At first glance, it would seem that the Republic of Singapore – a sovereign city-state and island country in Southeast Asia lying at the southern tip of the Malay Peninsula with only 130 square kilometers whose main religion is Buddhism – has nothing in common with Israel, which covers 20,330 square kilometers and is located 8,000 kilometers away.
Singapore won its independence only in 1965 and enjoys the world’s third-highest per-capita gross national product and is the third-largest oil refining and trading center. It has only 5.6 million residents, 39% of whom are foreign nationals (including about 10,000 Jews). But despite these and many other differences and the geographical distance between them, Israel and Singapore are very involved with each other.
A great deal of initial support for the Asian land came from Israel, a country that is not recognized by the neighboring Muslim-majority nations of Malaysia, Indonesia, or Brunei. Like Israel, Singapore is surrounded by enemy countries, and the main worry after independence was an invasion by Malaysia.
The Singapore Armed Forces was created after independence with help from the Israel Defense Forces; Singapore still maintains strong security ties with Israel.
But the reason that a Singaporean expert was invited to Jerusalem to speak on that country’s aging population at a recent roundtable discussion organized by the Israel-Asia Center at the Taub Center for Social Policy Studies in Israel is that both realize they are unprepared for coping with the aging of their populations.
The median age of Singapore’s residents is nearly 41 years – old compared to Israel’s 30-year median. Israel’s fertility rate is much higher – 3.11 children per woman compared with a worrisome 0.80 in Singapore that is well below the 2.1 children needed to replace the population when they pass away – hence the government’s encouragement of foreigners to immigrate to the island. Life expectancy in Singapore is 80 for males and 85 for females, placing the country 4th in the world for life expectancy. Israel is ranked eighth in life expectancy, with a very similar 80.6 years for men and 84.3 years for women.
The guest at the Taub Center’s beautifully restored stone-faced building in the capital’s Ha’ari Street was Christopher Gee, who heads the governance and economy department at Singapore National University’s School of Public Policy. He has for years conducted research on the policy implications and outcomes of his country’s aging population, specifically relating to old-age income support and managing healthcare costs.
Speaking on behalf of Israel at the roundtable – Building a National Plan for Israel’s Aging Preparedness: Lessons from Singapore” – was Prof. Yitzhak Brick, chairman of the Israel Gerontological Society, who is also an adviser to a special committee of Israel’s Knesset (headed by Knesset Member Tali Ploskov) on preparing a national plan for Israel’s aging population. Chairing the three-hour session was Prof. Dov Chernichovsky, a veteran health economist and senior researcher and health policy program chairman at Taub.
Israel’s over-70 population is expected to double by the year 2035. There are almost one million Israelis over the age over 65; this will swell to 1.66 million in 16 years. Responsibility for caring for the aged is spread out over numerous government and other bodies, and there is no publicly funded long-term care for the sick and disabled elderly.
Brick said that the special Knesset committee on aging worked intensively to write recommendations on numerous aspects of the problem, but these did not include how to cope with the financial costs. It published an interim report, but the planned Knesset elections on April 9, 2019 have brought everything to a halt. Thus a national plan is still waiting in the wings.
“We need comprehensive look at all issues related to aging, such as poverty, retirement age, employment, community long-term care, primary care givers, loneliness, integration and coordination of services, abuse and neglect, health, social welfare, public housing and the independent elderly,” Brick continued. Sadly, some 168,000 Israeli elderly – or 21% – live under the poverty line; 19% suffer from food; and 24% have to decide whether to buy food or pay for medications or heating in the house. Social Security allotments to the elderly aqer meager, and many elderly persons just above the poverty line don’t get many benefits of those below, so there are actually 300,000 Israeli elderly living in poverty. It would cost billions of shekels annually to fix the situation.
Brick urged the establishment of a single ministry for senior citizens to coordinate services on the national level and a single unit in each city or town on the local level, with all personnel and budgets moved to the new entities. “But we were told that it is nearly impossible politically.” Everyone wants to protect his own responsibilities, authority and budget.need one ministry for all this, for senior citizens, and need one local unit
The official Israeli retirement age is 67, but many seniors want to continue working in the same or in a different place, full or part time. “Most people at 67 are well physically and mentally, with a lot of experience that the country loses when they retire,” Brick asserted.
Gee adopted the Hebrew slang word balagan (meaning “mess” or “chaos”) to describe some of the problems regarding aging in his country.” In 1950, both our societies were very young. Ours is now the second-fasting aging population, and we have low fertility rates. We will be a super-aging society in 2050.” With the low share of young people (many couples have few children or even none), it will be a drag on the economic growth rate, as there will be too-few young people to work and support the elderly.
The Singaporean expert said his country produced various reports on aging since the 1980s and that the latest action plan of 2016 deals with
Employability, senior volunteering, health and wellness, social engagement and inclusion, housing, aged care services, transport, research on aging and public spaces friendly to seniors, among others.
While Singapore has very few nursing home beds for the elderly per capita (many fewer than in Israel), 84% of the whole population live in their own apartments – purchased from the government at a low price that they can hand down to their children and that can be held for a total of 99 years. It also has a great shortage in healthcare workers for the elderly – tens of thousands of them. Some old-age homes are high-rise buildings with 2,000 residents; they even have kindergartens for children on lower floors.
The main principle of the social support system is that “you are responsible for yourself. Your accumulated pensions and savings are there from your working life,” said Gee. “The family is first line of social support if you can’t provide for yourself. The provider of last resort is the community and the government. As in Israel., we have a balagan from too many government bodies, enablers, social service agencies, grants and grant makers, donors and volunteers; we have to sort this out.”
The Singapore government’s healthcare system is based upon the “3M” framework with three components: Medifund, which provides a safety net for those not able to otherwise afford healthcare; Medisave, a compulsory national medical savings account system covering about 85% of the population; and Medishield, a government-funded health insurance program for the very poor and sick. “But we need to strengthen community and home care, have better savings options, help healthy senior citizens to continue working and caring for each other.”
Prof. Shlomo Mor-Yosef, a physician who was head of the Hadassah Medical Organization for over a decade and head of the National Insurance Institute spoke from the audience. “Our two cultures are very different. Individual responsibility must begin at 20. People have to prepare themselves by saving and buying insurance. We have to adopt in our culture the notion that it is the responsibility not only of the government but also the individual. If universal public housing were available to those who can’t buy privately, it would be a different ballgame; every senior citizen would have an affordable place to live.”
Unfortunately, concluded Mor-Yosef, nobody in the current election campaign is discussing the problems of the elderly. So a national plan for the elderly is vital. The Knesset committee recommendations are only the first step.”
Both Singapore and Israel have a long way to go to solve the massive problem of coping with the growing mass of elderly – but at least they are now considering it seriously.