1 China’s demographic challenges

The past couple of years have been very lively in terms of the study of demographic changes in China. Last year, the results of the Census showed not only a very slow pace of population growth, but also a lower-than-expected total fertility rate (TFR). Then, in early 2023 we saw the announcement that national population growth had been thrown into reverse for the first time in many decades. Finally, in the spring of 2023, it was announced that India had overtaken China as the most populous country on earth.

All these developments were well covered in the international media. Much of the coverage was alarmist in nature, proclaiming that these demographic changes posed an existential threat to not only economic growth, but the social and political future of China. Talk of ‘getting old before it gets rich’ was widespread, as were (unfavorable) comparisons to younger, apparently more ‘demographically dynamic’ countries such as India. It was hard to ignore a certain kind of schadenfreude in some of the commentary: a sense that China had enjoyed such rapid economic (and political) growth in recent decades, and now the brakes would be rapidly applied.

Much of this commentary took a rather one-dimensional view and ignored many other features of change in China. This characterization was also reflected in the proposed response: that people just have more babies. Indeed, this approach has been adopted among many in both policy and academic circles. Remember, for example, the notorious suggestion some years ago proposing a tax on the childless? Of course, these two-dimensional ‘call and response’ suggestions ignore the fact that babies and children neither work nor pay tax, and would not join the labor force for at least another eighteen years, by which time stressed social institutions would no longer be sustainable.

These pronatalist pronouncements and policies often ignore the general circumstances of family formation in contemporary China. Most policies which have been instituted focus on ‘baby bonuses’: cash incentives which pale in comparison to the actual costs of bringing up a child in China. Such policies do not properly address the challenges associated with starting, and growing, a family in China. Getting a decent job is a major challenge, with youth unemployment running high. Being able to afford a small house, especially in a Tier One city, is out of reach for many young people. Work culture demands long hours and, still, both overtly and implicitly discriminates against parents. Accessing adequate, quality and affordable childcare is a severe challenge. Once of school age, the financial and psychological cost of ‘education fever’ to parents (and, indeed, their children) can be extremely high. Even practical issues should as the small area of many apartments make considering a ‘larger’ family an issue (Gietel-Basten, 2019).

Not only is the care for the house, children and older parents disproportionately placed on the shoulders of females, but their jobs are also more fragile and open to discrimination. Given that women are now characterized by higher educational attainment than men, the ‘risk’ associated with childbearing – the risk to their careers, but also their dignity and aspirations for life – have, arguably, never been higher. Under these circumstances, especially when added to the economic and social trauma of the COVID-19 pandemic, it is perhaps not surprising that TFR has remained low in recent years, even under circumstances of birth control policy reform.

All of this, added to a comparatively low ideal family size (which could be a legacy of prior birth control policies), suggests that TFR is likely stay low for some time and the pace of population aging (and decline) may well increase. All of this adds to this notion of the ‘demographic threat’ (Chen and Gietel-Basten, 2023).

2 Thinking differently about aging

However, this is only part of the story. We must reflect on how this new population paradigm of aging and decline came about. Yes, low fertility was perhaps the driving factor. However, so too were improvements in health and mortality. China is getting older, and its population is getting smaller. But the population is also getting healthier, and more highly educated—especially among the younger generation. Translating these human capital gains into productivity is going to be the key to offsetting the demographic challenges to the size and structure of not only the labor force, but also to deliver healthy aging and thus minimize dependency in older age. In other words, it is about ensuring that the full potential of all of China’s population can be met.

A second key part of the story revolves around institutions. There is no such thing as an optimal population size and structure. The extent to which demographic changes bring about opportunities and challenges is entirely dependent on the institutional framework within which they sit. This can be the nature of the labor market, but also health and social welfare systems and how they are funded. By extension, it is always more effective and efficient to reform these institutional systems in the face of demographic challenges than seeking demographic solutions. Paradigmatic and parametric reforms will have an immediate effect on the sustainaility of the pension system; having more babies will not.

Finally, to understand aging in China—and how we might respond to it—we must look beyond its borders. China is a very special, perhaps unique country in terms of its size, geography, political and economic system, and demographic history. However, it is far from the only country which is undergoing this demographic transformation now. It is certainly not the first to do so either. Placing China in such a comparative framework, therefore, enables us to better understand China itself, but also to learn more about the experiences of other countries, and what knowledge we might be able to transfer to our understand of China.

3 Contributions to this multidimensional, comparative mode of thinking

In this sense, the volume you have in your hands is extremely timely. The papers in this volume of CPDS approach various aspects of aging in China and the broader region; but each does so in an innovative manner, which contributes to this multidimensional, comparative view of aging in the country. The papers by Lyu et al. (2023) and Ivanova et al. (2023) both tell us about how aging came about through lower mortality, but both point to the need to measure and think multidimensionally, not least about patterns of wellbeing and the changing determinants of health. These are crucial factors in both ensuring that wellbeing is maximized among current older populations, but also that we can be better prepared and more resilient for future generations of older persons (Gietel-Basten, 2021).

The paper by Lyu et al. (2023) represents a methodological innovation by applying Arriaga’s decomposition method to the age/cause-specific contributions to the life expectancy gap between China and the Republic of Korea during 1990–2019. The results are very clear: a wide disparity at older ages coupled with some convergence at younger ages. This finding can be heartening for China in terms of the prospects for the younger population to ‘age better’ than their forebears. However, it makes clear the significant challenge posed to China to ensure that the wellbeing of the extant older population is maximized. In revealing the comparative causes of death and burden of disease, the paper re-emphasizes the need for a strong focus on the management of non-communicable diseases (such as heart disease) and, in turn, the need for enhanced preventive strategies. Finally, the example of high older suicide rates in Korea is also instructive for China in terms of the need to provide enhanced mental health services to older persons, but also the need to think more broadly about wellbeing. These high suicide rates come about through a perceived lack of dignity and a ‘role’ in later life. This, therefore, highlights the need to improve policies relating to work and, more particularly, lessening some of the challenges associated with the transition to post-work life. The work also raises a gendered dimension, considering the challenges for men to adapt to this post-work life under particular cultural and social expectations of roles.

The paper by Ivanova et al. (2023) looks at the processes and issues relating to health and aging in the Russian Federation. The paper observes the importance of historical effects on cohort size and the wellbeing of populations, as well as the high degree of regional variation and highly feminized nature of aging in the Russian Federation. All these features are relevant to China. The traumatic events of the mid-twentieth century are still felt in the echoes of health and wellbeing of many older people in China. Similarly, regional patterns of aging (and population decline) are highly diverse in China, with the north-eastern provinces particularly affected. Finally, while the history of high male mortality in Russia shapes the extreme sex ratios of older age there, we must also remember the highly skewed sex ratios at birth in China over recent decades and reflect on how this might affect aging in the future. Again, the article by Ivanova et al. (2023) reflects on the importance of considering the dimension of health in older ages. The focus on prevention and the need to change lifestyles is extremely valid, as is the need to develop quality social services and to maintain social contact. Again, the need to consider the specific mental health challenges of older men and women respectively is of critical importance.

The paper by Ivanova et al. discussed the importance of developing social services as well as maintaining social contact with peers and family. Building on this, the paper by Zhan and Huang (2023) discusses the extent to which these two components are embedded in Singapore’s policy of ‘state familism’. Their study demonstrates the extent to which Singapore has sought to mainstream intergenerational, familial support as the major component of care for older persons. This policy has come under a high degree of criticism as it perceived to be a sign of diminishing the government’s responsibility for supporting older persons. In partial response to this, the government has increased direct payments to older persons, and sought to provide greater support to ensure older people are engaged in the labor market, but also as care givers.

The story told by Zhan and Huang (2023) is a valid parable for the development of policies supporting older persons in China. Of course, it is important that intergenerational familial care is a part of the caring ecosystem. However, governments should be careful not to take this for granted, or even to impose it as an ultimate modality, especially under circumstances of the modernization of the family and high levels of internal migration. This can also have unforeseen circumstances. We have already identified the key role which caring for older persons can place a burden on the shoulders of parents of children, especially women. If the government is keen on supporting parents to meet their aspirations to have more children, then relieving—rather than reinforcing—care responsibilities for older persons may be more productive.

Finally, the paper by Liu et al. (2023) discusses an under-researched component of health in China—namely support for accessing health services for the country’s floating population. In a theme which is common throughout most of the papers, the contribution by Liu et al. emphasis the need to focus on health education and health seeking behavior which, in turn, is mediated by social participation and networks. The paper proposes to expand the coverage of health education among migrant groups, improve the accessibility of health education, and to use public medical and health services as ‘a window to guide migrants to seek medical treatment in an orderly manner while assisting their social integration’.

This paper goes back to key theme raised near the start of this introduction: ensuring that China can maximize the potential of everyone it has. There is no doubt that the country’s floating population has contributed enormously to China’s economic growth. This contribution has often been made at some significant physical and social sacrifice. Ensuring that the floating population can access high quality public services (including health and education for their children) is important not only to repay their contributions to the economy, but also to ensure they are better placed to make even greater contributions in the future. In raising the issue of health-seeking behavior and health education for the floating population, the article by Liu et al. (2023) raises the key point that China still has much to ‘squeeze out’ of its existing population through addressing these inequalities.

4 Conclusion

There is no doubt that China is part-way through a demographic transformation the like of which the world has not seen in size, pace, and scope. To maintain its position in the global political and economic hierarchy, it must continually adapt its systems and institutions to maintain their sustainability. These systems and institutions must be adapted to serve the individual, changing needs and requirements of citizens. There is good evidence that such changes are under way. The current Five-Year Plan, for example, contains much ‘good policy’ on gerontechnology, health and social welfare reform, (further) poverty reduction regional development and so on.

The papers in this issue make one thing clear: the extent China can weather this demographic transformation is going to be determined by how much it is able to maximize the full potential of its human capital. It has been empirically shown elsewhere that increasing labor force participation rates while utilizing improved education to increase productivity is a highly effective means of keeping dependency low, even under conditions of very low fertility rates (Marois et al., 2021). Cajoling women into having more children and rolling back reproductive rights and gender equality is not the answer. Rather, releasing the potential of all people within reformed, sustainable institutional frameworks must be the number one priority for China as it embarks on the next phase of its history.