China is aging faster than elsewhere

by Jan Booij

China is an aging society. In 2055 the number of people aged over 60 in China will increase to 478 million or 33% of the population. In comparison, in the Netherlands this will rise to 25% in 2050. By 2050 China will have 65 million more elderly people than the rest of the world together. China is aging faster than elsewhere: within 45 years China has become an aging society, whereas in the rest of the world it has lasted about 200 years. 

Shanghai is one of the fastest aging cities, with 22% of the population now aged over 60, far above the national average of 14%. Demographic research shows that the aging of the population in rural areas will be most drastic if the migration to the big cities continues to develop according to expectations. In China, the one-child policy also leads to a sharper decline in the growth of the labor force than elsewhere. At micro level, it means that when the parents of the single-child generation (’80 -) retire, the children will have the responsibility for 4 grandparents on their shoulders. Nowadays people can also have two children, but they often do not choose this. People are used to a 1-child family and the costs of raising a child are very high.

The care for the elderly is one of the spearheads of the Chinese government. There is still a lot of work to be done in this.

On October 13, 2018, I was invited to Guangzhou Congress at the Guangdong Medical Association as a guest speaker on care for the elderly. Guangdong is the largest province in the world (110 million inhabitants), Guangzhou (Canton) is the capital and is ten times larger than Berlin.

My approach was broader than elderly care. I have chosen to talk more about older people’s policies: how do you create cities where living and living is good for the elderly, in which older people can remain vital for as long as possible, how do you work on prevention and good facilities. How do you work on a city where elderly people are respected and contribute to that city? How can you use shops, the police, public transport, sports clubs etc. in this elderly friendly city? How important is a first comprehensive insurance system for long-term care, the importance of communities and is it possible to organise a kind of homehelp and professional homecare? how do you organize gatekeepers in your system, what risks do hospitals turn into organizations for care for the elderly, how do you prevent medicalisation of care? What is the position of the elder? All questions that are relevant there. But I also spoke about the end of life, senseless suffering and endless treatment. It is not always easy to talk about things like the end of life and death in China, but if you do it with respect, the conversations will often arise later on.

China also has migrants, especially internal migrants. These are people who have moved from the western parts of the country to the cities in the east to find work there. For us they are not easily recognized, but they recognize each other effortlessly. In different neighborhoods you see people living together, people know their own kitchens, their own habits, different ways of dressing, etc. Often these people have a different legal position than the local residents. A lesser position. Care for these migrants when it comes to elderly care is not yet a big issue. I did mention it and there is recognition that attention will have to be paid to this too.

The days after the congress I visited several hospitals, the government and a large organization for the care of the elderly. New construction will take place in the coming two years. Then 5,000 elderly people will live there and receive care.

Meanwhile I have been involved with China for over 20 years and care for the elderly and I visited the country almost every year. There are many contacts and there is trust. At the Erasmus University we train Chinese hospital directors from all over China, there are also many contacts,

The country faces immense issues and on a scale that is almost incomprehensible to us. It is a completely different world and every year I am amazed again, about good business and things that I am less enthusiastic about. But China is a country that deals with issues, annually attracts millions of people from the world of poverty and is working very hard to improve care for the elderly. There has never been a country where developments are going so fast. It is very special to experience this year very close this year.

In February I will go back to China. Then an important hospital in the Netherlands will cooperate with a hospital in Suzhou, China. The elderly are also central to this. The preparations and guidance of such a first visit are very interesting, because the differences are great.

Working together or doing business in China means you have to deal with Guanxi. A very interesting phenomenon. I know that many ENIEC members will also find this very interesting. Simply type the word in a search engine as Google and read about it. You can also find many videos about it.