Kanemasa Ito compares caring for his wife Kimiko to waging a daily war with the devil. The woman he loved has all but disappeared — lost to dementia, she can no longer eat, bathe, or go to the toilet alone.

“There is a demon inside her head,” Ito told AFP, articulating the dramatic change in the person he’d built a life with, while she babbles nonsensically.

One of the world’s most rapidly ageing and long-lived societies, Japan is at the forefront of an impending global healthcare crisis. Authorities are bracing for a dementia timebomb and their approach could shape policies well beyond its borders.

By 2025, one in five of the over 65s — around 7.3 million people — in Japan will have dementia, the health ministry estimates, up from around 4.6 million now.

Alzheimer’s Disease, a syndrome in which cognitive ability, emotional control, and social behaviour deteriorate, accounts for the majority of cases.

Ito’s wife was just 54 when she was first diagnosed. Now some 15 years on, he is close to breaking point trying to care for her and manage the disease.

No longer able to discern what is harmful from what is safe — Kimiko has previously tried to drink cleaning products, unaware of the hazard of ingesting them — she needs constant supervision.

“It exhausts me,” the 73-year-old confessed in an interview at their Kawasaki home.

Global health crisis

Their story is becoming increasingly common in a country where a lack of resources and caregivers means the burden falls increasingly on spouses and children.

Prime Minister Shinzo Abe is aiming to increase the number of nursing homes and raise care worker wages to tackle the problem.

There is also a goal to ease the burden of family caregivers and reduce the number of people who quit work — such as Ito — to care for dementia-stricken relatives — from 100,000 a year to zero.

Dementia is a major global health issue with cases soaring as people live longer. The World Health Organisation estimates a new case is diagnosed every four seconds.

Many developed countries are already facing challenges on how to fund care, but Japan’s issue is pronounced because its population has aged at a faster pace.

According to a 2016 OECD report, Japanese social spending as a percentage of GDP stands at 23.1 per cent, lower than other developed countries with high percentages of elderly people, such as France and Italy.

“Japan has run its social welfare system on the premise that family members would take charge,” said Katsuhiko Fujimori, chief research associate at Mizuho Information & Research Institute.

The government, he said, simply can’t achieve its goals without more money.

But a cash injection seems unrealistic given that Japan’s public debt is already more than twice the size of its economy.

And with a shrinking and ageing population and workforce, some elderly with higher incomes are already being forced to pay more out of pocket for nursing care expenses under the national insurance scheme.

‘I might kill her’

The overwhelming mental, physical and economic burden of caregiving has led to tragedy.

The total number of cases of abuse of the elderly rose to 16,384 in the fiscal year 2015 — up from 12,623 in fiscal 2006, the majority of which involved relatives, according to figures from the health ministry.

The reality of caring for a incapacitated loved one can push people to the brink.

One 50-year-old Tokyo resident who has been taking care of his 85-year-old dementia-stricken mother for six years, told AFP he had murderous thoughts about her.

“I seriously want to manage my anger because I might kill her if I explode,” said the man, who requested anonymity.

“I can imagine her being dead in front of me,” he added. “It scares me.”

Between 1996 and 2015, there were 754 murder-suicide cases involving family caregivers, mostly men, in Japan, according to a study by Etsuko Yuhara, an associate professor of welfare at Nihon Fukushi University.

Ito, who had closed a convenience store he used to run to take care of his wife, said he hopes the government will create a better environment for caregivers.

“Every day is a battle,” he said, referring to how Kimiko resists getting dressed in the morning and having her hair washed at night.

He regularly takes Kimiko out for a walk in a nearby park and grocery shopping, but it is hard to know if she is aware of what is happening.

Ito added: “It’s really tough to accept.”

JAKARTA – A proposed Indonesian tobacco law will roll back regulations to discourage smoking in a country that already has one of the highest smoking rates in the world and open the floodgates for advertising aimed at teenagers, a health ministry official said.

If the Bill initiated by the Parliament is passed, companies will no longer have to put grim pictures of lung cancer or other diseases linked to smoking on cigarette packs, said Mohammad Subuh, director-general of disease prevention and control at the health ministry.

Under existing regulations, 40 per cent of the front and back of a cigarette pack must contain a “health warning” in the form of pictures and text.

Under the tobacco Bill, reviewed by Reuters, cigarette packs would not be required to have a specific portion dedicated to health-related pictures.

Cigarette businesses that put up advertisements, either in electronic, printed or outdoor media, do have to include a health warning that is “written with clear alphabets, easily read and proportionate”.

School and playground areas would be designated as “no-cigarette-smoke zones” instead of “no-cigarette zones”, which would allow cigarettes to be sold or displayed there, Subuh said.

“Indonesia is the most liberal country for the tobacco industry,” said Subuh, who oversees the health ministry’s tobacco control efforts. “Let’s not open again the opportunities for the industry to lure teenagers to party with cigarettes. It’s like jumping from a helicopter without a parachute,” he said in an interview.

OUTPUT INCREASE

Last year, 54.8 per cent of males between 15 and 19 years old were smokers in Indonesia, more than double the percentage of smokers in 2001, according to the health ministry. The price of a pack of cigarettes in Indonesia can be less than US$2 (S$2.76).

A shocking video of a toddler reportedly puffing up to 40 cigarettes a day on the island of Sumatra went viral around seven years ago, firing up anti-tobacco activists who said it underscored the problem of underage smoking in Indonesia.

“Indonesia is terrifying because it has among the most baby smokers in the world. From elementary school until high school, the smoking rate is also one of the highest,” the health ministry’s Subuh said.

Indonesia is the only country in the Asia-Pacific region that has yet to ratify or be a party to the World Health Organisation’s Framework Convention on Tobacco Control (FCTC), which seeks to protect against the harmful consequences of smoking.

The tobacco Bill mainly aims to sharply increase cigarette output in Indonesia, already the world’s fourth-biggest producer, at a time when other Asian countries are taking measures to curb smoking.

Proponents of the Bill say it would safeguard a vital economic sector that employs millions of people and contributes nearly 10 per cent of state revenues.

“We don’t mind some regulations, as long as they are not excessive,” said Abdus Setiawan, a board member at the Indonesia Tobacco Growers’ Association. Setiawan said he already considers emblazoning cigarette packs with the message that “smoking kills” to be “excessive.”

To become law in Indonesia, the tobacco Bill has to be agreed between the government and the Parliament. President Joko Widodo agreed in March to start discussions on the Bill with the Parliament, but it is unclear when the President will make a decision.

US$17 BILLION INDUSTRY

Indonesia, a country of 250 million and the biggest economy in South-east Asia, is attractive for major cigarette companies at a time when growth is slowing in more developed markets.

Indonesia produced 269.2 billion cigarettes in 2015, while the total market was valued at 231.3 trillion rupiah (S$24 billion), according to research firm Euromonitor International.

Philip Morris International Inc and British American Tobacco PLC have controlling stakes in local cigarette makers PT Hanjaya Mandala Sampoerna Tbk and PT Bentoel Internasional Investama Tbk, respectively.

Other major domestic players include PT Gudang Garam Tbk and privately held Djarum Group.

Regulations for the industry have been poorly enforced and some companies target young Indonesians with new products such as fruit-flavoured cigarettes or clever advertising, activists say.

“A lot of advertisements here send the message that if you don’t smoke, you’re not macho, you’re not cool,” Muhammad Khanavi, a 14-year-old student, said on the sidelines of an anti-smoking event to mark World No Tobacco Day on Wednesday.

SEOUL – South Korean President Moon Jae-in’s quest for a squeaky-clean government is leading to delays in forming his cabinet more than three weeks into office, as efforts to find candidates free of even the slightest of ethics issues have proved challenging.

In an attempt to make a clean break with his predecessor Park Geun-hye, impeached and ousted over a corruption scandal in March, Moon vowed to bar, “without exceptions”, those who abused their powers to benefit themselves or family members from public jobs.

But the push has come at a cost: Key jobs including defence and unification ministers remain unnamed, while opposition lawmakers have raised ethics issues over several nominees soon after they were named and promised a tough grilling in parliament. Prime Minister Lee Nak-yon remains the only cabinet member confirmed so far to start the job.

That is frustrating an administration that wants to jump on major crises, such as a growing threat from North Korea, as it is being forced to extend an uneasy cohabitation with holdovers from Park’s former administration.

A sign of stress emerged on Wednesday, when Moon’s office accused the defence ministry, headed by a Park appointee, of deliberately not telling the new administration that four more launchers for a controversial US anti-missile system had already been deployed.

“Considering eight months’ worth of political vacuum created by the (corruption scandal), further delays in the appointments will be problematic,” a senior government official said, declining to be identified as he was not authorised to speak publicly on the matter.

‘EXCESSIVE STANDARDS’

Kim Man-heum, head of the Korea Academy of Politics and Leadership, said Moon’s administration “hamstrung itself because the candidates can’t meet the excessive standards that were set.”

“In comparison with the past, the current slate of candidates put forward by Moon is less problematic: aside from personal ethics, there is no case of a friend of the president or some clearly unqualified person being named,” Kim said.

On Thursday, the appointment of a senior Blue House aide was withdrawn due to problems discovered during the vetting process. Officials of the presidential office declined to elaborate.

Prime Minister Lee narrowly won parliamentary approval earlier this week after he admitted and apologise for his wife – a former teacher – for falsifying her place of residence in order to work at a preferred school district in Seoul.

Kim Sang-jo, the nominee to head the Korea Fair Trade Commission and a key architect of Moon’s policy to reform South Korea’s family-run conglomerates, as well as foreign minister designate Kang Kyung-wha, also face accusations of falsely registering a place of residence for family members.

Both Kim and Kang have said they are fully ready to explain their actions during hearings.

PARLIAMENT GAUNTLET

Though parliament only has the right to confirm or reject a prime minister, other cabinet nominees have mandatory hearings at which lawmakers can try to knock them out by digging up improper or illegal practices involving them or family members.

During the Park presidency, her first defence minister nominee withdrew after being accused of real estate speculation, improper lobbying over defence contracts and underreporting his assets. An education minister nominee also took himself out of consideration after allegations of plagiarism emerged.

An ethics controversy also tripped up former UN chief Ban Ki-moon in his quest for the presidency. Ban bowed out of the race in February following bribery scandals involving his brother and a nephew in the United States.

Moon pledged to avoid such problems by not hiring anyone who is linked to one of what he called five major improprieties: tax evasion, real estate speculation, falsifying residence, plagiarism and draft-dodging.

The main opposition party is using Moon’s own words against him.

“We will be more thorough and strict in the upcoming hearings for senior public officials; when we need to fight, we will fight.” Chung Woo-taik, acting chairman of the conservative Liberty Korea Party, said on Thursday. The party, which controls 107 seats at the 299-member National Assembly, opposed Lee for prime minister and boycotted his confirmation vote this week.

Moon made a public apology for the controversies surrounding his early nominees, saying his administration started without a proper transition period and did not have time to thoroughly vet candidates. He pledged to stick by his ethics principles for future hiring.

But experts say high ethics standards will have to be balanced with ability in order to break the appointment gridlock. Most potential candidates likely lived through years when many of the practices now scorned by the public were common or accepted, said Kim Sang-jin, a political science professor at Konkuk University.

“I am not certain whether anyone in public office today can actually meet all the criteria being required,” Kim said.