., 2018).
In order to assess the age-friendliness of the 18 districts, between 2015 and 2017 the Hong Kong Jockey Club conducted a baseline assessment using questionnaire surveys and focus group interviews, in partnership with ageing research centres in four universities: The Chinese University of Hong Kong, Hong Kong Polytechnic University, The University of Hong Kong and Lingnan University. Meetings at the district level included older people, district councillors, and local government officials who reviewed findings and proposed improvement projects. Based on the findings (4), professional support teams from the four universities have worked with District Councils to develop a three-year action plan for each district, identifying directions and actions to enhance their age-friendliness.
Future of Hong Kong’s Age-friendly Programme
Hong Kong has demonstrated considerable enthusiasm and practical outcomes in the age-friendly city movement at both central and local levels. However, a number of policy questions remain (5). For example, should the young-old, the old, or the oldest-old be listed first in a policy agenda? Should healthy older adults or the frail be given prior attention in policy planning? Should the most socially deprived older adults be targeted in planning?
Some stereotypes of older persons are also enduring and when resources are tight older people are not always seen as high on the list of priorities. For example, research indicates that the Hong Kong public values technological advances in health services above care of the elderly and end-of-life care, in contrast to a similar British survey in which end-of-life care was ranked the second highest (6). Further shifts in public attitudes may need to be part of Hong Kong’s ongoing evolution into a more age-friendly city. Nevertheless, the progress in territory-wide engagement with the concept of age-friendliness at official, charity, NGO, community and even family levels, bodes well for future progress in Hong Kong (2).
Acknowledgments: This case study was written in partnership with a team from the University of Manchester led by Tine Buffel and consisting of Tine Buffel, Natalie Cotterell, Chris Phillipson, and Samuèle Rémillard-Boilard; in collaboration with Grace Chan of Hong Kong.
(1) Government of the Hong Kong Special Administrative Region Hong Kong poverty situation report 2016. Hong Kong: Census and Statistics Department; 2017.
(2) Phillips DR, Woo J, Cheung F, Wong M, Chau PH. Exploring the age-friendliness of Hong Kong: opportunities, initiatives and challenges in an ageing Asian city. In: Buffel T, Handler S, Phillipson C. Age-friendly cities and communities: A global perspective. Bristol: Policy Press; 2018.
(3) Cadenza [website]. Hong Kong: The Hong Kong Jockey Club; 2018 (www.cadenza.hk, accessed 18 November 2018).
(4) Baseline assessment. In: Jockey Club Age-Friendly City [website]. Hong Kong: Jockey Club Age-friendly City Project (https://www.jcafc.hk/en/project-progress/baseline-assessment, accessed 17 November 2018).
(5) Chan G, Lou V, Ko L. Age-Friendly Hong Kong. In: Moulaert T, Garon S, editors. Age-friendly cities and communities in international comparison. Springer International Publishing; 2016.
(6) Mak YW, Chiang VCL, Chui WT. Experiences and perceptions of nurses caring for dying patients and families in the acute medical admission setting. International Journal of Palliative Nursing. 2013; 19(9): 423-431.