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ASEAN is getting older, fast. In this episode of ASEAN KITA, we speak with Director of Malaysian Research Institute on Ageing Assoc. Prof. Dr. Rahimah Ibrahim on what the region and Malaysia must do to prepare for a greyer future. From pensions to public transport, are we ready to age with dignity?
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00:00Hi, good morning. I'm Amir Raiman and you're watching ASEAN Kita, a show where we explore the stories, challenges and opportunities that lies within the region.
00:15Across Southeast Asia, the population is ageing faster than many policymakers expected. Fertility rates are falling, life expectancy is rising and by 2035, nearly 1 in 5 people in ASEAN will be over 60.
00:31But how prepared are we? Who bears the cost and what does ageing mean, not just for healthcare but for jobs, pensions, urban designs and perhaps even technology adoption?
00:43Today, we're asking what it truly takes to age well as a region and whether ASEAN is moving fast enough.
00:50Joining us this morning is Associate Professor Dr Rahima Ibrahim, Director of Malaysian Research Institute on Ageing.
00:57Dr Rahima, thank you for being with us. Let's get right into it.
01:01What are the clearest signs that Southeast Asia is no longer a young region? Are we already seeing the shift in population structures across countries?
01:11All right. Okay. So imagine pressing twice the speed on a video. In 2000, only 5% of ASEAN citizens were over 65. Today, it's almost 10%.
01:24Singapore has already hit 18% and Thailand hovers around 14 to 15%.
01:31The number of working age residents supporting each senior in Singapore has collapsed from about 10 to 3.5 in one generation.
01:42The youth bonus is ending for some members, even while it is just opening for others.
01:49So the key message is our demographic clock is ticking faster than our policy clock.
01:55So we need actions and we need it fast.
01:58And Prof, and Dr, why have fertility rates dropped so sharply in some ASEAN countries while staying high in others?
02:07And how might this different path affect the region's workforce in perhaps the next 20 years?
02:14So think of it as two traffic lanes.
02:19So we have one with ultra-low lane due to housing costs, later marriages and women's careers.
02:27And these social changes have pushed fertility to 0.97 in Singapore and roughly about 0.9 to 1% in Thailand.
02:40So we have another lane, which is the moderate lane.
02:43This is due to rural livelihoods and also faith-based norms that keep the Philippines at 1.9% and also allow around 2.4%.
02:55Sorry, 1.9 and 2.4 in terms of the total fertility.
03:02And Dr, as the number of retirees rises and working age population shrink, who's most likely to bear the financial burden?
03:10Is it governments or families or maybe businesses and why?
03:14So when we talk about this, it's always the current workforce.
03:19It's just a question of how.
03:21So we need a three-port system.
03:24The first is the true mandatory savings like EPF or CPF.
03:29Second port is the small payroll levy earmarked for long-term care.
03:36Thailand is currently drafting one at roughly 0.3 to 0.35% of their wages.
03:43And the third port is the tax-financed basic pension so that no elder slips through the cracks.
03:52So the risk has to move from our living room to the nation.
03:58And when a country crosses that 14% threshold of people age 65 and above,
04:05what are the first signs of stress on the healthcare system?
04:08And how can early prevention efforts help manage the rising costs?
04:14So countries typically add about one extra percent of GDP to health and care within a decade of crossing that line,
04:24largely due to chronic disease and frailty.
04:28Yet South Korea, between 2019 to 2022,
04:34the pilot and integrated care which links hospital discharge to home nurses and social workers.
04:42And this pilot has shown that it can cut avoidable admissions by 12%.
04:49So Singapore also did another program on GrabBar retrofits that costs about US $120 per home.
05:01But this pilot could, was shown to avert US $5,000 hip fracture bill.
05:10So the key message is that early prevention beats large later stage hospital costs always.
05:18And perhaps have we seen examples of cities in ASEAN that have successfully made their transport,
05:27housing or perhaps public spaces more age-friendly?
05:30Who led or funded the efforts, Dr. O?
05:33And could they be replicated in also less wealthy cities in the region?
05:38Okay, so I will discuss, I think, about three examples.
05:47The first one is in Singapore.
05:50The government funds upgraded lifts and friendly streets.
05:54And the program covered 4,000, over 4,000, sorry, 400,000 flats, which now have direct lift access.
06:04And then in Thailand, a 2% syntax health fund plus tourism levies poured into low-cost concrete ramps and tactile parts.
06:18So, and then they have, they hire volunteers to upkeep the facilities.
06:26And here in Malaysia, in Penang Island, you know, the City Council and NGO work neighborhoods with older residents
06:37and they map hazards and fixing each area for under 40,000 ringgit.
06:43So, start with paying benches and lighting before chasing big budgets.
06:49And perhaps, Dr, if in your perspective, in your point of view, what was the biggest obstacle
06:55or what could be the biggest obstacle in implementing this urban-friendly,
07:00which is more age-friendly to those who are ageing?
07:05And then what was the biggest obstacle?
07:07Is it funding?
07:08Is it bureaucracy in rolling out this age-friendly upgrades?
07:14So, age-friendly, you know, it's just another framework.
07:22And many countries or even state governments, they follow different,
07:28they have their own state initiatives or state framework.
07:34So, sometimes these, these kinds of age-friendly initiatives get, you know, overlooked
07:41or they are not funded by any of the existing initiatives, you know, like Smart City or, you know, Safe City.
07:50So, there are too many programs around that it could be competing, you know,
07:57it could be seen as a competing priorities and also resources.
08:03But actually, you can align all these initiatives to make it more coherent and coordinated.
08:11And in your view, who are the most vulnerable groups among older adults in ASEAN?
08:18We have women, we have person with disability.
08:21And what should we be done to make sure that social protection system do not leave them behind, doctor?
08:28So, the most vulnerable would be, you know, women over 75, rural or informal sector retirees,
08:40frail or disabled elders and anyone living alone, especially migrants and indigenous seniors.
08:45So, the key message is that we should give everyone a social protection floor and target extra help to the frailist.
08:55And also, ASEAN often looks to Japan and South Korea for policy inspiration.
09:02What lesson from their long-term care or perhaps community health models might actually work here
09:08and which one wouldn't translate well?
09:11Okay.
09:12For Japan, Japan's experience shows that the power of predictable funding and professional care managers,
09:22but its premiums are too heavy for rural ASEAN.
09:28For Korea, Korea has proven that linking hospitals to home and social care saves money,
09:35but you need a strong local government and broadband.
09:39So, the key message is we can copy the principle like the risk pulling plus the case management,
09:47but start lighter and scale.
09:50So, we should copy the principles but not the budget.
09:56Yeah.
09:58As you mentioned that Korea invested heavily in community health aids,
10:03perhaps what skill set would we need to replicate that kind of workforce here?
10:09Because we have been talking about Malaysia itself,
10:11we've been talking about the care economy here.
10:13So, what perhaps skill set we need to replicate it across maybe Malaysia and also ASEAN as a region?
10:21So, as a care worker or care navigator in the community,
10:25you should, like, the person should understand what it means to age.
10:32So, they need to know how a person aged and what happens to them functionally.
10:39So, what happens to a person's functional status when, as we age.
10:46That can include with or without any chronic diseases and what happens to their functional status
10:54and their social participation in the community.
10:58And other than that, you need to understand how best to support older adults in the community.
11:05Learning skills such as supporting with personal care, communication,
11:11helping with medication management,
11:16supporting with the skill set that will be useful for a care aide or a care worker in the community.
11:29And if, Doctor, if we fast forward to 2035,
11:34what would be your personal benchmark for judging ASEAN's success in handling ageing?
11:39And why does that single metric matters to you the most?
11:43My personal metric would be healthy life expectancy at age 60 or hail 60.
11:49Because today, Southeast Asia averages about 13.7 healthy years after 60.
11:56So, if every ASEAN member reaches 16 years or more by 2035,
12:01and we keep total health spending under 8% of GDP,
12:06we will give older people nearly three extra good years and protect their national budgets.
12:13So, we want more healthy years, not just more years.
12:17So, this is the real victory lap.
12:18Well, there's still a lot to unpack on ASEAN, on ASEAN kita,
12:23on how ASEAN can prepare itself for an ageing region
12:26with our guest, Associate Professor Dr. Rahima Ibrahim,
12:29Director of Malaysian Research Institute on Ageing.
12:32But we'll take a short break and we'll be right back after this.
12:35Welcome back on ASEAN Kita.
12:53On today's episode, we're discussing on how ASEAN can prepare itself for an ageing region
12:57with our guest, Associate Professor Dr. Rahima Ibrahim,
13:01Director of Malaysian Research Institute on Ageing.
13:03Now, the first block, we focus on ASEAN.
13:05The second block, we want to focus a bit more on Malaysia
13:08as we are the chairman of ASEAN 2025.
13:11But how can we as a nation lead by example?
13:14Dr. Malaysia is expected to hit ageing nation status by 2030.
13:19How ready is our existing pension pillars?
13:23How ready are we in terms of EPF, in terms of public service pension,
13:27to support much larger retiree base?
13:31Okay, so in Malaysia, we already crossed the UN Ageing Society threshold
13:40and which says that 7.7% of the population now age 65 and above,
13:48approximately 0.6 million people 65 and above right now,
13:53up from 7.4% just a year earlier.
13:59So, at the same time, our social welfare outlays are rising.
14:04The Bantuan Wagakmas monthly cash benefits was raised from $600 in budget 2025,
14:11a 20% jump in a single year.
14:15Health spending has also climbed to 6.5% of GDP in 2022,
14:20yet none of that is earmarked for long-term care, specifically.
14:28So, we are not ready in terms of the systems for long-term care
14:37and that the population will need with rising age.
14:46You mentioned that we are not ready in terms of ageing,
14:50of course, we are an ageing nation status by 2030.
14:53But what specific reform of perhaps higher contribution rates
14:58of a universal basic pension or perhaps a flexible retirement age
15:02should be prioritised by the government?
15:05So, Malaysia is currently a mix of modus welfare transfers
15:11and then we have fragmented regulation and high out-of-pocket spending.
15:16And these are neither equitable nor scalable.
15:20So, we need a reform on long-term care,
15:25especially on the long-term care insurance,
15:28which is a pooled social insurance scheme tied to functional need.
15:33And this can deliver a form of protection.
15:38So, these kinds of systems,
15:43the current social protection system is inadequate
15:46to cater for our longevity,
15:52the increase in our longevity.
15:55And without structural changes to our current system,
16:01we are bound to face some crisis in the future.
16:05And if I could bring you to the national health policy
16:10for older persons,
16:12it emphasises ageing in place.
16:14What practical steps?
16:16Is it home-based care subsidies
16:18or perhaps community nurses
16:20or digital health monitoring
16:22that the Ministry of Health is trying to emphasise
16:25on digitalisation
16:26can make ageing at home safe
16:29and also affordable in Malaysian suburbs
16:32and in the villages as well?
16:33Okay, so for ageing in place to happen,
16:39we need more community-based alternatives
16:42in terms of health and care.
16:45So, just imagine like if you come up
16:51from the hospital post-stroke,
16:54after a stroke,
16:55and then after you have been stabilised,
17:01you are advised to go home
17:03and suddenly there's nothing in the community
17:05that can support you
17:07to get well at home.
17:12So, families have to either purchase the services
17:16or find any family members
17:21that can help them to recuperate at home.
17:27So, without community-based care services,
17:31the ageing in place will not happen.
17:36And digitalisation is, of course,
17:42a way to improve services,
17:47but we have to also remember
17:50that not all older adults
17:52are well-versed with technology.
17:54So, digital literacy has to be deployed as well
18:00or implemented.
18:01So, classes on teaching older adults
18:04how to use smartphones
18:05and whatever apps that they need
18:08to access services
18:09must also be deployed.
18:11As you mentioned,
18:14there are a lot of steps
18:15needed to be taken
18:16before we can implement ageing in place.
18:20But also, another aspect is
18:21caregiver burnout
18:23is a term that has been raised
18:25many, many times
18:26by experts have been warned.
18:28And as caregiver burnout is rising,
18:30as families have to shoulder
18:32more responsibility,
18:33should perhaps the government
18:34or Malaysia introduce
18:35a caregiver allowance
18:37or perhaps tax relief
18:39or a paid family care leave
18:41and to ensure that
18:43caregiver burnout
18:44is not going to happen
18:45in the future
18:46as we are going to be
18:48an ageing nation
18:49by 2030, Doctor.
18:51Okay.
18:51I think we can start
18:53like from, you know,
18:55employers becoming more
18:58sensitive to the care needs
19:02and, you know,
19:04like becoming more
19:05family friendly, for example.
19:07So, knowing that care
19:09does not only happen
19:10from, you know,
19:11from parents to children,
19:12but now from children,
19:15adult children
19:15to their parents.
19:18So, employers should
19:20have this kind of mindset
19:21to support their staff
19:25who is having care
19:27responsibilities
19:29and then provide some support
19:32from the management perspective
19:35or from the employer's perspective,
19:39such as, you know,
19:41like supported leave
19:43and also getting, you know,
19:48getting some assistance
19:52assistance to carers
19:54providing care
19:56for frail
19:58of sick family members.
20:01So, what we need to understand
20:04is also that
20:05these caregivers
20:07are actually
20:08diverting their productivity
20:12from the labor force
20:14to, you know,
20:15to caring for someone
20:16at home
20:17who is requiring care.
20:20So, if we can support them,
20:21they can
20:21actually
20:23continue to be
20:25more productive,
20:26you know,
20:27if we support
20:28carers
20:29to
20:30perform their roles,
20:34you know,
20:35or to
20:36perform their responsibility.
20:40And you mentioned
20:41that employers
20:42need to be
20:43a bit more sensitive
20:44in terms of
20:45in terms of this issue.
20:46But recently,
20:48Putra Jaya has
20:48or Minister Azalina
20:50Uthman Syed
20:51has floated the idea
20:52of retirement age
20:53to be uplifted
20:55to the year 65.
20:56What do you think
20:57of the idea?
20:58How do you read
20:58into this situation?
20:59Is it a good idea
21:00or a bad idea, doctor?
21:02Okay.
21:03So,
21:04actually,
21:06we have been
21:08deliberating on,
21:12you know,
21:12upping the
21:13retirement age
21:14and
21:15every time
21:17it happens,
21:18people are not
21:18happy.
21:19Some camps
21:20are not happy
21:20because
21:21they are
21:23pros and cons
21:24to it.
21:26At my ageing,
21:28and myself
21:29personally,
21:30we believe
21:30in
21:31allowing
21:32or,
21:33you know,
21:33making it
21:34more
21:35supportive
21:38for people
21:39who wants
21:40to work
21:41or have
21:42to work,
21:43you know,
21:44because
21:45so,
21:47we should
21:47look at
21:48removing the
21:50barriers
21:50for older
21:51persons to,
21:52or senior
21:53workers to work
21:54if they want
21:55to work
21:55or they have
21:56to work.
21:57instead of
21:59upping
22:00the retirement
22:01age,
22:01we should
22:02look at,
22:03you know,
22:03removing
22:04stereotypes
22:04or
22:05structural
22:06barriers
22:07for
22:08individuals
22:09to continue
22:10working
22:10if they're
22:12able
22:13and,
22:14you know,
22:14feel useful
22:15through
22:17contributing
22:18to work.
22:19So,
22:21we should
22:23remove the
22:24stereotypes
22:25and also
22:26the
22:31barriers to
22:33employment
22:35for senior
22:37workers.
22:38And,
22:39if I could bring
22:40your attention
22:41to your own
22:42opinion piece,
22:43Doctor,
22:43in May 2025,
22:45your opinion piece,
22:46you warned that
22:46Malaysia has roughly
22:4760 geriatrician,
22:49but needs
22:5010 times
22:51that number
22:51by 2013.
22:53What specific
22:54incentive
22:55would realistically
22:56grow that
22:57pipeline,
22:58perhaps within
22:59five years
23:00down the road?
23:02Okay,
23:03so,
23:04I've been hearing
23:04from many
23:06colleagues that
23:06geriatrics
23:08is not a
23:08sexy
23:09line,
23:13you know,
23:13like people
23:14would go for
23:15cardiovascular
23:16or
23:17or even
23:19other
23:20specialties,
23:23but not
23:24geriatrics.
23:25So,
23:26we need
23:26some
23:28incentives
23:29to
23:29build
23:31this
23:31pathways
23:34or this
23:34pool of
23:36geriatricians
23:37in our country
23:38because
23:39because
23:39this
23:40specialized
23:43skills
23:44will be
23:45required
23:46in terms
23:46of
23:47looking at
23:48the overall
23:48health
23:49conditions
23:50of older
23:50adults,
23:51not just
23:51in a
23:52particular
23:53organ
23:53or in
23:54a particular
23:55setting
23:57in a
23:59particular
23:59setting
24:01or
24:01department.
24:02So,
24:03a geriatrician
24:04is someone
24:05who can do
24:05a comprehensive
24:06assessment
24:09of an
24:10older person
24:10and see
24:11what changes
24:12need to be
24:13made in terms
24:14of their
24:14medication,
24:15in terms
24:15of their
24:15treatment.
24:17And in
24:18terms of
24:18incentives,
24:20we have
24:21to
24:22make
24:24this
24:25career
24:28pathway
24:29as an
24:30attractive
24:31career
24:32path
24:33for
24:33youngsters
24:34and
24:36to
24:37make
24:37it
24:37more
24:38relevant
24:39to
24:40our
24:40society,
24:42we have
24:43to
24:43make
24:43sure
24:44to
24:44educate
24:44why we
24:45need
24:45more
24:46geriatrician,
24:47why we
24:47need
24:47more
24:47doctors
24:48who
24:48know
24:48about
24:49older
24:50adults'
24:50health
24:51conditions.
24:52So,
24:53with
24:53awareness
24:54and also
24:55with
24:55incentives
24:57because
25:00they only
25:01train
25:01sometimes
25:02a year
25:02only one
25:03geriatrician,
25:04so that's
25:05not enough.
25:06And of
25:07course,
25:08without
25:08any
25:09mechanisms
25:11to support
25:12this
25:12career
25:14path,
25:15people
25:15will
25:16run away
25:17from it.
25:19And if
25:20I could
25:21bring your
25:21attention to
25:21your last
25:22year's
25:22National
25:23Conference
25:23on
25:24Aging,
25:24you
25:25argued
25:25that
25:25the
25:25Malaysia's
25:26Health,
25:26Housing
25:27and
25:27Social
25:27Welfare
25:28Ministries
25:28are still
25:29working
25:29in silos.
25:30Perhaps
25:30if you
25:32could
25:32recommend
25:32what
25:33practical
25:33mechanism
25:34that
25:34could
25:34break
25:35those
25:35silos
25:36most
25:36effectively,
25:37doctor?
25:39Okay,
25:40so,
25:40yes,
25:40silo
25:41is not
25:41easy to
25:43break
25:43because
25:44it is
25:46what it
25:46is and
25:47people
25:47have been
25:48working
25:48in that
25:49kind
25:49of
25:50system
25:52for
25:53many,
25:53many
25:53years.
25:54So,
25:55we
25:55have to
25:56look at
25:57why
25:58breaking
25:58silos
25:59is very
25:59hard.
26:00The
26:00first one
26:01is we
26:01still have
26:02structural
26:03budget
26:04silos.
26:05So,
26:05the health
26:06and welfare
26:06budget
26:07sits in
26:07two
26:08ministries
26:08with
26:09different
26:10parliamentary
26:11committees.
26:11so,
26:13reallocating
26:15these
26:15funds
26:16means
26:16sometimes
26:17could mean
26:18losing
26:18their turf.
26:19You know?
26:21And secondly,
26:22we have
26:23legal and
26:24regulatory
26:24split.
26:26The
26:26healthcare
26:26is,
26:27our
26:28healthcare
26:28is regulated
26:29by the
26:30Private
26:30Healthcare
26:31Facilities
26:31Act,
26:32residential
26:33care,
26:34you know,
26:34or the
26:34care center
26:35by the
26:36Care Centers
26:36Act,
26:37and there
26:38isn't any
26:38law that
26:39obliges
26:40joint
26:40commissioning.
26:41So,
26:44we need
26:45a
26:46legal
26:47framework
26:47that
26:48bridge
26:50the
26:50two
26:51split,
26:54the
26:55legal
26:55and
26:55regulatory
26:56split.
26:57And also,
26:57in terms of
26:58professional
26:59and identity
26:59and the
27:01KPI
27:01culture
27:02in our
27:02ministries,
27:04so,
27:04our
27:05doctors
27:05are
27:05evaluated
27:06on
27:06medical
27:06outcomes,
27:08social
27:08officers
27:09on
27:09the
27:10cash
27:10transfer
27:11throughput,
27:11but there's
27:13no
27:13cross-disciplinary
27:15KPI
27:16because
27:18nobody
27:19measures
27:19their
27:19success.
27:21And
27:22our
27:23policymakers
27:23are still
27:24fearful that
27:26formalizing
27:27social care
27:28will let
27:29families
27:29off their
27:30hook.
27:31So,
27:32we still
27:32believe in
27:33the family
27:33will take
27:34care of
27:34their
27:35members,
27:36so,
27:38programs
27:38still
27:39are still
27:41optional
27:42and
27:42underfunded
27:43because we
27:45still believe
27:45in our
27:46family-centric
27:47norms.
27:49And on
27:50top of that,
27:51we have
27:51data silos.
27:52We don't
27:54have any
27:54data exchange
27:55between
27:56health and
27:57the social
27:58side.
27:59So,
28:00the risk
28:01stratification
28:02stops at
28:03the hospital
28:04gate.
28:06We would
28:07like to thank
28:07Associate Professor Dr. Rahimah
28:09Ibrahim, Director of
28:10Malaysian Research
28:11Institute on
28:11Ageing,
28:12on how ASEAN
28:13can prepare
28:13itself for an
28:14ageing nation.
28:15As Malaysia and the
28:16region face a
28:16demographic
28:17turning point,
28:18it's clear that
28:19how we treat
28:19our older
28:20citizens today
28:21will shape
28:22the society
28:22we become
28:23tomorrow.
28:23Thank you Dr. Rahimah
28:24for helping us
28:25better understand
28:26what it takes
28:26to age
28:26with dignity,
28:28resilience and
28:29also care.
28:30That's all the time
28:30that we have
28:31on ASEAN Kita
28:31today.
28:32I'm Amir Rahimah.
28:33Thank you for
28:33watching and
28:34see you next time
28:34on ASEAN Kita.
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