China’s rapidly aging population: program and policy implications

The proportion of elderly citizens in China will continue to grow very quickly, as a combination of China’s one-child policy and low mortality takes effect, increasing the stress on an already troubled health care system. Only 40 percent of elderly males and just 13 percent of elderly females receive any kind of support from a pension:

Observations and policy implcations include:

• demographic context: with fewer children and improved living standards, the proportion of elderly in China’s population has grown substantially over the last 20 years. As the elderly population continues to grow and the availability of family caregivers decreases, more elderly with poor health will need to seek care in institutions
  
• the oldest-old: the oldest-old (aged 80 plus) in urban areas are more likely to suffer from frailty than those living in rural areas, possibly because of urban-rural differences in social support networks, the environment, and lifestyle
  
• challenges to tradition: including movement of many rural youth to cities, an erosion of traditional respect for elders because of newfound economic power of young adults, decline in intergenerational coresidence, adult children with fewer siblings to support their older parents
  
• nutrition: China’s adult overweight population is growing significantly; in 2004, almost one-quarter of all Chinese adults were overweight. The proportion of elderly who develop obesity-related diabetes and heart disease will increase, and the total medical cost for treating these diseases could reach almost 9 percent of China’s gross domestic product by 2025.
  
• environmental factors: Research suggests that those elderly living in richer cities are generally more affected by air pollution than elderly living in poorer cities, because residents of these richer cities had greater chronic exposure to air pollution during urban economic development
  
• living arrangements: The elderly - especially the oldest-old - are more likely to live with family when they are healthier, and are more likely to live in institutions when they are suffering from physical disability, cognitive impairment, or chronic illness. The oldest-old are more likely to remain in the home rather than in an institution when there is a family caregiver (often a daughter-in-law). More research is needed to determine which solutions can address the lack of available caregivers and and to provide the elderly with appropriate health resources, including formal and informal care
  
• heath care and health insurance: Both urban and rural poor have similar low levels of health insurance coverage -24 percent and 20 percent, respectively. Health care services are largely unaffordable to uninsured poor and rural populations. By 2030, older adults (45 plus) will account for two-thirds of the total disease burden in China. The Chinese government has pledged about 1.5 percent of its total gross domestic product to health care over the next few years but without reforms in the delivery system to strengthening regulation, China will not fully reap the benefits of additional funding