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376 23. Growing Older inWorld Cities: Themes, Interpretations, and Future Research Michael K. Gusmano andVictor G. Rodwin 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, the extent of local discretionary policies, and how they affect the availability and use of care by older persons living in world cities. What can be said, in conclusion, about the health and well-being of older persons in these four cities? Does the hypothesis that world cities are converging hold up against the evidence we have presented on the extent to which the policy responses to population aging are converging in these cities? In this final chapter, we speculate on the key policy implications from the experience of these cities, explore the many gaps in what we know, and propose a research agenda to address the questions raised in this book. A Portrait of the Older Persons in FourWorld Cities As we noted at the outset, population projections for 2015 indicate that Inner Tokyo will have the highest percentage of persons sixty years old and over (35 percent) in comparison to Paris (20 percent), Manhattan (18 percent), and Inner London (14.3 percent). At present, however, Paris has approximately twice the percentage of persons eighty-five years and over (2.8 percent) of that in Manhattan, Inner London, and Inner Tokyo. Racial and ethnic diversity. Along with the substantial growth in the number of people eight-five and over, these cities have experienced, to varying degrees, an increase in racial and ethnic diversity. The percentage of the older population in NewYork and Greater London comprised of racial and ethnic minorities increased steadily between 1980 and 2000. By 2000, racial and ethnic minorities made up almost 43 percent of the older population in NewYork and approximately 20 percent of the older population in Greater London. We do not have data on race and ethnicity for Paris or Tokyo, but we have information about the percentage of foreign born, foreign born who were naturalized (in Paris), and foreigners (Paris and Tokyo). Roughly one-quarter of the population in Inner London and Manhattan, and about 20 percent of the population in Paris, was born abroad. In Paris, the foreign-born population is higher than in the first Growing Older inWorld Cities 377 ring. Similarly, there is a greater percentage of racial and ethnic minorities in Inner London than in Outer London, but in Manhattan the percentage of racial and ethnic minorities is lower than in the surrounding boroughs. The growth of diversity in these cities creates a challenge for the organization and delivery of services. Cities with diverse populations must develop ways to deliver care that is sensitive to different cultural norms and must recognize the divergent life experiences of their older populations. Tokyo, which collects data on foreigners rather than on the foreign born, has a far more homogeneous population than do Manhattan and Paris. In Inner Tokyo, 3 percent of the population are foreigners; in the twelve outer wards, only 1.6 percent are foreigners. These data, however, understate the inter-Asian diversity within Tokyo, as they do not account for Japanese of Korean descent or illegal immigrants fromAsia. Because of a decreasing birth rate and increasing longevity, Japan’s working -age population is shrinking; at the same time, the need for formal long-term care providers is growing. To improve economic growth and to ensure an adequate number of formal care providers for Japan’s aging population, policy makers are debating the merits of loosening the country’s immigration policy. If this change occurs, Tokyo will undoubtedly be the destination for many immigrants, and the lessons from New York and London will be ever more relevant. The health status of older persons. In contrast to the urban health-penalty literature , evidence from these world cities suggests that the health status of their older residents is the same or better than the health status of those living in their nations. In London, there are no differences between the health of older persons living in London and in the nation, but older persons in Paris and New York are healthier than their counterparts in the rest of their countries. Life expectancy at sixty-five in the urban cores...

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