Aging population challenges China(Xinhua)Updated: 2004-06-09 10:56China is well anticipated to become the second nation immediately after Japan that will suffer a rapidaging of its population in the coming decades, according to the Green Book of Population and Laborpublished Monday in Beijing.Issued by the Chinese Academy of Social Sciences, or Chinas top think tank, the book focuses onissues related to the demographic transition now underway and the current educational developmentsituation.Compared with developed countries, Chinas aging problems will rapidly arise amid its comparativelypoorer social and economic conditions, posing severe challenges to the countrys lofty ambition ofbuilding an all-round well-off society.Statistics show that, from 2000 to 2007, the number of Chinese people aged 65 or older will increasefrom the current less than 100 million to more than 200 million, up over 4 million per year and theaged will make up 14 percent of the total population.But from 2028 to 2036, the number of the same group will surge from 200 million to over 300 million,indicating that the aged Chineses total will increase by some 10 million each year and make up 20percent of the nations total population in the end.A senior Chinese official claimed last month that China is moving closer to the point that is as much asit can bear.An earlier New York Times article said that unless some drastic transitions happen in Chinas socialpolicies, the country will surely become an aging society with ever faster steps than any other worldpowers in history.So, China, like some other countries, is set to handle many tough challenges regarding aging-relatedissues like finance, society and productivity.Hu Angang, one of Chinas top economists, said that finding ways to ensure the healthy developmentof Chinas aging society is the biggest challenge China would have to face this century, since Chinahas to bear the same social burdens as rich countries with its poor-country income level.According to the book, during their expected 71-year average life span, Chinese people will suffer 8years of ill health on average, causing roaring long-term nursing expenditures. Moreover, with thespeedy and large scale aging trend of the people, the resources that families and society use for dailysupport and medical care for the aged will also surge.Spending increase for the aged will surely reduce the countrys total deposits and thus reduce thegeneral social investment, imposing a negative impact on the sustainable, coordinated, steady andfast development of the nations economy.Chinas current framework of the support of the aged will also confront historical challenges. There isno doubt that during the ongoing mechanism transitional process, the lack of a huge amount ofpension, or only 44.9 percent of the urban employees and 85.4 percent of the retirees covered,
remains a tough issue that more governmental efforts must focus on.Because of the relatively high ratio of those aged from 15 to 59, or 67 percent of the total population,the burden on their shoulders to support the aged has begun to mount.According to the book, it is a dire need to tighten management of the taxation and funds and thereform of both the urban and rural support system is pressing.Experts said that with the downsizing of rural families and the decrease of farming income, issuesshould be put on the agenda to explore a rural support system of the aged that matches Chinasconcrete situation.But both Chinese society and families dont have efficient awareness of the potential crisis regardingthe aged support issues, said experts.http://www.chinadaily.com.cn/english/doc/2004-06/09/content_337985.htminas ConcernOver Population Aging and Healthhttp://www.prb.org/Articles/2006/ChinasConcernOverPopulationAgingandHealth.aspxChinas Concern Over Population Aging and Healthby Toshiko Kaneda(June 2006) As late as 25 years ago, China was concerned it had too many children to support. Today, however,China faces the opposite problem: as a result of the success of its "one-child" policy, the country faces the prospectof having too few children to support a rapidly aging population (see Figure 1 for Chinas projected aging trendbetween 2000 and 2050).Figure 1Population Pyramids, China: 2000 and 20502000 2050Source: World Population Prospects: The 2004 Revision (2005).
The dramatic fertility decline and improved longevity over the past two decades are causing Chinas population toage at one of the fastest rates ever recorded, accompanied by an increase in the prevalence of chronic disease anddisability in the population.Meeting the health and long-term care needs of this growing elderly population will result in soaring health carecosts—and with a shrinking working-age population to help pay the bill. Indeed, the challenge of paying for healthcare in China is immense, especially since the Chinese health care system has already experienced large increases inoverall costs and greater private expenditure since shifting to a market-oriented system in the early 1980s.1But while China is not prepared to meet the health needs of its growing elderly population, its government hasrecognized these challenges and is starting to develop a comprehensive response. As a first step, Chinese healthofficials have implemented various chronic-disease prevention programs at the national level. They are also startingto set up long-term care delivery systems for the elderly. But while Chinas economy continues to grow rapidly,whether it will be able to allocate enough income to meet these rising health care costs remains as a major concern.A Profile of Aging, Chronic Disease, and DisabilityChina has made vast improvements in health over the past five decades, with life expectancy at birth increasing bytwo-thirds from 40.8 to 71.5 between 1955 and 2005.2The country already has about 102 million elderly (those ages65 and over), or over one-fifth of the worlds elderly population.3And the percentage of elderly in China is projectedto triple from 8 percent to 24 percent between 2006 and 2050, to a total number of 322 million (see Figure 2).4Figure 2Percentage of Older Adults (Age 65+) in China, 1950-2050Source: World Population Prospects: The 2004 Revision (2005).
Because chronic health problems become more common in old age, Chinas population aging has led to increases inthe countrys prevalence of chronic disease and disability, creating a greater need for long-term care. And improvedliving standards in China have exacerbated the epidemic of chronic disease by increasing exposure to major riskfactors such as smoking, high-fat and high-calorie diets, and more leisure time without physical activity.Chronic diseases accounted for almost 80 percent of all deaths in China in 2005, with the major causes beingcardiovascular disease, cancer, and chronic respiratory diseases.5Hypertension prevalence in adult population(currently 19 percent) has increased by one-third over the past decade.6Prevalence of obesity, though still around 7percent, has almost doubled in a decade. These trends suggest potential increases in the prevalence of theseconditions for future cohorts of Chinas elderly.Demographic Trends Endanger the Chinese Health Care SystemThe rate of increase in health care costs has already exceeded the growth of the national economy and individualearnings.7Long-term care for the elderly, traditionally provided at home in China by adult children (especially bydaughters-in-law), will become increasingly less feasible in coming decades when parents of the first generation ofthe one-child policy start reaching old age and retiring. These singletons will face the need to care for two parentsand often four grandparents without siblings with whom to share the responsibility, a problem sometimes referred toin China as the "4-2-1 problem."And the macro-level outlook for health care spending is no better. While the number of elderly in the population whorequire care is growing, the size of the working-age population (who pay much of the health care costs) is shrinking.The elderly-support ratio—the working-age adult (ages 15 to 64) per number of elderly (age 65 and above)—isprojected to decline drastically, from 9 persons to 2.5 persons by 2050.8This demographic shift is troublesome for a health care system that already faces a number of challenges—mostimportant of which is the rapid increase in overall costs and in private health care spending.9The health care systemin China—once regarded as exemplary for low-income agrarian societies—has degenerated considerably in accesssince the early 1980s at the same time as its costs have soared. A system that relied heavily on public subsidies andprovided egalitarian access to basic health care has shifted to a market-oriented system that relies heavily on privatefunding and is characterized by excessive usage fees.Now, rising out-of-pocket costs prevent many Chinese from seeking early care and have resulted in wide disparitiesin health care access, particularly between urban and rural areas. These trends are of particular concern to theelderly, who likely have higher health care needs yet less means to afford that care, and who also make up largerproportion of the rural population than the younger population.Public Health Responses to Population AgingThe Chinese government has only recently acknowledged the consequences of rapid population aging and hasstarted to address them in various policies and programs:Strategies for long-term care. Though public funding for the long-term care of the elderly in China is still limited,the Chinese government has started to allocate more funding in this area.10At the same time, new opportunities forentrepreneurship in the health service industry have opened—a result of Chinas social-welfare reform in the 1990s,which decentralized government-funded welfare institutions and significantly reduced their government financing.11Today, an increasing number of private elder homes as well as the countrys former government-sponsored elderhomes (which used to be reserved exclusively for elderly with no children and no other means of support) areproviding an alternative to familial elder care.12However, these facilities are still small in number, of varyingstandards, and are often too expensive for many elderly and their families.Community-based long-term care services for the elderly in China—both informal and local government-supported—have also begun to emerge, especially in urban areas.13These efforts are serving various needs of the elderly andtheir family caregivers, including daily care, home maintenance, and information and referral services.14
The lack of a trained workforce in caregiving to elderly is an important issue facing Chinas long-term care deliverysystem.15Some local government agencies (such as the labor union and the department of health) are training laid-off workers to work in long-term care—but these training programs are short and cover only limited basic caregivingskills.Some observers are calling for more knowledge-based training programs that offer a broader range of caregivingskills. Besides long-term care, the government has plans to develop geriatric medical training at an undergraduatelevel and to establish more geriatric units to increase the countrys capacity to address the specific health care needsof the elderly.16Strategies for primary and secondary prevention. Chinas ministry of health has also been addressing chronicdisease prevention and control. In 2002, for instance, it established the National Center for Chronic and Non-Communicable Disease Control and Prevention to oversee efforts at the national level; the same year, it unveiled theDisease Surveillance Points System, a national resource for chronic disease surveillance.17The ministry is also working to develop the first long-term (from 2005 to 2015) comprehensive national plan forchronic disease control and prevention in cooperation with relevant sectors and supported by the World HealthOrganization (WHO). Reducing adult male smoking, hypertension, overweight and obesity, and building capacity forchronic disease control are among the plans highest priorities.Programs targeted toward specific diseases have also increased. These efforts include a community-basedintervention on management of hypertension and diabetes conducted in three cities (Beijing, Shanghai, andChangsha) between 1991 and 2000; a national cancer control plan, the Program of Cancer Prevention and Control inChina; and ratification of the WHO Framework Convention of Tobacco Control. Furthermore, to prevent chronicdisease at early ages, projects to improve nutrition and health status have been undertaken. These projects arefocused mainly on primary schools and have achieved encouraging reductions (by as much as 30 percent in one yearin one example) in the prevalence of childhood obesity.18Outlook for the FutureThe challenges of population aging are daunting for any country, but especially so for China. Unlike developedcountries where economic development preceded population aging, China faces the massive demands of populationaging at one of the fastest rates ever and while its economy is still not fully developed—hence, without the fundsnecessary to address the demands. Chinas dilemma is how to allocate resources among competing needs of varioussectors while still continuing its economic growth.In addition to the 4-2-1 problem, trends in both the female labor-force participation and the sex ratio of youngChinese may well create additional issues for a society which traditionally has left elder care to its women, especiallydaughters-in-law. The labor-force participation among young Chinese women is very high and could affect theinformal provision of long-term care in the coming decades. The sex ratio at birth for the young cohorts born afterChinas one-child policy is highly skewed toward boys, potentially creating a future deficit of daughters-in-law aselder caregivers.19While the trend of population aging is inevitable and can even be accelerated by further declines in mortality andfertility, stemming the epidemic of chronic disease is one promising way to reduce the overall impact of aging onChinas social and economic development. Investing in a formal long-term care system to complement the informalcare currently provided primarily by family members could also encourage their continued participation in theprovision of care. Addressing these elder care challenges will be crucial to Chinas continued social and economicdevelopment and stability.Toshiko Kaneda is a policy analyst at the Population Reference Bureau.
Chinas Aging Population Expanding FastBy: Author UnknownBeijing Times, August 21, 2002http://www.globalaging.org/elderrights/world/fast.htmChina faces social problems caused by a sharp increase in its aging population, the ChineseAcademy of Sciences (CAS) warned in a recent report on the issue, the Beijing Daily reported onWednesday.The number of people aged over 60 in China exceeded 90 million at the end of 2001, accountingfor about one half of Asias over-60s and one fifth of the worlds total, according to the reportfrom a dozen CAS members.The rise in the number of octogenarians in China was much higher than of 60-year-olds, whichwould mean a heavy burden on society, the report said.Experts urged relevant departments to take measures to improve social welfare and medical caresystems for senior citizens.They suggested that universities should intensify research into the problems of old age andmedical institutions should pay more attention to geriatric health.Heavy BurdenStatistics show that the number of Chinese people older than 60, which accounts for more than10 percent of the countrys population, is increasing at a rate of 3.2 percent per year.The huge aging population brings various social and economical problems to China, which isstill a developing country, said Li Baoku, vice-minister of Civil Affairs.The elderly will be a big burden for China through the year 2050, when that population willreach 400 million, accounting for 25 percent of the total, according to Zhang Wenfan, presidentof the Chinese Old-age Association.Traditional VirtueChina aims to gradually set up a series of networks for the aged, including social endowmentassurance and a looking-after service, by 2010.More than 70 percent of seniors are financially supported and looked after by their families andonly less than 17 percent of them enjoy pensions.
About 70 percent of seniors are concentrated in rural areas and almost wholly depend on supportfrom their children because of the lack of a social welfare system for people in rural regions.Those who are childless or do not live with their children make up 25.8 percent of the totalelderly population. In Beijing, the rate is 34 percent. These people depend completely on thesociety.It will be practical for China to support its aging population through a combination of family anda modern pension system.After all, respecting and providing for the elderly is a traditional virtue of the Chinese people andshould be continued, experts said.Friday, 1 September, 2000, 10:57 GMT 11:57 UKChinas ageing populationThe young have many elderly relatives to care forChinas state lottery will have to make a lot of money if it is to improve living standards forthe countrys rapidly rising elderly population.China has 130 million elderly residents, who make up just over 10%of the population.But with the changing balance of young and old that figure ispredicted to rise more than 31% by the year 2050.This is as a result of the strict one-child policy, introduced in 1979 inan attempt to control Chinas booming population. Under the law eachcouple living in the cities is allowed only one child, unless one or bothpartners are from an ethnic minority or they are both only children.In most rural areas, a couple may have a second child after a breakof several years.The law is particularly strict in cities, where forced sterilisations, late abortions andpunishment of couples who break the rules have often triggered international criticism.But the policy has badly backfired, leaving the working population struggling to provide forthose who have retired.ResentmentA growing number of single young people are finding themselves faced with the dauntingprospect of caring for parents and four grandparents - a phenomenon known as a 4-2-1family.Chinas populationgrowth1950: 563m1960: 650m1970: 820m1980: 985m1990: 1.14bn2000: 1.26bnUS Census BureauYoung people could one daybe outnumbered
But this does not change the fact that with the communist welfare system fastdisintegrating under the pressure of economic reforms, many people are finding itincreasingly hard to provide care for their elders.Those that can afford it have begun to transfer their traditional responsibilities of lookingafter their relatives at home to private nursing homes - a move which has itself sparkedsome resentment.Elderly people in China were traditionally venerated and todays elderly population expectsto be looked after. Some people have even sued their families for neglect.By the year 2030 officials estimate that care for an estimated 300 million elderly willconsume a full 10% of national income.Unless further action is taken, experts say the burden of caring for a greying populationcould begin to have a major impact on the speed of Chinas development.http://www.globalaging.org/elderrights/world/fast.htm