Ryotaro Katsura (*)
Abstract: The aging characteristics of Vietnam's population structure are very similar to the three characteristics Japan experienced (i.e. speed, scale, seniority). We will realize community welfare where elderly people who have experienced a great tragedy in the war can end their lives with peace of mind while learning from the experiences of the elderly people in the war without entrusting their lives to their families and women. In other words, the integration of education on peace and welfare (i.e. social care) is important. It is necessary for Japan to relearn family values from Vietnam, and for Vietnam to learn how to do community-based welfare from Japan. It is the time for more international cooperation between Japan and Vietnam to creatively restructure new Asia-based welfare policies for the elderly (i.e. ideas, methodologies, methods and techniques) based on families and communities.
Keywords: Aging problems & Gerontology, Spiritual asian family values, Community solidarity, War life history, Integration of welfare and peace education, Asian perspectives for social care development
1. Why is It Important to Consider the Aged in Vietnam now?
I had been thinking of the problem of Messrs. Nguyen Viet and Duc (twins with congenital problems caused by the defoliant, Agent Orange), as a problem of caring for the handicapped. However, if we think deeply about the issue of providing care, it touches everyone’s life, including the aged, and pertains to the dignity of life itself. Of course, in Vietnam lots of people who lived through the American War are now reaching old age.
I have also been paying attention to the problem of the graying of the population in Vietnam. The first reason my attention turned to this problem is that I began to notice that the pace of graying in Vietnam is very much faster than it is in other Asian countries. The UN defines a society as “aging” if 7% to 14% of its population is 65 years old and over (Katsura, 2006). Then I noticed that looking at the future of Vietnam reveals important data for forecasting the future of other countries in Southeast Asia. The second reason I began to pay attention to the elderly in Vietnam is that their way of life represents "human life in war.” It is true that the elderly of many countries have lived through wars, large and small. But, the elderly in Vietnam experienced one of the most miserable wars in history, the American War. The third reason is that, though China receives a lot of attention due to its rapid economic growth, Vietnam is also undergoing rapid economic development within a socialism system, much like China. In other words, I am interested in how the elderly in Vietnam will live in a future that includes receiving medical services, health insurance, and elderly care in a social system that has two aspects: capitalism in the economic sphere, and socialism in the political one. Lastly, I want to know how these issues relate to the daily lives, culture, and spiritual climate of the people in nations that have been supporting them.
2. Outline of Vietnam and the Country’s Spiritual Climate
Vietnam is a long and narrow country expanding north to south on the eastern edge of the Indo-Chinapeninsula. Both the north and south fall within the monsoon zone. The north is subtropical and the south is tropical. In the mountainous areas, where some minority races live, it is cold in the winter. That is, there are a variety of climates in Vietnam. The plains constitute a granary of various crops including rice, and constitute one of the best food producing regions in Southeast Asia. Therefore, the land has often been invaded by other nations. From ancient times, ethnic Vietnamese, represented by the Kinh, have been fighting to prevent a sustained invasion by China. In modern times the land, as a colony of France, was divided into plantations. In the World War II, invasion by the Japanese army resulted in hunger being experienced by the populace. Some while after World War II, the U.S.A. invaded the nation, taking over from France. The American War waged by the U.S.A. separated the land into North and South pursuant to the world’s cold war structure. Both sides promoted misery and mired the country down in war. After reunification in 1975, Vietnam coped with border wars in 1979 and about ten years more sending voluntary soldiers to prevent Cambodia from Khmer Rouge until 1989. As can be seen by this brief account, it is not too much to say that the history of Vietnam is a history of wars.
Vietnam recovered quickly economically, thanks to the "Doi Moi policy" that promoted economic capitalism within a socialist political framework. The U.S.-Vietnam Bilateral Trade Agreement (BTA) was signed in 2000, and Vietnam joined the WTO in 2007. Now, Vietnamese society is going to change drastically. However, this change will cause some gaps in Vietnamese society.
3. Families and the Elderly in a Stream of Rapid Social Changing
I am of the opinion that five important gaps brought about rapid social change in Vietnam. In terms of social changing, it means three big streams. The first is "internationalization," the second is "globalization", and the third is "aging". The social change in Vietnam is also among these three major streams (or trends). These are “the gap” between North and South, “the gap” between urban cities and farm villages, "the gap” between the majority Kinh race and the minority races," and “the gap” between males and females. Recently, the gap between wealth and poverty is getting wider and wider even within the same poor farm villages. The most basic group constituting society is "the family". Families in Vietnam are also changing rapidly. By so-called modernization, the bonds that tie families together and that hold people into local communities are becoming weak.
It is said that if we want to imagine a future Vietnam, we can see it clearly by paying attention to the shape of their families. The characteristics of Vietnamese families are also features of Asian families in general. The father-dominated or, patriarchal system, in Vietnam is influenced by Confucianism in China, and is resembled to those of other Asian countries. However, it is said that in some points, the details of the Vietnamese system differ from those of China and other Asian countries. The difference is that the Vietnamese system incorporates equality between husband and wife. The family system in China emphasizes the relationship between parents and children (especially sons). Researchers say the relationship between husband and wife is very important in Vietnam (Katsura, 2003). Furthermore, in Vietnam, the elderly are very likely to live with a family members. A recent research report stated that for all households, seniors living alone in Hanoi constituted 6.9% and in Ho Chi Minh 4.8%. The number of households in those cities after the war with couples with both spouses alive was 12.5% and 4.5%, respectively. On the other hand, the percentages of households with three generations living together were 57.4% and 51.0%, respectively. So, more than half of the elderly in Vietnam were living with their married sons (Le Ngoc Van, 2002). In the metropolitan area of Hanoi, four-person households account for about 30% of the total. On the other hand, in Ho Chi Minh metropolitan area, the proportion of four-person household is about the same as about 30%. The four-person household together make up the majority of the total. The average family size is 3.8 in the Hanoi metropolitan area. The Ho Chi Minh metropolitan area has 3.6 people, which is about the same (JICA Survey Team, 2014). Perhaps, these figures are not very different today. The elderly in Vietnam very much wish to live with their families. There is another study that found that approximately 50% of the elderly are willing to live with their married sons, and approximately 10% the elderly are willing to live with their married daughters. (Le Ngoc Van, 2002). According to the Census 2019, the population was 96,208,984, of which 47,881,061 (49.8%) were men and 48,327,923 (50.2%) were women. The number of households was 26,870,0079, an increase of 4.4 million from 2009. The average household size is 3.6, a decrease of 0.2 from 2009. The average annual household growth rate from 2009 to 2019 was 1.8%, the lowest growth rate in the last 40 years (Central Population and Housing Census Steering Committee, 2019). In yet another study, examining farm villages, the elderly were found to be much more willing to live in extended families than urban people were.
The Vietnamese social security system does not provide very muchsupport, so we might say that families are the most important group caring for the elderly.
4. The Traditional Sense of Values in Asia and the Power of the Elderly
Vietnam may someday, as an underdeveloped country, experience changes in their social welfare system that are different from the process experienced in advanced countries like Japan. Namely, in the burst of rapid economic development after the Doi Moi policy, if we ask whether the government, the local community, or the family can cope with the trend toward fewer children and an aging population while maintaining a family style based on local communities and networks of relatives (clans), the answer could be that the issues may be very difficult to resolve. As you may learn by observing the result of the single-child policy in China, a socialist nation may find it difficult to reach a goal through government initiative. Dealing with the issues of many elderly and fewer children in Vietnam is certainly not a problem specific to Vietnam. This may be a destiny which many Asian countries face.
So far, I have been studying the problem of the elderly in Asian countries, and found that the features in Asia are different from those in Europe and North America from various perspectives. The features of social change in Asia seem to have the following three characteristics. Since I started studying Asian society and culture, I have focused on three new keywords: "Rapid pace", "Gaps", and "Diversity”. The first meaning of ‘Rapid-pace’ here is that other Asian countries are aging at a tremendous speed, and secondly, regarding ‘Gap’, Vietnam has five Gaps (i.e. region, urban and rural, majority & minority, gender, and the gap between rich and poor) are common to other Asia, and the final ‘Diversity’ is that in the case of Asia, each country has a different historical and cultural and social background and ethnical peoples construstion is very different from the Europe and America. I already described the application of the former two words in themes related to aging and the gap between wealth and poverty. Now, let me describe here how diversity becomes an important keyword for considering the future of Asian welfare, and let’s think together about what we should be learning from the elderly in Vietnam.
Asian countries have a variety of types of races, religions, and lifestyles that affect the management of daily life. Culture and society in each country is configured with multilayered and multiplexing tones based on these historical and social aspects. Vietnam is especially characterized by having areas with different cultural climates, with many minority races and a mixture of many religions. There is no other Asian country that has such clear diversity as Vietnam. In this country, the common cultural climates of Asia: the rice culture, bamboo culture, and tea culture, extend with the monsoon climate. Spiritual human ties to ancestors, nourished by territorial and blood bonds, exist there as various lifestyles, traditional ways of thinking, senses of value, and ways of apprehending life and death. These spiritual factors are firmly embedded in daily life in this modernizing society.
Taking care of parents, for example, it is a most difficult subject in Vietnam; how to maintain the traditional culture while recognizing the legitimacy of a variety of values and lifestyles, all the while attempting to harmonize socially provided care with private family care? In this context, it has become a feature of Vietnamese social welfare to simultaneously develop mutual support type social welfare centered on temples, on the one hand, and private fee-supported elderly homes for the wealthy living in urban areas, on the other.
Public homes for the elderly in Vietnam accommodate many poor seniors who have lost their relatives in war. Most of them are the widows of war heroes who contributed to victory in the American War. On the other hand, South Vietnamese old people also once contributed to their country, and seniors who are still agile but who do not receive enough under the social security and pension systems care for their grandchildren, while themselves being cared for by their families. By participating actively in local festivals and temple events, they play their roles in their local community. Healthy old folks create health-maintenance and mutual support institutions, typical of a senior citizen's clubs, in each locality, and they try to convey the misery of war to the innocent young. Observing the things the elderly do in this country, I was much impressed by the strength of the elderly, having the patience and fortitude to keep ongoing that had been cultured by the war time. This asks the old people like us to learn how to live from these. In Japan, most of the tragic elderly people of World War II are dying or nearing the end of life. Nothing makes human being as unhappy as the war from those who have experienced the atomic bombings of Hiroshima and Nagasaki. The greatest enemy of human being is war. It is now difficult to hear directly from the elderly who have experienced the war. Therefore, Vietnam is also required in the field of education to listen to the life-history of the elderly who have directly experienced the American War so on. In other words, social-welfare activities for elderly and peace education for next genelation are the same. Nothing is more valuable than the testimony of those who have experienced in war times more than any book or record, the elderly.
5. The Importance of Gerontology as a Meeting Point for the Study and Practice of both Welfare and Peace Building
On one occasion, I was given a chance to examine Vietnamese society as a guest researcher in Social Work at the National University of Singapore for three months from September to December, 2009. It only takes few hours by plane to travel between the two countries, but the social climates of the two are completely different, and I could really grasp the diversity of Asia. By looking simultaneously at Singapore, that advanced urban city-state in Asia, and Vietnam, a country with many poor segments living under socialism, I developed a view of how social welfare will develop in Asia in the future, as three key words spun in my brain: Diversity, Rapid change, and Gaps. It is the time for us researchers to create another model for building an "Asian", social welfare society based on these three keywords and to take into account the geographical and historical social culture of Asia.
The common dynamic thread between the two nations is the powerful lives of the elderly. From this visit to these Asian countries and seeing how the elderly lived there, I learned that family and networks of relative (clans) are the basis of Asian human relationships, as expressed in both countries. Further, I could fully appreciate the desire of the people, full of longing that war would never occur again, to work to construct a peaceful society. I could see the advisability of developing a future welfare system for the elderly that incorporated peace education and peace studies.
If we look at people who must depend on a social insurance system because of the breakdown of families and the local community, where there is no relationship with neighbors, caused by rapid economic growth after World War II, as in Japan, we are advised by the example of Asian countries, especially by Vietnamese seniors, that we cannot provide true welfare for the elderly without studying deeply the entire way of life, knowing what the wars were like, and the people who lived through those wars.
We should study deeply the history of these wars, for example, through the eyes of the older people who actually experienced them. We should not simply set up social systems and services for anonymous “recipients.” By sharing feelings and impressions with them, we (not just people engaged in social welfare, but actually all people engaged in every field) have to reconsider all problems, including the problems of the handicapped and the problem of racial discrimination in Japan.
At the end of 2006, Mr. Bunro Fujimoto, a representative of Negau Kai (a conference to support Viet and Doc’s growth) at the time he was Dean of the Care and Welfare Department at Osaka College of Social Health and Welfare, discussed with Mr. Check, Principal of Ho Chi Minh Municipal School for Teachers of Young Children, an exchange seminar that would be held between the Osaka College of Social Health and Welfare and this school. From his experience with his own family, Principal Check suggested the elderly care problem as a theme. In December of the same year, the first Japan-Vietnam Friendship Elder Care Seminar was held at Ho Chi Minh Municipal School for Teachers of Young Children, directed by the Osaka College of Social Health and Welfare (Fujimoto, 2008). They presented lectures and held exchanges there. After that, they held a total of 5 seminars at Saigon University (the School for Teachers was incorporated into Saigon University), Tu Du Hospital, and Ton Duc Thang University, to make for deeper exchanges. Not only people from Osaka College of Social Health and Welfare, but actually about 20 researchers in this field in the Kansai, Hokkaido, and Tokyo universities, participated in the seminars, and the Asian Elderly & Handicapped Welfare Cooperation Meeting was founded.
Quan Chun Nursing School in Ho Chi Minh will have in its schedule, a caregiver education course starting in 2012. Japanese researchers and practitioners will support the course.
Starting from the issue of providing insurance for Mesrrs. Nguyen Viet and Duc, solidarity and exchanges are expanding between Vietnam and Japan regarding the elderly care problem (Katsura, 2013). I believe that solving the problems of the elderly can contribute to the construction of true sustainability and the creation of world peace (Katsura, 2020).
As a recent success case, my NPO ASCA (Asian Social Care for Aged and Disabled) has been evaluated for the results of the exchange project through home care at Dinh Thung Village in the Mekong Delta area for more than 5 years, and HCMC City HIDS (Ho Chi Minh City Institute for Development Studies, 2020). A delegation of 15 people visited Kyoto-city in Kyoto and Kashihara-city in Nara prefecture and inspected the welfare situation for the elderly (long-term care insurance and home medical welfare), which was a great success. After that, in 2020, we conducted an interview survey with the elderly of their life history on war time and of the families sent out by ‘technical intern trainees’ in the village of Trung Gian Village in Thanh Hoa Province.
6. Concluding Remarks and Future Research Orientations
Japan's welfare for the elderly has developed the social security and social welfare services centered on Western models, so instead of listening to the experiences of the elderly during the war, we have focused on mere welfare models and systems. It was for example, families and welfare facilities have been separated only functionally, and the attitude of re-learning what welfare is from the war experiences of the elderly has been lacking. In other words, welfare education and mental education in long-term care welfare have not been sufficiently provided. I think that true welfare education is now required to have a perspective of re-learning from the elderly, that is, Japan may re-learn from Vietnam in the fields of home education, community education, and public education.
The future welfare of the elderly in Vietnam will require a family welfare, a community welfare perspective, and a gender-free perspective.
The need for welfare facilities where family members can gather, the development of a home-based welfare system from a community-based perspective, and the training of male and female care and welfare specialists (i.e. we call them as ‘social care workers’ as leaders of specialist for the young genelations in not only medical and nursing systems but also community health systems for SDGs) from a gender-free perspective. It will be an inevitable issue for social development and real quality of life society- we call it ‘inclusive society’ in general.
I consider that strengthening peace education by the elderly as war-experienced people will lead to the development of true gerontology by integrating the fields of peace, welfare and education, and will lead to the true development of regional peacebuilding. In order to solve the "social problem of Vietnamese technical intern trainees", which is now a big social problem, Japanese people now are pursued to reconsider that Vietnamese social welfare are based on the values of families, community and the history of the American War. I would like to conclude that learning the true meaning of them are required.
The future goal of my research and practice is to conclude a human resources exchange agreement with Hue city and Kashihara-city, where we will create a future ‘Hospice’ (i.e. an integrated facility for end-of-life medical care and welfare) in Hue city. To that end, Hue's Medical College of Hue University and ASCA will act as an intermediary to conclude a collaborative cooperation agreement between the two cities. If this project is successful, it will undoubtedly be a model for Vietnam's future home-based welfare policies for aged people and real peace building for all the generations.
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(*) Visiting Scholar of. Sociology and Social Development & Social Work, Vietnam-Japan University (VJU), Hanoi, Vietnam; Chair-person of NPO ASCA (Asian Social Care for Aged and Disabled), Nara Japan; Senior adviser of Institute of Peace Study and Education, Kyoto Museum for World Peace; Ritsumeikan University, Kyoto, Japan.
References
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