China's aging population poses challenges, but policy changes can help

Problems that need attention include China's growing obesity rate and high smoking rates among men and rising levels of urban pollution, challenges that could increase health costs if they trigger disease in older ages, according to the report published online by the Journal of the Economics of Ageing.

In addition, China should reform migration policies to allow older Chinese residents to move about the nation more freely and retain full health benefits when they relocate. Such a change would allow older citizens to follow their children as they move about China.

The three authors of the study are James P. Smith of the RAND Corporation, John Strauss of the Department of Economics at the University of Southern California, and Yaohui Zhao with the National School of Development of Peking University.

"There will not be a demographic fix to healthy aging in China, even if the one-child policy is relaxed, since fertility is unlikely to change much" said Smith, Chair in Labor Market and Demographic Studies at RAND, a nonprofit research organization. "Government policies need to focus on improving health behaviors, combatting pollution and allowing elderly parents to live with their adult children."

Researchers say that Chinese people, reaping the health benefits of dramatically improved education levels, will live longer and healthier lives in future decades, even among those who live in remote areas of the nation.

"If you look at a cross section right now, it can be very misleading for population aging in China," Smith said. "In 20 years, Chinese people who are 50 today are not going to look at all like Chinese people in their 70s right now."

Better education will make a difference in the health of Chinese citizens as they get older, researchers say. For example, the survey found that today 80 percent of women and 40 percent of men over the age of 75 were illiterate. But in the age range of 45 to 54, only 20 percent of women and 5 percent of men were illiterate, and the education levels of young adults is virtually the same for both men and women today.

But Chinese people also are making the same health-threatening lifestyle choices as people in the rest of the world. Smoking rates among men remain high, rates of obesity among men and women are growing, and China's urban areas have extraordinarily high levels of pollution. And as young people migrate to cities for schooling and jobs, their aging parents could be left to fend for themselves in remote areas, according to the study.

The research team analyzed information from the 2011-2012 wave of the China Health and Retirement Longitudinal Study (CHARLS), which is collected by researchers headed by Zhao at Peking University and is funded in part by the U.S. National Institute of Aging.

The survey is a nationally representative sample of people 45 and older in continental China. Chinese respondents from more than 10,000 households will continue to be followed every two years in face-to-face interviews.

In 1950, the life expectancy in China was about 40 years, growing to about 70 today, with every indication the trend toward longer life will continue. The biggest change that will affect Chinese people as they age is a rising education level.

Chinese citizens also are getting diagnosed and treated for common conditions such as hypertension and diabetes, conditions that just a few years ago they didn't even realize they had. "The silent killers are now being heard," Strauss said.

The tradition of children caring for aging parents also is undergoing dramatic change, with fewer children available as caretakers. In 1950, the average Chinese woman had six children. Projections are that in China, in part due to the one-child policy, by 2050 women will have 1.9 children, or below replacement level fertility.

"If you have five kids, it's a lot more certain that one of them will take care of you than if you only have one or two," Zhao said.

Today, more than 90 percent of elderly people have a child living with or near them. But indications are that that is changing.

While 94 percent of people over 75 live with or near a child, that is true for only 82 percent of those 55 years old. And when children leave rural areas for cities, some government policies make it difficult or impossible for parents to follow.

For example, today almost all rural Chinese people have health insurance. But insurance pools are operated at the county level, and reimbursement for care decreases while co-payments increase for care received outside of one's home county. Such policies discourage older parents from following their adult children to new locations.

"A larger fraction of parents will not have access to an adult child," Zhao said. "That's not a crisis of the moment, but a potential crisis of the future."

Changes in China's one child policy are unlikely to affect this since China's fertility rate is very similar to other countries at the same level of development, according to researchers.