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An apocalyptic vision of ageing in China

Old age care for the largest elderly population in the world

Eine apokalyptische Vision der demographischen Alterung in China

Das Problem der Altenpflege in dem Land mit der größten Anzahl alter Menschen weltweit

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Abstract

According to the National Bureau of Statistics of China, by 2010 the number of people aged 60 or over had reached 178 million in China or 13 % of its population. With the largest elderly population in the world in absolute numbers, China faces a challenge of providing care for the elderly both in the present and the future. Unlike old age pensions and health protection for the elderly, in Chinese society elderly care had never been considered to be a social problem but rather the individual familyʼs responsibility. After the turn of the millennium, as the repercussions of increasingly ageing demographics, the results of the One-Child Policy and drastic changes in traditional family structures gradually became more apparent, this issue of elderly care has increasingly become one of the most pressing concerns for the ageing society. As there is little existing research on this particular topic, this article aims to shed light on elderly care in China, focusing on the care of elderly needing assistance with activities of daily living, since this group of elderly are most in need of care, their numbers having risen to 33 million in 2010. This article argues it is urgent for China to switch from informal family-based elderly care to the stateʼs formal long-term care, illustrates that a model of social insurance (e.g. as in Germany) is advocated by many Chinese scholars and points out the ways in which it is different from both the commercialized models (e.g. as in the USA) and state organized “Beveridge” models (e.g. as in Sweden).

Zusammenfassung

Einem Bericht des Staatlichen Amtes für Statistik der Volksrepublik China zufolge stieg die Zahl der 60- und über 60-Jährigen in China bis zum Jahr 2010 auf 178 Millionen. Das macht 13 % der gesamten Bevölkerung Chinas aus – und entspricht dem größten absoluten Wert in Bezug auf die Anzahl alter Menschen weltweit. Entsprechend sieht sich China bereits jetzt, vor allem aber für die Zukunft, mit dem Problem der Altenpflege konfrontiert. Anders als die Alterssicherung und die Gesundheitsversorgung alter Menschen wurde die Altenpflege bislang nicht als soziales Problem, sondern vielmehr als individuelle und familiäre Aufgabe betrachtet. Seit der Jahrtausendwende zeichnen sich immer deutlicher die Auswirkungen der zunehmenden demographischen Alterung und die Folgen der Ein-Kind-Politik ab, einschließlich der drastischen Veränderung der traditionellen familiären Struktur, sodass auch das Problem der Altenpflege in der Alterungsgesellschaft Chinas immer deutlicher zutage tritt. Da bislang nur wenige Studien zu diesem Thema vorliegen, möchte sich dieser Aufsatz dem Problem der Altenpflege, insbesondere der Betreuung alter, pflegebedürftiger Menschen und ihrer Unterstützung bei den täglichen Aktivitäten des Lebens widmen. Die Zahl der Menschen in dieser Altersgruppe ist bereits auf 33 Millionen gestiegen. Der vorliegende Beitrag kommt zu dem Schluss, dass China das familienbasierte in ein staatlich organisiertes Pflegemodell umwandeln muss. Außerdem weist er darauf hin, dass eine soziale Pflegeversicherung von mehreren chinesischen Wissenschaftlern bevorzugt wird. Dieses Modell geht zurück auf das Sozialversicherungsmodell in Deutschland und unterscheidet sich grundlegend vom kommerziellen Modell der Vereinigten Staaten von Amerika wie vom Staatsfürsorgemodell in Skandinavien.

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Notes

  1. The very popular newspaper “Global Times” addressed the issue through with a full-page spread including discussions and debates about searching for an institutional scheme for long-term care in their 18 May 2013 publication, inviting many experts and specialists from the area of gerontology and sociology to discuss this issue and introduce it to public.

  2. Concerning the construction of different stages of life, like the pre-school stage, education, occupational career and retirement through statutory social policy by state see [16].

  3. The ageing society is linked to the process of demographic transition and population ageing which are characterized through the increase of median age, the prolongation of the life expectancy and the growing share of old age people in the total population [3, 11].

  4. See the results of the Fifth Population Census of the PR China, available on the webpage of National Bureau of Statistics in China: http://www.stats.gov.cn/tjsj/pcsj/rkpc/dwcrkpc/.

  5. Before the founding of the People’s Republic of China in 1949 life expectancy amounted to 42 years for both genders, and after the sharp increase in the last 6 decades it has risen to 73 years in 2010 according to the United Nation World Population Prospects: 2006 revision.

  6. The number of senior citizens who live in empty-nest families peaked at 99 million in 2012 and will climb to 100 million in 2013. See the data provided by the Vice Minister of Ministry of Civil Affairs (MOC)—Dou, Yupei, on the webpage of the MOC: http://fss.mca.gov.cn/article/lnrfl/ywjs/201305/20130500459697.shtml

  7. The number of loss-of-single-child (childless) families has reached nearly 1 million in China in the year 2012. Annually about 200,000 children in China are abducted and sold by organized criminal networks of trafficking in human beings. See the report about the loss-of-single-child families in China from the Xinhua News Agency on: http://www.zj.xinhuanet.com/newscenter/rb/2013-03/03/c_114868873.htm.

  8. ‘Activities of daily living’ is a term used by health care professionals to refer to daily self-care activities, such as feeding ourselves, bathing ourselves, dressing ourselves and walking. The ability or inability to perform these tasks is generally used as a measurement of the ‘functional status’ of the elderly. Instrumental activities of daily living are not necessary for fundamental functioning, and people who are in need of care usually lead independent lives in their communities, the major assessment criteria are for instance: Assistance with housework, transportation within the community, use of telephone and handling finances [15, 19].

  9. By comparison, in Germany there were about 2.54 million people who were care-dependent in 2012, of whom 79.6 % were 65 years of age or older, about 11.9 % of the elderly population in Germany (Bundesministerium für Gesundheit: Zahlen und Fakten zur Pflegeversicherung: http://www.bmg.bund.de/pflege/zahlen-und-fakten-zur-pflegeversicherung.html)

  10. The term ‘completely disabled old people’ refers to those who have lost the ability to self-care entirely and require permanent care, while the term ‘partially disabled people’ describes those who have lost this ability only partially and need temporary care.

  11. “Maodong” is a word from the northeast dialect in China, which means that the people prefer to stay indoors at home during a long and cold winter.

  12. The rural MLSS was tried out by local communities in China since the millennium. From 2006 this programme has become a national programme through pressure from the State Council of China. It stipulated that rural residents whose income falls below the local poverty line can claim a monetary assistance from the local administration.

  13. See the report of Ministry of Civil Affairs (2009) “The Statistical Report on Civil Affairs Matters in 2009”, available on: http://finance.people.com.cn/nc/GB/11853946.html.

  14. However, it must be noted that this construction of three major models for long-term care insurance is only associated with a scientific observation of Chinese scholarly circles, and represents a form of social construction according to the cognitive exploration of these actors in the absence of a current international consensus in the domain of long-term care insurance on a mature global model. This cognition of the objective world in China is interconnected with a creation of an ideal type by scientific actors, for, as Max Weber has indicated: “An ideal type is formed by the one-sided accentuation of one or more points of view and by the synthesis of a great many diffuse, discrete, more or less present and occasionally absent concrete individual phenomena, which are arranged according to those onesidedly emphasized viewpoints into a unified analytical construct…” ([40], p. 90). The construction of an ideal type by social scientists also serves to reduce the complexity of social facts in the social world (see [28]).

  15. In 1968, the Algemene Wet Bijzondere Ziektekosten (general law on exceptional medical expenses) was introduced in the Netherlands, which attempted to expand the health insurance system to cover the entire Dutch population against special health care needs. At the time, this programme also created one of the earliest forms of a type of long-term care [36].

  16. However, another quite important system, that of Medicare in the United States, which shares features with the Beveridge model, appears to be of little concern to Chinese long-term care experts and is therefore in need of further exploration in the future. The Medicare system targets elderly Americans over 65 who are not covered by the health insurance system, for whom this system provides reimbursement of medical costs as well as some forms of assistance for those in need of care [32].

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T. Liu and L. Sun declare no conflict of interest.

The accompanying manuscript does not include studies on humans or animals.

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  1. Fakultät für Soziologie, Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Germany

    Tao Liu

  2. Faculty of Technology, Policy & Management, Delft University of Technology, Jaffalaan 5, 2628, BX Delft, The Netherlands

    Li Sun

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Correspondence to Li Sun.

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Liu, T., Sun, L. An apocalyptic vision of ageing in China. Z Gerontol Geriat 48, 354–364 (2015). https://doi.org/10.1007/s00391-014-0816-5

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