Event Recap – Caring for the Elderly in China: The Building of a Services Society

March 15, 2017
Arthur Kleinman_170306

Compared with a 12 percent increase in average life expectancy during the 19th century, the doubling of average life expectancy during the 20th century is remarkable as a result of better nutrition and healthcare. Accompanied with this much longer life expectancy is the global challenge of aging, in which the ratio of the number of working population to the number of retirees is rapidly shrinking. By 2050, there will be more people 65 years or older than people younger than 15. People above 85 years old represent the fastest growing group in worldwide demographics.

This issue has become increasingly salient in China since the Chinese are aging faster than anticipated. By 2030, more than a quarter of Chinese will be over 60 years old. Arthur Kleinman, Professor of Anthropology and Professor of Psychiatry at Harvard Medical School, explored what this means for the Chinese economy, society and government in a Critical Issues Confronting China Seminar Series talk, "Caring for the Elderly in China: The Building of a Services Society."

Most people over 60 years have three or four chronic health problems, such as arthritis, high blood pressure, respiratory or cardiovascular disease. More than half of the people over 85 years have some degree of dementia. The Chinese healthcare system is very inadequate in dealing with these problems, despite the fact that the Chinese government has poured an enormous amount of money into healthcare in recent years. China doesn't have a primary care system but a hospital-centric system, in which Chinese elderly often find themselves lacking support and quality care.

Most Chinese in big cities live in high-rise apartment complexes. Older people are very uncomfortable staying by themselves in such an environment, when their children are at work and grandchildren at school during the day. It's not infrequent that older people end up getting lost when wandering outside their apartment complexes. In fact, Alzheimer’s disease is the most expensive elderly problem to deal with, much more so than cancer and stroke. Adverse experiences in younger ages, poor nutrition, rapid transfer of lifestyles from rural areas to mega-city environments, unhealthy habits of smoking and alcohol, as well as hypertension are all contributing factors to wide-spread dementia. Other Southeast Asian countries, such as Vietnam, Thailand and Malaysia, are right behind China in facing such challenges.

What does this trend mean for Chinese businesses? Enterprises formerly in the mining sector, facing the problem of overcapacity, are considering shifting to the services sector by engaging in elderly care. Large real estate companies, such as Vanke (万科集团), are considering construction projects specifically catering to elderly needs, such as their wish of staying in their own community after retirement. A problem in many of these projects designed for the elderly, such as an integrated community consisting of retirement homes, assisted living and nursing home and care, is their price tag – these projects are really for wealthy retirees. Much more needed are facilities for middle-income retirees, such as respite care and day hospitals, to provide temporary relief to the elderly's regular family caregivers.

As Chinese demand for nannies exceeds supply, Chinese families' traditional solution of relying on distant relatives from the countryside, or hiring rural women as nannies has become insufficient. The Chinese have begun to resort to other options. One is to explore what technology, such as robots and sensors, can do to substitute for labor in taking care of the elderly. Another is to revive elements from traditional Chinese culture to extend longevity, such as tai chi or qi gong, in combination with other forms of exercise, for the purpose of "nurturing life" (养生).

In addition to the family and cultural approaches to a productive active aging, there is a policy approach too. President Xi Jinping has named “nurturing the elderly” (养老) “a central issue” for the government. How to ensure financial security for older people, provide regular health maintenance checkups, and encourage social participation, such as continued learning and volunteer work, are all dimensions for the government to consider for improvement. One policy change could be to extend the official retirement age from 55 years old for women and 60 years old for men, but that would run against the challenge of creating almost 20 million new jobs a year for young people. The Ministry of Civil Affairs and the Ministry of Health are all engaged in confronting this challenge. One of their initiatives is to elevate nursing schools to improve the quality of nurses while trying to expand eldercare facilities.

Services for the elderly are becoming a large part of the services sector of the Chinese economy. The shortage of nannies will be acute enough for the Chinese to consider not only migrants from Chinese rural areas but also immigrants from Southeast Asian countries. As people live longer after retirement, their quest for a meaningful life will also become salient. There will be more room for ethics, aesthetics and religion to fill.

China is a microcosm of a global demographic transition to a more aging population. International organizations, such as the World Health Organization, the World Bank and the United Nations Development Program (UNDP), as well as local grass-root non-governmental organizations (NGOs), are all needed in the endeavor to improve health and social well-being of a rapidly aging population and thereby contribute to social development goals.