“By nature,” Confucius said, “men are pretty much alike; it is learning and practice that set them apart.” But it is no less true that in old age, people once again become more and more alike. Educational and career attainments do nothing to prevent the body and mind from eventually running down: breath is shorter, vision and muscles weaken, bones become brittle, memory clouds, susceptibility to disease increases. Such changes are imperceptibly gradual. But one day, perhaps after a climbing a flight of stairs or lifting a grandchild for a hug, comes the shocking realization—“I'm old.”
But that shock can be considerably lessened with better planning and decision-making. Preparation for the so-called retirement years as senior citizens is no less important than the choices made decades earlier regarding schooling and career. And, like these earlier decisions, individuals do not stand alone. Academic achievement, for instance, is a product not only of personal study, but also of a positive educational environment. This is provided by family encouragement and finances, public schools supported by taxpayers, and educational subsidies from government and private donors.
Similarly, families, society, and the government all have supporting roles to play in promoting a positive public health environment. Individual choices about smoking, drinking, exercise, and eating habits are influenced by how well families and schools teach personal hygiene, first aid, and the basics of public health and safety. And long-term health depends heavily upon government provision and regulation of professional health care facilities. The wisdom with which such roles are fulfilled says a great deal about the overall quality of life in any society.
In Taiwan, the status of public health is shifting toward higher standards. The majority of Taiwan's senior citizens, for example, recently had their health care worries reduced by a new national health insurance plan, initiated in March. Most senior citizens now have at least some measure of basic coverage, although the health care environment still has many blind spots and shortcomings. Among the these are inadequate rehabilitation staff and facilities for stroke victims, and a serious shortage of private groups that target specific diseases or disorders (such as arthritis) and provide emotional support for sufferers and their families, as well as the latest information on medication, diet, and exercise.
But as health care improves in Taiwan, its scope also needs to expand into areas formerly neglected. Take, for instance, health education for senior citizens and their families. Accurate and timely information can help prevent injuries and forestall diseases. Falls and bums become common and worrisome problems for senior citizens as their muscles and coordination weaken. Although commercial products, such as special handles, grips, and seats for the bathroom, kitchen, and bedroom are readily available in the United States, these are difficult to find in Taiwan---even though many are manufactured here for the U.S. market. People need to know about the existence and value of such items. Similarly, products to help arthritics unscrew bottles, open doors, and support painful joints have long been on the market overseas, but cannot be readily found here, reducing the quality of life for unnumbered people.
Moreover, diseases common among older citizens, such as diabetes, cancer, and heart disorders, have well-defined early warning signs that individuals and their families can watch for---but only if they know what they are. To date, the dissemination of such information has been wholly insufficient. People also need to recognize the early symptoms of mental disorders that may afflict aging people, problems that in the past have often been ignored or downplayed because families, in fear of losing face, refuse to admit that their relatives have such difficulties. Such ignorance brings only pain to the sufferers and those around them. Correcting such shortfalls is the responsibility not only of government agencies, but also health-related civic organizations and businesses in the private sector.
Yet adequate health care, health education, and health-related products are only a part of what constitutes overall quality of life for older people. For instance, ask senior citizens in Taiwan what frustrates them most about their lifestyle, and “fear of movement” is likely to be high on the list. Whether “oldness” comes at sixty-five, seventy, or eighty, a common source of this self-perception is a sudden restriction on movement. Weakened muscles, a broken hip, arthritic joints, occasional dizziness, or some other problem suddenly makes life much more difficult. Why?
Taiwan, in cities and in the countryside, is no longer a user-friendly place, especially if people are unsure on their feet. Modernization has brought the age of the motor vehicle. Thus, walking on the sidewalks---or, more typically, along streets and alleys because sidewalks don't exist---is increasingly dangerous. Cars, buses, and trucks now rule the roadways, and motorcycles, both parked and in motion, occupy sidewalk space. People in wheelchairs or using walkers don't have a chance. For other senior citizens, a stroll down the block can be as complicated and dangerous as it is for an unaccompanied three-year-old. Vehicles zip by only inches from elbows, and a sudden stop, turn, or wobble can mean injury or worse.
Complaints about traffic problems, unmaneuverable sidewalks, and the gross shortage of public parks and other places to walk and relax out-of-doors are legion these days. But senior citizens have a right to be even more vehement in their criticism. Younger people need to be reminded that until they solve such problems, a host of their elders are trapped in their homes by fear. Prolonged confinement, with a television set as the primary comfort, is no way to end one's years. While a solid public health system includes a broad range of health care services for the ill and disabled, it must also encompass the broader quality-of-life issues embedded in the environment. Today's taxpayers and lawmakers have every reason to adopt this wider view of public health. After all, the problems they solve today will have no small impact on the quality of their own retirement years.