To the Editor: China ended its 35-year-old One-Child Policy in October 2015 to slow the aging of its population. This was announced when the authors were in Shanghai as delegates of Chicago Sister Cities International's Chicago-Shanghai Social Services Exchange Program. The One-Child Policy was a driving force behind rapid population aging in China. The vibrant city of Shanghai has a population of more than 24 million; more than 2.7 million are aged 65 and older, equal to the total population of Chicago. Seeing is believing. Panoramic scenes of older adults practicing tai chi, dancing, singing, and exercising on the streets and in the parks, in front of children's playgrounds, with no or few children in sight, even on rainy days, were striking. Exercising and dancing in groups may be partly cultural but also policy driven. There were park bulletin boards with governmental health promotion messages. There was colorful, inviting exercise equipment in the park, literally a “playground for adults.” There were gadgets to help frail nursing home residents engage in physical and cognitive exercise to delay progression of disabilities. What was most striking was Shanghai's openness to learning from the world. Program directors and staff talked about ideas, systems, programs, and equipment imported or learned from other countries in Asia, Europe, and North America. They identify, adapt, and implement best practices from around the world. Shanghai is one of the first cities in China to experiment with a long-term care insurance system based on what they learned from Japan, Germany, and other countries. The United States has developed and tested model care programs for older persons. Such programs have inspired many countries, but the United States lags in incorporating such model programs into its own healthcare system. Most Americans do not have long-term care coverage, unless they are poor enough to be eligible for Medicaid or other public programs. Many Americans do not know that Medicare does not cover long-term care. The United States planned to establish long-term care insurance as part of the Affordable Care Act, but these plans were quietly repealed in 2013. The current U.S. long-term care system is largely funded by Medicaid and thus managed by each state. States learn from each other but seldom from other countries, assuming that foreign models are irrelevant because of cultural and system differences. This attitude differs from what was observed in Shanghai. Global learning on aging is crucial. Chicago and Shanghai face remarkably similar challenges: coordinating medical and social services, improving dementia and end-of-life care, protecting older adults from abuse and neglect, achieving effective public-private partnerships, and establishing systems to enable older adults to remain in their own communities. Low wages in long-term care work make it difficult to attract workers. Migrant workers are often hired to care for older adults in Shanghai and Chicago. The extent and speed of aging in Shanghai drives the urgent search for solutions by the government and communities. Such urgency is highly needed in Chicago and the United States to mobilize political will to care for aging baby boomers with increasingly complex medical and social service needs. There were sepia images of old Shanghai displayed on the walls of old-age facilities to help older residents feel comfortable in their era as youth, while the outside world is quickly changing. Nevertheless, the United States cannot live in the past. The United States must innovate and engage in global learning to develop an effective long-term care system. Further international efforts to learn from one another should be made to address population aging before it is too late. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors contributed to the ideas expressed in this letter. This is not an empirical paper and does not include data or analysis. Sponsor's Role: There is no sponsor for this submission.
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