Growing Older in World Cities

Cover

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Table of Contents

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pp. vii-x

List of Figures and Tables

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pp. xi-xviii

Acronyms and Special Terminology

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pp. xix-

Part I. Introduction

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pp. 1-

1. Growing Older in World Cities: Implications for Health and Long-Term Care Policy

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pp. 1-16

Declining birth rates, increasing longevity, and urbanization have created a new challenge for cities: how to respond to an aging population. Although population aging and urbanization are not new concerns for national governments around the world, the consequences of these trends for quality of life in cities have received scant attention...

2. How Can We Compare New York, London, Paris, and Tokyo? Defining Spatial Units of Analysis

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pp. 17-25

Among the four world cities examined in this book, Tokyo surely stands out as most different from the other three. Beyond being the largest city in terms of population size and surface area, it is also the most culturally distinctive. While sharing the attributes of a modern metropolis with New York, Paris, and London, Tokyo preserves its Asian roots with regard to such social patterns as community organization...

Part II. New York

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pp. 27-

3. Growing Old in the City That Never Sleeps: Aging in New York

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pp. 27-57

An apt variation on an ancient Chinese curse might be, “May you live in an interesting place.” New York is just such a place. Barring Las Vegas, it comes as close as any city can to operating around the clock, seven days a week. Few of the city’s longtime residents would disagree that it is growing more hectic and harried by the minute...

4. The Health of Older New Yorkers

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pp. 58-

Dr. Martin Luther King Jr. averred in 1966 that “of all the forms of inequality, injustice in health is the most shocking and the most inhuman.”¹ Despite recent improvement in some measures of health in New York City, including life expectancy and infant mortality, significant disparities persist. We examine in this chapter the physical health status of older persons in New York City...

5. Organizing Care for Older Persons in New York: The Social Class Vulnerabilities of a World City

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pp. 79-102

How does one grow old in a city? For most older New Yorkers, the answer would be that one doesn’t. One lives a full life, full of the energy of a center of such lives. For the out-of-towner, growing old or, in the language of gerontology, “aging in place” in New York City is equally absurd. It is the familiar line. The more than thirty million visitors that flood New York City...

6. The Housing of Older New Yorkers

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pp. 103-125

Perhaps the single most important element that helps define a city’s quality of life is its housing. It is not just a source of shelter, but also a major component of household wealth, especially for older persons, who have higher ownership rates than do younger persons, and the vast majority of whom own their homes free of mortgage...

7. Lifestyle Patterns, Social Networks, and Use of Formal Services in New York: The Impact of Ethnicity, Class, and Culture on Older People

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pp. 126-152

A major objective of supportive services for older persons is the maintenance of a positive quality of life. Although this goal is rarely defined as such, factors that contribute to a positive quality of life for an older person include economic security, adequate health care, suitable housing and environmental conditions (including personal and household safety and adequate transportation), and meaningful roles...

Part III. London

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pp. 153-

8. Aging, Health, and Social Services in London

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pp. 153-173

This chapter has two aims: to present a summary of the social, demographic, and health profiles of older people in London; and to identify some key issues concerning services for older people that require the attention of city government and welfare administration. London lies in the southeast of Great Britain, at the center of the United Kingdom’s largest concentration of population...

9. Inequalities among Older People in London: The Challenge of Diversity

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pp. 173-200

Tackling inequality and reducing poverty are high on the British government’s policy agenda. In 1999, the government published Opportunity for All, outlining its strategy to “eradicate child poverty, provide employment opportunities for all who can work and ensure that older people live secure, active and fulfilling lives.”¹ A central part of that strategy is reduction of income inequality and inequalities...

10. Long-Term Care Facilities in London

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pp. 201-213

Few aspects of Britain’s welfare services have changed as much over recent decades as has residential and nursing-home care. Up to the late 1970s, there were many long-stay geriatric nursing homes and wards (and even hospitals) run by the National Health Service (NHS), and local authorities had built up a considerable number of their own residential care homes...

11. Living Arrangements and Housing among Older People in London

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pp. 214-233

“When a man is tired of London he is tired of life; for there is in London all that life can afford.” Samuel Johnson’s familiar quotation of 1777 aptly poses an issue about the relation between contemporary cities and the older population, men and women. On ceasing formal employment, do retired people find capital or world cities inimical to or supportive of the lifestyles and activities that they wish to pursue?...

Part IV. Paris

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pp. 235-

12. Growing Older in the City of Light

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pp. 235-251

Paris evokes many of the images of a world city. It is a center of political power and transnational corporations, a place for the pursuit of science and artistic creation, a hub for museums and libraries, a transmission belt for fashions and ideas, and so much more. In its heyday (1870–1910)—la belle époque–Paris radiated a sense of youth and boundless energy...

13. The Health of Older Parisians

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pp. 252-267

The most striking aspect about the health of older Parisians is that their life expectancy, at sixty-five years, is among the highest not only in France but also in the world. In this chapter, we begin by examining the basis for this finding over the period from 1990 to 1999—before the heat wave of 2003. We also refine it by presenting a typology of health status...

14. Inequalities and Quality of Life among Older Persons in Paris

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pp. 268-282

In France, the legal retirement age is sixty years. As a result, from a legal, administrative, or statistical perspective, sixty is considered an important threshold; it marks a significant change in status. Persons who have passed this threshold become “older persons,” which introduces a number of changes in their rights and social benefits. The term “older persons” now includes an important and growing number...

15. Living Arrangements and Long-Term Care for Older Persons in Paris

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pp. 283-300

In France, since 1997, there have been significant efforts to improve and rationalize long-term care services for older persons. Some reforms promoted under the banner of “aging and solidarity” have increased resources to finance more home help for the most dependent older persons—and assist their caregivers. In this regard, the replacement of the disability allowance (PSD)...

Part V. Tokyo

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pp. 301-

16. Tokyo: A Pathbreaker in Long-Term Care?

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pp. 301-303

Over the course of the past century, among the four cities studied in this book, Tokyo has undergone the greatest physical changes. Very few buildings survived the great earthquake of 1923 and the carpet bombing of 1945. More recently, the economic boom years of the 1980s, and efforts to heat up the economy in the 1990s, have led to massive urban construction projects. Of the four, Tokyo is also the city that has experienced the least social change...

17. Aging, Socioeconomic Status, and Neighborhood Differences in Tokyo

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pp. 304-313

What is it like to grow old in Tokyo? How different is it from growing old in New York, Paris, or London? Is it different from growing old in other parts of Japan? To answer these questions, it is important to start by comparing the demographic, socioeconomic, and health status of the older persons in Japan, Tokyo Prefecture, and Central Tokyo’s twenty-three wards...

18. The Challenge of Aging in a Global City: Tokyo

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pp. 314-318

I conducted a comparative analysis on the availability and use of social and medical services in Tokyo and its various districts: Minamitama, where middle-class businesspeople live; the southeastern area, which includes Meguro Ward, Setagaya Ward, and Shibuya Ward, where wealthier people live; and the more solidly lowerand working-class district...

19. Growing Old with Tokyo

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pp. 319-333

We first came to Tokyo from New York in the summer of 1965. John had just graduated from college and was about to embark on a year of Japanese-language training before graduate school; Ruth was the mother of a two-month-old boy and for a year or so had been working with older people in East Harlem. As we drove in the dark from Haneda Airport...

20. Creativity under Uniformity: Implementation of Japan's New Long-Term Care Insurance in Central Tokyo

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pp. 334-346

Before Japan’s new long-term care insurance (LCTI) system went into effect, medical and nonmedical aspects of long-term care (LTC) had been financed by distinct schemes: medical services by health insurance and nonmedical services by general revenue. While medical services were well financed, the budget for nonmedical welfare services was restricted...

21. Long-Term Care in Tokyo: Home or Institutional Care?

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pp. 347-359

Urbanization, modernization, and the increasing participation of women in the labor force are transforming the traditional role of the Japanese family, once rooted deeply in Confucian family values. I explore here the policy implications of the changing role of the family for older persons in Central Tokyo’s twenty-three wards. Specifically, I document the efforts to address the decreasing capacity...

Part VI. Comparative Analyses

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pp. 361-

22. The Continuum of Long-Term Care in World Cities: From Institutionalization to Home Care

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pp. 361-375

Discussions of long-term care usually evoke images of “warehousing” frail older persons in nursing homes, hospitals, and other institutional settings. Most long-term care, however, is provided in the community. As the preceding chapters suggest, world cities have a particularly acute need for innovative solutions for the provision of long-term care...

23. Growing Older in World Cities: Themes, Interpretations, and Future Research

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pp. 376-390

New York, London, Paris, and Tokyo confront common challenges resulting from population aging and longevity. But they do so within national health, social, and long-term care policy contexts that are different. While there is a vast literature about these national-level differences, we know less about how these policies are implemented at the local level...

Contributors

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pp. 391-396