1. Aging population challenges China
(Xinhua)
Updated: 2004-06-09 10:56
China is well anticipated to become the second nation immediately after Japan that will suffer a rapid
aging of its population in the coming decades, according to the Green Book of Population and Labor
published Monday in Beijing.
Issued by the Chinese Academy of Social Sciences, or China's top think tank, the book focuses on
issues related to the demographic transition now underway and the current educational development
situation.
Compared with developed countries, China's aging problems will rapidly arise amid its comparatively
poorer social and economic conditions, posing severe challenges to the country's lofty ambition of
building an all-round well-off society.
Statistics show that, from 2000 to 2007, the number of Chinese people aged 65 or older will increase
from the current less than 100 million to more than 200 million, up over 4 million per year and the
aged 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 Chinese's total will increase by some 10 million each year and make up 20
percent of the nation's total population in the end.
A senior Chinese official claimed last month that China is moving closer to the point that is as much as
it can bear.
An earlier New York Times article said that unless some drastic transitions happen in China's social
policies, the country will surely become an aging society with ever faster steps than any other world
powers in history.
So, China, like some other countries, is set to handle many tough challenges regarding aging-related
issues like finance, society and productivity.
Hu Angang, one of China's top economists, said that finding ways to ensure the healthy development
of China's aging society is the biggest challenge China would have to face this century, since China
has 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 8
years of ill health on average, causing roaring long-term nursing expenditures. Moreover, with the
speedy and large scale aging trend of the people, the resources that families and society use for daily
support and medical care for the aged will also surge.
Spending increase for the aged will surely reduce the country's total deposits and thus reduce the
general social investment, imposing a negative impact on the sustainable, coordinated, steady and
fast development of the nation's economy.
China's current framework of the support of the aged will also confront historical challenges. There is
no doubt that during the ongoing mechanism transitional process, the lack of a huge amount of
pension, or only 44.9 percent of the urban employees and 85.4 percent of the retirees covered,

2. 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 the
reform 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, issues
should be put on the agenda to explore a rural support system of the aged that matches China's
concrete situation.
But both Chinese society and families don't have efficient awareness of the potential crisis regarding
the aged support issues, said experts.
http://www.chinadaily.com.cn/english/doc/2004-06/09/content_337985.htmina's Concern
Over Population Aging and Health
http://www.prb.org/Articles/2006/ChinasConcernOverPopulationAgingandHealth.aspx
China's Concern Over Population Aging and Health
by 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 prospect
of having too few children to support a rapidly aging population (see Figure 1 for China's projected aging trend
between 2000 and 2050).
Figure 1
Population Pyramids, China: 2000 and 2050
2000 2050
Source: World Population Prospects: The 2004 Revision (2005).

3. The dramatic fertility decline and improved longevity over the past two decades are causing China's population to
age at one of the fastest rates ever recorded, accompanied by an increase in the prevalence of chronic disease and
disability in the population.
Meeting the health and long-term care needs of this growing elderly population will result in soaring health care
costs—and with a shrinking working-age population to help pay the bill. Indeed, the challenge of paying for health
care in China is immense, especially since the Chinese health care system has already experienced large increases in
overall costs and greater private expenditure since shifting to a market-oriented system in the early 1980s.1
But while China is not prepared to meet the health needs of its growing elderly population, its government has
recognized these challenges and is starting to develop a comprehensive response. As a first step, Chinese health
officials have implemented various chronic-disease prevention programs at the national level. They are also starting
to set up long-term care delivery systems for the elderly. But while China's 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 Disability
China has made vast improvements in health over the past five decades, with life expectancy at birth increasing by
two-thirds from 40.8 to 71.5 between 1955 and 2005.2
The country already has about 102 million elderly (those ages
65 and over), or over one-fifth of the world's elderly population.3
And the percentage of elderly in China is projected
to triple from 8 percent to 24 percent between 2006 and 2050, to a total number of 322 million (see Figure 2).4
Figure 2
Percentage of Older Adults (Age 65+) in China, 1950-2050
Source: World Population Prospects: The 2004 Revision (2005).

4. Because chronic health problems become more common in old age, China's population aging has led to increases in
the country's prevalence of chronic disease and disability, creating a greater need for long-term care. And improved
living standards in China have exacerbated the epidemic of chronic disease by increasing exposure to major risk
factors 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 being
cardiovascular disease, cancer, and chronic respiratory diseases.5
Hypertension prevalence in adult population
(currently 19 percent) has increased by one-third over the past decade.6
Prevalence of obesity, though still around 7
percent, has almost doubled in a decade. These trends suggest potential increases in the prevalence of these
conditions for future cohorts of China's elderly.
Demographic Trends Endanger the Chinese Health Care System
The rate of increase in health care costs has already exceeded the growth of the national economy and individual
earnings.7
Long-term care for the elderly, traditionally provided at home in China by adult children (especially by
daughters-in-law), will become increasingly less feasible in coming decades when parents of the first generation of
the one-child policy start reaching old age and retiring. These singletons will face the need to care for two parents
and often four grandparents without siblings with whom to share the responsibility, a problem sometimes referred to
in 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 who
require 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)—is
projected to decline drastically, from 9 persons to 2.5 persons by 2050.8
This demographic shift is troublesome for a health care system that already faces a number of challenges—most
important of which is the rapid increase in overall costs and in private health care spending.9
The health care system
in China—once regarded as exemplary for low-income agrarian societies—has degenerated considerably in access
since the early 1980s at the same time as its costs have soared. A system that relied heavily on public subsidies and
provided egalitarian access to basic health care has shifted to a market-oriented system that relies heavily on private
funding 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 disparities
in health care access, particularly between urban and rural areas. These trends are of particular concern to the
elderly, who likely have higher health care needs yet less means to afford that care, and who also make up larger
proportion of the rural population than the younger population.
Public Health Responses to Population Aging
The Chinese government has only recently acknowledged the consequences of rapid population aging and has
started 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.10
At the same time, new opportunities for
entrepreneurship in the health service industry have opened—a result of China's social-welfare reform in the 1990s,
which decentralized government-funded welfare institutions and significantly reduced their government financing.11
Today, an increasing number of private elder homes as well as the country's former government-sponsored elder
homes (which used to be reserved exclusively for elderly with no children and no other means of support) are
providing an alternative to familial elder care.12
However, these facilities are still small in number, of varying
standards, 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.13
These efforts are serving various needs of the elderly and
their family caregivers, including daily care, home maintenance, and information and referral services.14

5. The lack of a trained workforce in caregiving to elderly is an important issue facing China's long-term care delivery
system.15
Some 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 caregiving
skills.
Some observers are calling for more knowledge-based training programs that offer a broader range of caregiving
skills. Besides long-term care, the government has plans to develop geriatric medical training at an undergraduate
level and to establish more geriatric units to increase the country's capacity to address the specific health care needs
of the elderly.16
Strategies for primary and secondary prevention. China's ministry of health has also been addressing chronic
disease 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 the
Disease Surveillance Points System, a national resource for chronic disease surveillance.17
The ministry is also working to develop the first long-term (from 2005 to 2015) comprehensive national plan for
chronic disease control and prevention in cooperation with relevant sectors and supported by the World Health
Organization (WHO). Reducing adult male smoking, hypertension, overweight and obesity, and building capacity for
chronic disease control are among the plan's highest priorities.
Programs targeted toward specific diseases have also increased. These efforts include a community-based
intervention on management of hypertension and diabetes conducted in three cities (Beijing, Shanghai, and
Changsha) between 1991 and 2000; a national cancer control plan, the Program of Cancer Prevention and Control in
China; and ratification of the WHO Framework Convention of Tobacco Control. Furthermore, to prevent chronic
disease at early ages, projects to improve nutrition and health status have been undertaken. These projects are
focused mainly on primary schools and have achieved encouraging reductions (by as much as 30 percent in one year
in one example) in the prevalence of childhood obesity.18
Outlook for the Future
The challenges of population aging are daunting for any country, but especially so for China. Unlike developed
countries where economic development preceded population aging, China faces the massive demands of population
aging at one of the fastest rates ever and while its economy is still not fully developed—hence, without the funds
necessary to address the demands. China's dilemma is how to allocate resources among competing needs of various
sectors 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 young
Chinese may well create additional issues for a society which traditionally has left elder care to its women, especially
daughters-in-law. The labor-force participation among young Chinese women is very high and could affect the
informal provision of long-term care in the coming decades. The sex ratio at birth for the young cohorts born after
China's one-child policy is highly skewed toward boys, potentially creating a future deficit of daughters-in-law as
elder caregivers.19
While the trend of population aging is inevitable and can even be accelerated by further declines in mortality and
fertility, stemming the epidemic of chronic disease is one promising way to reduce the overall impact of aging on
China's social and economic development. Investing in a formal long-term care system to complement the informal
care currently provided primarily by family members could also encourage their continued participation in the
provision of care. Addressing these elder care challenges will be crucial to China's continued social and economic
development and stability.
Toshiko Kaneda is a policy analyst at the Population Reference Bureau.

6. China's Aging Population Expanding Fast
By: Author Unknown
Beijing Times, August 21, 2002
http://www.globalaging.org/elderrights/world/fast.htm
China faces social problems caused by a sharp increase in its aging population, the Chinese
Academy of Sciences (CAS) warned in a recent report on the issue, the Beijing Daily reported on
Wednesday.
The number of people aged over 60 in China exceeded 90 million at the end of 2001, accounting
for about one half of Asia's over-60s and one fifth of the world's total, according to the report
from a dozen CAS members.
The rise in the number of octogenarians in China was much higher than of 60-year-olds, which
would mean a heavy burden on society, the report said.
Experts urged relevant departments to take measures to improve social welfare and medical care
systems for senior citizens.
They suggested that universities should intensify research into the problems of old age and
medical institutions should pay more attention to geriatric health.
Heavy Burden
Statistics show that the number of Chinese people older than 60, which accounts for more than
10 percent of the country's 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 is
still 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 will
reach 400 million, accounting for 25 percent of the total, according to Zhang Wenfan, president
of the Chinese Old-age Association.
Traditional Virtue
China aims to gradually set up a series of networks for the aged, including social endowment
assurance and a looking-after service, by 2010.
More than 70 percent of seniors are financially supported and looked after by their families and
only less than 17 percent of them enjoy pensions.

7. About 70 percent of seniors are concentrated in rural areas and almost wholly depend on support
from 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 total
elderly population. In Beijing, the rate is 34 percent. These people depend completely on the
society.
It will be practical for China to support its aging population through a combination of family and
a modern pension system.
After all, respecting and providing for the elderly is a traditional virtue of the Chinese people and
should be continued, experts said.
Friday, 1 September, 2000, 10:57 GMT 11:57 UK
China's ageing population
The young have many elderly relatives to care for
China's state lottery will have to make a lot of money if it is to improve living standards for
the country's 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 is
predicted to rise more than 31% by the year 2050.
This is as a result of the strict one-child policy, introduced in 1979 in
an attempt to control China's booming population. Under the law each
couple living in the cities is allowed only one child, unless one or both
partners are from an ethnic minority or they are both only children.
In most rural areas, a couple may have a second child after a break
of several years.
The law is particularly strict in cities, where forced sterilisations, late abortions and
punishment of couples who break the rules have often triggered international criticism.
But the policy has badly backfired, leaving the working population struggling to provide for
those who have retired.
Resentment
A growing number of single young people are finding themselves faced with the daunting
prospect of caring for parents and four grandparents - a phenomenon known as a 4-2-1
family.
China's population
growth
1950: 563m
1960: 650m
1970: 820m
1980: 985m
1990: 1.14bn
2000: 1.26bn
US Census Bureau
Young people could one day
be outnumbered

8. But this does not change the fact that with the communist welfare system fast
disintegrating under the pressure of economic reforms, many people are finding it
increasingly hard to provide care for their elders.
Those that can afford it have begun to transfer their traditional responsibilities of looking
after their relatives at home to private nursing homes - a move which has itself sparked
some resentment.
Elderly people in China were traditionally venerated and today's elderly population expects
to 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 will
consume a full 10% of national income.
Unless further action is taken, experts say the burden of caring for a greying population
could begin to have a major impact on the speed of China's development.
http://www.globalaging.org/elderrights/world/fast.htm