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APARC and Korea Program Director Gi-Wook Shin recently joined the Japan Economic Foundation (JEF) to discuss his research project "Talent Flows, Brain Hubs, and Socioeconomic Development in Asia." The conversation was published in the May/June 2023 issue of the Japan SPOTLIGHT, the online journal of JEF.

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JS: How do you see the different situations vis-Ă -vis demography among Asia-Pacific nations? Some countries like Japan are suffering from depopulation while some are seeing an increase in population. How do you assess the political and economic implications?

Shin: As you mentioned, Japan and South Korea are going through very serious demographic crises with low birth rates, aging populations, and declines in the working-age population. On the other hand, India and many countries in Southeast Asia have very young populations, and we might expect an increase in talent mobility within the Asia-Pacific region. In the past, a lot of Chinese, Indian, and Korean students came to the United States and Europe. But now more people are going to Japan and South Korea. Their level of education has improved; the quality of universities in advanced Asian countries is quite good. We should think about the policy implications of the increase in regional talent mobility in the Asia-Pacific region.

JS: For example, India and Japan are referred to as complementary because India has lots of young people and Japan does not. Would you say that if Japan expanded opportunities for immigrants, it would make the relationship between Japan and India more complementary? Of course, India-Japan relations can be discussed in the context of skilled immigrants but there is still some disagreement on the issue of immigration of unskilled immigrants.

Shin: In the past, Japan and South Korea accepted largely unskilled labor from China and Southeast Asia. This unskilled migration will continue, but at the same time, Japan and South Korea need to accept more skilled migrants. India can be a good source. It is encouraging to see more foreign students who come to Japan, for example, for college and then stay to work. However, most foreigners leave after a few years of work. If you look at Australia, in contrast, many international students go there for college, stay, and eventually naturalize as Australian citizens. One may point out that Australia is very different from Japan or South Korea, which I partially agree with. However, until the 1970s, Australia was also promoting racial homogeneity. Under their “White Australia” policy, they were accepting only white Europeans, but couldn’t sustain the economy with the low population growth. They had to open up, promoting multiculturalism. This has led to an increase in immigrants from Asia, such as from China and India. Going back to your question, Japan and India can be complementary to each other: one needs talent, the other has a strong supply of IT workers.

JS: As you have just explained, the economic implications of this depopulation could cause us a shrinking economy. We should perhaps encourage the flow of talent to supplement the stagnant economy with immigrants – but what do you think about the political implications of this declining population in terms of security concerns?

Shin: Let me give you an example from South Korea. This is a big issue for South Korea because it maintains a large military. On the one hand, there is no way to maintain the military’s current size or level due to a shrinking population but on the other hand, I don’t think you can bring immigrants into the military. It’s not like bringing immigrants into a company. Another political implication is the change in the voting landscape as the proportion of older people or senior citizens is really increasing. They tend to be more conservative, in favor of conservative parties. This may not be an issue for Japan because the Liberal Democratic Party (LDP) gets a lot of support from senior citizens anyway, but in South Korea and other countries where there is a regular change of power, this has potentially huge political implications.

JS: Looking at the possible merits of depopulation, some economists would say that of course depopulation has demerits, but it may still have some merits because individual wealth may increase. What is your perspective on this notion?

Shin: Some jobs can be replaced by robots or AI, and then not only may we not need so many people, but there may be less competition for jobs. Still, I think for any country to maintain the scale of its economy you must maintain a certain level of population. It is not only about production but also consumption. If you have a declining population then consumption will decline in tandem, which will negatively impact the economy. Japan has a fairly large population and the market may be good enough to be self-sufficient for now. But should the population become half of what it is today, then it probably may not be able to sustain the current scale of the economy. While overall you don’t want too many people, South Korea and Japan should be concerned about their declining populations.

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Depopulation is a concern shared by Japan and South Korea. Immigration of high-skilled labor could be a solution for mitigating it. In this regard, Japan SPOTLIGHT interviewed Prof. Gi-Wook Shin, who is working on a new research initiative seeking to examine the potential benefits of talent flows in the Asia-Pacific region.

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Across the world, societies are experiencing unprecedented demographic shifts as migration and aging reshape population landscapes. At the forefront of this global transformation is the Asia-Pacific region, particularly the countries of East Asia. Demographics and Innovation in the Asia-Pacific — a new book edited by APARC Director Gi-Wook Shin, Deputy Director Karen Eggleston, and Joon-Shik Park, a professor in the Department of Sociology at Hallym University in Chuncheon, Korea — provides a multidisciplinary examination of the demographic challenges facing East Asian nations and possible solutions.

At a virtual book launch held on March 2, 2021, contributing chapter authors James Feyrer, Joon-Shik Park, and Kenji Kushida joined Karen Eggleston to discuss their findings.

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Published in APARC’s in-house series, the book is the second volume resulting from APARC’s Stanford Asia-Pacific Research Innovation project. It collects the research findings of participants at the project’s third conference that was held in South Korea in June 2019.

James Liang, a research professor of economics at Peking University and a leading scholar of demographics and social studies, opened the event by situating the discussion about population structure in the context of the U.S.-China technology race. China is quickly catching up with the United States in the quality of its talent pool and the number of its labor resources. It will continue to outpace and surpass the United States in talent and innovation power in the next 10-20 years, Liang says.

China, however, is on a demographic cliff, facing severe population aging and low fertility rates. Its population of young workers aged 25-44 year-olds is projected to decline much faster and sooner than its overall population, leveling out against the labor and innovation gains the United States makes through the inflow of international talent into U.S. universities and entrepreneurial ventures. To sustain its long-term growth in labor quality and innovation, China will need higher birth rates and additional talent gains through migration, argues Liang.

James Feyrer’s book chapter examines the macroeconomic relationship between workforce demographics and aggregate productivity in Asia. Feyrer confirms that the high-income Asian nations like Japan and Korea, and even some middle-income countries of the region, will no longer enjoy a “demographic dividend” boosting aggregate productivity. However, he finds that the negative consequences of shifting to an older population structure may be less severe than previously projected, and even weakening with time. Feyrer believes this may be a result of improved food security and better overall health experienced by old cohorts in childhood, reinforcing the long-reaching impacts of healthcare on societal well-being.

Joon-Shik Park focused on the specific challenges facing Korean society, where birth rates have dropped severely. These historic declines continue to contribute to rising social and political unevenness across Korean society today. Initially seen most visibly in rural areas and smaller villages, Park’s now sees this unevenness affecting the dynamics of medium-sized towns and more urban areas as well. Korea and other aging societies must find viable solutions to address these issues if they are to prevent demographic divides from hobbling development and innovation, Park says.

Closing the book launch event, APARC Research scholar Kenji Kushida offers perspectives from rapidly aging Japan. where the challenges of shrinking and aging populations, rural-to-urban population distribution, and labor shortages spur advances in technology and innovation. Kushida documents this trend across multiple sectors.

He shows that drone technology has increased the productivity of short-staffed surveying firms, while AI-assisted industrial machines allow a broader range of laborers to work in manufacturing. Even in traditionally human-dominated environments like nursing homes, staff increasingly use robots to help improve the physical and mental well-being of elderly patients. Rather than strictly retarding growth, Kushida makes the case that demographic challenges serve as a catalyst for the development and implementation of new technologies.

As the research collected in Demographics and Innovation in the Asia-Pacific demonstrates, the challenges facing aging Asian societies are complex, but there is reason to look to the future with optimism. As the editors of the volume state in their introduction to the book, “Few concepts are as critical for sustained improvement in living standards as innovation.” New technologies and solutions will be foundational to addressing the challenges of the new demographic frontiers many societies are now approaching.

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Contributing authors to the new volume 'Demographics and Innovation in the Asia-Pacific' convened for a virtual book launch and discussion of the challenges facing aging societies in East Asia and the roles technology and innovation may play in rebalancing them.

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Book cover showing a robotic hand holding an older human hand.

Demographic transition, along with the economic and geopolitical re-emergence of Asia, are two of the largest forces shaping the twenty-first century, but little is known about the implications for innovation. The countries of East Asia have some of the oldest age structures on the planet: between now and 2050, the population that is age 65 and older will increase to more than one in four Chinese, and to more than one in three Japanese and Koreans. Other economies with younger populations, like India, face the challenge of fully harnessing the “demographic dividend” from large cohorts in the working ages.

This book delves into how such demographic changes shape the supply of innovation and the demand for specific kinds of innovation in the Asia-Pacific. Social scientists from Asia and the United States offer multidisciplinary perspectives from economics, demography, political science, sociology, and public policy; topics range from the macroeconomic effects of population age structure, to the microeconomics of technology and the labor force, to the broader implications for human well-being. Contributors analyze how demography shapes productivity and the labor supply of older workers, as well as explore the aging population as consumers of technologies and drivers of innovations to meet their own needs, as well as the political economy of spatial development, agglomeration economies, urban-rural contrasts, and differential geographies of aging.

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Karen Eggleston
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Gi-Wook Shin
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Shorenstein APARC
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978-1-931368-63-6
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Noa Ronkin
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Technological progress boosts productivity and has made societies wealthier, but the impact of new digital technologies could be different from anything seen before. Some experts predict a future with robots and other forms of automation increasingly replacing workers, contributing to stagnant income, and worsening inequality. Yet it is difficult to pinpoint the net impact of advanced technologies on labor. There is anecdotal evidence that robotics and automation reduce manufacturing employment and wages, but evidence from the service sector remains scant. Collaborative research by APARC experts is now starting to fill this gap.

The researchers — including Karen Eggleston, APARC deputy director and director of the Asia Health Policy Program (AHPP), Yong Suk Lee, the deputy director of the Korea Program, and University of Tokyo health economist Toshiaki Iizuka, a former AHPP visiting scholar — set out to probe the impact of robots on services provided in nursing homes in Japan. Their study, one of the first investigations of service sector robots, offers an offset to the dystopian predictions of robot job replacement.

Published by the National Bureau of Economic Research, the study suggests that robot adoption has increased employment opportunities for non-regular care workers, helped mitigate the turnover problem that plagues nursing homes, and provided greater flexibility for workers. It is also published in AHPP's working paper series and is part of a broader research project by Eggleston, Lee, and Iizuka, that explores the impact of robots on nursing home care in Japan and the implications of robotic technologies adoption in aging societies.

Since we are currently still in the early phase of robot diffusion in the service sector, researchers and policymakers need to continue to monitor and assess the extent to which robots complement or augment some types of labor while substituting for others.
Eggleston, Lee, and Iizuka

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Japan has been on the front lines of a demographic crisis, grappling with a declining overall population, increasing proportion of seniors, and aversion to large-scale immigration. It has also been an early adopter of robots to address the shortage of care workers relative to a growing demand for long-term care services. Japan’s experience is especially instructive as more countries face aging populations, helping shed light on how demographics interact with new automation technologies.

In a VoxEU.org article, Eggleston, Lee, and Iizuka describe their study, its findings, and its implications. Examining the relationship between robot adoption and nursing home staffing in Japan, they find that robot-adopting nursing homes had between 3% and 8% more staff than their non-adopting counterparts. The increases in staffing occurred entirely among the non-regular employees. Nursing homes with robots also appeared to have higher management quality and were better able to reduce the burden on care workers. The results suggest “that the wave of technologies that inspires fear in many countries could help remedy the social and economic challenges posed by population aging in others.”

The Financial Times Magazine has recently featured the study by Eggleston, Lee, and Iizuka, calling it “groundbreaking in several ways but perhaps most clearly for setting its sights not on manufacturing but on the services sector, where robots are only just beginning to make their mark.” The great value of the study, the article notes, is that it lays the foundation for an empirical debate “on a subject that will be deluged with human emotion as robots continue their march into the services sector.”

You can also listen to a Financial Times podcast that features the new study (the segment starts at 4:52).

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In one of the first studies of service sector robotics, APARC scholars examine the impacts of robots on nursing homes in Japan. They find that robot adoption may not be detrimental to labor and may help address the challenges of rapidly aging societies.

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Shorenstein APARC's annual overview for the academic year 2019-20 is now available.

Learn about the research, events, and publications produced by the Center's programs over the last twelve months. Feature sections look at how APARC has continued its mission amid COVID-19 restrictions and how our research has been adapted to factor in the impact of the pandemic. Learn about new talent at the Center, including new leadership of the Japan Program and an enhanced focus on South Asia research. Catch up on the Center's policy work, education initiatives, events, and outreach.

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Friction between machines and humans has existed since the beginning of the automated industry and machine-assisted work. It’s a trend that fuels the imaginations of pop culture and political debates alike as people voice worries about the roles increasingly sophisticated robots and technology are taking in society and workplaces.

But is this concern warranted? According to APARC’s Yong Suk Lee, the deputy director of the Korea Program and the SK Center Fellow at FSI, and Karen Eggleston, the deputy director of APARC and the director of the Asia Health Policy Program, perhaps not. A recent article published by the Stanford Institute for Human-Centered Artificial Intelligence (HAI) highlights Lee and Eggleston’s ongoing research into innovative uses of technology across industries, particularly in healthcare. Their findings indicate that the adoption of robotics ultimately does more to augment and adjust, rather than outrightly replace, the role of human labor in the workplace.

What will ultimately matter is whether there will be entirely new occupations, what economists call the ‘reinstatement effect.’ Simply saying that robots lead to permanent job reductions isn’t the end of the story.
Yong Suk Lee
Deputy Director of the Korea Program

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Lee studies the impacts of AI and robotics across multiple industries, including manufacturing, retail banking, and nursing homes. A trend he sees across most sectors following the adoption of robotics or AI is a positive increase in productivity. This has impacts for both the short-term and long-term relationships between humans and their robot coworkers, or “co-bots.” While it is true that the introduction of automation and robots initially replaces a significant number of workers in sectors such as manufacturing, over time, that impact reverses and there are job gains in many cases.

“The impact of robots often evolves over time from replacing human workers to augmenting them,” Lee explains, “and productivity gains [can] create opportunities for existing and new occupations.” This happens in a variety of ways. In some cases, the use of robotics and automation in one area frees up time, labor, and resources to employ more people in other, higher-skilled areas. In another situation, increases in productivity brought on by automation allow for greater company growth than would not have been possible otherwise. This, in turn, spurs the need to expand the workforce.

Alternatively, supplementing the labor of a small workforce with robotics and AI can also spread limited resources much farther. Lee and Eggleston’s studies of the impacts of robots on nursing home care in Japan repeatedly show that the use of robots positively increases the quality of service that oftentimes-understaffed care facilities can provide to the elderly and infirm. This can range from monitoring the physical condition of patients and reliably delivering medications to providing mental and emotional support to elderly residents through the use of robotic humanoid companions. Such innovative use of tech fills critical gaps that a human-only workforce would struggle to meet in a staffing shortage like Japan faces.

Looking to the future, Lee shares this perspective: “When the automobile was invented, we suddenly had a new demand for drivers. Now we’ll have to see if [automation] creates demand for other new occupations.” It’s an area of innovation and research he, Dr. Eggleston, and other Stanford researchers will be closely watching with their human eyes in the years to come.

Read the original article by Stanford HAI here >>

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Cover image of the book "Healthy Aging in Asia", showing a smiling elderly Chinese woman with a cane standing in a small village.
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New Book Highlights Policy Initiatives and Economic Research on Healthy Longevity Across Asia

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Yong Suk Lee and Karen Eggleston’s ongoing research into the impact of robotics and AI in different industries indicates that integrating tech into labor markets adjusts, but doesn’t replace, the long-term roles of humans and robots.

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Noa Ronkin
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The world’s population is aging at a faster rate and in larger cohorts than ever before. In countries like Japan that have low fertility rates and high life expectancy, population aging is a risk to social sustainability. Developing policies and healthcare infrastructure to support aging populations is now critical to the social, economic, and developmental wellbeing of all nations. As the COVID-19 pandemic has repeatedly shown, accurate projections of future population health status are crucial for designing sustainable healthcare services and social security systems.

Such projections necessitate models that incorporate the diverse and dynamic associations between health, economic, and social conditions among older people. However, the currently available models – known as multistate transition microsimulation models – require high-quality panel data for calibration and meaningful estimates. Now a group of researchers, including APARC Deputy Director and Asia Health Policy Program Director Karen Eggleston, has developed an alternative method that relaxes this data requirement.

In a newly published paper in Health Economics, Eggleston and her colleagues describe their study that proposes a novel approach using more readily-available data in many countries, thus promising more accurate projections of the future health and functional status of elderly and aging populations. This alternative method uses cross‐sectional representative surveys to estimate multistate‐transition contingency tables applied to Japan's population. When combined with estimated comorbidity prevalence and death record information, this method can determine the transition probabilities of health statuses among aging cohorts.

In comparing the results of their projections against a control, Eggleston and her colleagues show that traditional static models do not always accurately forecast the prevalence of some comorbid conditions such as cancer, heart disease, and stroke. While the sample sets used to test the new methodology originate in Japan, the proposed multistate transition contingency table method has important applications for aging societies worldwide. As rapid population aging becomes a global trend, the ability to produce robust forecasts of population health and functional status to guide policy is a universal need.

Read the full paper in Health Economics.

Learn more about Eggleston’s research projects >>

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Asia Health Policy Director Karen Eggleston and her colleagues unveil a multistate transition microsimulation model that produces rigorous projections of the health and functional status of older people from widely available datasets.

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Accurate future projections of population health are imperative to plan for the future healthcare needs of a rapidly aging population. Multistate‐transition microsimulation models, such as the U.S. Future Elderly Model, address this need but require high‐quality panel data for calibration. We develop an alternative method that relaxes this data requirement, using repeated cross‐sectional representative surveys to estimate multistate‐transition contingency tables applied to Japan's population. We calculate the birth cohort sex‐specific prevalence of comorbidities using five waves of the governmental health surveys. Combining estimated comorbidity prevalence with death record information, we determine the transition probabilities of health statuses.

We then construct a virtual Japanese population aged 60 and older as of 2013 and perform a microsimulation to project disease distributions to 2046. Our estimates replicate governmental projections of population pyramids and match the actual prevalence trends of comorbidities and the disease incidence rates reported in epidemiological studies in the past decade. Our future projections of cardiovascular diseases indicate lower prevalence than expected from static models, reflecting recent declining trends in disease incidence and fatality.

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Health Economics
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Megumi Kasajima
Hideki Hashimoto
Sze‐Chuan Suen
Brian Chen
Hawre Jalal
Karen Eggleston
Karen Eggleston
Jay Bhattacharya
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This interview was originally produced by the Oliver Wyman Forum.

Coronavirus has dramatically increased the use of technology as governments, healthcare providers, and businesses tackle the pandemic and its devastation. But even before the crisis, Japan, a country long at the forefront of robot production and usage, had begun to use this technology in many of its nursing homes.

About 60 percent of the country’s nursing facilities now use robots. The proliferation of machines has had a relatively minor impact on turnover or wages of caregivers because of strong demand for care, an aging working population, and government subsidies for robot implementation, according to research by Karen Eggleston, the deputy director of the Shorenstein Asia-Pacific Research Center and director of the Asia Health Policy Program (AHPP), Yong Suk Lee, a center fellow and the deputy director of the Korea Program, and Toshi Iizuka, professor at the University of Tokyo and former visiting scholar with AHPP. Robot-adopting nursing homes, the researchers found, had between eight to 11 percent more staff than those who didn't adopt robots.

Caregiving is a physically demanding task. Staff frequently lift residents in and out of bed, and many suffer from back pain. Many of the robots deployed in Japan either help caregivers perform physical tasks or facilitate movement by the residents themselves.

The research couldn’t be timelier. Nursing homes have taken a heavy toll from the coronavirus. The disease has claimed the lives of more than 28,000 residents and workers of care facilities in the United States – approximately 35 percent of all deaths in the nation as of May 11. By contrast, Japan’s overall death toll stands at a little over 900 in early June.

Professors Eggleston and Lee discussed the implications of their research in a Zoom interview with Partha Bose, a partner at Oliver Wyman and a leader of the Oliver Wyman Forum, as well as Jilian Mincer, managing editor of the Oliver Wyman Forum, and Dan Kleinman, the Forum’s digital editor.

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From a labor economics point of view, Japan has been struggling with staffing in these care facilities. What made it much more acceptable for robots to be used in their situation versus other sectors?

Karen Eggleston: Japan has an extreme demography that it’s dealing with. The demand for long-term care is going up quite a bit while the overall population is declining. Although they're relaxing some immigration, there are issues with that. Some of the policy goals were to support robotics and to understand how it complements or substitutes for specific tasks in long-term care — to bring down back pain among care workers, for example — and to explicitly set a target for percentage of healthcare providers and long-term care clients who say it's acceptable to have a robot involved in their care.

They went into it well aware that robots weren't going to completely push out the workforce, but it's all a question of what type of tasks they can be involved with and how they can get an early read on that and start developing appropriate robots and re-engineering the care processes to meet that surge in demand.

What kinds of tasks are robots being used for in Japan right now?

Yong Suk Lee: There are these wearable transfer-aid robots that can actually help care workers lift persons and move around. There are similar types of robots that are non-wearable. And there are robots that directly assist the elderly in their care: They can use these to move around, and related to that, bathing activities, going to the bathroom, and so on.

The main type of robots are monitoring robots. They’re basically a camera system. They signal to the nurses or caregivers in an aid station if there seems to be abnormal movement so that they can actually go there — especially during the night when there's less staffing to actually go and check how the residents are doing. Those are the highest in terms of rate of adoption. And then there are those cute communication types of robots to help patients with dementia communicate with their families and caregivers.
 
What sort of facilities are using these robots? Do they tend to be urban facilities, or can they be anywhere in the country, like rural areas?

Lee: Based on preliminary results, adoption is higher in urban areas, but it's not significantly different. In China, it could differ drastically because there's a huge urban-rural divide in China of public health systems or public service in general. Robots are capital intensive. In South Korea, there are private homes that are wealthier and those could adopt new technologies earlier, but still, adoption in general is not widespread due to sufficient immigrant labor providing care. There could be an urban-rural divide for sure. Because of government subsidies in Japan, it equalizes distribution across regions.
 
Eggleston: We find more part-time or irregular nurses in urban areas. That may seem counterintuitive, but when you think about it, having that concentration of human capital in urban areas might facilitate that kind of part-time work and so on. There are differences we can see in our data between urban and rural homes, but we don't see large differences in terms of robot adoption and use.

Are there kinds of conditions that robots are better suited for than others?

Lee: In general, most robots are related to mobility issues. The biggest consequences of the elderly staying in homes are pressure ulcers on their skin because of their extended time in bed and low levels of mobility. Robots could provide a major contribution if they help residents move about and reduce pressure ulcers.

Communication robots are helpful for patients with dementia. The adoption of those isn't high compared to monitoring robots, but I think it's becoming more accepted and especially helpful for certain types of patients.
 
Do you think robots will be helpful for medical care?

Eggleston: That's the hope. For example, night monitoring reduces the probability of a severe fall which requires hospitalization and so on. There are contentious issues with nursing homes about physical restraints for patients, which are not allowed. And so, adding robots might deal with some of the outcomes. Both the producers and users of robots are hoping this will have a significant impact on the quality of care. 

As you look at how the coronavirus has affected long-term care facilities, do you wonder what the outcomes might've been had some of these facilities had robots?

Lee: Yes. What our findings indicate is that robots are not replacing workers in Japan. They're allowing firms to adopt more nurses — the skilled type of caregivers, which is an important finding directly related to the quality of care. Allowing critical personnel to actually focus more on patients. If there were certain technologies in place, caregivers could have spent their time more efficiently. I believe that's going to be a discussion going forward in the US and in many other countries that have suffered drastically. 

Eggleston: Particularly the communication and monitoring robots would help to some extent. They can save caregivers from having to go room-to-room and enable communication between people at the facility, and also with their households.

We do know that there's a potential there, and it might affect future adoption in nursing homes in the US and elsewhere. But given the huge financial hit the industry has taken as a whole, it might be a while before that plays out.

Given the coronavirus’s prevalence in nursing homes, people may be wary of taking jobs there. Can these robots be used in a recruiting capacity for nursing homes?

Lee: Certified nursing assistants in the US are not well-paid and it’s a physically demanding job. Now there's an extra concern of, "What will happen to me when I work here?" A lot of nursing homes had enormous difficulty recruiting people. They were paying extra for nurse aids, but they weren't able to recruit given the situation.

Potentially, nursing home facilities that have the capacity to adopt robots may be able to advertise this as not only being able to improve the quality of care for the residents but providing better work conditions for the caregivers. What we're finding in our research is those that adopt these robots tend to have better management practices.

What has surprised you most in your research?

Lee: We didn't find that robots replaced care workers. They’re being used to supplement the workers and maybe have better outcomes in quality of care. This is having an overall net positive effect both on jobs and productivity.

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Karen Eggleston and Yong Suk Lee speak to the Oliver Wyman Forum on how robotics and advancing technologies are helping staff in Japanese nursing homes provide better and safer care to their patients.

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Life expectancy in Japan, South Korea, and much of urban China has now outpaced that of the United States and other high-income countries. With this triumph of longevity, however, comes a rise in the burden of noncommunicable diseases (NCDs) like diabetes and hypertension, reducing healthy life years for individuals in these aging populations, as well as challenging the healthcare systems they rely on for appropriate care.  
 
The challenges and disparities are even more pressing in low- and middle-income economies, such as rural China and India. Moreover, the COVID-19 pandemic has underscored the vulnerability to newly emerging pathogens of older adults suffering from NCDs, and the importance of building long-term, resilient health systems. 
 
What strategies have been tried to prevent NCDs—the primary cause of morbidity and mortality — as well as to screen for early detection, raise the quality of care, improve medication adherence, reduce unnecessary hospitalizations and increase “value for money” in health spending? 
 
Fourteen concise chapters cover multiple aspects of policy initiatives for healthy aging and economic research on chronic disease control in diverse health systems — from cities such as Singapore and Hong Kong to large economies such as Japan, India, and China. 
 
 
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Karen Eggleston
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