Social Technology for Aging Societies

PODCAST | ep14 | with Arthur Kleinman, Hong-Tu Chen, Ann Forsyth, and Fawwaz Habbal

People aged sixty-five and older make up the fastest growing population around the world, posing unique challenges to societies. A Harvard initiative called Social Technology for Global Aging Research is founded on the belief that there’s a great potential for technologies and interventions to benefit the elderly, but only if they are developed with a deep understanding of day-to-day life. In the scope of this collaboration, technology for the elderly covers a wide range of needs—from engineering hardware for mobility to designing living environments and even tackling the logistics of meeting friends for tea. It’s an expansive collaboration between Harvard scholars and their Chinese counterparts. We speak with four collaborators who share fascinating examples of their work.

Episode graphic with headshots of four speakers.

Listen to episode #14 (44:28) by clicking the play button below:

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The founder of the initiative, Arthur Kleinman, believes that aging societies represent an unprecedented transformation of the global population that introduces a range of challenges. He emphasizes the need to bring together various disciplines—such as medical practitioners, engineers, and anthropologists, to name a few—to collaboratively solve problems the elderly face in their day to day lives. Much of the team’s research is conducted on the ground in China, where about 30 percent of the population of China will be sixty-five or older by 2050.

Fawwaz Habbal points out the particular challenges of engineering products and services for this constituency, but also highlights the great insights that emerge from using a multidisciplinary approach.

Ann Forsyth discusses the desire of the elderly to “age in place,” and what that means from an urban planning and housing perspective. The locations that may be desirable at one stage in life often change in older age. In China, for example, many older people have moved from the rural areas to the cities, and culturally it’s frowned upon to relocate parents to assisted living facilities.

Designing social interventions can be just as powerful as designing an effective piece of hardware. Drawing on his vast experience with older patients and elder resources, Hong-Tu Chen describes a simple method for fostering connections between children and their elderly parents.

All four scholars share fascinating stories about unintended consequences of new technologies, and surprisingly simple interventions that can have a powerful impact on quality of life.

Guests:

Arthur Kleinman, Faculty Associate. Esther and Sidney Rabb Professor, Department of Anthropology, Harvard University; Professor of Medical Anthropology in Global Health and Social Medicine; Professor of Psychiatry, Harvard Medical School.

Hongtu Chen, Assistant Professor of Psychology, Department of Psychiatry, Harvard Medical School.

Ann Forsyth, Faculty Associate. Ruth and Frank Stanton Professor of Urban Planning; Interim Chair, Department of Urban Planning and Design, Harvard Graduate School of Design.

Fawwaz Habbal, senior lecturer in applied physics, Harvard John A. Paulson School of Engineering and Applied Sciences.

Episode Credits:

Hosted by Erin Goodman, Executive Director of the Weatherhead Center
Produced, edited, and mixed by Michelle Nicholasen, Editor and Content Producer at the Weatherhead Center

Transcript:

ERIN GOODMAN: Welcome to the Epicenter Podcast. I'm your host Erin Goodman, executive director of the Weatherhead Center for International Affairs.
Today we're going to talk about aging and aging societies on a scale from the global to the individual. As fertility rates decline and lifespans extend, people 65 and older make up the fastest growing age group around the world. It's a demographic transformation that will impact nearly every country on every level.
Today we look at the question of care for an older population, and not just health care but the kind of care that can help the elderly live a fulfilling life and continue to be engaged in their communities.
We're speaking to four scholars at Harvard who are collaborators in a research initiative on social technology for global aging. This initiative was founded in 2018, and it's a multidisciplinary collaboration that brings together social scientists, anthropologists, engineers, physicians, public health specialists, and designers from six schools at Harvard and nine institutions in China to plan, work through, and implement social technological interventions that address the social and health care needs of aging societies.
It's a fascinating line of research and we're going to dive in to learn more. The founder of the initiative, Arthur Kleinman, is Professor of Medical Anthropology in the Department of Global Health and Social Medicine, Professor of Psychiatry at Harvard Medical School, and the Esther and Sidney Rabb Professor of Anthropology in the Department of Anthropology. He is also a China scholar and his lifelong work in global health and Social Medicine spans almost 50 years.
Hongtu Chen is Assistant Professor of psychology in the Department of Psychiatry, and at the Department of Global Health and Social Medicine at Harvard Medical School.
Ann Forsyth is the Ruth and Frank Stanton Professor of Urban Planning at Harvard's Graduate School of Design. Trained in planning and architecture, she works on the social aspects of physical planning and urban development.
Fawwaz Habbal is a senior lecturer in Applied Physics at Harvard's John A. Paulson School of Engineering and Applied Sciences where he previously served as Director of Graduate Studies and Executive Dean for education and research.
So we can think of some obvious challenges that an aging population presents such as the cost of health care. Let's review the challenges that you see and how they might vary in different societies. Arthur, should we start with you?
ARTHUR KLEINMAN: Sure, I'm happy to start. Well, we're entering a world we have never been in before. So this is not just a demographic transition, this is a transition for the planet, and Japan in 2050 will be the first society in the world that has 40% of its population over 65 years of age.
China won't be all that far behind at between 28% and 30%. But the United States won't be all that far behind at 25% of its population. We've never seen figures like this in the past. This is the population that in most societies has a fair amount of the wealth of society. Look at the United States. Where is the wealth of our society? It's in the population above 50 years of age. OK.
This is also the group that has the highest rates of chronic illnesses, almost by definition, this is the age category with chronic illnesses. Chronic medical illnesses like diabetes, heart disease, cancer, et cetera, chronic mental health problems, and also accompanying social problems.
And this is also occurring at a time in which there have been massive shifts in the organizations of societies and the way that economics are thought about. So I believe we're going into a time that is simply unprecedented, and the needs of that time, the problems it creates, the opportunities also it creates, are vastly different from what we've thought about in the past.
And that's why the Weatherhead, with all of its interests, should be interested in this topic.
ERIN GOODMAN: Indeed, we're very interested in this topic because it is so interdisciplinary and comparative.
Let's get back to this concept of social technology, and we're going to explore this in-depth. Your initiative looks closely at the social context of new technologies for the elderly as they're being developed. What was the motivation behind this approach, and why is this social dimension so important? Arthur?
ARTHUR KLEINMAN: In the health domain, we have example after example of technologies used to respond to particular health problems that have often made the situation worse, not better either because of unintended consequences of the actions taken of the technologies and what they do, or for other reasons.
So take for example, the fact that all of these elder people, myself included, I am 82 years of age, they have health problems, they have chronic illnesses, and they have acute exacerbations of those illnesses. They face problems that run from-- we face problems that run from health insurance in the United States.
There is-- long term care insurance is held by a relatively small percentage of the population, and most elderly who are not middle class or well-to-do can't afford long term care insurance, and insurance companies don't want to write long term care insurance because they don't make that much money off of it.
On the other hand, if we were Dutch, if we were German, if we were Scandinavian, if we were Japanese, we would belong to national health systems that had long term care insurance written into them. So the social system itself has a lot to do with the experience of the elderly at this point, and that's one reason why policy matters.
Take, for example, something as simple as the electronic medical record. When I was a young physician over half a century ago, there was enormous optimism about building an electronic medical record because of all the things that could do in terms of making it easier for physicians to get at what the evaluation of tests were for patients, what the present situation was with their medications, and how their own experiences had changed.
Now if you look at the electronic medical record today, it's used for only one thing, billing. OK, so something happened. Something happened during that period of time that radically shifted a technology.
And if we look also at the electronic medical record with regard to patient satisfaction in our country, in the United States, a lot of dissatisfaction with the fact that often the doctors back has turned to the patient when the patient comes in because the record, the electronic medical record was created largely by electrical engineers, OK, not by clinicians.
Hence for the clinician trying to find the relevant information requires her to literally turn her back on her patients, which from a clinical standpoint is one of the things you don't want to happen. It's an unfortunate thing because it breaks the connection between patient and doctor.
ERIN GOODMAN: Mm. Hongtu, you've done a lot of work on elder care resources what's been your experience with technology for older patients?
HONGTU CHEN: Well let me add one context to this discussion. Four or five years ago when we started this project, our Chinese colleagues did a small survey. They went to-- at that time, they could easily find an Expo of aging technology, the technological device developed by our different industrial entities that was intended to help elders.
They went there. They were pretty amazed that there are lots and lots of them in those expos, but very few-- then they went-- they took some of them, ask the elderly people, have you ever seen this? None of them know this.
So there were two problems. One is that lots of devices were developed, but no elderly people knew it or used it. And then second thing is that there are some of them that the elderly people, they did purchase, very small sample of this large supplies.
They did purchase, and then they used them. But after a while, they stopped using it. There are always some flaws or some broken, then there's nobody would fix it or to improve it. And then there were also-- some of them would find some examples from the media but they will not be able to find where you can get it, or where for most people they cannot afford it.
So there are quite a large group of develop the technologies that cannot go to the field or be used. That was when we started this project. So the idea-- original idea was to so-called to integrate the technological innovation part, and the social system part.
The idea that if we can integrate them both well, then in the beginning part of that development or innovation phases, you will do a right job. You will know better about the needs of elderly people and develop something that will fit them.
And on the later part, once you develop it, there will be somebody in the society who might be willing to purchase the or at least contribute some of the financial support, and to deliver it and also to organize social forces to help not only how to use and how to teach people to use them, but also how to repair it.
All these social systems are usually lacking, so our idea was to integrate both technological side and the social system side.
ERIN GOODMAN: Fawwaz, what are the challenges of working with this age group from an engineering perspective?
FAWWAZ HABBAL: The question is, when we have a human challenge, how does the human challenge manifest itself? So when we look in this particular case, the elderly as a case where humans want to continue being living a life that's full and happy and be able to contribute.
This is a case where we see that there are intrinsic values connected to other values such as biological and health values and social values. When we look at systems like this, things becomes really very interactive and very complex.
The fact that there are social, cultural, technical solutions are very important, but there are also other things involve the ethical considerations, the privacy, the trust the convenience also which promote very different way of thinking about these matters.
So I'd like to just underscore that there is this interaction between what I call it-- or integration between social science and engineering, or social science and social values.
ERIN GOODMAN: Now let's turn to Ann. How does urban planning come into the mix?
ANN FORSYTH: Well, and I might say something because it's that context that I'm sort of on the group to represent as an urban planner, and one of those contexts is the physical context. When you ask people around the world what they want to do when they get older, they say they want to age at home. They want to stay in the same place.
It's not totally clear whether that's the home of their middle years or when they move to later, whether they just mean they want to stay out of a nursing home or could move somewhere else, or whether they really want to just stay put. But they certainly want to have a sense of stability. And to do that you need an environment that can support aging at the level of the home, at the level of the neighborhood, and at the wider context, and that includes not only the physical space but the services.
And then there's a temporal dimension to it. The home that may be very suitable for you at 65 may not be supportive enough when you're 85 and have some additional health concerns or chronic conditions. It also may not be the same place as it was when you were 65 because some of your peers have moved away, they've died. And so your social context has changed even if you're living in the same place.
And then we have a lot of wider changes that are occurring. One, for instance, is climate change. So the environmental conditions in which you're living might have changed over time. So a home that was perfectly viable when you were 65 may not be able to withstand the rain or the heat and so on when you're 85.
So this wider context means that it's very hard to say that I'm going to move somewhere or stay somewhere at 65 and it's going to really support me when I'm 85. And I think some of the role of this project is to try and look and see how technology can help future-proof environments, but also the constraints that environments place on technology because technologies require a certain level of support in the environment.
If you have robots, they need sort of flat areas to move along and so on. Or if you have social communication technologies they need an infrastructure. But really this-- as we're thinking about people growing older, this physical context, the social context, and also how that changes over time become really key.
ERIN GOODMAN: I think we're getting a picture of what you mean by social technology.
ANN FORSYTH: Arthur, we've already started talking about this idea of social technology but I don't think we've yet defined it. Could you define it?
ARTHUR KLEINMAN: Well, you probably can do a better job than me or Fawwaz or Hongtu, but the way that I understand our use, and the reason that I use that term, social technology, was that not to indicate principally social media, for example, but to say that technology in interaction with social science and social understanding, social awareness, can make for a much better outcome in its effects in the world.
So this project does something which I think is quite rare, not unique but quite rare. It brings social scientists, it brings design people, it brings public health people, it brings engineers together right from the start so that we can argue about-- we can present different perspectives on things that usually are just defined rather simply by engineers.
And let me give you an example, and this is one thing that we've been-- our Chinese colleagues who are an intimate part of this research and many of them are my former students have been working with.
So in Shanghai, the government with the best of intentions decided that poor elderly people, especially women, were living in five story walk-ups, and that it would be a good idea to place an elevator on those walk-ups, each of the walk-ups. That's straightforward, but what came out of that in the absence of a kind of this social awareness, social attention, they didn't think about the fact that the people on the fifth floor and the people on the first floor might not be willing to pay the same amount toward the maintenance of the elevator.
So an elderly person on the first floor said, yeah that's great to have an elevator on the building, but I'll never use it. I'm not paying anything towards its upkeep. Person on the fifth floor said it's wonderful for me, absolute necessity. I'm happy to pay. It produced a kind of local brouhaha.
And they originally were going to put elevators on 30,000 buildings. They just used the 1,000 as a demonstration project, and to the best of my knowledge they've never moved beyond that because they found so much local resistance in the response of people.
Now every one of us here with social understanding, including my great colleague Fawwaz Habbal who's an absolutely outstanding engineer, using common sense and social sense would have thought about this in advance and said, you can't you can't ask the person on the first floor and on the fifth floor to pay the same amount toward the maintenance of the elevator. They're not going to do that because the usage patterns are so different.
And I think again, that's where at the beginning, if you can plan for things, you can have interesting things happen. Take for example something that relates to the work of one of Fawwaz's colleagues, Conor Walsh who builds exoskeletons.
So part of our work was to see whether an exoskeleton for the legs, which comes out of Conor Walsh's lab, and is basically a thick pair of pants tied to a battery and a motor which can make someone after a stroke or with Parkinsonism have a more normal gait and be able to walk more easily and with fewer problems.
When shown to elderly women in Shanghai in high rise buildings, they surprised everyone by saying, oh, this is a great development but we would never use it. And so the question became, well wow, they recognize it's an engineering breakthrough, but why would they never use it?
And the reason is that so dangerous is it from the standpoint of cars crisscrossing to cross a street in Shanghai, a major intersection, that they never felt they would trust the technology well enough to want to wear it, use it, and cross the street. But, they said, you could do something for us if you took our needs into account.
And so from the anthropological standpoint that's a big deal, local needs. OK, what was their need? Their need was that they had five or six friends their same age, in their 80s or 90s, who were indifferent high rise buildings, all of them with limited mobility. They said, if you could find a way of getting us once a week to a teahouse and back safely, that would make all the difference in our lives.
And so that then became for us, and is for our Chinese colleagues who were collaborating with, the focus of one of the projects which is how would you help not six, not 60, not 600, not 6,000, not 60,000, but 600,000 people in this circumstance get from their apartment to a teahouse and back safely again.
ERIN GOODMAN: Let's stay with China for a moment. What are some of the problems specific to China's elderly population?
ARTHUR KLEINMAN: I mean, although it is a global program, our focus is on China. Just think of the issues that China has. In 1949, 80% of the Chinese population was rural. Today, more than 70% of the Chinese population is urban. But in rural areas, when you go to the poorer rural areas, who are there?
They're elderly who are often without adult children who've moved to the cities, who are unable any longer to take care of the farming in. Settings in which the services are hard to deliver and often difficult to find because it's much easier to provide services in market towns or county towns than it is in remote rural settings.
So one of the issues facing China today is a policy issue about whether it's going to try to move its elderly from the most remote rural areas into County towns that look to us more urban because they have high rise and are better places to deliver supportive care and actual health care. But what about the experiences of those elderly? Do they want to move from rural to urban areas? What happens after they do move to those settings?
In fact, this is a good place to ask Ann about this because Ann is such an expert on housing, and this issue of the elderly wanting to be cared for at home, and even the Chinese government with its ideal that 90% of elderly will somehow be cared for at home. Ann, how do you see cultural issues in China affecting that process?
ANN FORSYTH: Oh, it's quite complicated. I've recently been doing a literature review with Yingying Lyu and our team looking at this. It sort of depends on what you mean by aging at home. As Arthur said, many people in rural areas are aging. The young people have left and the older people are in rural areas.
Well, for some of them, the rural areas are actually not very supportive of their aging. There aren't services, the homes are actually not well designed or lack services, like central heat and running water, and yet when people move to towns and cities, perhaps to be with their children, they can be left alone. They are at home but they're in their children's home and they're alone all day.
It's very interesting reading the various qualitative studies that have been done so far, and we're doing this in order for us to extend them. Some people are actually managing by living part year in town and part year in a rural area. Other people move from their own home to their children's homes.
So in fact, what's happening with the housing situation is a lot of complex changes. There are some interesting things about the filial piety issue in that children want to make sure that they will look after their parents and are often reluctant to put them in specialized housing because that may be seen as abandoning their parents.
And it's sort of seen as a big negative even though putting having parents move to some kind of assistive living circumstance might be very positive for the quality of life of the older people person physically and socially, as they're with other people who are like them.
It's a very complex landscape as the new forms of housing are only just emerging. Some of them are there for different kinds of income groups in different kinds of places. China is pretty decentralized. So what happens in one place may not be happening somewhere else.
ERIN GOODMAN: So this is not a straightforward issue. Deciding where to live in older age is often more complicated than it might first appear.
I'd like to move on to another question, which is some concrete examples of the technologies that you've developed, or that are in progress at the moment. Could you give us some examples? Fawwaz, you and your students have been working on the integration of appliances, for example. Could you tell us about that?
FAWWAZ HABBAL: When Ann talked about aging at home or aging in place, that's very, very difficult because you have to look at the context. The context relate to a lot of things, the health of the person, mentally and physically.
So let's take things like finding space and time, creating space-time orientation. That's extremely important, if somebody has some mental difficulty, or even physical difficulties, there are things of that type that we've been started working on thinking about. Creating simple things like panic buttons, having door alarms, making the right sound for the alarm versus the sound of a boiling kettle.
Things around doors, windows, how can you make them safe? How can you create a system that can shut off the stove when something boils, or when the light is off, turn it on, creating the right thermostat, detecting noise?
People are moving from one place to the other for some reasons, and knowing that this person moved into a room, close the door, and then a number of hours passed without this person coming out should call for attention. Items like this may sound trivial-- for us may sound trivial because we do it every day and we are at ease with it.
However, for elderly people these are really critical things. So part of the thing that we are really doing quite a bit on is how we can integrate appliances. How we can put things in a systems that can relate to each other and be able to operate somewhat independently and be able to allow people to not only the elderly themselves but also the caregivers, the friends, the families to be able to respond and know about this.
So quite a bit of our work is related to how you make not only the person aware of a condition, but also others in their ecosystem aware of it and come to help when it's needed.
ERIN GOODMAN: Arthur?
ARTHUR KLEINMAN: It might give us some examples of actually some of the interesting things, some of our students working with us have done. So one group of students involving medical students, several undergraduates, and several graduate students worked on what they called reminiscencential therapy for elderly who had some degree of cognitive difficulty, and developed a tool that was a computer tied to pictures that could go through the past history of a particular individual from the time when they were young, their time when they married, the raising of children.
And all of these around the themes of what people felt. Did they feel the loss of the past? What did they need? Did they feel that they needed support with feelings of loss and hopelessness or sadness?
And then used it therapeutically in terms of not only getting people to disclose what their problems were, but to begin to rebuild confidence about having had a long life recognizing the coherence of their life, seeing the trajectory as it was portrayed through pictures, and being supported by someone with a therapeutic approach working with those pictures. They actually went on to win an international competition with that design.
Another one of our students has worked in a hospice setting in a-- I'm sorry, in a palliative care setting in a cancer hospital in rural China. And now palliative care has been introduced a number of times into China and we have one component of our work you'll hear about with Eric Krakauer that is doing this in a major way.
But where it actually occurs on the ground, it's very difficult to do in the way it's done in America where we work where we straightforwardly talk about death and dying, develop advanced directives, et cetera.
In the Chinese setting this is very-- especially in the rural or the semi-rural Chinese settings, this very difficult because traditionally you're not supposed to talk to older people about death or dying. Therefore, advanced directives have to be done in some indirect way. Even disclosure around major illnesses is not necessarily something the family wants the elderly person to know about or talk about.
The entire understanding of what is the ethical basis of elder care is different in the Chinese setting. This particular student did a marvelous job speaking to the social workers who provide the palliative care and discovering how they do it, how they develop a deeply human relationship with people who are in the end stages of cancer or other disorders, and how they build a kind of culturally informed way of dealing with palliative issues.
So now side by side with that, there is an issue for us that is a larger issue that faculty are working on. And you might speak to Eric Krakauer about this one, but because of China's past with the colonial abuse of substances, when the Brits forced opium on the Chinese population, and the opium wars that came out of that, China has a long history of resistance to allowing the easy access to, let's say morphine which is routinely used in American end of life care to remove pain, to reduce pain.
Reducing pain and controlling pain is critical to palliative care, and the Chinese setting is very difficult to have access to morphine. One of the things that Eric Krakauer has worked on is the idea of having a digital lock box where the morphine can be accessed in a way that would be both acceptable to the government and acceptable to families and individuals, and therefore used, actually used.
But this is the kind-- what this student has gotten into, and I've extended their work toward Eric's is are cultural issues that really affect how in this case palliative care as a technological intervention is carried out, and suggests that in order to be performed in China in an acceptable way it's going to have to be culturally transformed. How does that transformation take place?
ERIN GOODMAN: Hm. I'd like to bring up the subject of loneliness and isolation. It's a very common experience for the elderly. How can social technology help those who experience isolation, loneliness, and related health problems? Arthur, should we start with you?
ARTHUR KLEINMAN: On November 15, Daedalus the Journal of the American Academy of Arts and Sciences will publish an issue that I edited on mental health, and part of that issue shows that depression is a huge problem worldwide and depression amongst the elderly is very common, but about half of depressions don't require any kind of medical input like psychotherapy or a drug, et cetera.
That they respond to things like friendship, a confiding relationship, emotional support, exercise, diet, activities, and it's on this side that we have, and I think Ann is one of the really leading thinkers here, has been to think about well-being. How do you how do you help with the well-being of a person?
Winnie Yip, if you get a chance to talk to her in the School of Public Health has also been very interested in this, and Winnie and I have a related project on meaningful aging in Hong Kong, which is which takes into this idea of not just responding to illness, but enhancing or augmenting wellness and how that can happen.
I think what Ann has just pointed to is this is a very complicated thing that requires not just some sort of technological input, but as Fawwaz has pointed out, technological input that comes together with the right social circumstance with the right social supports and the like.
ERIN GOODMAN: Ann, you've looked into age-friendly communities. What role does the built environment play in one's ability to connect with others?
ANN FORSYTH: You know, these age-friendly communities have been around for a really long time, and I recently did a review of all the evaluations of age-friendly communities. There's a lot of work that looks at how age-friendly different environments are, and there are some evaluations of age friendly programs, but virtually none of them look at them in the long term.
So it is interesting. We know a lot about what probably makes an age-friendly community, but there hasn't been enough kind of long term, I'd say qualitative study of what's important. In terms of loneliness from the built environment perspective, I've got many students who think, you ah, you build a park, or you build a public space, people will interact and they won't be lonely.
In fact, there's a little bit of truth in that, but it's more about social connections. And so they can happen in different ways. They can happen in public spaces, but they can happen through technologies, through programs, through social organizations, clubs and religious groups, and so on.
So I think the big picture about an age-friendly community is it's not just one thing. It's not just one recipe. And it also needs some participation from older people, perhaps just providing informal feedback perhaps in a more sort of a way in which they sort of have a committee or so on. But you really need to have input from older people because an age-friendly community in one place is not exactly the same as an age-friendly community in another because the people are different from place to place.
ERIN GOODMAN: Fawwaz?
FAWWAZ HABBAL: I'd like to give two examples, not quite related to what Arthur talked about, but maybe complementary. I was one time, not a long time ago, with a group of women, elderly, aged probably 65 to 75 like that, and they all express signs of depression of some sort. And when you try to understand some of it, it's very difficult really because we cannot tell exactly the origins of some of these, and we are not trying to create mitigation in a sense.
But one thing we did and with some help of colleague of mine is we did a theater. We decided to act a case that's a hypothetical case, has nothing to do with any of them. And every member of that group almost everyone created become part of that theater.
When we went in, no one was talking to anyone. They don't know each other. When we finished, everybody was talking to everybody. And everybody is promising the other saying that we should get together, we should have something together, and so on and so forth.
I was very surprised and somewhat impressed by how somewhat simple exercise can make such a shift, and later I was told that there were cases where in Bogota in Colombia where this whole city changed by creating some arts and some artistic expressions inside the city and went from being someone a group of people who really were disrupting the social life there to something that were basically conquered and become much better.
Another example of that is when people can never relate to a piece of art. Doesn't need to be art in a museum, but it's a piece of something that looks aesthetically pleasing, and try to describe it to each other.
And simple exercises like these seem to create a lot of connectedness and a lot of-- just alleviate some of the stresses and some of the feeling of isolation that many of us can feel.
ERIN GOODMAN: Hm. Hongtu, let's turn to you.
HONGTU CHEN: In isolation, we want to have some friends, some social contact, but if you ask most of Chinese elderly people, you ask 10 of them, I think seven or eight of them will say what brings them the most satisfaction, deep satisfaction, is to have a good connection with their children. And that connection between children also want to connect to parents. And the communication technology is available.
And the problem many of the children who do not live with their parents, they live in another city, they talk to their elderly parents, they all say that after a while, they don't have much to talk about. And they run out of topics or they cannot continue the conversation.
And that is very actual needs. And one of our colleagues in Hefei province and his students, they tried to do a small ethnography. They ask their students to go back to talk to their grandparents and come back to say what topics will you talk, you can talk longer, and they can repeat them.
And they found out that one topic is that can carry relatively longer conversation is to talk about the elder person's biographical details and talk about their life stories. And then they come back to teach each other, say how do we carry out a conversation about somebody else's life story and the biographical construction? And that developed a program to have both technological contents and also the social-cultural contents.
And so I think that was a good example that the availability of technology cannot solve a quite important loneliness issue.
ERIN GOODMAN: That's a really important point, Hongtu. Thank you. And these are wonderful examples of social interventions. It comes down to the very basic process of bringing people together and helping them share and interact.
Before we go, I want to take a step back and ask about why your focus has been on China and to what extent your research is applicable to other countries and cultures.
ARTHUR KLEINMAN: Well clearly we believe this is a two way street with the United States, and that things learned in China will be applicable to the United States. Preceding this study, Hongtu and I, Hongtu Chen and I had a six-nation project on looking at different models of elder care in Hong Kong, China a Taiwan, Korea, Japan, and Thailand.
So we have in mind a comparative framework. Chinese make up 22% to 23% of the world's population, so if we are going to be focused on one group it seems to me this is one of the larger groups we could focus
ERIN GOODMAN: Ann?
ANN FORSYTH: Oh, well, I was just going to say that China is very diverse, like Eastern and Western China, rural and urban China, it is not one place. And so it actually shows a range of the issues and experiences that occur in aging around the world. So I don't think of it as a narrow emphasis at all, and this issue of aging in place is one that is of everywhere in the world.
So as much as this project is trying to help kind of future-proof aging in place, I think it's super relevant for lots of places.
[MUSIC PLAYING]

ERIN GOODMAN: I'd like to Thank our scholars today for speaking with us about the universal topic of aging societies. One important takeaway from this discussion is that if we want new technologies for the elderly to succeed, they need to be developed within a deep understanding of the social context. We've heard plenty of great examples of projects coming out of this initiative, and we look forward to more.
This is Erin Goodman signing off from the Weatherhead Center for International Affairs at Harvard University. To hear more meaningful conversations like this one, please follow Epicenter on your favorite listening platform.

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Social Technology for Aging Societies

PODCAST | ep14 | with Arthur Kleinman, Hong-Tu Chen, Ann Forsyth, and Fawwaz Habbal

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