Summary report of 1^st to 9^th  DIHAC policy review meetings

 Myo Nyein Aung,  Nadila Mulati, Yuki Goto, Myat Yadana Kyaw, Yuiko Nagamine, Nam Eun Woo, Malcolm Field

Digitally Inclusive Healthy Ageing Communities (DIHAC) is a five-year study using a mixed-method to identify contextual influences of digital inclusion and its consequences on healthy ageing in Japan, the Republic of Korea (ROK), Singapore, and Thailand. As the population is getting older, our world is becoming more digital. Empowering older adults to become a member of the digital world will benefit them physically, socially, and psychologically. The result of this project is expected to pave the way to digitally inclusive, healthy ageing communities (DIHAC) across Japan and Asia.

The first year (2021) of the project mainly focused on the review of each country’s digital policies, the current state of digitalization, health promotion policies and activities in the context of COVID-19, existing digital dived, best practices, and projects to close “gray digital divide” contributed by investigators, collaborators, and researcher of DIHAC study. A total of nine joint meetings were held, and researchers from Japan, the Republic of Korea, Singapore, Thailand, Malaysia, India, and China have participated.

The very first DIHAC policy review meeting was held in person on 23^rd April 2021 at Juntendo University with researchers from Juntendo University and Tokyo Medical and Dental University. The objectives, methodology, and scope of the study were explained by principal investigator Dr. Myo Nyein Aung and the team planned monthly activities for policy discussions.

TABLE. Summary of nine DIHAC meetings

The digital-based policy is an entrance for the country to adopt information and communication technologies (ICTs) and contribute to the current state of digitalization. Therefore, in the consecutive three meetings, the national effort for the digitalization of Singapore, Thailand, ROK, and the ICTs in Japan was presented. Moreover, via different ICTs indexes, we took a closer look at the current state of countries’ digitalization. Links between the development of national ICTs policies and the current adaptation of ICTs at the macro level were discussed. The Republic of Korea was the first to integrate digital technology in public administration in 1960 and Singapore launched a national computerization plan in early 1980. Although later than the former two, Thailand came up with a Digital Thailand plan in 2016 with four phases to be rolled out over the 20 years(1-3). Japan sees ICT as a means of solving problems due to the increasing ageing population. Interestingly, the internet usage of senior citizens in Japan increased in 2019 when compared to 2018, especially for people over 80 years which was doubled. People over 60 years old use the internet mainly for information retrieval for social and public services(4). The International Telecommunication Union (ITU) ICTs Development Index (IDI), the E-Government Development Index (EDGI), and the IMD world digital competitiveness ranking (WDC) were presented to comprehensively understand the current state of the digitalization in Japan, ROK, Singapore and Thailand. All four countries ranked in higher place among these three indexes in Asia and the Pacific region. Well-designed digital-based policy, efforts in various aspects, and investments to facilitate the adaptation of ICTs might be the answer to this outstanding performance.

The digital gap between different age groups exists in all countries, and older adults are more likely to be excluded from the digital world. To have a comprehensive evidence-based understanding of this topic, at the 5th policy review meeting of the DIHAC study, Dr. Nagamine, assistant professor from Tokyo Medical and Dental University presented the study “Understanding the role of Internet access on health and health equity toward healthy ageing in the Western Pacific Region”. The report was published by the Japan Gerontological Evaluation Study (JAGES), the biggest Japanese older people cohort project. The report studied older people in Japan and Myanmar highlighted that addressing the digital divide among older people would contribute to fostering health equity among older adults. Internet usage has an association with social participation and older people who are from socially disadvantaged backgrounds showed a 40% lower risk of depression after accessing the internet. Internet usage differs according to social-economic status and location (urban or rural) where the older adults reside(5).

Building a digitally inclusive society is indispensable for the nations’ digitization journey. A deeper understanding of the mechanism of the digital divide is necessary to successfully conduct this project. Hence, at the sixth meeting in September, Dr. Myo Nyein Aung associate professor from Juntendo University and principal investigator of the study reviewed digital divides from theoretical perspectives and reports from ITU and OECD meeting notes. ICT accessibility is the first-level divide and an essential prerequisite for the digital inclusion of older people. Japan and OECD reports showed that digital exclusiveness is likely to be the convergence of multiple social factors such as ageing, poverty, female, low education, and being in rural. To develop a digitally inclusive community for older people, not only accessibility to technology or digital devices but also digital literacy and appropriation mechanisms for the users are to be addressed, not yet in many places. As a policy recommendation, while governments are increasingly speeding up the use of digital technology, empowerment to promote ICT appropriation and accessibility for older adults are urgently required to ensure equality in health outcomes. DIHAC study team will be exploring paths to maximize older persons’ opportunity to utilize digital technology and the internet to do whatever they value in different settings.

The emergence of the COVID-19 pandemic has highlighted the digital divide among the countries, as well as within the countries. with the “stay-at-home” and “physical distancing” measures are taking place, older adults are more susceptible to feeling isolated if they are not fully equipped to use the internet. The 7th virtual DIHAC meeting was taking place in October to discuss the Ageing population in the context of the COVID-19 pandemic, specifically, the situation in Japan and Thailand. Moreover, how health promotion projects were affected by the outbreak, and the prevalence of digital skill training classes in Japan were discussed in the coming month. As a super-aged society, Japan has developed community-based health promotion programs all around the nation. In 2019, 95.9% of the communities in Japan have various types of care-prevention activities, and functional training is the most common activity. During the pandemic, 39.13% of health promotion programs for older adults integrated digital technology in Tokyo whereas 13.04% in Shizuoka prefecture. Digital skill classes were provided for seniors in the communities in Japan.
Lastly, the ninth DIHAC virtual meeting focused on the different aspects of ICTs use in ROK, Malaysia, and China. The pilot study introduced by the Korean team focused on the empowerment of the community-dwelling seniors in regards to the digital skill, and the presenters from the Malaysia team and China introduced the digital app focusing on the health outcome. Through this meeting, we had a glance at the utility of digital technology, its relationship with seniors, and its integration with health in a different setting.

The details of each meeting can be found in the above table. And also, in https://digital-ageing.com/surveys-and-blog/.

The DIHAC study meetings will be continued from April 2022, with the participation of researchers from various countries, we will carry on to deepen our knowledge and exchange our experiences.

References

[1] Smart Nation: The Way Forward Executive Summary. Smart Nation and Digital Government Office Singapore; 2018.

[2] Digital Government Policy and Best Practices of Korea: World Bank Group; 2021 [Available from: https://olc.worldbank.org/content/digital-government-policy-and-best-practices-korea.

[3] Bukht R, Heeks R. Digital Economy Policy: The Case Example of Thailand. 2018.

[4] Information and Communications in Japan 2020. Ministry of Internal Affairs and Communications, Japan; 2021.

[5] Kondo N KC, Nagamine Y, Ota A, Shobugawa Y, Cable N, Tajika A, Nakagomi A, Chishima I, Ide K, Ueno T, Fujihara S, Fujinami Y, Yasufuku Y, and Ando Y. Understanding the Role of Internet Access on Health and Health Equity toward Healthy Ageing in the Western Pacific Region. 2021.

About authors

Myo Nyein Aung MD, MSc, Ph.D. is an Associate Professor at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan. He is also affiliated with the Advanced Research Institute for Health Sciences and the Faculty of International Liberal Arts, Juntendo University, Tokyo, Japan.

Nadila Mulati is a Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan.

Yuki Goto MD, Assistant Professor, and a Ph.D. candidate at the Department of Internal Medicine, Tokyo Dental and Medical University, Japan.

Myat Yanada Kyaw MD is a Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan.

Yuiko Nagamine MD, MSc, Ph.D. is Assistant Professor at Tokyo Medical and Dental University, a family medicine physician and she is also a member of the JAGES study group.

Nam Eun Woo MPH, Ph.D. is a professor and Head of the Dept. of Health Administration, Software Digital Healthcare Convergence College, Yonsei University, Republic of Korea.

Malcolm Field Ph.D. is a professor at Kyorin University, Faculty of Social Sciences, and Waseda University, Faculty of International Liberal Arts.