We held the Joint Congress of the 20th International
Association of Rural Health and Medicine (IARM) and the 67th Annual Meeting of
the Japanese Association of Rural Medicine (JARM) for three days from 10th to
12th October 2018 in Tokyo. The main theme of this congress was "Challenges
to community-based rural medicine in aging societies with declining productive
populations". Currently, overpopulation is one of the big problems all over
the world, but the population in developed countries is now decreasing.
Furthermore, in these countries the ratio of elderly people is becoming
greater. The birth rate seems to be lower in the households with high income. Since
globalization will spread all over the world and the income will be high even
in the developing countries, disparity of each country may decrease and world population
is thought to decrease in the next century. The problems of aging society will be
serious around the world.
In particular, Japan has the highest aging
population in the world, the percentage of people that are 65 years of age and
older is 28.1% (2018). Furthermore, even in Japan, the aging rate of rural
areas is much higher, and this causes many various problems in societies. It
was of great significance to hold this congress to discuss the problems of aging
society in Japan, and the policies and measures for the aging society must be a
good model for the other countries which could face similar issues in the future.
Through this congress, the following
problems were revealed.
In developed countries, aging and
population declines have already become a social problem.
The proportion of elderly people in rural
areas is high in developing countries as well as in the developed ones, and many
elderly and children have to be responsible for agricultural labor in
Today, the retirement age limit tends to be
raised to secure labor because of decreasing working age population.
In order to raise the retirement age, it is
necessary for elderly to keep the individual labor capacity at a high level.
Accident and trauma during agricultural
work of the elderly have not decreased.
Most elderly people have at least one chronic
disease such as hypertension.
The increase in the number of patients with
dementia has recently become a major problem as aging progresses.
From the presentations in this congress, it
was shown that health conditions of the elderly living in rural areas are worse
than those in urban areas. This is related to rural areas with low income, insufficient
educational standards, and inconvenience for receiving some medical service.
For as patients with dementia in the rural
areas, many patients cannot visit medical institutions nor receive any social services.
■ Tokyo Declaration
Based on the above problems, we have adopted
the following matters in regards to the Tokyo Declaration at this congress.
The most important thing for preventing the
threat in an aging society is that elderly people continue to be healthy and
In order to make safe labor circumstances
for elderly people, it is necessary to medically analyze physical abilities and
mental condition of elderly workers. We should consider the results in
connection with the factors in the working environment, and suggest some
Considering about the relation between occupational
safety and health from the point of view of geriatrics, we should list up jobs which
are suitable for elderly workers, and should also create safe working environments
In order to be an effective and productive
worker for elderly people, employers as well as elderly workers must continue
to learn better education and training for jobs.
We should improve the agricultural
environment in the rural areas so that aged farm workers can safely engage in
agricultural work so longer.
For agricultural workers with low income in
rural areas, we should suggest a guarantee system for the workers and urge national
and local governments to provide long term care and medical services.
We should promote to reduce the burdens of
agricultural workers, and this will be able to decrease the labor of children.
necessary to improve the infrastructure in rural areas by using not only
conventional methods but also new devices such as IT or social network. For
achievement of this, we should cooperate with private enterprises or