Tokyo Declaration

October 12, 2018

■Introduction

We held the Joint Congress of the 20th International Association of Rural Health and Medicine (IARM) and the 67th Annual Meeting of the Japanese Association of Rural Medicine (JARM) for three days from 10th to 12th October 2018 in Tokyo. The main theme of this congress was "Challenges to community-based rural medicine in aging societies with declining productive populations". Currently, overpopulation is one of the big problems all over the world, but the population in developed countries is now decreasing. Furthermore, in these countries the ratio of elderly people is becoming greater. The birth rate seems to be lower in the households with high income. Since globalization will spread all over the world and the income will be high even in the developing countries, disparity of each country may decrease and world population is thought to decrease in the next century. The problems of aging society will be serious around the world.

In particular, Japan has the highest aging population in the world, the percentage of people that are 65 years of age and older is 28.1% (2018). Furthermore, even in Japan, the aging rate of rural areas is much higher, and this causes many various problems in societies. It was of great significance to hold this congress to discuss the problems of aging society in Japan, and the policies and measures for the aging society must be a good model for the other countries which could face similar issues in the future.

Through this congress, the following problems were revealed.

1. In developed countries, aging and population declines have already become a social problem.

2. The proportion of elderly people in rural areas is high in developing countries as well as in the developed ones, and many elderly and children have to be responsible for agricultural labor in developing countries.

3. Today, the retirement age limit tends to be raised to secure labor because of decreasing working age population.

4. In order to raise the retirement age, it is necessary for elderly to keep the individual labor capacity at a high level.

5. Accident and trauma during agricultural work of the elderly have not decreased.

6. Most elderly people have at least one chronic disease such as hypertension.

7. The increase in the number of patients with dementia has recently become a major problem as aging progresses.

8. From the presentations in this congress, it was shown that health conditions of the elderly living in rural areas are worse than those in urban areas. This is related to rural areas with low income, insufficient educational standards, and inconvenience for receiving some medical service.

9. For as patients with dementia in the rural areas, many patients cannot visit medical institutions nor receive any social services.

■ Tokyo Declaration

Based on the above problems, we have adopted the following matters in regards to the Tokyo Declaration at this congress.

1. The most important thing for preventing the threat in an aging society is that elderly people continue to be healthy and productive.

    

2. In order to make safe labor circumstances for elderly people, it is necessary to medically analyze physical abilities and mental condition of elderly workers. We should consider the results in connection with the factors in the working environment, and suggest some improvement plans.

    

3. Considering about the relation between occupational safety and health from the point of view of geriatrics, we should list up jobs which are suitable for elderly workers, and should also create safe working environments for them.

    

4. In order to be an effective and productive worker for elderly people, employers as well as elderly workers must continue to learn better education and training for jobs.

    

5. We should improve the agricultural environment in the rural areas so that aged farm workers can safely engage in agricultural work so longer.

    

6. For agricultural workers with low income in rural areas, we should suggest a guarantee system for the workers and urge national and local governments to provide long term care and medical services.

    

7. We should promote to reduce the burdens of agricultural workers, and this will be able to decrease the labor of children.

    

8. It is necessary to improve the infrastructure in rural areas by using not only conventional methods but also new devices such as IT or social network. For achievement of this, we should cooperate with private enterprises or government.