Women and Aging in China

Joan Kaufman, Sc.DGlobal Health and Social Medicine, HMS

Hauser Center for Non Profit Organizations and Ash Center, HKS

Harvard Shanghai Meeting, May 2012

ChinaChina’’s Demographic Situation and s Demographic Situation and Implications for Aging Population:Implications for Aging Population:

Diminishing demographic dividend

Very low fertility level, unlikely to be reversed and onset of negative population growth (population decline)

Aging Population - especially rural

Increasing burden of NCDs

Burden on families and only children

8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8

0-4 5-9

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84

85+A

ge

Percent of total population

8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8

0-4 5-9

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84

85+

Age

Percent of total population

Age Pyramid, 2000

Age Pyramid, 2030 (projected)

Total number of old people in China by sex 2000 Source: NBS 2000 census

Total No. of Aged People by Age & Sex 2000China

108.21

101.85

94.66

81.99

61.07

0

5,000

10,000

15,000

20,000

25,000

60-64 65-69 70-74 75-79 80+

Thou

sand

s

50.00

60.00

70.00

80.00

90.00

100.00

110.00

120.00

women

men

sex ratio(men/100women)

635450

50 4637

All Ages Ages 60+ Ages 80+

Women Men

Women and AgingProjected World Population, by Sex, at Specified Age Groups, 2025Percent

Source: United Nations, World Population Prospects:The 2004 Revision (medium scenario), 2005.

Aging in China - Dependency Ratios

Elderly people 60 years and above constitute 12% of the population now (166 million people) and will increase to 30% (400 million) by 2050

3 traditional ways for caring for the elderly – family support, self-care and the social security (pension) system

Filial piety - the mainstay of Chinese social structure for old age support, especially in rural China

One-Child Policy - shifting demographics and ability of only children to support elderly parents

One-Child Policy - Social Security system at risk as the worker to retiree ratio drops: from 20:1 to 2.5: 1 by 2020

ChinaChina’’s total labor size will decline by s total labor size will decline by 11% in the next 20 years11% in the next 20 years

Its new entrants (20Its new entrants (20‐‐24) will drop by 24) will drop by 45% in the next 10 years45% in the next 10 years

Who pays for old age?Primary Financial Source of the Elderly by Age in China, 2004

中国分年龄老年人主要生活来源 （2004）Source: national population sample survey in China, 2004

01020304050607080

60-64 65-69 70-74 75-79 80-84 85+

%

salary

retirement wage

Childre/ relatives

social pension

others

The family support system is weakThe family support system is weak

4

2

1

4-2-1 syndrome

Heavy Weight on Chinese FamiliesHeavy Weight on Chinese Families(140 million only children, a third of all Chinese households)(140 million only children, a third of all Chinese households)

% of elderly women w/one child, at age 60

Other Issues

Chronic Diseases and Aging Population

NCDs are China’s number one health threat 80 percent of its 10.3 million annual deaths 68.6 percent of the total disease burden

The main NCDs in China: cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic obstructive pulmonary diseases (COPDs) Lung cancer

China’s rapid population aging is estimated to increase the NCD burden by at least 40 percent by 2030

China’s PHC poorly equipped to deal with prevention and treatment of NCDs (drug availability and lifestyle prevention programs)

China’s hospitals and in patient health insurance systems will be increasingly burdened by cost of NCD morbidity and mortality in aging population

Rural/Urban inbalancesChina’s rural areas are aging more rapidly than its cities, largely due to rural-to-urban migration. In 2008, the aged proportion (60 years old and above) was 9.4 percent in rural areas and 6.9 percent in urban areas, a gap of 2.4 percentage points. By 2030, the aged proportions in rural and urban areas will be 21.8 percent and 14.8 percent, respectively, a gap of 7.09 percentage points (25).

Schools Turning into to Elderly Homes(Jiangsu province, China, 2007)

Its new entrants (20Its new entrants (20‐‐24) will drop by 24) will drop by 45% in the next 10 years45% in the next 10 years

Unbearable Weight on Chinese FamiliesUnbearable Weight on Chinese Families(140 million only children, a third of all Chinese households)(140 million only children, a third of all Chinese households)

% of elderly women w/one child, at age 60

UNFPA best practice projects for Aging Women

5 determinants of psychological stress for older women in China:

Suffering from chronic diseases Lack of support from family members Low level of social security Low level of health knowledge Lack of opportunity to participate in

community activities

PUDONG - 21.4 percent of Pudong’s total registered populationof 2.7 million at the end of 2009 were over 60. In Pudong, 32 percentof older persons are living alone (17.4% widowed)