Old, poor, and ill: it seems China has a big challenge on her hands. About one in three Chinese elderly report having poor health, and nearly one in four have consumption levels below the poverty line, according to findings released today from a landmark survey of Chinese adults aged 45 and over. With a rapidly ageing population – the fastest in the world – China is clearly faced with the challenge of putting in place adequate health care and retirement support for this growing elderly population of 60 years and over. Surveying 17,708 individuals from 10,287 households from a nationally representative sample of China excluding Tibet, the China Health and Retirement Longitudinal Study (CHARLS) provides policymakers and researchers with a broad range of data on the real circumstances of mainlanders as they age. The first major report from the study was released today at a press conference at Beijing’s Peking University, which directed the multi-disciplinary study. It provides critical insight on China’s ageing population, combining extensive socioeconomic data, such as on employment, education and consumption, with self-reported and actual measures of physical and psychological health, including blood pressure and cognitive decline. One of the key findings is that a significant number of elderly (defined in the study as age 60 and over) suffer from health limitations, says Albert Park, one of the study’s principal investigators and an economics professor at the Hong Kong University of Science and Technology. “There will be a big challenge to provide adequate physical care for those who need assistance, and the health care system needs to a much better job of providing sufficient insurance, diagnosing chronic disease risk, and encouraging healthier lifestyles,” he says. Nearly two in five elderly report difficulty in completing basic daily activities on their own, 24 per cent report requiring assistance with basic daily activities, and one in three experience bodily pain. Physical exams show that 54 per cent have hypertension, of whom 40 per cent – or 40 million elderly – were undiagnosed prior to the survey. ...some of the gender gaps we find in China are quite large, such as those for depressive symptoms and cognitive function Physical health problems of the elderly increase steeply with age, and women and the poor are more likely to be in ill health. In fact, elderly women fared worse than men across all health measures. Most strikingly, women were much more likely to experience psychological distress, with more than 48 per cent of elderly women and 32 per cent of elderly men reporting depressive symptoms, such as restless sleep or feelings of fear. Overall, 40 per cent of the Chinese elderly (74 million) report depressive symptoms. Park says these findings of gender gaps in health “definitely merits further investigation”. “While it is true that elderly women in many countries are in poorer health than men, some of the gender gaps we find in China are quite large, such as those for depressive symptoms and cognitive function,” he says. “Some of these differences may be associated with the much higher rate of illiteracy among elderly women in China, which is known to lead to poorer health and lower socioeconomic status. But the high incidence of depressive symptoms and suicides among women in China suggest that other social factors may be important as well.” The study found a very strong positive relationship between health and wealth. Elderly women were slightly more likely than men to have per capita consumption levels below the government’s new poverty line (2,433 yuan per year). Overall, elderly poverty is high compared to the rest of the population: 23 per cent of the elderly (42.4 million) live below the poverty line; it’s 15 per cent among those aged 45 to 60. Family support plays a significant role in the well-being of the elderly, the study shows. However, private sources of support will decline with fewer children, so public support programmes will increasingly be needed. In recent years, the Chinese government has made significant strides in strengthening its social safety net programs for older adults. The very early retirement of urban citizens, especially women, creates a large financial burden 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. Material, physical and psychological well-being can be greatly affected by one’s retirement decision. The study found huge gaps between urban and rural Chinese in retirement behaviour. “Cities are like European countries, rural areas are like poor developing countries,” says Park. In urban areas, the employment share declines from nearly 80 per cent at age 45 to 49, to 20 per cent at age 60-64. In rural areas, the majority of elderly work even at age 65-69, with rates not dropping below 20 per cent until after age 80. Across the lifespan, women were much less likely than men to be in the workforce, with a significant gender gap in the drop-off with ageing. In the 50-54 age range, 75 per cent of men work, compared to less than 45 per cent of women. “China will need to fundamentally reform the pension system to encourage longer working lives,” says Park. “The very early retirement of urban citizens, especially women, creates a large financial burden.” Study participants will be followed-up with every two years – the second wave of the survey will be done this summer – allowing researchers to track the changes among the elderly, and the impact of policies, as China continues to develop.