Friday, August 13, 2010

What the “111 Year Old” Mummy Doesn’t Tell Us

As I have stepped up my professional tracking of Japanese issues overall, I have been paying less attention to overseas media coverage of those same matters. I have been doing much less blogging and consequently have not been taking up media foibles. Just too distracted. But the missing centenarians story was irresistible.

The macabre story of the “111 year old” Tokyoite who turned out to have been dead for some 30 years while his family continued to receive his deceased wife’s public pension payments for the last six years (some English-language reports claim that they were receiving his pension payments but one Japanese story has some details that contradict this take) quickly morphed into a much bigger story about handwringing over social neglect and government incompetence as a search for the “oldest” Tokyo resident, a “113 year old” woman, ended at an empty fenced-in lot. By the end of the August 5 workday, a nationwide effort to track down the 40,399 centenarians living in Japan had uncovered 71 missing individuals. This CNN video clip picked up on the social angle—the deterioration of family and neighborhood ties—while this WaPo report carried a touch of both. But the numbers fail to tell us anything of the sort. There’s some truth to the incompetence angle, but not much. Let me explain.

The final national numbers are not in, but the city of Osaka, with 809 residents on its registries* who are or will be centenarians as of September 15**, give us a fair-sized sample. Of the 809, the Osaka municipal government decided to check on the 108 who had not received Long-Term Care Insurance benefits during the last two years, which they properly considered good cause for suspecting that those individuals may no longer resided at their places of registry, and wound up failing to locate 64, of whom 19 were foreign nationals. Now does that mean that Osaka failed to keep track of 64 out of 108, or 59.3%, of its centenarians? But that assumes that a similar proportion of the remaining 701 would, if nothing goes corrected, be suffering the same fate as the missing 64. It seems far-fetched that these 200 year old residents (give or take a couple) who left tracks in the national healthcare system in the last couple of years will somehow go missing as they move to another municipality or to that Big Nursing Home in the sky without the fact being duly recorded in the Osaka registries. Is the ultimate leakage then more like 64 out of 809, or 7.9%? Not so. Remember that there were a lot more of their age cohorts when they came into this world. That means that most of their age cohorts in Osaka had their deaths or relocations duly registered in the municipal records. To save hours of time tracking down the actual numbers, let’s take the available most recent number of Osaka newborns, 22,892 in 2007 as a surrogate. Is 0.28% (64 over 22,892) still unacceptably high? Perhaps. But this is patently wrong. The oldest missing Osaka centenarian clocked in at 127. So the fail rate for the system is actually 64 over 22,892x(27+1), or, 0.01%. And we are not accounting for the over-127 crowd, who apparently managed to be captured by the registry system on their way out, so to speak.

Are we there yet? Not quite, for there’s an interesting twist to the Osaka numbers. 45 out of the 64 missing centenarians are registered in Nishinari Ward. This should ring a bell for any self-respecting Japanese journalist, for Nishinari Ward represents the fringes of the post-WW II Japanese economy. Specifically, like Sanya, its Tokyo counterpart, it served as the place where day laborers and welfare recipients congregated in crowded, often unsanitary hostels. It was exactly the kind of place where down-and-out forty-, fifty-, sixty somethings who had lost their connections with family and friends back in the day, smack dab in the age group where people who would show up as missing centenarians today would show up. Take them out as mostly a local phenomenon and we are down to 0.03% for the percentage of the Osaka population.

But that’s not end of it. It is unlikely that the 45 Nishinarians, given their harsh living conditions, had survived nearly to the end of their first century, let alone beyond it. (For example, lethal tuberculosis thrived long after it had been brought under control in the rest of Japan.) More likely, they must have died and slipped unnoticed through the cracks in the underbelly of the registry system decades ago. Ironically, the municipal welfare authorities became aware of 48 (out of the 64) missing Osakites, including the 45 Nishinarians, when they conducted a survey when the national Long-Term Care Insurance system was launched in 2000. However, they had failed to notify the registry authorities of the fact. Embarrassing? Certainly. Administrative malfeasance? Surely. But not exactly the kind of administrative neglect towards the elderly that the reports suggest.

Going back to the social angle, the “111 year old” mummy had been in the family for over 30 years. The Nishinari examples suggest that many if not most of the other cases also go back decades. If something went wrong in Japan, it happened a long time ago. And Japanese society (and local bureaucracies) still cares enough that almost all deaths—at least in contrast to what the media reporting suggests—go duly recorded in the public records. Note also that the daughter of the “113 year old” woman had continued paying her mother’s national healthcare insurance premiums in the hopes that she would some day return.

Now I happen to suspect that there is something to be said for the conventional wisdom about the fading of family and neighborhood connections in Japan. But it is not supported by the issue of the missing centenarians. The best media stories use facts to illuminate; too often, they merely illustrate. In this case, they actually mislead.
* There are two types of residency registries in Japan, one for Japanese and another for foreigners. They are administered by cities, townships, villages and, in the case of the major cities, wards. The two sets will be merged no later than 15 July 2012.

** I don’t know why Osaka picked this date. The national census opts for zero hour October 1.

5 comments:

Janne Morén said...

You could ask why the government would need to keep tab of the elderly in particular. After all, it's not like you're incapacitated just because you're getting old, and old people aren't the only ones dropping off the radar either. As you say, many of these "missing elderly" actually went missing when in their middle ages.

What seems to be missing is really mostly routines for communication between government agencies. A number of these missing people were reported to the police decades ago, but that information was never passed on to other authorities.

Jun Okumura said...

Janne:

The government does need to keep tabs on people drawing public pensions if only to make sure that their families don’t pull the Dead Souls trick. And a survey had to be conducted at the inauguration of the Long-Term Care Insurance system if only to alert potential recipients of the benefits. (It’s telling that the 45 missing Nishinarians were detected in an LTCI check.) For the most part, the bits and pieces of the municipal bureaucracy did do their jobs, but you’re right, there obviously wasn’t a well-oiled system in place to connect them. (Which is why I felt the transgression was minor. No individual was being hurt by the lapse.) The left hand needs to know what the right hand is doing. Solution? IT. Which puts the ball in your court.

Janne Morén said...

In the "grandpa is decomposing in the attic"-cases there's no obvious systemic problem; the families are committing a crime by not reporting a death, of course. I can honestly not think of a good way to check for this that would also not be rather intrusive for the vast majority of people who are not busy rotting away at hteir former homes

Relatives that draw the pension of a lost or deceased relative are committing fraud. You don't really need any major legal or procedural changes; just asking for people to show up in person (or arrange for a city employee to come by if bedridden) once a year to renew the application info would likely prevent 99% of these cases. Most seem to be simple "crimes" of opportunity or omission after all.

For those that actually disappeared - well, that needs a good national debate on whether it's legally OK to disappear (after all, courts have struck down attempts by homeless people to register addresses where they live, indicating that formal disappearance is not only allowed but mandatory in some cases); whether the nations interest to track citizens trump the wishes of citizens that simply don't want to be tracked; and so on.

It's not a technical issue but a social and cultural one. The last people to weigh in on it should be those - like me - who are wielding a hammer seemingly perfectly fit for that particular nail.

Anonymous said...

The reason for September 15th is simple. It's Respect for the Elderly Day(敬老の日).

Jun Okumura said...

Janne:

I agree with you for the most part, but there is a legitimate place for non-intrusive information technology in all of this. Specifically, a checklist that a) must be filled out before a report can be filed and b) triggers automatic notifications to the relevant sections of the government for appropriate action would be a useful supplement to manuals and rules of procedure. With that, let me add some thoughts on around the integrity of the municipal registry.

A municipal government obviously has a legitimate interest in knowing whether or not a person actually lives at the address where he is registered since significant revenue and expenditures are directly affected by the population within its jurisdiction. Normally, this is not a problem since the registry system is self-policing; most of the relevant municipal services require registration. The pension system is a problem because cash is fungible, unlike, say attending a public kindergarten. You don’t have to be that specific person to partake of it. The cause for misappropriation may not be something nearly as sinister as homicide or macabre as the decomposing/mummifying grandpa; more likely would be, say, a spouse or parent moving out without telling the family his/her whereabouts. So requiring recipients to show up once a year to prove their existence—which, by the way, calls for a foolproof photo ID system—sounds like a good idea. There will remain, though, people who are unable to show up for health reasons physical and/or mental. So a municipal government worker goes to take a look and the family might claims He/She doesn’t want to see anybody. There’s a need for effective procedures to deal with this problem, because that’s exactly what reportedly happens sometimes when municipal government workers make a house call. That’s probably useful in avoiding physical abuse of the elderly and the otherwise impaired. At some point, society cannot continue to rely solely on the volition of the individual or the goodwill of the immediate family. We are seeing this most obviously in the recent reports on child abuse.

And thanks, Anonymous.