- Open Access
Can China afford rapid aging?
© The Author(s) 2016
- Received: 2 April 2016
- Accepted: 6 July 2016
- Published: 18 July 2016
China’s rapid aging has caused widespread concern, but it seems that the situations and consequences of rapid aging are not adequately acknowledged. This study analyzed the problem of ageing in China from the aspects of elderly people’s health status, income source, daily care, suicide, the weak social security system in terms of pension, health expenses, and long-term care costs as well as incoming accelerating ageing process in China. All these factors indicate that it is difficult for China to afford the issue of a rapidly aging population.
- Health status
- Social security system
- Long-term care
With the sharp decline in China’s fertility rate (from the census data of 2.63 in 1982 to 1.18 in 2010) and the great rise in life expectancy (from 67.77 years old in 1981 to 74.83 in 2010), both the number and proportion of the elderly in China have risen rapidly. In 1982, there were 49.28 million people aged 65 and over, accounting for 4.91 %. In 2000, the number of those aged 65 and over rose to 88.27 million (7.10 %). By 2010, the number of the elderly aged 65 and over had reached 118.93 million (8.92 %). In rural areas, the population aged 65 and over was 66.67 million, which accounted for 10.06 % (PCO 2002, 2012).
The Chinese government has also realized that China’s rapid aging is an issue. In the Decision of the Central Committee of the Communist Party of China on Some Major Issues Concerning Comprehensively Deepening the Reform passed at the Third Plenary Session of the 18th Central Committee of the Communist Party of China held in November 2013, the government stated that they would respond actively to the aging of the population, quicken steps to establish a social endowment service system and develop the service industry for the elderly, and improve the system of care for seniors. However, this resolution includes no detailed measures to actively respond to the aging of the population.
With the development of China’s population, society and economy, Chinese family size is shrinking and the number of children is dwindling; urbanization brings numerous young people to cities, but the social security system is not well established yet as far as pensions are concerned. All these aging-related issues pose considerable challenges (CHARLS Research Team 2013; Zhao et al. 2014).
Health status of the elderly
The data from China’s 2010 population census divided the health status of the elderly into four kinds, i.e., healthy, basically healthy, unhealthy but able to take care of oneself, and not able to take care of oneself. The data indicated that in the elderly population aged 65 and over, healthy people accounted for 35 %, basically healthy people, 43 %, those not healthy but able to take care of themselves, 18 %, and those unable to take care of themselves, 5 %. In the population aged 80 and over, the percentage of these four population groups is 19, 41, 29 and 10 % respectively. In the rural elderly aged 65 and over, the percentage of the four population groups, i.e., healthy, basically healthy, unhealthy but able to take care of oneself, and not able to take care of oneself, is 32, 42, 22 and 4 % respectively. In the rural elderly aged 80 and over, the percentage of the four groups is 16, 39, 34 and 11 % respectively (PCO 2012). Moreover, microcosmic survey data indicated that health status of the elderly is even worse than this seems to indicate. In a self-rated health survey, 31.8 % of elderly people stated that they were in bad or worse health, 38.1 % had physical disabilities (having difficulty in completing basic daily activities), 23.8 % reported needing help in basic daily activities, and 33.4 % reported physical pain (CHARLS Research Team 2013).
Remaining life expectancies by health status (years)
Remaining life expectancy by status
Status at 65
Status at 80
Only IADL disabled
Only IADL disabled
Only IADL disabled
Health status can affect the elderly in many ways. Above all, if the elderly are not well enough to work, they can barely earn an income; thus, older people in rural areas may rely heavily on the support of their family members. Next come living arrangements. Since the disabled elderly need long-term care, they often need to live with their adult children. Finally, in terms of the healthcare they receive, spending on health care and family care for ill elderly people is on the rise (Du 2013).
Main income sources
The data from China’s 2010 population census indicated that as far as the main sources of support for people aged 65 and over are concerned, 49 % comes from the support of other family members, 20 % comes from their labor income and 25 % from pensions for the elderly and retired veterans. As they get older, the elderly gradually lose labor capacity and rely more and more on the support of other family members. For people aged 65, 40 % take labor income as main source of support; for 70-year-olds, the percentage drops to 23 %; for people aged 80, it is 5 %. At the same time, 31 % of people aged 65 have the main source of support coming from other family members; for the people aged 70, the percentage is 44 %, and for the people aged 80, the percentage rises to 63 % (PCO 2012).
Regarding the dual urban–rural structure in China, there are enormous differences between urban and rural areas in methods of elderly care. In urban areas, the main source of support for people aged 65 and over comes first from the pensions for the elderly and retired veterans, accounting for 67 %; it comes secondly from the support of other family members, accounting for 24 %; labor income only takes up 4 %. In rural areas, the main source of support for people aged 65 and over comes first from the support of other family members, accounting for 59 %; 28 % rely on their labor income; only 5 % rely on pensions for the elderly and retired veterans (PCO 2012). Elderly women rely more on the support of other family members. In the whole of China, 60 % of women aged 65 and over rely mainly on the support of other family members; in rural areas, the percentage is even as high as 71 % (PCO 2012).
Distribution of income sources for people aged 60 and over by health status (%)
Unhealthy but able to take care of oneself
Not able to take care of oneself
Support of other family members
Pensions for the elderly and retired veterans
Income from transfers
Guaranteeing the lowest living
One important point is that a small proportion of the elderly receive pensions for the elderly and retired veterans as their main income source, and most of these people live in urban areas. The social security systems for the elderly who live in rural areas are at a low level. On the other hand, the percentage of elderly people in poor health who name pensions for the elderly and retired veterans as their main income source is less than 20 %, while the proportion of the older people who mainly depend on the support of other family members is up to around 70 %. Chinese elderly people enjoy low social security, and more needs to be done to help the elderly in this respect.
Traditionally, an elderly person’s spouse and children are his or her main caregivers, and spouses can take care of the daily life of the elderly who need care. Nevertheless, many elderly people are widowed. According to data from the 2010 population census, 41 million elderly people are widowed in China, accounting for 34 % of all elderly people, including 12.01 million elderly men (accounting for 21 % of all elderly men) and 28.98 million elderly women (accounting for 47 % of all elderly women). In rural areas, 24.50 million elderly people are widowed, accounting for 37 %; 7.67 million elderly men are widowed, accounting for 24 %; 18.63 million elderly women are widowed (49 %) (PCO 2012). For men, the average age of widowhood is 72.6, and after becoming widowed, men may survive 11.2 years; for women, the average age of widowhood is 70.6, and after becoming widowed, women may survive 14.7 years. In rural areas, the average age of widowhood for men is 68.3, and after becoming widowed, rural men may survive 13.0 years; the average age of widowhood for women is 66.3, and after becoming widowed, rural women may survive 17.0 years (Jiang et al. 2015).
In China, traditionally, children are the main caregivers for the elderly. However, traditional elderly care within the family is suffering a huge impact. Firstly, with social and economic development and the implementation of the family planning policy, the number of children has fallen. According to data from the 2010 population census, the average number of surviving children is 2.60, 2.18, 1.94 and 1.82 for 60–64 year-old, 55–59 year-old, 50–54 year-old, and 45–49 year-old women (PCO 2012). However, as social competition becomes even fiercer, along with the accelerating pace of life, the time cost of taking care of an older person for their adult children is increasingly high, and the long-term care could easily result in family conflict and psychological problems (Tang and Lou 2010). Secondly, the family planning policy that has been implemented over the last 35 years has produced about 160 million only-child families, and has also led to numerous families who are bereft of their only child. Eventually (if the mother reaches the age of 90) the risk of losing a male child for a mother is 14.94 %, while that for a female child is 12.21 %. The average age of the mother’s loss of a male child is 57 years old and 51.44 years old for a female child. The time the mother survives after this bereavement is 25 years for a male child, and 30 years for a female child (Jiang et al. 2014). Statistics estimate that at least one to two million families have lost their only child in China. It has been predicted that the number of families bereft of their only child may reach 11.84 million by 2050 (Wang 2013a). Parents who have lost their only child are vulnerable in their physical health, psychological health, economic situation, and social networks. They actively or passively self-exclude themselves from the outside world (Wei et al. 2016).
Due to the decline in the number of children, the traditional pattern of daughters getting married and moving out, as well as the current large-scale influx of rural residents into cities, it is becoming more and more usual for elderly people to live alone. The 2010 census data indicated that among people aged 65 and over, 14.44 million households of elderly people live alone, and 8.12 million of such elderly people are in rural areas; 13.53 million households are elderly couple households, and 6.84 million such households live in rural areas (PCO 2012).
An increasingly serious “empty nest” phenomenon poses a great challenge in terms of the daily care of the elderly and is giving rise to some extreme social problems. For example, on November 24, 2015, in Xialu District of Huangshi City of Hubei Province, an elderly unmarried man was found to have died in his home more than 6 years before he was discovered: only his skeleton was left (Mu 2015).
As China is becoming an aging society, there is a growing demand for care for the elderly, especially for those who are disabled. However, with the decline in family size and rise in rural-to-urban migration of young people, the availability of family members to provide care and support to elderly parents will most likely continue to decrease (Wu et al. 2009). The unprecedented weakening of family caregiving and the relative absence of community and institutional care make care for disabled elderly an important social issue which urgently needs to be solved.
High suicide rates among the elderly population
Because of changes in family structure and intergenerational relations, the structural authority of the elderly has been undermined, but appropriate protection mechanisms have not been established for those elderly who are in a weak position. With the decline of traditional filial piety and respect for the elderly, the elderly are increasingly being regarded as consumers of resources within the family and in society as a whole (Li et al. 2009). When the elderly lose the capacity to work, caring for them becomes a major difficulty. Especially for the rural elderly, there are few sources of care. Once they cannot take care of themselves, if there are neither children to take care of them, nor a nursing house to go to, they may become desperate and commit suicide.
The elderly commit suicide mainly because of either their hard life or the pain of disease, these two reasons accounting for 60 % of direct causes of death. Another important factor leading to suicide among the elderly relates to their emotional problems. As in the fierce competitive society, middle-aged people are anxious to seek how they can lighten the load in market societies so as to stand out. Undoubtedly, the elderly, who are even more vulnerable, seem to become a burden to their adult children. “I could hardly bear my own burdens, let alone care for the elderly,” some farmers are quite straightforward with their indifference to their elderly parents during the interview. Actually, most of the older people committing suicide did not want to die (Xuan 2014).
Suicide rates for older people by age group in rural China (per 100,000)
Rural vs urban differences in potential years of life lost (PYLL) due to suicide are large. The PYLL due to suicide was approximately twofold higher in rural areas compared with urban areas (Sun and Zhang 2015). In China’s vast rural areas, especially in the economically underdeveloped regions, there are many family tragedies where the elderly commit suicide, which indicates the poor situation of the aged in rural areas. It critical to solve this problem and help the country deal with its aging population (Ge 2016).
China’s population aging (Unit: Million, %)
People aged 65 and over
People aged 80 and over
Elderly dependency ratio
According to the United Nations data and prediction results (United Nations 2015), for the percentage of people aged 65 and over within the total population to increase from 10 to 20 % it will take: 18 years in China (2016–2034); 22 years in Japan (1984–2006); 57 years in Germany (1951–2008); 68 years in Sweden (1947–2015); 56 years in the United States of America (1972–2028). All these developed countries took or will take a longer time for the proportion of older people to double from 10 percent.
According to a report published in 2013, the number of older people with functional disabilities exceeded 37.50 million, those with chronic diseases more than 100 million, older people in an “empty nest” exceeded 100 million, 23 million older people lived under the poverty line, and 50 million older people were left behind in rural areas (Wu and Dang 2013). Furthermore, those numbers are expected to increase in the years to come.
In the Decision of the Central Committee of the Communist Party of China on Some Major Issues Concerning Comprehensively Deepening the Reform, passed at the Third Plenary Session of the 18th Central Committee of the Communist Party of China held in November 2013, it was stated that China would respond actively to the aging of the population, quicken steps to establish a social endowment service system, and develop the service industry for the elderly. In recent years, the Chinese government has energetically promoted new social insurance projects, to provide better security for the elderly. Public medical insurance, in particular, which is important for the elderly, has almost reached full coverage, and the endowment insurance program is also being popularized throughout the whole country.
Nevertheless, as can be seen from the discussion above, the security level of these projects and programs is relatively low and they are far from paying all medical expenses or living expenditure after retirement for most rural elderly people. There will still be problems and challenges for China’s elderly people in the foreseeable future: low security and income level and a weak ability to resist risks; significant growth in demands for care giving and a shortage of care-giving service resources; many health risks and a heavy medical burden; increasing problems adapting living arrangements inclined to independent living and the phenomenon of the “empty nest”. For a long time, the spouse and children will be the main caregivers for elderly people. With the advent of small families and the decline in the number of children in a family, the trend for family members to take complete care of the elderly will be difficult to sustain. Because of the dramatic decline and low level in fertility during the past several decades, China has benefited notably in terms of economic and social development because of an enormous demographic dividend. However, with the closure of the opportunity window of the population, as well as increasing life expectancy, it will be very difficult for China to afford its rapidly aging population.
The three authors made substantial contributions to conception, design, acquisition, analysis and interpretation of data. The leading author was QJ. All authors read and approved the final manuscript.
This research was supported by Key Project of National Social Science Foundation of China (15ZDB136) and the Spanish Ministry of Economy and Competitiveness (CSO2012-31206).
The authors declare that they have no competing interests.
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