Aging in Asia [1 ed.] 9781617281310, 9781607416494

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AGING ISSUES, HEALTH AND FINANCIAL ALTERNATIVES SERIES

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AGING IN ASIA

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AGING ISSUES, HEALTH AND FINANCIAL ALTERNATIVES SERIES

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Aging in Asia Jason L. Powell and Ian G. Cook 2009. ISBN 978-1-60741-649-4

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AGING ISSUES, HEALTH AND FINANCIAL ALTERNATIVES SERIES

AGING IN ASIA

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JASON L. POWELL AND

IAN G. COOK EDITORS

Nova Science Publishers, Inc. New York

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Copyright © 2009 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com

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Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS.

LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Aging in Asia / [edited by] Jason L. Powell, Ian G. Cook. p. cm. Includes index. ISBN  (H%RRN) 1. Aging--Asia. 2. Older people--Asia. I. Powell, Jason L., 1971- II. Cook, Ian G. HQ1063.2.A78A45 2009 305.26095--dc22 2009015100

Published by Nova Science Publishers, Inc.  New York

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CONTENTS Introduction: Aging in Asia - A Contextual Opening

1

Part One. Aging in Asia – Case Studies

5

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Chapter 1

Aging, Life Expectancy and Changes in Life Style: Situational Analysis of Pakistan Ahmad Raza, Ashraf Khan Kayani and Hasan Sohaib Murad

Chapter 2

Population Aging in Bangladesh: Trends and Challenges Hafiz T. A. Khan

Chapter 3

Growing Old in a Global City: The Challenge of Urbanization for Active Aging in Hong Kong Helen Bartlett

7

19

41

Chapter 4

Active Aging and China: Perspectives and Issues Sheying Chen and Elaina Y. Chen

69

Chapter 5

Aging in Nepal: Emerging Issues and Challenges Sara Parker

91

Chapter 6

Changes in the Living Arrangements of the Elderly in Korea Ik Ki Kim

Part Two. Rethinking Aging in Asia Chapter 7

Aging, Growth and Financial Markets – Economic Implications and Challenges Confronting East Asia Takashi Kihara

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111 129 131

vi Chapter 8

Chapter 9

Contents Rethinking Aging - the Selfless Consumer: Older People, Risk and Uncertainty in Contemporary China Steven Miles Patterns and Processes of Longevity in Asia Ian G. Cook and Trevor J.B. Dummer

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Index

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INTRODUCTION: AGING IN ASIA - A CONTEXTUAL OPENING

Jason L. Powell1 and Ian G. Cook2 1

University of Liverpool Liverpool Jon Moores University

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2

‘Age’ is a social characteristic that every culture uses to move people into and out of statuses, roles, rights, and obligations and is perceived differently in various societies. The process of creating social and economic categories based on ‘age’ is known as aging, and varies from culture to culture, and from one historical context to another. We can see how changes in the proportion of older people in a population at each age categorization have important social consequences in different societies across Asia. One of the fundamental aims of Aging in Asia is to outline the connotation of such changes in Asia. Indeed, many countries in Asia, particular in East Asia, are now on the edge of drastic demographic changes. Some countries will face demographic challenges related to a declining share of their working populations and an increase in the share of aged dependents as early as 2015 to 2020 (Powell and Cook, 2007). This is expected to have adverse effects on their economic performance and prospects through a decrease in the labor force, and lower saving and investment rates. However, there are a number of Southeast Asian countries that will face a diametrically opposite problem. Although populations are still very young in these countries, over the next two decades a bulge in the size of the working age population will occur (Hendricks and Yoon, 2007). This raises the potential for significant levels of unemployment and related social problems. Increasing

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liberalization and regional integration imply that cross-border movements of capital and labor will mediate these development imbalances between ‘older’ and ‘younger’ countries in Asia. Many Asian countries such as China, Korea, Pakistan, Japan, Hong Kong and Nepal will experience a significant aging of their populations during the next several decades. The collection of chapters explores how aging in Asian countries are addressing and anticipating the challenges of an aging society. It suggests that Asia's preparedness for an aging population is decidedly mixed across different national states. While growth policies have been successful, much work is still needed in many countries to establish an adequate and farsighted policy framework in the areas of pensions, health insurance, and labor market policies (Powell and Cook, 2007). For far too long we have tended to focus on occidental societies (Hendricks and Yoon, 2007). But many of the developing countries and a few low-income developing countries in the region are on the same demographic path. It must be emphasized the importance of bringing these developing countries into the discussion about aging as soon as possible, as many of these countries are aging faster than they are developing. This provides a contextual backdrop to an understanding of ‘Aging in Asia’, focusing on the demographics of population aging in Asia. The book discusses the differences in the magnitude of the aged population in different parts of Asia and highlights the perennial concerns of care and support facing the aged and their families as Asian societies grapple with the aging population. Globalization is one important factor presenting new challenges as well as opportunities to aging in Asia (Turner, 2008). The array of chapters in this book substantiates these challenges and opportunities afforded to different countries in Asia in light of demographic shifts, which range from an examination of broad issues of support for the aged and policy directions in East and Southeast Asia, to specific concerns relating to older people in China, Hong Kong, Japan, Pakistan, Korea, Bangladesh and Nepal. Population aging across these countries are experiencing increased longevity and a declining birth rate, which is becoming more prevalent. The book explains how, due to changes in population structure, aging will alter trends in the decades ahead in Asia. This book is unique in that the research cited is not only rich on aging experiences across Asia but is an important process in bringing together evocative, engaged and comparative insights as to how we understand complex aging and welfare issues. The book has sensitivity to addressing a number of

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nation states and countries that gleans a more holistic analysis of the contours of aging in the Asian continent.

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STRUCTURE AND ORGANISATION OF THE BOOK The book is in two parts. The first part utilises a number of ‘case study’ approaches of nation states in Asia and through comparative analysis how those countries are experiencing the parameters of change, changing demographics and the political economy of aging. In chapter one, Raza et al examines populational aging in Pakistan. They powerfully illustrate the impact of life expectancy on aging of a population by varying life expectancy and populational growth rates. The chapter examines trends drawn from the United Nations to forecast the implications for Pakistan for the health and lifestyle of older people. Linked to this and for very illuminating comparative analysis, in chapter two, Hafiz T. Khan illuminates the challenges of population aging in Bangladesh with critical implications for socio-economic infrastructure, health and health care and demographic issues associated with a rapid aging population. In chapter three, Bartlett examines the pace of populational change in Hong Kong. In particular, she observes how increasing urbanization is having a major aspect on older people’s experiences and lives especially in domains of the family and social care. In chapter four, Chen and Chen examine ‘active aging’ in China. They skilfully tease out the distances situated between social and economic policy on the one hand, and experiences of older people on the other hand, in context of active aging in China. In chapter five, Parker and Pant provide an exceptional narrative of Nepal and the impact of population aging. They explore how aging and gender inter-relate to drawing out the consequences of social and economic policies in Nepal. In chapter six, Kim examines the implications of populational aging on the changing living arrangements of older people in Korea. The chapter points to the multifaceted issues such as urbanization and changes in family structure that impinges on such shifts in living arrangements. Whilst part on focuses on the above case studies of different countries within Asia, part two focuses much more on re-thinking an understanding of aging as a population, lifestyle and identity across China and Asia. For example, in chapter seven, Kihara examines the impact of populational aging across Eastern Asia. He suggests that different countries in East Asia will have an unevenness of experience with reference to capital accumulation and contribution to world markets based on populational aging. In chapter eight, Steven Miles offers a fresh

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theoretical exposition in interpreting the implications of populational aging in China. He does this by examining key sociological ideas relating to risk, uncertainty, consumption and aging identity in China for older people. In the final chapter, Cook and Dummer re-appropriate a critical analysis of aging by analysing how social changes to health, lifestyle and life expectancy provides a prognosis of the patterns and processes of aging in Asia. We hope that the case studies identified and social, economic and cultural implications provide rich data and discussion for understanding how and why aging in Asia has become of increasing importance. This importance and significance cannot be understated. Demographics show that countries in Asia either have the highest proportion of older people, or the speed at which their population is aging is quicker than anywhere else in the world. This demands conceptual, theoretical and empirical understanding – and this book is an exciting attempt to situate these form of analysis in unlocking the implications of populational aging across Asia.

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PART ONE. AGING IN ASIA – CASE STUDIES

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Chapter 1

AGING, LIFE EXPECTANCY AND CHANGES IN LIFE STYLE: SITUATIONAL ANALYSIS OF PAKISTAN Ahmad Raza, Ashraf Khan Kayani and Hasan Sohaib Murad Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

University of Management and Technology/University of the Punjab

INTRODUCTION This chapter is divided into two major parts: theoretical and empirical. In theoretical part, we investigate the impact of life expectancy on ageing of a population by varying life expectancy and keeping population growth rates approximately similar. On the other hand, we also examine ageing by fixing varying growths rates. In both cases, growth rates are natural rates where population age distributions are closed to migration. In the empirical aspect we make use of the population projections for Pakistan prepared by United Nations (1999). In the population projections, only medium and low variants are considered. Here, we intend to show the proportionate distributions and number of older persons over a period of time until 2050. In light of the degree of the magnitude of older persons in the coming years problems associated with social changes in life style of older persons are discussed.

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THEORETICAL BACKGROUND Basically, study on aging of a population started with the advent of demographic transition theory after World War II. After World War II, North America in particular, and Western world in general, faced problem of baby boom causing influx of children entering school system and later on overwhelming majority of them entering universities. This was mainly due to the inability of the private sector to provide jobs. This started the beginning of the break-up of existing family system through factors such as common-law marriages; rising illegitimacy rates (just to mention a few). The baby boom also gave rise to the importance of the discipline of demography. One of the most important demographic contributions at the time was demographic transition theory with four stages (Kirk, 1996). These stages were based on historical as well as “recent data”. First stage was identified when birth rates and death rates were extremely high and approximately equal. In the second stage, significant decline in mortality and constant fertility were prevailing, giving rise to a very high growth rates. In the third stage after decades of mortality decline, decline in fertility started. Most of the developing countries of today are at this stage. In the final or fourth stage both fertility and mortality declined to the extent that either growth rate is zero or below replacement level. Most of the Western countries are at this stage at present. It may be appropriate to mention that mortality decline in the forth stage is increasingly limited to old age groups. Since most of the data on fertility and mortality in developing countries were not reliable, a need was felt to develop a model or theory through which these parameters can be estimated. For this stable population model was developed. In a stable population, fertility and mortality remain constant and interaction between fertility and mortality produces a unique age-distribution over a period of time. The unique age-distribution, thus sought, is different, except in extreme cases, from the initial age-distribution and is termed the stable age-distribution (Coale, 1956 and 1957). The central idea in the stable population theory is that: (a) the population is closed to migration; (b) age-specific fertility and mortality schedules remain constant; and (c) the interaction between constant fertility and mortality schedules, over a long period of time, produces a stable age-distribution. These characteristics of the stable population are also called the ‘intrinsic characteristics” which in fact are the characteristics of initial conditions of fertility and mortality (U.N., 1968, p. 8). Mathematical proof of the stable population theorem is given by Coale (1972) and Lopez (1961).

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One of the major features of stable population theory is the determination of the effects of changes in mortality and fertility schedules on the age-distribution. Before the exploration of the theory, it was thought that high mortality produces a young population and low mortality produces an old population. Coale (1956) is the first to demonstrate that the aging process of a population is largely dependent on fertility and not on mortality, except in extreme cases. A high fertility schedule produces a younger population, while a low fertility schedule produces on older population. The mortality effects on the age-distribution are significant when there are extreme differences in the mortality levels (U.N., 1968, p. 105). For example, if the fertility schedule is fixed and mortality levels vary, say, from life expectancy of 20 years at birth to life expectancy of 75 years at birth, the resultant agedistributions would be dissimilar. Coale (1972, pp. 152-64) has also demonstrated the effects of age-specific mortality changes on the age-distribution. In his analysis, Coale assumed a fixed fertility schedule and a specified monotonic time pattern of mortality change. It is shown that the effects of mortality decline on the age-distribution are dependent on the age-groups that experience the decline. For example, the effects of mortality decline in the age-distribution differ when mortality changes occur only to persons under age five from those when mortality decline is experienced only by older age-groups. The age-selective changes in mortality pose serious problems when one is estimating demographic parameters using the stable population model. The Coale principle still holds good in empirical proportions as they occur in real life. The stable population theory is useful in determining the necessary relationships among demographic processes under given conditions. The theory is considered to be the most powerful tool of analysis yet available in demographic literature. One of the criticisms of the theory, however, is that the stable population concept is highly abstract in nature. It is argued that no population has been found to have mortality and fertility schedules constant over a long period of time. To rectify the inadequacy of the stable population model, the concepts of semi-stable and quasi-stable populations have been developed to help demonstrate the practicality of the stable population model in the real populations (U. N., 1968, p. viii). These concepts are described below. The populations where fertility and mortality schedules are constant over a shorter period of time and the age-structure is either constant or changes very slightly are know as semi-stable populations. The major distinctions between a stable population and a semi-stable population are in terms of the time lag between the initial and the final age-distribution. In a stable population the time lag between initial and stable age-distribution is very long, while in a semi-stable

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population the time lag is very short, or usually zero. In the light of this distinction, most populations of the world may be characterized as semi-stable populations (U.N., 1968, pp. vii-ix). In a quasi-stable population, fertility remains constant and the risks of mortality diminish continuously. Since age-structure is largely determined by fertility (except for extreme mortality changes (Coale, 1956)], the age-structure is presumed to be constant. Most of the developing nations of today in which mortality has declined in the past and fertility remained constant are classified as quasi-stable populations. The importance of the quasistable population concept lies in the fact that one of the assumptions in the stable population theory (that concerning mortality) can be relaxed without effects on the age-distribution. The extent to which changes do occur are given in the U.N. Manual IV (1967, p. 47). It may be added that both the concepts of semi-stable population and quasistable population reflect the operational power of the stable population theory. One indication of this operational power of the stable population theory is that it has enabled demographers to prepare reliable estimates even when the data are scanty.

IMPACT OF LIFE EXPECTANCY AND GROWTH RATE ON AGEING Using stable population model, Coale and Demeny (1967) developed Regional Model Life Tables. West Model is used for South Asian countries. In these tables one can get growth rates, proportion of population in age distribution, birth rates and death rates. For each of the different life expectancies (e0 s’) the derived crude birth and death rates and rates of natural increase are given in table 1. Examination of Table 1 suggests that as the life expectancy increases, birth rates decline slightly relative to death rates. The growth rate increases slightly correspondingly. The variations here above are due to the nature of Model Life Tables where birth rates result out of gross reproduction rates (G.R.R=2.0). Table 2 shows percent (%) of older females by age groups in stable age distributions when e0 is varied from 62.5 years to 75.0 years. It can easily be observed that very minor variations in % females age 65 + take place even if e0 changes from 62.5 years to 75.0 years. As a note of caution, these changes in % 65+ are not entirely due to changes in e0. The rate of growth or birth rates (also

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change slightly in Table-1). Nevertheless, the effects of life expectancy on older population may be described minimal at the best. Contrary to Table 2 where e0 was varied and growth rates remained between 1.9% and 2.3%, we fix e0 at 65 years and vary growth rate from 0.0% to 2.5% to see the effects on % of older age groups. The resulting stable age distributions are taken from stable Age Distributions prepared by United Nations on South Asian Pattern (1990). The selected age distributions (females) are given in table 3 with fixed e0 at 65 years and growth rates given at the top of each of age distribution. From table 3, it is very clear that as the growth rates increase from 0.0% to 2.5% the proportion of aged females decline substantially from 14.96% to 5.19% respectively.

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Table 1. Crude Birth and Death Rates and Rate of Natural Increase by Life Expectancy in Stable Age Distribution (Model West for Females) Life Expectancy (e0) Birth Death Annual Growth Rate in years Rate/1000 Rate/1000 (%) 62.5 29.60 10.24 1.9 65.0 29.50 9.14 2.0 67.5 29.40 8.10 2.1 70.0 29.29 7.13 2.2 72.5 29.14 6.30 2.3 75.0 28.96 5.55 2.3 Source: Coale, A.J. and Demeny, Paul (1966): Regional Model Life Tables and Stable Populations, Princeton University Press (West Modes).

Table 2. Percent of older Females by Age in Stable Age Distributions (Model West) by Varying Life Expectancy (e0) in years Age Group

62.5 65.0 67.5 70.0 72.5 75.0 % % % % % % 65-69 2.31 2.30 2.29 2.30 2.32 2.36 70-74 1.69 1.69 1.70 1.72 1.76 1.82 75-79 1.08 1.10 1.12 1.14 1.19 1.26 80+ 0.75 0.83 0.87 0.93 1.02 1.15 Total (65+) 5.87 5.92 5.98 6.09 6.29 6.59 Source: Coale, A.J. and Demeny, Paul (1966): Regional Model Life Tables and Stable Populations, Princeton University Press.

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Table 3. Proportionate Stable Age Distributions for Older Females by Varying Annual Growth Rates, U.N. South Asian Pattern with Fixed Life Expectancy E (0) 65 years Population Growth Rate (%)

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Age Group 0.0 0.5 1.0 1.5 2.0 65-69 4.90 4.20 3.55 2.97 2.45 70-74 4.01 3.35 2.77 2.25 1.82 75-79 2.93 2.39 1.92 1.53 1.20 80-85 1.81 1.44 1.13 0.88 0.67 85+ 1.31 1.00 0.75 0.56 0.41 Total 14.96 12.38 10.12 8.20 6.55 Source: United Nations (1990) Stable Population Age Distributions, International Economic and Social Affairs, New York, P.242.

2.5 2.0 1.45 0.93 0.51 0.30 5.19 Department of

This proves the axiom of the stable population theory that age distribution of a population is largely determined by fertility and not by mortality. In other words, ageing of a population is mostly due to low fertility and not due to mortality. In light of this, we may safely state that increase in life expectancy has not that significant effect on ageing of population. The conclusions drawn, so far, lead to another question on definition of aged population. Agedness is a social construct which is usually based on age at retirement. If an average person lives, say 75 years need to re-define aged person is called far.

AGEING IN PAKISTAN Pakistan is the sixth most populous country in the World. It is estimated that in mid 2008, total population of Pakistan was about 160.9 million (Economic Survey of Pakistan, 2008 p.195). Economic Survey of Pakistan (ESP), 2007-2008 has published demographic indicators mostly estimated by Federal Bureau of Statistics (p.198). The demographic indicators published by the ESP are reproduced in Table 4. From Table 4 one may observe that fertility, mortality and rate of population growth all are declining when compared to past experiences. Of course, evaluation or comments on the quality of such data are not relevant here. However, declining trends in demographic rates are of an interest for the futuristic vision. As stated/shown earlier, decreasing birth, death, and growth rates would ultimately result in agedness of the population.

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Table 4. Selected Demographic Indicators, Pakistan Latest Available 3.8 26.1 7.1 1.8 76.7 350-400 Male: 64 years Female: 66 years Source: Pakistan, Government of (2008): Pakistan Economic Survey, 2007-08, Finance Division, Pakistan.

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Indicators Total Fertility Rate (TFR) 2005-06 Crude Birth Rate (CBR) 2005-06 Crude Death Rate (CDR) 2005-06 Population Growth Rate Infant Mortality Rate (IMR) (2005-06) Maternal Mortality Rate (MMR) (2004-05) Life Expectancy at Birth (2005-06)*

To illustrate the increasing number of persons age 65+, we have selected population projections for Pakistan prepared by United Nations in 1998. From these projections, we have selected medium and low variant projections and ignored the high variant projections in light of Table 4. Population projections by UN for Pakistan from 2000-2050 are given in Table 5 for both medium and low variants. Table 5 shows total population, population age 65+ and percent population for age 65+ for both the variants. A close look at number of old persons and proportion of old persons in both the variants are startling. In medium variant population age 65+ will increase from 4.999 millions in 2000 to 37.214 millions in 2050. The same is true for low variant. In other words, the number of older persons will increase over seven times the older persons in 2005. Comparison by proportion of older persons (% of total population above age 65) in the two variants conforms to the general demographic expectations. Though total population in 2050 in low variant is 83% of that in medium variant, proportion age 65+ in low variant (12.92%) is about 20% higher than those in medium variant (10.77%). In other words as the fertility declines, number of older people will increase substantially. Today Pakistan is concerned with negative effects of high population growth rate and by middle of this century, it will also face problem of increasing older persons. It is a situation of a dilemma. Several long-term advantages of low fertility are conceivable.

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Ahmad Raza, Ashraf Khan Kayani and Hasan Sohaib Murad Table 5. United Nations Population Projections for Pakistan, 2000-2050

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Medium Variant * Low Variant * Year Total Population % Total Population %65+ Population 65+(Milli Population (in 65+ (in (Millions) ons) 65+ million) million) 2000 156.483 4.999 3.19 155.404 4.999 3.22 2010 199.745 7.027 3.52 195.086 7.027 3.60 2020 244.211 11.158 4.57 232.607 11.158 4.80 2030 280.245 18.180 6.26 256.636 18.186 7.09 2040 315.328 26.868 8.52 276.220 26.868 9.73 2050 345.484 37.214 10.77 287.924 37.214 12.92 Source: U.N. (1999): World Population Prospects, The 1998 Revision, Vol.II: Sex and Age, New York. * Assumptions on Fertility and Mortality are not given.

However, with substantial increase in proportion of older persons a new set of problems associated with the aged people will emerge. In a developing country such as Pakistan, public concern about the aged people will be expressed in terms of their increasing needs for money and health care. Two sets of issues may also result from the increasing number of aged people. The first set of issues may involve matters of public ethics, personal preferences, and allocation of public expenditure. The second set of issues may be institutional care, problems of their roles and statuses in the society.

IMPACT OF AGEING ON LIFESTYLES Vaclav Samil (2005) states that “demographic discontinuities” will have deep and serious consequences for the emerging global order. Much of the fortunes of the current stakeholders for global leadership and economic prowess will be overshadowed by the changing demographic realities.Althought, the ageing population in the Muslim world and particularly in Pakistan have different cultural consequences than their counterparts in Europe, North America and Japan. The declining fertility rates and corresponding increasing older persons is going to have serious social and economic repercussion for the Pakistani society. The “irreversible population trends” (Samil, 2005; Jones and Leete, 2002) of the world are going to redefine much of the human societies by 2050. In Pakistan, growing numbers of older person will particularly impact upon:

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A. the social and economic structure of the family and B. the new role definition for the older persons in the Pakistani society. Pakistani society is a traditional Muslim society rooted in deep religious God –consciousness (Raza,Murad and Kayani,2008).The institution of family and its functions have been defined by the peculiar cultural tradition of the Muslims spanning over 1400 years. However the cultural contacts with West and modernization and urbanization have led to cultural transformation of the social and cultural organization of the family and its institutional role in shaping the behavior of individuals. Traditionally the older persons in the Pakistani society lived and played a very powerful social and economic role. They not only transferred the cultural knowledge to the younger generation but also help them learn and develop a set of social attitudes about practical life(Raza,Murad and Kayani,2008).This role is now changing due to modern social and economic pressures caused by modernization and urbanization of traditional society. We hardly find any elaborate policy document which investigates or lays down principles for the management of the new role of the older people in our ever changing family structure. Due to new social and economic causes the family’s social and economic structures are moving towards either ‘joint-family’ or ‘nuclear family’ direction. In the joint family system we still find the presence of older persons such as grandfather and grandmother and some attention given to their social, psychological needs. In the growing nuclear families of major urban centers such as Lahore and Karachi, we hardly find proper management system for the older persons in place, being torn off from their families. As indicated earlier that the demographic shift in the current population composition of the Pakistani society might cause major social and economic breakdowns for the future social and economic sustainability of the society. The growing number of older person by 2050 and corresponding declining fertility rates would greatly hamper the relative calm and social harmony of the Pakistani society. There is hardly any National Policy framework for the economic and social integration of the older population of the country into a meaningful way of life, which they used to enjoy in joint and extended joint family systems of yesteryears. The traditional family is now shifting ‘burden’ of the older parents to the ‘old homes’ and ‘senior citizens’ homes across major urban centers, which are unfortunately ill-equipped and lack resources to meet the needs of social and economic well-being of a nonproductive sector of the society. Altough, at times we come across rhetoric from leadership and bureaucrats in the local media and press to help the lot of growing numbers of helpless older persons, but hardly any concrete programme of social

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action is implemented by these quarters to bring real social improvement. The rapid ‘nuclearization’of the family system in major cities has left the older persons in limbo with no shelters, home, clothes and food to sustain them. The modernization and urbanization have brought irreversible changes in the traditional family lifestyle of the people and the older persons have become more vulnerable to the new forces of economic and social progress driving new generations of Pakistanis for a more wealthy and lavish lifestyle with few commitments to a larger social and economic networks of the traditional family organization. It appears prima facie that the older persons would be maladjusted in the larger social and economic systems of the society. They will have to face new psychological, social and economic threats to their meaningful lifestyle, which is fastly eroding under forces of social and economic modernization in the country and all around it. The days are fast disappearing when the older persons were seen to be the repositories of wisdom and transmitters of traditional cultural values to the younger generations. Those who were born and bred in extended joint families of rural calm and quiet in early 1940s and 1950s, now find themselves grappling with the noise and humdrum of the fast-moving urban lifestyle. Their children and their grandchildren are not willing to listen to their age-old wisdom and advice to decide about theirs careers and future life. The only exception to this are the struggling joint families where grandfathers and grandmothers still play some role in decision-making and household social and economic organization. The older people are confused and unable to carve a new role for themselves in the changing social and economic networks and relationships. Similarly, Government is not responding to new social and economic realities perpetrated by the new demographic transition of the society. There is no National Policy and almost no budgetary allocation to develop new institutional mechanisms to meet the ever increasing challenges faced by the older persons in the society. There is no large scale national social security/pension network for the growing number of urban old to effectively meet their economic, social and medical needs. Although Pakistani society has achieved successful ‘family planning’ (Jones and Leete, 2002) along with other Asian nations; it still has to assess the real-time social consequences of such planned population growth in the country. The growing numbers of older persons as discussed in the first part of the chapter would cause further economic, social and political problems for the troubled economy. The absence of any systematic policy framework for the social management of the older persons has further aggravated the social and economic woes of the faltering economic strength of the traditional family system. The urban nuclear families are fast abandoning their old parents leaving them

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vulnerable and maladjusted for any meaningful social role in the larger social existence. The public policy makers and leadership need to respond effectively to this future demographic and social transition scenario in order to avert any large scale social disorder and economic breakdown. If declining fertility rates are a good omen for the effective management of economic and social progress on one hand, the growing number of ‘aged’ person poses a new social challenge to the policy makers on the other side of social spectrum. The social policy makers have to work out social programmes where by growing number of older persons are properly taken care and their wealth of knowledge and expertise is effectively reintegrated into the national socioeconomic growth strategies of the country. However the demographic projections and their analysis presented in earlier section of the chapter calls for an immediate social action from the government as well as other social stakeholders such as nuclear families to reach out for effective plans to save the rising numbers of older persons from forthcoming social, economic and psychological stresses caused by modernization and urbanization. The social imagery of a calm and quiet old-age is under serious threat and might pass into a memory of a bygone age.

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REFERENCES Coale, Ansley J. (1972): The Growth and Structure of Human Populations, Princeton, New Jersey: Princeton University Press. Coale, Ansley J. (1957): How the Age Distribution of a Human Population is Determined, Cold Spring Harbor Symposia on Quantitative Biology, 22:83:89. Coale, Ansley J. (1956): The Effects of Changes in Mortality and Fertility on Age Composition, Milbant Memorial Fund Quarterly, 34(1), January: 79-114. Coale, Ansley J. and Demeny, Paul (1967): Regional Model Life Jables and Stable Populations, Princeton, New Jersey: Princeton University Press. Jones.G.,and Leete,R. (2002), ‘Asia’s Family Planning Programs as Low Fertility is Attained’, Studies in Family Planning,Vol.33,No.1,pp-114-126.Available at:http://www.jastor.org/stable/2696337.Accessed on:25/11/2008. Kirk, D. (1996), ‘Demographic Transition Theory’, Population Studies, Vol.50, No.3, pp-361-367. Available at:http://www.jastor.org/stable/2174639. Accessed on: 25/11/2008. Lopez, Alvaro (1961): Problems in Stable Population Theory, Princeton, New Jersey, Office of Population Research.

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Pakistan, Government of (2008): Economic Survey of Pakistan, 2007-08, Finance Division, Islamabad. Raza, A., Murad.H.S. and Kayani, A.K.(2008), ‘God, culture and old-age; the social constructions of gerontological experience in Muslim society’, Journal of Societal and Social Policy.(Forthcoming). Samil, V. (2005), ‘The Next 50 Years: Unfolding Trends”, Population and Development Review. Vol.31, No.4, pp-605-643. Available at:http://www.jastor.org/stable/3401519. Accessed on 25/11/2008. U.N. (1999): World Population Prospects, the 1998 Revision, vol. II: Sex and Age, New York. U.N. (1990): Stable Population Age Distributions Department of International Economic and Social Affairs, New York. U.N.(1968): The Concept of a Stable Population Application to the Study of Population of Countries with Incomplete Statistics, U.N. Population Studies, No. 39. New York. U.N. ((1967): Methods of Estimating Basic Demographic Measures from Incomplete Data, U.N. Population Studies No. 42, Manual IV. New York.

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Chapter 2

POPULATION AGING IN BANGLADESH: TRENDS AND CHALLENGES Hafiz T. A. Khan University of Middlesex

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INTRODUCTION This chapter examines the overall population change, its relevance to ageing issues and emerging challenges in Bangladesh. Population increases all over the world and the rate of growth is seen to be faster in less developed world compared to the developed world. Asia is heading towards many opportunities and challenges as it contains huge population - six out of the ten world’s top ranking countries such as China, India, Indonesia, Pakistan, Bangladesh and Japan (ESCAP, 1996; CIA, 2005) and about four billion people today live in Asia, i.e., more than 60 percent of the world’s total population (Lutz, 2005). Studies also indicate that by 2050, nearly 1.2 billion people (out of the expected 1.5 billion aged 65 years or more) will reside in less developed regions (UN, 2002). Within the changing pattern of global scenarios, questions remain about the likely quality of life of older persons in those countries specially who will live in poor settings. Despite sustained domestic and international efforts to improve economic and demographic prospects, Bangladesh remains poor, scarce of resources, overpopulated and ill-governed. Almost half of the GDP is generated through the service sector and nearly two-thirds of Bangladeshis are employed in the agriculture sector, with rice as the single-most-important product. Major

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impediments to growth include natural disasters such as frequent floods and cyclones, inefficient state-owned enterprises, inadequate port facilities and transportation system, a rapidly growing labour force that cannot be absorbed by agriculture, delays in exploiting energy resources (natural gas and coal), insufficient power supplies and slow implementation of political and economic reforms. Any reform of economic progress is blocked in many instances by political infighting, corruption at all levels of government, bureaucracy, public sector unions, and other vested interest groups (Khan and Raeside, 2005). Despite all barriers, one encouraging hope is that the GDP growth has been a steady 5 percent for the past several years. Given all present circumstances, the population of Bangladesh is ageing due to demographic transition from high fertility and mortality to relatively low fertility and moderate mortality. This demographic transition will profoundly affect various sectors of development such as the health and socioeconomic development of all nations. The continued growth of the aged population has laid down several issues related to status and roles of elderly, care and living, health, social support and overall well-being in the society. Considering the context of Bangladesh, in this chapter elderly population is deemed to be as having number (or proportion) of people aged 60 years and over and often called older people or older adults. Until recently, several attempts have been made to explore the study of age structural transition, ageing and policy implications in Bangladesh. Kabir (1992) stated that Bangladesh is expected to have a rapid increase in its aged population by 2025 without any formal program for their welfare. The dependency ratio will increase substantially and consequently, the burden will increase for young wage earners and the government. In a study, Kabir (1994) focused on economic participation and dormant potentials of the elderly. Findings of the study pointed to the different characteristics of older people featuring their living arrangements and status within their families, education level, involvement in economic activities, ties with family, possessions of wealth and assets etc. For women the literacy rate and income are found to be lower than for men (Kabir, 1998). Abedin (1999) also expressed similar views about socio-economic and demographic issues of ageing in Bangladesh. Most recently Khan and other associates attempted to overview recent demographic change and consequences of population ageing in Bangladesh and highlight and emphasise the ageing situation within South-Asian context (see for example, Khan and Raeside, 2005; Khan, 2006; Khan and Leeson, 2006; Kalam and Khan, 2006).

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AGE-STRUCTURAL TRANSITION IN BANGLADESH The age-structural transition is a process of changing age structure from a young aged population to an old aged population and obviously is an outcome of so called ‘demographic transition’ whose trajectories are determined by the speed and timing of decline in fertility and mortality. Like everywhere population ageing is viewed as natural outcome of the process of demographic transition and there is no exception in the case of Bangladesh. The process of ageing begins recently with successful improvement of various socio-economic and public health programmes in Bangladesh (Khan and Raeside, 2005). Past studies in Bangladesh demonstrated that interplay of trends in fertility and mortality has resulted in population ageing and reshaped the growth, structure and distribution of population (Kabir, 1993; Samad and Abedin, 1998). According to the 2007 Bangladesh Demographic and Health Survey, total fertility rate is estimated to be 2.7 compared to 6.3 in 1975 (BDHS, 2008). The UN also predicts that the TFR will fall below replacement by the year 2030 and the UN’s medium projection of the TFR in 2050 is 1.85 and the dramatic change in fertility will have major ramifications on the age structure of the population of Bangladesh (Khan and Raeside, 2005). On the other hand, life expectancy has improved consistently in Bangladesh although a gap exists between males and females. Thus with the gradual improvements in education, infrastructure and medical facilities, it is likely that fall in mortality could further check population growth in Bangladesh (Khan and Raeside, 2005). In the process of demographic transition, various combinations of age cohorts are evolved for a population pyramid. The population of Bangladesh is still quite young (Figure 1). The share of the young aged population will increase consistently for Bangladesh. The number of older persons increased almost more than 2.4 times from 1950-2000 and will accelerate as anticipated (Figure 2). But over the next 50 years, this increment is expected to accelerate. By the year 2050, the number of persons aged 60+ is expected to increase to 43.1 million, which is about six times higher than that of 2000. It also shows that although the country’s population growth rate is declining, the absolute number of older population is rapidly increasing (Figure 2). It can be concluded from the discussion that transition of ageing broadly depends on socio-economic, demographic, public health and cultural changes in a society. The faster the changes, the higher increment will occur in the old age cohort and hence will emerge new challenging issues of ageing. The new emerging trend of population cohorts will have numerous effects on the existing policy and planning strategy of the Government.

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60+

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

10 8

Male

6 4

Figure 1. Population Pyramids of Bangladesh, 1950-2050.

Age

2 Population (% )

0

Population in 1950

2

4

6

Female

8

10

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60+

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

10 8

Male

6 4 2 Population (% )

0

Population in 2000

2

Figure 2. Trends of elderly population and growth rate.

Source: Redrawn population pyramids using data from World Population Prospects, UN (2007).

Age

4

6

Female

8

10

24

Hafiz T. A. Khan 50

3 .1 43

45 40

2.5

Population (million)

35 30

1.5

25 20 15 10 5

1

4 .0 19 02 3.

75 3.

1950

1975

31 7.

Growth rate (%)

2

0.5

0

0 2000

Pop 60+ years

2025

2050

Growth rate

Source. Drawn using World Population Prospects database, United Nations (2007).

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POPULATION AGEING IN BANGLADESH - A SOUTH-ASIAN PERSPECTIVE In order to understand ageing situation in Bangladesh as compared to neighbouring countries one should follow some standard procedures. There are several ways to measure indices of population ageing, namely i) the ageing index, ii) median age, and iii) support ratios. These indices are used in the paper to measure ageing situation. The ageing index is defined as the number of persons 60 years old and over per hundred persons below age of 15 years. As estimated numerically Bangladesh will experience a rapid growth of elderly population. The projected increase in both the absolute as well as relative size of the elderly population in Bangladesh draws a growing concern for demographers and social policy-makers. Sex ratios are decreasing overtime as females are living longer in Bangladesh. The median age of population will also increase consistently. Bangladesh is heading towards an ageing society by 2050 with a huge elderly population of over 43 million (Table 1). This will rank the country a third position in possessing the number of older persons in the region. There will be enormous implications of these combined impacts on Bangladeshi society. Such an increasing ageing trend will eventually compel to change the allocation of resources between the generations.

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4.3 5.4 8.2 6.6 8.2 5.5

Bhutan

India

Maldives

Nepal

Pakistan

Sri Lanka

9.3

5.7

5.5

5.5

7.1

6.7

3.8

5.2

29.0

16.5

14.1

20.0

20.2

23.3

5.6

17.0

40.9

37.9

38.4

33.1

37.5

43.8

42.6

40.4

26.8

41.8

40.9

40.3

35.0

40.2

47.3

37.2

16.7

21.8

23.1

19.7

18.2

17.9

33.7

20.8

2050

13.4

21.6

17.2

24.8

14.4

9.8

10.5

17.0

1950

(%)

34.7

13.6

13.4

13.6

20.2

16.6

8.3

13.9

2000

Ageing Index

Source: Calculated from World Population Prospects, United Nations (2007).

4.5

6.9

Afghanistan

Bangladesh

2000

1950

1950

2050

< 15 years (%)

years (%) 2000

Population aged

Population aged 60+

173.6

75.6

61.0

101.5

110.9

130.1

16.6

81.7

2050

27.5

18.8

19.3

18.9

22.7

19.3

16.3

21.0

2000

43.4

34.1

32.5

36.8

38.6

39.9

23.0

35.1

2050

Median Age

Table 1. Ageing in Bangladesh: 1950-2050

99

106

98

105

107

102

107

105

2000

Ratio

Sex

90

104

96

102

104

103

107

100

2050

5.42

48.11

7.24

0.10

335.48

0.21

4.45

43.13

2050

60+ (m)

Population

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Hafiz T. A. Khan

While comparing the ageing in Bangladesh within South-Asia, it can be seen from Table 1 that the pattern of ageing index is likely to vary across the selected countries. By 2050, countries like India, Sri Lanka, Maldives and Bhutan, will have an ageing index of at least 100 and more. However, India will have a huge older population with a huge absolute population size (over 335 million in 2050). On the other hand, Bhutan and Maldives are observed to have a comparatively less absolute elderly population. In some places people are on move because of unavoidable circumstances such as ethnic conflict and war. Older persons are seemed to be more vulnerable in such situations and face numerous difficulties often in settling a new place where socio-economic and health care facilities are absent or limited. Moreover, we do not see any clear picture of their situation in the existing ageing literature and therefore more research would require in ageing as the regional perspectives. The total dependency ratio is a commonly used measure of potential social support. It is based on the simple notion that all persons under 15 and those of 60 years and more are likely to be in some sense dependent on the population in the working ages from 15-59. Those in working ages are assumed to provide direct or indirect support to those in dependent ages. Such support may be provided within the family, through religious or communal institutions or by the State. Figure 3 shows that total as well as child dependency ratios are decreasing in Bangladesh. On the other hand, the adult dependency ratio will drop until 2020 and afterwards will rise steadily. Elderly population are generally classed into two broad categories. Those who are aged between 60 and 70 years are often called young-elderly and those over 80 years are called old-elderly. There are several characteristics that would mark off oldest old as an entity different from the rest of the old. They are economically unproductive, socially isolated, psychologically insecure and physically diseased and disabled. In Bangladesh, only a tiny 1.9 percent is estimated to be old-elderly in 2050. On the other hand, it would be a big change for Sri Lanka and India containing 6.0 percent and 3.1 percent respectively. The increasing trend of elderly in Bangladesh is also supported by other sources and more elderly live in rural area than urban place of residence (Khan and Leeson, 2006).

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50

50

45

45

40

40

35

35

30

30

25

25

20

20

15

15

10

10

5

Child

Elderly

Total

0

Old-age dependency ratio

Child and total dependency ratios

Population Aging in Bangladesh

5 0

50 19

60 19

70 19

80 19

90 19

00 20

10 20

20 20

30 20

40 20

50 20

Source: Drawn using World Population Prospects database, United Nations (2007). Note: child dependency those who are below 15 years of age and adult dependency those who are aged 60 years and more. Figure 3. Trends of dependency ratios (Total, child and older adult) in Bangladesh: 19502050.

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Table 2. Percent of Population Aged 80+ in Selected Asian Countries Countries 1950 2000 Bangladesh 0.6 0.4 India 0.4 0.6 Sri Lanka 0.1 1.1 Pakistan 0.5 0.5 Nepal 0.4 0.4 Source: World Population Prospects database, United Nations (2007).

2050 1.9 3.1 6.0 2.0 1.4

The following sections will discuss country’s key issues and challenges relevant to ageing in Bangladesh.

SOCIO-ECONOMIC SITUATION AND OLD-AGE SUPPORT The socio-economic consequences can be seen as a by-product of combined effect of current demographic changes and existing socio-economic structure of the society. Bangladesh is experiencing steady urbanization. In 1950, only 4.2 percent people lived in urban areas that has increased to 25 percent by 2005 and

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will expect to grow up to 39.3 percent by 2030 (UN, 2007). However, as such no major change is appeared in county’s urban planning in addressing huge elderly population. Urbanization and other urban facilities attract young adult to move cities for many reasons. Children may leave parents living alone as they migrate to cities, other regions of the country, or even abroad. Increased distances between children and parents and subsequent difficulties in maintaining contact may hinder support to elders. On the other hand, higher earning of children in the new place indicates sending more remittances or financial support to parents which eventually has huge impact on daily lives of elderly in Bangladesh. In Bangladesh, older people traditionally like to live with their sons whether married or unmarried. Evidence from a recent survey shows that vast majority elderly live in joint or extended family (Khan and Leeson, 2006). Socio-culturally, extended family structure dominates family institutions, particularly in the rural area, that comprise most of Bangladesh. Family is the stable social unit which maintains traditional relationship with the elders. It is evident that demographic factors compounded by modernization, industrialization and urbanization have brought about serious changes to the social values among people, leading to the gradual breakdown of the extended family, although the nuclear independent family life has not fully emerged in the country (Amin, 1998; Knodel et al., 2000). However, the changes have certainly left an impact on the family life of the people and the caretaker has become the care-seeker, and ageing has become a social problem as much as a social process. The rise in landlessness, change in overall distribution of living arrangements, an increased survival rates, and availability of sons for support of elderly have counter balanced the forces of changing lifestyles and household structure (Amin, 1998). Older people in more developed countries are generally less likely to work than those in less developed countries. Older people predominantly in rural agrarian societies often work out of necessity – retirement may be a luxury reserved for urban elites (Kinsella and Phillips, 2005). In Bangladesh, more than 50 percent of all older men are considered economically active. The economic activity of women tends to be under reported where older women engage mostly in subsistence agriculture, household industries and domestic works. Table 3 shows that Bangladeshi elders are more involved in labour force participation than other neighbouring countries. The older persons contribute not only to household structure and functions but also to economic activity, decision-making materials and non material contributions to households. Men and women have separate work responsibilities and economic activities.

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Table 3. Work participation rate among elderly by sex

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Countries Male Bangladesh 76.9 India 60.5 Sri Lanka 53.5 Source: Rajan et al., (2005).

Female 18.1 16.1 11.3

Men are mainly play decision-making and outside works while women do normal household activities in Bangladesh. Study shows that an overwhelming majority older people have monthly income less than 5000 Taka and average monthly income is estimated to be about 3204 Taka or approximately US$46 (Khan and Leeson, 2006). This indicates that an inequality of income distribution exists in Bangladesh where poverty is a predominant factor for wellbeing of elderly in Bangladesh. Poverty rates are typically higher for older women than for older men. About half of the population in Bangladesh live under poverty line or do not have adequate housing. This reflects that many of them are poor and are unable to invest money to improve their housing conditions. According to Khan and Leeson (2006) the high rates of poverty among elderly people caused a new concern. Some live alone and most feel safe to live nearby relatives and friends. Education is an important determinant of human life and found to be associated with choice of family size, contraceptive preference, child care, nutrition, health care and so forth (Caldwell, 1980; Khan and Raeside, 1994; Jejeebhoy, 1995). While literacy has increased throughout the world, many older people, particularly women and the oldest old, grew up with few educational opportunities. In some less developed countries, the vast majority of older residents particularly women are illiterate (Table 4). The rural elderly are more disadvantaged in Bangladesh. Though the current literacy levels among the elderly are pretty low, the future elderly are expected to be more literate and hence more demanding. Table 4. Literacy rate of elderly among selected countries Countries Bangladesh India Sri Lanka Source: Rajan et al., (2005).

Male 32.2 40.7 88.5

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Hafiz T. A. Khan

In a patriarchal society like Bangladesh where responsibility primarily goes to sons to take care of elderly and for any type of support they needed. The recent national data supports the hypothesis that sons bared most expenses of treatments of parents. It is found that close kin is always extending help first. As can be seen from Table 5 that most of the cases son and daughter in law are coming forward to assist elderly during sufferings from diseases and bear expenses of any treatment. This is a traditional cultural system in Bangladesh. Male elderly can bear their own expenses and in many cases maintain good health status. This is consistent with an earlier finding by Mostafa and Streatfield (2001) that a higher proportion of males and married elderly have good health compared to married females and widows. The role of the elders in decision-making depend on how much authority the elderly posses on the members of the households or on the family. Thus as there is no system of public social security, old people generally depend on their adult children, particularly on sons, for old-age support and security. Increased workforce migration, changes in family structure, trends towards smaller familysize, and other socio-economic changes may adversely affect the traditionally oldage support system in Bangladesh.

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Table 5. Distribution of patterns of support from family members Sex of older people (%) Male Treatment costs paid for by Self 58.7 Son 39.5 Daughter 1.7 Grandchild 0 Others 0 Assistance obtained during illness Self 0.9 Son/Daughter-in-law 53.6 Daughter/Son-in-law 26.0 Grandchild 1.1 Others 13.6 *Total percentages exceed 100 due to multiple responses. Source: Khan and Leeson (2006).

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Female 15.5 64.6 11.2 3.3 5.2

34.3 53.7 7.0 1.8 1.8

20.9 43.7 69.5 25.8 4.1

11.1 73.1 48.1 13.6 8.8

Population Aging in Bangladesh

31

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INTERGENERATIONAL SOLIDARITY Intergenerational relationship refers to interactions and relationships between parents, children, grandparents, and grandchildren at the micro-social level (Kinsella and Phillips, 2005). Traditionally, family as a social unit plays important role vis-à-vis caring elders and supervision younger. Within families, intergenerational relations often determine the willingness and even the ability of families to provide care and support for older members. Intergenerational relations are observed in Asia where family members take the care of elders as responsibility, mutual obligation and religious duties vice versa. Such good relationships allow transfer of wealth from one generation to the next, supporting of elders and enhance social respect. With rapid urbanization, modernization and migration, debates often centred upon the levels of familial support from close relatives (Mba, 2002; Rajan et al., 2005; Chan, 1997; Martin and Kinsella, 1994). Long-term care for older people has become a key issue throughout the world and it involves a range of support mechanisms, including nursing and assistance in the home, various forms of community care and day care, residential care, and longstay hospitals (Phillips, 2000). Some demographers argued that the family will continue to be the sole source of support for the elderly in Bangladesh even though intergenerational relationship will change (Amin, 1998; Kabir, 1998). The kinship network also allows elderly to maintain their status in the household. In Bangladesh, elderly people generally like to live with family members. It is evident from a recent national survey data that elderly people feel better to stay with their grandchildren and about 55 percent of them are staying with a family less than 5 family members. On the other hand, a majority of them play with them and about 78 percent grandchildren are also caring their grandparents mostly if any mentally and physically (Khan and Leeson, 2006). Past studies also demonstrate that survival of the elderly increases if they live with spouse or sons and daughters (see for example, Rahman et al., 2004). Elderly people do not only take advantage from the family, they are doing a respectable job of caring grandchildren, sharing ideas, playing role in household decision-making process, extend financial or moral help to family members. Evidence shows that a majority of them are taking care of grandchildren in their leisure time. They usually spend leisure time by praying and visiting and gossiping with family members and neighbours (Khan and Leeson, 2006).

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HEALTH AND SOCIAL CARE Deteriorating health in old age is quite natural and is a bit concern in Bangladesh. Nearly 97 per cent Bangladeshi elderly reported that they suffer from some sort of health problem and an overwhelming majority suffer from eye problem, weakness, back pain and arthritis (Khan and Leeson, 2006). This finding is consistent with previous studies conducted in Bangladesh that major health problems are stomach ache and diarrhoea, followed by asthma, peptic ulcer, blood pressure, diabetes, cardiac, dental and eye problems (Abedin, 1999). It is a depressing situation more so because of the poor socio-economic conditions. The scenario becomes worse for those who are left behind in the rural areas mostly uncared for and lonely (Coleman, 1995; Khan, 2004). Study shows that most of the elderly are suffering from multiple health complications. Health problems are found to be more among women compared to men. This statement is consistent with previous findings of Kabir (2001). A majority of elderly people (about 55 percent) received their treatment from village doctors followed by pharmacy (about 26 percent). Surprisingly only a small proportion (about 9 percent) would like to have treatment from government hospitals or clinics. It can be attributed to as people are often complaint against poor quality and service delivery in government hospitals (Khan and Leeson, 2006). Poor administrative capacity, less accountability and unaccounted corruptions are often blamed behind the less attraction of government health services in hospitals. Despite all this, significant changes in human resources for health have taken place in recent years leading to overall improvement in the coverage of health services. These include production and deployment of more health and health-related personnel, refresher training for health personnel in service and greater use of health volunteers. Currently, two types of care and service systems are available in Bangladesh for the elderly people - traditional or indigenous, and modern. Modern services are offered by both governmental and non-governmental initiatives. Traditional services include care by the family or relatives, charity or alms giving, and permission to live in religious premises such as mosques, graveyards, mazars, and dargas. On the other hand, aged persons in an average Bangladeshi family are often treated as a burden mainly because of economic reasons. Many older persons are seen to have been begging in streets. They suffer from serious illness and often live in frustration and pains without care and company. Many organisations are coming forward to help older persons in Bangladesh. Alongside with national NGOs, some international British charity organisations responded quickly to help vulnerable elderly people in Bangladesh such as Help

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Population Aging in Bangladesh

33

Age International (HAI) and Sir William Beveridge Foundation. Through the financial assistance from HAI, RIC Bangladesh has been actively running various action programmes for elderly poor people in Bangladesh and to build awareness about their rights and responsibilities to society in addition to helping Government who basically needs social pension to survive. On the other hand, most recently the initiative launched by Sir William Foundation was to alleviate the distress and preserve the dignity of poor elderly and enhance their quality of life by providing health and social care in their own homes. Having gathered experience in the UK, this charity begun with a completely different homecare project in Bangladesh aiming for a long-term strategy helping older people by providing domiciliary care. The concept of domiciliary care (home care) service is new to Bangladesh. It provides free care and assistance to those aged 58 years and over to support them to stay within their family environment and enjoy their family and social advantages.

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SOCIAL SAFETY NET AND NON-CONTRIBUTORY PENSION Mandatory old-age pension plans cover more than 90 percent of the labour force in most industrialized countries (Kinsella and Phillips, 2005). Governments are responsible for mandating, financing, managing and insuring public pensions. However, in Bangladesh by and large people do not have any pension or social security. Government pension is available for only a handful of retired government and industrial employees. Only 2.1 percent elderly people receive any type of pension which indicates a vast majority is still outside of the pension coverage and the pension contribution is the lowest for Bangladesh compared to Indian and Sri Lanka (Khan and Leeson, 2006). It indicates that government is doing very little in terms of providing financial supports to elderly in Bangladesh. From 1998, the government introduced a new pension programme 'bayaska bhata' (allowance for the aged), under which the 10 poorest and the most vulnerable old persons (five men and five women) of each union/ward are given a monthly allowance of Tk 100 each. In response to a question of any old age allowance, it is found that less than 2 per cent elderly received such kind of old allowance which very tiny and the amount is also very small (Table 6). Government has a long-term plan to increase both the amount as well as the number of recipients. The number of old-age pension beneficiaries has now gone up from half a million to over 1.3 million and remuneration has been increased Taka 180. Government’s made a plan to expand the coverage of old-age pension among all the eligible 8 million elderly poor people (New Nation, 2004).

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Hafiz T. A. Khan Table 6. Receive any old allowance

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Old allowance Yes No Total Source: Khan and Leeson (2006).

Frequency 16 942 958

Percent 1.7 98.3 100

Under the Annual Development Programme (ADP) government has planned to establish six centres for the elderly in six administrative division of the country. The main purpose of the scheme is to provide life long support for the poor elderly who like to come and stay. These homes are officially called Shanti Nivas (home of peace) complex. In these old-age homes, food, accommodation and medical treatment are offered free of cost to the inmates. Each has accommodation for 100 inmates; 60 females and 40 males. However, the present provision is tiny as compare to the huge demand from elderly. More initiative is observed from personal levels to serve the poor elderly such as Mr. K.A.Z. Mukul and Begum Khaleda Zia old-homes. A positive awareness has been observed to do something for the elderly and it has become a part of voluntary services in the society of Bangladesh. They are maintaining in an organised way and fully self sustainable.

FACTORS AFFECTING POPULATION AGEING IN BANGLADESH A theoretical framework is proposed in this section as to how the socioeconomic conditions and demographic situation interlinks each others and finally affecting the demography of ageing in Bangladesh (Figure 4). This pictorial display will help us to understand the likely scenario of ageing in Bangladesh. Demographic situation and economic development have enormous impacts and vice versa. From the above discussion one can draw a conclusion that socioeconomic, cultural and demographic situations are influencing each other and are responsible for a “demographic ageing” outcome. This theoretical notion usually works irrespective of time and space. Any demographic movement from one point in time to another is likely to depend on the policy and planning adopted in between. Proper policy implementation has always a positive impact on development and that eventually reflects by its demography of ageing. Therefore,

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the pathway analysis enables us to understand how changes are taking place in many aspects of our life particularly in well-being of elderly. Steady increase in older cohort may raise new issues and challenges. Elderly are socially respected and play important role in family, voluntary sector and local development. Their contribution is merely no less than what they receive from family and society. Therefore mass awareness building is crucial among general people in order to protect our older population by taking proper actions with regard to socio-economic safety and security, living condition, intergenerational support, health care facilities, voluntary activities.

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CONCLUDING REMARKS This chapter explores the overall ageing situation in Bangladesh and to address the important issues and challenges that need to be considered for policy implications. It was found that socioeconomic and demographic changes are taking place in Bangladesh. Although growth rate for elderly is relatively slow, however the absolute size of population is getting larger and larger. In 1950, approximately 3 million elderly people were in Bangladesh and that has been projected to be 43 millions by 2050. This change in population characteristics will have serious consequences for society as well as for the overall socio-economic development of the country. It has been stressed that elderly should not be viewed as a liability but as a productive and valued asset (ESCAP, 1996; Hermalin, 1995). Ageing is a natural phenomenon and problems associated with it cannot be solved overnight. However, a positive attitude towards ageing may largely help to minimize its impact upon the society. The society must bear in mind that it owes an obligation to the elderly people since where it stands now is the ground prepared by the elders. Besides being merely grateful, the society and the government may well benefit from the invaluable guidance and advice of the elders bred of life-long experience. Social peace and progress is basically conditioned by healthy human relationship, sense of mutual respect and sympathy and finally dedication to collective good-caring for the old is thus the manifestation of a progressive peaceful society. The following proposals are recommended for the wellbeing of older population in Bangladesh: 1. To use resources most effectively and to attain maximum returns, priority sectors should be targeted in relation to the population age-structure, Aging in Asia, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

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Hafiz T. A. Khan residence, health and educational needs. The huge youth bulge generation needs education, housing and employment opportunities. Government of Bangladesh should learn from each other’s experience and to act promptly in implementing various strategies for a long-term benefit of the society. Perhaps Bangladesh can use its huge youth population as good purposes such as “windows of opportunity” for the coming decades and this will be a demographic chance to develop the country. In order to achieve such an objective Government should invest in human capital and manpower. 2. Older people in Bangladesh are vulnerable in many ways and they become very poor as age. Proper shelter and housing, financial support, and health care are the main concerns among poor elderly. Since a decreasing trend of family support prevails over the years for a variety of reasons and there is no guarantee in old-age support from families and relatives therefore government should take some responsibility in this regard. Assistance for maintaining the poor and destitute elderly in old age homes should continue and government and NGOs should join together to provide food, clothing and shelter to the poor elderly so that beggary among elderly may be eradicated from Bangladesh. Government should provide non-contributory pension as widely as possible and to involve NGOs, social workers and local communities. Perhaps government can encourage people to save money for their later life by launching attractive savings products. 3. It appears that structure and composition of families and households are undergoing a change from joint and extended mutigenerational type to nuclear one. The elderly people are in problems with the changing situation of our traditional joint family system. They often left to live alone and face socio-economic, health and emotional problems on their own. The emotional, social, physical and economic supports provided by the family are indispensable and cannot be replaced by other institution (Abedin, 1999). So government should introduce a law which will enforce people to support their parents in old age and to protect from any abuse. In Bangladesh abuse is common and people are not aware of abuse. Therefore, there should be strict law which will prevent people not to exploit older persons and to protect them from social, mental and physical abuses. 4. The older persons not only receive support and care from the family members but also render care and support to the family members such as financial help and care to grandchildren. Their contribution should be

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recognised and should pay special tribute to their contributions. Therefore, government should encourage intergenerational support and contact so that multi-generation can get benefit of it. This can be done through mass media and cultural activities. So the gist is that we should give priority to our family and do as much as possible for the welfare of the family members. 5. Various types of health education need for aged population. Not only physical health but also mental and emotional health of the older persons is equally important for their well-being. Health education programme should be introduced for healthy ageing that will help understanding and create awareness about the health problems among the elderly and help adoption of a healthy life style. The elderly should be given nutritional advice to minimize dietary deficiencies and imbalance. Government should give special emphasis on preventive medicine for both communicable and non-communicable diseases. This initiative will help to prevent from major diseases such as cancer, stroke and heart disease on the one hand, and to transform knowledge to the next generation. So this initiative, of course, has a positive impact particularly in a developing country setting like Bangladesh. 6. Public concern about population ageing is most recent. To respond to the emerging issues, government should take proper steps now to cope with situations. Vast campaign through mass media should be initiated by government as well as by NGOs to protect the elderly people in Bangladesh. Perhaps government should engage them in some voluntary social work programmes so that the country will get benefit and to accommodate them in a financial institution vice versa. Ageing topic should incorporate into school text curriculum so that the children might know in advance the reality of ageing. It also help children how to behave with elderly, to extend their kind supports to elderly when needed, sharing their feelings between grandchildren and grandparents, their pains and happiness in order to offer a healthy ageing society in future. Comprehensive research is needed to understand better the ageing situation in Bangladesh. Perhaps nationally representative data may help policy makers to go insight the root causes of various issues and their solutions. Government can conduct join research with other neighbouring countries in order to learn more which in turn will help in adopting necessary steps towards the welfare of elderly people in Bangladesh. Systematic research on ageing and discrimination of knowledge in general may help both researchers and policy-makers to draw policy

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implications in order to achieve the targeted healthy ageing society. Government should prepare policy agenda how to respond to those new issues and to prepare a guideline as to how to achieve those targets.

USEFUL NOTES The article uses data from secondary sources of information such as published national and international sources including data obtained from the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2006 Revision population database (United Nations, 2007). It also illustrates tables from authors earlier publications see for example Khan and Leeson (2006).

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REFERENCES Abedin, S. (1999). Social and health status of the aged in Bangladesh, Paper 4. Dhaka: Centre for Policy Dialogue. Amin, S. (1998). Family structure and change in rural Bangladesh. Population Studies 52(2):201-13. BDHS (2008). Bangladesh demographic health survey 2007, Main report, Dhaka: National Institute for Population Research and Training (NIPORT). Caldwell, J. C. (1980). Mass education as a determinant of the timing of fertility decline. Population and Development Review 6:225-256. Chan, A. (1997). An overview of the living arrangements and social support exchanges of older Singaporeans. Asia-Pacific Population Journal 12(4):3550. CIA (2005). The world fact-book, rank order-population. US Central Intelligence Agency, http://www.cia.gov/cia/publications/factbook/rankorder/ 2119rank.html. Coleman, D. (1995). Spouse migration from the Indian Sub-Continent to the UK: a permanent migration stream. People and Place 3(1):1-8. ESCAP (1996). Population ageing and development. Report of the Regional Seminar on Population Ageing and Development, 11-14 December, Bangkok. Hermalin, A.I. (1995). Ageing in Asia: setting the research foundation. AsiaPacific Population Research Reports. Number 4. East-west Centre, Hawaii.

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Jejeebhoy, S.J. (1995). Women’s education, autonomy and reproductive behaviour: experience from developing countries, Oxford: Clarendon Press. Kabir, M. (1991). Aging in Bangladesh: Its social, economic and health consequences, Proceedings of the workshops on Dissemination of Current Statistics Organized by Bangladesh Bureau of Statistics (BBS), UNDP and CIDA, Dhaka, Bangladesh. Kabir, M. H. (1992). Demographic and socio-economic aspects of aging in Bangladesh. Paper presented at the round table on the Aging of Asian population, May 4-6, 1992, ESCAP headquarters, Bangkok, Thailand. Kabir, M. H. (1993). Ageing in Bangladesh: the demographic picture in productive ageing in Asia and the Pacific. Asia Population Studies No. 129, UN, ESCAP, Bangkok. Kabir, M. H. (1994). Local level policy development to deal with the consequences of population aging in Bangladesh. ESCAP, Asian Population Studies Series No. 131-A. Kabir, Z. N., (1998). “Aging trends- making an invisible population visible: the elderly in Bangladesh”. Journal of cross-cultural gerontology 13:361-378. Kalam, I.M.S. and Khan, H.T.A. (2006). Morbidities among older people in Bangladesh: Evidence from an Ageing Survey. BRAC University Journal, 3(2):75-84. Kinsella, K. and Phillips, D.R. (2005). Global ageing: The challenge of success, Population Bulletin 60(1), Washington, DC: Population Reference Bureau. Khan, H.T.A. (2004). Asian family and migration: some important issues. Asian Profile 33(2):187-204. Khan, H.T.A. and Raeside, R. (1994). Urban and rural fertility in Bangladesh: a causal approach. Social Biology 41(3-4):240-251. Khan, H.T.A. and Raeside, R. (2005). Socio-demographic changes in Bangladesh: A Study on Impact. BRAC University Journal, 2(1),1-11. Khan, H.T.A. (2006). Age structural transition and population ageing in Bangladesh. Generation Review, 16(1):6-10. Khan H.T.A and Leeson G.W. (2006). The Demography of ageing in Bangladesh: A Scenario analysis of the consequences. Hallym International Journal of Ageing, 8(1):1-21. Knodel, J., Friedman, J., Anh, T.S. and Cuong, B.T. (2000). Intergenerational exchanges in Vietnam: family size, sex composition and the location of children. Population Studies 54:89-104. Lutz, W. (2005). The “Asian Century” will be based on Human Capital, in Population Network Newsletter, IIASA, Austria.

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Martin, L. and Kinsella, K. (1994). Research on the demography of ageing in developing countries. In Linda Martin and Samuel H. Preston (eds), Demography of Ageing. Washington D.C.: National Academic Press. Mba, C.J. (2002). Determinants of living arrangements of Lesotho’s elderly female population. Journal of International Women’s Studies 3(2). Mostafa, G. and Streatfield, K. (2001). Health implication of an aging Bangladeshi population; The Elderly: Contemporary Issues. New Nation (2004). Editorial, The New Nation, Daily September 23, Dhaka. Rahman, O. Menken, J. and Kuhn, R. (2004). The impact of family members on the self-reported health of older men and women in a Rural area of Bangladesh. Ranjan, S.I., Perera, M., Begum, S. (2005). Economics of pensions and social security in South Asia: Special focus on India, Sri Lanka and Bangladesh. Research paper, New Delhi: Indian Council for Research on International Economic Relations, www.saneinetwork.net/pdf/SANEI_II/ PensionStudy.pdf. Phillips, D.R. (2000). Ageing in the Asia-Pacific Region, London: Routledge. Samad, M.A. and Abedin, S. (1998). Implications of Asia’s population future for the family and the elderly: the case of Bangladesh. Economic and Social Commission for Asia and the Pacific, UN. United Nations (2002). World population ageing 1950-2050, New York. United Nations (2007). World Population Prospects: The 2006 revisionpopulation database, Population Division, New York, http://esa.un.org/unpp.

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Chapter 3

GROWING OLD IN A GLOBAL CITY: THE CHALLENGE OF URBANIZATION FOR ACTIVE AGING IN HONG KONG Helen Bartlett

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University of Queensland, Australia

INTRODUCTION The issue of population ageing is a worldwide phenomenon, dominating the policy agenda of many countries. The consequences for Asia are particularly great as it is the most rapidly ageing region in the world. By the year 2050, about twothirds of the world’s population of people aged over 60 will live in Asia. While only one in ten Asians lived in urban areas two generations ago, more than half of the region’s population now reside in an urban setting (Hugo 2003). Rapid urbanization in the region is having a major impact on people’s lives, particularly the lives of older people. While the economic ‘burden’ of population ageing has driven the agenda, with a focus on the cost of pensions and health care, less attention has been given to strategies for achieving active or healthy ageing until recent years. Active ageing is now a goal widely adopted by policy makers and governments as a response to the challenge of population ageing (World Health Organization 2002). The increased focus on promoting active ageing signifies a paradigm shift in ageing policy from one which views old age as a ‘burden’ to understanding ageing as a life-course opportunity for further exploration and social participation.

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While this transition is by no means universal, active or healthy ageing is now one of the most important frameworks that structure the contemporary discourse on ageing (Bartlett, et al. 2008; Peel, et al. 2004; Walker 2002). Conceiving ageing as a process of continuous participation and involvement necessarily engages the wider aspects of social, cultural and economic participation and citizenship. Policy makers have to create favourable social and cultural conditions and provide resources that help cultivate social inclusion and individual choice. Given increasing proportions of older people now live in the city, an urban environment that optimizes opportunities for social participation, health and security becomes an important imperative to their wellbeing. The purpose of this chapter is to explore the impact of urbanization on ageing in Hong Kong. It examines the challenges of urbanisation for achieving active ageing in the territory. The following sections will provide an overview of the history of urban transformation and ageing trends in Hong Kong. The major challenges presented by urbanization for older people will then be explored, focusing on population density, pollution, housing, built environment and transport. The impact on family structure and values is also considered, along with care and support issues. In the final section, the implications for policy will be outlined.

URBAN TRANSFORMATION IN HONG KONG The history of urban development in Hong Kong is a spectacular story. The territory has undergone radical transformation over the past hundred years, changing from a fishing village to a bustling and vibrant metropolis. In 1851, the population of Hong Kong was only 32,983 (Tsai 2001). By 2008, the number has almost reached 7 million. Much of this growth occurred only within the past fifty years. Rapid population growth and economic development since the late 1950s resulted in the intensive urbanization of Hong Kong. Urban development activity in the territory was estimated at rates of 1.5 buildings demolished and 1.3 buildings constructed per day between 1984 and 1993 (Susnik and Ganesan 1997). Much of this activity was concentrated in urban areas which constitute less than 25% of the area of the territory. With a total of 7,687 skyscrapers, in 2008 Hong Kong was identified as one of the world’s most active cities in terms of building activity on completed high-rise buildings (Emporis Corporation 2008). The process of metropolitan transformation in Hong Kong is closely tied to the changing economic and geopolitical roles of the territory in the region (So and Chiu 2000). Before WWII, Hong Kong was an entrepôt centre specializing in

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China trade. From the 1960s onwards, Hong Kong embarked on export-led industrialization and formed a regional production network with South Korea, Taiwan, Singapore and Japan. Following the opening of Mainland China in 1984, the Hong Kong economy was substantially restructured with the territory becoming a global city which specializes in international financial, business and entertainment services (Breitung 2006; Meyer 2000). Hong Kong was ranked fifth, following, New York, London, Paris and Tokyo, in the 2008 Global Cities Index compiled by the American journal Foreign Policy. The ranking was based not only on business but also on political and cultural influences as well as the ability of the city to set global agendas (Anonymous 2008).

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POPULATION TRENDS Responding to the pressures of acute population growth and widespread poverty, the Hong Kong Government started to provide public housing for lowincome families in the 1950s. In 1972, it announced a Ten-year Housing Programme with targets to house 1.8 million persons. This programme also created new towns in the New Territories with the purposes of decentralizing the population from the overcrowded urban districts and supplying workers for newly developed industrial areas (Yeung and Wong 2003). These processes of urban development and population decentralization continued throughout the 20th century. In 2006, there was a total of 852,796 persons aged 65 or over living in 18 district council districts in Hong Kong (Figure 1). From 1961 to 2006, the number of older people increased at an average annual growth rate of 5.1%. While older persons constituted only 2.8% of the total population in 1961 (Bartlett and Phillips 1995), they made up 12.4% of the Hong Kong population in 2006 and this group is projected to increase to 26% by 2036. This change is also reflected in the dependency ratio which increased from 50 to 168 between 1961 and 2006 (Census and Statistics Department 2007; 2008). Table 1 summarizes changes in the geographical distribution of Hong Kong’s older population between 1981 and 2006. It reports a 670.7% increase in older persons living in the New Territories between 1981 and 2006. The rise of the older population in the metropolitan area in the same period was only 76.5%. These trends are the result of government policy over the last few decades to decentralize the population from Hong Kong Island and Kowloon to the new towns in rural areas.

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Figure 1. Boundaries of the District Council Districts in Hong Kong.

Table 1. Changes in the Distribution of Hong Kong’s Older Population (Aged 65+), 1981-2006 Figures in bracket are % of total population in the district People Aged 65+ District Council District Central and Western Wan Chai Eastern Southern Sham Shui Po Kowloon City Wong Tai Sin Kwun Tong Yau Tsim Mong Kwai Tsing

1981

2006

22,300 (8.1) 19,697 (8.6) 30,761 (6.7) 12,353 (5.7) 34,568 (7.6) 31,280 (6.5) 32,479 (6.6) 33,647 (5.5) 31,552 (7.7) 20,699 (5.0)

30,900 (12.4) 22,600 (14.6) 82,900 (14.1) 37,000 (13.5) 60,700 (16.5) 52,000 (14.4) 74,500 (17.6) 93,700 (16.0) 37,100 (13.3) 72,600 (13.9)

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Location Quotient* 2006 1.0 1.2 1.1 1.1 1.3 1.2 1.4 1.3 1.1 1.1

% of Change 1981-2006 +38.6 +14.7 +169.5 +199.5 +75.6 +66.2 +129.4 +178.5 +17.6 +250.7

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Table 1. (Continued) People Aged 65+

Tsuen Wan Tuen Mun Yuen Long North Tai Po Sha Tin Sai Kung Islands Total

8,944 (4.6) 5,660 (4.8) 12,329 (6.6) 9,182 (8.1) 5,363 (7.3) 6,319 (5.5) 3,304 (7.9) 4,616 (10.1) 325,053 (6.6)

33,600 (11.6) 44,900 (8.9) 44,400 (8.3) 28,600 (10.2) 28,000 (9.5) 62,700 (10.3) 33,700 (8.3) 12,200 (8.9) 852,100 (12.4)

Location Quotient* 2006 0.9 0.7 0.7 0.8 0.8 0.8 0.7 0.7 -

Broad Areas Metro Area New Territories -New Towns

(85.6) (14.4) -

(57.7) (42.3) (37.7)

-

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District Council District

1981

% of Change 1981-2006 +275.7 +693.3 +260.1 +211.5 +422.1 +892.2 +920.0 +164.3 +162.1

+76.5 +670.7 -

* Proportion of people 65+ in District Council District / proportion of people 65+ in Hong Kong. Sources: 1. Yeh, Anthony Gar-On, ‘The changing spatial distribution of elderly population and its planning implications’, Table 6.1. 2. Planning Department (2007) Projections of Population Distribution 2007-2016, Table 7 and 9. 3. Census and Statistics Department (2007) 2006 Population By-census Thematic Report: Older Persons, Table 56.

While there is a substantial increase in numbers of seniors living in the New Territories, older persons constituted only 10% of the population in this area in 2006. This proportion is far lower than that of Kowloon (15.9%) and Hong Kong Island (13.7%). Districts with the highest proportion of older people include Wong Tai Sin (17.6%), Sham Shui Po (16.5%) and Kwun Tong (16%), demonstrating a concentration of older people in the old urban areas. This pattern of distribution is in stark contrast to the trend of gradual dispersal of the overall population of Hong Kong to the New Territories over the past decades (Yeh 1999). Location quotients for the percentage of older population in different district council districts further illustrate where the older population is located (Table 1). This index is frequently used for comparing the distribution of an activity or phenomenon to some base or standard, in this case to total population in Hong Kong. If the quotient of a district is greater than 1, it suggests a relative concentration of older persons in that area compared to the overall population. If

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the quotient is smaller than 1, it indicates that the district has less of a share of older people than the general population. As Table 1 demonstrates, old districts in the Metro Area like Wong Tai Sin, Sham Shui Po and Kwun Tong have a high concentration of older persons while the share of older people in new towns and rural areas is below the Hong Kong average. To summarize, urbanization and demographic transition in Hong Kong have given rise to a distinctive spatial distribution of the older population. This pattern of distribution, especially the concentration of older people in old urban areas, has implications for ageing policy and for promoting active ageing in Hong Kong. The key challenges resulting from such rapid urban development and transformation are explored below.

CHALLENGES TO ACTIVE AGEING IN HONG KONG

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Hong Kong’s rapid industrialization has largely ignored the health and welfare of the community until quite recently, in particular that of the older population (Bartlett 1995). In terms of meeting the requirements of an ‘agefriendly’ city, Hong Kong has a number of challenges and these mitigate against the goals of active or healthy ageing.

High Population Density Hong Kong is a city that has one of the highest population densities in the world. In 2006, about 6.8 million people lived in an area of 1,104 km2 or an average of 6,159 persons per square kilometres. In reality, as the Hong Kong population is unevenly spread and with two-thirds of its residents living within a 10 km2 radius, the density of population in many districts is far higher than the average figure suggests. As Table 2 reveals, this is especially the case in old urban districts. For example, the population densities in Kwun Tong and Wong Tai Sin are 51,984 and 45,540 persons per square kilometres respectively. These figures are 7 to 8 times higher than the average population density of Hong Kong. Scientists long suspect that a highly dense or crowded living environment has an adverse impact on the mental and physical health of residents. However, findings from studies on the negative impacts of a congested environment are inconclusive (Baldassare 1975; Bharucha-Reid and Kiyak 1982; Lester 1995; Rustemli 1992; Schmitt 1978).

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Table 2. Population Density and Median Household Income of District Council Districts, 2006

District Council District Central and Western Wan Chai Eastern Southern Sham Shui Po Kowloon City Wong Tai Sin Kwun Tong Yau Tsim Mong Kwai Tsing Tsuen Wan Tuen Mun Yuen Long North Tai Po Sha Tin Sai Kung Islands Total

Monthly Household Income < $10,000 (% of household)

Population

Area (km2)

Population Density (persons per km2)

Median Household Income (HK$ per month)

250,064 155,196 567,690 275,162 365,540 362,501 423,521 587,423

12.4 9.8 19.0 39.1 9.5 9.8 9.3 11.3

20,167 15,836 29,878 7,037 38,478 36,990 45,540 51,984

25,700 28,000 22,000 20,500 13,700 19,800 14,700 15,000

19.4 20.8 21.4 22.1 34.8 27.0 31.1 32.6

280,548 523,300 288,728 502,035 534,192 280,730 293,542 607,544 406,442 137,122 6,841,280

7.2 19.9 60.0 82.0 144.3 140.0 147.0 69.4 126.8 168.0 1,084.8

38,965 26,297 4,812 6,122 3,702 2,005 1,997 8,754 3,205 816 6,307

16,500 14,600 20,800 15,200 15,000 17,000 18,500 19,800 21,600 17,800 17,500

29.7 31.4 22.8 31.1 31.2 27.4 25.0 23.2 18.2 25.6 27.0

Source: 1. Census and Statistics Department (2007), 2006 Population By-census: Basic Tables for District Council Districts. 2. Census and Statistics Department (2008), Population and Household Statistics Analysed by District Council District, 2007.

Previous studies conducted in Hong Kong also found little support for a causal relationship between high urban density and negative psychological change. Instead, it was found that the Hong Kong people developed diverse ways of managing space, time and interaction to cope with their extremely crowded living situations (Chan 1999; Mitchell 1971; Schmitt 1961). Further research is required, however, to determine how older people have adapted to their changing living conditions.

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A study of urban density in Hong Kong discovered that people’s perception of crowding is mediated by satisfaction with living quarters, conflict with others for space, and privacy (Chan 1999). As many older people remain living in old urban districts where properties are densely populated, poorly maintained and with little or no social amenities, they may be subjected to a disproportionately higher risk of crowding and other adverse psychological effects. This is especially the case for seniors who are living in the so-called bedspaces or cage homes that are very common in these districts (Dorfman 1998). The 2007 General Household Survey found that about 11,500 persons aged 60 or over in Hong Kong lived in bedspaces or cocklofts of private flats (Legislative Council 27/02/2008). These older people face particularly high risks of social isolation and loneliness through living in a noisy and dirty environment, with very little privacy (Cheung, et al. 1998; Li 2001).

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Pollution While findings on the effects of a crowded environment are inconclusive, there is clear evidence of the negative impacts of pollution on health of older people. Over the past decade, the environmental conditions of Hong Kong have deteriorated substantially, especially air quality. Between 1999 and 2004, the concentrations of particulates and ozone in the territory increased by 15% and 26% respectively, causing the percentage of time in a year with visibility less than 8 km to rise from 4% to 18% in this period. Between 1991 and 2002, the level of nitrogen dioxide also increased by 26% (Environmental Protection Society of Hong Kong 2005). The major sources of air pollution in Hong Kong are vehicle emissions, power plants and marine traffic and it is estimated that approximately 80% of the city’s smog originates from other parts of the Pearl River Delta. A study on effects of air pollution on daily mortality in Hong Kong found that poor air quality effects mortality outcomes, especially during the cool season when the air pollutant levels are higher (Wong, et al. 2001). It should be noted that air pollution exercises a disproportionate impact on the older generation. There is evidence that ozone has an effect on daily hospital admissions attributable to all causes of circulatory diseases with the strongest effects on arrhythmias and heart failure in the older population (Wong, et al. 1999). Air pollution has also been found to exacerbate the risk of asthma and hospital admissions for patients with chronic obstructive pulmonary disease (COPD) in the territory. The prevalence of COPD among older Chinese aged 70 years or above in Hong Kong is estimated to be 9% (Ko, et al. 2007).

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Figure 2. Seniors exercise in a park situated along main road and overpass in the Eastern District.

In addition to air pollution, there are elevated concentrations of cadmium, copper, lead and zinc in soils and street dusts in urban parks and recreational areas in Hong Kong. Not surprisingly, the parks with high metal concentrations are located in old urban commercial districts and industrial areas that are particularly prone to pollution (Li, et al. 2001). Many of these parks are favourite gathering places for older persons living in the area (Figure 2).

Built Environment, Housing and Transport Urbanization in Hong Kong has proceeded at a spectacular scale and pace, particularly accelerating in the mid-1980s when Hong Kong evolved into an international business and financial hub. The booming of the property market and escalation of speculative transactions of real estate spurred the processes of urban reconstruction. While the number of buildings demolished in the territory prior to 1986 remained below 500 per year, this value has not dropped below 700 since 1987 (Susnik and Ganesan 1998).

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Urban development has not, however, proceeded at an even pace in different parts of Hong Kong. For the CBD where businesses and shops are located, the pace of development and redevelopment is astonishingly fast. A ten-year old building in these districts is considered an old building. In contrast, the pace of development and change is far slower in the old urban districts and ex-industrial areas. Older people have remained living in the old urban areas like Sham Shui Po, Wong Tai Sin and Kwun Tung, where the problem of urban decay is most prominent (see Table 1 and 2). Most of the properties in these districts were built decades ago and many are badly managed and maintained. These districts also have little or no medical, educational and community facilities (Figure 3). They are areas of multiple social deprivations with a high concentration of older people, lone parents, low income families and new migrants from the mainland (Forrest, et al. 2004; Lo 2005). Research has found that dwelling conditions and residential satisfaction exert a great influence on psychological well-being of older persons in Hong Kong (Ng, et al. 2005; Phillips, et al. 2005). Older people living in old urban areas are at risk of poor mental health because of their relatively deprived social conditions. Many of them however refuse to seek external help or support because of the fear of being stigmatized (Lam and Boey 2005). Although urban redevelopment may improve living conditions of residents in these dilapidated districts, the relocation of them away from the original living places creates new challenges, especially for older persons. The adoption of a ‘market-‘ or ‘private sector-led’ urban renewal strategy by the government worsened the situation of this group of people. Before the late 1980s, the Hong Kong Government played only a marginal role in the redevelopment of residential buildings and most of the renewal projects were carried out by private developers. The focus of these projects was on physical use of land and residents of the old districts were seldom consulted and involved in the redevelopment process. In 1988, the government set up the Land Development Corporation to carry out redevelopment through joint ventures with private developers. This was subsequently replaced by the Urban Renewal Authority in 2001. While it claimed to adopt a ‘people-oriented’ approach in its redevelopment projects, critics argued that the Urban Renewal Authority still used a ‘project-centred’ strategy that focused on achieving self-financing urban renewal, and did little to preserve or regenerate local communities and networks in old urban districts (Forrest, et al. 2002; Ng 2002; Susnik and Ganesan 1998). Like many big cities in the world, urban redevelopment in Hong Kong often resulted in gentrification where poor urban neighbourhoods were replaced by upmarket private housing estates or big shopping malls.

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Figure 3. Street scene in Sham Shui Po District.

As a result, many older residents can no longer afford to live in the same district after the renewal project is completed. Case studies of redevelopment in Hong Kong show that older people living in the poor urban areas were often displaced and relocated to far away suburbs (Chui 2001; Susnik and Ganesan 1998). The physical and social dislocation of older people acts against the concept

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of ageing in place and subjects older people to risks of social isolation and exclusion. Table 3. Projected Types of Housing Needs of the Elderly Households 20012006, 2006-2011

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Types of Housing intended to move into Public rental housing Private owner-occupied housing Private rental housing Total Source: Chiu and Ho (2006).

2001-2006

2006-2011 (Projected)

10,498 817

14,923 1,161

350 11,665

497 16,581

The issue of housing is not a problem confined to older people living in old urban areas. Overall, there is a lack of choice or flexibility in the housing market for older people in Hong Kong. A recent housing aspiration survey (Chiu and Ho 2006) found that most older respondents intended to move into public rental housing in the near future (Table 3). However, the same survey also found that housing type preference of older people in descending order was private housing (54%), subsidized housing (42%), and elderly homes (4%). In addition, older people prefer owning (58%), rather than renting (42%) their house and they showed a strong preference for ageing in place and for housing with universal design. The findings reflect a mismatch between intention (move to public rental housing) and preference (privately own rather than rent their own house) and highlight the lack of purpose-built retirement housing equipped with necessary facilities and services in the private housing market. This is especially the case for older people from middle class backgrounds (Chiu and Ho 2006; see also Chow and Chi 2003). In addition, although the Hong Kong Government started to adopt ‘universal design’ in planning and incorporated improvements such as additional ramps and handrails in all new urban projects in the late 1990s (Architectural Services Department 2004), the lack of age- or disability-friendly facilities is still a common problem in many districts. Good transport systems are another necessity for active ageing and Hong Kong has the most dense public transport system and pedestrian over-crossings in the developed world (Urban Transport Fact Book 2005). The possession of a safe and fast public transport network makes Hong Kong a very convenient place to

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live. Although many older people in Hong Kong have no access to private cars, they have many options to meet their daily mobility needs. Most of the public transport operators in Hong Kong also offer concessionary fares for older or disabled passengers. In spite of this, the lack of age-friendly public transport or pedestrian environment in Hong Kong remains a concern. In particular, the lack of well-designed footpaths, pedestrian crossings and stepless walkways are common obstacles that restrain mobility of older people in the territory.

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Family Structure, Values and Community Support Urban sociologists have long been aware that urbanization is an agent of social change (Wirth 1938). Rapid population turnover and increased heterogeneity have significant impacts on values and structures of the local community. This may overwhelm existing social or familial networks and leave the community in a state of disorganization or instability. The process of urbanization in Hong Kong has substantially altered family structure and contributed to the erosion of traditional values and practices. Nuclear families are replacing the multigenerational household and in 2006, the nuclear family comprised 67% of households in the territory (Table 4). This has impacted on the living arrangements of older people. While the percentage of older persons living alone remained stable at around 12% between 1996 and 2006, the proportion of older people living with their spouse only increased from 16.2% in 1996 to 21.2% in 2006. Over the same period, the number of older adults living in non-domestic households also increased from 5.5% to 10%. These changes demonstrate that the traditional idea of extended family is becoming obsolete in modern Hong Kong. Rapid urban development and population displacement has also resulted in significant changes in familial values and practices that directly impact on the care and well-being of older persons. In traditional Chinese society, older people were revered and it was the primary duty of sons and daughters to look after their parents when they were old (Fei 1992). A number of studies on filial expectation and practice in the territory have found that informal support within the social network of older people is reduced and increasingly subjected to the criteria of exchange and reciprocity (Cheng and Chan 2006; Chou and Chi 2001; Chow 2001; Ng, et al. 2002). Although older people still consider the practice of filial piety important, it is increasingly unlikely that children will be the only source of daily support and care.

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Table 4. Household Composition and Proportion of Older Persons by Living Arrangement, 1996-2006 (%)

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Living Arrangement Living alone Living with spouse and children Living with spouse only Living with children only Living in nondomestic household Household Composition One unextended nuclear family One vertically extended nuclear family One horizontally extended nuclear family

1996 Older Persons

Whole Population

2001 Older Persons

Whole Population

2006 Older Persons

Whole Population

11.5

4.3

11.3

4.3

11.6

5.4

32.1

34.4

32.1

34.4

30.4

32.9

16.2

9.0

18.4

9.3

21.2

10.6

28.2

5.8

24.7

5.9

23.1

6.5

5.5

1.3

9.1

2.5

10.0

3.3

63.6

66.2

67.0

9.9

8.5

7.4

1.2

0.9

0.7

Source: 1. Census and Statistics Department (2007), Hong Kong Social and Economic Trends, 2007. 2. Census and Statistics Department (2008), A Profile of Older Persons, 2006.

The nuclearization of families and loss of prestige and power of older persons in the family increase the risk of social isolation or alienation of seniors. Suicide rates among older people have increased in Hong Kong and the territory now has one of the highest suicide rates of older people in the world; 12 times higher than for the younger generation and 4 times above the average. The rate is highest among the 75 or above age group. If passive suicides cases were taken into account, the overall suicide rate for older people would be higher (Yip, et al. 1998). Abuse of older people is another emerging problem which points to the increasing vulnerability of older persons as victims of violence and neglect in contemporary Hong Kong (Yan and Tang 2003). Rapid industrialization and urban renewal has also resulted in the weakening or destruction of the original urban fabric and community networks (Chui 2003). The problem is particularly prominent in the new towns located in the New Territories. Although the Hong Kong Government committed to the ideas of

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‘balanced community’ and ‘self-containment’ in its new town planning projects, these goals (especially the latter) have seldom been achieved (Yeh 2003) as employment has not decentralized with the population and residents of the new towns are forced to commute long distances to continue working in urban areas (Hui and Lam 2005). Furthermore, new town development in Hong Kong has often emphasized housing needs at the expense of social facilities and transport (Phillips 1987). As a result, inhabitants of the new towns enjoy a better living environment but with very high social cost. It has been discovered that new towns have higher delinquency rates and triad activities, poorer neighbourhood relationships, higher records of family violence and abuse, as well as higher levels of stress and depression than other parts of Hong Kong (Chow 1987; 1988; Forrest, et al. 2002; 2004; Lee 1993; Yeh 2003). Older residents of the new towns are often in a disadvantaged position. As the population of the new towns is young, there are often not enough social and recreational facilities catering to the needs of older people living in these districts. Given the long commuting time and cost involved, older inhabitants of the new towns seldom travel to other parts of Hong Kong. They are left behind most of the time when the younger generation goes to work in the urban areas. A study of older people living in Tuen Mun found that relatively poor informal support was provided by their adult children (Ng, et al. 2002). Consequently, these seniors are at higher risk of social isolation and alienation.

Financial Security The process of global city formation is known to bring social and spatial polarization as well as divergent patterns of income and wealth (Sassen 2006). Recent studies on Hong Kong confirm these trends. A recent report on state of the world’s cities names Hong Kong as the most unequal city in Asia, with a Gini coefficient of 0.53 which is relatively high by international standards (United Nations Human Settlements Programme 2008). Signs of widening occupational segregation and income inequality have been identified, producing greater social fragmentation and a stronger class distinction, not only between the rich and the poor but also among the middle class (Chiu and Lui 2004; Yip and La Grange 2005). The expansion of professional and managerial jobs has also created a lowincome poverty trap amongst the lower socio-economic groups (Lee, et al. 2007). While Hong Kong has not developed the kind of urban ghettos that are common in other major cities, census data nevertheless reveal the emergence of strong patterns of spatial polarization in recent decades (Breitung and Gunter 2006;

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Forrest, et al. 2004; Lo 2005). In particular, there are multiple deprivations in the old urban areas of Hong Kong where many older people live (see Table 2). Hong Kong’s older citizens are over-represented among the poor. According to the Hong Kong Council of Social Service, the proportion of persons 65 or over in low-income households rose from 26.9% in 1996 to 31.5% in 2005 (as quoted in Subcommittee to Study the Subject of Combating Poverty 2007: 6). While the median real income of households headed by older people has improved over time, income inequality among these households remained at a very high level between 1981 and 2001 (Chou and Chow 2008). The welfare system of Hong Kong is characterized by a combination of largescale investment in the social infrastructure (like housing and education) with very low levels of transfer payments (such as pensions and unemployment benefits)(La Grange and Yung 2001). Hong Kong was one of the few industrialized societies without a retirement protection scheme for its senior citizens until 2000. It is argued that the recently implemented Mandatory Provident Fund is incapable of providing adequate retirement protection for the present generation of mature adults who are going to retire within the next thirty years (Chou, et al. 2003; 2004). As of June 2006, about 19% of people aged 65 or over were receiving Comprehensive Social Security Allowance and about 54% of them were in receipt of an Old Age Allowance (Subcommittee to Study the Subject of Combating Poverty 2007). Older people living alone are the most socially deprived group. With limited financial resources and low transfer payments, many of them are living barely above the subsistence level and in very poor living conditions (La Grange and Yung 2002). Hong Kong women tend to have less retirement security than men as their resources are predicated on smaller income and fewer years of formal service as a result of poor working opportunity and segregation (Lee and Kwok 2005; Lee 2001). Income polarization has also been observed between the sexes, as women are overrepresented at the bottom of the earnings and occupation hierarchy (Chiu and Lui 2004). The evidence therefore suggests that women in Hong Kong are more vulnerable than men to impoverishment in later life.

Care and Support Another feature of rapid societal change in Hong Kong is the demand for residential aged care facilities. According to the Hong Kong Council of Social Service (press release on 06/05/2008), there are currently 6,200 people on the waiting list for publicly subsidized nursing home places and the waiting period

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averages 4 years. In 2007, only about 6% of the list was allocated a place and more than 1,500 persons passed away while waiting for the service. The demand for places has spurred the development of a private residential care sector. In 2008, there were approximately 600 such homes in Hong Kong, many of them located in obsolete urban zones like Kowloon City and Sham Shui Po, where rent and land prices are relatively low (see Figure 4 and Table 5). These private residential care homes charge lower fees but tend to have poor facilities and management, raising public concern over quality in recent years (Secretary for Health Welfare and Food 29/11/2006).

Figure 4. A private residential care home for the elderly in the Sham Shui Po District.

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Table 5. Distribution of Private Residential Care Homes for Older People in Hong Kong, 2008 No. of Private % of Total Residential Care Homes Central and Western 33 5.6 Wan Chai 24 4.0 Eastern 61 10.3 Southern 22 3.7 Sham Shui Po 62 10.4 Kowloon City 74 12.5 Wong Tai Sin 33 5.6 Kwun Tong 20 3.4 Yau Tsim Mong 42 7.1 Kwai Tsing 33 5.6 Tsuen Wan 21 3.5 Tuen Mun 34 5.7 Yuen Long 42 7.1 North 37 6.2 Tai Po 27 4.5 Sha Tin 18 3.0 Sai Kung 5 0.8 Islands 6 1.0 Total 594 100.0 Source: Compiled from Home of the Elderly Database http://www.hkelderly.org/ emap.html (accessed on 8 May, 2008).

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District Board District

Given the poor and costly living conditions and long waiting lists for aged care services in Hong Kong, it is not surprising that some older people choose to retire to Guangdong Province. The social and economic integration of the territory with the Pearl River Delta Region also facilitates the practice of cross-border retirement. A survey on cross-border retirement migration plans conducted in 2001 found that about 6.7% of the 1,867 respondents aged between 45 and 59 planned to live in China when they retire (Chou 2007). In 2006, 1.6% or 12,900 persons aged 65 or over had taken up residence in the Mainland (Census and Statistics Department 2006). In responding to this new trend of cross-border retirement, the Hong Kong Government introduced a Portable Comprehensive Social Security Allowance Scheme in 1997 that provides the welfare recipients with an option to permanent residence in Guangdong. The scheme was extended to Fujian Province in 2005 and the number of recipients stands currently at around

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2,500 to 3,000 each year (Subcommittee to Study the Subject of Combating Poverty 2007). A study on the determinants of residential mobility in Southern China (Ma and Chow 2006) found that only those who were older and had weaker informal support tended to move to China with ‘lower living cost’ and ‘better living environment’ their two primary reasons for leaving Hong Kong. Many of the respondents, however, did not consider amenity opportunities or availability of informal assistance at the destination as determinants of migration. Although retiring to China can ease some of the problems older people face in living in urban Hong Kong, the move may also create new difficulties as the seniors are detached from friends and relatives as well as subjected to poor quality of management and care in nursing homes in China. Retiring to China is still not an option for most older persons in Hong Kong, but this issue is another illustration of the dilemmas faced by older people living in a global city.

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DISCUSSION AND POLICY IMPLICATIONS Interest in environmental issues has grown significantly within the gerontology field over the past decade (Kendig 2003; Phillipson 2004; 2007) as rapid urbanisation and the consequences for older people need to be better understood. Researchers are exploring the impact of living in disadvantaged urban areas on the risks of social isolation and exclusion of older people (Abbott and Sapsford 2005; Scharf, et al. 2007; Smith, et al. 2004). It is now widely agreed that an enabling and inclusive urban environment is vital to attaining the policy goals of active and healthy ageing (OECD 2003; World Health Organization 2007). This chapter explores the issues confronting older people and the risks they face living in contemporary Hong Kong. The evidence suggests that, although Hong Kong has been repeatedly elected one of the most liveable cities in the world (Mercer Human Resource Consulting 2007) and rated the best place to do business or travel, it is not necessarily a good place to grow old or retire. This is especially the case for older people with a lower socio-economic background. Overall, the combination of an ageing urban population with the increase in pollution, the decline of the extended family and traditional values, the low incomes of many older people and the limited availability of social welfare and care provision create significant risks for older people living in Hong Kong. The social and spatial polarization and fragmentation created in the formation of Hong Kong as a global city further increase the insecurity and range of problems that

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older people experience. The globalization of finance, economic restructuring and the surge in migration have set in motion new dynamics of inequality and social divisions in most parts of the world. They produce harmful consequences particularly for older people who are often over-represented among the poor (Phillipson 2007; Wilson 2002). The case of Hong Kong confirms these observations. As Sassen (1996) argued, major cities are now the terrain where processes of globalization assume concrete and localized forms and the impact on older people’s lives is a clear illustration of what she called ‘the lower circuits of globalization’ (ibid.: 209-210). This analysis highlights the urgency for policy makers and town planners to focus on the needs of older people in building an enabling and inclusive urban environment. Early in 1994, the Hong Kong Government laid down ‘dignity of the elderly’, ‘care in the community and ageing in place’ and ‘continuum of care and integration of services’ as the guiding principles of its ageing policy (Health and Welfare Bureau 2002). In 1997, the Elderly Commission was formed to advise the government on policies and services for older people. The government also plays an active role in promoting and involving older people in building a sustainable urban space in recent years (Asia and Pacific Leadership Forum on Sustainable Development for Cities 2004). These moves reflect determination of the Hong Kong Government to improve the life situation of its older citizens. However, substantial social and welfare reforms and the use of inter-sectoral and inter-disciplinary approaches are required in the coming years to create an agedfriendly environment and to attain the policy goal of active ageing in Hong Kong.

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Bartlett, H. 1995 'Community health policy and provision in Hong Kong: challenges for 1997 and beyond', Health and Place 1(4): 243-249. Bartlett, H. and Phillips, D. 1995 'Aging trends - Hong Kong', Journal of CrossCultural Gerontology 10: 257-265. Bartlett, H., Warburton, J. and Lui, C.-W. 2008 'Promoting social inclusion of older people: challenges for policy on ageing in Australia', in T. Anme and M. McCall (eds) Culture, Care and Community Empowerment: Intermnational Applications of Theory and Methods, Tokyo: Kawashima Shoten Publishing Co. Bharucha-Reid, R. and Kiyak, H. A. 1982 'Environmental effects on affect: density, noise and personality', Population and Environment 5: 60-72. Breitung, W. 2006 'Hong Kong: China's global city', in R. Schneider-Silwa (ed) Cities in Transition: Globalization, Political Change and Urban Development, Dordrecht: Springer. Breitung, W. and Gunter, M. 2006 'Local and social change in a globalized city: the case of Hong Kong', in W. Fulong (ed) Globalization and the Chinese City, London: Routledge. Census and Statistics Department 2006 'Hong Kong Residents’ Experience of and Aspiration for Taking Up Residence in the Mainland (Thematic Household Survey Report No. 25)', Hong Kong: Census and Statistics Department. — 2007 'Hong Kong Population Projections 2007–2036', Hong Kong: Census and Statistics Department. — 2008 '2006 Population By-census Thematic Report: Older Persons', Hong Kong: Census and Statistics Department. Chan, Y.-K. 1999 'Density, Crowding, and Factors Intervening in Their Relationship: Evidence from a Hyper-dense Metropolis', Social Indicators Research 48: 103-124. Cheng, S.-T. and Chan, A. C. M. 2006 'Filial Piety and Psychological Well-Being in Well Older Chinese', The Journals of Gerontology 61b(5): P262-P269. Cheung, C.-K., Leung, K.-K., Chan, W.-T. and Ma, K. 1998 'Depression, loneliness, and health in an adverse living environment: a study of bedspace residents in Hong Kong', Social Behavior and Personality 26(2): 151-170. Chiu, R. L. H. and Ho, M. H. C. 2006 'Estimation of elderly housing demand in an Asian city: Methodological issues and policy implications', Habitat International 30: 965-980. Chiu, S. W. K. and Lui, T.-l. 2004 'Testing the Global City-Social Polarisation Thesis: Hong Kong since the 1990s', Urban Studies 41(10): 1863-1888.

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Chou, K.-L. 2007 'Cross-border retirement migration plan in Hong Kong middleaged adults', Habitat International 31(3-4): 366-374. Chou, K.-L., Chi, I. and Chow, N. 2003 'Future elderly welfare recipients in Hong Kong', Hallym International Journal of Ageing 5(2): 183-199. Chou, K.-L. and Chow, N. W. S. 2008 'Income Inequality Among Older Adults in Hong Kong: An Analysis of Change from 1981 to 2001', The Journal of Applied Gerontology 24(5): 388-403. Chou, K.-L., Chow, N. W. S. and Chi, I. 2004 'Preventing Economic Hardship Among Chinese Elderly in Hong Kong', Journal of Aging and Social Policy 16(4): 79-97. Chou, K. L. and Chi, I. 2001 'Social Support Exchange among Elderly Chinese People and Their Family Members in Hong Kong: A Longitudinal Study', International Journal of Aging and Human Development 53(4): 329-346. Chow, N. 2001 'The practice of filial piety among the Chinese in Hong Kong', in I. Chi, N. L. Chappell and J. Lubben (eds) Elderly Chinese in Pacific rim countries: Social support and integration, Hong Kong: Hong Kong University Press. Chow, N. and Chi, I. 2003 'Catering for the elderly', in Y. M. Yeung and T. K. Y. Wong (eds) Fifty Years of Public Housing in Hong Kong: A Golden Jubilee Review and Appraisal, Hong Kong: The Chinese University Press. Chow, N. W. S. 1987 'Moving into new towns - the costs of social adaptation', Asian Journal of Public Administration 9(2): 132-142. — 1988 'The quality of life of Tuen Mun inhabitants', Asian Journal of Public Administration 10(2): 194-206. Chui, E. 2001 'Doomed Elderly People in a Booming City: Urban Redevelopment and Housing Problems of Elderly People in Hong Kong', Housing, Theory and Society 18(3-4): 158-166. — 2003 'Unmasking the ‘naturalness’ of ‘community eclipse’: The case of Hong Kong', Community Development Journal 38(2): 151-163. Dorfman, R. 1998 'Madame Wong Lives in a Cage', Journal of Gerontological Social Work 29(4): 57-68. Emporis Corporation 2008 'Online Global Building Database': http://www.emporis.com/en/bu/sk/st/ma/ci/ (accessed on 28 May, 2008). Environmental Protection Society of Hong Kong 2005 'Improving the air quality in Hong Kong: A progress report', Hong Kong: Environmental Protection Society of Hong Kong. Fei, X. 1992 From the Soil: The Foundations of Chinese Society, Berkeley: University of California Press.

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Forrest, R., Grange, A. L. and Ngai-Ming, Y. 2002 'Neighbourhood in a high rise, high density city: some observations on contemporary Hong Kong', The Sociological Review 50(2): 215-240. Forrest, R., Grange, A. L. and Yip, N.-m. 2004 'Hong Kong as a Global City? Social Distance and Spatial Differentiation', Urban Studies 41(1): 207-227. Health and Welfare Bureau 2002 'Rethinking Policy, Reinventing Ageing' Second World Assembly on Ageing, Madrid. Hugo, G. 2003 'Urbanisation in Asia: An Overview' Conference on African Migration in Comparative Perspective, Johannesburg, South Africa. Hui, E. C. M. and Lam, M. C. M. 2005 'A study of commuting patterns of new town residents in Hong Kong', Habitat International 29: 421-437. Kendig, H. 2003 'Directions in Environmental Gerontology: a Multidisciplinary Field', The Gerontologist 43: 611-614. Ko, F. W. S., Tam, W., Wong, T. W., Chan, D. P. S., Tung, A. H., Lai, C. K. W. and Hui, D. S. C. 2007 'Temporal relationship between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Hong Kong', Thorax 62: 780-785. La Grange, A. and Yung, L. B. 2001 'Aging in a tiger welfare regime: The single elderly in Hong Kong', Journal of Cross-Cultural Gerontology 16: 257-281. La Grange, A. and Yung , L. B. 2002 'Poverty and single elders in Hong Kong', Ageing and Society 22: 233-257. Lam, C. W. and Boey, K. W. 2005 'The psychological well-being of the Chinese elderly living in old urban areas of Hong Kong: A social perspective', Aging and Mental Health 9(2): 162-166. Lee, K.-m., Wong, H. and Law, K.-y. 2007 'Social Polarisation and Poverty in the Global City: The Case of Hong Kong', China Report 43(1): 1-30. Lee, K. M. W. and Kwok, H.-k. 2005 'Older women and family care in Hong Kong: differences in filial expectation and practices', Journal of Women and Aging 17(1/2): 129-150. Lee, W.-l. 1993 'Environment, Opportunity and Juvenile Delinquency in a New Town of Hong Kong' Department of Social Sciences, Vol. PhD, Hull: University of Hull. Lee, W. K. M. 2001 'The feminization of poverty among the elderly population of Hong Kong', Asian Journal of Women's Studies 7(3): 31-62. Legislative Council 27/02/2008 'Bedspace apartments and cubicle apartments': http://www.info.gov.hk/gia/general/200802/27/P200802270202_print.htm (accessed on 14 May 2008).

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Lester, D. 1995 'An extension of the association between population density and mental illness to suicidal behavior', Journal of Social Psychology 135: 657658. Li, K. C. 2001 'Policy implications on the assistance of the ‘caged elderly’ in Hong Kong', Journal of Health and Social Policy 12(4): 35-52. Li, X., Poon, C.-s. and Liu, P. S. 2001 'Heavy metal contamination of urban soils and street dusts in Hong Kong', Applied Geochemistry 16: 1361-1368. Lo, C. P. 2005 'Decentralization and polarization: contradictory trends in Hong Kong's postcolonial social landscape', Urban Geography 26(1): 36-60. Ma, A. and Chow, N. W. S. 2006 'Determinants of elderly residential mobility in Southern China: exploration and implications', Ageing International 31(1): 59-70. Mercer Human Resource Consulting 2007 'World's Top 100 Most Livable Cities': http://bwnt.businessweek.com/interactive_reports/livable_cities_worldwide/ (accessed on 10 June 2008). Meyer, D. R. 2000 Hong Kong as a Global Metropolis, Cambridge: Cambridge University Press. Mitchell, R. E. 1971 'Some social implication of high density housing', American Sociological Review 36: 18-29. Ng, A. C. Y., Phillips, D. R. and Lee, W. K.-m. 2002 'Persistence and challenges to filial piety and informal support of older persons in a modern Chinese society: A case study in Tuen Mun, Hong Kong', Journal of Aging Studies 16: 135-153. Ng, M. K. 2002 'Property-led urban renewal in Hong Kong: Any place for the community?', Sustainable Development 10: 140-146. Ng, S. H., Kam, P. K. and Pong, R. W. M. 2005 'People living in ageing buildings: Their quality of life and sense of belonging', Journal of Environmental Psychology 25 347-360. OECD 2003 'Ageing, Housing and Urban Development', Paris: Organisation for Economic Co-operation and Development. Peel, N., Bartlett, H. and McClure, R. 2004 'Healthy ageing: how is it defined and measured?', Australasian Journal on Ageing 23(3): 115-119. Phillips, D. R. 1987 'Social services and community facilities in the Hong Kong new towns', in D. R. Phillips and A. G. O. Yeh (eds) New Towns in East and South-east Asia: Planning and Development, Hong Kong: Oxford University Press. Phillips, D. R., Siu, O.-l., Yeh, A. G. O. and Cheng, K. H. C. 2005 'The impacts of dwelling conditions on older persons’ psychological well-being in Hong

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Kong: the mediating role of residential satisfaction', Social Science and Medicine 60: 2785-2797. Phillipson, C. 2004 'Urbanisation and ageing: towards a new environmental gerontology', Ageing and Society 24: 963-972. — 2007 'The 'elected' and the 'excluded': Sociological perspectives on the experience of place and community in old age', Ageing and Society 27(3): 321-342. Rustemli, A. 1992 'Crowding effects of density and interpersonal distance', Journal of Social Psychology 132: 51-58. Sassen, S. 1996 'Whose city is it? Globalization and the formation of new claims', Public Culture 8: 205-223. — 2006 Cities in a World Economy (3rd Edition), Thousand Oaks: Pine Forge Press. Scharf, T., Phillipson, C. and Smith, A. 2007 'Aging in a difficult place: assessing the impact of urban deprivation on older people', in H.-W. Wahl, C. TeschRomer and A. Hoff (eds) New Dynamics in Old Age: Individual, Environmental and Societal Perspectives, New York: Baywood Publishing. Schmitt, R. C. 1961 'Implications of density in Hong Kong', Journal of the American Institute of Planners 29: 210-217. — 1978 'Density, health, and social disorganization revisited', Journal of the American Institute of Planners 44(2): 209-211. Secretary for Health Welfare and Food 29/11/2006 'Replies to Legislative Council questions': http://www.fhb.gov.hk/en/legco/replies/2006/lq061129_q20.htm (accessed on 10 June 2008). Smith, A. E., Sim, J., Scharf, T. and Phillipson, C. 2004 'Determinants of quality of life amongst older people in deprived neighbourhoods', Ageing and Society 24: 793-814. So, A. Y. and Chiu, S., W. K. 2000 'Modern East Asia in world-systems analysis', in T. Hall, D. (ed) A World-Systems Reader: New Perspectives on Gender, Urbanism, Cultures, Indigenous Peoples and Ecology, New York: Rowman and Littlefield. Subcommittee to Study the Subject of Combating Poverty 2007 'Report on Elderly in Poverty', Hong Kong: Subcommittee to Study the Subject of Combating Poverty, Legislative Council of the Hong Kong Special Administrative Region. Susnik, A. and Ganesan, S. 1997 'Urban renewal and displacement in Hong Kong', Urban Geography 18(4): 324-346. — 1998 'Select case study findings from comprehensive urban renewal in Hong Kong', Hong Kong Papers in Design and Development 1: 109-120.

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Tsai, J.-f. 2001 The Hong Kong People's History of Hong Kong, Hong Kong: Oxford University Press. United Nations Human Settlements Programme 2008 'State of the World’s Cities 2008/2009', Kenya: United Nations Human Settlements Programme. Urban Transport Fact Book 2005 'Major High-Income World Urban Areas: Freeway Access and Capacity': http://www.publicpurpose.com/utworldfwy.htm (accessed on 7 May 2008). Walker, A. 2002 'A strategy for active ageing', International Social Security Review 5(1): 121-139. Wilson, G. 2002 'Globalisation and older people: effects of markets and migration', Ageing and Society 22: 647-663. Wirth, L. 1938 'Urbanism as a way of life', American Journal of Sociology 44(1): 1-24. Wong, C.-M., Ma, S., Hedley, A. J. and Lam, T.-H. 1999 'Does ozone have any effect on daily hospital admissions for circulatory diseases?', Journal of Epidemiology and Community Health 53: 580-581. — 2001 'Effect of Air Pollution on Daily Mortality in Hong Kong', Environmental Health Perspectives 109 (4 ): 335-340. World Health Organization 2002 'Active Ageing: A Policy Framework', Madrid: Would Health Organization. — 2007 'Global Age-friendly Cities: A Guide', Madrid: World Health Organization. Yan, E. and Tang, C. S.-K. 2003 'Proclivity to Elder Abuse: A Community Study on Hong Kong Chinese', Journal of Interpersonal Violence 18(9): 999-1017. Yeh, A. G.-O. 1999 'The changing spatial distribution of elderly population and its planning implications', in A. G.-O. Yeh and D. Phillips (eds) Environment and Ageing: Environmental Policy, Planning and Design for Elderly People in Hong Kong, Hong Kong: Centre of Urban Planning and Environmental Management, University of Hong Kong. Yeh, A. G. O. 2003 'Public housing and new town development', in Y. M. Yeung and T. K. Y. Wong (eds) Fifty Years of Public Housing in Hong Kong: A Golden Jubilee Review and Appraisal, Hong Kong: The Chinese University Press. Yeung, Y. M. and Wong, T. K. Y. (eds) 2003 Fifty Years of Public Housing in Hong Kong: A Golden Jubilee Review and Appraisal, Hong Kong: The Chinese University Press. Yip, N. M. and La Grange, A. 2005 'Globalization, de-industrialization and Hong Kong's private rental sector', Habitat International 30(4): 996-1006.

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Yip, P. S., Chi, I. and Yu, K. K. 1998 'An epidemiological profile of elderly suicides in Hong Kong', International Journal of Geriatric Psychiatry 13(9): 631-7.

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Chapter 4

ACTIVE AGING AND CHINA: PERSPECTIVES AND ISSUES Sheying Chen1 and Elaina Y. Chen2

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1Sheying

Chen is the Associate Vice Chancellor for Academic Affairs and Professor of Sociology at Indiana University Southeast, New Albany, IN, USA 2 Elaina Y. Chen is a Research Assistant and M.D. student at Indiana University School of Medicine, Indianapolis, IN, USA

ABSTRACT In recent years, the term “active aging” has enjoyed rapid expansion of its use in the research literature and (supposedly) also in the official documents of governments on aging. This chapter begins with a review of this trend by highlighting the international and national contexts in order to understand the continuity of policy, theory, and practice, particularly within the cultural, political, and socioeconomic settings of the People’s Republic of China. Real progress of the country’s aging undertaking will be assessed, and major issues will be highlighted for policy consideration along with a discussion of the implications.

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ACTIVE AGING AS A WHO INITIATIVE In 2002, the World Health Organization (WHO) published a document entitled Active Ageing: A Policy Framework, which was developed by WHO’s Ageing and Life Course Programme (drafted by Peggy Edwards, a Health Canada consultant) with international input, as a contribution to the Second United Nations World Assembly on Ageing held in April 2002 in Madrid, Spain. The Policy Framework was designed to mainly address the following questions (WHO, 2002): How do we help people remain independent and active as they age? How can we strengthen health promotion and prevention policies, especially those directed to older people? As people are living longer, how can the quality of life in old age be improved? Will large numbers of older people bankrupt our health care and social security systems? How do we best balance the role of the family and the state when it comes to caring for people who need assistance, as they grow older? How do we acknowledge and support the major role that people play as they age in caring for others? A special concern was articulated for developing countries including China: “while it took 115 years for the proportion of older people in France to double from 7 to 14 percent, it will take China only 27 years to achieve the same increase…while developed countries grew affluent before they became old, developing countries are getting old before a substantial increase in wealth occurs (Kalache and Keller, 2000)” (WHO, 2002, p.11). Moreover, rapid aging in developing countries is accompanied by dramatic changes in family structures and roles, as well as in labor patterns and migration. “Urbanization, the migration of young people to cities in search of jobs, smaller families and more women entering the formal workforce mean that fewer people are available to care for older people when they need assistance” (WHO, 2002, p.11). The proposed solution to the widespread dilemma was “to inform discussion and the formulation of action plans that promote healthy and active ageing” (WHO, 2002, p.2). The notion of active aging is the foundation of the above Policy Framework, which was adopted by WHO in the late 1990s “to convey a more inclusive message than ‘healthy ageing’ and to recognize the factors in addition to health care that affect how individuals and populations age (Kalache and Kickbusch, 1997)” (WHO, 2002, p.13). Despite its all-encompassing definition of health that includes mental and even social well-being, WHO provides yet another broad vision of active aging to highlight “the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age” (WHO, 2002, p.12). According to WHO (2002), the word “active” refers to continuing participation in (and contribution to) social, economic, cultural,

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spiritual and civic affairs, not just the ability to be physically active or to participate in the labor force. Especially, the Policy Framework reiterates WHO’s goal as stated in the Brasilia Declaration on Ageing and Health in 1996 that healthy older persons remain a resource to their families, communities and economies. Of course, equally important are continuing opportunities for aging to be a positive experience, with the aim to extend healthy life expectancy and quality of life for all people as they age, including those who are frail, disabled and in need of care. It should be noted that there are other United Nations (U.N.) agencies and programs that have also dealt with aging issues along with the WHO, such as the U.N. Center for Human Settlements (Habitat) and the UN Educational, Scientific and Cultural Organization (UNESCO). The U.N. General Assembly itself has also addressed the position of older persons in society on numerous occasions in the past 50 years. In 1948, and again in 1969, it adopted resolutions concerning the rights and welfare of the elderly. Aging issue was also included in the World Population Plan of Action (adopted by the World Population Conference of 1974). In 1978, the General Assembly decided to convene the First World Assembly on Aging in 1982 (Vienna), to address one of the major challenges of the twentieth century, that is, an increase in longevity of 20 years since 1950 (the most dramatic demographic change the world had witnessed, as so-called “demographic agequake” or “silent revolution”). The First World Assembly on Aging in 1982 adopted an International Plan of Action, recommending an array of initiatives in employment and income security, health, housing, education and social welfare. Subsequently, on December 16, 1991, the General Assembly adopted the U.N. Principles for Older Persons, addressing a comprehensive set of needs for independence, participation, care, self-fulfillment and dignity. Later, the General Assembly declared 1999 as the International Year of Older Persons with its Proclamation on Aging and the theme of the year, “towards a society for all ages”. Under the framework of the U.N. Principles for Older Persons, the year’s themes empahsized the situation of older persons, individual lifelong development, relationships between the generations, and the interrelationship of population aging and development. Twenty years had passed when nations were ready to meet again at the Second World Assembly on Aging. After participating in the review of the outcomes of the First World Assembly on Aging, delegates from the developing countries expressed a concern that despite the positive aspects of the first Plan of Action, the recommendations contained therein were more suited to the needs of developed countries (Dávila, 2002). The Group of 77 (an alliance of developing countries) and China wanted the Second World Assembly on Aging to respond to

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their concerns including external debt with “a forward looking document that takes into account the special needs and challenges facing the older population particularly in developing countries” (Dávila, 2002). As a result, the revised Plan of Action considers the social, cultural, economic and demographic realities of the new century in both developed and developing countries and offers a practical tool to assist policy-makers in responding to the challenges in their societies. The WHO Policy Framework, in this context, started enthusiastic promotion of active aging to help governments and societies (See Population and Social Integration Section, 2008, for the Asian Pacific region) plan for policies that will ensure that older persons can continue to contribute to society in a meaningful way to the best of their ability.

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ACTIVE AGING IN THEORY AND PRACTICE The Second World Assembly on Aging stressed that “Countries with older populations must increasingly promote active ageing through policies of preventive medicine, continued learning and a flexible work schedule” (all that, apart from making good use of the human potential of older people, will help to meet the possible costs deriving from the new population structure) (Aznar, 2002). It could be noted, however, that the term “active ag(e)ing” never appeared in the Madrid International Plan of Action on Ageing itself and appeared only once in the Political Declaration, 2002. Instead, “active” still tended to be used in a conventional way to describe such words as participation, life/lifestyle, individual/person, and role/agent. At that time, of course, “active aging” as an umbrella health and well-being policy term had been yet an emerging international direction. Today, it has become central to international and national aging policy development (Hutchison, Morrison and Mikhailovich, 2006), which has been influenced by both political agendas and aging research. Below, let us take a brief look at related literature to better understand the meaning and implications of active aging by placing it in a scientific context. While active aging has become a new trend in aging policy development, it is not a new concept (Hutchison, Morrison and Mikhailovich, 2006). The society, however, has come a long way to arrive at this point. Western social gerontology considers power and prestige among the elderly largely due to ability to control goods, knowledge, and other resources. Therefore, despite the “golden age” rhetoric for the elderly, there was hardly ever a time when being old itself was truly venerated. During the first half of the twentieth century, old age was equated

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with dependence in research and, as such, being really active was largely out of the spotlight (if not out of the question). Later, the idea of successful aging emerged through individual adjustment in later life and, during the 1970s and 1980s, the notion (successful aging) was expanded to encompass three dimensions: survival, physical functioning and happiness (Rowe and Kahn, 1987). Since the early 1960s, researchers in the U.S. argued that the key to “successful ageing” was activity and financial success. Activity theory considers optimal or successful aging as dependent on people maintaining their activity patterns and values via finding substitute statuses and roles for relinquished ones (Kossuth and Bengtson, 1988). Empirical research has shown that most people indeed benefit from a high level of activity in age. Yet investigators have also discovered that activity carried on merely for the sake of being active may not be beneficial, or may even have negative effects (some individuals may actually prefer and benefit more from inactivity). Since empirical evidence for the activity theory failed to consistently support importance of continued activity, this approach was criticized for placing unrealistic expectations on individuals to maintain higher levels of activities associated with middle age into their advanced old age and for making no account for other confounds such as disability, illness, frailty, inter-cultural relevance, obesity, drug or alcohol addiction, or a lifetime of inactivity (Hutchison, Morrison and Mikhailovich, 2006). Nevertheless, the notion of successful aging based on continued activity has helped to counter the negative effects of disengagement and social exclusion, which are also of great theoretical interest to social gerontologists. The concept of successful aging reemerged in the late 1990s (Rowe and Kahn, 1997), along with a new strategy called “productive aging” (MorrowHowell, Hinterlong and Sherraden, 2001). The latter has been developed to promote older adults’ contributions to society in social and economic capacities by incorporating a life course perspective that favors older people being active well beyond the usual retirement age. When the new concept of active aging began to emerge in the 1990s, it was quite natural to extend the emphasis to include health, active participation, and the inclusion of older citizens in all areas of family, community and national life. Although it was considered to reflect many of the important domains of influence such as the specific needs of older people, health outcomes and inequalities, cultures and the social determinants of health and illness (Hutchison, Morrison and Mikhailovich, 2006), active aging was said to shift strategic planning away from a “needs-based” approach (which tends to assume that older people are passive targets) to a “rights-based” approach (which recognizes the rights of people to equality of opportunity and treatment in

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all aspects of life as they grow older, along with their responsibilities) (WHO, 2002, p.13). This certainly represents a higher stage of development, though the criticism seen earlier against successful aging may also apply here, particularly in view of those older persons with severe frailty, disability, and illness (e.g., advanced dementia including Alzheimer’s disease) with no or little possibility of independent living. While active aging was proposed as a policy framework, researchers have used it to guide research, just like under those previously proposed frameworks. Major research reports since the 1970s have identified four major categories of factors contributing to healthy aging, with their weights being approximately 20% for genetic factors, 20% for environmental factors, only 10% for healthcare, but 50% for lifestyle (Chi, 2002). According to the International Council on Active Aging (http://www.icaa.cc/profesional_education/researchandreports.htm), most experts believe physical activity is the top solution for successful aging. Thus, active aging in practice has been frequently associated with certain things specifically targeted to older adults, such as fitness or wellness centers, exercise, and other lifestyle changes. In other words, active aging takes place when older adults regularly participate in a variety of structured and unstructured physical activities. Communities are expected to promote active aging and implement a diverse array of physical activity programs, helping to make more accessible selfdirected physical activity opportunities for people of age 50 and above. Note here a much younger age than most retirement ages is used to promote implementation of active aging early, which shows the preventative nature of the concept (i.e., life-long preparation for old age). Compared with the 2002 WHO proposal and its broad conception of active aging, we see in the above a continued emphasis on such basics as physical health. Active aging, however, was meant to convey a more inclusive message than “healthy ageing” and to recognize the factors in addition to health care. Remember all the dimensions or aspects that the active aging concept is supposed to include (e.g., continuing learning and flexible work schedule; participation in and contribution to social, cultural, spiritual and civic affairs; remaining a resource to families and communities; security and rights; optimizing opportunities for good quality of life; positive experience and happiness; etc.). Since the notion involves almost every aspect of life, active aging may mean quite differently to different people in terms of agenda or priority setting. This possibility bears on the study of individual country cases and should make their comparison rather interesting.

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ACTIVE AGING AND CHINESE AGING POLICY Complications in impletmentation tend to distort or even derail a policy proposal, and the WHO framework is not one without controversy. It has already rendered active aging a “political backwater” in Europe (Ney, 2005; UNESCO, 2008). What is the situation in China, a country of 1.328 billion people with 11% of them being aged over 60 as of 2006 (WHO, 2008)? To understand the big picture, a historical perspective would be helpful. China’s current aging policy and administrative system were developed after the First World Assembly on Aging in 1982. Since the beginning, aging undertaking in China has articulated a direction to ensure elderly people to have living support, healthcare, education, contribution, and entertainment. These were summarized in the People’s Republic of China Law on the Protection of the Rights and Interests of the Elderly as a goal of “Five Haves”. The five-year plan for the development of China's aging undertaking during 2006-2010 lists both learning and instruction (added under former president Jiang Zheming’s directive) in the area of eduation, and therefore the goal now includes six objectives, or “Six Haves of the Elderly”. The official translation of the goal is: “All elderly people are to be provided for and enjoy proper medical care. They are to be given opportunities to pass on their experience as well as to learn new things. They should be given the opportunity to do what they can for the society, while enjoying their later years” (State Council of PRC, 2006). It is noticeable that the Chinese government’s 2006 White Paper on The Development of China's Undertakings for the Aged included a chapter on “Safeguarding Elderly People's Legitimate Rights and Interests”, in addition to other major themes (i.e., Old-age Security System and Social Services for an Aging Society, Health and Medical Care for the Aged, Cultural Education for the Aged, and Participation in Social Development), corresponding to the multifold goal of "Six Haves of the Elderly" (although enjoyment/entertainment was not listed here as a separate category). Before the 1980s, gerontology was largely nonexistent in China except for some scarce geriatric research in medicine (Tao, 2001). Though, the newcomer seemed to also have had some advantage, besides being still ahead of most other developing nations. However the reality has evolved so far (which will be examined later), the articulated goals and objectives of the Chinese aging policy seem to be rather compatible with the WHO goal of active aging. From the above review, we can understand that this is no accident. The First World Assembly on Aging in 1982 served as the most important background and impetus for the initiation of China’s official aging undertaking. And, as shown in the above, there has been a great deal of continuity from the First World Assembly on Aging in

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1982 to the Second World Assembly on Aging in 2002, despite a shift of emphases and catchwords over time (e.g., from healthy aging to active aging). The Chronicle of Chinese Aging Wrok compiled by the China National Committee on Aging and the Gerontological Society of China (2004) provides a good review of the development of China’s aging undertaking between the two World Assemblies on Aging. The Ministries of Labor and Civil Affairs Administration were the major players in China’s preparation for the First World Assembly in 1982, and in implementting its comprehensive International Plan of Action as well as the 1991 U.N. Principles for Older Persons. The year of 1999 was declared by the U.N. General Assembly as the International Year of Older Persons with a Proclamation on Aging. Coincidentally or not, it was also chosen by China to establish in October the China National Working Commission on Aging (CNWCA), the most important advisory and coordinating body of the State Council with a mandate to supervise aging work nationwide. CNWCA has had 26 agency members (China National Committee on Aging, 2008): Organization Department of the Communist Party of China (CPC) Central Committee, Publicity Department of CPC Central Committee, the Working Committee of CPC Central Committee for the Institutions of the Central Committee, the Working Committee of CPC Central Committee for the Institutions under the Central Government, Development and Reform Commission, Ministry of Education, State Ethnic Affairs Commission, Ministry of Public Security, Ministry of Civil Affairs, Ministry of Labor and Social Security, Ministry of Justice, Ministry of Finance, Ministry of Personnel, Ministry of Construction, Ministry of Culture, Ministry of Health, State Administration of Radio Film and Television, General Administration of Sports, China National Tourism Administration, General Administration of Press and Publication, National Population and Family Planning Commission, General Political Department of the military (PLA), All China Federation of Trade Unions, All China Women's Federation, Chinese Communist Youth League, and China National Committee on Ageing. In other words, the CNWCA has represented almost the entire Chinese government as well as its most important administrative affiliates. The main responsibilities of CNWCA include organizing and coordinating important activities on aging in China initiated and sponsored by U.N. and other international organizations, among many other duties. The CNWCA Office is housed in the Ministry of Civil Affairs Administration, where it was combined with the China National Committee on Aging (CNCA) after a reorganization in August 2005 (Ministry of Civil Affairs Administration, 2008). Under the new structure, domestic work would be conducted under the name of the CNWCA

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Office, while international exchange and cooperation on aging-related matters would be mainly carried out under the name of CNCA. The CNWCA Office/CNCA thus functions as the secretariat of CNWCA. It is supervised by the the Ministry of Civil Affairs Administration, its staffing was approved by then Ministry of Labor and Personnel, and its leader enjoys the status of a Vice Minister in the State Council (Ministry of Civil Affairs Administration, 2007). Its provincial and local counterparts were also established to form a national network. It should be noted that CNCA itself was originally configured as a national committee on aging issues in preparation for the First World Assembly on Aging at a time when aging tended to be considered and translated as a problem. In February 1995, the State Council approved a change of its name from a committee on aging issues/problems (Zhongguo Laoling Wenti Quanguo Weiyuanhui) to its current name of Zhongguo Laoling Xiehui (the English translation CNCA needed no change without the world of “issue” or “problem” in it). The intent was to convey a more positive message, and hopefully a more positive public perception, about aging (i.e., not inherently an issue or problem), which has eventually led to nationwide adoption of the idea of active aging after the Second World Assembly on Aging in 2002. Chinese aging policy instruments include several major categories, which can be summarized as follows: a) ruling party and government leaders’ reports to CPC and People’s Congresses, and Party and state leaders’ speeches, proclamations, and directives about aging work, and b) laws and policies specifically guiding and governing aging work (including official documents issued by agencies in charge of aging work, important speeches of the leaders of aging agencies, and, somewhat singularly, “culture”) (China National Committee on Aging and Gerontological Society of China, 2004). For an evidence-based analysis or empirical study of Chinese aging policy, we must deal with those very extensive and diverse policy documents, with the help of critical thinking to achieve any relevant and accurate observation and conclusion. An extensive search and review have found frequent use of the word “active” (Jiji) in Chinese aging policy documents, yet the phrase “active ag(e)ing” (Jiji Laoling Hua) as a relatively new jargon has not been adopted or incorporated in a majority of the policy instruments, new or as amended, to any notable extent (if at all) (e.g., General Secretary Hu Jintao's report at the 17th CPC Congress, 2007; Chairman Wu Bangguo’s report to the 11th National People’s Congress on behalf of the NPC Standing Committee, 2008; PRC State Council’s Priorities for 2008; China’s 11th Five-Year Plan, 2006; Government White Paper on Aging, 2006; Central Committee of CPC and State Council Decision on Enhancing Aging Undertaking, 2000; the Law on the Protection of the Rights and Interests of the

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Elderly, 1996; CNWCA Office and Departments of Justice and Public Security Joint Opinion on Enhancing Protection of Legal Rights of the Elderly, 2003; Departments of Justice and Civil Affairs Administration Notice of Providing Legal Assistance to Protect Legal Rights of the Elderly, 1996; CNWCA Office, Development and Reform Commission, Departments of Education, Civil Affairs Administration, Labor and Social Security, Finance, Constrution, Health, Commission on Population and Family Planning, and General Tax Bureau Joint Opinion on Expediting the Development of Elderly Service Industry, 2006; Department of Finance and General Tax Bureau Notice on Tax Policy Issues Regarding Old Age Service Agencies, 2000; CNWCA Office, Development and Reform Commission, Departments of Education, Civil Affairs Administration, Labor and Social Security, Finance, Constrution, Health, Commission on Population and Family Planning, and General Tax Bureau Joint Opinion on Promoting Comprehensive Family-Based Elderly Support Service, 2008; All China Women’s Federation Opinion on Enhancing Elderly Women Work, 2000; Central Committee of Communist Youth League and CNWCA Office Joint Opinion on Implementing Volunteer Service for the Elderly Jinhui Action, 2002; Department of Health Opinion on Enhancing Healthcare for the Elderly, 2001; Department of Culture Opinion on Enhancing Old Age Cultural Work, 1999; State Council Decision on Establishing Unified Basic Old Age Insurance for Enterprise Staff and Workers, 1997; Department of Civil Affairs Administration Interim Protocol for Rural Residential Institutions for the Elderly, 1997; Department of Civil Affairs Administration Interim Provisions for Rurual “Five Guarrantees” Work, 2006; Department of Civil Affairs Administration Guidelines for Developing Rural “Five Guarrantees” Support Service Agencies, 2006) (China National Committee on Aging, 2008). Like those formally endorsed U.N. policy statements more than half a decade ago, the Chinese policy documents diaplay a tendency to keep their continuity in development rather than following shifting trends in terminology (even though the government claims to be active in almost everything related to its aging undertaking). It should be noted that historically in the People’s Republic of China, people were more used to administrative directives than the laws. The government’s daily aging work was carried out according to the specific instructions in those notices, decisions, and opinion papers, commonly referred to as “red letterhead documents” (Hongtou Wenjian). They dealt with those aspects of life that were very important to aging people, including housing (e.g., Departmental Offices of Civil Affairs Administration and Construction Joint Notice on Promoting and Implementing Construction Design Stardards for Older People), healthcare (e.g., Department of Health Opinion on Enhancing Aging Healthcare), income security

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(e.g., Department of Labor and Social Security Notice on Issues Related to Improving Basic Old Age Insurance Policy for Urban and Rural Staff and Workers), legal rights (e.g., Departments of Justice and Civil Affairs Administration Joint Notice on Protecting Older People’s Legal Rights and Improving Old Age Legal Assistance), cultural needs (e.g., Department of Culture Opinion on Enhancing Old Age Cultural Work, and Notice of Approval of Creating the Monthly Journal of Chinese Aging), and funding (e.g., People’s Bank of China Notice of Approval for Establishing Chinese Aging Fund). Such documents also included those issued by a couple of so-called mass organizations (e.g., All China Women’s Federation Opinion on Enhancing Elderly Women Work, and Central Committee of Communist Youth League and CNWCA Office Joint Opinion on Implementing Volunteer Service for the Elderly Jinhui Action), which were actually quasi-governmental entities (Chen, 1996). As indicated earlier, Chinese aging policy documents put a lot of emphasis on taking active approaches to the country’s aging undertaking, as evidenced by a high frequency of the use of the word “active” (Jiji). This word is also frequently used in the speeches and proclamations of government leaders at all levels to promote the country’s “Six Haves of the Elderly” goal. However, “active” has tended to be used in a conventional way to describe such specific aspects as participation and more frequently in describing governmental and societal work rather than individual lifestyle. On the whole, the continuity of Chinese aging policy has been characterized by a comprehensive scope from the beginning guided by the two World Assemblies on Aging. Nevertheless, the missing or rare inclusion of the newest catchphrase of “active aging” in so many policy instruments (not including special regions, e.g., HKSAR Labour and Welfare Bureau, 2007) as well as the ambiguity/flexibility of the idea itself have resulted in different interpretations and left some unclear about its meaning and relevance as something possibly new to the country’s practice.

ACTIVE AGING AND CHINESE AGING RESEARCH China did not fully realize aging as a potential issue for itself until getting deeply involved with the First World Assembly on Aging in 1982. A national network of aging work agencies was established afterwards and coordinated by the CNCA. In August 1984, China convened its own first national work meeting on aging in Beijing, with two follow-up meetings held in 1985 (Beijing) and 1987 (Shanghai) for exchange of work experience. In addition to these organization and promotion efforts, research on aging emerged as a heated subject attracting multi-

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disciplinary interests. The restoration or revitalization of many social science disciplines at the turn of the 1980s, particularly sociology and later social policy and social work, helped to dramatically expand the field of social gerontology. A number of large-scale and small-scale surveys were conducted, providing much needed empirical evidence of the country’s aging issues. In April 1986, China convened its first national scholarly seminar on aging, with biomedical/geriatric, psychological, and social scientists and practitioners joining together to explore matters related relevant to various branches of gerontology. The Gerontological Society of China (GSC) was launched at the conference with sponsorship from the Chinese Aademy of Sciences and the Chinese Academy of Social Sciences, with daily oversight responsibility given to the CNCA. An international seminar on aging was also held in Beijing in the same year. Two years later in 1988, China Research Center on Ageing was created. Since then, numerous conferences and seminars were conducted within the rapidly expanding field of study in some of the country’s largest cities and other places (Tao, 2001), covering such diverse topics as geriatric medicine, health and mental health, pension and income security, marriage and family, old women, education, contribution, population aging, and sustainability. Besides these seminars and workshops conducted by scholars and academics, some meetings and conferences convened by government agencies carried special significance in Chinese aging policy making and implementation. Social security reform, for example, was a major topic for a consultation seminar on population aging and social security convened by the State Planning Commission in September 1986, which laied a foundation for the reform of China’s social security system in the 1990s (Tao, 2001). While things like social security, community service, and family support were among some of the most favored topics for continued social research on aging in China, Chinese gerontologists and others related to aging research were also informed of the significance of healthy aging, successful aging, productive or efficiency aging, and active aging. Amid various policy discussions heated to different degrees, they have tried to operationalize the ideas and conduct theoretical and empirical studies to not only understand the constructs but also their related factors. Healthy aging has become a major theme for research and international exchange (e.g., Workshop on Healthy Aging Studies in China with International Exchanges, MPI for Demographic Research, Rostock, Germany, July 30-August 3, 2001), including health behavior and lifestyle (Woo, n.d.). There have not been so many studies of successful aging in China, though there are researchers who have investigated the “distribution” and related factors of successful aging in such

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a major city as Shanghai (Li et al., 2006). While there have been fewer studies on productive aging, serious inquiry has treated the topic in a positive way (e.g., Cheng and Li, 2005) despite an assertion that it is not suited for China (Ge, 2002). In terms of active aging, researchers tried to understand its meaning and are trying to figure out a way to apply the idea in the unique Chinese setting. Given still limited opportunities and resources, an intergenerational issue is particularly notable in terms of older people’s curtailed rights for employment and education (in order to make room for the younger generations in workplaces and colleges). Presumably, the theme of active aging will be more and more reflected in Chinese policy documents, though researchers are still facing their unique challenges (e.g., unemployment, limited resources and access to formal education) in helping the country to fully meet the U.N. framework’s expectations. Overall, active aging is attracting a lot more interests than some of the other topics, probably only next to healthy aging (by a rough measure of their presence in the Chinese cyberspace/Internet). Investigators have included senior scholars as well as graduate student researchers, using both qualitative and quantitative analyses (e.g., Pan, 2006; Xu, Xiao and Chen, 2006; Huang, 2008; Guo and Shi, 2006). While some entrenched bias interests feared challenges by emerging investigators with innovative research (e.g., Chow, 1997), experts with genuine scholarly interests (e.g., Croll, 1997; Ikels, 1997) provided objective and constructive input which is of vital importance to a healthy development of Chinese aging research in and outside China. Extensive international exchange under such a positive theme as active aging (Cook and Powell, 2003) has helped Chinese scholars and policy makers to stay on the right path and be integrated into the mainstream, with great implications to Asia’s development along with the rest of the world.

ACTIVE AGING AND PRACTICAL ISSUES Life expectancy in China has had a steady increase over the past half century including recent years (see Table 1). On the other hand, China’s statutory retirement age is still 55 for female staff and workers, while Chinese men normally retire at the age of 60. For certain blue-collar workers, women quit work at the age of 50 while men retire at 55. In reality, employees of state-owned enterprises may even retire in their 40s or 50s. The average retirement age in China is 51.2 (Editorial, 2006), ten years lower than the world's average.

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Table 1. Life expectancy at birth (years) 1950-1955

1975-1980

1990

2000

2006

2045-2050

Both sexes

40.8

65.3

68

71

73

79.0

Female

42.3

66.3

69

72

75

81.3

39.3 Male 64.5 68 70 Sources: WHO, 2008; Population Division of DESA, 2002.

72

76.7

For gerontologists, these facts do not bode very well for active, productive, and healthy aging. For policy makers, they pose a huge dilemma while the official messages have been mixed. On the one hand, China faces a chronicle problem of unemployment with millions of youth entering the job market each year, which makes vacating positions for them in the workforce necessary via early retirement. On the other hand, how to afford a rapidly increasing demand for pension and other retirement benefits has been bringing greater and greater pressure on the Chinese government. Keep in mind that this is still a developing country with one out of ten in the population living on less than US$1 per day based on 2004 data (WHO, 2008). Squeezed by these conflicting demands, one official report would say China may raise the retirement age to reduce welfare burden associated with a rapidly aging society (Editorial (2006), while another would say China won’t change retirement age due to the concern of increasing unemployment (Xinhua, 2005). It should be noted that the problem here is actually not just about retirement. In the process of economic reform, many were laid off or displaced in the government’s bid for higher productivity of the Chinese economy, which has shown a direction opposite to Western welfare reform (particularly American workfare) (Chen, 2004). Those people also needed to find a way back to work, especially amid another “great transfer” of the government’s work emphasis, or fundamental change of its general public policy (GPP) toward a “harmonious society” or more balanced development (Chen, 2008). Different from Western societies where agism often goes against public policy, age discrimination in China was advocated and imposed by the reformist government in the country’s early stages of opening up as a strategy to change the infamous “gerontocracy” in the hope to rejuvenize leadership at all levels. Age restriction is still allowed, sponsored, or even imposed by public policy for those specific economic and political reasons, and more strictly enforced regarding leadership opportunities than common, mandatory retirement age in China. If active aging is to be taken seriously as the new policy framework for the country, it will have to eventually abolish such age limits for various work and formal

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education opportunities. However, because of those historical and economic complications, the matter will hardly disappear in the near future, especially by simply taking a political approach. On the other hand, those knowing only of an admirable cultural tradition of age veneration in Chinese family and society will need to pay attention to such realities, which may be at the root of many “aging problems”, including health and mental health issues that may lead to even elderly suicide. In order to strike a desirable balance between unemployment and social security/welfare burden with economic efficiency/productivity as the top priority for a historically “economic state” (Chen, 1996 and 2004), reemployment not only became a major issue for the displaced workers but also considered as a good solution for the young retiree (International Labour Organization Labour Law and Labour Administration Department, 2002). However, reemployment is affected by multiple factors, including information and incentives (Giles, Park and Cai, 2006). Reemployment also requires job training, among other social services, while the Chinese junior college system has not functioned so effectively as the American community college system in terms of open admissions and transfer opportunities to facilitate workforce development (Chen, 2003). China does have various “Universities for the Aged” with very limited capacities. They may be advanced by taking advantage of the recent development of community colleges in China by forming joint ventures. This should help with two aspects of the “Six Haves of the Elderly” goal, that is, learning and instruction, which are important for realizing active aging in China also in terms of participation and contribution by older people. Since active aging does not seek to minimize the issues concerning the frail elderly (Cook and Powell, 2003), health care (including mental health) for the elderly continues to be an outstanding issue and must be treated as a prority in China (Chen and Chen, 2007). Dementia, for example, has been a major public health problem, taking a heavy toll on the elderly and their families in China. Based on a systematic or meta analysis of the results of twenty-five studies conducted during the years of 1980–2004, Dong and colleagues (2007) found that the pooled prevalence of dementia was 1.6% for Alzheimer disease and 0.8% for vascular dementia (the two major subtypes of dementia in China), for the research samples aged 60 years and older. They also found a higher prevalence of Alzheimer disease in the illiterate elderly population (3.2%) than in those who received years of education, which seems to lend support to active aging to be implemented at younger ages in terms of education (particularly in terms of uniquely early retirement ages in China). They also revealed a troubling trend of significantly increasing chronological prevalence of Alzheimer disease from 1980

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to 2004. On the other hand, according to WHO (2008), total expenditure on health averaged about only 4.7% of China’s GDP in recent years. Chinese general government expenditure on health as percentage of total government expenditure has averaged about 1%, which in 2005 accounted for 38.8% of the total expenditure on health. Out-of-pocket expenditure accounted for 85.3% of private expenditure on health, down from 95.6% in 2000 but still very high, reflecting the underdevelopment of nongovernmental health insurance. For a country of 1.3 billion people, there were only some 109,000 community and traditional health workers in 2001. As a result, younger and healthier elderly are increasingly functioning as a major source of care for the frail and very old elderly, which lends support to active aging in the Chinese socioeconomic context. However, it does not exempt public policy from supporting dependent elderly and their heavily impacted family caregivers, particularly given China’s trends of population change and economic development (see Table 2). The other seemingly “less active” aspect of China’s “Six Haves” goal is to take care of the living or basic needs of the elderly, particularly in terms of financial support. Wang and Zhang (2005) used the 2000 Census data plus national sample survey results, roughly around the time when active aging was introduced, for their research on this topic. Among the 130 million Chinese older people, about 33% were employed while 67% were unemployed. Nationwide, elderly population in poverty ranged from 9.21 to 11.68 million, with a poverty rate at 7.1% - 9.0%. Although Chinese culture emphasizes family support and the government has counted on it to deal with the “gray tide” challenge, research has revealed that the income of the elderly was very important to family and community care (Chen, 1996). It has now become even more important in an increasingly market-oriented society, where family support structure has also been significantly weakened by birth control (particularly the country’s “one child” policy), job competition for younger generations, higher mobility, modernization, and increased Western cultural influence that is no less profound than the once shocking impact of the Cultural Revolution. Table 2. China’s Population Growth vs. National Income Growth 1990

1995

2000

2005

2006

Population growth rate

1.4

1.7

0.8

0.6

0.6

Gross nat’l income per capita US$

800

1490

2340

4110

4660

Source: WHO, 2008.

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CONCLUSION AND DISCUSSION Active aging as a U.N./WHO proposed/sponsored policy framework indicates a new stage of research and practical development worldwide. Although the framework did not particularly elaborate on its relationship with healthy aging, successful aging, productive aging, and other previously used, popular terms, the continuity of desired policy and practice direction is evident, and therefore previously validated research conclusions remain relevant. Health behavior and lifestyle change, for example, continue to be a cornerstone for active aging. Security and provision in terms of income support, housing assistance, health service, and personal care still constitute a special concern in policy making, especially for the very old and frail elderly. In this regard, both the needs and the rights of older people are important, whereas highlighting the latter should further enhance the social protection of the aging population by treating older people not only as recipients of services but also co-owners of the society even when they become dependents due to loss of ability and functionality. On the other hand, active aging stresses individual responsibility in terms of a healthy lifestyle based on scientific research, with the idea of life-long preparation for old age. Active aging combines the essences of healthy and productive aging to also advocate for older people to participate in educational and socioeconomic activities and remain an important resource to their family, community, and economy. By addressing the situations of both developed and developing nations, this comprehensive notion of active aging allows for governments to have arious emphases and also leaves the possibility of ambiguity and confusion. This chapter has endeavored to seek conceptual clarity as well as a comprehensive understanding of practical development by identifying the continuity of related policy and research ideas and highlighting some of the differences. Chinese aging policy was systematically developed under the guidance of the two World Assemblies on Aging, with the benefits of cooperating with the U.N., WHO, and the international community. The lines and steps of its development have corresponded to the changes indicated in the above, with the same kind of continuity in policy and theory as evidenced by an examination of Chinese official documents. Social security and service remain to be a top concern, with the role of the state and that of the family and community being kept in the spotlight. Healthy aging is still a remote goal given the health and mental health problems suffered by a large number of older people on the one hand and their problematic health behavior or lifestyle on the other. There has been an economic reason for such an “epidemic” as smoking (Chen and Chen, 2007), yet lifestyle and policy change may be anticipated as the country’s GPP (general public policy) has headed

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toward another fundamental change (Chen, 2008). Since the initial Chinese economic reform period preceded the active aging framework and caused great pains in vulnerable groups including the elderly, stressing individual responsibility (as the notion active aging would suggest) after China’s GPP stepped into the transition toward a more welfare state-like orientation might appear to be in the wrong timing. This might also help to explain the lack of such a term in Chinese policy documents. Similarly, because of China’s unique unemployment and limited access to higher education problems, optimizing opportunities for the elderly in those aspects has been a thorny subject for Chinese policy makers. Nevertheless, after freeing itself from many old “economic state” functions and burdens, Chinese public policy has emphasized more on healthy and successful aging as well as welfare for the elderly. Chinese policy makers may agree more and more with researchers on the idea of life-long preparation for old age. Gerontologists may do more to educate people about how to achieve better quality of life and health in later life, including the idea of independent living which has seemed to go against Confucian preaching emphasizing on family and dependence on offsprings. While the Chinese society has counted on healthy and able elderly as an important resource to their family and community, how to support their role (including that as caregivers) in terms of optimizing the opportunities (rather than unbearable burdens) is far from resolved. Given the tremendous impact of rapid social changes on cultural traditions, family structure and relations, and economic and political systems, a more effective solution will not only help the nation to tackle the underlying issues but also provide good lessons to other nations in Asia and other parts of the world.

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Mu, Xinyu (2005). Age discrimination and aging social and pubic policy. Chinese Aging Network, http://www.cnelder.com/2005/4-18/49512.shtml. Ney, Steven (2005), Active aging policy in Europe: Between path dependency and path departure. Ageing International, 30(4): 325-342. Pan, Lei (2006). Strategy Study on Active Aging: Take Shandong as an Example. M.A. Dissertation, Shangdong Normal University. Population and Social Integration Section (PSIS) (2008). Expert Group Meeting on setting the agenda of the High-level Regional Review Meeting on the Implementation of the Shanghai Implementation Strategy for the Macao and Madrid Plans of Action on Ageing, Shanghai, China, 30 June - 1 July 2006. UN Economic and Social Commission for Asia and the Pacific, Emerging Social Issues Division (ESID): http://www.unescap.org/ESID/ psis/meetings/AgeingJuly2006/. Population Division, DESA (2002). World Population Ageing 1950-2050, United Nations. Rowe, J.W., Kahn, R.L. (1987). Human aging: Usual and successful. Science, 237(4811): 143–9. Rowe, J.W., Kahn, R.L. (1997). Successful aging. Gerontologist, 37(4): 433–40. State Council of the People’s Republic of China (2006). The Development of China's Undertakings for the Aged. Government White Paper, Dec. 1. Tao, Liqun (2001). The challenge of the 21st century – gray China: Past and future of Chinese gerontological research. Keynote speech at the Tsinghua University Gerontology Seminar, April 27-28. UNESCO (2008). Overcoming the barriers and seizing the opportunities for active ageing policies in Europe. International Social Science Journal, 58(190):617631. Wang, Dewen, and Zhang, Kaiti (2005). The Chinese elderly: How do they live and how many of them are in poverty? Chinese Journal of Population Science, No.1. WHO (2002). Active Ageing: A Policy Framework. A contribution to the Second World Assembly on Ageing, Madrid, April. WHO (2008). WHO Statistica Information System, http://www.who.int/whosis/ data/. Woo, Jean (n.d.), Diet, nutrition, lifestyle and health in older Chinese adults. United Nations System Standing Committee on Nutrition. http://www. unsystem.org/SCN/archives/scnnews19/ch17.htm#TopOfPage. Wu, Bangguo (2008). NPC Standing Committee report to 11th National People’s Congress. http://news.xinhuanet.com/english/2008-03/21/content_783270 6.htm, March 8.

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Xinhua (2005). China won't change retirement age. People's Daily Online, December 16. http://english.peopledaily.com.cn/200512/16/eng20051216 _228469.html. Xu, Qing; Xiao, Huan-yu; and Chen, Yu-zhong (2006), Sports for the Aged and Active Aging: The Case Study in Shanghai. Journal of Xi'an Institute of Physical Education, No.3.

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Chapter 5

AGING IN NEPAL: EMERGING ISSUES AND CHALLENGES Sara Parker

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Liverpool John Moores University and Bijan Pant Liverpool University

ABSTRACT This chapter will first provide a brief outline to Nepal before moving on to examine the issues surrounding a changing population structure and its impact on the elderly in Nepal. Specific attention will be given to the gendered dimension of the changes taking place in Nepal and consideration given to recent policies and interventions taking place in Nepal. Nepal has been engaged in an ongoing conflict between the Maoists revolutionaries, the monarchy and parliamentarian political parties for over a decade. This conflict has led to an ineffective democracy and has resulted in a high level of political instability and change. As well as having impacts on peoples’ livelihood and on areas such as education and health provision (Singh 2004, Singh et al 2005, Watchlist 2008, Whiting 2006) it has also impinged on the political process. Following the ‘People’s Movement’ in 2007 the monarchy in Nepal came to an end and in 2008 Nepal was declared a republic. The constitution of Nepal is currently being rewritten by the transitional government. In such a context issues of aging have not been considered to be of high priority. This chapter will seek to address some of the key concerns surrounding aging in Nepal and will explore some of the recent policy

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Sara Parker changes which are being proposed, highlighting the important role for NGOs to work with and collaborate with the newly formed government. Further it highlights the need for more research on this area so that government and other relevant agencies can take action to prevent the problems becoming any worse.

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INTRODUCTION NEPAL IN THE CONTEXT OF SOUTH ASIA Nepal is a landlocked country with three clear geographical regions, Himalayan mountains in the north, hills and mountains in the middle and plain land in the south (see Map 1). Administratively it is divided into 5 regions, 14 zones and 75 districts with 3913 Village Development Committees in the country (Thapa 2003). The population is estimated at 23 million (HDR 2008) and growing at around 2.4% per year. Images of Nepal are largely based on the romantic notion of a Shangri-la ‘Heaven on Earth’ due to the vast socio-cultural and geographical diversity that is found within a relatively small region. Yet the reality is that Nepal is an extremely poor country that despite four decades of development and remains one of the poorest in South Asia with two out of three Nepalese people are living in poverty (DfID 2003). Today per capita income is $260 per head leaves Nepal ranked as being the poorest country in South Asia (World Bank 2006) and 145 on the Human Development Index ranking (HDR 2008). In 1996, before the insurgency began, Nepal ranked 124 out of the 137 countries on the United Nations Development Programmes Human Development Index (HDI). Although Nepal has since then moved from the rank of “low” to “medium” development countries (its HDI score in 2006 was 0.53 HDR (2008) inequality and poverty remain challenges for Nepal. Inequalities appear to have increased over the past two decades despite GDP growth rates of on average 5% per year (DfID 2003). There is a particular stark contrast between urban and rural areas with poverty rates ten times higher in rural areas than in the Kathmandu Valley and Human Development Indicators (HDI) being 30-40% lower in rural areas (DfID 2003, HDR 2004). With over 85% of the population living in rural areas the slight improvements noted above make little impact on the majority if the population who remain isolated. Clear urban rural disparities exist in Nepal in relation to health care with Singh et al (2006) highlighting the under-5 mortality rate in urban areas is 93.6 per 1,000 compared to 147 per 1,000 in rural areas. There are 59 indigenous ethnic groups (37% population) in Nepal identified on the basis of

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linguistic and socio-cultural distinctiveness from the dominant Hindu caste population. Those without land in rural areas, such as the Dalits1 (estimated at 15% of the population DfID 2003) are at particularly social and economically disadvantaged (Pearson 1999). Although legal restrictions based on a caste system have been abolished many discriminatory attitudes and practices persist to the detriment of Dalits, indigenous ethnic groups and women (Bishwarkarma 2003, DfID 2003). Gender inequalities are also apparent and shall be explored further in the following sections. Singh (2004) provides insight into the long term impact of political conflict on population health in Nepal noting the urban bias for hospital and health care provision which already existed had been negatively effected by conflict in rural areas leaving it even harder to provide adequate health provision in rural areas. It is widely acknowledged that women and children are the most vulnerable to the effects of conflict. Whilst reports are available examining the impact of the conflict on children and gender (Standing and Parker 2007, Singh et al 2006, Watchlist 2005) little has been written on the impact of this on the elderly who are often left to pick up the pieces of a post conflict society.

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AGING POPULATION IN NEPAL It has long been recognised that populations in South Asia, although less aged than other populations of Asia and the West, are aging rapidly (see Martin 1990) and there is a lack of research into the issues surrounding an increasingly aging population in the region. Singh (2003) notes that in 2002 SAARC [South Asian Association for Regional Cooperation] countries had less than 6% of their population in the over 65% bracket and as a result more focus has been on improving the longevity of the population in SAARC countries. The issue of aging in the SAARC region has been neglected in population research as well as in Nepal (Archarya 2001, Singh 2003). As Cook and Dummer (2009, this volume) note “for some countries in Asia an aging population is still an exception rather than a normal component of population composition”. This is especially true for the SAARC nations with all but one having 8% or less of its population in the over 60’s cohort (see table 1 above).

1

The Dalit are also referred to by the collective term ‘traditional occupational caste’ or the so-called ‘untouchable’ class or by their individual family name.

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Source: from table 1 in Cook and Dummer 2009, this volume.

However, all SAARC nations except Afghanistan are expected to have over 14% of their population in the over 60 category by 2050. The population pyramid of Nepal (figure 1 below) shows the male to female ration of the population and highlights the higher numbers of elderly men in Nepal compared to females over the age of 60. The population project diagram (figure 2) also shows how the number of elderly in Nepal will increase in the coming decades (Earth trends 2003). The increase in the elderly as a percent of the population will bring challenges to a developing economy such as Nepal as resources are required to meet their health and social needs. Whilst definite national demographic data is unavailable a study by Shrestha and Weber (2004) highlights that the longevity of people with intellectual disability (ID) has increased in Nepal during recent decades due to improvements in nutrition, sanitary conditions and health services. This in turn has implications for the services needed in order to support these people in their old age and given the issues highlighted above add further pressures on service provision for the elderly at a time when family structures are changing and other forms of support have not yet been established. As noted above there is a lack of research in this area though the work of MICDA (2008) due to its work over the past ten years in Chitwan is a notable exception. The rise in the elderly population and the specific health associated with this cohort of the population suggest this areas warrants further study.

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Figure 1. Population Pyramid of Nepal 2001 [these need to be in BandW, and check format for figures and tables].

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Table 2. Comparative data on HDI. Life expectancy, literacy and probability of survival for SAARC countries

Afghanistan Maldives Sri Lanka Bhutan India Pakistan Nepal Bangladesh

HDI Rank

HDI value 2006

Life expectancy at Birth (years) 2006

na 99 104 131 132 139 145 147

na 0.749 0.742 0.613 0.609 0.562 0.530 0.524

42.9 67.6 71.9 65.2 64.1 64.9 63 63.5

Adult literac y rate (% ages 15 and above 2006 28.0 97.0 90.8 54.3 65.2 54.2 55.2 52.5

GDP per capita (PPP US$) 2006

Probability of not surviving past age 40

Probability of surviving past age 65 female % cohort

na 5,008 3,896 4,010 2,489 2,361 999 1,155

na 12.2 7.2 16.8 16.8 15.4 17.4 16.4

Na 67.7 81.3 67.6 66.1 66.6 61.3 63.2

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Source: Data HDR (2008a).

Whilst slow growth rates have an advantage for developing countries a lack of income and low levels of HDI pose serious problems to these nations meeting the needs of an aging population. The above table highlights that life expectancy in Nepal in the lowest in the SAARC nations at 63 years old. Yet as noted above the percentage of elderly people is due to increase in the coming decades. Help Aged International (2007) in a recent report highlight that in 2006 1.6 million of Nepal's citizens were aged over 60 and that this figure is expected to increase to around 7.2 million by 2050. Further with a largely rural population, many older people in Nepal have to deal with poverty and often have problems accessing vital services and resources. Nepali society is strongly dominated by patriarchal perspectives where women’s health and aging issue remain virtually absent from mainstream development agendas. Moreover, there are a lack of policies that have been developed to address women aging issues, programmes such as health and education are the key sectors that can bring change on this matter. Whilst it is difficult to separate the impact of conflict on the population in Nepal from the impact of poverty over the past decade it is acknowledged that peoples’ access to basic services such as education and health care has been limited, especially in rural areas, by the conflict. According to IRIN (2005) health facilities in rural Nepal contracted during the

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nine-year conflict. Only a handful of organisations have managed to collect data on the subject. According to the local human rights organisation, INSEC, at least 40 rural health posts were destroyed between January 2002 and December 2004. Health workers said that their posts were usually attacked when they refused to give medical aid to the rebels (IRIN 2005). People reported feeling caught between the Government controlled army and the rebels leaving many areas with basic services only. In addition to this in many remote areas NGOs also pulled out during the height of the conflict. The challenge that now faces the newly constituted Government in Nepal is to meet the needs of the population, both urban and rural and meet the expectations of the population who are waiting for changes that will improve their daily situation.

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HEALTH, AGING AND GENDER IN NEPAL Nepal is one of the few countries where women have a lower life expectancy than men (HDR 2004, UNDP 2008). This in the main is due to their low social economic status within society. More recently the Human Development Report notes that women have only just begun to outlive men with a female life expectancy ratio of 101.4% compared to males (HDR 2008a). Further it is widely acknowledged that women and children living in remote areas are considered to be the most marginalized and excluded. It is interesting to note that in the Nepali language there is only one word “linga” used for both sex and gender, to distinguish between them, “praakritik linga” means natural/biological sex, and “sammaajik linga” means socially construed gender. Sex refers to biology whereas gender refers to the social and economic roles and responsibilities that society and families assign to women and men. Both sex and gender influence health risks, health-seeking behavior, and health. When it comes to research and knowledge development, older women face double jeopardy — exclusion related to both sexism and agism. It is widely acknowledged that current information concerning ways in which gender and sex differences between women and men influence health in older age is inadequate (Eckerman and Brauner-Otto 2008, NEPAN 2007, WHO, 2007:2). In Nepal, there is still a tendency for clinical studies to focus on men and exclude women. Moreover, Nepalese women and girls at large suffer from poor health compared with their male counterparts, due to lack of adequate health services, general poverty, and, in some cases, the socio-cultural preference for male children (ADB, 1999:11). The main causes for the deplorable condition of women’s health are traditional customs. In most families women eat only after

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everyone else has eaten. Respect for male members of the household can best be seen in the kitchen. Only in a few families do all the members of the family eat together and usually the women eat alone, and last of all Apart from the issues in women’s health, ADB’s report notes:    

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

Shorter life expectancy for women than for men High infant and child mortality rates and neglect of girls’ health High maternal mortality rate High male/female sex ratio, reflecting the physically more difficult life of women Lack of access to adequate health services, especially for reproductive health care and for contraceptive devices (p.11).

Singh et al (2006) report maternal mortality rate (MMR) is one of the highest in the world at 539 per 100,000 live births with over 90% of birth deliveries being at home in rural areas. It is estimated to be more than 60 percent amongst pregnant women. Risk related to pregnancy and child delivery is the biggest killer for women. Such high MMR rate is one of the factors resulting in women having lower life expectancy than men. Chances of dying in childbirth have increased as a result of conflict in the past decade but should now be improving given recent political changes. Given the above, it is not surprising therefore that health provision in Nepal has focused on meeting women’s reproductive needs as well as addressing issues such as high infant mortality. As women’s health situation improves and more people live longer new challenges will be posed to government and the service sector. There is a large discrepancy between urban and rural women in terms of their access to health services. Though there has been little research in the gendered nature of health needs of the elderly in Nepal the same lack of doctor, nurses and health provision will impact on the elderly and it is expected the same gendered exclusions will apply in old age. A recent study by Eckerman and Brauner-Otto (2008) on the elderly in Chitwan Nepal highlights that importance of access to health services and the market in order for children to be able to provide for their parents in their old age. More studies of this nature are needed to fully understand the gendered dimensions of providing for the elderly in Nepal. A range of factors contribute to women’s bad health in Nepal including discrimination at all stages of their lives (see box 1). There is a high level of gender inequality in Nepal from birth to death (NEPAN 2008) and highlights the need for gender mainstreaming of all policies within Nepal.

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Box 1.

According to the WHO (2007:5) findings the following are the major issues that increase women’s vulnerability to poor health in old age:     

 

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

Discrimination against the girl child leading to inequitable access to food and care between female and male infants and children; Restrictions on education at all levels; Childbirth without adequate health care and support; Low incomes and inequitable access to decent work due to genderdiscrimination in the labour force; Care-giving responsibilities associated with motherhood, grandmothering and looking after one’s spouse and older parents that prohibit or restrict working for an income and access to an employeebased pension; Domestic violence, which may begin in childhood, continue in marriage and is a common form of elder abuse; Widowhood, which commonly leads to a loss of income and may lead to social isolation; Cultural traditions and attitudes that limit access to health care in older age — for example, older women are much less likely than older men to receive cataract surgery in many countries.

A major factor contributing to women’s poor health in Nepal is the patriarchal nature of Nepalese families. Practices relating to marriage and family life are clearly gender defined in Nepal and the roles of men and women within families are stereotyped. Women have a lower status in economic, social and family hierarchies. Women’s roles have been fixed and limited within a private place not in the public arena. Women are disadvantaged and domesticated according to Nepalese tradition and as a result they are subservient to men in all aspects of life. Another area where women are marginalized is that of education. The literacy rate is estimated at 41.7% with gender and regional disparities being clearly evident (DfID 2003, Thapa 2003). In the older population literacy rates for those aged 65 and over is reported to be as low as 27% for males and only 4.07 for women (Singh 2003, NEPAN 2007). Despite an increase in enrolment rate of females within the formal education system the drop out rate is extremely high (USAID 1998). Female literacy rates (over 15 years) are as low as 22% in rural

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areas of Nepal compared to the male rural literacy rate of 51.9% (NRC-NFE 2003). Low levels of education and literacy need to be taken into consideration when designing policies to meet the needs of the elderly and appropriate means of communicating with the elderly. Depending on written media is not enough; other more visual and oral forms of communication need to be incorporated into dissemination strategies. Nepal has a long history of NGO activity with agencies focusing on issues of gender, health and education. The past two decades has seen an increase in NGO activity, with over 30,000 NGOs being registered in Nepal working for social development and there is evidence to suggest some of these are starting to emerge to meet the needs of the elderly (NEPAN 2007). One area that also warrants more research surrounds that of the well being of the elderly. Chalise et al’s (2008) detailed study into issue of loneliness of elderly in Nepal found high level of loneliness and low levels of social well being with over 60 years age in the Kathmandu valley. Further the study found that men were receiving more social support than women creating some concern about the level of social support for women. The authors felt that traditional ideals which dictate that women should be shy, patient, good, sequestered, devoted, faithful, and restrained may explain this difference. If this is the case then research needs to be conducted with elderly females to see how they can be supported in accessing social support and asserting their rights. This chapter now moves on to explore the impact of migration of young people on the elderly and sheds further light on the issues of loneliness and wellbeing of the older generations.

MIGRATION AND AGING IN NEPAL Another key factor impacting on the elderly population in Nepal is an increase in out- migration from rural to urban areas in Nepal as well as an increase in migration overseas. This chapter will first examine the nature and implications of internal migration on the elderly before moving on to explore the impacts of migration overseas. One of the impacts of migration into urban centres is an ever increasing pressure being placed on the services which are availalbe to the elderly in urban centres. In many cases migration into cities such as Kathmandu has seen an increase in the number of people living in slum dwellings. A study presented by KC (2003) notes that a key factor behind internal migration is poverty and this has been exacerbated with the recent conflict in rural areas. The population structure of migrants differs from the non-migrant population as highlighted below (Figure 3).

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Source: KC (2003: 131). Figure 3. Population pyramids for internal migrants compared to non-migrant population, Nepal 2001.

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Whilst the 20-34 year old cohort dominates the population there is a notable number of elderly (65+) included in the population. Chalise and Brightman (2006) support this research and note a dominance of elderly women in urban areas and a male dominance in rural areas. Further they highlight that elderly men are more likely to be married compared to females due to the fact that men are more likely to have younger spouses coupled with a higher level of acceptance of remarriage amonst male widowers compared to females. Both studies call for more rearch to be carried out in this area (KC 2003, Chalise and Brightman 2006). Migration to urban areas has seen the Kathmandu valley, including Lalitpur and Bhaktapur, more than doubling in population between 1994 and 2004 with the area now having more than 1.5 million residents (IRIN 2007). A recent report by Water Aid Nepal highlighted the health and hygiene issues related to growing squatter settlements in Kathmandu that are placing an extra burden on already overpolluted rivers and water system. KC (2003) also reports a lack of health facilities and services in urban areas being exacerbated by internal migration. IRIN (2007) report of one 76 year old resident in a squatter area in Kathmandu having lost both his son and daughter in law to communicable diseases, as they were unable to afford medical care. The death of his son and daughter-in-law leave him in a vulnerable position in his old age and reflects the reality facing many of the elderly population in Nepal. Once families have uprooted and migrated to urban areas it is often difficult to return to their home villages. The impact of overseas migration on the elderly in Nepal have been little documented. Official data states that over 3% of the population have migrated overseas in search of employment in recent years (KC 2003). Remittances sent back to Nepal from overseas make important contributions to the Nepalese economy and a recent study by Seddon et al (2006) suggests that remittances could be ten to twenty times greater than the official data suggests. Often those migrating are young,and personal research by both of the authors in a variety of locations in Nepal from mountainous villages to terai region suggests that many rural villages are suffering not from being overpopulated but from a lack of young people who are able to tend the land and support the younger and older members of the population. This problem has been worsened with the recent conflict leading to young and old leaving villages in search of more security in urban areas. The lack of youth in the villages has resulted in many villages being left with distorted population structures whereby the very young and elderly have been left to fend for themselves. Whilst remittances flow back into these communities the lack of young people to help in the busy agricultural season, a lack of young people to conduct and learn about important cultural ceremonies as

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well as a lack of young people to help care for the elderly has resulted in further out-migration from rural to urban areas of the elderly. Many homes remain empty and land is left unfarmed. In rural communities in Nepal the elderly play an important role in providing childcare and also contributing to the daily activities of the household, such as cooking, cleaning and production of handicrafts. Once in urban areas these skills are often underutilized leaving the elderly feeling less useful and adding to feelings of loneliness and sadness. The emotional aspects of an aging population and impacts of being unable to remain in the family home is an area that warrants further study in Nepal. One study by Gautam (2008) highlights the impact on the elderly in terms of feeling of anxiety, helplessness and loneliness. In addition to this elderly people face the extra burden and stress of social and cultural burdens including household ones. Due to the isolation they feel they often reluctantly also migrate away from the birth home to more urban areas despite the fact they would rather live with their families in their original homes. Gautam (2008) feels the problem of migration is perhaps one of the most serious challenges facing an aging population in Nepal. Earlier studies also note the impact of migration and the breakdown of traditional family structures that often underpin the provision of care to the elderly in Nepal. Goldstein and Beal (1986) also note the gendered dimension of migration means that it is often women who are left in rural villages to both tend to the land, children and dependents. A lack of social security and health insurance and the preference to live in a nuclear family are gradually forcing Nepali elders to take refuge in the government-run shelters (Thinley 2002).

FUTURE POLICIES – WORK OF NEPAN IN NEPAL Given the fact that an aging population is a reletivaly recent concern in Nepal it is vital that lessons are shared at a regional an itnernational level so that policies can be developed to best meet the needs and challenges presented by a rising number of older people in a nation with such a low GDP. International assemblies such as the "Second World Assembly on Ageing" held in Spain in April 2002 helped to put the spotlight onto the issues of an aging population.

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In Nepal this event led to the Government assigning a task force, led by the Non Governmental Organisation, NEPAN2, to draft a country paper. This paper highlighted the plight of the elderly in Nepal and is being used to help the Government formulate policies to support the elderly. In an article by Thinley (2002) a spokesperson from NEPAN has gone on record stating, "Elderly people are still considered a burden in our society, they are deprived of dignity and their contribution to the society is highly neglected". Further he said, "The old people today do not have income, health insurance or any organisational support". The Government of Nepal needs to address the challenges posed by an aging population and plan ahead to ensure needs are met and policies are in place to support the older population. Further, the international community, which provides 60% of Nepal's development budget, has a larger role to play in protecting the rights of the most vulnerable, including the elderly, in Nepal. Age Demands Action (ADA), initiated by HelpAge International and supported by DFID (DFID 2007, HelpAge International 2008) has created an opportunity for issues relating to older people being placed on the political agenda and creates a forum for older people to demand their rights. ADA acknowledges the vital role NGOs will play in ensuring Governments take a bottom-up approach to identifying the needs of older people and developing policies to meet them. NEPAN has taken advocacy steps, both before and after the adoption of the Madrid International Plan on Action on Ageing in 2002. They translated the MIPAA into the Nepalese language as well as organized workshops and lobbied throughout Nepal to educate older people. Since writing the country strategy paper in 2002 NEPAN have continued to work with the elderly and feel that the environment for older persons in Nepal is changing positively and the government is moving forward to embrace MIPAA (NEPAN 2008). They have continued to work with elderly people via workshops, training and conducting research. In addition to this credit schemes have started to help directly tackle issues of poverty and access to credit. As well as working on the ground to help resolve some of the issues highlighted in this chapter NEPAN also work closely with the newly formed Government, especially the Ministry of Women, Children and Social Welfare (MWCSW), to draft policies such as the senior citizen act as part of the national three year interim plan (2007 – 2010) (NEPAN 2008). NEPAN is 2

Nepal Participatory Action Network (NEPAN) is a member-based organization, formed in January 1995 by a group of likeminded development practitioners in Nepal. NEPAN envisages a situation in Nepal where the poor and underprivileged people become the main focus for sustained, equitable and humanistic development. It promotes and facilitates participatory development approaches for the empowerment of the people through research, advocacy, lobbying and capacity building activities. We believe in sharing skills and experiences without any boundaries from http://www.nepan.org.np/

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now represented on the UNESCAP National Coordinating Body on Ageing and Non-governmental Organizations for Older Persons in Asia and the Pacific (2002)3 . Meetings were held between the Nepal delegation from ADA and Ministry representatives on and around International Day for Older People (1 October). Further a three-day programme, organised jointly with the MWCSW, National Senior Citizens' Organisations Network and Sankalpa Nepal was held which was considered to be a great success (Age International 2007). Through these activities the voices of the elderly were raised with Government officials and through the media. The Government is currently preparing legislation which will address the basic fundamental right of the elderly including rights to pensions and health care provision. Following the Madrid Plan of Action the Government has formulated a National Plan of Action in its Tenth Plan (2002-2002) for senior citizens (Sharma and Dahal 2007). There is currently a pension system in place which is mainly accessed by former military personnel, police officers or civil servants and only reaches an estimated 7% of the elderly population (NEPAN 2007). What is needed now in Nepal is for the social welfare system to develop to extend this provision to the elderly population. The responsibility for disseminating pensions and implementing acts has been devolved down to the local level through Ministry of Local Development (MLD). It is important that the MWCSW plays an active role in ensuring the needs of the elderly are met through the MLD and that roles and responsibilities for these agonies are made clear. It is important to note that a number of organizations are working to support the elderly in Nepal in addition to Government agencies. According to NEPAN (2007) there are about 50 day care centers, 20 old age homers and more than 100 elderly clubs running by over 50 different organizations. Whilst this work is to be encouraged and provides important services care must me taken to monitor the quality of these services and ensure the NGOs are provided with financial support to provide these services. The MWCSW along with the Social Welfare Council has an important role to play in supporting NGOs in this area. Further as NEPAN (2007) point out international agencies also have a role to play in this field.

3

http://www.unescap.org/esid/psis/ageing/profile/ngo2.html

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CONCLUSION AND DISCUSSION

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This chapter has provided an outline of the key issues surrounding aging in Nepal. It has shown that aging has only recently come onto the political agenda due to a low life expectancy. Further, gendered inequalities which face women in all spheres of life have been seen to continue into their old age. Although Nepal’s population is still relatively young in the coming decades we can expect to see an increase in the elderly within Nepal. It is vital that research in undertaken and experiences shared between Nepal and other countries in similar economic, social and cultural situations. Whilst gender issues have begun to take central stage on the political agenda aging remains marginalised by Governments and the donor community. Unless further research is carried out into this area the issue of an aging population in Nepal risk becoming further neglected. The work on agencies such as NEPAN needs to expand so that appropriate plan, policies and services can be developed in time to meet the needs of the elderly in Nepal. Recently the Nepalese Age Demands Action delegation has begun to lobby Government and relevant agencies demanding that the issues of the elderly are met with specific attention being paid to social pensions, healthcare and age discrimination (Age International 2007). The Nepalese Age Demands Action delegation are recommending that the Government: 

  

commit to fulfilling all the clauses of the Senior Citizens' Act on Ageing and ensure the full participation of older people in its monitoring and implementation commit to funding primary healthcare for older people reduce the social pension age requirement from 75 to 65 years introduce a plan to prevent and punish social discrimination of older people.

The role of networks such as NEPAN in promoting these types of initiatives cannot be underestimated and highlights the important role played by the NGO sector in bringing issues of the previously marginalized and unheard onto centre stage. In a post-conflict society, such as Nepal, it is vital that the newly formed government draws upon the strong connections that have been developed by NGOs with the wider civil society and utilize these networks to work with and for the people of Nepal, including the elderly population. The major issues of poverty, inequality and exclusion which face the majority of the population in Nepal are particularly pertinent to the elderly who are

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amongst the most vulnerable and neglected section of society. Unemployment, migration of the young and a lack of service provision is particularly acute in rural areas. The Government and development agencies need to seize the opportunity of a ‘New Nepal’ and begin to implement effective policies and programmes to ensure that the needs of an expectant population in order to ensure peaceful democracy is maintained and the citizens of Nepal achieve the basic human right to live along an dignified life.

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REFERENCES Acharya, S (2001). Population Ageing: Some Emerging Issues In The SAARC Region With Reference To Nepal Population and Development in Nepal, Vol. VIII, December 2001 available from Central Department of Population Studies Nepal, Tribhuvan University Nepal. ADB, (1999).. Women in Nepal, Country Briefing Paper, Kathmandu, Nepal. Beal, C M and Goldstein, M C (1982).. Work, aging and dependency in a Sherpa Population in Nepal Social Science and Medicine Vol 16 12 p141-147. CBS (2007). Population profile of Nepal Central Bureau of Statistics Nepal http://www.cbs.gov.np/population_profile.php accessed 02/02/2009 Chalise, H N and Brightman, J D (2006). Aging trends: Population ageing in Nepal Geriatrics and Gerontology International Vol 6 199-204. Chalise, H N, Saito, T, Takahashi, M and Kai, I (2008). Relationship specialization amongst sources and receivers of social support and its correlations with loneliness and subjective well-being: A cross sectional study of Nepalese older adults Archives of Gerontology and Geriatrics Volume 44, Issue 3, May-June 2007, Pages 299-314. DfID (2003). Country Strategy Paper accessed 12th October 2003 available online at http://www.dfid.gov.uk/Pubs/files/cap_nepal_draft.pdf. DfID (2007). Older people around the world unite to demand action on ageing 1 Oct 2007 avaialbel at http://www.dfid.gov.uk/news/files/help-age.asp accessed 5/2/2009. Earth trends (2003). Population Health and Human Well-being in Nepal available at http://earthtrends.wri.org/pdf_library/country_profiles/pop_cou_524.pdf accessed jan 27th 2009. Eckerman, J and Brauner-Otto, S (2008). Social and Economic Context, Gender, and care for the Elderly in Nepal paa2008.princeton.edu/ download.aspx?submissionId=81115 accessed 2/02/2009.

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Gautam, T R (2008). Migration and the Problem of Old Age People in Nepal Dhaulagiri Journal of Sociology and Anthropology Vol.2 p 145 146 Available at http://www.n]pjol.info/index.php/DSAJ/article/viewFile/1361/1337 accessed 01/02/2009. Goldstein, M C and Beall, C M (1986). Family change, caste and the elderly in a rural locale in Nepal Journal of Cross-Cultural Gerontology Springer Netherlands Vol 1 N3 p305-316 available at http://www.springerlink.com/ content/w186841146035531 accessed 29/01/2009. HDR (2004). Human Development Report 2004 (UNDP). HDR (2008a). Human Development Reports Statistics available at http://hdr.undp.org/en/statistics / accessed 01/02/2009. HDR (2008b). 2008 Statistical Update Nepal The Human Development Index going beyond income http://hdrstats.undp.org/2008/countries/ country_fact_sheets/cty_fs_NPL.html accessed 01/02/2009. Help Age International (2008). Nepal Country Profile available at http://www.helpage.org accessed 02/02/2009. IRIN (2005). Nepal: Focus on the impact of the conflict on rural health. Integrated Regional Information Networks 28th Feb 2005 Available: http://www.irinnews.org/report.asp?ReportID=45810andSelectRegion=Asiaa ndSelectCountry=NEPAL. Accessed 28/01/2009. IRIN (2007). NEPAL: Impoverished urban squatters face high risk of poor health available at http://www.irinnews.org/Report.aspx?ReportId=72319 Access 1/02/2009. IRIN (2009). NEPAL: Lives at risk as severe power cuts hit hospitals http://www.irinnews.org/Report.aspx?ReportId=82384 accessed 01/02/2009. IRIN (2009). NEPAL: Lives at risk as severe power cuts hit hospitals http://www.irinnews.org/Report.aspx?ReportId=82384 accessed 01/02/2009. KC, B K (2003). Internal migration in Nepal Central Bureau of Statistic Publication Population Monograph Chapter 15 available at http://www.cbs.gov.np/Population/Monograph/Chapter%2015%20%20Intern al%20Migration%20in%20Nepal.pdf accessed 01/02/2009. Martin, L (1990). The status of South Asia’s growing elderly population Journal of Cross-Cultural Gerontology Springer Netherlands Vol 5 N2 p93-117 available at https://commerce.metapress.com/content/t542820x757j617m/ resource-secured/?target= fulltext.pdfandsid=og5nequp2ki40555hc2uasus andsh=www.springerlink.com accessed 29/01/2009. MICDA (2008). Michigan Centre on the Demography of Ageing health and Ageing Research in Nepal available at http://micda.psc.isr.umich.edu/ networks/harn.html accessed 28/01/2009.

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NEPAN (2008). Nepal: NGO Report on MIPAA Progress 2002-2008. Completed Questionnaire by Nepan (February 2008). available at http://www.globalaging.org/agingwatch/events/ngos/nepal.pdf accessed 29/01/2009. Parker, S and Standing, K (2006). ‘The Impact of Conflict on Schooling in Nepal’, Chapter 2 in Leach, F. and Dunne, M. (2006). Education, Conflict and Reconciliation: International Perspectives, Oxford: Peter Lang. Pearson, M. (1999). Nepal A Health Briefing Paper produced by IHSD a Resource Centre for The Department for International Development accessed 31st Oct 2003 available at http://www.healthsystemsrc.org/publications/Country_health/Nepal.pdf. Seddon, D, Adhikari, J and Gurung G (2002). Foreign Labor Migration and the Remittance Economy of Nepal Critical Asian Studies Vol 34 issues 1 p19-40. Sharma, I and Dahal, B (2007). Elderly people in Nepal: What happened after the MIPPA 2002 Country Report. Shrestha, S and Weber, G (2002). The situation of older people with intellectual disability in Nepal: pilots study Journal of Intellectual and Development Disability Vol 27 Issue 4 Dec 2002 p242-254. Singh, M L (2003). Ageing of the population of Nepal Central Bureau of Statistic Publication Population Monograph Chapter 19 available at http://www.cbs.gov.np/Population/Monograph/Chapter%2019%20%20Agein g%20of%20the%20Population%20of%20Nepal.pdf accessed 01/02/2009. Singh S, (2004). Impact of long-term political conflict on population health in Nepal Canadian Medical Association Journal Vol 171 (12). 1499-1501. Singh S, Bøhler E, Dahal K, Mills E (2006). The State of Child Health and Human Rights in Nepal. PLoS Med 3(7).: e203 doi:10.1371/journal.pmed.0030203 accessed 28/01/2009. Singh S, Dahal K, Mills E (2005). Nepal's war on human rights: A summit higher than Everest. International Journal for Equity in Health 2005, 4:9 Available: http://www.equityhealthj.com/content/4/1/9. Accesssed 28/01/2009. Standing, K and Parker, S (2006). ‘School in Nepal: ‘zones of peace’ or sites of gendered conflict?’ Chapter 10 in Leach, F. and Mitchell, C. (2006)., Combating Gender Violence in and Around Schools, Stoke on Trent: Trentham. Thapa, D. (2003). A Kingdom under siege Nepal’s Maoist Insurgency, 1996 to 2003 The Printhouse, Kathmandu. Thinley, T D (2002). Government to take elderly’s plight to the world assembly The Kathmandu Post April 3rd 2002 available at

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http://www.nepalnews.com.np/contents/englishdaily/ktmpost/2002/apr/apr03/ index.htm accessed 2/02/2009. UNFPA Nepal (2008). Gender Overview available at http://www.unfpanepal.org/en/programmes/gender.php accessed 25/01/2009. United Nations Development Programme (2003). Human development indicators 2003: Nepal. In: Human Development Report 2003 New York: Oxford University Press. Available: http://hdr.undp.org/reports/global/ 2003/pdf/hdr03_HDI.pdf..accessed 26/05/2003. UNDP (2008). Gender and Social Development at http://www.undp.org.np/ gender/index.php accessed 2/2/2009. US Census Bureau (2008). Nepal Population Pyramid available at http://www.census.gov/cgi-bin/ipc/idbpyrs.pl?cty=NPandout=sandymax =300andSubmit.x=14andSubmit.y=13 accessed 01/02/2009. USAID (1998). Impact evaluation: Promoting Education for Girls in Nepal USAID CDIE Impact Evaluation Report No 5 YSAID Washington accessed online via. Watchlist (2005). Watchlist Caught in the middle: Mounting violations against children in Nepal's armed conflict. New York: Women's Commission for Refugee Women and Children. Available: http://www.watchlist.org/ reports/nepal.report.php. Accessed 28/01/2009. Whiting A (2006). Crisis profile: What's going on in Nepal? Available:http://www.alertnet.org/thefacts/reliefresources/111997404550.htm Accessed 28/01/2009. WHO,( 2007).. Women, Ageing and Health: A Framework for Action, Focus on Gender, Geneva.available at www.who.int/entity/ageing/publications/ Women-ageing-health-lowres.pdf. WHO/SEARO, 2003 Nepal Country Health Profile, available at http://intranet/cntryhealth/nepal/index.htm accessed 29/01/2009. World Bank (2006). Poverty Reuction Poevrty in Nepal available at http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASI AEXT/EXTSAREGTOPPOVRED/0,,contentMDK:20574069~menuPK:4934 47~pagePK:34004173~piPK:34003707~theSitePK:493441,00.html. World Bank (2000). World Development Report 2000/01: Attacking Poverty. (Washington DC: World Bank).

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Chapter 6

CHANGES IN THE LIVING ARRANGEMENTS OF THE ELDERLY IN KOREA Ik Ki Kim Dongguk University, Korea

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INTRODUCTION Korea has experienced a demographic transition since 1960s due to successful implementation of economic development plan and initiation of family planning program. The crude birth rate sharply declined from 42 per thousand to 32 during the period of 1965-70. The reduction of the crude birth rate by 10 percent for the five year period is a record high (Kim, 1987). Since then, the fertility level has steadily declined without interruption, reaching 9.0 per thousand in 2005. Not only the fertility but the mortality level has consistently declined since the beginning of the 1960s. The mortality decline has taken place earlier than the fertility decline (Lee, 1980). In accordance with the sharp decline of the mortality level, life expectancy at birth has substantially increased over time. Life expectancy at birth for males increased from 51.1 years in 1960 to 69.5 years in 1995, then to 75.1 in 2005, while that for females increased from 53.7 years in 1960 to 77.4 years in 1995, then to 81.9in 2005(NSO, 2005). Increase of the life expectancy at birth in conjunction with the fertility decline has brought about an increase in both the absolute number and proportion of the elderly in Korea (Kim, 2007).

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The elderly population aged 60 and over in Korea increased from 1.5 million in 1960 to 3.3 million in 1990, and are projected to increase to 9.9 million by the year 2020(Kim et al., 1996). In total numbers, the number of those aged 60 and over has doubled within the past three decades and is expected to increase by almost three times that of the 1990 figure and more than six times that of the 1960 figure. The proportion of those aged 60 and over was 3.3 percent in 1960, and then has consistently increased up to 6.1 percent in 1995, then reached to 9.3 percent in 2005 (NSO, 2005). Accordingly, family composition of the elderly in Korea has sharply changed over time (Lim and Lee, 2008). The proportion of one-generation family has increased from 16.9 percent in 1990 to 18.7 percent in 2000, then to 34.6 percent in 2005. The proportion of one-person family has also increased from 8.9 percent in 1990 to 16.2 percent in 2000, then to 32.0 percent in 2005. On the other hand, the proportion of over three-generation family has decreased from 48.0 percent in 1990 to 30.0 percent in 2000, then to 9.0 percent in 2005. During the period of demographic transition, Korea experienced a rapid urbanization process as well. In 1960, only 28 percent of the population lived in cities. By 1975, the proportion has increased to 48 percent. During this period, urban areas absorbed almost 90 percent of Korea's population increase (Kim, 1987). The urbanization process has continued since then. The urbanization rate increased to 78.7 percent in 1995 (EPB, 1995). The Korean population has experienced such a rapid urbanization, but the urbanization rate for the older population has been lower than that for the total population. Different from the total population, the proportion of urban residence for those aged 60 and over was from 19 percent in 1960 but increased to 58.5 percent in 1995, then to 80.8 in 2005(NSO, 2008). Furthermore, the increase in the proportion of older people has been higher in rural areas than in urban areas. In 1960, the proportion of those aged 60 and over was 4.1 percent of urban population and 6.8 percent of rural population. These numbers grew to 6.9 percent in urban areas and 17.9 percent in rural areas in 1995 (EPB, 1998). The greater increase in rural areas is mainly due to the massive outmigration from rural to urban areas and the out-migration has been mainly among young people (Moon, 1978; Kim, 1987). Modernization theorists have argued that the status and well-being of the elderly are closely related to their living arrangements (Cowgill, 1986; Cowgill and Homes, 1972). Living arrangement is a very important mechanism to the elderly because it is closely related to the support for them. Co-residence with family members seems to be the best way of supporting the elderly because most types of support (financial support, emotional support, assistance in activities,

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etc.) are possible with co-residence. Co-residence is viewed as a form of insurance against future need for the elderly (Martin, 1989). Of course, living alone does not necessarily mean a lack of support from family members. However, the elderly living alone or with their spouse only normally have a limited access to these types of support. Modernization theory hypothesizes that urban residence is negatively associated with living with children (Martin, 1989). In Korea, however, rural residence is expected to negatively related to living with children because of the massive out-migration of young population. Massive out-migration of young people from rural areas due to industrialization and urbanization has brought about different patterns of living arrangements between urban and rural settings. In this context, the main purpose of this paper is to describe the changing patterns of the Korean elderly, then to analyze the urban-rural differentials of the living arrangements of the elderly. For the description of the changes in the living arrangements of the elderly, this paper uses the census data. For the analysis of the urban-rural differentials of the living arrangements, this paper employs a nationally representative survey on living arrangements and socioeconomic characteristics of the Korean elderly, which was conducted by Kim et al.(1997). The total sample size for the survey is 1,199. In this study, some demographic variables (age, sex, marital status) and socioeconomic variables (educational attainment, home ownership, health status, income, employment status) are expected to affect their living arrangements of the elderly. The effects of these variables on the living arrangements are expected to be different in urban and rural areas. Chapter II of this paper describes the changing patterns of the living arrangements of the elderly in Korea. Then, Chapter III highlights the urban-rural differentials of the living arrangements of the elderly using cross-tabulations and logit regression analysis. Finally, Chapter IV provides summary and conclusion of this paper.

CHANGES IN THE LIVING ARRANGEMENTS OF THE ELDERLY IN KOREA Table 1 shows the trends of living arrangements of the elderly by sex, marital status and place of residence from 1980 to 2000. Two major features of the changes during this period are the increased proportion of those living alone or living with spouse only and the decreased proportion of those living with children. The proportion of the elderly living alone was only 4.8 percent in 1980, but

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increased to 9.5 in 1990, then to 16.8 percent in 2000. The proportion of the elderly living with spouse only was 10.1 percent in 1980, but increased to 17.5 in 1990, then to 29.2 in 2000. On the other hand, the proportion of the elderly living with any child decreased from 80.5 percent in 1980 to 68.2 percent in 1990, then to 49.1 percent in 2000. Both the proportion of the elderly living with married child and that with unmarried child have decreased. The proportion of the elderly living with married child decreased from 61.7 percent in 1980 to 51.5 percent in 1990, then to 35.7 percent in 2000. The proportion of the elderly living with unmarried child decreased from 18.8 percent in 1980 to 16.7 percent in 1990, then to13.4 percent in 2000.

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Table 1. Living arrangements of the elderly by sex, marital status and place of residence, 1980-2000 (Unit: %) Total 1980 % living apart from child1 19.5 % in one-person household 4.8 % in couple-only household 10.1 % living with married child2 61.7 % living with unmarried 18.8 child3 Total 100.0 1985 % living apart from child1 25.2 % in one-person household 6.7 % in couple-only household 13.2 % living with married child2 57.4 % living with unmarried 17.3 child3 Total 100.0 1990 % living apart from child1 31.8 % in one-person household 9.5 % in couple-only household 17.5 % living with married child2 51.5 % living with unmarried 16.7 child3 Total 100.0

Male Female Unmarried Married Urban Rural 22.8 1.5 18.0 48.2

17.6 6.8 5.4 69.6

13.1 8.1 74.3

27.3 0.9 22.0 46.3

15.2 3.3 6.5 63.5

22.2 5.8 12.3 60.5

29.0 12.8

12.6

26.3

21.3

17.3

100.0 100.0

100.0

100.0

100.0 100.0

29.7 2.3 23.2 44.6

22.5 9.4 7.2 65.2

17.6 11.8 70.3

33.5 1.3 27.2 43.6

19.5 5.2 8.7 60.5

29.9 8.0 16.9 54.9

25.7 12.3

12.1

23.0

20.0

15.2

100.0 100.0

100.0

100.0

100.0 100.0

38.4 3.5 30.9 38.5

27.9 13.1 9.6 59.2

22.5 17.3 65.0

41.9 1.1 36.5 36.8

24.2 7.0 12.3 56.7

40.5 12.4 23.6 45.6

23.1 12.9

12.5

21.3

19.1

13.9

100.0 100.0

100.0

100.0

100.0 100.0

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Table 1. (Continued) Total

Male Female Unmarried Married Urban Rural

1995 % living apart from child1 43.1 % in one-person household 13.8 % in couple-only household 24.0 % living with married child2 43.6 % living with unmarried 13.3 child3 Total 100.0

50.6 4.9 41.4 30.4

38.6 19.1 13.8 51.4

31.6 25.4 58.9

55.6 1.2 50.0 27.0

33.6 10.2 17.7 50.4

55.5 18.6 32.3 34.7

19.0 10.0

9.5

17.5

15.9

9.9

100.0 100.0

100.0

100.0

100.0 100.0

58.1 5.9 47.5 24.3

46.6 23.5 18.0 42.7

39.0 33.7 50.6

61.9 1.4 55.8 22.0

42.5 13.8 23.5 41.0

62.6 21.0 37.1 28.3

17.6 10.8

10.4

16.1

16.5

9.1

100.0 100.0

100.0

100.0

100.0 100.0

2000

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% living apart from child1 50.9 % in one-person household 16.8 % in couple-only household 29.2 % living with married child2 35.7 % living with unmarried 13.4 child3 Total 100.0

Notes: 1) The elderly person lives alone, lives with a spouse only, lives with relatives, or non-relatives. All but a small proportion of the elderly have children in Korea. 2) The elderly person lives with at least one married child with or without an unmarried child. 3) The elderly person lives with at least one unmarried child without a married child. Source: KNSO (Raw data from a two percent sample from censuses of each year); Kim, C.S. 2003. “Household and family.” In The Population of Korea. P. 228.

The living arrangements of the elderly show different pattern between the male elderly and the female elderly, between the married elderly and unmarried elderly and between the urban elderly and the rural elderly. The proportion of the elderly living alone is much higher for the female elderly than for the male elderly. On the other hand, the proportion of the elderly living with spouse only is much higher for the male elderly than for the female elderly. The proportion of the elderly living alone was 6.8 percent for the female elderly and 1.5 percent for the male elderly in 1980. This proportion increased to 23.5 percent for the female elderly and 5.9 percent for the male elderly in 2000. The proportion of the elderly living with spouse only was 18.0 percent for the male elderly and 5.4 percent for the female elderly in 1980. This proportion increased to 47.5 percent for the male elderly and 18.0 percent for the female elderly in 2000.

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The proportion of the elderly living with any child is higher for the female elderly than for the male elderly. However, it is interesting that the proportion of the elderly living with married child is higher for the female elderly but the proportion of the elderly living with unmarried child is higher for the male elderly than for the female elderly. In 2000, the proportion of the elderly living with married child is 42.7 percent for the female elderly and 24.3 percent for the male elderly but the proportion of the elderly living with unmarried child is 17.6 percent for the male elderly and 10.8 percent for the female elderly. Table 1 also indicates that the marital status shows different patterns of the living arrangements of the elderly in Korea. The proportion of the elderly living apart from children is higher for the married than for the unmarried. On the other hand, the proportion of the elderly living with married children is much higher for the unmarried elderly than for the married elderly but the proportion of the elderly living with unmarried children is a little higher for the married elderly than for the unmarried elderly. In 2000, the proportion of the elderly living apart from children is 61.9 percent for the married elderly and 39.0 percent for the unmarried elderly. The proportion of the elderly living with married children is 50.6 for the unmarried elderly and 22.0 percent for the married elderly. The proportion of the elderly living with unmarried children is 16.1 percent for the married elderly and 10.4 percent for the unmarried elderly. Table 1 also shows the urban-rural differentials in the living arrangements of the elderly in Korea. The proportion of the elderly living apart from children is higher for the rural elderly than for the urban elderly. More specifically, both the proportion of the elderly living alone and that of the elderly living with spouse only are higher for the rural elderly than for the urban elderly. On the other hand, both the proportion of the elderly living with married children and that of the elderly living with unmarried children are higher for the urban elderly than for the rural elderly. In 1980, the proportion of the elderly living alone was 5.8 percent for the rural elderly and 3.3 percent for the urban elderly. The proportion of the elderly living with spouse only was 12.3 percent for the rural elderly and 6.5 percent for the urban elderly. The proportion of the elderly living with any child was 84.8 percent for the urban elderly and 77.8 percent for the rural elderly. In 2000, the proportion of the elderly living alone is 21.0 percent for the rural elderly and 13.8 percent for the urban elderly. The proportion of the elderly living with spouse only is 37.1 percent for the rural elderly and 23.5 percent for the urban elderly. The proportion of the elderly living with any child is 57.5 percent for the urban elderly and 37.4 percent for the rural elderly. Table 1 indicates that

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the urban-rural differentials in the living arrangement of the elderly deepen, that is, the gap of the differences in the living arrangements of the elderly is widening over time. The big discrepancy of the living arrangements of the elderly between urban and rural areas is mainly due to the massive out-migration of young people from rural areas during the process of rapid economic development.

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URBAN-RURAL DIFFERENTIALS IN THE LIVING ARRANGEMENTS OF THE ELDERLY This chapter analyzes the different patterns of the living arrangements of the elderly in Korea using a surveyed data in 1997. The 1997 survey indicates that among the 1,199 respondents, 35.6 percent are the elderly aged between 60 and 64 years (Kim et al., 1999). The proportion of the elderly aged between 65 and 69 years is 25.6 percent. The proportion of the elderly aged between 70 and 74 years and that of the elderly aged 75 years and over are 18.0 percent and 20.8 percent, respectively. The age distribution of the elderly in urban areas seems to be similar to that in rural areas. The rapid process of modernization and urbanization in Korea has brought about big changes in the patterns of living arrangements of the elderly. Modernization and urbanization have also brought about urban-rural differentials in the living arrangements of the elderly. This chapter shows urbanrural differentials in the living arrangements of the elderly by some related factors(Kim, Ik Ki. 2004). Table 2 indicates the living arrangements of the elderly by region as of 1997. On the whole, the proportion of the elderly living alone is 12.1 percent, which is increased by 5.4 percent during the past 9 years. The proportion of the elderly living with spouse only is 38.4 percent. The proportion of the elderly living with unmarried children is 14.9 percent and that of the elderly living with married children is 34.6 percent. Table 2. Living arrangements of the elderly by region, 1997 Unit: Numbers(%) Living arrangements Living alone Living with spouse only Living with unmarried child Living with married child Total

Whole 137(12.1) 433(38.4) 168(14.9) 391(24.6) 1130(100.0)

2 = 75.50 P = 0.000.

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Urban areas 55( 9.1) 175(29.2) 108(18.0) 262(43.7) 599(100.0)

Rural areas 82(15.5) 258(48.7) 61(11.4) 130(24.4) 531(100.0)

118

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Living arrangements of the elderly show significantly different patterns between urban and rural areas. The proportion of the elderly living alone is 9.1 percent in urban areas, whereas that is 15.5 percent in rural areas. The proportion of the elderly living with spouse only is 29.2 percent in urban areas but 48.7 percent in rural areas. Combining these two categories together, we can see that 38.3 percent of the elderly in urban areas live alone or with spouse only and 64.2 percent of the elderly in rural areas live alone or with spouse only. On the other hand, the proportion of the elderly living with any child is 61.7 percent in urban areas while that is only 35.8 percent in rural areas. Table 3 shows the living arrangements of the elderly by age and region. On the whole, age is closely related to the living arrangements of the elderly. The proportion of the elderly living alone is higher in the group of 70 years and over, whereas the proportion of the elderly living with spouse only is greater in the younger age group below 70 years. The proportion of the elderly living with any child is greatest (64.0%) in the highest age group (75 years and over). In terms of the age, urban-rural differentials are distinctive. Table 3. Living arrangements of the elderly by age and region Unit: %

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Region

Whole

Urban areas

Rural areas

Living arrangements

Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total

Age Below 64 years 8.0 51.8 20.5

65 - 69

70- 74

10.2 39.8 17.3

15.7 33.1 11.7

75 years and over 18.4 17.6 5.0

19.6 404(100)

32.7 288(100)

39.5 205(100)

59.0 232(100)

8.1 41.9 24.2

4.8 30.6 12.8

15.9 21.8 15.3

9.4 11.0 5.3

25.8 223(100)

42.7 134(100)

47.1 117(100)

74.3 123(100)

8.0 64.0 16.0

14.8 47.9 13.4

15.5 48.1 7.0

28.7 25.0 4.6

12.0 180(100)

23.9 142(100)

29.5 129(100)

41.7 216(100)

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2

P

157

0.00

98.0

0.00

75.5

0.00

Changes in the Living Arrangements of the Elderly in Korea

119

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In the age group of below 64 years, the proportion of the elderly living alone or with spouse only is 50.0 percent in urban areas but it is 72.0 percent in rural areas. In urban areas, the proportion of the elderly living with any child in the highest age groups is 79.6 percent. In rural areas, however, the proportion of the elderly living with any child in this age group is only 46.3 percent. Table 4 examines the living arrangements of the elderly by sex and region. Living arrangements of the elderly show significantly different patterns between the male and female elderly. On the whole, the proportion of the elderly living alone is 5.4 percent for the male elderly but 19.0 percent for the female elderly. On the other hand, the proportion of the elderly living with spouse only is 49.9 percent for the male elderly but only 26.8 percent for the female elderly. The proportion of the elderly living with any child is somewhat greater for the female elderly (54.3%) than for male elderly (44.8%). This discrepancy between male and female elderly is related to the longer life expectancy of female elderly. The sex differentials in the living arrangements of the elderly are distinctive in rural areas. In rural areas, the proportion of the elderly living alone is 6.9 percent for the male elderly but 25.4 percent for the female elderly. The difference of 18.5 percent between the male and female elderly is much greater than that in urban areas (9.9%). Table 4. Living arrangements of the elderly by sex and region Unit: Number(%) Region Whole

Urban Areas

Rural Areas

Living arrangements Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total

Sex Male 31( 5.4) 284(49.9) 111(19.5) 144(25.3) 570(100.0) 11( 4.0) 111(39.0) 74(25.9) 89(31.1) 285(100.0) 20( 6.9) 173(60.7) 37(13.0) 55(19.4) 285(100.0)

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Female 106(19.0) 149(26.8) 57(10.3) 245(44.0) 558(100.0) 43(13.9) 64(20.4) 34(10.8) 171(54.8) 311(100.0) 63(25.4) 86(34.8) 24( 9.6) 75(30.3) 246(100.0)

2

P

126.5

0.000

71.7

0.000

55.3

0.000

120

Ik Ki Kim

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Again, in rural areas the proportion of the elderly living with spouse only is 60.7 percent for the male elderly but 34.8 percent for the female elderly. The difference of 25.9 percent is also greater than that in urban areas (18.6%). Table 5 indicates the living arrangements of the elderly by marital status and region. Among the elderly who are currently married, the proportion of living with spouse only (58.1%) is greater than that of living with children (40.3%). Furthermore, among the elderly who are currently married, the proportion of living with spouse only in rural areas(67.7%) is much greater than that in urban areas(48.1%). Among the widowed elderly, the proportion of living alone is 31.7 percent, while that of living with any child is 68.3 percent. The proportion of living alone among the widowed elderly in urban areas is 23.0 percent but that in rural areas is twice of that proportion (45.6%). On the other hand, the proportion of living with children among the widowed elderly in urban areas is 77.1 percent but that in rural areas is only 54.7 percent. Table 6 illustrates the living arrangements of the elderly by education and region. Educational attainment is also shown to be a significant variable affecting the living arrangements of the elderly. The proportion of the elderly living with any child is the highest in the category of being illiterate (60.8%). Table 5. Living arrangements of the elderly by marital status and region Unit: Number(%) Region

Whole

Urban Areas

Rural Areas

Living arrangements

Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total

Marital status Currently married 12( 1.6) 429(58.1) 129(17.5) 168(22.8) 738(100.0) 1( 0.2) 174(48.1) 83(23.0) 104(28.7) 361(100.0) 11( 3.0) 255(67.7) 46(12.2) 64(17.1) 376(100.0)

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2

P

526.9

0.000

253.7

0.000

271.5

0.000

Widowed 120(31.7) 39(10.4) 218(57.9) 377(100.0) 53(23.0) 25(10.6) 154(66.5) 232(100.0) 46(45.6) 15(10.5) 64(44.2) 145(100.0)

Changes in the Living Arrangements of the Elderly in Korea

121

Table 6. Living arrangements of the elderly by education and region Unit: %

Regio n Whole

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Urban areas

Rural areas

Living arrangements Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total

Education Illiterate

Literate 17.1 40.1

Elementary school 9.0 41.9

Middle and High 5.6 46.6

College andabove 13.2 40.8

19.9 19.3 13.5

10.2

16.1

18.7

14.4

47.3

32.7

33.1

29.1

31.6 47(100)

206 (100)

231 (100)

398 (100)

248 (100)

15.8 12.2

15.0 22.0

7.3 31.0

2.3 39.9

13.9 37.9

12.2

16.0

18.0

23.6

15.7

59.8

47.0

43.6

34.2

32.5

97 (100)

100 (100)

208 (100)

154 (100)

40 (100)

23.6 25.8

18.8 53.6

10.8 53.8

10.8 57.7

14.2 57.1

14.5

6.0

13.9

10.8

14.2

36.1

21.7

21.5

20.7

28.5

109 (100)

131 (100)

190 (100)

94 (100)

7 (100)

2

P

71.7

0.00

51.9

0.00

37.9

0.00

The proportions in other categories are in the range of 42.9 percent to 49.2 percent. This proportion also varies from region to region. The proportion of living with any child among the elderly who are illiterate is 72.1 percent in urban areas but 50.6 percent in rural areas. The proportion of living with any child

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among the elderly who have the educational attainment of middle and high schools is 57.8 percent in urban areas but only 31.4 percent in rural areas. Table 7 describes the living arrangements of the elderly by employment status and region. Employment status proved to be another important variable influencing the living arrangements of the elderly. According to Table 7, the patterns of living arrangements of the elderly are significantly different between those who are employed and those who are not employed. The proportion of the elderly living alone doesn't make big difference between these two groups. However, the proportion of living with spouse only and that of living with children are significantly different. The proportion of the elderly living with spouse only is 53.9 percent among those who are employed but it is only 28.3 percent among those who are not employed. On the other hand, the proportion of the elderly living with children is 37.5 percent among those who are employed but it is 57.5 percent among those who are not employed. The magnitude of this difference is more distinctive in rural areas. For example, in the case of living with spouse only, the difference of the proportion between the employed elderly and the unemployed elderly is 13.3 percent in urban areas but 27.4 percent in rural areas. Table 7. Living arrangements of the elderly by employment status and region Unit: Number(%) Region

Living arrangements

Whole

Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total

Urban Areas

Rural Areas

Employment status Employed Unemployed 39( 8.6) 94(14.1) 246(53.9) 188(28.3) 88(19.2) 81(12.1) 83(18.3) 301(45.4) 456(100.0) 663(100.0) 9( 6.2) 42( 9.5) 58(39.7) 117(26.4) 40(27.1) 68(15.4) 39(27.0) 215(48.7) 146(100.0) 442(100.0) 30( 9.8) 52(23.4) 188(60.5) 71(32.1) 48(15.5) 13( 5.7) 44(14.2) 86(38.8) 310(100.0) 221(100.0)

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2

P

119.5

0.000

28.2

0.000

80.1

0.000

Changes in the Living Arrangements of the Elderly in Korea

123

Table 8 examines the living arrangements of the elderly by home ownership and region. Home ownership is also believed to be an important factor affecting the living arrangements in Korea. As expected, home ownership proved to be a critical variable influencing the living arrangements of the elderly. Among the elderly who own a house, the proportion of living alone or with spouse only is 63.1 percent, while this proportion is only 15.6 percent among the elderly whose children own a house. On the other hand, the proportion of the elderly living with married children among the elderly whose children own a house (78.9%) is extremely higher than the proportion in the category of the elderly who own a house (18.3%). The great differences of the proportions between those who own a house and those whose children own a house seem to appear both in urban and rural areas. In urban areas, the proportion of living with married children among the elderly whose children own a house is 83.4 percent and the proportion among the elderly who own a house is 24.1 percent. In rural areas, the proportion among the elderly whose children own a house is 70.7 percent and that among the elderly who own a house is 13.6 percent.

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Table 8. Living arrangements of the elderly by home ownership and region Unit: Number(%) Region

Living arrangements

Whole

Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total

Urban Areas

Rural Areas

Home ownership Elderly Child, living (spouse) together or not 72(10.1) 20( 7.5) 375(53.0) 22( 8.1) 131(18.6) 15( 5.4) 130(18.3) 212(78.9) 708(100.0) 269(100.0) 24( 7.6) 5( 3.0) 137(43.5) 13( 7.2) 78(24.8) 11( 6.4) 76(24.1) 145(83.4) 314(100.0) 174(100.0) 48(12.2) 15(15.8) 238(60.6) 9( 9.8) 54(13.6) 3( 3.6) 54(13.6) 67(70.7) 394(100.0) 95(100.0)

2

P

324.9

0.000

160.2

0.000

146.2

0.000

Health status is also believed to be an important factor influencing the living arrangements of the elderly. However, health status turned out to be not as

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important as other variables. According to Table 9, the differences of the proportions in all three categories of health status seem to be trivial in spite of the statistical significance. One notable thing is that the proportion of living alone is higher among the elderly who have bad health than among the other elderly both in urban and rural areas. So far, this paper individually dealt with the effects of some important variables affecting the living arrangements of the elderly. Now, it may be worthwhile to combine all these variables together in examining the determinants of the living arrangements of the elderly. Table 10 illustrates the results of the logit regression of living with children. On the whole, marital status, home ownership, income, and pocket money are shown to be significant variables influencing the risks of living with children at the level of p=0.05. However, the logit results show different patterns between rural and urban areas. In the model of urban areas, marital status, income and pocket money turned out to be significant. Table 9. Living arrangements of the elderly by health status and region Unit: %

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Region

Whole

Urban Areas

Rural Areas

Living arrangements

Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total Living alone Living with spouse only Living with unmarried child Living with married child Total

Health status Good Neither good nor bad 9.2 8.2 44.0 16.1 32.1 14.1 30.7 554(100) 45.6 156(100) 6.0 5.4 37.6 15.6 17.3 21.7

2

P

33.8

0.00

15.2 22.5 17.5

34.7

0.00

14.5

0.000

Bad

17.5 33.3 13.6 35.6 415(100)

39.1 303(100) 13.1 51.7 14.6

57.2 86(100) 11.5 52.1 4.8

44.8) 206(100) 19.7 44.0 9.8

20.6 251(100)

31.6 70(100)

26.5 209(100)

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Table 10. Logit results of the risks of living with children

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Independent variable Age Sex(Male) Marital status(currently married) Education(Middle school and above) Home-ownership (elderly own) Health(good) Income Pocket money Employment status(employed) Constant

Whole B 0.028 0.449 -0.830

P 0.098 0.097 0.001

Urban areas B P 0.023 0.367 0.783 0.066 -1.275 0.001

Rural areas B P 0.038 0.100 0.371 0.318 -0.662 0.037

-0.363

0.159

-0.407

0.293

-0.357

0.338

-0.699

0.004

-0.557

0.121

-0.945

0.006

0.021 0.024 -0.045 -0.198

0.918 0.000 0.000 0.375

-0.463 0.026 -0.065 0.083

0.152 0.000 0.000 0.829

0.366 0.020 -0.019 -0.103

0.172 0.000 0.151 0.738

-2.845 0.030 2=345.9 P= 0.000

-0.781 0.578 2 = 193.3 P = 0.000

-3.867 0.034 2 = 115.6 P = 0.000

In the model of rural areas, marital status, home ownership and income were found to be significant. The variables which commonly affect the risks of living with children in both models are only two (marital status and income). Pocket money is significantly influencing the risks of living with children in urban areas but not in rural areas. On the other hand, home ownership influences significantly the risks of living with children in rural areas but not in urban areas.

CONCLUSION This study shows that patterns of the living arrangements of the elderly are quite different in urban and rural areas. The most salient finding is that more than half of the rural elderly live alone or with spouse only. Only 35.8 percent of the rural elderly live with children. Age differentials in the living arrangements of the elderly are more distinctive in rural areas than in urban areas. Sex differentials in the living arrangements are also more distinctive in rural areas, especially among the elderly who live alone or with spouse only. Marital status is another important variable which differentiates the living arrangements in urban and rural areas. Educational attainment also differentiates the living arrangements in urban and rural areas. It is especially notable that in urban areas the proportion of the elderly

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living alone or with spouse only is extraordinary higher among the more educated elderly. Likewise, home ownership, employment status and income status are also important variables influencing the determinants of the urban-rural differential in the living arrangements as expected. Contrary to the expectation, however, health status turned out to be not so significant as other variables in determining the urban-rural differentials in the living arrangements of the elderly. Logit results of the risks of living with children indicate that the determinants of living with children are different in urban and rural areas. In the model of urban areas, marital status, income, and pocket money were shown to be significant variables which affected the risks of living with children. On the other hand, in rural areas home ownership, marital status and income proved to be significant variables which influenced the risks of living with children. In this study, the modernization theory which argues that urban residence is negatively associated with living with children was not supported in Korea. Rather, rural residence proved to be negatively associated with living with children. The massive out-migration of young population from rural areas is the main reason for the negative relationship of rural residence to living with children. Living arrangements are significant in terms of providing support (financial, emotional, and physical) for the elderly and enabling them to participate fully in the daily activities (Eu, 1991; Kim, 1999; Kim and Choe, 1992). With respect to providing support, living with married children is especially important for the elderly. As indicated, however, the proportion of the elderly living without children has continuously increased due to rapid socioeconomic transformation in recent decades, especially in rural areas. While the idea of filial piety remains strong in contemporary Korea, the way in which it is exercised differs from how it was exercised in traditional society (Kim, 1999). The traditional idea of filial piety in Korea was to care for old parents by way of living together with parents and support them emotionally and physically. Today, however, many parents do not expect their children to support them. According to a Korean fertility survey in 1974, many adults did not expect to receive support from their children when they become old (Kwon, 1977). This is a critical sign that the tradition of strong family support in Korea has been changing and that the strong tradition of support for elderly family members could continuously weaken in the future. In Korea, the family ties have traditionally been much stronger in rural than urban areas. In this context, the elderly in rural areas are facing a crisis. The trend of rural-to-urban migration of young population has continued until recently mainly due to the relatively worsening socioeconomic conditions in rural areas. In addition to the rapid process of population aging, this tendency of

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continuous out-migration of young people would make the situation of the elderly in rural areas more serious. As a consequence of changes and rapid process of population aging, special measures for the welfare of the elderly would be necessary (Choe, 1992; Rhee et al., 1991; Rhee et al., 1993; Kim, 1999; Lim and Lee, 2008). To the extent that the role of the family is declining, there should be an increasing role for the government to take care of the elderly in both urban and rural areas. Nonetheless, the role of the government would be more urgent in rural areas.

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REFERENCES Choe, Sung Jae. 1992. "Ageing and Social Welfare in South Korea" in Phillips. D. R.(ed.), Ageing in East and South-East Asia. London: Edward Arnold. Chung, K.H. 2000. “The relationship between living arrangements of the elderly and intergenerational support.” Presented at the Annual Conference of Korean Sociological Association. Cowgill, D.O. 1986. Aging Around the World. Belmont. Calif.: Wadsworth. Cowgill, D.O. and L.D. Holmes(eds.). 1972. Aging and Modernization. New York: Appleton-Century-Crofts. Economic Planning Bureau(EPB). 1998. Population and Housing Census 1995. Eu, Hongsook. 1991. The Determinants of Living Arrangements among the Korean Elderly. Ph.D. Dissertation. Brown University. Kim, C.S. 2003. “Household and family” in (Kim and Kwon eds.) Population of Korea. KNSO(Korean National Statistical Office) Kim, Ik Ki. 1987. Socioeconomic Development and Fertility in Korea. Population and Development Studies Center. Seoul National University. Kim, Ik Ki. 1999. “Population Aging in Korea: Social Problems and Solutions.” Journal of Sociology and Social Welfare. Vo. 26.No.1. Kim, Ik Ki. 2004. “Different patterns of the living arrangements of the elderly in urban and rural Korea.” Paper Presented at the World Congress of Sociology in Beijing. Kim, Ik Ki. 2007. “Demographic changes in Korea during the period of 19602000.” In (Phillips ed.) Generational Change and Social Policy Challenges Australia and South Korea. Kim, Ik Ki and E.H. Choe. 1992. "Support Exchange Patterns of the Elderly in Korea." Asia-Pacific Population Journal 7(3). Kim, Ik Ki et al. 1996. "Population Aging in Korea: Changes since the 1960s." Journal of Cross-Cultural Gerontology.

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Kim, Ik Ki et al. 1997. Survey on Family Structure and Life Quality of the Korean Elderly. Kim, Ik Ki et al. 1999. Life of the Korean Elderly: Diagnosis and Prospects of. Center for the Human Resources. Kwon, T.H. 1977. Demography of Korea: Population Change and Its Components 1925-66. Seoul: Seoul National University Press. Lee, Hae Young. 1980. "Demographic Transition in Korea." Bulletin of the Population and Development Studies Center 8. Lim, S. H. and Y.S. Lee. 2008. “A study on the improving living condition of the Korean elderly as a way of social integration”. Presented at the Spring Conference of Korean Gerontological Society. Seoul. Martin, Linda. 1989. "Living Arrangements of the Elderly in Fiji, Korea, Malaysia, and the Philippines." Demography. Vol. 26. No. 4. Moon, Seung Gyu. 1978. "Urban-Rural Disparity in Socioeconomic and Demographic Changes in Korea, 1960-1970." Bulletin of the Population and Development Studies Center. Seoul National University. National Statistics Office(NSO). 1995. Korea Statistical Yearbook. 998. Statistic Illustrated by Graphs. 1997. Korea Statistical Yearbook. 2005. Population and Housing Census. Rhee, Ka Oak et al. 1991. A Study on the Establishment of Home Help System in Korea. Seoul: Korean Institute for Health and Social Affairs. Rhee, Ka Oak et al. 1993. Development of Welfare Policies for the Elderly. Seoul: Korean Institute for Health and Social Affairs.

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PART TWO. RETHINKING AGING IN ASIA

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In: Aging in Asia Editor: J. L. Powell and I. G. Cook

ISBN 978-1-60741-649-4 © 2009 Nova Science Publishers, Inc.

Chapter 7

AGING, GROWTH AND FINANCIAL MARKETS – ECONOMIC IMPLICATIONS AND CHALLENGES CONFRONTING EAST ASIA Takashi Kihara

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Kyushu University, Japan

INTRODUCTION: POPULATION AGING IN EAST ASIA It is not yet common knowledge that East Asia1 is in the midst of population aging. In fact, the rates of population aging in many East Asian countries are far higher than that of Japan which is famous for its rapid aging in comparison to Europe. The number of doubling years (the number of years from the year when the elderly people (age 65 or older) ratio in all population reaches 7%, to the year when it exceeds 14%) is commonly used to measure how rapid aging is. According to the United Nations (2007), the speed of aging in Singapore, Korea, and Vietnam to become Aged Societies is expected to be much faster than that of Japan (Table 1).

1

Hereinafter, given no reference to the contrary, “East Asia” means the ASEAN 10 countries (i.e., Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam) plus 3 Northeast Asian countries (i.e., China, Japan and Republic of Korea (South Korea)).

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Table 1. “Doubling Years” (Number of years necessary for the elderly ratio to reach 14% after reaching 7%) Countries/ Economies

Elderly Ratio> 70

Elderly Ratio>1 40

Doubling Years

Countries/ Economies

Elderly Ratio> 70

Elderly Ratio> 140

Doubling Years

Brunei

2024 7.28％

2048 14.26％

24

Lao PRD

2037 7.03%

(After 2050)

－

Cambodia

2040 7.07％

(After 2050)

－

Malaysia

2020 7.11％

2043 23 14.02％

China

2001 7％

2026 14.08％

25

Myanmar

2018 7.07%

2038 14.16%

20

Hong Kong

1983 7.05％

2014 14.01％

31

Philippines

2028 7.06%

(After 2050)

－

Indonesia

2018 7.08％

2039 14.27％

21

Singapore

2000 7.15%

2016 14.24%

16

Japan

1970 7.07％

1994 14.01％

24

Thailand

2002 7.14%

2024 14.42%

22

Korea

2000 7.36％

2017 14.14％

17

Vietnam

2020 7.03%

2038 14.24%

18

Source: United Nations (2007) and the author’s estimates. Note: The upper figure in each cell under “Elderly Ratio >7%” or “Elderly Ratio >14％” is the year in which the elderly ratio reaches 7% or 14% respectively. The lower figure in the cell is the elderly ratio in the year mentioned.

The United Nations (2007) predict that every country and economy of East Asia will experience an increase in its elderly ratio (Figure 1), whereas it will experience a decrease in the ratio of the working population (ages 15–64) by 2050 (Figure 2). Demographic phases among East Asian countries remain divergent. The prospects of aging of these countries are, however, commonly rapid, as noted. Furthermore, many nations of this region will be aged with underdevelopment. These remarkable features of East Asian population aging might have considerably strong impacts on economic vitality and capital formation of this region, and on the world through international trade and investment.

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Source: United Nations (2007).

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Figure 1. Elderly (Age 65 or over) Ratio Medium Projection Variants.

Source: United Nations (2007). Figure 2. Working Age Population (age 15-64) Ratios (Medium Projection Variants).

DRAMATIC CHANGES IN LIFE EXPECTANCY AND TOTAL FERTILITY RATE, AND A SLOWER MOVE TO DEVELOPMENT Population aging in East Asia has two outstanding features compared with that occurring in Europe, North America or other regions: its rapidity and economic development situation of East Asian countries.

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The total fertility rate (TFR; the number of children a woman has in her life on average) and life expectancy at birth (LE; the number of years during which a baby born survive on average) have been changing rapidly in East Asia; those are the main causes of rapid population aging in this region. The transitions of the total fertility rate and life expectancy from 1950–55 to 2000–05 and from 2000– 05 to 2045–50 are depicted in Figures 3 and 4. According to the United Nations (2007), the TFR of the world declined from 5.02 in 1950–55 to 2.65 during the 2000–05 period. During that period, Asia experienced a substantial decline in TFR from 5.87 to 2.47. Furthermore, the world LE increased from 46.38 years to 66.04 years. In Asia, it has increased more: from 41.2 years to 67.54 years. Among Asian regions, Eastern Asia and South Eastern Asia have undergone considerable changes2. In stark contrast, there has been little progress in TFR and LE of Africa during the last 50 years. Sub-Saharan Africa has registered a small decline in TFR from 6.73 to 5.48 and a small increase in LE from 37.58 to 48.77 years. Even 50 years from now, the TFR and LE in Sub-Saharan Africa is not expected to reach the levels experienced in Eastern Asia during 2000–05.

Source: United Nations (2007). Figure 3. Total Fertility Rates (TFR) and Life Expectancy at birth (LE) (lower right: 1950550 middle;2000. 05. upper left:2045. 50.

2

Eastern Asia under United Nations term includes China, North Korea, Japan, Mongolia, and South Korea; “South Eastern Asia” includes ASEAN 10 countries and East Timor. In Eastern Asia, TFR has declined from 5.67 to 1.66; LE has increased from 42.94 to 73.18. In South Eastern Asia, TFR has declined from 5.96 to 2.51; LE has increased from 40.87 to 68.48.

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Source: United Nations (2007).

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Figure 4. Total Fertility Rates(TFR) and Life Expectancy at birth (LE) Lower right:1950. 55. Middle;2000. 05 Upper left;2045. 50.

A second remarkable characteristic of East Asian population aging is that many of these countries are still in the process of economic development. Figure 5 shows the relation between per-capita GDP (Gross Domestic Products) and the elderly ratios. In addition to developed Japan, Singapore, and South Korea, developing China and Thailand have already become Aging Societies, in which the elderly ratios are greater than 7% (7.73% in China; 7.24% in Thailand in 2006). Notwithstanding, their per-capita GDPs remain at low levels (measured in PPP dollars of 2000, the respective per-capita GDPs of China and Thailand in 2006 were $6,621 and $8,065). When GDP per capita is measured on the horizontal axis and the elderly ratios on the vertical axis as portrayed in Figure 5, all countries’ data exhibit an upward trend to the right: the rise in income level is associated with aging. Even though the elderly ratio of Indonesia (5.51%) has not reached the 7% threshold, its upward trend is so steep that aging with a low average income is expected. This chapter specifically addresses the economic implications and challenges of aging, with particular examination of East Asia, where the progress of aging is most remarkable among regions in Asia. In the following sections, negative influences of aging on economic growth (Section 2) and on saving and prices of financial assets (Section 3) are investigated statistically with reference to relevant economic theories. Policy efforts to mitigate the negative effects of aging in macroeconomic, fiscal, and financial spheres are then discussed (Section 4). Finally, Section 5 touches upon possible areas of regional efforts to tackle issues related to aging, with concluding remarks.

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Source: World Bank (2008). Note: GDP per capita is measured in terms of Purchasing Power Parity (PPP) US dollars of 2000. Figure 5. Eldery Ratios and Per Capita GDP in East Asia 1975-2006).

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IMPACTS OF AGING ON ECONOMIC GROWTH – NEOCLASSICAL GROWTH MODEL AND EMPIRICAL STUDIES Aging of the population, along with its accompanying reduction in labour force, is expected to impart substantial impacts on saving, investment, current account balances, and economic growth. Among those, the first to be discussed is the impact of aging on the GDP per-capita growth rate. Bloom and Canning (2004) estimated the GDP per-capita growth rate using panel data of the world during 1960–1995 with the modified neo-classical growth model, which assumes conditional convergence: the lower the income level of the country is, the more rapid the growth it achieves to converge toward the steadystate income level, if other conditions are equal. Bloom and Canning (2004) derive the following equation to estimate the income-per-capita growth rate (gy) given an initial working age population (w0), its growth rate (gw), an initial level of income per capita (y0), and other controlled variables X (e.g., life expectancy, inflation, geography). gy=λ(Xβ+ p + w0 - y0) + gw In that equation, λ is the rate of convergence and β is the coefficient vector of variables X. Aging in Asia, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Table 2. Growth Regression with Demography (Asia and Sub-Saharan Africa) Dependent variable: Growth rate of real GDP per capita

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Explanatory Variables/ Estimated Methods Constant Log (Initial working-age population ratio) Growth of working-age population ratio Log (Initial GDP per capita) Log(Initial life expectancy) Log (1+CPI Inflation) East Asia

(i) OLS

(ii) 2SLS

(iii) OLS

(iv) 2SLS

(v) 2SLS

(vi) 2SLS

(vii) 2SLS

(viii) 2SLS

-0.018 (-0.49) 0.081*** (5.43) 0.818*** (3.77) -0.010*** (-7.25) 0.039*** (4.84) -0.031*** (-6.23) 0.019*** (6.37)

-0.0002 (-0.005) 0.090*** (5.38) 1.589*** (4.21) -0.011*** (-7.05) 0.037*** (4.26) -0.030*** (-6.21) 0.017*** (4.87)

-0.026 (-0.65) 0.076*** (4.85) 0.745*** (3.32) -0.011*** （-7.16） 0.043*** (4.50) -0.030*** (-6.18) 0.021*** (6.92) -0.005** (-2.25)

-0.019 (-0.41) 0.079*** (4.51) 1.496*** (3.49) -0.011*** （-6.32） 0.042*** (4.14) -0.029*** (-6.13) 0.018*** (5.24) -0.006** (-2.16)

0.057 (1.32) 0.086*** (5.69) 1.724*** (3.15) -0.012*** (-5.60) 0.023** (2.19) -0.031*** (-7.15)

0.059 (1.38) 0.078*** (4.81) 1.624*** (2.83) -0.012*** (-5.91) 0.022** (2.16) -0.030*** (-7.23) 0.006 (1.20) -0.011*** (-2.82) 0.029*** (11.03)

0.035 (0.52) 0.104*** (4.92) 0.793 (0.93) -0.011*** (-4.33) 0.032** (2.03) -0.0312*** (-6.98) 0.008 (0.99) -0.007* (-1.74)

0.052 (1.16) 0.073*** (4.18) 1.323* (1.92) -0.012*** (-5.30) 0.023** (2.15) -0.031*** (-7.12) 0.003 (0.46) -0.011*** (-2.88) 0.029*** (10.99) 0.619 (0.70) 0.803 149/45

Tropics Openness Sachs–Warner Openness × growth of working-age ratio Adj. R2 No. of Observations/ Countries

0.466 380/60

0.469 348/60

0.479 380/60

0.487 348/60

-0.011*** (-2.71) 0.031*** (12.26)

0.808 149/45

0.813 149/45

2.879*** (2.62) 0.933 149/45

Source: The author’s estimates. Note: Figures in parentheses are t values.***, ** and * respectively signify a 1%, 5% and 10% significance level.

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Bloom and Canning (2004) find significant positive relations between the income per-capita growth rate on the one hand, and the initial working-age population ratio as well as the growth of working-age population ratio on the other. In this chapter, the growth rates of real GDP per capita are estimated using panel regression, referring to Bloom and Canning (2004), but extending the estimation period and particularly addressing developing countries. The panel data of 82 developing countries in the regions of “East Asia and the Pacific”, “South Asia”, and “Sub-Saharan Africa” (under the classification of World Bank) during 1973–2004 with a four-year interval for one observation are used for estimation6. The estimated results are presented in Table 2. Similar to the results of Bloom and Canning (2004) with worldwide samples, the larger working age population has a positive and significant effect on GDP per-capita growth. Developing countries can benefit from a Demographic Dividend, which is a high growth rate enjoyed by a country with large and increasing working age population. (1) The coefficients of (the logarithm of) the initial working age population ratio are commonly positive and significant at the 1% level7. The coefficients of growth of working age population ratio are generally positive and significant at the 1% level. The estimators are close to one (0.8–1.7), which is consistent with the estimated equation described above (i.e. a 1% increase in the Growth of Working age ratio engenders 1% rise in the Growth rate of per-capita real GDP). Both relations are robust, irrespective of the model specifications, which suggests that an increase in the working-age population ratio will raise the growth rate of GDP per capita. (2) The estimators of the coefficients on other variables also have robust signs and values, as predicted. The coefficients of (logarithm of) Initial GDP per capita are negative and significant at the 1% level, showing that conditional convergence exists. The coefficients of (logarithm of) Initial life expectancy are mostly positive and significant at the 1% level, which indicates that increased human capital has a

6

Data for “Growth rate of real GDP per capita” , “Working Age (15–64 years old) population ratio”, “Life Expectancy” and “CPI inflation rate” were obtained from World Development Indicators (WDI) 2006 (World Bank 2006). A dummy variable to indicate “East Asia” is set to one for countries belonging to “East Asia and the Pacific” but not the Pacific islands. Data for “Initial GDP per capita” are the GDP per capita in 1996 PPP dollar, listed in cgdp series of Penn World Table ver.6. Data for the “Tropics” were obtained from Easterly (2001); data for “Openness” were retrieved from Sachs and Warner (1995). Panel data are regressed by the General Least Squares Method (GLS) weighted by cross section variance, and, to accommodate the possible endogenous problem, Two Stage Least Square Method (2SLS) instrumented by demographic variables with one period lag. 7Increase in working age population ratio from 50% (0.5) to 60% (0.6) is expected to raise the percapita growth rate by about 1.8% ((log(0.6)-log(0.5))0.1=0.0182).

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robust and positive impact on economic growth8. The coefficients of Inflation rate (logarithm of 1+CPI (Consumer Price Index) inflation), which indicate deterioration of the policy environment, are estimated to be negative and significant at 1% in all specifications9. The regression results on geographical dummies of East Asia and Tropics show that a country located in East Asia has a growth rate that is 1–2% (0.01– 0.02) higher than average, whereas a country located in tropical areas has a 0.5–1% (-0.005 to -0.01) lower growth rate than average10. (3) In the estimated models from (v) to (viii), the indicator of Openness (Sachs and Warner 1995) 11 and its interactive term with the growth rate of working age population ratio are introduced. The results of these estimations show that a country with an open economy enhances the growth impact of an increased working age ratio by twice or three times more (2–3% instead of 1%)12. As indicated by the panel regression results presented above, the positive and significant impacts of working age population ratio are robust, irrespective of estimated countries, number, periods of observations, or other explanatory variables. Figure 6 depicts the relation between the growth rate of working age population and the GDP per-capita growth rate of each observation of samples used for estimation. It clearly illustrates a positive relation between both variables. As Figure 7 portrays, the growth rates of working age populations will slump in coming decades for most East Asian countries.

8

An increase in Life Expectancy from 60 years to 70 years is expected to raise the growth rate by 0.5% ((log(70)–log(60))0.03=0.0046). 9 An increase in the Inflation rate from 0% to 10% is expected to reduce the growth rate by 0.3% ((log(1.1)-log(1))(-0.03)=–0.0029). 10 The absolute values of the coefficients of the “Tropics” are smaller than those described by Bloom and Canning (2004), although the signs of the both coefficients and the value of the coefficients of “East Asia” are consistent with results of other precedent studies, e.g. Clemens et al. (2004). 11 A country is classified as “open” if none of following indicators matches: (i) its black market exchange rate premium exceeds 20%; (ii) quota on imports of intermediates and capital goods exceeds 40%; (iii) it has a socialistic economic system, or (iv) it had a state monopoly of crop exports (Sachs and Warner 1995). 12 The coefficients of “Openness” suggest that an open economy could raise the growth rate by 3% (0.03) by itself. Instead of “Openness “ , when the variable of “Openness” times growth of working age population ratio” are introduced, the coefficients of this interactive term have the positive and significant value from 2 to 3, as is indicated by Bloom and Canning (2004). Nevertheless, when both variables––“Openness” and “Openness times growth of working age population ratio”––are introduced in the estimation, the latter variable is not significant. It means that good policies such as Openness, are not indispensable to bear the fruit of Demographic Dividend, but to raise the demographic impact on economic growth.

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Source: The author’s estimates from all samples of growth regression shown in Table 2.

(Fig. 7) Growth rate of working age population ratio in East Asia 2 1.5 China 1

Indonesia Japan

0.5

Malaysia

0 -0.5 -1

Philippines

1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-2000 2000-05 2005-10 2010-15 2015-20 2020-25 2025-30 2030-35 2035-40 2040-45 2045-50

Growth rate of working age population ratio(%)

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Figure 6. Growth rate of working age population ratio (horizontal axis) and GDP percapita growth rate (vertical axis) (all samples for regression).

Korea Singapore Thailand Vietnam

-1.5 -2 year

Source: United Nations (2007) and the author’s estimates. Figure 7. Growth rate of working age population ratio in East Asia.

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IMPACT OF AGING ON SAVING AND FINANCIAL MARKETS

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Aging and Saving Numerous theoretical analyses and empirical studies have examined the sizable impacts of population aging on demand for different classes of financial assets, both through its effect on saving and through varying demands for assets according to the risk preferences of different age groups. For instance, the IMF (2004) describe that “the empirical literature often finds a robust link between the proportion of high net savers in the population and asset prices, suggesting that the aging of baby boomers could cause real stock prices to fall.”13 In the case of the United States, as the baby boomers, who were born during 1946–1964, have moved to their prime saving years i.e. ages 40–64, stock prices have risen in real terms. Therefore, “the demographic forces will conspire against the stock market after 2010, when the oldest of the baby boomers begin to turn 65.”14, suggesting the possibility of the Asset Market Meltdown that will pertain after retirement of baby boomers. This section first addresses the theoretical and empirical studies which indicate that an increase in the share of aged population (age 65 or older), or that a decrease in the share of the high-saving generation (ages 40–64) in its population will reduce the national saving rate.

(1) Life Cycle/ Permanent Income Hypothesis and Empirical Studies “Population aging will lead to declines in household, private, government, and national saving rates”15 . This message is consistent with the Life Cycle and Permanent Income Hypothesis (LC/PI) related to consumption. The lifetime personal income, on average, increases during working age, and decreases thereafter. Lifetime consumption, on the other hand, tends to be stable, irrespective of age, and depends on the permanent income during the person’s lifetime. The hypothesis predicts that negative saving (dissaving) occurs during youth and elderly periods. One recent paper in the relevant literature describing this relation is that of Bosworth and Chodorow-Reich (2007). According to their regression results, demographic variables have become salient forces affecting the national saving rate (Gross National Saving (GNS) /Gross National Income (GNI)). Increases in 13

IMF (2004) p.150 IMF (2004) p.150 15 Horioka, 2007 Abstract. 14

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the elderly ratio and youth dependency ratio both reduce the rate of saving. “The significance of the demographic effects varies across regions, however.”16 The coefficients of demographic variables are large and highly significant for Asian economies, compared to those of industrialized countries, Latin America, and other developing nations. Bosworth and Chodorow-Reich (2007) reported results of the regressions of age-saving profile using a third-order polynomial. The estimated results show that the highest saving rates are associated with a population aged 40–50 (Figure 8). Kihara (2007a, b) estimated the saving rate (Gross Domestic Saving (GDS) /GDP) using panel data of 64 developing countries in Asia and Sub-Saharan Africa, covering 1973–2004, with similar explanatory variables and the methodology to those of Bosworth and Chodorow-Reich (2007). All variables are 4-year averages or initial values of the relevant 4-year periods17. Table 3 presents similar empirical results to those of Bosworth and Chodorow-Reich (2007), irrespective of its different sample countries and sample periods18.

16

Bosworth and Chodorow-Reich (2007) p.11 In addition to the differences in sample coverage, the following modifications of the estimation methods from Bosworth and Chodorow-Reich (2007) are made: (i) Instead of the “youth dependency ratio” and “elderly ratio”, Kihara (2007a,b) explicitly used a “high saving generation ratio” which is the ratio of the population aged 40–64 during the “prime saving period” over working age population (aged 15–64), and the “elderly ratio” as demographic explanatory variables. It is expected that an increase in “high saving generation ratio” would raise the saving rate, whereas an increase in the “elderly ratio” would reduce the saving rate. (ii) Bosworth and Chodorow-Reich (2007) incorporated variations by country or time into estimation models with country fixed effects or time fixed effects. Kihara (2007a,b) incorporated the country or time variations using Generalized Least Squares model using country weights or time weights. (iii) Bosworth and Chodorow-Reich (2007) incorporated “diminishing marginal effects” of income per capita on saving in the estimated model by including linear and quadratic terms of income per capita as explanatory variables. Positive coefficients of linear term and negative coefficients of quadratic term are expected. Kihara (2007a,b), on the other hand, considered the diminishing marginal effect of income on saving using the natural logarithm of income per capita as an explanatory variable. 18The coefficients of GDP per-capita growth rate and of its lagged variable are both positive and remain constant at around 0.2–0.7. These coefficients estimated in Bosworth and ChodorowReich (2007) are 0.3–1.0.The effect of GDP per capita on the saving rate is positive but decreasing in its impact as GDP per capita increases (i.e. the variable is logarithms of the values more than 1). The countries located in East Asia had significantly higher saving rates during the estimated period. The coefficient of logarithm of Life Expectancy is positive in the estimation of specification II, where the coefficient is significant. This result might reflect the fact that the longer he survives after his retirement, the more he needs to save for his remaining life. 17

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Source: Bosworth and Chodorow-Reich (2007).p.30 Figure 5. Note: Age Distribution Coefficients are computed based on regression of saving (investment) as a share of GNI on real GDP growth, lagged GDP growth, and a thirdorder polynomial approximation of the age distribution.

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Figure 8. Saving and Investment Profiles by age in Asia.

Table 3. Demographic Impacts on Saving of Asia and Sub-Saharan Africa Dependent variables: GDS /GDP (t-values in parentheses) Explanatory Variables Constant High Saving Gen. (ages 40– 64/15– 64) Elderly Ratio (age 65 over/15– 64) Percapita GDP Growth

GLS (Country Weights)

GLS (Time Weights)

I -0.560*** (-20.30) 0.500*** (4.02)

II -0.938*** (-12.64) 0.405*** (3.35)

III -0.563*** (-6.35) 0.426*** (4.06)

IV -0.682*** (-9.41) 0.775*** (2.97)

V -0.739*** (-3.93) 0.773*** (2.95)

VI -0.202 (-1.04) 0.379 (1.49)

-2.097*** (-7.46)

-2.137*** (7.72)

-2.600*** (-12.28)

-2.813*** (-4.72)

-2.848*** (-4.69)

-2.698*** (-4.71)

0.654*** (7.10)

0.564*** (6.37)

0.466*** (5.11)

0.568*** (2.78)

0.556*** (2.68)

0.350* (1.76)

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Table 3. (Continued) Explanatory Variables Lagged percapita GDP Growth Log(GD P per capita) Log(Life Expectan cy) East Asia

GLS (Country Weights)

Adjusted R2 Countries /Observat ions

GLS (Time Weights)

I

II

III

IV

V

VI

0.448*** (4.55)

0.405*** (4.25)

0.235*** (2.67)

0.244 (1.11)

0.231 (1.03)

0.012 (0.05)

0.096*** (22.93)

0.084*** (17.15)

0.076*** (15.84)

0.103*** (10.98)

0.101*** (8.77)

0.094*** (8.65)

0.116*** (4.85)

0.036 (1.37)

0.019 (0.33)

-0.083 (-1.45)

0.790

0.810

0.124*** (13.04) 0.882

0.345

0.343

0.160*** (6.75) 0.415

64/382

64/382

64/382

64/382

64/382

64/382

Source: Kihara (2007a) p.21, (2007b) p.112. Note: All equations (I –VI) are estimated by Generalized Least Squares method (GLS) with cross-section or period heteroskedasticity weights. Figures in parentheses are t values.***, ** and * respectively signify a 1%, 5% and 10% significance level.

Regarding the demographic variables, most coefficients are significant and robust. The coefficients of the high saving generation ratio are positive, with values of 0.4–0.8, and are significant at the 1% level, meaning that a 1% increase in the high saving generation ratio would raise the gross domestic saving rate by 0.4–0.8 percentage points. The coefficients of the elderly ratio, on the other hand, are significant and negative, with values of -2.0 – -2.8, and the variation of the estimators is small and robust. The negative impact of aging on saving is so great that a 1% hike in the elderly ratio per working age population would reduce the saving rate by more than 2%. As described above, population aging has a substantial and negative impact on the saving rate. If the age-induced fluctuation of saving rates in Asia were much larger than in other regions, as Bosworth and Chodorow-Reich (2007) reported, the rapid aging in East Asia would have much larger macroeconomic impacts than in other areas on declining saving, investment and growth.

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(2) Saving profile by age and High saving generation of East Asia Does each household actually save more during ages 40 to early 60, and save less when the household head retires and ages, as the LC/PI hypothesis on consumption predicts? The Japanese Household Survey shows that the worker household’s surplus, which equals income minus expenditure, and which is allocated either to deposits, insurance, or securities, is the largest for household heads of ages 40–49; the surplus falls substantially when the household head becomes an elderly person (age 65 or over)(See Figure 9). This tendency underscores that the saving profile of Japanese households is consistent with the LC/PI hypothesis. Figure 10 shows that East Asian economies can anticipate an increase in the share of population aged 40–64, which is expected to save more than other age groups, for some decades, except for Japan whose share of that age group already peaked around 1995. By about 2050, however, many countries and economies in this region will experience a reduction in the share of the high saving generation.19

Source: Statistics Bureau, Family Income and Expenditure Survey, various years. Note: Surplus is defined as income minus expenditure. Figure 9. Household Surplus by Age Cohort (per month for worker house hold head).

If the decline in this generation were to induce a reduction in saving, sustained investment and growth would have to be matched by more efficient use of less saving, or would have to be supplemented by capital inflows from abroad. The financial market vulnerabilities of the countries in the region should be rectified during the period when ample saving could be used, if the decline in this

19

Peaks in the share of high saving generation of East Asian economies are expected to be the following: Singapore, 2015; Korea, 2020; Thailand, 2025; China, 2030; Vietnam, 2035; and Indonesia, 2045.

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generation were to induce a large impact on the financial market through an Asset Market Meltdown.

Source: United Nations (2007).

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Figure10. Share of High Saving generation (ages 40 to 64) in East Asia.

Aging, Asset Prices and Return on Assets – Asset Market Meltdown Hypothesis Abel (2001) reports that, in a rational expectations general equilibrium model, a baby boom raises stock prices; stock prices are rationally anticipated to fall when baby boomers retire, even though consumers continue to hold assets throughout retirement because of a bequest motive20. This means an Asset Market Meltdown is expected to occur when baby boomers retire. Bosworth et al. (2004) review numerous studies described in the relevant literature and conclude that “empirical evidence suggests that portfolio allocation does vary with the investor’s age”.

20

From the demand function for capital assets qtKt+1 = Nt s and the supply function of capital assets Kt+1 = Ktqt og qt = {1/(1+)} log qt-1 – {1/(1+)} log 1/(1+)} log t, where q is asset price, K is capital asset, N is the number of people, s is the saving rate, and  is the fraction of each generation which is expected to fall to the steady state if previously raised. q is also expected to fall to the steady state once raised according to the move of . With a bequest motive, the demand for assets will be higher, but the supply of assets will be higher too. The bequest motive does not raise the price with ample supply of assets. Therefore, it does not attenuate the asset market meltdown.

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A recent study of Davis and Li (2003), using panel data of seven OECD countries, presents the estimate of the post-war demographic influence on real equity prices and returns and real long-term bond yields. The results show that real equity prices rise with the working-age (20–64) population (age 40–64 in particular). They also show that real bond yields rise with the share of age 20–39 population, while the yields fall with the share of age 40–64 population because high-saving households (ages 40–64) wish to keep long-term bonds in their investment portfolio. Park and Rhee (2005), using panel data from 25 countries for the period of 1980–2002, estimate the effects of the age structure on real interest rates (real yield to maturity), and real returns to stocks (average rate of increase in stock prices). They find a statistically significant and negative relation between the fraction of the high-saving 40–64-year-old population and real interest rates. However, they cannot identify a correlation between the elderly population and real stock returns21. Following Park and Rhee (2005), Bessho and Kihara (2006) estimate the impacts of aging on real price levels of stock indices and on real yield to maturities of government bonds using panel data for more countries (50 countries for stocks, and 49 countries for bonds), and a longer period of estimation (1950– 2004) than those used by Park and Rhee (2005)22.

(1) Impacts of Aging on Real Stock Price Indices Bessho and Kihara (2006) regress the stock price indices on the fraction of high-saving generation (ages 40–64) relative to the whole working-age population (ages 15–64), the elderly population (ages 65 or over) relative to the working-age population, and other variables (real GDP growth rates, real yield to maturity (YTM) of government bonds, and the CPI inflation rate)23.

21

They argued that this evidence implies that the elderly population tends to prefer safe assets such as bonds. 22Data used are from IMF (2006) and World Bank (2006). World Bank (2006) lists only data from 1960 on. For that reason, the data for GNI per capita, GDP per capita, and real growth rate are from 1960 to the present. Demographic variables are derived from the United Nations (2005). The 5 year averages are calculated for dependent variables, as well as explanatory variables, to produce the longest time-series of variables 11 periods (1950–2004, 5-year intervals). Fixed effects for countries are considered in all estimations. The elderly ratio is defined as ratio of population aged 65 or older to the population aged between 15 and 64. A high saving generation ratio is defined as the ratio of population between of age 40–64 to the population of 15–64. 23 Stock Price-Earnings Ratios, which Park and Rhee (2005) used as one explanatory variable, are not used here because of a lack of data.

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Table 4. Estimated results of Prices and Returns of Financial Assets Dependent variables Explanatory variable/Mod el Log(Elderly Ratio) Log(High Saving Gen. Ratio) Real GDP growth rate Real Yield to maturity Inflation Rate (CPI) Log(Money/ GDP) Log(GNI per capita) (Current $US) Log(Real GDP per capita) (Year2000 $US) AR(1)

(I) (Log) Stock Price Indices s

(II) Real Yield to Maturity

(1)

(2)

(3)

(1)

(2)

(3)

-0.289 (-0.40) 2.608** (2.08)

-0.277 (-0.48) 2.531*** (3.35)

-0.914* (-1.77) 2.354*** (3.24)

7.524*** (3.87) -7.057*** (-4.28)

6.874** (2.00) -19.847*** (-4.64)

6.958*** (3.74) -7.692*** (-3.88)

0.083*** (3.50) -0.043*** (-2.78) -0.042*** (-3.32)

0.107*** (7.27)

0.029 (0.32)

-0.010 (-0.08)

-0.890*** (-2.74) 0.642 (0.74)

-1.103** (-2.33)

-0.902*** (-3.35)

2.695*** (4.33)

0.807 (0.96)

-0.0001 (-0.50)

Adjusted R 2

0.490*** (4.02) 0.722

0.767*** (13.62) 0.822

0.759*** (16.24) 0.831

0.383

0.359

0.385

Observations

133

253

291

244

196

244

Source: Bessho and Kihara (2006), pp.43-45. Note: Figures in parenthesis are t-values. ***, ** and * respectively signify a 1%, 5% and 10% significance level.

An increase in the high-saving generation is expected to induce more holding of assets in preparation for retirement, thereby driving up asset prices. They assume the first autoregressive process (AR(1)) in error terms, which is consistent with the model of Abel (2001). Table 4(I) shows the results, which suggest that an increase in the high-saving generation raises the average stock price index, which is consistent with the theory and empirical literature. The results here, although sometimes statistically not significant, indicate a negative correlation between the

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fraction of elderly population and the stock prices, suggesting possible asset market meltdown at the timing of retirement of the baby boomers.

(2) Impacts of Aging on Real Interest Rates (Yield to Maturity of Government Bonds) Table 4(II) shows results of the regression of interest rates on demographic variables. The results of Bessho and Kihara (2006) portray a clear positive correlation between the fraction of the elderly population and the real YTM, whereas it is evident that the fraction of the high-saving generation and the real YTM are negatively correlated. These results are consistent with those of Davis and Li (2003), reflecting the high-saving generation’s wish to hold long-term bonds in their investment portfolios, which leads the prices of bonds to rise and concurrently YTM to fall. The results of Bessho and Kihara (2006) are mostly consistent with theoretical explanations for demographic impacts on financial assets. The empirical results confirm the possibility for the real stock price to fall, and for the real interest rates to rise as aging proceeds.

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Baby Boomers in East Asia – Possibility of an Asset Market Meltdown It is often pointed out that, for the Asset Market Meltdown Hypothesis to hold, a country needs not only to have baby boomers, which bring huge demands for financial assets and an upsurge in asset prices, but to have a following generation with a low fertility rate to reverse the trend. Do the demographic trends in East Asia have such an up and down pattern? Figure 11 and 12 depict the current and estimated quantities of people in each age cohort (5 years interval) of Eastern Asia and South Eastern Asia (under United Nations definition) in the years 2005, 2030, and 2050. In Eastern Asia, the baby boomer generations are readily apparent in the data. The peak population cohort created by baby boomer generations move right to the high-saving generations (ages 40–64 between the dotted lines) on Figure 12 during 2030– 2050, when a large fraction of the population would be of the aged generations (ages 65 or over). South Eastern Asia is expected to experience increases in the population of high saving ages, but the population of aged cohorts would increase more. The ratio of the population of ages 65 or over to the population of ages 40– 64 is expected to rise substantially from 14.8% in 2005 to 37.3% in 2050 (See Table 5). Most populous age cohorts would move to aged generations, reflecting decreasing fertility rates in South Eastern Asia.

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For East Asia as a whole, it is expected within some decades to have smaller high saving generations who purchase financial assets more than other generations, and to have a substantially larger share of aged population who would sell out their asset holdings to compensate their income losses after retirement. Reflecting these demographic trends in East Asia, one can not deny the possibility of the Asset Market Meltdown Hypothesis to hold, i.e. the prices of financial assets are expected to fall and the interest rates are expected to rise in some decades to come.

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Source: United Nations (2007). Figure 11. Population of Age Cohorts (each 5 years) in Eastern Asia.

Source: United Nations (2007). Figure 12. Population of Age Cohorts (each 5 years) in "South Eastern Asia".

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Table 5.The ratio of the population of age 65 or over /the population of ages 40–64 in East Asia Country /Area Eastern Asia Japan

In 2005

In 2030

In 2050

19.56%

32.14%

58.78%

41.28%

70.54%

China

17.12%

28.90%

Korea

17.68%

42.33%

In 2005

In 2030

In 2050

14.84%

21.44%

37.29%

105.13%

Country /Area “South Eastern Asia” Thailand

16.03%

33.47%

53.36%

55.28%

Malaysia

11.16%

22.13%

33.89%

84.30%

Philippines

12.10%

17.90%

27.05%

Singapore

14.58%

57.33%

81.96%

Source: United Nations (2007) and the author’s estimates.

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CHALLENGES OF AGING IN EAST ASIA AND POLICY MEASURES TO BE TAKEN The rapidly aging East Asian economies will face challenges in the next few decades in the macroeconomic, fiscal, and financial spheres, as well as in difficult equity issues.

Macroeconomic Sphere Population aging and the resulting reduction in workers is expected to affect saving, investment, and external balances, as well as the economic growth rate, in various ways. What policies must be adopted to mitigate negative macroeconomic impacts of aging? As the IMF (2004) reports, if a policy to help respond to demographic change, to boost labour supply, saving, or productivity can serve as answers to these challenges, especially in macroeconomic sphere.

(1) Increase in Labour Supply Most solutions to the increase in labour supply suggested so far are not immune to reservations. One way to address this issue is to promote immigration of young workers from labour-abundant countries. Nevertheless, this response necessitates

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supplemental policies to help migrants assimilate and to minimize stress on the host population, both of which are quite difficult in many countries. To encourage an increase of the fertility rate is another response to be considered. However, it entails a long lag before an eventual increase in the labour force, even if such policies were effective at increasing the number of babies born. A promising means to enhance the labour force is to increase the participation rate of working-age population, women, and the elderly population in the labour market by means of, for example, pension reform (e.g. raising the retirement age)24. In many East Asian countries, the ages of eligibility to receive pension benefits are as low as 55 years old. Prolonging the pension-eligible age up to 60 or 65 years old would create an additional labour supply and pension contribution, as well as limit further pension outlays, as described below.

(2) Increase in Saving One way to increase national saving is to increase the saving of governments: to register fiscal surpluses. It is, however, difficult in many countries in East Asia because a substantial increase in social expenditures (e.g. health care) is expected in the near future, in addition to a growing demand for infrastructure. Pension reforms with reduction of benefits or from pay-as-you-go to the individual provident fund can contribute to an increase in private saving. (3) Sound policy and Institutional Reform to promote productivity In developing countries, it is also important to retain sound macroeconomic policies with low inflation and sustainable public debt, as well as to formulate policies and institutional frameworks to attract domestic saving, capital inflow, and capital formation for enhancing productivity.

Social Security Reform Aging tends to exert fiscal pressure through increases in social security expenditures; easing this pressure seems to be important. Many countries in East

24

The IMF (2004) predicts that a policy mix which includes a 3.75% point increase in the participation rate, 2.3 year extension of the retirement age, and immigration of 10% of the population would maintain the labour force to population ratio of advanced countries at the current level through 2050.

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Asia already have fiscal deficits. Nevertheless, health expenditures are low and are privately borne to a large degree (Figure 13).

Source: World Bank (2007).

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Figure 13. Health Expenditure Public v.s. Private % of GDP;year 2004.

Public pension reforms are currently underway in developed countries. Reforms to sustain pension systems include postponing retirement ages, reduction in pension benefits by mode of reduction in replacement rates or modification of indexation methods of benefits to prices, or to working-age population, rather than to wages, and increases in the contribution rate. However, in many East Asian countries, because public health insurance and public pension schemes have not yet covered all people, expanding their coverage requires more public funds in this era of aging. They will therefore face difficult policy choices to expand the coverage of social security programs, and to restrict the public expenditure for social services in tandem.

Financial Sphere Substantial impacts of aging will be felt on East Asian financial markets, including the possibility of an Asset Market Meltdown, change in the demand for different assets or portfolios of households, and increased volatility and uncertainty of asset prices. De Brouwer (2005), however, noted in relation to the financial markets in East Asia that, “in general, the region’s financial markets are weak, undeveloped,

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and unsophisticated.”25 The qualities of financial infrastructure of some countries lag behind others. Market liquidity, measured by trading volume and turnover ratios, has been increasing in recent years, but it remains low26. Although the issue base has expanded (e.g. asset backed securities, Islamic bonds, MDBs (multilateral development banks) issues), the overall investor base remains narrow, and a substantial share of local currency bonds are still held by commercial banks. In addition to the precaution against the recurrence of East Asian financial crisis, the foreseeable strong impacts of population aging in East Asia on saving and the financial assets will serve as another rationale to foster local currency denominated bond markets. The bond markets can provide a long-term safer financial asset for retirees. Efforts or initiatives in each local market have been made in such areas as improving rating agencies, bond price evaluation agencies, secondary market, settlement systems, and disclosure of bond market information. In this respect, it is important to enhance market liquidity by increasing the variety of the fixed income securities. The following financial products are particularly recommended in aging societies to administer duration risk, inflation risk, and longevity risk to ensure fixed income for elderly people: (a) long-dated bonds (30 years, 50 years, lengthening of government bonds maturities, increased issuance of long-term bonds), (b) index-linked bonds, (c) long-term derivatives, (d) longevity bonds, and (e) sovereign bond based mutual funds27.

REGIONAL COOPERATION AND CONCLUDING NOTES Aging in East Asia can impart huge impacts on regional economies which have enhanced mutual linkages of international flows of goods, services and capital, as well as on the global economy in which East Asian economies are the main source of international liquidity. For mitigating effects of demographic change, it would be effective to facilitate the international mobility of goods, capital, and labour. However, balances between pros and cons should be well considered. Immigration might increase the labour force, but the country requires

25

De Brouwer (2005) p.1. Turnover ratios of corporate bond markets (0.32 in countries of Emerging East Asia on average in the first half of 2007) are particularly low relative to those of government bonds (1.35 on average). 27 Related references are Visco (2005), Park and Rhee (2005) and Kihara (2008). 26

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the ability to integrate immigrants into society. Emigration (labour mobility) would increase income transfer to the originating country, but the country might face a so-called brain drain problem. Capital account liberalization might increase the capital inflow to sustain investment, but a huge inflow might raise the risks of a financial crisis28. Diverse stages of demographic transition among economies of the region afford opportunities for regional cooperation29. The following areas are suggested to be of particular importance; The first area to cooperate is information sharing and technical assistance. The experience of population aging can be shared to help formulate policy responses. Experiences to be shared might include (a) design and reform of pension systems, (b) fostering asset management services, (c) allocation of the national pension system assets, (d) how to respond to demand for long-term government bonds, (e) experiences to foster financial markets, and (f) creating an environment to foster the participation of women and elderly people in the labour market. In this context, a multinational platform for information sharing and intellectual support related to public pension systems and financial markets should be created, because both areas of developments have to be proceeded in tandem30. Technical assistance can be provided in the social sector (e.g., medical treatment technology, medical infrastructure), fiscal areas (e.g. tax collection), and capital markets, so that the saving of the working age population throughout the region can be channelled to capital formation. For instance, technical assistances can be rendered to creating, or upgrading, infrastructure of bond markets such as the trading system, depository, clearing, settlement systems, bond evaluation systems, and regulatory frameworks. It is also important to enhance the banking system to channel small saving in rural areas to local investment. Further development of the stock markets and capacity building for foreign asset investments will contribute to ensure the sufficiently high return on assets of pension funds, with appropriate care of possible risks. Technical assistances in these areas provided by financially developed countries are desirable31. The second area is the cross-country financial cooperation. International financial market linkages can be regionally enhanced. Regional saving must be mobilized to support the growth momentum, to build up social infrastructure, to 28

IMF (2004) pp.157-162 Park and Rhee (2005) p.44 30 Kihara (2008) p.115. 31 Kihara(2008)p.110 29

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educate youth, and to develop the private sector32 . For that purpose, the region might cooperate to enhance linkages among the financial markets in such areas as cross-listings of stocks, regional clearing and settlement systems, credit enhancement and investment mechanisms, regional rating agencies, and regional common standards.. In this connection, the regions should develop local-currency-denominated bond markets. In regional financial cooperation after the financial crisis of 1997– 98, initiatives to develop Asian bond markets were advanced, although limited, to cope with the risks of “double mismatches” in currencies and maturities of assets and liabilities in addition to excessive reliance on commercial banking for domestic financing. Population aging would add another reason for further development of bond markets, which would provide efficient financial intermediation in East Asia, which ensures a high, stable rate of return for retirees. The Asian Bond Market Initiative (ABMI) of ASEAN+3, the Asian Bond Fund (ABF) of Executives' Meeting of East Asia and Pacific Central Banks (EMEAP), Asia-Pacific Economic Cooperation (APEC), and the Asian Cooperation Dialogue (ACD) are some examples in operation, or to be envisaged, for this cooperation. The third area is concerned with fiscal sphere. Fiscal soundness can be maintained through international surveillance mechanisms and peer review. Population aging poses a threat to fiscal soundness because of increased expenditures for social security including health care and pension benefits, as well as a smaller tax base. This might create an inequality between current and future generations. However, it might be difficult for incumbent governments that have been elected by the current generation to remedy this intergenerational problem. International surveillance by multilateral organizations such as the IMF and MDBs as well as regional peer pressure from other governments can provide an impetus to a government to maintain the fiscal soundness and overcome intergenerational problems33. Population aging in this region might present negative externalities among countries in East Asia or to the globe as a whole, through external trade or

32

Park and Rhee (2005) 0.45 and Rhee (2005) p.47. For example, IMF Article IV Surveillances seem to be important for policymakers. As Krueger (2005) points out, the surveillances provide technical assistance and policy advice for public pension and health care system reforms under sound pro-growth macroeconomic policies. They assist, advise, or disseminate information related to increasing the statutory retirement age, penalties against early retirement, changing indexation provision, lowering replacement rates, or taxation of benefits of retirees.

33Park

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financial flows. In itself, this issue must be tackled collectively in the region or even globally. It is essential for all relevant parties in East Asia to be innovative in creating new areas for cooperation to mitigate undesirable outcomes of population aging. At the dawn of year 2009, the globe is in the midst of financial crisis, worst in 60 years34. Stock prices in almost all markets in the world have been sharply driven down and the world economy has been seriously stagnated. In addition to the current global credit crunch, aging would set another downward pressure on the trend of stock prices. The main causes of the current global financial crisis, which reflects the collapse in the markets of risky assets such as sub-prime mortgages and the subsequent credit crunch as well as the slump in economic activities, are different from the demographic forces of aging. Both, however, are in common to put a downward pressure on the stock prices, being driven by the sluggish demand for these securities. Even if the current financial crisis would be over in some years, the pressure of Asset Market Meltdown in the financial markets of aged societies may remain. In this context, further development of less volatile financial assets with stable income, local currency denominated bonds for instance, are required both for remedy of world financial markets35, and for ensuring stable income of increasing retired generation.

REFERENCES ADB Asian Bond Monitor (ADB/ABM) (Nov. 2004 – Nov. 2007). Abel, Andrew B., (2001). “Will Bequests Attenuate the Predicted Meltdown in Stock Prices when Baby Boomers Retire?” Review of Economics and Statistics, 83 (November 2001), pp. 589-595. Bessiho, Shun-ichiro, and Takashi Kihara, (2006). “Policy Responses and Regional Cooperation in Aging East Asia: An Introduction” International Conference on Aging East Asia－Regional Cooperation and Policy Responses, MOF/Japan and ADBI. 34

Blanchard(2008)(p.8) noted in December 2008 “the global economy is facing its worst crisis in 60years” 35In order to limit the risk of contagion in Asian markets from current credit turmoil, Kang and Miniane(2008) of IMF propose, in addition to short-term financial risk management, longerterm financial reforms to strengthen Asia’s financial system, such as further development of local bond markets, to be implemented

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Blanchard, Olivier (2008) “Cracks in the System – Repairing the damaged global economy” Finance and Development December 2008, IMF, pp.8-10. Bloom, David E. and David Canning, (2004). “Global demographic change: Dimensions and economic significance” NBER Working Paper Series 10817. Bosworth, Barry P., Ralph C. Bryant and Gary Burtless, (2004). “The impact of aging on financial markets and the economy: A survey” The Brookings Institution. Bosworth, Barry and Gabriel Chodorow-Reich, (2007). “Saving and Demographic Change: The Global Dimension” Center for Retirement Research at Boston University. Bryant, R.C., (2004). “Demographic Pressures on Public Pension Systems and Government Budgets” Brooking Discussion Papers in International Economics. Bryant, R.C, (2007). “Cross-Border Dimension of Population Aging” Annual Meeting of the Asian Development Bank. Clemens, Michael, Steven Radelet and Rikhil Bhavnani, (2004). “Counting chickens when they hatch: The short term effect of aid on growth” Center for Global Development Working Paper No. 44. Davis, E Philip and Christine Li, (2003). “Demographics and Financial Asset Prices in the Major Industrial Economies” Brunel University Department of Economics and Finance Discussion Paper #03-07, London: Brunel University, 2003. De Brouwer, Gordon, (2005). “A New Financial Market Structure for East Asia: How to Promote Regional Financial Market Integration” OECD/ADBI 7th Round Table on Capital Market Reform in Asia. Feldstein, Martin; Charles Horioka, (1980). “Domestic saving and international capital flows” Economic Journal 90(358), pp.314-329. Hiroi, Yoshinori, (2003). “Overview of Social Securities in Asia” Hiroi, Komamura Social Security in Asia, University of Tokyo Press (Japanese). Horioka, Charles Yuji, (2007). “Aging, Saving, and Fiscal Policy” Asian Development Bank Institute. IMF (International Monetary Fund), (2004). “How will Demographic Change Affect the Global Economy? “World Economic Outlook, Chapter III, pp.173180. IMF International Financial Statistics Various issues. Kang, Kenneth and Jacques Miniane (2008) “Global Financial Turmoil tests Asia” Finance and Development December 2008, IMF, pp.34-36.

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Kihara, Takashi, (2007a). “Ageing East Asia – Its Impacts on Growth, Saving and Financial Markets” Journal of Political Economy October 2007, Kyushu University, pp.101-128 (Japanese). ––––, (2007b). “Ageing, Growth and Financial Markets – Policy Challenge of East Asia” MOF/PRI Discussion Paper Series 07A-10, Ministry of Finance, Japan (Japanese). ––––, (2008). Financial Market Enhancement and Social Security in the Ageing Asia – Possible Areas of Intellectual Assistances JICA Visiting Scholar Reports (Japanese). Park, Daekeun, and Changyong Rhee, (2005). “Meet the Challenge of Aging Economies”, 2005/FMM/TWG1/012, APEC. Poterba, James M., (2001). “Demographic structure and asset returns” Review of Economics and Statistics 83(4), pp.565-584. ––––, (2004). “Impact of Population Aging on Financial Markets” NBER Working Paper 10851. Sachs, J.D and A. Warner, (1995). Economic Reform and the Process of Global Integration, Brookings Papers on Economic Activity,1, pp.1-118 Brooking Institution. United Nations, (2007). “World Population Prospects: 2006 Revision.” Visco, Ignazio (OECD), (2005). “Ageing and pension system reform: implications for financial markets and economic policies” A report prepared at the request of Deputies of G10. World Bank, (2006). World Development Indicators 2006. ––––, (2007). World Development Indicators 2007. ––––, (2008). “World Development Indicators Online.”

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Chapter 8

RETHINKING AGING - THE SELFLESS CONSUMER: OLDER PEOPLE, RISK AND UNCERTAINTY IN CONTEMPORARY CHINA Steven Miles

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University of Liverpool

INTRODUCTION The rise of a consumer society in China raises a whole raft of questions regarding the apparent incompatibility between Chinese notions of selfhood and what it means to be an older person in such a rapidly changing society. In this chapter I will consider older people’s experience of what in many respects can best be described, at least from the perspective of older people, as a risk society. This raises some interesting issues as sociologists have more often considered the implications living in a risk society for younger people as consumers (Miles 2000). Specifically, the concern here is with how older people reinforce their status as the beneficiaries of a relational society in a world in which those relations appear to be increasingly under threat. If we accept that the cultural orthodoxy of individualism underpins the consumer society, what does this mean in for society in which individualism is yet to establish itself as a valid cultural norm?

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IDENTITY IN CULTURAL CONTEXT Before we can begin to address the above issue directly it is important to put this debate in its historical context. Assumptions are often made about the implications of a consumer society for aspects of identity without adequate resource to the cultural, geographical and historical conditions in which identities emerge. The suggestion here is that the changing socio-cultural context in which older people find themselves may not offer suitable degrees of support and that they may find themselves in a situation where they are increasingly having to live with the insecurities and uncertainties associated with a risk society without having the luxury of the freedoms that such a society implies. The nature of identity is not universal. Identity simply does not exist in many eastern cultures in the same ways it does in the western world. The primary contrast is one based on a perceived sense of individual identity as characterised in the west as opposed to a more communal sense of identity proposed in East Asian countries such as China. Before going on to look at the specific contexts in which Chinese identity arises I would like to consider the historically situated nature of identity and in doing so will suggest that the rapidity of social change brings with it a degree of incongruence that leaves older people in a potentially problematic situation. In order to highlight the significance of the historical dimension to this debate I want to consider in some detail the specific contributions of Robert David Sack (1992) and Yi-Fu Tuan (1982). Tuan points out that many cultures have very little sense of self apart from that implicated by the group. This he demonstrates historically. For example in the Medieval and Renaissance worlds open-planned barn-like buildings offered little privacy to either the lord or the peasant and people actively thought of themselves as a functioning part of a household. As time moved on such spaces were segmented and rooms took on specific functions which allowed a more distinct separation between the individual and the group and thus a more elaborate sense of self. By the eighteenth and nineteenth century the home, at least in the west, became ever more separated from work, education and recreation. But as both Tuan and Sack point out the increased segmentation of the external world characterised by these changes and the increased sense of self they brought about was ambivalent in nature. Sack quotes Tuan (1982: 139) on this point in arguing that this process rewards us with a “sense of independence, of an untrammelled freedom to ask questions and explore, of being clear-eyed, without vision, rational, and personally responsible” whilst simultaneously creating its own problems of “isolation, loneliness, disengagement, a loss of natural vitality and of innocent pleasure in the givenness of the world, and a feeling of burden because reality has no meaning other than what a person

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chooses to impart to it”. It is this sense of burden that may have particular implications for older people in the context of social change in China. The transition towards a consumer society produces is far from seamlessly produced in a developing society such as China. Indeed, such a society is perhaps best characterised as a society that is obliged to negotiate the tensions that persist between traditions of the past and the present and the modern ways of the present and the future. Perhaps the key to understanding these tensions lies in the notion of selfhood. As many authors have noted Chinese selfhood as an expression of Confucian tradition emphasises the interdependent nature of the self. As such, Heine (2001) comments on the contrasts between Eastern and Western selves and points out that the East Asian self is usually described as being collectivistic or interdependent. In other words, relationships with other in group members play an absolutely fundamental role in who or what a person is. Crucial in this regard is the maintenance of interpersonal harmony within a person’s five cardinal relationships: father-son, husband-wife, elder-younger, emperor-subject and friend-friend. The suggestion here is that the relationship between elder and younger is especially important for as a focal point for older people’s sense of security and stability in the rapidly changing conditions in which they find themselves. Particularly crucial then are obligations implied by these roles and the way in which the dilution of these obligations may compromise an older person’s status in a consumer society. As Heine (2001) suggests East Asian relationships are essentially selfdefining. From this point of view “Social actions follow not from volition, sentiments or needs as they do from perceptions of one’s relationships with other” (Ho, 1995: 116). The relatedness of individuals to other individuals underpins Eastern conceptions of individuality. The individual adapts to different role expectations and situational demands. In this sense the social world is an enduring phenomenon and not something he or she can alter at his or her will. The individual must be flexible in light of the inflexible social world in which he or she finds him or herself and vice versa. As Ho (1995: 131) goes on to put it, an individual is not complete without the interpersonal relationships in which he places himself, particularly in terms of his or her relationship to the family. In this context, the individual is obliged to make sacrifices for the group and through these sacrifices he or she is able to cement a sense of his or her own place in the world; of his or her own identity. The point here, as Heine suggests, is that the Confucian framework underlying cultural definitions of the East Asian self may actually conflict with any desire to be self-sufficient and autonomous and in such a way may cause tensions as regards the emergence of an apparently more individualistic consumer

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society. In effect, Confucianism actively legislates against the development of individuality in a society in which there is not even really any kind of established notion of individual rights. Although economically China is moving toward a model of a capitalist society in which the individual is paramount such a norm is not sufficiently culturally or historically established. Ho goes on to argue that people adopting the filial attitudes associated with Confucianism tend to be conformist in nature. This is also reflected in recent decades by the Chinese Communist Party’s use of group identities to control individuals in what is essentially a passive relationship between the individual and the state (Pye 1991).

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CONSUMING IDENTITY Things are apparently changing insofar as the conformity referred to above is at least partly tempered by an increasingly evident willingness to stick out from the crowd, but as debates regarding the role of consumption in identity construction indicate this does not necessarily mean that the individual is in any genuine sense liberated. China is increasingly a society defined by consumption. Gittings (2005) describes such a transformation as occurring by the end of the 1990s with the emergence of a new middle class who could express and act upon its desires for consumption and acquisition. In the aftermath of Tiananmen Square the Chinese Communist Party was forced to enter into a social contract with the people of China offering them the freedoms and choices associated with the market in exchange for maintenance of the political status quo. Such cultural developments developed alongside as broader intentions to deviate from Maoist orthodoxy, as Davis (2000) has pointed out, were endorsed as a short-term compromise in order to spur efficiency and jump start a stagnant economy. From this point of view there was no intention at least to begin with to allow individuals to accumulate personal wealth or property rights, precisely because any link between economic and political reform was explicitly rejected. But by the early 1990s China had gone so far down this road that to reverse it would have been a social and a cultural impossibility as much as it was an economic one. In this context, the political regime remained intact but the relationship between agents of the state and ordinary citizens had fundamentally changed. Alongside the increasing onus on consumption brought about by rapid economic change Chinese values were beginning to coalesce around freedom from those of a sexual nature to those implied by notions of citizenship. These changes were underpinned, as Gittings (2001) demonstrates, by important economic changes and not least the emergence of a housing market that

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encouraged social mobility and the accumulation of wealth. New high-rise apartment blocks offered young people a world of aspiration in which their families appeared to play less and less of a fundamental role. Meanwhile divorces soared in China and arranged marriages were on the decline as young Chinese insisted in making life decisions on their own behalf. Perhaps the most fundamental shift that occurred in the nature of Chinese social life was the breaking up of the key relationship between work and home. Such a development had important implications for the opening up of the individual’s private life insofar as lifestyles and living standards were no longer as homogenous as they had been in the past. As a result the individual’s relationship to the state was also altered in that the individual’s sociability was inevitably becoming increasingly autonomous. Authors such as Conghus Li have therefore identified an 's-generation' of single-child consumers with radically different attitudes to previous generations and crucially a higher degree of correlation between the work they do and the reward they receive for that work. In this context consumption appeared to offer the Chinese people a means for personal liberation. Madsen (2000) describes the way in which an emerging consumer society in China has brought a raft of relative freedoms to its people, not least in the form of the ability to live a private life among people who have chosen a lifestyle similar to your own whilst minimising association with others who are different from yourself. Madsen's argument is that the benefits of a consumer society as it is emerging in China is always inevitably counteracted by a loss of traditional values and a situation in which more traditional and arguably static values associated, for example, with village life in China are abandoned leaving many people feeling a sense of unexplained loss as if they no longer belong. The process Madsen describes constitutes a clash of meaning in which those that have succeeded in the new market economy may also themselves be isolated from family members who simply do not understand or want to understand the new ways of thinking. Commentators such as Stockman (2000) have recognised that the Confucian family structure and implications for a communal definition of selfhood as defined through patriarchal hierarchies of generation, age and sex had previously represented a fundamental obstacle to China’s modernization. And yet the family retains its function as the key socialising agent in China and the ‘intergenerational contract’ in which older people take on as many domestic responsibilities as possible in the expectation that the younger generation will take care of them when they become dependent remains in place (Stockman 2000; Ikels 1993). There is indeed evidence to suggest that young people are still as tied to their families as they were in the past, but the extent to which such a situation can be

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maintained when the territorial relationships between generations are increasingly likely to be altered, remains highly debatable. Such processes are being played out and only time will tell. What we can acknowledge as de Burgh (2006: 122) suggests is that,

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“There is less sense of intergenerational reciprocity, less automatic respect for the older, more romantic love, more freedom for women to decide their own paths. But the ‘uncivil’ individual has appeared. As the State has loosened its grip on family life, it has not only been replaced by traditional culture but by the competing influences of the market economy and consumerism”.

As Gabriel and Lang (2003: 92) suggest behind the consumer’s ostensible quest for identity “lurk more fundamental cravings for respect and self-love, born out of the injuries that modern life inflicts on us”. In effect, the narcissism of the west creates an idealised fantasy of the self that are less than partially resolved by the ephemeral images thrown up by consumerism. From this point of view consumerism creates a world of image-conscious insecurity. On the one hand the consumer exercises freedom, on the other he or she is a self-deluded addict. But what implications will such developments have for the nature of Chinese cultural traditions and more specifically for the experience of older people who live out those traditions? Pye (1991: 449 - 450) suggests that the problem here is that in Chinese culture, “The individual is expected to be selfless in sacrificing for the collectivity, but in return the collectivity offers only limited rewards… Individuals are, of course, given a degree of security through association with the group which establishes their sense of identity… the individual learns to be content with getting relatively little out of what is often a very unfair exchange”. The danger here is that under the conditions of a commodified society and the pressures on selfhood which such a society engenders the collective spirit that underpins Chinese social relations may be increasingly jeopardised so that the investment made in the family by an older person may not always be reciprocated by the generations that follow. In particular, Sack (1992) argues that contemporary consumer culture creates a mismatch between the private and the public, and thus between the subjective and the objective. We live in a context in which the public world, the private world and the world of the self are all in a state of flux. Sack suggests that commodities and their contexts accentuate such tensions. I want to take this one step further to argue that such tensions take on a particular meaning in a country in which the influence of such commodities is in relative historical terms, so sudden in nature. For Sack the possible reactions to modern life depend on part on a person’s ability to adjust to the tensions created

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by commodities. Thus they may see the new meanings available through consumption as an opportunity to explore, “And they may see the juxtapositions of contexts as stimulating, entertaining, and liberating –permitting self and group expression. To these people, many modern things and places can be out of place, but that is itself the modern context and is to be applauded” (Sack 1992: 172). But as Sack notes on the other side of the equation, the rapid turnover of contexts and the disorienting nature of change in a consumer society may create what is for many people an alienating and inauthentic modern landscape. In other words, the consumer society accentuates the contradictions of the modern world. Moreover, it may accentuate these contradictions for older people who may feel less comfortable with the obligation to confront risk that is implied by the risk society as their vision of the world is so bound up in notions of filial piety.

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RISK AND CONSUMPTION In order to better understand the sorts of tensions that older people may experience I want to consider the suggestion that older people’s experience of an emerging consumer society is bound up with the emergence of a risk society and that the risks associated with a consumer society are especially magnified for older people even though it has more often been assumed that the fact that young people are apparently at the ‘cutting edge’ of social change means that their experience has received more attention in this respect (Miles 2000). In this context Furlong and Cartmel (1997) talk about how a risk society results in a weakening of collectivist ties and an intensification of individualist values the end result of which is a social world that people regard as unpredictable and full of risks that can only be negotiated at the individual level despite the fact that chains of human interdependence remain influential. Ulrich Beck (1992) argues in his book Risk Society that the world has undergone an historical transformation in which old predictabilities and uncertainties are being challenged. As Higgs (1998) has noted from a sociological point of view the notion of risk deals with issues of uncertainty and fear. Lying at the heart of Beck’s (1992) thesis is the suggestion that the identification and awareness of risks has overwhelmed the modern project. In a risk society risks essentially become unmanageable and this is no more clearly demonstrated in the UK at least than in the context of the Welfare State which can no longer deal with the issues for which it was created. In this context older people are labelled, “ageing is treated as “external”, as something that happens to one, not as a phenomenon actively constructed and

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negotiated” (Giddens 1994: 170). From this point of view older people have very little control over their own future when in fact they need to confront the issues of ageing as an active process of self-actualisation. For both Beck and Giddens the risk society promotes a process of individualisation in which the individual is left to cope in a situation where support mechanisms are less secure than in the past. In the UK this process is characterised by a situation in which older people accessing welfare benefits are actively separated out from those who are selfsupporting and self-reliant. As Higgs (1998: 192) puts it, the risk society produces a contradictory kind of citizenship for older people who are expected to take responsibility for extending the period of a fit and healthy third age; when of course the experience of the ‘third age’ continues to be underpinned above all else by physiological processes. Furthermore, Higgs argues that these processes transform older people into objects of consumption around which packages of care are assembled. The new citizen is obliged to engage with risk in a constructive fashion, for the only alternative is to fall through the security net that lay beneath. As Higgs points out Beck and Giddens argue that there are benefits to be had from the reflexive approach to identity associated with a risk society if an individual is able to accept the challenges put in front of him in a less secure world. On the other hand the above obligation may be an obligation too far for older people struggling to see how they can fit into a society that is changing so rapidly. The world in which older people find themselves is an unfamiliar one based upon momentary experience, “In a life composed of equal moments, speaking of directions, projects, and fulfilments makes no sense. Every present counts as much, or as little as any other, and each one is – potentially, the gate opening into eternity. Thus the distinction between the mundane and the eternal, transient and durable, mortal and immortal, is all but effaced. Daily life is a constant rehearsal of booth mortality and immortality – and of the futility of setting one against the other. Simultaneity replaced history as the location of meaning. What counts – what has the power to define and shape – is what is around here and now. “Older” and “younger” objects are all on the same plane, that of the present” (Bauman 1992: 168).

For Beck (1992) individualization is a key concept. He argues that in a risk society the family is an increasingly unstable frame of reference. Rather the individual him or herself becomes the reproduction unit for the social. Under such conditions the family loses its influence as individuals become their agents of their own livelihood and of their own biographical planning and organization.

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“The individual is indeed removed from traditional commitments and support relationships, but exchanges them for the constraints of existence in the labor market and as a consumer, with the standardizations and controls they contain. The place of traditional ties and social forms (social class, nuclear family) is taken by secondary agencies and institutions, which stamp the biography of the individual and make that person dependent upon fashions, social policy, economic cycles and markets, contrary to the image of individual control which establishes itself in consciousness.” (141)

It is important to recognise here that Beck does not claim that that the influence of the family entirely disappears in a risk society. For women in particular the problem is that the family rhythm still applies alongside the broader uncertainties of a life ties to the market which creates what Beck describes as ‘conflictual crises and incompatible demands’. As the individual becomes increasingly dependent upon the market he or she is delivered over to an external form of social control previously unfamiliar and hence unsettling for the individual. The above process creates particular tensions for older people in China who are experiencing levels of social change at an unprecedented level of acceleration and who are thus potentially left floundering somewhat in a world that no longer appears to offer the securities of the past. In effect the individual’s identity has to become increasingly reflexive or the consequences are potentially dire. As Furlong and Cartmel (1997: 4) put it, “Individualized lifestyles come into being in which people are forced to put themselves at the centre of their plans and reflexively construct their social biographies… In all aspects of their lives, people have to choose between different options, including the social groups with which they wish to be identified, and temporary allegiances are formed in respect to particular issues”. Identity has to be chosen by the individual who can no longer depend on things happening to them, but rather has to live with the consequences of their own choices, when in the past those choices were made by the mutual dependence invested in the family unit. The concern here is that although older people are subject to the same broad social changes as everybody else, they may actually be less well equipped to deal with such transitions.

THE ‘GREYING’ CONSUMER I will now go on to consider the particular aspects of older people’s consumption that may contribute to the sorts of uncertainties and unpredictability’s associated with a risk society before concluding with some

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suggestions some thoughts as to the effect of older people’s changing experience of consumption in China. There is a broad recognition that demographic changes, not least in the developed world, mean that the so-called ‘greying market’ is increasingly significant, at least from a marketing point of view. In discussing the status of the greying consumer in the west Gunter (1998) points out that older people are a highly diverse group and discretionary buying power has been shown to be greater amongst the over-50s than it is the under 50s (French and Fox (1985). The greying consumer constitutes a market of growing size and significance in the western world as Gunter (1998) suggests and “People reaching what some writers have called the ‘Third Age’… will have experienced a rapidly changing social and technological environment and their experiences of leisuretime activities will be shaped by these experiences.” (140) Some authors have thus commented on the emergence of new positive images of aging in the media, advertising and public consciousness. Such representations focus on the active, mobile and autonomous nature of older age and reflect a broader cultural shift towards a ‘post-modern’ lifecourse focused around the priorities of a consumer society. As Katz (2002) puts it, “the postmodern lifecourse has created new avenues for self-care and self-definition in late life, thus empowering elders to innovate resourceful roles and ways of life both for themselves and those who will follow” (28). In this context all older people’s experiences become impermanent and insecure, even the very social structures that previously appeared to offer such security can no longer do so. This reflects a broader process in which positive cultural imagery in the form of marketing and its relationship to consumerism have contributed to a “new aging” (Katz and Marshall (2003). But is this also the case in China? As Croll (2006) points out, the majority of people in China continue to work into older age and few actually retire with a pension or with savings given the nature of their investment, both in terms of energy and wealth in their families. Croll argues that retirement is no longer the privileged life-phase it was in the past and familial resource flows remain the most important source of support for older people. Under these circumstances, older people are left in a situation in which guarantees about their future are less and less forthcoming. The potential source of long term support is blurred by the alternative means of identity offered to younger generations by the consumer society. In this context, Croll refers to some of his own empirical research which indicates that older people feel that the widening generation gap and declining levels of respect leave them increasingly at risk, whilst the diminution of family size and broader process of migration leave their situation ever more perilous. Furthermore, Croll argues that older people tend to see the symbols of images of a consumer society as testament to the ‘evil’ of modern times. In many senses, older people in China are

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‘selfless’; they simply do not have a highly developed sense of their individual needs. In this context, Croll questions the viability of a situation in which the well-being of an older person’s family is their life insurance.

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CONCLUSIONS The long-term consequences of the emergence of a consumer society upon older people’s identities in China are in some sense a matter for conjecture. The benefits of individualism are certainly being grasped by the younger generations of China who already perceive consumer lifestyles as the norm. Such developments will create divisions within generations as well as between them. But for older people the likelihood is that an increased onus on individualism will prove an increasingly alienating experience as the predictabilities of the past crumble beneath their feet. The negative dimensions of a society defined by consumption are likely to be felt most vigorously by older people who cannot relate to a world in which consumer images and symbolism have gained such status. As products of a culture which filial piety plays such a key role older people in China simply may not have the raw materials they require to deal with the risk society in a pro-active constructive fashion and in this sense their risk is culturally bound. The processes described above amounts to a transition from a society that places it faith in the character of individuals as demonstrated by his or her commitment to the mutual bonds of family life to one in which personality comes to the fore. A consumer society is a society in which visual demonstrations of personality come to the fore and in which practical demonstrations of character are likely to be less fundamental than they were in the past. The suggestion here is not that the reciprocal relationships of the past are being swept aside in China, but that the emergence of a consumer society means that the future of older people in China is potentially a precarious one, both practically in terms the degree of support they can depend upon from younger generations and emotionally in terms how they perceive themselves in this changing society. China is a country in which some of the characteristics of a risk society are arguably felt in their most severe guises precisely because those risks constitute such a fundamental shift in the nature of the relationship between the individual and society. China’s history is one of constant change and the biographies of older people China demonstrate how socio-economic and political change is manifested most graphically in everyday life. The breakdown of traditional ties and the construction of biographies apparently determined by the market constitute yet another manifestation of change and one that may prove

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equally as serious as some of the apparently more fundamental historical transitions of the past. In the west long-established notions of individual identity prepare the individual for such challenges. The prominence of mutual hierarchical obligation in older people’s lives in China means they are not similarly predisposed. The consumer society offers an arena of self-discovery and one in which identity solutions are apparently available across the counter. A continued focus on the experience of older people on the part of social scientists entrusted with understanding the significance of the changes going on in China and elsewhere in East Asia may help us understand more easily the potential risks associated with a society that exposes itself to a world of a consumption that inevitably divides and just as much and perhaps more so than it provides.

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REFERENCES Bauman, Z. (1992) Mortality, Immortality and Other Life Strategies, Stanford: Stanford University Press. Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage. Li, C. (1998) China: The Consumer Revolution, new Delhi: Whey Eastern. Croll, E. (2006) China’s New Consumers, London: Routledge. Davis, D. (2000) The Consumer Revolution in Urban China, London: University of California Press. De Burgh, H. (2006) China Friend or Foe?, Cambridge: Icon Books. French, W.A. and Fox, R. (1985) Segmenting the senior citizen market, Journal of Consumer Marketing, 291, 61 – 74. Furlong and Cartmel (1997) Young People and Social Change: Individualization and Risk in Late Modernity, Buckingham: Open University press. Gabirel, Y. and Lang, T. (2003) The Unmanageable Consumer, London: Sage. Giddens, A. (1994) Beyond Left and Right: The Future of Radical Politics, Cambridge : Polity. Gittings, J. (2005) The Changing Face of China: From Mao to Market, Oxford: Oxford University Press. Gunter, B. (1998) Understanding the Older Consumer, London: Routledge. Heine, S. (2001) Self as cultural product: an examination of East Asian and North American Selves, Journal of Personality, 69, 6: 881 – 905. Higgs, P. (1998) (Risk, governmentality and the reconceptualization of citizenship, pp. 176 – 194 in P. Higgs (ed.) Modernity, Medicine and Health: Medical Sociology Towards 2000,London: Routledge.

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Ho, David Y. F. (1995) Selfhood and identity in Confucianism, Taoism and Budhism, and Hinduism: Contrasts with the West, Journal for the Theory of Social Behaviour, 25: 2, 115 – 139. Ikels, C. (1993) Settling accounts: the intergenerational contract in an age of freedom In Davis, D. and Harrell, S. (eds.) Chinese Families in the post-Mao Era, Berkeley: University of California Press). Katz, S. (2002) Growing older without aging? Positive aging, anti-ageism, and anti-aging, Generations, 27 – 32. Katz, S. and Marshall, B. (2003) New sex for old: lifestyle, consumerism and the ethics of aging well, Journal of Aging Studies 17, 3 – 16. Madsen, R. Epilogue: The Second Liberation , 312- 319 in D. S. David (ed.) The Consumer Revolution in Urban China, London: University of California Press. Miles, S. (1998) Consumerism as a Way of Life, London: Sage. Miles, S. (2000) Youth Lifestyles in a Changing World, Buckingham: Open University Press. Pye, L. (1991) The state and the individual: An overview interpretation, China Quarterly, 127 443-466. Sack, R. D. (1992) Place, Modernity and the Consumer’s World, London: Johns Hopkins University Press. Stockman, N. (2000) Understanding Chinese Society, Cambridge: Polity. Tuan, Y-F (1982) Segmented Worlds and Self: Group Life and Individual Consciousness, Minneapolis: University of Minnesota Press.

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In: Aging in Asia Editor: J. L. Powell and I. G. Cook

ISBN 978-1-60741-649-4 © 2009 Nova Science Publishers, Inc.

Chapter 9

PATTERNS AND PROCESSES OF LONGEVITY IN ASIA Ian G. Cook and Trevor J.B. Dummer

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Liverpool John Moores University and IWK Health Centre/ Dalhousie University

INTRODUCTION Had this chapter been written some decades ago, there would have been little attention paid to longevity in Asia. Instead, we would have been more concerned with the factors that limit and restrict longevity, factors such as floods, famines, droughts and highly infectious diseases. The rise of the elderly in Asia has been a major human success story, as it has been elsewhere in the globe. Success can bring problems, however, hence there are increasing levels of government concern with how the elderly can be supported effectively as their life span reaches the 70s, 80s and beyond. On the negative side, the speed of change in Asia has tended to leave the development of an effective social security and welfare system struggling to keep up with the changing demographic needs of the populace. On the positive side, more of the elderly are physically and mentally active, capable of meeting their own needs rather than being reliant on state support. And yet, the onset of a debilitating health condition or the death of a spouse can turn the active elderly into the vulnerable elderly. Likewise, the major credit crunch of 2008-9 can damage the private sector pension fund provision on which so many of the Asian elderly are increasingly reliant, leading to financial vulnerability in old age.

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Our aim in this chapter is to summarise the changing demographic patterns and processes in Asia. We focus especially on longevity, which is impacting upon a number of Asian countries, particularly Japan, Singapore and Hong Kong and, increasingly, China. But we would be remiss to focus only on longevity; there are still countries or regions in this vast continent for which longevity is the exception rather than the rule. Therefore, short life spans too are also pertinent to our analysis. In countries like Nepal or Bangladesh, or for ethnic groups such as the Palestinians, old age is still the exception to the rule, as it has been in many societies since time immemorial. Further, increased lifespans are not inevitable; there are still a range of Malthusian and Neo-Malthusian checks to longevity. We therefore examine a range of factors that limit longevity. Our structure is:  

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   

Towards silver surfers and golden oldies Opposites to longevity: birth rates and life expectancy in selected countries Urbanisation and the elderly Traditional Malthusian checks today Neo-Malthusian constraints on longevity Conclusions

Population aging, an increase in the proportion of older people, is a consequence of the demographic transition, which relates to a decline in both mortality (death rates) and fertility (birth rates) (UN, 2002). As a country develops, shifting from a pre-industrial and agrarian society through to an industrial or post-industrial one, death rates and fertility both decline and the age distribution of the population shifts towards older aged people. Whilst the demographic transition model is limited and somewhat simplistic it has utility in describing general demographic trends within countries or regions. The demographic processes (declining birth and death rates) underpinning demographic transition link directly to the epidemiological transition model. This model provides a framework to interlink a nation’s changing mortality and morbidity profile, which affects death rates, with the population and socioeconomic changes associated with development and which influence fertility (Omran, 1971). In pre-industrial societies mortality is commonly from famine and infectious disease epidemics (diseases of poverty). As society develops, infectious diseases decline and there is increasing mortality and morbidity caused by lifestyle factors and chronic illnesses, paradoxically linked to increasing life expectancy (diseases of affluence). In this late phase deaths and fertility decline

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and population aging occurs. Depending on the development stage of an individual country its position in the epidemiological transition is variable. Across Asia many countries are at different stages in the demographic transition and epidemiological transition, resulting in very different profiles of aging and longevity. In China, for example, diseases of poverty and diseases of affluence are both found, with some of the former having a seeming resurgence in recent decades at the same time as the latter are on the increase (Cook and Dummer, 2004).

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TOWARDS SILVER SURFERS AND GOLDEN OLDIES As a continent, Asia has always been associated with huge populations, ‘Yet the distribution of the people is curiously irregular. The majority of the people of Asia are found in two countries – India, with an average density of 177 and a total population of about 320,000,000; and China, with a total population of probably 400,000,000 (density, 260)’ Stamp, 1931: 44). Stamp was writing of the early 1920s, therefore his ‘India’ refers to the Indian sub-continent now comprising of India itself plus Pakistan and Bangladesh. Three other densely populated areas to which he also refers were Japan (83,500,000, 1925; density 320), Java (36,500,000, 1925; 717) and Ceylon [modern day Sri Lanka] (4,500,000, 1921; 178). His accompanying map showed very high population densities along the Ganges, in the areas around Mumbai, north Java and high population densities in most of Japan and east China stretching westwards into the ‘Red Basin’ of Sichuan Province in the heart of that country. To him, the alluvial plains and the monsoon climate were the key factors underpinning this distribution. Nowadays, the corresponding population for India alone was estimated for mid-2006 as 1119.5 million while Pakistan was nearly 157 million and Bangladesh nearly 139 million (Britannica World Data, 2007: 750-755). Likewise, China’s estimated population was 1311.4 million, Japan 127.7 million, Indonesia 222.7 million and Sri Lanka nearly 20 million. Within a relatively short space of time, and a few generations, large populations have become very large populations indeed, and it is only for Japan that the increase in numbers is relatively modest. Bloom and Canning (2006: 8) have examined the pattern of what they call ‘the biggest demographic upheaval in history, an upheaval that is still running its course’. Box 1 summarises the key features this upheaval is attributed to.

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Ian G. Cook and Trevor J.B. Dummer Box 1. Factors influencing demographic change (Bloom and Canning 2006: 9-10)  

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







Total fertility rate: has fallen from around 5 per woman in 1950 to 2.5 in 2006, and to 2 by 2050 if predictions are correct; Infant and child mortality: infant mortality in developing countries has dropped from 180 per 1000 live births to 57 today and potentially less than 30 by 2050, while developed countries have seen a corresponding decline from 59 to 7 deaths per 1000 live births (forecast 4 by 2050). Child mortality has declined substantially, especially in developed regions. Life expectancy and longevity: increased globally from 47 in 195055 to 65 in 2000-05. ‘It is projected to rise to 75 years by the middle of this century, with considerably disparities between the wealthy industrial countries, at 82 years, and the less developed countries, at 74 years’ (ibid.: 9). Exceptions to this trend are sub-Saharan Africa due to HIV/Aids, and some parts of the old Soviet Union due to the knock-on effects on health of economic problems. Despite these exceptions, ‘The number of people over the age of 60, currently about half the number of those aged 15 to 24, is expected to reach 1 billion (overtaking the 15-24 age group) by 2020 and almost 2 billion by 2050’ (ibid.:9-10). Those aged 80 or over will rise from 1 per cent to 4 per cent of the world’s population by 2050. Age distribution: working-age population: contrasting cohorts of baby-boomers, followed by reduced fertility rates, coupled to longevity gives rise to complex demographic patterns over time. Migration: means that 119 million people currently live in a different country from their birthplace, and another 99 million might move similarly in the next 45 years. Urbanization: estimates are that more than half the world’s population would be urban by 2007, with implications for transportation, the environment and socioeconomic disparities among others. A feature of this urbanization is the growth of megacities such as Tokyo (35 million people), followed in order by Mexico City, New York, Sao Paulo and Mumbai, all 17-19 million, and many more around the globe.

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declining deaths rates, especially infant mortality rates; and, increasing life expectancy and longevity, associated with declining adult death rates. These features have resulted in a changing age distribution in the population. Additional influences relate to demographic trends in population mobility and migration, as well as increases in the pace of urbanisation and the growth of cities. The combination of these factors, allied to specific geographical and historical conditions, result in a complex set of outcomes that can only be fully understood by in-depth analysis of preconditions, current situation and future prospects for each country. Space, however, precludes this; we shall attempt, as far as possible to portray individual contexts and complexities for a selection of countries only, while also conducting comparative analysis of similarities and differences across this vast continent. Table 1 presents various demographic characteristics of all Asian countries, highlighting the percentage of the population ages 60+, both in 2006 and projected for 2050. Japan leads the way in percentage of population aged over 60 years, at 27%, second and third are Georgia and Cyprus and fourth place is Russia, which is included here due to the huge proportion of its area that lies in Asia, but yet which remains more of a European country with higher levels of longevity, notwithstanding the economic travails of recent years. Following these are the flying geese countries (i.e. China, Singapore, Korea), as well as Kazakhstan, plus other countries in Central Asia and the Middle East, and Indonesia and India. In general, for most of the Asian countries the male-female sex ratio at aged 60+ and aged 80+ shows that there are less men than women in each country attaining these older ages (Table 1). In human populations the male-female sex ratio at birth results in more males than females being born (Hesketh and Zhu, 2006), although distortions to this trend occur in a number of countries including Asia and North Africa, due in part to the tradition of a preference for sons (Dummer and Cook, 2008). Generally females have longer life expectancy than males and hence despite trends in the sex ratio a higher proportion of women attain old age. For example, Japan has 72 men per 100 women aged 60+. This ‘feminisation’ of the population, coupled with the trend for husbands/partners to die before their spouses, results in a high number of older single females. This trend has implications for financial support for older women whose participation in the labour force is often low and who lack economic security in old age. Thus in some Asian countries the demographic process is creating a population of vulnerable older women (Mujahid, 2006).

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374,802 34,751 795 144 24,282 1,118 434 6,795 921 561 2,595 147,799 1,653 51 2,284 ,,945

Asia

Japan

Georgia

Cyprus

Russian Federation

China, Hong Kong SAR

Armenia

Republic of Korea

Israel

Singapore

Dem. People's Rep. of Korea

China

Kazakhstan

China, Macao SAR

Sri Lanka

Thailand

20,702

6,919

214

3,600

431,532

5,622

1,983

2,561

18,401

833

3,577

34,755

349

1,077

46,748

1,231,237

1,568,124

400,029

11

11

11

11

11

11

13

13

14

14

16

17

17

18

27

9

8

20

28

29

41

28

31

23

38

25

41

33

39

31

30

36

42

24

20

83

88

89

60

92

78

89

77

77

67

91

51

84

67

78

88

88

72

440,170

Less developed regions

32

247,753

More developed regions

% 2050 Aged 60+

% 2006

No. 2006

Country or area

No. 2050

Sex ratio

Population aged 60 years and older (‘000)

10

9

10

8

9

10

8

6

7

6

6

5

6

5

3

10

11

4

2006

3

3

2

3

3

4

2

3

2

3

2

3

3

2

1

4

4

2

2050

Potential support ratio

55 / 55

55 / 50

..

63 / 58

60 / 60

..

55 / 55

65 / 60

60 / 60

63 / 59.5

65 / 65

60 / 55

65 / 65

65 / 60

65 / 65

-

-

Men / Women

Retirement age

Table 1. Demographic characteristics of Asian countries, 2006 and 2050

17 / 20

17 / 21

21 / 24

14 / 19

17 / 20

13 / 17

20 / 23

21 / 24

18 / 23

17 / 20

22 / 26

14 / 19

20 / 23

17 / 20

22 / 27

17 / 20

17 / 19

19 / 23

Men / Women

Life expectancy at 60

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Country or area Lebanon Azerbaijan Indonesia Turkey India Myanmar Kyrgyzstan Viet Nam Malaysia Bhutan Iran (Islamic Republic of) Philippines Turkmenistan Uzbekistan Pakistan Nepal Mongolia Cambodia Bangladesh Lao People's Dem. Republic Jordan

Population aged 60 years and older (‘000) No. No. % % 2006 2050 2006 2050 372 1,147 10 24 777 2,591 9 27 19,049 67,355 8 24 5,988 23,056 8 23 89,922 329,683 8 21 3,926 15,521 8 24 401 1,481 8 22 6,358 29,768 7 26 1,847 8,405 7 22 156 646 7 15 4,562 26,393 6 26 5,221 25,387 6 20 301 1,437 6 21 1,653 8,153 6 21 9,445 46,745 6 15 1,608 7,225 6 14 153 863 6 24 821 3,905 6 15 8,264 40,672 6 17 321 1,520 5 13 303 1,932 5 19 Aged 60+ 85 71 82 83 91 86 68 88 91 92 95 85 70 77 96 77 83 58 93 84 104

Sex ratio 2006 9 9 12 12 12 13 10 12 14 12 15 15 14 13 15 16 17 17 17 15 18

2050 4 3 4 4 5 4 4 3 4 7 4 5 5 5 7 7 4 7 6 8 5

Potential support ratio

Retirement age Men / Women 64 / 64 62 / 57 55 / 55 60 / 58 58 / 58 .. 62 / 57 60 / 55 55 / 55 .. 65 / 60 60 / 60 62 / 57 60 / 55 60 / 55 55 / 55 .. .. 57 / 57 60 / 60 60 / 55

Life expectancy at 60 Men / Women 17 / 19 17 / 21 16 / 18 16 / 18 16 / 18 17 / 18 16 / 20 18 / 20 17 / 19 17 / 18 17 / 18 17 / 19 15 / 19 16 / 20 17 / 17 15 / 17 15 / 18 16 / 18 15 / 17 16 / 17 17 / 19

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Country or area Tajikistan Maldives Dem. Republic of TimorLeste Brunei Darussalam Syrian Arab Republic Bahrain Saudi Arabia Iraq Occupied Palestinian Territory Afghanistan Oman Yemen Kuwait Qatar United Arab Emirates 1,118 6,253 976 5,249 1,280 326 2,115

170 1,365 111 790 89 22 77

4 4 4 4 3 3 2

5 5 5 5 5 5 11 6 20 9 24 25 23

76 98 110 92 144 235 145

97 122 85 105 110 88

278 136 7,003 267 8,106 8,318

50 18 929 34 1,163 1,338

9 20 19 23 16 13

Aged 60+ 86 112

% 2050 16 15

No. 2050 1,710 102

No. 2006 333 17

% 2006 5 5

Sex ratio

Population aged 60 years and older (‘000)

Table 1. (Continued)

17 19 24 23 40 59 72

19 21 19 23 20 20

2006 15 16

9 16 5 12 3 3 4

12 5 5 4 6 8

2050 7 7

Potential support ratio

60 / 55 60 / 55 60 / 55 50 / 50 .. ..

55 / 55 60 / 55 60 / 55 60 / 55 60 / 55 ..

Men / Women .. .. ..

Retirement age

17 / 19 14 / 15 18 / 20 15 / 17 19 / 22 18 / 20 20 / 23

14 / 16 18 / 22 17 / 19 18 / 20 17 / 19 15 / 16

Men / Women 17 / 20 16 / 17

Life expectancy at 60

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Table 1 sources: World Population Prospects: The 2004 Revision, vol. I: Comprehensive Tables (United Nations publication, ST/ESA/SER.A/244); vol. II: Sex and Age Distribution of Populations (United Nations publication, ST/ESA/SER.A/245); Living Arrangements of Older Persons around the World (United Nations publication, ST/ESA/SER.A/240); United Nations, Demographic Yearbook (various issues); national statistics; United States Bureau of the Census, International Programs Center, International Data Base; International Labour Organization, International Labour Office database on labour statistics LABORSTA internet (http://laborsta.ilo.org); United States Social Security Administration, Social Security Programs Throughout the World (Europe, September 2004; Asia and the Pacific, March 2004; Africa, September 2005, the Americas, March 2004), and International Updates (through September 2005). By contrast, for some countries such as India and China, the male/female sex ratio at 60+ is closer to parity at 91. These countries have a somewhat skewed male/female sex ratio compared to many other countries – i.e. a higher ratio of boys than girls are born (Dummer and Cook, 2008) – and this is reflected in the proportion of men reaching old age. Some of the relatively affluent countries which still have quite young populations (including Jordan, Brunei, Kuwait an Oman) have male/female sex ratios for age 60+ that exceed 100, indicating a bias for aging and longevity in these countries in favour of men. The potential support ratio is the ratio of the population aged 16-64 years compared to population aged 65+ years. It is an indicator of the development status of a nation, as it reflects an aging population distribution, and has declined amongst most developed countries and is projected to shrink rapidly across Asian countries over the next 20 years (Mujahid, 2006). Lower support ratios indicate declining birth rates coinciding with population aging and generally, countries with highest life expectancy also have the lowest support ratios. These trends may be indicative of problems in the future with regards to supporting an aging population: including the availability of care givers, particularly in countries without adequate state support for the elderly and where the family is usually the main support provider. This trend also has financial implications because of the economic costs of establishing or maintaining support networks. By 2050 most countries in the region are projected to have large aging populations and in many countries the potential support ratio is projected to be between 1 and 5, suggesting that within four decades most countries in the region will be dealing with issues related to an aging population and declining birth rates and a requirement to support this increasingly aging population. Clearly in these situations health and social welfare / support for older people will become crucial issues that require planning now.

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Source: Britannica World Data, Britannica Book of the Year 2007, Chicago: Encyclopaedia Brittanica.

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Figure 1. Percentage of population defined as elderly in Asian countries (2000).

Figure 1 shows the spatial distribution of the percentage of elderly (aged >60 years) in the Asian countries, highlighting a clear East-West and North-South trend, with the more developed eastern and northern countries having the highest proportion of their population defined as elderly. As is well known these are exciting times for many Asian countries, with booming economies and a rapid transition for many from being inward-looking, insular, peasant societies to being outward-looking, sophisticated, urban-industrial societies that are benefiting from a combination of cheap labour, adequate or even abundant natural resources, state-led provision of infrastructure and high levels of Foreign Direct Investment (FDI). Whether or not one accepts the ‘Flying Geese’ theory, it is certainly the case that in East and South East Asia at least, Japan led the way in economic development and change followed by such countries as Taiwan, Singapore, South Korea and Hong Kong, then the likes of China and Thailand, followed by Vietnam. Apart from Vietnam, where percentage of elderly is 7%, these are all countries where the percentage of elderly is above the Asian average of 9%. We do not wish to be economic determinists, but it is salutary that all these aforementioned countries are represented here, and it is to their credit that their people are living longer.

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Whilst the challenges to coping with an aging population are great we must also look with optimism at the positive aspects. In a social sense older people offer experience and wisdom as well as the potential for economic input (United Nations, 2008). The growth of the so called silver marker is one positive aspect of the demographic transition, and in many countries in the region, including Hong Kong, China and Japan, the silver market is becoming a fast growing sector of the economy. For instance, in China the silver market is thought to be worth an estimated US$37.5 billion, and international trade fairs highlighting products geared directly towards the elderly are now part of the commercial landscape in some urban centres (United Nations, 2008). Table 1 only provides a snapshot in 2006 and projections for 2050. We therefore provide Table 2 for countries where percentage of elderly is 7% or greater in order to compare demographic change over a 20 years or more period, and add the most recent figures for the total per cent elderly as a final column to aid comparisons. The period covered is of the order of only two decades and yet some of the differences are extraordinary. Twenty years ago only four countries had over 10% of their population within the 60 or more age range, namely Israel, Hong Kong, the former USSR and Japan. Now, it is 9 countries that have passed this significant milestone, as can be seen in the final column, while Japan is far ahead of this figure, with Russia not too far behind. Some countries have an increase in proportion of the elderly of 5% or more, with Japan’s increase being a remarkable 10.5%. Rigg (1997: 142) noted for Southeast Asia just over a decade ago that, although the population was generally young, ‘ a significant challenge for the future will be support and care of the elderly’ as significant change took place in their societies, including modernisation, allied to ‘greater mobility and the spatial dysjuncture [sic] of family members’ which reduces the possibility of co-residence. Often , these latter have a specifically urban element. We consider these aspects in a later section, but first we turn to countries where aging is an exception. As noted above, much of Asia is undergoing a period of rapid demographic change, driven by declining birth and death rates, with a concomitant increase in the proportion of the population defined as elderly (aged 60+ years). For many countries in the region longevity and increasing life expectancy is becoming an increasingly normal component of the population structure. For example, life expectancy is 82.6 years in Japan, 82.2 years in Hong Kong, 80.7 years in Macao, 80 years in Singapore and 78.6 in South Korea. China is fast approaching these countries with a life expectancy of 73 years, which contrasts dramatically with the next most populace country in the region, India, where life expectancy is only 64.7 years – although the percentage of the elderly in India still exceeds 7%.

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Table 2. Demographic Change Over Two Decades 21st Century Total % 60+

Country

Census Total % % Total % Year Population 60-74 75 + 60+ Notes

Japan

1980

117

9.8

3.1

12.9

Russia

1979

262.4

9.6

3.4

13

Israel

1983

4

9.4

3.1

12.5

13.1

Hong Kong

1981

5

8.2

2

10.2

Lebanon

1970

2.1

7.7

7.7

14.9 9.8

Bhutan

1969

0.9

7.1

7.1

1982 est.

7.2

Turkey

1980

44.7

6.6

6.6

2000 est.

8.8

China

1982

1008.2

6.3

1.3

7.6

10.4

Singapore

1980

2.4

5.9

1.3

7.2

10.7

Taiwan

1980

18

5.7

1

6.7

Thailand

1980

47

5.5

5.5

12 9.4

Sri Lanka

1981

14.8

5.2

1.4

6.6

9.7

South Korea 1980

37.4

5.1

1

6.1

Vietnam

1979

52.7

4.9

0.9

5.8

Indonesia

1980

147.5

4.5

1.1

5.6

India

1981

685.2

4.2

0.8

5

1980 est.

7.1

Kyrgzstan

na

na

na

na

na

na

9

Kazakhstan

na

na

na

na

na

23.4 USSR, 1980 est. 18.5

13.7 1980 est.

8 7.2

10.6

Source: Britannica World Data, Britannica Book of the Year 1985, Chicago: Encyclopaedia Brittanica (except final column, for which it is as Table 1).Opposites to longevity: birth rates and life expectancy in selected countries

An issue for India is the huge variation in life expectancy and elderly population within different regions, but India would now seem to be amassing the wealth required to ameliorate poverty and improve health for the poor within Indian society. For some countries in Asia an aging population is still an exception rather than a normal component of population composition: Bangladesh, Pakistan, Nepal, Cambodia, Laos and the Philippines are all still young nations where the proportion of the elderly (aged 60+) is well below 7% (see Table 1 and Figure 1 above). Despite the processes of globalisation and rapid economic development these countries are predicted to have elderly populations around or below 10% by 2025. In a positive sense the slow rate of growth of the elderly population in these countries means they have longer to plan and develop policies to cope with the

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issues facing aging societies, issues that are currently facing rapidly developing and aging countries such as China and India. On the other hand, these countries face enormous problems to improve the health and wellbeing of their populations. Bangladesh, discussed further below, provides a reminder that some of the problems faced by such countries may be insuperable, or, at the very least will require significant external support via Foreign Direct Investment in the private sector or assistance with infrastructure development in the public sector in order for longevity to eventually occur. Khan, (2009, this volume) considers a range of issues concerning Bangladesh, as do Parker and Bihan (2009, this volume) for Nepal where the proportion of the elderly is on the increase, but from a low base. Caldwell and Caldwell (2002; 2006) among others have drawn attention to ill health in Dhaka, the capital of Bangladesh. Their analysis shows clearly the concentration of ill health among the shanty-town dwellers of the basties (bosties), Dhaka’s squatter settlements. Dhaka had a population of only 300,000 in 1951, but with rural-urban migration reached around 12,000,000 by the early years of this century, and the city is growing at 500,000 a year, fuelled mainly via migration rather than indigenous growth. In the 2002 paper, Caldwell and Caldwell report a 1999 health survey of the poorer population of the city. On the positive side, many reported better health in the city compared to previous rural areas due to greater availability of health services and doctors in the city. The ‘very poor environment in which they lived’ was the main negative factor in limiting health gains, with this including a dreadful lack of sanitary facilities and high levels of atmospheric pollution , including lead, nitrous oxides abd suspended particulate matter. The pollutants retard mental and physical development of children, and contribute to respiratory diseases, while the lack of toilet facilities and clean tap water means ‘that such infections as pneumonia and diarrhoea remain major killers of children, and tuberculosis of adults’ (ibid.: 62). There was also a lack of professional trained birth attendants present, with local untrained albeit experienced women taking their place as midwives. By their 2006 article, the authors found that Under-Five Mortality thanks to ‘improved public health measures, especially immunization’ (Caldwell and Caldwell, 2006: 57) had enabled a major drop in mortality from 153 per thousand in 1983/4-1993/4 to 98 in 1994-2004 in rural areas, while the equivalent urban drop was from 114 to 92 in these time periods. Although Dhaka in general is healthier than rural areas, compared to the latter ‘urban slums now appear to suffer from worse infant and child mortality’ (ibid.: 58). Features of the bosties such as open sewers, floods, lack of waste collection, lack of proper drainage facilities and paved streets, lack of security of tenure making all but the most basic improvements by the bosty dweller a waste of time and resources combine

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with a range of social and cultural factors to limit the potential benefits of proximity to sophisticated urban healthcare. Here, we can use the term ‘social distance’ for the poor often receive ‘disrespectful’ treatment from public health providers, while poor women often lack the education to demand or request professional assistance at antenatal, natal and postnatal stages. There is also the cultural dimension in which, for example: ‘The preference for giving birth at home reflects a view that the hospital is an alien environment, where little provision is made for the needs of expectant mothers, and the home is the most supportive environment, as a woman can get care from family and friends. It is also in keeping with the institution of purdah, the practice of maintaining female modesty by screening them from men or strangers. Male relatives often oppose the change from the private home to a more public hospital’ (Caldwell and Caldwell, 2006: 60-61).

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This example of Dhaka shows that despite urban advantages, for the poorest of the poor, cities can be life-limiting locations rather than life-enhancing ones. Although we hope that these urban constraints will prove to be the exception rather than the rule, along with the other constraints and limitations noted previously we recognise that although Asian demographic success is here today; this does not necessarily mean that it will still be with us tomorrow.

URBANISATION AND THE ELDERLY Cities might not at first sight seem to be locations suitable to the elderly; they are full of traffic, subject to environmental pollution, can be insecure due to glaring socio-economic disparities between rich and poor, and at the mercy of the global economy, which at the time of writing is showing signs of recession, including a collapse in property prices, the sub-prime mortgage market and thus banks. And yet, despite such negativities something about cities is generally encouraging the elderly to flourish and a city such as Shanghai for example, is becoming known as a city of the elderly, as Cook and Powell, 2007b, have shown. A few years ago Rigg summarised the situation in Singapore, a city-state in which due to high rates of increase in the elderly population, from 3.7 per cent over 60 in 1960 to 8.5 per cent in 1990 and projections of up to 29.4 per cent by 2030, ‘has raised fears that those who have not made sufficient contributions to the Central Provident Fund may find themselves without an adequate income’ (Rigg, 1997: 144). A ‘Maintenance of Parents Bill’ was passed in 1994, imposing a legal

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obligation on children to support their parents on retirement. Such an Act was also found elsewhere, for instance in China where a system of ‘support contracts’ were rolled out in the 1990s from a mid-1980s model tried out in Jiangsu Province to other Provinces including Beijing (Powell and Cook 2000: 86); such experiments led to a law passed in 1996 on ‘The Rights and Interests of the Elderly’ that imposed similar obligations on family members to support their aging parents (Du and Tu, 2000, cited in Cook and Powell, 2005: 84). Such laws are obviously drastic steps; so bound up with ‘Asian values’ and neoConfucian-like obligations and family responsibilities, that it would probably be nigh-on impossible to legislate similarly in the countries of Western Europe, North America and elsewhere. Be that as it may, ‘face’ is still so important in many Eastern societies that one can easily imagine how difficult it must be for elderly parents to deal with the shame of having to take their children to court in order to secure adequate income. In China, there have been examples of ‘gerontocide’ in which suicide is preferable to such a public humiliation. Cook and Powell (2005: 84-5) give the example of a 76 year man in 2004, who blew himself up during such a court case because his family had offered only 350 Yuan a month rather than the 600 Yuan he needed. As they note: ‘In a society of rapid transformation, the elderly in particular may be vulnerable to a sense of abandonment within a more materialistic and selfish new world epitomized by the forces of global capitalism and seeping impingement into day to day living of older people in China’ (ibid: 85)

To this quote we can add the comment that such rapid transformation is often urban, in that the pace and pressures of urban living can make it difficult to retain basic human values, including the need to offer regular support, financial or otherwise, to one’s aging parents. Another feature of urbanism is the mobility and spatial disjuncture noted above by Rigg. The fact that half the world’s population is now urban means that population loss from rural areas has continued apace, but it is a differentiated population loss. Noted many years ago by the noted economist and social scientist Gunnar Myrdal and others, the ‘cycle of circular and cumulative causation’ of regional inequalities is fuelled by the departure of the younger, better-educated, more skilled people from the rural population. As a result, there can often be a residual elderly population left in rural areas, along with women and/or grandchildren as the males in particular migrate to the towns and cities to look for work. Life can be hard in such a rural location as the elderly are often required to

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work to maintain their livelihood, work the family plot and look after the grandchildren. And so, in China for example, with regard to the elderly: ‘official data for the 1990s showed that 26 percent of people [i.e. the elderly] in rural areas still depended on their own labor earnings compared to only 7 percent in urban areas’ (Cook and Powell, 2005: 85). Such work ensures an active lifestyle that could on the one hand ensure longevity, or it could on the other hand hasten decline as the pressures become too much for the aging person, especially if their spouse dies. Another aspect to note is childlessness. In Singapore, for example, groups of childless immigrants have been identified as samsui (female labourers), coolies (male labourers) and amahs (domestic servants) (Davidson and Drakakis-Smith, 1995, cited in Rigg, 1997: 144). Such groups can face a potentially lonely and dependent old age, but in Singapore the authorities have combated this possibility via state support for Voluntary Welfare Associations, Public Assistance plus a Rent and Utilities Access Scheme for which they are eligible (ibid.). However, facilities for the elderly are under huge pressure as the numbers grow. Balancing that to some extent is the fact that, as Heller (1996: 19) points out, for booming economies such as Singapore (and notwithstanding the setback of the Asian Financial Crisis in the late 1990s), the aged population has built up ‘a stock of assets, both real and financial (and both internal and external), that can be drawn upon to help finance the consumption needs of an elderly population’. Some labourers and amahs will have accumulated such resources, but the likelihood is that most will not; the variability within the elderly needs to be recognised, in order to differentiate between ‘silver surfers’ or ‘golden oldies’ with their grey dollars, grey yen or grey yuan for instance, and who are usually the active elderly, from the elderly poor who are likely to be vulnerable and require effective external support systems. The current credit crunch may also have precipitated a movement towards the vulnerability end of the spectrum, not least because it is occurring at the same time as the potential Asset Market Meltdown that Kihara (2009, this volume) predicates after retirement of the baby boomer generation that is now coming towards retirement age. Of all countries of Asia it is Japan that is furthest down the aging road. By September 2007, it was calculated that 22% of the population was aged over 65 [not the 60 noted in the above tables], with 27.44 million of the 127.76 million population officially classed as elderly, and with 7 million people aged 80 or older (AP, 18th September 2007). In the world’s most highly populated metropolis, Tokyo, the elderly are more likely to be concentrated in the central wards, while younger families have moved to the suburbs (Cybriwsky, 1998: 103). The historic older wards are more likely to have higher proportions of the elderly, with some

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(such as Chiyoda ward) reaching near to this 22% proportion as far back as the mid-1990s. The lack of younger people caused officials of one ward to offer financial incentives to pay newly-weds, provided that no partner was aged over 40 years, and the combined ages were under 70 with a combined income below a set threshold, to come and live there (ibid.: 176). Further, urban developers ‘are often on the lookout for properties owned by older people, calculating that land might become available after an owner’s death. Sons and daughters who inherit such property are often forced to sell it to pay the city’s extraordinarily high inheritance taxes’ (ibid.: 103-4). This last point could be a potent factor in a growing phenomenon of elderly migration, which also reflects worries about financial security, rising numbers of never-married people, plus higher divorce rates that leads to reduction in the classic ‘Asian extended families’ syndrome, so that for example ‘divorce is no longer a shame with severe social stigma. For many, divorce in fact means the start of a new life in retirement. Divorce rates among senior couples in Japan are likely to rise after April 2007 when a policy will be put in place to grant a divorced woman up to half of her spouse’s pension’ (Toyota, 2006: 519). Intriguingly, the new generation of Japanese elderly are also ‘seeking new life experiences after retirement’ (ibid.: 520). They may be part of a new phenomenon called ‘global householding’, and although the numbers are still small, Toyota studied Japanese retirees in Chiang Mai, Thailand and gives estimates of there being over 1000 living there, while others have estimated 15,000-20,000 in Bangkok. The vast majority of those in Chiang Mai were male, but if Toyota is correct about the impact of the new divorce settlements one would expect to see an increase in female retirees in these and other locations, due to climate, low living costs and the novelty of having an exotic place in which to live. Some live ‘pendulum lives’ spending the winter in Thailand and the summer in Japan, in similar vein to those north Europeans who use the Mediterranean as a similar pendulum point for the winter. Paradoxically, due to Japan’s strict immigration laws and restrictions on being able to pay extra for hospital care even if one can afford it, there is an element of forced migration in some of the examples Toyota gives, with families looking overseas for cheap care for even older family members, in contrast to Singapore and Hong Kong where amahs now number many thousands and provide the care for the host elderly at a cheap rate. Another linked phenomenon to this migration is ‘medical tourism’ in which people (not necessarily older, but likely to be) from North America or Western Europe will have a replacement hip operation in an Asian country like India where costs are much cheaper but where the standard of private health care is good. A hip may cost $40,000 to replace in the United States, $15,000 in France

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but only $6,000 in India and the operation is often combined with conventional sightseeing activities in the Asian country. The home health agency or insurance provider may even pay towards the cost of the operation, perhaps leaving the patient to find the airfare only (Eggertson, 2006; Turner, 2006). Inherent in such activity is a twist on the old problem of ‘brain drain’ in which doctors and nurses from Asian countries migrate to the wealthier countries of North America or Western Europe, and this activity too raises ethical issues for global society in general, not just for the countries involved. As Dummer and Cook (2008) note, for instance, Indian health provision does not reach the poorest sectors of Indian society, so we can ask is it just that wealthy people from overseas can take advantage of this type of opportunity for surgery purely because of differential incomes at the global scale?

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TRADITIONAL MALTHUSIAN CHECKS TODAY Thomas Malthus famously suggested that population growth would be checked by wars, famines and other calamities. The burgeoning growth in human population in the last century and a half suggests that his views were wrong. But at the time of writing two drastic examples of Malthusian checks have recently occurred; namely Cyclone Nargis that hit Myanmar and the earthquake that hit Sichuan Province in China. As a result, tens of thousands have died in each country, and it is expected that the death toll will rise still further as disease spreads in Myanmar, and as eventual removal of the rubble in China reveals a truer level of devastation, while aftershocks may threaten the area further. Both of these tragedies would seem to have a major human element, especially in Myanmar where the military government took too long to allow a large-scale international relief effort into the country, for fear of a diminution in governmental power and control. In contrast, in China the relief effort has not needed much in the way of international intervention due to the large-scale response of the authorities, who within 14 minutes of the quake started to send troops to the earthquake zone. What is emerging in Sichuan, however, is the high death toll in schools. Parents of the lost children are accumulating evidence that purports to show a lack of steel and concrete in the collapsed structures, with allegations of corruption against local officials and builders who took dangerous shortcuts to fulfil their contracts (Branigan, 2008: 2). In contrast to the collapse of many school buildings, government buildings generally seem to have been built of sufficient strength to withstand the earthquake. The Chinese authorities are

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promising a full enquiry into these allegations, and severe action against any found guilty of such inhuman crimes. It is also only a few years since the Asian tsunami hit so many countries around the Indian Ocean, from the epicentre of an earthquake off the coast of Sumatra in Indonesia right across to Thailand, Sri Lanka and East Africa. The death toll was around 250,000 and despite this, too, seeming a natural disaster, there was a human element via the lack of an early warning system to warn of the huge tidal wave that arose in the aftermath of the earthquake. The contrast made was with the Pacific Ocean early warning system that is designed to provide a rapid spread of information should a similar tsunami arise in this ocean, and at least provide some opportunity of evacuation to higher ground before the tidal wave hits the land. Other anthropomorphic factors to also be referred to in the aftermath of the Asian tsunami was the removal of mangrove swamps along some coastlines, swamps that would have helped to dissipate the power of the giant wave somewhat, while related to this removal of swamps many tourist facilities have been built too close to the shore in many Asian countries, rendering more people vulnerable in the face of disaster. The main discourse on Asia today is one that emphasises economic development, but while this is indeed an important part of human affairs on this continent, there is also vulnerability to a wide range of hazards. In China, for example, over the seven different regions that can be identified across the People’s Republic, are the wide range of environmental pressures noted in Table 3. Of this long list, the most severe include air and water pollution, including the impact of large-scale coal burning and rapid industrialisation, respectively, drought and desertification with the spread of desert conditions across the north of China, notwithstanding the valiant attempts to build huge-scale shelter belts of trees across North China, soil erosion and the ever-present earthquake threat, as illustrated above (Cook, 2007; Cook and Murray 2001; Murray and Cook, 2002, 2004). One of the concerns over the giant Sanxia Dam, for instance is that an earthquake may damage the dam to cause widespread flooding at the cost of many thousands of lives. There is concern that other dams in Sichuan Province have been severely damaged by the 2008 earthquake, and remedial work has been undertaken to try to ensure that flooding does not take place over a vast area of the Chengdu plain.

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Region 1. Temperate Humid and Subhumid Northeast China 2. Warm Temperate Humid and Subhumid North China

Main Environmental Pressures Water pollution; Soil pollution; Frost.

Water pollution; Soil pollution;Lowering of groundwater table;Drought; Desertification; Floods;Soil erosion (Loess Plateau); Locusts (North China Plain);Salinisation (North China Plain);Tidal waves. Air pollution; Frost; Drought; Floods; Soil erosion (Mountains); Leaching (South West);Tidal waves and tsunami. Typhoons; Frost; Floods; Soil Erosion (Mountains); Leaching; Earthquakes and avalanches (Mountains). Drought; Desertification (Ordos Plateau);Rats.

3. Subtropical Humid Central and South China 4. Tropical Humid South China 5. Temperate Inner Mongolia Grasslands 6. Temperate and Drought; Salinisation;Rats (Pastoral Area). Warm Temperate Desert of Northwest China 7. Tibetan Plateau Frost; Hailstorms; Rats. Source: Cook, I.G. and Murray, G. (2001), China’s Third Revolution: Tensions in the Transition to Post-Communism, London: Curzon: 204.

In the light of such environmental hazards it is quite remarkable to what extent China and other countries have extended their population’s lifespan. Then there is the other classic Malthusian check of war, which fortunately much of the Asian continent has now been spared for several decades. But although often less dramatic than, say, the Vietnam War or the two Iraq wars, conflict has been a feature of the life of people in many countries, including Nepal where there has been government-Maoist conflict until the recent ceasefire, Afghanistan where the war against the Taliban/ Al Qaeda has largely replaced previous struggle against the Soviet Union, Islamic insurgency in the south of the Philippines, the continuing struggle between Israel and its neighbours, including the Palestinians in Gaza (Hamas) or supporters in the Lebanon (Hisbollah). ‘Terrorism’ is a feature of many Asian societies, including war with the Tamil Tigers in Sri Lanka, Naga insurgency in India, tribal rebellions in Myanmar and those based in Sumatra. Blood is shed via bombings, including suicide bombings, landmines, the

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ubiquitous cheap Kalashnikov and other increasingly ingenious and lethal means, including Sarin gas in Japan. Often, the deaths from such conflicts are relatively small-scale, having an impact factor that outstrips the actual loss of life; nevertheless many Asian conflicts have the potential to escalate towards massive loss of life and could prove a limiting factor in further expansion of longevity across the continent.

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NEO-MALTHUSIAN CONSTRAINTS ON LONGEVITY How many people can the Earth support? Is there a restriction on the amount of population growth that is possible, and is there a limit to human longevity? Neo-Malthusian constraints on longevity include, apart from the ‘natural’ disasters noted in the previous section, the threat of both resurgent and new communicable diseases, global warming and climate change, and the biophysical composition of the human body. Across the globe, for example, medical experts and decision takers have been building their contingency plans and, where possible, stocks of vaccines in order to deal with the ‘big one’, the major pandemic that has been expected for several years. SARS and Avian Flu have provided the opportunity to test some of these contingencies with, to date, significant success in restricting deaths from these diseases to the minimum. It may be unfashionable given the nature of modern development in the tropics, but it is worth considering whether the nature of the tropical environment with its high levels of humidity and temperature combined poses an intrinsic risk to the human species. Especially when animal species – pigs and chicken in particular – are in close proximity to humans, does this create a particularly lethal situation for the rise of new dangerous viruses and bacteria capable of crossing the species barrier to deadly effect? Or is this merely another danger, to sit alongside potential cross-species threats of foot and mouth, blue tongue disease, CJD and bovine tuberculosis, all of which are found in the temperate climate of the UK for example? A few decades ago, Western colonial specialists on ‘the tropics’ such as O.H.K. Spate or Pierre Gourou, for instance, were quite clear on the threat of ‘tropical diseases’. The sub-continent of India, for example, was at one time viewed as ‘something of a world endemic home of cholera and small-pox [sic], from which the diseases burst forth in occasional epidemic years to bring death and terror in a random harvest of epidemics’ (Spate and Learmonth, 1972: 138). Similarly, in a chapter entitled ‘Unhealthiness of the Hot, Wet Regions’, Gourou examines such diseases as malaria, intestinal diseases, kala-azar that ‘causes

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considerable havoc in India’ (Gourou, 1966: 11) and also sleeping sickness. These are largely caused by environmental conditions in which:

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‘The steady high temperature, the humidity of the air, the many water surfaces fed by the rains are necessary for the continued existence of pathogenetic complexes in which man, an insect, and a microbe or parasite are closely associated’ (ibid.: 8).

Thanks to vaccination campaigns, greater attention to sanitation, urbanisation and economic development the dangers that the tropical environment once posed would seem to be far less and the risk to humans are now considerably reduced. Certainly, diseases such as typhoid or schistosomiasis are no longer the dangers that they once were, but, unfortunately, they have not been eradicated as Cook and Dummer (2004) and Dummer and Cook (2008) have shown for China and India respectively; indeed such diseases may now be resurgent, giving a new twist to the epidemiological transition model discussed above, suggesting that diseases of poverty and affluence can exist together in large developing countries such as China or India. Dengue Fever in India may even be associated to an extent with the high population densities of contemporary urbanisation, although the evidence as yet is still not definite, with ‘metropolitan areas such as Delhi and rural states such as Haryana and Maharashtra alike suffering from this mosquito vectored disease’ (Dummer and Cook 2008). It may be, therefore, that resurgent diseases combined with such new diseases as HIV/AIDS may at some point endanger the longevity gains of recent decades. The prognosis is difficult: on the one hand there is evidence that the human species can build up resistance to pathogens; on the other, it is clear that resistance of the disease-carrier, such as malarial parasites to pesticides and drugs can also increase. As Porter (1997: 488) notes of the malaria parasite it was in South-East Asia that it first showed resistance to chloroquine and ‘The parasite changes its genetic makeup more rapidly than the pharmaceutical industry can produce new or tested drugs’. There are also concerns about the side-effects of new drugs, of global air travel that ‘has provided a perfect means of spreading infected mosquitoes around the globe, while global warming is exceeding the habitats suitable for them’ (ibid.), and more recent worries that the major pharmaceutical companies have little interest in new low-cost drugs due to their low profit margins coupled with the high cost of the research required to make marginal gains in the struggle against disease. Perhaps the biggest environmental hazard facing the world today is the threat of climate change. For the health and well being of many of some of the poorest

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nations in the world the impact of climatic changes (such as warmer climates and water scarcity) on health may be profound. For example, Asia is likely to experience increases in cholera due to rising water temperatures increasing the prevalence of cholera bacteria and rising malaria incidence as environmental conditions cause malarial mosquitoes to proliferate. There is also a high likelihood that global warming may hasten the spread of animal born diseases to human populations. Such animal to human disease transmission (zoonosis) is a consequence of declining animal habitats and increasing human populations, combined with changing environmental condition, which result in more contact between humans and wildlife and consequent crossover of diseases (BBC News, 2008). Although many of the countries in Asia are geographically vast the huge increases in the human population, and environmental changes due to climate change and urban development, are putting more and more people into contact with wildlife and associated animal born diseases. Linked to climate change, and caused by socio-economic, environmental and ecological factors, emerging infectious diseases are a major threat to the health of many nations, especially those in Asia. As already noted these emerging infectious diseases include variants on old infectious diseases (i.e. multi-drug resistant TB and malaria) and diseases that have only recently entered human populations (i.e. avian influenza and SARS). Jones et al (2008) identify emerging infectious disease hotspots that are concentrated in Asia, and it is these nations where the financial resources required for monitoring and managing public health are either scarce or not available. Hence, many Asian nations are faced with the twin problems of coping with increasingly older populations, who require more social support and health care, and dealing with health issues driven by climate and environmental change. Rising temperatures will lead to high levels of ice melt, both in the Arctic and Antarctic but also in the mountain glaciers of the Himalaya. Floods are the result, exacerbated by economic development that has stripped forest cover in upland areas or removed mangrove swamps along coastlines, reducing areas of absorption of water in each case. High population concentrations in delta areas and coastal cities means that millions will be increasingly vulnerable as the 21st Century unfolds. According to Anam: ‘In the next 50 years, 17% of Bangladesh’s landmass is sure to go underwater, causing more than 30 million people to become homeless. Those who live further inland will be only slightly better off: the cyclones and floods that are already a feature of the weather will occur more frequently and with greater ferocity. Geological events stimulated by changes on temperature will mean intense pulses of rainfall followed by periods of drought, and a potential

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Ian G. Cook and Trevor J.B. Dummer collapse of the monsoon cycle itself. If the sea level rises by 5m (16ft), Dhaka will go under’ (Anam, 2008: 8).

In her visit to the Jamuna chars – short-lived islands composed of silt that become habitable after a few years but are intensely vulnerable to the changing direction of the river – Amar found that people had been made homeless by the river ‘eleven’ times in one case and ‘seventeen’ in another. This is one of the ultimate hand-to-mouth existences around the world, with the men leaving to work in other places and the women responsible for all the work in home, garden or field. A joint UK-Bangladesh project is helping these people who are “the hardcore poor” who not only own nothing but ‘even the ground beneath their feet is a fleeting luxury’ (ibid.). Such an existence may become the prototype for millions, with implications for longevity, unless or until drastic action is taken around the globe to combat the climatic changes that may already be too far gone for remedial action.

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CONCLUSIONS We have shown that for some countries in Asia longevity and old age is now a feature of the demographic landscape. Developed nations, including Japan and Russia, have large populations of old people and life expectancy is as high, or indeed higher, than the most developed nations of the west. Rapidly developing and industrialising countries such as China and the Tiger economies of South East Asia are fast approaching these countries in terms of life expectancy and longevity. However, such countries aside, there are many in the region where old age is not the norm, where infectious diseases dominate and where natural disasters sit side-by-side with economic hardship to put tremendous strains on already weak health care systems and social support networks. Population aging is occurring in these countries, but at a slow rate and unevenly (both spatially and socially). The shifts in demographic profile that will inevitably occur over the next 30 years will pose major challenges to these societies. Most of the developing nations of Asia will have large elderly populations by 2050, but these are likely to be characterised by a predominance of older women who are often economically disadvantaged and who will exert significant pressures on the health care system. Spatially many of the elderly are likely to become marginalised, this includes large pockets of elderly populations remaining in rural and remote areas. These depopulated areas lack adequate support infrastructure as younger and more mobile residents migrate to cities in search of

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jobs and economic opportunities. Conversely, in many countries in Asia rapid urbanisation has resulted in large elderly populations living in overcrowded cities, putting further pressures on these individuals. Across the region there will be a decline in potential support ratios for the burgeoning older population, and for countries where the burden of care for the elderly is traditionally through the family network this again will create tremendous pressures on both the individuals themselves and state support networks. On the positive side, population aging is a welcome result of increasing life expectancy and a consequence of medical, health care, economic and social improvements (United Nations 2008). It is therefore a welcome feature that pertains to many, but at present not all, countries in Asia. The changing demographic structure for the region – apparent or forecast – should therefore be viewed in a positive light. Because the pace of population change in some of the more economically challenged countries in Asia is slow these countries have the added advantage of time to plan and develop adequate social and health care support networks. Coping with an aging population is a challenge for all countries, not just Asia, but by committing resources and anticipating the challenges many countries in the region are well placed to cope with these demands in the future. It is clear that a comprehensive strategy for dealing with issues associated with demographic transition – aging population combined with increasing prevalence of chronic diseases – is essential for all countries. This strategy must go hand-in-hand with the Western world providing support to ensure suitable public and environmental health care systems and social support infrastructure are put in place and funded. Only then will all countries in the region be in a position to cope with the twin issues of population aging (through the process of demographic and epidemiological transition) and the health and social impacts of global environmental change. It remains to be seen whether Asia and the West together will respond adequately to these challenges.

REFERENCES Anam, T. (2008). Losing the ground beneath their feet, The Guardian, G2, 4th September: 6-11. AP (2007). Record number of elderly hits 22% of population, The Guardian, 18th September. BBC News (2008). Map pinpoints disease ‘hotspots’. BBC News http://news.bbc.co.uk/go/pr/fr/-/1/hi/sci/tech/7252923.stm. Accessed 08/10/08.

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Bloom, D.E. and Canning, D. (2006). Booms, busts, and echoes: how the biggest demographic upheaval in history is affecting global development, Finance and Development, 43, 3:8-13. Branigan, T. (2008). The last photo of Zhou Yao, 14 – one of thousands of children killed at their desks, Guardian, 19th May: 1-2. Britannica World Data (2008). Britannica Book of the Year 2007, Chicago: Encyclopaedia Brittanica. Caldwell, J.C. and Caldwell, B.K. (2002). Poverty and mortality in the context of economic growth and urbanization, Asia-Pacific Population Journal, 17, 4: 49-66. Caldwell, J.C. and Caldwell, B.K. (2006). Important issues in the continuing mortality revolution in the Asian and Pacific region, Asia-Pacific Population Journal, Special Issue, 47-64. Cook, I.G. (2007b). Environment, health and sustainability in Twenty-First Century China, Chapter 3 in Sanders, R. and Chen, Y. (eds), China’s PostReform Economy – Achieving harmony, Sustaining Growth, London: Routledge. Cook, I. G. and Dummer, T.J.B. (2004). Changing health in China: re-evaluating the epidemiological transition model, Health Policy, 67: 329-343. Cook, I.G. and Murray, G. (2001). China’s Third Revolution: Tensions in the Transition to Post-Communism, London: Curzon. Cook, I.G. and Powell, J.L. (2005). China, aging and social policy: the influences and limitations of the bio-medical paradigm, Journal of Societal and Social Policy, 4, 2: 71-89. Cook, I.G. and Powell, J.L. (2007b). Ageing urban society: discourse and policy, chapter 7 in Wu, F. (ed.), China’s Emerging Cities, London: Routledge. Cybriwsky, R. (1998). Tokyo: The Shogun’s City at the Twenty-First Century, Chichester, England: Wiley, Second Edition. Davidson, G.M. and Drakakis-Smith, D. (1995). The price of success: disadvantaged groups in Singapore, paper presented at the first EUROSEAS Conference, Leiden, Netherlands, 29th June-1st July. Du, P. and Tu, P. (2000). Population ageing and old-age security, in Peng, W.Z. and Guo, Z.G. (eds), The Changing Population of China, Oxford: Blackwell. Dummer, T.J.B. and Cook, I.G. (2008). Health in China and India: a crosscountry comparison in a context of rapid globalisation, Social Science and Medicine, 67, 4: 590-605. Eggertson, L. (2006). Wait-list weary Canadians seek treatment abroad, Canadian Medical Association Journal, 174 (9): 1247.

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Gourou, P. (1966). The Tropical World: Its Social and Economic Conditions and its Future Status, London: Longmans, Fourth Edition. Heller, P.S. (2006). Asia: ready or not, Finance and Development, 43, 3:18-22. Hesketh, T. and Zhu, X. (2006). Abnormal sex ratios in human populations: causes and consequences, Proceedings of the National Academy of Science, 103, 36: 13271-13275. Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL and Daszak P (2008). Global trends in emerging infectious diseases, Nature 451, 21: 990994. Mujahid G (2006). Population ageing in East and South-East Asia, 1950-2050: implications for elderly care. Asia-Pacific Population Journal, 21, 2: 25-43. Murray, G. and Cook, I.G. (2002). Green China: Seeking Ecological Alternatives, London: RoutledgeCurzon. Murray, G. and Cook, I.G. (2004). The Greening of China, Beijing: China Intercontinental Press. Omran (1971). The epidemiologic transition: a theory of the epidemiology of population change, Milbank Memorial Fund Quarterly, 49: 509-538. Porter, R. (1997). The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present, London: HarperCollins. Powell, J.L. and Cook, I.G. (2000). “A tiger behind, and coming up fast”: governmentality and the politics of population control in China, Journal of Aging and Identity, 5, 2: 79-89. Rigg, J. D. (1997). Southeast Asia: the Human Landscape of Modernization and Development, London: Routledge. Spate, O.H.K. and Learmonth, A.T.A. (1972). India and Pakistan: A General and Regional Geography, London: Methuen, Reprint of Third Edition. Stamp, L. D. (1931). Asia, London: Methuen, Second Edition. Toyota, M. (2006). Ageing and transnational householding: Japanese retirees in Southeast Asia, International Development Planning Review, 28, 4: 515-531. Turner, L. (2007). Medical tourism: Family medicine and international healthrelated travel, Canadian Family Physician, 53(10): 1639-1641. United Nations (2008). Regional dimensions of the ageing situation, New York: United Nations Publications. United Nations Department of Economic and Social Affairs (2002). World Population Ageing, 1950-2050, New York: United Nations Publications.

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INDEX

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A absorption, 195 academics, 78 acceleration, 167 accommodation, 34 accountability, 32 activity theory, 71 acute, 43, 105 ADA, 102, 103 addiction, 71 adequate housing, 29 adjustment, 71 administrative, 32, 34, 73, 74, 76 ADP, 34 adult, 26, 27, 28, 30, 55, 177 adults, 20, 53, 56, 72, 87, 105, 124 advertising, 168 advocacy, 102 affiliates, 74 Afghanistan, 25, 92, 94, 180, 192 Africa, 63, 132, 135, 136, 140, 141, 176, 177, 181, 191 age, 1, 7, 8, 9, 10, 11, 12, 13, 16, 17, 18, 20, 21, 24, 27, 30, 32, 33, 34, 35, 36, 41, 46, 52, 53, 54, 68, 70, 71, 72, 73, 79, 80, 83, 84, 85, 88, 92, 94, 95, 96, 97, 98, 100, 103, 104, 105, 111, 115, 116, 117, 129, 131, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 147, 149, 150, 151,

153, 154, 163, 166, 168, 170, 171, 174, 176, 177, 178, 179, 180, 181, 183, 188, 196, 198 ageing, 7, 12, 14, 19, 20, 21, 24, 26, 27, 28, 34, 35, 37, 38, 39, 40, 41, 42, 46, 52, 59, 60, 61, 64, 68, 70, 71, 72, 85, 86, 87, 103, 105, 108, 165, 198, 199 ageing population, 14 agent, 53, 70, 163 agents, 162, 166 aging, 1, 2, 3, 4, 8, 9, 39, 40, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 89, 91, 94, 95, 101, 102, 104, 105, 124, 129, 130, 131, 132, 133, 134, 139, 142, 145, 147, 149, 151, 152, 153, 154, 155, 156, 168, 171, 174, 181, 183, 184, 187, 188, 196, 197, 198 aging identity, 4 aging population, 2, 3, 83, 91, 94, 101, 102, 104, 181, 183, 184, 197 aging process, 9 aging society, 2, 80 agrarian, 28, 174 agricultural, 100 agriculture, 19, 28 aid, 30, 95, 156, 183 AIDS, 194 air, 48, 49, 62, 63, 191, 194 air pollutant, 48, 63 air pollution, 48, 49 air quality, 48, 62

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Index

air travel, 194 Al Qaeda, 192 alcohol, 71 alienation, 54, 55 alluvial, 175 alternative, 166, 168 Alzheimer’s disease, 72, 81 ambiguity, 77, 83 ambivalent, 160 Antarctic, 195 anxiety, 101 APEC, 154, 157 Arabia, 180 Arctic, 195 argument, 163 armed conflict, 108 Armenia, 178 arrhythmias, 48 arthritis, 32 ASEAN, 129, 132, 154 Asia, 1, 2, 3, 4, 5, 19, 26, 31, 38, 39, 40, 41, 55, 60, 63, 64, 65, 84, 87, 90, 91, 103, 125, 127, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 140, 141, 142, 143, 144, 147, 148, 149, 150, 151, 152, 154, 155, 156, 157, 170, 173, 175, 177, 178, 181, 182, 183, 184, 188, 191, 194, 195, 196, 197, 198, 199 Asian, 1, 2, 3, 10, 11, 12, 16, 20, 24, 27, 39, 61, 62, 63, 70, 91, 92, 107, 129, 130, 131, 132, 133, 137, 140, 143, 149, 150, 151, 152, 154, 155, 156, 160, 161, 170, 173, 177, 178, 181, 182, 186, 187, 188, 189, 191, 192, 195, 198 Asian countries, 1, 2, 10, 129, 130, 131, 137, 150, 151, 160, 174, 177, 178, 181, 182, 190, 191 Asian values, 187 Asia-Pacific Economic Cooperation, 154 aspiration, 52, 163 assets, 20, 133, 139, 144, 145, 146, 147, 148, 151, 152, 153, 154, 155, 188 assumptions, 10 asthma, 32, 48 attitudes, 15, 91, 97, 162, 163

Australia, 41, 125 Austria, 39 authority, 30 autonomy, 39 availability, 28, 59, 181, 185 avian influenza, 195 awareness, 33, 34, 35, 37, 165 Azerbaijan, 179

B babies, 150 baby boom, 8, 139, 144, 147, 188 baby boomers, 139, 144, 147 back, 32, 80, 100, 189 back pain, 32 bacteria, 193, 195 Bahrain, 180 Bangladesh, 2, 3, 19, 20, 21, 22, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 94, 174, 175, 179, 184, 185, 196 Bangladesh Demographic and Health Survey, 21 banking, 153, 154 banks, 152, 186 barrier, 193 barriers, 20, 87 basic needs, 82 basic services, 94 BDHS, 21, 38 behavior, 15, 60, 78, 83, 95 Beijing, 77, 85, 125, 187, 199 benefits, 56, 80, 83, 150, 151, 154, 163, 166, 169, 186 Best Practice, 60 Bhutan, 25, 26, 94, 179, 184 bias, 79, 91, 181 birth, 2, 8, 9, 10, 12, 80, 82, 92, 96, 101, 109, 132, 133, 174, 176, 177, 181, 183, 184, 185, 186 birth control, 82 birth rate, 2, 8, 10, 109, 174, 176, 181, 184 black market, 137 blocks, 163 blood, 32

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Index blood pressure, 32 blue-collar workers, 79 bond market, 152, 153, 154, 155 bonds, 145, 147, 152, 153, 155, 169 Boston, 156 bottom-up, 102 bovine, 193 boys, 181 brain drain, 153, 190 breakdown, 17, 28, 101, 169 buildings, 42, 49, 50, 64, 160, 190 Bureau of the Census, 181 bureaucracy, 20 burning, 191

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C cadmium, 49 Cambodia, 129, 130, 179, 184 campaigns, 194 Canada, 68 cancer, 37 capacity building, 102, 153 capital accumulation, 3 capital flows, 156 capital goods, 137 capital inflow, 143, 150, 153 capital markets, 153 capitalism, 187 capitalist, 162 caregivers, 82, 84 caretaker, 28 carrier, 194 case study, 3, 64, 65 cataract surgery, 97 categorization, 1 category b, 92 causal relationship, 47 CBS, 105 CDR, 13 cell, 130 cement, 161 Census, 43, 45, 47, 54, 58, 61, 82, 108, 125, 126, 181, 184 Census Bureau, 108

205

Central Asia, 177 Central Bank, 154 Central Intelligence Agency, 38 Central Provident Fund, 186 changing environment, 195 changing population, 89 chicken, 193 chickens, 156 child mortality, 96, 176, 185 childbirth, 96 childcare, 101 childhood, 97 childless, 188 children, 8, 16, 28, 30, 31, 37, 39, 53, 54, 55, 91, 95, 96, 97, 101, 108, 111, 113, 114, 115, 118, 120, 121, 122, 123, 124, 132, 185, 187, 190, 198 China, vi, 2, 3, 19, 43, 58, 59, 61, 63, 64, 67, 68, 69, 73, 74, 75, 76, 77, 78, 79, 80, 81, 84, 85, 86, 87, 88, 129, 130, 132, 133, 143, 149, 159, 160, 161, 162, 163, 167, 168, 169, 170, 171, 174, 175, 177, 178, 181, 182, 183, 184, 185, 187, 188, 190, 191, 192, 194, 196, 198, 199 China Daily, 85 chloroquine, 194 cholera, 193, 195 chronic diseases, 197 chronic illness, 174 chronic obstructive pulmonary disease, 48, 63 CIA, 19, 38 circulatory disease, 48, 66 citizens, 56, 60, 71, 94, 103, 105, 162 citizenship, 42, 162, 166, 170 civil servants, 103 civil society, 104 classes, 139 classical, 134 classification, 136 cleaning, 101 climate change, 193, 194 clinics, 32 coal, 20, 191 cohort, 21, 35, 91, 92, 94, 100, 147 colleges, 79, 81

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Index

combined effect, 27 commerce, 106 commercial bank, 152, 154 commodities, 164 communication, 98 Communism, 192, 198 Communist Party, 74, 162 Communist Party of China, 74 communities, 36, 50, 69, 72, 100, 101 community, 31, 46, 50, 53, 54, 60, 62, 64, 65, 71, 78, 81, 82, 83, 84, 102, 104 community service, 78 competition, 82 complications, 32, 81 composition, 15, 36, 39, 91, 110, 184, 193 concentration, 45, 46, 50, 185 conception, 72 concrete, 15, 60, 190 conflict, 26, 48, 89, 91, 94, 96, 98, 100, 104, 106, 107, 108, 161, 192 conformity, 162 Confucianism, 162, 171 confusion, 83 Congress, 75, 86, 87, 125 conjecture, 169 consciousness, 15, 167, 168 constraints, 167, 174, 186, 193 construction, 162, 169 constructionist, 85 Consumer Price Index, 137 consumerism, 164, 168, 171 consumers, 144, 159, 163 consumption, 4, 139, 143, 162, 163, 165, 166, 167, 169, 170, 188 contamination, 64 contingency, 193 continuity, 67, 73, 76, 77, 83 contracts, 190 control, 70, 82, 162, 166, 167, 190, 199 convergence, 134, 136 cooking, 101 COPD, 48 coping, 197 copper, 49 correlation, 145, 146, 147, 163

correlations, 105 corruption, 20, 190 costs, 30, 62, 70, 181, 189 couples, 189 covering, 78, 140 CPC, 74, 75, 86 CPI, 135, 136, 137, 145, 146 credit, 102, 154, 155, 173, 182, 188 crimes, 191 critical analysis, 4 critical thinking, 75 criticism, 72 cross-border, 2, 58 cross-country, 153, 198 cross-cultural, 39 cultural factors, 186 cultural influence, 43, 82 Cultural Revolution, 82 cultural transformation, 15 cultural values, 16 culture, 1, 18, 75, 82, 164, 169 currency, 152, 154, 155 current account balance, 134 curriculum, 37 cyberspace, 79 cycles, 167 cyclones, 20, 195 Cyprus, 177, 178

D danger, 164, 193 database, 24, 27, 38, 40, 181 death, 8, 10, 12, 96, 100, 173, 174, 177, 183, 189, 190, 191, 193 death rate, 8, 10, 174, 177, 183 deaths, 174, 176, 177, 193 debates, 31, 162 debt, 70, 150 decay, 50 decentralization, 43 decision-making process, 31 decisions, 76, 163 deficits, 151 definition, 12, 15, 68, 147, 163, 168

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Index de-industrialization, 66 delinquency, 55 delivery, 32, 96 dementia, 72, 81, 85 democracy, 89, 105 demographic change, 1, 20, 27, 35, 39, 69, 149, 152, 156, 168, 176, 183 demographic characteristics, 177 demographic data, 92 demographic factors, 28 demographic structure, 197 demographic transition, 8, 16, 20, 21, 46, 109, 110, 153, 174, 183, 197 demographics, 2, 3 demography, 8, 34, 40 density, 42, 46, 47, 48, 60, 61, 62, 63, 64, 65, 175 dependency ratio, 20, 26, 27, 43, 140 dependent variable, 145 deposits, 143 depression, 55 deprivation, 65 derivatives, 152 desert, 191 destruction, 54 developed countries, 28, 29, 68, 69, 151, 153, 176, 181 developed nations, 196 developing countries, 2, 8, 39, 40, 68, 69, 94, 136, 140, 150, 176, 194 developing nations, 10, 73, 83, 140, 196 development banks, 152 diabetes, 32 diarrhoea, 32, 185 dietary, 37 dignity, 33, 60, 69, 102 directives, 75, 76 disability, 52, 71, 72, 92, 107 disabled, 26, 53, 69 disaster, 191 discipline, 8 disclosure, 152 discourse, 42, 191, 198 discretionary, 168 discrimination, 37, 80, 87, 96, 97, 104

207

discriminatory, 91 diseases, 30, 37, 48, 174, 193, 194, 195, 196, 197 dislocation, 51 disorder, 17 displacement, 53, 65 dissaving, 139 disseminate, 154 distortions, 177 distress, 33 distribution, 8, 9, 10, 11, 12, 21, 28, 29, 43, 45, 46, 66, 78, 86, 115, 141, 174, 175, 176, 177, 181, 182 diversity, 90 division, 34 divorce rates, 189 doctors, 32, 185, 190 dominance, 100 donor, 104 double jeopardy, 95 download, 105 draft, 102, 105 drainage, 185 drought, 191, 192, 195 droughts, 173 drugs, 194 duration, 152 dusts, 49, 64 duties, 31, 74

E early retirement, 80, 81, 154 early warning, 191 earnings, 56, 188 ears, 80, 92, 193 earthquake, 190, 191 East Asia, 1, 3, 65, 125, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 140, 142, 143, 144, 147, 148, 149, 150, 151, 152, 154, 155, 156, 157, 160, 161, 170, 182, 194, 196, 199 East Timor, 132 eastern cultures, 160 ecological, 195

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Index

economic activity, 28 economic change, 30, 162, 174 economic cycle, 167 economic development, 34, 35, 42, 82, 109, 115, 131, 133, 182, 184, 191, 194, 195 economic efficiency, 81 economic growth, 133, 134, 137, 149, 198 economic growth rate, 149 economic integration, 58 economic performance, 1 economic policy, 3 economic problem, 176 economic reform, 20, 80, 84 economic security, 177 economic status, 95 economic sustainability, 15 economic systems, 16 economically disadvantaged, 91, 196 education, 29, 73, 74, 76, 88, 107, 108, 119, 123 educational attainment, 111, 120 elderly population, 20, 23, 24, 26, 28, 45, 63, 66, 81, 82, 85, 92, 98, 100, 103, 104, 106, 110, 145, 147, 150, 184, 186, 187, 188, 196 elders, 28, 30, 31, 35, 63, 86, 101, 168 emerging issues, 37 emotional, 36, 37, 101, 110, 124 emotional health, 37 employees, 33, 79 employment, 36, 55, 69, 79, 86, 100, 111, 120, 124 employment status, 111, 120, 124 empowerment, 102 energy, 20, 168 England, 198 entertainment, 43, 73 environment, 33, 42, 46, 48, 53, 55, 59, 60, 61, 102, 137, 153, 168, 176, 185, 186, 193, 194 environmental change, 195, 197 environmental conditions, 48, 194, 195 environmental factors, 72 environmental issues, 59 epidemic, 83, 193 epidemics, 174

epidemiology, 199 equality, 71 equilibrium, 144 equity, 145, 149 erosion, 53, 191, 192 estates, 50 estimating, 9 estimators, 136, 142 ethical issues, 190 ethics, 14, 171 ethnic groups, 90, 174 Europe, 14, 73, 87, 129, 131, 181, 187, 190 Europeans, 189 evacuation, 191 evolution, 198 exchange rate, 137 exclusion, 52, 59, 71, 95, 104 exercise, 49, 72 expenditures, 150, 154 expertise, 17 exports, 137 externalities, 154 eye, 32

F fabric, 54 failure, 48 faith, 169 familial, 31, 53, 168 family, 3, 8, 15, 16, 20, 26, 28, 29, 30, 31, 32, 33, 35, 36, 39, 40, 42, 53, 54, 55, 59, 63, 68, 71, 78, 81, 82, 83, 84, 91, 92, 96, 97, 101, 109, 110, 113, 124, 125, 161, 163, 164, 166, 167, 168, 169, 181, 183, 186, 187, 188, 189, 197 family environment, 33 family life, 16, 28, 97, 164, 169 family members, 30, 31, 36, 40, 110, 124, 163, 183, 187, 189 family planning, 16, 109 family structure, 3, 15, 28, 30, 42, 53, 68, 84, 92, 101, 163 family support, 36, 78, 82, 124 family system, 8, 15, 16, 36

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Index family violence, 55 famine, 174 fear, 50, 165, 190 fears, 186 February, 60, 75, 107 feelings, 37, 101 fees, 57 feet, 169, 196, 197 females, 10, 11, 21, 24, 30, 34, 92, 97, 98, 100, 109, 177 fertility, 8, 9, 10, 12, 13, 14, 15, 17, 20, 21, 38, 39, 109, 124, 132, 147, 150, 174, 176 fertility rate, 14, 15, 17, 21, 132, 147, 150, 176 Fiji, 126 filial piety, 53, 62, 64, 124, 165, 169 finance, 60, 188 financial crisis, 152, 153, 154, 155 financial institution, 37 financial markets, 151, 153, 154, 155, 156, 157 financial resources, 56, 195 financial support, 28, 33, 36, 82, 103, 110, 177 financial system, 155 financial vulnerability, 173 financing, 33, 50, 154 First World, 69, 73, 74, 75, 77 fiscal deficit, 151 fishing, 42 fitness, 72 flexibility, 52, 77 flooding, 191 flow, 100 focusing, 2, 42, 98 food, 16, 34, 36, 97 forced migration, 189 Foreign Direct Investment (FDI), 182, 185 formal education, 79, 81, 97 Fox, 168, 170 fragmentation, 55, 59 France, 68, 189 freedom, 160, 162, 164, 171 freedoms, 160, 162, 163 frustration, 32

209

fulfillment, 69 funding, 77, 104 funds, 151, 152, 153

G gas, 20, 193 Gaza, 192 GDP per capita, 94, 133, 134, 135, 136, 140, 142, 145, 146 geese, 177 gender, 3, 91, 95, 96, 97, 104, 108 gender inequality, 96 generation, 15, 31, 36, 37, 48, 54, 55, 56, 110, 139, 140, 142, 143, 144, 145, 146, 147, 154, 155, 163, 168, 188, 189 genetic factors, 72 Geneva, 108 geography, 134 Georgia, 177, 178 geriatric, 73, 78 Germany, 78 gerontology, 39, 59, 70, 73, 78 girls, 95, 181 glaciers, 195 global economy, 152, 155, 156, 186 global leaders, 14 global warming, 193, 194, 195 globalization, 2, 60, 61, 65 goals, 46, 55, 59, 73 God, 15, 18 government, 17, 20, 32, 33, 34, 35, 36, 37, 41, 43, 50, 60, 67, 70, 74, 75, 76, 77, 78, 80, 82, 83, 89, 96, 101, 102, 104, 125, 139, 145, 150, 152, 153, 154, 173, 190, 192 government expenditure, 82 government policy, 43 GPP, 80, 83 grandparents, 31, 37 Gross Domestic Product (GDP), 19, 82, 90, 94, 101, 133, 134, 135, 136, 137, 138, 140, 141, 142, 145, 146, 151 groundwater, 192 groups, 8, 9, 10, 11, 20, 55, 84, 91, 117, 120, 139, 143, 167, 174, 188, 198

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Index

growth, 2, 3, 7, 8, 10, 11, 12, 13, 17, 19, 20, 21, 23, 24, 35, 42, 43, 82, 90, 94, 133, 134, 135, 136, 137, 138, 140, 141, 142, 143, 145, 146, 149, 153, 154, 156, 176, 177, 183, 184, 185, 190, 193, 198 growth rate, 3, 7, 8, 10, 11, 12, 13, 21, 23, 35, 43, 82, 90, 94, 134, 136, 137, 138, 140, 145, 146, 149 Guangdong, 58 guidance, 35, 83 guiding principles, 60 guilty, 191

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H Hamas, 192 hanging, 154 happiness, 37, 71, 72 harm, 15, 161, 198 harmony, 15, 161, 198 harvest, 193 Hawaii, 38 hazards, 191, 192 health, 2, 3, 4, 14, 20, 21, 26, 29, 30, 32, 33, 35, 36, 37, 38, 39, 40, 41, 42, 46, 48, 50, 61, 65, 68, 69, 70, 71, 72, 78, 81, 83, 84, 87, 89, 90, 91, 92, 94, 95, 96, 97, 98, 100, 101, 102, 103, 106, 107, 108, 111, 121, 122, 124, 150, 151, 154, 173, 176, 181, 184, 185, 186, 189, 194, 196, 197, 198, 199 health care, 3, 14, 26, 29, 35, 36, 41, 68, 72, 81, 90, 91, 94, 96, 97, 103, 150, 154, 189, 195, 196, 197 health care system, 154, 196, 197 health education, 37 health expenditure, 151 health insurance, 2, 82, 101, 102, 151 health problems, 32, 37, 83 health services, 32, 92, 95, 96, 185 health status, 30, 38, 111, 121, 122, 124 healthcare, 72, 73, 76, 104, 186 heart, 37, 48, 165, 175 heart disease, 37 heart failure, 48 height, 95

helplessness, 101 heterogeneity, 53 heteroskedasticity, 142 Higgs, 165, 166, 170 high risk, 48, 106 high school, 120 high temperature, 194 higher education, 84 hip, 14, 124, 189 HIV, 176, 194 HIV/AIDS, 194 holistic, 3 home ownership, 111, 121, 122, 123, 124 homeless, 195, 196 homogenous, 163 Hong Kong, 2, 3, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 58, 59, 60, 61, 62, 63, 64, 65, 66, 86, 130, 174, 178, 182, 183, 184, 189 hospital, 48, 63, 66, 91, 186, 189 hospital care, 189 hospitals, 31, 32, 106 host, 150, 189 host population, 150 household, 16, 28, 29, 31, 47, 53, 54, 96, 101, 112, 113, 139, 143, 160 households, 28, 30, 36, 53, 56, 143, 145, 151 housing, 29, 36, 42, 43, 50, 52, 55, 56, 61, 66, 69, 76, 83, 162 Housing and Urban Development, 64 hub, 49 human, 14, 29, 32, 35, 36, 70, 85, 95, 105, 107, 136, 165, 173, 177, 187, 190, 191, 193, 194, 195, 199 human capital, 36, 136 Human Development Report, 95, 106, 108 human resources, 32, 85 human rights, 95, 107 human values, 187 humans, 193, 194, 195 humidity, 193, 194 humiliation, 187 husband, 161 hygiene, 100 hypothesis, 30, 139, 143

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Index

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I ice, 37, 195 identification, 165 identity, 3, 160, 161, 162, 164, 166, 167, 168, 170, 171 imagery, 17, 168 images, 164, 168, 169 imbalances, 2 IMF, 139, 145, 149, 150, 153, 154, 155, 156 immigrants, 153, 188 immigration, 149, 150, 189 immortal, 166 immortality, 166 implementation, 20, 34, 72, 78, 104, 109 imports, 137 incentives, 81, 189 incidence, 195 inclusion, 42, 61, 71, 77 income, 2, 20, 29, 43, 50, 55, 56, 69, 76, 78, 82, 83, 90, 94, 97, 102, 106, 111, 122, 123, 124, 133, 134, 136, 139, 140, 143, 148, 152, 153, 155, 187, 189 income distribution, 29 income inequality, 55, 56 income support, 83 incomes, 59, 97, 190 incompatibility, 159 independence, 69, 160 India, 19, 25, 26, 27, 29, 40, 94, 175, 177, 179, 181, 183, 184, 185, 189, 192, 193, 194, 198, 199 Indian, 33, 38, 40, 175, 184, 190, 191 Indian Ocean, 191 Indiana, 67 indication, 10 indicators, 12, 108, 137 indices, 24, 145 indigenous, 32, 65, 90, 185 individual rights, 162 individualism, 159, 169 individuality, 161, 162 individualization, 166 Indonesia, 19, 129, 130, 133, 143, 175, 177, 179, 184, 191

211

industrial, 33, 43, 49, 50, 174, 176, 182 industrialisation, 191 industrialization, 28, 43, 46, 54, 66, 111 industrialized countries, 33, 140 industrialized societies, 56 industry, 194 inequality, 29, 55, 56, 60, 90, 96, 104, 154 infant mortality, 96, 176, 177 infant mortality rate, 177 infants, 97 infections, 185 infectious, 173, 174, 195, 196, 199 infectious diseases, 173, 174, 195, 196, 199 inflation, 134, 136, 137, 145, 150, 152 influenza, 195 influenza a, 195 information sharing, 153 Information System, 87 infrastructure, 3, 21, 56, 150, 152, 153, 182, 185, 196, 197 inheritance, 189 inheritance tax, 189 inhuman, 191 initiation, 73, 109 injuries, 164 inmates, 34 insecurity, 59, 164 insight, 37, 91 instability, 53, 89 institutions, 26, 28, 167 instruction, 73, 81 instruments, 75, 77 insurance, 2, 82, 101, 102, 111, 143, 151, 169, 190 integration, 2, 15, 58, 60, 62, 126 intentions, 162 interaction, 8, 47 interactions, 31 interdependence, 165 interest groups, 20 interest rates, 145, 147, 148 intergenerational, 31, 35, 37, 79, 125, 154, 163, 164, 171 International Labour Office, 181 International Monetary Fund, 156

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Index

international standards, 55 international trade, 130, 183 internet, 79, 181 interpersonal relationships, 161 interval, 136, 147 intervention, 190 intrinsic, 8, 193 investment, 1, 56, 130, 134, 141, 142, 143, 145, 147, 149, 153, 154, 164, 168 investment rate, 1 ions, 18 Iran, 179 Iraq, 180, 192 Islamic, 152, 179, 192 isolation, 48, 52, 54, 55, 59, 97, 101, 160 Israel, 178, 183, 184, 192

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J Japan, 2, 14, 19, 43, 129, 130, 132, 133, 143, 149, 155, 157, 174, 175, 177, 178, 182, 183, 184, 188, 189, 193, 196 Japanese, 143, 156, 157, 189, 199 Java, 175 job training, 81 jobs, 8, 55, 68, 197 joining, 78 joint ventures, 50, 81 Jordan, 179, 181 Jun, 85

K Kazakhstan, 177, 178, 184 Kenya, 65 kinship network, 31 Korea, 2, 3, 43, 109, 110, 111, 113, 114, 115, 121, 124, 125, 126, 129, 130, 132, 133, 143, 149, 177, 178, 182, 183, 184 Korean, 110, 111, 124, 125, 126 Kuwait, 180, 181 Kyrgyzstan, 179

L labor, 1, 2, 20, 28, 33, 68, 69, 97, 134, 149, 150, 152, 153, 167, 177, 181, 182, 188 labor force, 1, 69 labour force, 20, 28, 33, 97, 134, 150, 152, 177 labour market, 150, 153 land, 50, 57, 90, 91, 100, 101, 189, 191 language, 95, 102 Laos, 184 large-scale, 56, 78, 190, 191 later life, 36, 56, 71, 84 Latin America, 140 law, 8, 30, 36, 100, 187 laws, 75, 76, 187, 189 leadership, 14, 15, 17, 80 learning, 70, 72, 73, 81 Lebanon, 179, 184, 192 legislation, 103 leisure, 31, 168 leisure time, 31 liberalization, 2, 153 liberation, 163 life course, 71 life expectancy, 3, 4, 7, 9, 10, 11, 12, 21, 69, 94, 95, 96, 104, 109, 117, 132, 134, 135, 136, 174, 177, 181, 183, 184, 196, 197 life experiences, 189 life span, 173, 192 life style, 7, 37 lifestyle, 3, 16, 70, 72, 77, 78, 83, 87, 163, 171, 174, 188 lifestyle changes, 72 lifestyles, 28, 163, 167, 169 lifetime, 71, 139 likelihood, 169, 188, 195 limitations, 186, 198 linear, 140 linguistic, 91 liquidity, 152 literacy, 20, 29, 94, 97 literacy rates, 97

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Index

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living arrangements, 3, 20, 28, 38, 40, 53, 110, 111, 113, 114, 115, 116, 117, 118, 120, 121, 122, 123, 125 living conditions, 47, 50, 56, 58 living environment, 46, 55, 59, 61 living standards, 163 lobby, 104 lobbying, 102 local community, 53 location, 39, 166, 187 London, 40, 43, 61, 125, 156, 170, 171, 192, 198, 199 loneliness, 48, 61, 98, 101, 105, 160 long distance, 55 long period, 8, 9 longevity, 2, 69, 91, 92, 152, 173, 174, 175, 176, 177, 181, 183, 184, 185, 188, 193, 194, 196 long-term bond, 145, 147, 152 losses, 148 love, 164 low-income, 2, 43, 55, 56

M Macao, 87, 178, 183 macroeconomic, 133, 142, 149, 150, 154 macroeconomic policies, 150, 154 Mainland China, 43 mainstream, 79, 94 maintenance, 161, 162, 186 major cities, 16, 55, 60 malaria, 193, 194, 195 Malaysia, 126, 129, 130, 149, 179 males, 21, 30, 34, 95, 97, 109, 177, 187 management, 15, 16, 57, 59, 153, 155 mandatory retirement, 80 manpower, 36 marital status, 111, 112, 114, 118, 122, 123, 124 market, 2, 49, 50, 52, 80, 82, 96, 137, 139, 143, 144, 147, 150, 152, 153, 162, 163, 164, 167, 168, 169, 170, 183, 186 market economy, 163, 164 marketing, 168

213

markets, 3, 66, 151, 152, 153, 154, 155, 156, 157, 167 marriage, 78, 97 marriages, 8, 163 mass media, 37 maternal, 96 meanings, 165 measures, 125, 185 media, 15, 37, 98, 103, 168 median, 24, 56 medical care, 73, 100 medicine, 37, 70, 73, 78, 199 Mediterranean, 189 melt, 195 memory, 17 men, 20, 28, 29, 32, 33, 40, 56, 79, 92, 95, 96, 97, 98, 100, 177, 181, 186, 196 mental health, 50, 78, 81, 83 mental illness, 63 messages, 80 meta analysis, 81 metropolitan area, 43, 194 Mexico City, 176 middle class, 52, 55, 162 Middle East, 177 middle-aged, 61 midwives, 185 migrant, 98, 99 migrant population, 98, 99 migrants, 50, 98, 99, 150 migration, 7, 8, 30, 31, 38, 39, 58, 59, 60, 61, 68, 98, 100, 101, 105, 106, 110, 111, 115, 124, 168, 177, 185, 189 military, 74, 103, 190 military government, 190 Ministry of Education, 74 Minnesota, 171 MLD, 103 mobility, 53, 59, 64, 82, 152, 163, 177, 183, 187 model specification, 136 models, 123, 137, 140 modernization, 15, 16, 17, 28, 31, 82, 115, 124, 163, 183 momentum, 153

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Index

money, 14, 29, 36, 122, 123, 124 Mongolia, 132, 179, 192 monopoly, 137 monsoon, 175, 196 Moon, 110, 126 morbidity, 174 mortality, 8, 9, 10, 12, 20, 21, 48, 90, 96, 109, 166, 174, 176, 177, 185, 198 mortality rate, 90, 96, 177 mortgage, 155, 186 mosquito vector, 194 mosquitoes, 194, 195 motherhood, 97 mothers, 186 motion, 60 mountains, 90 mouth, 193, 196 movement, 34, 188 MPI, 78 multilateral, 152, 154 multiple factors, 81 Muslim, 14, 15, 18 Muslims, 15 mutual funds, 152 mutual respect, 35 Myanmar, 129, 130, 179, 190, 192

N narcissism, 164 nation, 3, 84, 101, 181 nation states, 3 National People’s Congress, 75, 87 national saving, 139, 150 natural, 7, 10, 20, 21, 32, 35, 71, 95, 140, 160, 182, 191, 196 natural disasters, 20, 196 natural gas, 20 natural resources, 182 NCA, 75 negative influences, 133 negative relation, 124, 145 neglect, 54, 96 neighbourhoods, 50

Nepal, 2, 3, 25, 27, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 174, 179, 184, 192 Netherlands, 106, 198 network, 16, 31, 43, 52, 53, 75, 77, 197 New Jersey, 17 New York, 2, 14, 18, 40, 43, 65, 85, 86, 108, 125, 176, 199 next generation, 37 NGO, 98, 104, 107 NGOs, 32, 36, 37, 90, 95, 98, 102, 103, 104 nitrogen dioxide, 48 nitrous oxide, 185 noise, 16, 61 nongovernmental, 82 normal, 29, 91, 183, 184 North Africa, 177 North America, 8, 14, 131, 170, 187, 189 North Korea, 132 Northeast, 129, 192 Northeast Asia, 129 novelty, 189 NRC, 98 nuclear, 15, 16, 28, 36, 53, 54, 101, 167 nuclear family, 15, 53, 54, 101, 167 nurses, 96, 190 nursing, 31, 56, 59 nursing home, 56, 59 nutrition, 29, 87, 92

O obesity, 71 obligation, 31, 35, 165, 166, 170, 187 obligations, 1, 161, 187 observations, 60, 62, 137 obsolete, 53, 57 occupational, 55, 91 OECD, 59, 64, 145, 156, 157 oil, 192 old age, 8, 21, 32, 33, 36, 41, 65, 68, 70, 71, 72, 83, 84, 92, 96, 97, 100, 103, 104, 173, 177, 181, 188, 196 older adults, 20, 53, 71, 72, 105

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Index older people, 1, 2, 3, 4, 13, 15, 16, 20, 28, 29, 30, 31, 33, 39, 41, 42, 43, 45, 46, 47, 48, 50, 51, 52, 53, 54, 55, 56, 58, 59, 60, 61, 65, 66, 68, 70, 71, 79, 81, 82, 83, 94, 101, 102, 104, 107, 110, 159, 160, 161, 163, 164, 165, 166, 167, 169, 174, 181, 183, 187, 189 Oman, 180, 181 online, 105, 108 open economy, 137 optimism, 183 oral, 98 Organisation for Economic Co-operation and Development, 64 orientation, 84 oversight, 78 overtime, 24 ownership, 111, 121, 122, 123, 124 oxides, 185 ozone, 48, 66

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P Pacific, 38, 39, 40, 60, 62, 70, 87, 103, 125, 136, 154, 181, 191, 198, 199 Pacific Region, 40 pain, 32 Pakistan, 2, 3, 7, 12, 13, 14, 18, 19, 25, 27, 94, 175, 179, 184, 199 Pakistani, 14, 15, 16 pandemic, 193 paradigm shift, 41 parasites, 194 parents, 15, 16, 28, 30, 31, 36, 50, 53, 96, 97, 124, 187 Paris, 43, 64 particulate matter, 185 passive, 54, 71, 162 pathogens, 194 patients, 48 pay-as-you-go, 150 Pearl River Delta, 48, 58 pedestrian, 52 peer review, 154 penalties, 154

215

pendulum, 189 pension, 16, 33, 36, 78, 80, 85, 97, 103, 104, 150, 151, 153, 154, 157, 168, 173 pension plans, 33 pension reforms, 151 pension system, 103, 151, 153, 157 pensions, 2, 33, 40, 41, 56, 103, 104 peptic ulcer, 32 per capita, 82, 90, 94, 133, 134, 135, 136, 140, 142, 145, 146 per capita income, 90 perception, 48, 75 perceptions, 161 personal wealth, 162 personality, 169 pesticides, 194 pharmaceutical companies, 194 pharmaceutical industry, 194 Philippines, 126, 129, 130, 149, 179, 184, 192 physical abuse, 36 physical activity, 72 physical health, 37, 46, 72 physiological, 166 pigs, 193 pilots, 107 planning, 21, 28, 34, 45, 52, 55, 66, 71, 109, 166, 181 plants, 48 play, 16, 29, 31, 35, 68, 101, 102, 103, 161, 163 pleasure, 160 pneumonia, 185 polarization, 55, 56, 59, 64 police, 103 policy choice, 151 policy instruments, 75, 77 policy makers, 17, 37, 41, 60, 79, 80, 84, 154 policy making, 78, 83 political instability, 89 political parties, 89 politics, 199 pollutant, 48 pollutants, 63, 185 pollution, 42, 48, 49, 59, 185, 186, 191, 192 polynomial, 140, 141

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Index

poor, 19, 29, 32, 33, 34, 36, 48, 50, 51, 55, 56, 57, 58, 59, 60, 90, 95, 97, 102, 106, 184, 185, 186, 188, 196 poor health, 95, 97, 106 population density, 42, 46, 63 population growth, 7, 12, 13, 16, 21, 42, 43, 190, 193 Population Growth Rate, 12, 13 population pyramid, 21, 23, 92 population size, 26 portfolio, 144, 145 portfolios, 147, 151 positive correlation, 147 positive relation, 136, 137 poverty, 29, 43, 55, 63, 82, 87, 90, 94, 95, 98, 102, 104, 174, 184, 194 poverty line, 29 poverty rate, 82, 90 poverty trap, 55 power, 10, 20, 48, 54, 70, 106, 166, 168, 190, 191 power plants, 48 PPP, 94, 133, 134, 136 preference, 29, 52, 95, 101, 177, 186 pregnancy, 96 pregnant women, 96 premium, 137 preparedness, 2 president, 73 press, 15, 56, 86, 170 pressure, 32, 80, 98, 150, 154, 155, 188 prestige, 54, 70 prevention, 68 preventive, 37, 70 PRI, 157 price index, 146 prices, 57, 133, 139, 144, 145, 146, 147, 148, 151, 155, 186 privacy, 48, 160 private, 8, 48, 50, 52, 53, 57, 66, 82, 97, 139, 150, 154, 163, 164, 173, 185, 186, 189 private sector, 8, 50, 154, 173, 185 probability, 94 production, 32, 43, 101 productivity, 80, 81, 149, 150

profit margin, 194 prognosis, 4, 194 program, 20, 109 property, 49, 162, 186, 189 property rights, 162 protection, 56, 83 prototype, 196 psychological stress, 17 psychological well-being, 50, 63, 64 public, 14, 17, 20, 21, 30, 33, 43, 52, 57, 75, 80, 81, 83, 84, 85, 86, 97, 150, 151, 153, 154, 164, 168, 185, 186, 187, 195, 197 public debt, 150 public funds, 151 public health, 21, 81, 151, 185, 195 public housing, 43 public pension, 33, 151, 153, 154 public policy, 17, 80, 82, 83, 84, 85 public sector, 20, 185 pulses, 195

Q Qatar, 180 quality of life, 19, 33, 62, 64, 65, 68, 72, 84

R radius, 46 rainfall, 195 random, 193 range, 2, 31, 59, 96, 119, 174, 183, 185, 186, 191 rate of return, 154 rating agencies, 152, 154 rational expectations, 144 raw materials, 169 real estate, 49 real income, 56 real terms, 139 reality, 37, 46, 73, 79, 90, 100, 160 recession, 186 reciprocal relationships, 169 reciprocity, 53, 164

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Index recognition, 168 reconstruction, 49 recreation, 160 recreational, 49, 55 recreational areas, 49 recurrence, 152 redevelopment, 50, 51 reforms, 20, 60, 150, 151, 154, 155 refuge, 101 regenerate, 50 regional, 2, 26, 43, 97, 101, 133, 152, 153, 154, 187 regional cooperation, 153 regional economies, 152 regional integration, 2 regression, 111, 122, 136, 137, 138, 139, 141, 147 regression analysis, 111 regressions, 140 regular, 187 regulatory framework, 153 relationship, 28, 31, 35, 47, 63, 83, 124, 125, 161, 162, 163, 168, 169 relationships, 9, 16, 31, 55, 69, 161, 164, 167, 169 relative size, 24 relatives, 29, 31, 32, 36, 59, 113, 186 relevance, 19, 71, 77 remittances, 28, 100 Renaissance, 160 rent, 52, 57 replacement rate, 151, 154 reproduction, 10, 166 residential, 31, 50, 56, 57, 59, 64 residential buildings, 50 resistance, 194 resources, 15, 19, 24, 32, 35, 42, 56, 70, 79, 85, 92, 94, 182, 185, 188, 195, 197 respiratory, 185 responsibilities, 28, 33, 72, 74, 95, 97, 103, 163, 187 restructuring, 60 retirees, 152, 154, 189, 199

217

retirement, 12, 28, 52, 56, 58, 61, 71, 72, 79, 80, 81, 85, 88, 139, 140, 144, 146, 148, 150, 151, 154, 168, 187, 188, 189 retirement age, 71, 72, 79, 80, 81, 85, 88, 150, 151, 154, 188 returns, 35, 145, 157 revolutionaries, 89 rewards, 160, 164 rhetoric, 15, 70 rhythm, 167 rice, 19 rings, 160 risk, 4, 48, 50, 54, 55, 104, 106, 139, 152, 155, 159, 160, 165, 166, 167, 169, 193, 194 risk management, 155 risk society, 159, 160, 165, 166, 167, 169 risks, 10, 48, 52, 59, 95, 122, 123, 124, 153, 154, 165, 169 rivers, 100 rural, 16, 26, 28, 29, 32, 38, 39, 43, 46, 90, 91, 94, 96, 97, 98, 100, 101, 105, 106, 110, 111, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 153, 185, 187, 194, 196 rural areas, 32, 43, 46, 90, 91, 94, 96, 98, 100, 105, 110, 111, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 153, 185, 187 rural communities, 101 rural population, 94, 110, 187 rural women, 96 Russia, 177, 183, 184, 196 Russian, 178

S sadness, 101 safety, 35 sample, 82, 111, 113, 140 sample survey, 82 sanitation, 194 SAR, 178 Sarin, 193 SARS, 193, 195 satisfaction, 48, 50 Saudi Arabia, 180

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Index

saving rate, 139, 140, 142, 144 savings, 36, 168 scarcity, 195 schistosomiasis, 194 school, 8, 37, 119, 120, 123, 190 SCN, 87 sea level, 196 search, 68, 75, 100, 196 Second World, 63, 69, 70, 74, 75, 84, 85, 87, 101 secretariat, 75 securities, 143, 152, 155, 167 security, 16, 30, 33, 35, 40, 42, 56, 68, 69, 72, 76, 78, 81, 83, 100, 101, 150, 151, 154, 161, 164, 166, 168, 173, 177, 185, 189, 198 segmentation, 160 segregation, 55, 56 self, 30, 170, 171 self-care, 168 self-definition, 168 self-discovery, 170 self-report, 40 senior citizens, 15, 56, 103 sensitivity, 2 separation, 160 series, 136, 145 services, 32, 34, 43, 52, 58, 60, 64, 81, 83, 92, 94, 95, 96, 98, 100, 103, 104, 151, 152, 153, 185 settlements, 100, 185, 189 sex, 29, 39, 95, 96, 111, 112, 117, 163, 171, 177, 181, 199 sex differences, 95 sex ratio, 96, 177, 181, 199 sexism, 95 shame, 187, 189 Shanghai, 77, 79, 84, 86, 87, 88, 186 shape, 166 shaping, 15 sharing, 31, 37, 102, 153 shelter, 36, 191 shortage, 85 short-term, 155, 162 shy, 98 sign, 124

significance level, 135, 142, 146 signs, 136, 137, 186 silver, 174, 183, 188 Singapore, 43, 129, 130, 133, 143, 149, 174, 177, 178, 182, 183, 184, 186, 188, 189, 198 sites, 107 skills, 101, 102 sleeping sickness, 194 slums, 185 smog, 48 smoking, 83 sociability, 163 social attitudes, 15 social behavior, 60 social care, 3, 33 social change, 4, 7, 53, 61, 84, 160, 161, 165, 167 social class, 167 social consequences, 1, 16 social construct, 12, 18, 85 social contract, 162 social control, 167 social development, 98 social distance, 186 social exclusion, 60, 71 social expenditure, 150 social gerontology, 70, 78 social group, 167 social impacts, 197 social infrastructure, 56, 153 social integration, 15, 126 social isolation, 48, 52, 54, 55, 59, 97 social life, 163 social network, 53 social participation, 41, 42 social policy, 17, 24, 78, 167, 198 social problems, 1 social relations, 164 social security, 16, 30, 33, 40, 56, 58, 66, 68, 74, 76, 77, 78, 81, 101, 150, 151, 154, 156, 157, 173, 181 social services, 73, 81, 151 social structure, 168 social support, 20, 26, 38, 98, 105, 195, 196, 197

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Index social support network, 196 social transition, 17 social welfare, 59, 69, 103, 181 social work, 36, 37, 78 social workers, 36 socioeconomic, 17, 20, 34, 35, 67, 82, 83, 111, 124, 176 socioeconomic conditions, 124 sociological, 4, 165 sociologists, 53, 159 sociology, 78 soil erosion, 191 soils, 49, 64 South Africa, 63 South Asia, 10, 11, 12, 40, 90, 91, 92, 106, 136 South Asian Association for Regional Cooperation, 91 South Korea, 43, 125, 129, 132, 133, 182, 183, 184 Southeast Asia, 1, 2, 183, 199 Soviet Union, 176, 192 Spain, 68, 84, 101 spatial, 45, 46, 55, 59, 66, 182, 183, 187 specialization, 105 species, 193, 194 spectrum, 17, 188 speech, 87 speed, 4, 21, 129, 173 spheres, 104, 133, 149 spiritual, 69, 72 spouse, 31, 53, 54, 97, 111, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 173, 188 squatter, 100, 185 Sri Lanka, 25, 26, 27, 29, 33, 40, 94, 175, 178, 184, 191, 192 stability, 161 staffing, 75 stages, 8, 80, 96, 153, 175, 186 stakeholders, 14, 17 standards, 55, 154, 163 State Council, 73, 74, 75, 87 state-owned enterprises, 20, 79 statistics, 106, 181

219

statutory, 79, 154 steady state, 144 steel, 190 stigma, 189 stigmatized, 50 stock, 139, 144, 145, 146, 147, 153, 155, 188 stock markets, 153 stock price, 139, 144, 145, 146, 147, 155 stomach, 32 strains, 196 strategic planning, 71 strategies, 17, 36, 41, 98 strength, 16, 190 stress, 17, 55, 101, 150 stretching, 175 stroke, 37 subjective, 105, 164 subjective well-being, 105 sub-prime, 155, 186 Sub-Saharan Africa, 132, 135, 136, 140, 141, 176 subsistence, 28, 56 suburbs, 51, 188 successful aging, 71, 72, 78, 83, 84 suffering, 32, 100, 194 suicidal behavior, 63 suicide, 54, 81, 187, 192 suicide rate, 54 Sumatra, 191, 192 summer, 189 supervision, 31 supplemental, 150 supply, 144, 149, 150 surgery, 97, 190 surplus, 143 surpluses, 150 surveillance, 154 survival, 28, 31, 71, 94 survival rate, 28 surviving, 94 sustainability, 15, 78, 198 swamps, 191, 195 symbols, 168 sympathy, 35 syndrome, 189

Aging in Asia, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

220

Index

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

T Taiwan, 43, 182, 184 Tajikistan, 180 Taliban, 192 Taoism, 171 targets, 38, 43, 71 task force, 102 tax base, 154 tax collection, 153 taxation, 154 technical assistance, 153, 154 temperature, 193, 194, 195 tenure, 185 territorial, 164 territory, 42, 48, 49, 53, 54, 58 Thailand, 39, 129, 130, 133, 143, 149, 178, 182, 184, 189, 191 thinking, 3, 75, 163 threat, 17, 154, 159, 191, 193, 194 threats, 16, 193 threshold, 133, 189 Tiananmen Square, 162 tiger, 63, 199 time periods, 185 timing, 21, 38, 84, 147 Tokyo, 43, 61, 156, 176, 188, 198 tourism, 199 tourist, 191 Toyota, 189, 199 trade, 43, 130, 154, 183 trading, 152, 153 tradition, 15, 81, 97, 124, 161, 177 traffic, 48, 186 training, 32, 81, 102 transactions, 49 transfer, 31, 56, 80, 81, 153 transfer payments, 56 transformation, 15, 42, 46, 124, 162, 165, 187 transition, 8, 16, 17, 20, 21, 39, 42, 46, 84, 109, 110, 153, 161, 169, 174, 182, 183, 194, 197, 198, 199 transitions, 132, 167, 170, 176 translation, 73, 75 transmission, 195

transnational, 199 transport, 42, 52, 55 transportation, 20, 176 travel, 55, 59, 194, 199 trees, 191 tribal, 192 tropical areas, 137 tsunami, 191, 192 tuberculosis, 185, 193 Turkey, 179, 184 Turkmenistan, 179 turnover, 53, 152, 165 typhoid, 194

U ulcer, 32 uncertainty, 4, 151, 165 unemployment, 1, 56, 79, 80, 81, 84 UNESCO, 69, 73, 87 UNFPA, 108 unions, 20 United Arab Emirates, 180 United Nations, 3, 7, 11, 12, 13, 14, 24, 25, 27, 38, 40, 55, 65, 68, 69, 87, 90, 108, 129, 130, 131, 132, 133, 138, 144, 145, 147, 148, 149, 157, 181, 183, 197, 199 United Nations Development Program (UNDP), 39, 90, 95, 106, 108 United Nations Development Programme, 90, 108 United States, 139, 181, 189 universities, 8 urban areas, 27, 41, 42, 45, 46, 50, 51, 52, 55, 56, 59, 63, 90, 98, 100, 101, 110, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 188 urban centers, 15, 98, 183 urban population, 59, 110 urban renewal, 50, 54, 64, 65 urbanization, 3, 15, 16, 17, 27, 28, 31, 41, 42, 46, 53, 59, 110, 111, 115, 176, 177, 194, 197, 198 USAID, 97, 108 USSR, 183, 184 Uzbekistan, 179

Aging in Asia, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Index

V

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

vaccination, 194 values, 16, 28, 42, 53, 59, 71, 135, 136, 137, 140, 141, 142, 146, 162, 163, 165, 187 variability, 188 variables, 111, 122, 123, 124, 134, 136, 137, 139, 140, 141, 142, 145, 146, 147 variance, 136 variation, 142, 184 vascular dementia, 81 vector, 134 vein, 189 victims, 54 Vietnam, 39, 129, 130, 143, 182, 184, 192 Vietnam War, 192 village, 32, 42, 163 violence, 54, 55, 97 viruses, 193 visible, 39 vision, 12, 68, 160, 165 volatility, 151 vulnerability, 54, 97, 173, 188, 191

221

welfare state, 84 welfare system, 56, 103, 173 well-being, 15, 20, 29, 35, 37, 42, 50, 53, 63, 64, 68, 70, 98, 105, 110, 169, 185 wellness, 72 Western countries, 8 Western Europe, 187, 189 Western societies, 80 wildlife, 195 windows, 36 winter, 189 wisdom, 16, 183 women, 20, 28, 29, 32, 33, 40, 56, 63, 68, 78, 79, 91, 94, 95, 96, 97, 98, 100, 101, 104, 150, 153, 164, 167, 177, 185, 186, 187, 196 workers, 36, 43, 79, 81, 82, 95, 149 workforce, 30, 68, 80, 81 working population, 1, 130 World Bank, 90, 108, 134, 136, 145, 151, 157 World Development Report, 108 World Health Organization (WHO), 41, 59, 66, 68, 69, 70, 72, 73, 80, 82, 83, 87, 95, 97, 108 World War II, 8 writing, 102, 175, 186, 190

W wages, 151 war, 26, 107, 145, 188, 192 warrants, 92, 98, 101 water, 100, 185, 191, 194, 195 weakness, 32 wealth, 17, 20, 31, 55, 68, 162, 163, 168, 184 web, 108 welfare, 2, 20, 37, 46, 56, 58, 59, 60, 62, 63, 69, 80, 81, 84, 103, 125, 166, 173, 181 welfare reform, 60, 80 welfare reforms, 60

Y Yemen, 180 yield, 145 yuan, 188

Z zinc, 49 zoonosis, 195

Aging in Asia, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,