CHINA

Fertility in China has declined dramatically from more than six children per woman in the 1950s and 1960s to about 1.8–2.0 children per woman today, which is roughly the same as in the United States. Average life expectancy at birth for both sexes combined in China has increased from about 41 years in 1950 to 68.4 years in 1990, and 71 years in 2000, and will continue to increase (United Nations, 1999 vol. 1). The large cohorts of baby boomers, those born in the 1950s and 1960s, will become elderly in a couple of decades. Such demographic regimes have determined that the population of China, the most populous country in the world with about 1.3 billion people in 2000, is aging at an extraordinarily rapid speed and on a large scale. This article summarizes the demographic trends of aging, living arrangements, economic status, retirement patterns, and access to health and longterm care of the elderly in China.

Increase in proportion and number of elderly

The proportion of elderly (defined as those aged sixty-five and above in this article) of the Chinese population was 5.6 percent in 1990 and 7.0 percent in 2000. However, this proportion will climb quickly to 15.7 percent in 2030 and 22.6 percent in 2050, under medium fertility and medium mortality assumptions (United Nations, 1999, vols. 1 and 2). Note that the medium fertility assumes that the Chinese fertility level will be about 1.9 children per woman in the first half of the twenty-first century, and the medium mortality assumes that life expectancy at birth in China will increase from 71 years in 2000 to 78.7 years in 2050. Under such assumptions, the average annual rate of increase in the proportion of the elderly population between 2000 and 2050 will be 2.4 percent, while the average annual growth rate of the total population of China during the same period will be only 0.3 percent. In 2000, China's population consists of 21.1 percent of the total world population, and the Chinese elderly population is about 20.8 percent of all elderly living in the world. By 2050, China is projected to have 16.6 percent of the total world population, but will have 22.9 percent of the world's elderly (United Nations, 1999, vol. 2).

In Western societies, the aging transition has been spread over a century or more. In China, however, this change will take place within a few decades and will reach a level of population aging similar to that of most developed countries by the middle of the twenty-first century. It will take about twenty years for the elderly population to increase from 10 percent to 20 percent in China (2017–2037), compared with twenty-three years in Japan (1984–2007), sixty-one years in Germany (1951–2012), sixty-four years in Sweden (1947–2011), and fifty-seven years in the United States (1971–2028) (United Nations, 1999, vol. 2). By the middle of the twenty-first century, the proportion of elderly persons in China will be higher than that in the United States by 0.9 percentage points, and the average annual increase between 1990 and 2050 in China will be 2.6 times as high as that in the United States.

The very large size of the elderly population is another unique feature of population aging in China. In 1990 there were sixty-seven million, and in 2000, eighty-eight million, elderly persons aged sixty-five and over. Under the medium mortality assumption, there will be 235 million elders in China in 2030 and 334 million in 2050. China's elderly population will be fairly close to the total population size of the United States, and 4.4 times as large as the U.S. elderly population, by the middle of the twenty-first century. In 2050 China's elderly population will outnumber India's by 103 million, whereas the total Chinese population will be smaller than that of India by 51 million (United Nations, 1999, vol. 2).

Increase of those aged eighty and above

The oldest old persons, aged 80 and above, are most likely to need help, and most of the younger elderly persons, aged sixty-five to seventy-nine, are relatively healthy. There were about 7.7 million oldest old in China in 1990 and 11.5 million in 2000; their number will climb extremely [SPC1] rapidly, to about 27 million in 2020, sixty-four million in 2040, and one hundred million 2050, under the medium mortality assumption. The average annual increase of the oldest old between 2000 and 2050 will be 4.4 percent. The percent share of the oldest old among the elderly population in 2050 will be 2.3 times as high as that in 2000 (United Nations, 1999, vol. 2), as China's baby boomers, those born in the 1950s and 1960s, become oldest old after 2030.

Aging problems in rural and urban areas

Although fertility in rural China is much higher than in urban areas, aging problems will be more serious in rural areas because of the continuing massive rural-to-urban migration, the large majority of which is young people. Under the medium fertility and medium mortality assumptions, the proportion of elderly will be 26 percent in rural areas and 22 percent in urban areas by the middle of the twenty-first century. The proportions will be 31 percent in rural areas and 26 percent in urban areas under medium fertility but low mortality assumptions (Zeng and Vaupel, 1989). It is also important to note that the extremely rapid and large-scale population aging in China is accompanied by a per capita GNP that is considerably lower (especially in rural areas) than that in many other developing countries. Thus, resources for addressing the serious problems caused by rapid population aging are limited.

Economic status

Income data collected in a survey are not reliable because people usually do not wish to reveal how much money they actually make. For this reason, we will use only self-reported economic status in the following discussion, based on such questions as "Do you feel that your monthly income is enough for payment of living costs?" and the ownership of some household facilities. According to a national survey on China's support systems for the elderly, conducted by the China Research Center on Aging in 1992, 12.7, 53.1, 22.7, and 11.6 percent of the rural elderly reported that their monthly income was enough with savings, roughly enough, a little bit difficult, and rather difficult, respectively. The corresponding figures for the urban elderly were 15.3, 63.9, 15.9, and 5.0 percent, respectively. About 0.8, 47.4, 14.7, and 7.3 percent of the rural elderly had a telephone, a television set, a washing machine, and a refrigerator in their home, in contrast to 7.5, 88.2, 51.5, and 46.6 percent for the urban elderly (CRCA, 1994). Obviously, the economic status of the rural elderly is substantially worse than that of their urban counterparts.

Access to health services and long-term care

Based on the 1992 survey, 66.6 percent of the urban elderly had their medical expenses paid entirely or partially by the government or collective enterprises in 1991. However, this figure was only 9.5 percent for the rural elderly (CRCA, 1994). According to a national survey on healthy longevity of the oldest old conducted by China Research Center on Aging and by Peking University in 1998, around 80 percent of the Chinese oldest old reported that they could get adequate medical care when they were sick. Note that the term "medical care" used in the survey includes traditional Chinese medicine, which is cheap and widely available even in poor and remote areas. As a result, we should not interpret the 1998 survey figures as an indication of good and modern health service facilities in China today.

The census data show that the proportions of elderly men and women who lived in nursing homes in 1990 in the urban areas were 2.1 and 0.8 percent, respectively. The corresponding figures for rural elderly men and women were 0.8 and 0.2 percent, respectively. Given the extremely limited long-term care facilities available and that a large majority of the elderly live with children, especially those in rural areas, perhaps the major cause of institutionalization of elderly persons in China in 1990 was childlessness (or absence of children). Therefore, the percent of the elderly living in nursing homes was extremely low, compared with that in developed countries, where the most common reason for an elderly person to move into an institution is disability. Chinese elderly women's lower social and economic status made them less likely to be able to access long-term care facilities. This is another social disadvantage faced by elderly women in Chinese society, and merits the attention of both society and the government.

Retirement patterns

In China the pension system, which was introduced in 1952, supports only employees of state-owned enterprises in urban areas; its coverage now includes about 140 million persons (Poston and Duan, 2000). Farmers do not have a retirement pension, but continue to work until their health fails. In general (with extent depending on location), China provides the "Five Guarantees" of food, clothing, shelter, medical care, and a funeral for old persons who are childless, disabled, and have no close relatives to rely on (Poston and Duan, 2000). According to the 1992 survey of the elderly, only 5.9 percent of the rural elderly age sixty and over were pension recipients, in contrast to 73.7 percent in the urban areas (CRCA, 1994). The rural elderly have almost no social security coverage. This is a strategically important issue to be considered by policy makers; the old age insurance system should be made universal and strengthened as soon as possible.

Living arrangements and family support

Among the elderly, 37.4 percent of men and 66.5 percent of women do not have a surviving spouse. The proportion of those not living with a spouse increases tremendously with age, due to high rates of widowhood at advanced ages (the divorce rate in China is very low). Many more elderly women are widowed than men because of the gender differential in mortality at old ages. The proportion of old men and women living alone is 8.0 and 10.2 percent, respectively. Elderly women are more likely to be widowed and thus live alone. On the other hand, elderly women are economically more dependent. Therefore, the disadvantages of women in marital life and living arrangements are substantially more serious than those of men at old ages (Zeng and George, 2000).

On the basis of 1990 census data, a large majority of old men (68.8 percent) and women (74.8 percent) live with their children ("children" includes grandchildren hereafter). Female elderly persons are more likely to live with their children, because elderly women are more likely to be economically dependent and widowed. Among the elderly who live with offspring, a majority (68.5 percent of men and 80.1 percent of women) live with both children and grandchildren. Multigeneration family households are one of the main living arrangements for the elderly.

In the cultural context of Chinese society, the philosophy regarding the support of one's older parents is quite different from that of modern Western societies. Filiality (xiao) has been one of the cornerstones of Chinese society for thousands of years, and it is still highly valued. The philosophical ideas of filiality include not only respect for older generations but also the responsibility of children to take care of their old parents, which is stated clearly in the Chinese constitution and in laws protecting the rights of elderly persons (Zeng, 1991). Families have been playing, and will continue to play, crucial roles in bearing the costs of caring for the elderly, given limited pensions and health service facilities, especially in rural areas.

ZENG YI

See also JAPAN; POPULATION AGING; SOUTH ASIA.

BIBLIOGRAPHY

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ZENG Y. Family Dynamics in China: A Life Table Analysis. Madison: University of Wisconsin Press, 1991.

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