China, too, faces challenge of an aging society

by Cesar Chelala

Parallel to its economic development, China is facing the challenge of a rapidly aging population. This is happening at a time when urbanization and industrialization is quickly increasing in the country. It is a trend that has weakened traditional family support networks, particularly for the elderly. New policies are necessary to face this situation.

In 1979, China adopted a one-child policy to limit population growth and ensure economic stability. As a result, with fewer children and better living standards, the proportion of elderly in the population has grown substantially and will continue to do so in coming years.

According to one study, within 20 years China will have 350 million citizens over the age of 60, which is more than the current U.S. population.

This situation will present special problems as well as unique opportunities. This century’s leading countries won’t be those that consider their aging citizens as dependent and disabled, but those that empower them to be active participants in the country’s economic growth — what some people now call “active aging.”

In this regard, the International Monetary Fund reported last year that China’s economy should surpass the U.S. economy in real terms in 2016. In spite of this, one of China’s greatest fears is that the country will grow old before it grows rich.

As stated in UNFPA’s (U.N. Population Fund’s) “The State of World Population 2011,” professor Jiang Xiangqun, a gerontologist at Renmin University, Beijing, has argued that when developed countries entered the period of significant population aging, they had a much higher level of per capita income.

The situation for older people was also affected when state-owned enterprises trimmed their ranks by tens of millions. They were let go with small pensions and were replaced by younger workers. The vast majority of retired older workers now have extremely low pensions that are almost irrelevant and, in many cases, make them unable to meet some basic needs.

As a result, the vast majority of older Chinese live with their families, a situation that reflects the Confucian tradition of respect for age and experience as well as a national law, passed in 1996, making it a legal obligation for people to take care of elderly family members.

According to some estimates, 98 percent of old people in China remain in their homes, or try to do so. Many remain mostly by themselves in “empty nests,” as their children migrate to cities for work or start their own families in separate homes.

Some researchers have called this phenomenon the “1-2-4 problem”: one child taking care of two parents and four grandparents.

However, as China’s population ages rapidly, the young workforce available for economic growth is diminishing. This may hinder not only the development of the country but also the quality of life for its senior citizens, since the young will be less able to support their elders. This is happening as the ratio of elderly dependents to people of working age rises sharply. It is estimated that over the next few decades this ratio will rise from 10 percent in 2012 to 40 percent by 2050.

As the numbers of caregivers fail to keep pace with the growing elderly population, more of them, particularly those with poor health, will seek care in specialized institutions.

The proportion of elderly who develop diseases such as diabetes, heart disease and different kinds of dementia will increase. It has been estimated that the total medical cost for treating these diseases could reach almost 9 percent of China’s gross domestic product by 2025.

The government has responded to the challenge of elders’ care by constructing more nursing homes. However, most of these homes are located in big cities, and their quality varies widely. Also, they only provide basic health care and services, and tend to lack trained social workers.

As things stand now, the Chinese government has to devise new strategies to deal with the demographic challenge of a rapidly aging population.

It is necessary to improve a social security system to cover both rural and urban areas, improve the administration of welfare institutions, and address old people’s special needs with physical and mental health support.

China’s health care system will have to address the shifting disease burden of an older population, such as the rising tide of noncommunicable diseases.

At the same time, it is critical to increase the training of social workers through special courses that teach them to understand and deal with the needs of older people.

It is also important to increase the retirement age, which is now 60 for men and 50 for women, taking into account that today’s life expectancy is now 73.

Because of medical advances, people now can still be productive at later ages. How the government meets this challenge will be a measure of the kind of society China intends to build in the future.

Cesar Chelala, M.D. and Ph.D., is an international public health consultant.