How China cares for the elderly will shape its future
Parallel to its economic development, China is facing the challenge of a rapidly ageing population. At a time of rapid urbanisation, this trend has weakened traditional family support networks. New policies are necessary.
China's one-child policy has resulted in fewer children and better living standards, but the proportion of elderly has grown substantially and will continue to do so.
This will present problems but also unique opportunities. This century's leading countries will be those that consider their ageing population not as dependent and disabled; instead, they will empower them to be participants in economic growth. This is what some now call 'active ageing'.
The International Monetary Fund forecast last year that China's economy would surpass America's in real terms in 2016. In spite of this, one of China's greatest fears is that the country will grow old before it grows rich. As reported in the UN's 'State of World Population 2011', Professor Jiang Xiangqun - a gerontologist at Renmin University in Beijing - has pointed out that when developed countries initially entered a period of significant population ageing, they had a much higher level of per capita income.
When Chinese state-owned enterprises got rid of tens of millions of older workers, and replaced them with younger ones, the elderly employees received only small pensions. As a result, the vast majority of older Chinese live with their families, a situation that corresponds with the Confucian tradition of respect for age and experience.
But many also remain by themselves in 'empty nests' as their children migrate to cities for work or start their own families in single-generation homes. Some researchers have called this phenomenon the '1-2-4 problem' - one child taking care of two parents and four grandparents.
At the same time, China's young workforce is diminishing. This may hinder not only the development of the country but also the quality of life for its senior citizens, since the young will be less able to support their elders. As this happens, more elderly people will seek care in specialised institutions.
The government has responded by constructing more nursing homes. However, most are in big cities, and their quality varies. Also, they provide only basic health care and services, and mostly lack trained social workers.
The Chinese government must improve the social security system to cover rural and urban areas, improve the oversight of welfare institutions and address old people's needs. How the government meets this challenge will be a measure of the kind of society China intends to build.
Dr Cesar Chelala is an international public health consultant