The latest census on China’s population has confirmed the much-anticipated concern about ageing and low fertility. In 2020, China had a population of 1.41 billion people , an increase of about 72 million from 1.34 billion in 2019. This represents a smaller annual percentage rise of 0.53 per cent compared to 0.57 per cent from 2000 to 2010. The proportion of the population aged 60 years or above and 65 and over increased to 18.7 per cent and 13.5 per cent, respectively. Based on United Nations definitions, China is an ageing society. The number of births was 12 million, down from 14.65 million in 2019, despite the relaxation of the one-child policy. The total fertility rate is 1.3 births per woman, well below the replacement level of 2.1. The two major concerns, ageing and low fertility, are not uncommon and happen to other countries as well. What makes it particularly challenging is the speed and scale of the problem as China is the most populous country in the world, and it could have a spillover effect at the global level. The impact of ageing on GDP has not been fully appreciated and understood. Based on our calculations, if there is no significant change in the fertility rate, the proportion of China’s working-age population will decline from 70 per cent at present to 60 per cent in 2050. If the Chinese government aims to maintain an annual GDP growth rate of 7 per cent up to 2045, the output per worker needs to reach nine times the 2015 level, which would be extremely difficult. For a more realistic 3 per cent growth, labour productivity still needs to roughly triple by 2045. It has yet to be determined whether China is prepared for the impact of a reduced workforce on GDP growth, the increase in older adults on the affordability of the country’s pension scheme and the sustainability of unbalanced urban and rural development . There has been much blame placed on the one-child policy for China’s ageing population and falling fertility. However, if we examine the trajectory of the country’s total fertility rate (TFR), it is clear it has been falling since before 1979, when the policy was introduced. The one-child policy only accelerated the rate of decline. Furthermore, if we look at the TFR in some major cities , such as Beijing, Shanghai and Guangzhou, we see it has been well below replacement levels for several years. This means that it has been the choice of many people not to have children, thus in their case the one-child quota has not been utilised and any relaxation would have no effect. Furthermore, the much-anticipated increase in number of births by allowing a second child in the last few years has not occurred. The number of births continues to decrease and the trend is expected to persist in the future, as we have seen in many high-income Asian societies. It is interesting to note that in some Western countries, such as Australia, the United States , Britain and some Nordic countries, TFR has not fallen below 1.6. Meanwhile, no matter how hard the low-fertility Asian countries try, they struggle to break through the 1.3 mark. Apparently, the aspiration of family formation in high-income societies in Asia has undergone many changes. Small family size has become the norm in modern China. The improvement in educational opportunities and financial independence of women have increased the opportunity cost of having babies. It is highly doubtful that relaxing the one-child policy or even some incentivising measures can reverse the fertility trend. For example, some pronatalist policies, in terms of providing financial support to encourage the second and third births, have not been found to be particularly successful, as observed in other places such as South Korea , Japan, Singapore and Taiwan. Instead, cultivating a more family-friendly culture and working environment might be able to remove barriers for those couples who want to have babies. Encouraging young people to get married has a significant impact on fertility as births outside marriage are still not as common in Asia as they are in Western countries. Then, for couples who still choose to remain child-free, family circumstances might be too difficult to change. We can help remove the barriers for those couples who want to have children. However, making things worse, the proportion of couples who do not want to have children appears to be increasing in number . Ultimately, what really matters for dealing with an ageing society and a shrinking workforce is to make economic activities more robust. China must move away from labour-intensive manufacturing and adopt the latest modern technology to improve efficiency and be less labour-dependent. China needs to achieve sustainable development by rectifying the unbalanced growth of rural and urban regions while improving the living conditions of the country’s hundreds of millions of internal migrants . We also need to promote good governance to ensure an efficient government and maintain the sustainability of pension funds to meet the needs of the growing number of older adults. Any directive from the government is not going to work well without community buy-in. What would be more effective is to build up an attractive living environment to improve the quality of life for many. Working on quality rather than quantity will bring broader benefits. By then, it might be possible to attract younger migrants from other countries to replace the shrinking workforce and slow down population ageing. In doing so, China can buy time to build up a healthier populace before the population’s age becomes a hindrance to its prosperity Paul Yip is a chair professor (population health) at the Department of Social Work and Social Administration at the University of Hong Kong