Aging Chinese Face a Bleak Picture

After a pilot launched in 2008, research for the landmark China Health and Retirement Longitudinal Study (CHARLS) began in 2011 with support from Peking University, the National Science Foundation of China, and the World Bank. The CHARLS website briefly describes the study and its development:

The China Health and Retirement Longitudinal Study (CHARLS) aims to collect a high quality nationally representative sample of Chinese residents ages 45 and older to serve the needs of scientific research on the elderly. The baseline national wave of CHARLS is being fielded in 2011and includes about 10,000 households and 17,500 individuals in 150 counties/districts and 450 villages/resident committees. The individuals will be followed up every two years. All data will be made public one year after the end of data collection. CHARLS adopts multi-stage stratified PPS sampling. As an innovation of CHARLS, a software package (CHARLS-Gis) is being created to make village sampling frames.

CHARLS is based on the Health and Retirement Study (HRS) and related aging surveys such as the English Longitudinal Study of Aging (ELSA) and the Survey of Health, Aging and Retirement in Europe (SHARE). The pilot survey of CHARLS was conducted in two provinces (Gansu and Zhejiang) in 2008 and collected data from 48 communities/villages in 16 counties/districts, covering 2,685 individuals living in 1,570 households. The response rate of the pilot survey was 85%.

The CHARLS questionnaire includes the following modules: demographics, family structure/transfer, health status and functioning, biomarkers, health care and insurance, work, retirement and pension, income and consumption, assets (individual and household), and community level information. [Source]

The first major report on the study was released today at a press conference in Beijing, and its findings portray a dismal future for china’s rapidly aging populationsizable portions of China’s elderly are living with illness, depression, and poverty, and the population pyramid is only expected to become more top-heavy. The Wall Street Journal summarizes the baseline report:

The survey of living conditions for China’s 185 million elderly paints a bleak picture that defies the efforts of the government to build what it calls a “harmonious society,” one dedicated to human welfare rather than simply economic growth. Of the generation that built China’s economic boom, 22.9%—or 42.4 million—live in poverty with consumption of less than 3,200 yuan a year ($522).[…]

[…]While careful to credit the government with progress on expanding pension and health-care coverage, it also showed that physical disability and mental-health problems are widespread: Of those surveyed, 38.1% reported difficulty with daily activities and 40% showed high symptoms of depression.

[…]An aging population means the problems [typical in developing nations] are compounded. The number of old people for every hundred working-age members of the population—known as the dependency ratio—will rise from 11 in 2010 to 42 in 2050, according to projections from the United Nations.

Other countries will also see a rise in the dependency ratio. But the pace of aging in China is particularly marked—a consequence of the one-child policy. [Source]

The South China Morning has more on the CHARLS report, including a close look at the health issues facing China’s elderly populating, and the implications this will have on the health care system. While the report gives credit to the government for expanding health care coverage, a CHARLS researcher notes the limitations of current insurance schemes:

The researchers say China has done “a remarkable job” expanding health insurance coverage to nearly the entire elderly population, with 92 per cent of urban elderly and 94 per cent of rural elderly having health insurance of some type. But benefits remain inadequate and disparate across programmes.

“The glass is sort of half-empty, half-full,” says John Strauss, a professor of economics at the University of Southern California, and one of CHARLS’ principal investigators. “It’s full in the sense that coverage is nearly complete, but the generosity of the insurance is still limited and nothing like what we’d call major medical insurance to cover very high expenditures.”

Across all health insurance schemes, 15 to 39 per cent of adults had out-of-pocket costs for inpatient care that exceeded 50 per cent of their per capita expenditures. [Source]

Despite the report’s dreary projections into the future, the Wall Street Journal’s China Realtime Report points out that stark differences between the social situation that once surrounded today’s elderly and what younger populations are facing today should also be considered:

One important factor in the disabilities and depression suffered by many of China’s elderly is trauma experienced in early life: Chinese people over 60 grew up with famine in the 1950s and the tumult of the Cultural Revolution, and that leaves a mark.

Today’s working-age population enjoyed far less traumatic childhoods. They also have higher incomes than their parents did, thanks to greater participation in China’s 30-year economic boom. Both factors mean their old age should be better than that of their parents, says John Strauss, a professor at the University of Southern California and one of the heads of the study. [Source]

For more on China’s aging population or other demographic trends, see prior CDT coverage.