Living the good life, dying a 'good death'
Sat, Sep 08, 2007
The Straits Times
Speech by Health Minister Khaw Boon Wan
LAST week, I spent some time in the Japanese island of Okinawa. It has a population of 1.4 million, largely concentrated in the capital city of Naha. But it also has a significant rural-sector population spread over 40 small towns and villages. I visited one such village, called Ogimi.
The village has a reputation as 'the village of long life'. It has the highest number of centenarians, adjusted for population, in Japan and, most probably, in the world. Out of 3,500 people, 1,050 are above 65 and 100 above 90. Among them, 16 are above 100: one man and 15 women.
Okinawa has 740 centenarians. In comparison, Singapore has over 500, but out of a much larger population of 4.5 million. What is particularly impressive about Okinawa and Ogimi is that 80 per cent of their elderly live independently, requiring no hospital or nursing-home care. They manage quite nicely on their own, with support from family and community and in close communication with those around them.
I visited Ogimi not to seek the secret of longevity. A local academic who has studied this subject and observed the villagers for years briefed me on his research. As genetic factors are beyond our control, his briefing focused on non-genetic factors, of which there are many. But he singled out three important ones that help explain the villagers' longevity.
First, their traditional diet: They eat more pork, more tofu, more dark green vegetables and more seaweed than other Japanese. And their salt intake is low, about half of Japan's national average and many times lower than in Western countries.
Second, they are physically active. They exercise a lot and keep active all their lives. They work for as long as there is work available. It is common to see some of the villagers continue to work into their 70s and 80s, even in laborious work such as farming and weaving.
When work is not available, they are committed to an active social life, in senior citizens' clubs, village events and volunteer activities.
Third, their active daily life in turn benefits their sleep at night. They sleep easily and while they do not sleep long, they sleep soundly with little interruption.
So this is the Ogimi secret to longevity: a healthy diet, an active life and good quality sleep. I had several longevity meals and also joined the villagers in their activities, of which there were many: folk dancing, singing, socialising or simply helping one another. The elderly are fiercely independent and are proud of their independence. The oldest woman is 106 and lives with her daughter who is 80. Although recently wheelchair-bound, that does not stop her from coming to the community centre to observe the village dancing and simply to socialise.
Given their diet and regular activity, the prevalence of diabetes and cardiovascular diseases is way below Japan's national average. Osteoporosis is also less of a problem, with the incidence of hip fractures at half the US rate. Unlike most elderly villagers in other parts of the world, the old folks in Ogimi walk with straight backs. I did not meet any hunchbacked residents.
We talked about the younger generation. They lamented the erosion of traditional village lifestyles and worried a lot about the bad influence of fast food. They prefer their 'slow food' tradition - prepared from fresh ingredients and cooked slowly to carefully remove the animal fat. They also practise 'hara hachi bu': eating moderately and only to 80 per cent full. The other 20 per cent, they believe, will only go to enrich doctors. We did not meet any who were obese.
Ogimi is, of course, not entirely a bed of roses. Among the 16 centenarians, three are bedridden, including the oldest man who, at 108, also suffers from dementia. I visited several nursing homes where the bedridden elderly were being served. Just like in some of our nursing homes, many seemed unaware of what was going on around them.
The difference is that their residents are one generation older. We met many grandparents who were in their 80s but still fit, looking after bedridden great-grandparents. The parents who form the third generation were, however, missing, having to work in cities. The children who could form the fourth generation are few in number, if any, as Japan is facing a rapidly declining birth rate.
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