1 Editorial

The first characteristic of “Chinese Path to Modernization” is “the modernization of a huge population”, which refers to that China’s modernization is historically making 1.4 billion people live a prosperous and dignified life. Meanwhile, the demographic characteristics such as negative population growth, declining birth rate and population ageing will accompany Chinese modernization for a long time. In the face of long-term negative population growth expectations, how to deal with negative population growth and how to actively coping with population ageing has become the focus of research. Academic research has shifted from focusing on population quantity in the past to focusing on population quality and structure, hoping to give full play to the advantages of human resources, transform the demographic dividend into talents dividend, and promote high-quality population development.

The launch of this special issue aims to explore how different countries respond to negative population growth and population ageing, and then hopes to find out how China can learn from the world. This editorial first introduces recent changes in China’s population and current research priorities and then introduces the four research papers in this special issue.

2 Negative population growth, declining birth rate, and population ageing in China

By the end of 2022, China’s population has decreased by 850,000 compared with the end of the previous year (9.56 million births and 10.41 million deaths), and the natural population growth rate is -0.60‰, which is the first negative population growth under normal population development after the founding of the People’s Republic of China in 1949. Although the population has experienced negative growth, the characteristics of China’s huge population will remain for a long time. According to the fprojection of World Population Prospects 2022, India’s population will exceed that of China this year, but China’s population will remain at more than 1.4 billion in the next 10 years or so, which is a huge scale(United Nations, 2022).

Since 1992, when China’s total fertility rate fell below the replacement level, it has been fluctuating and declining. It has dropped to an ultra-low fertility rate of 1.3 in 2020, and has dropped further since then, starting a natural negative growth. In a closed population that is hardly affected by international migration, a normalized, stable, and long-term negative growth of the total population will be the general trend (Yuan, 2023). The influencing factors leading to low fertility include demographic factors such as reduced fertility motivation, declining size and structural ageing of childbearing age women, delayed age of marriage and first birth, as well as socioeconomic factors such as family gender inequality, rising childbearing costs, and changing opinions on childbearing. These factors have also become the most important link in coping with negative population growth (Du, 2023).

While experiencing negative population growth, China has also entered a new stage of ageing society. The main characteristics of the new stage include a huge number of elderly people, significant differences between urban and rural areas, the oldest-old is emerging, and the health status of the elderly is improving. China is currently the only country in the world with more than 200 million elderly people. By the end of 2022, there was 280.04 million people aged 60 and over in China, accounting for 19.8% of the national population (of which 209.78 million people are aged 65 and over, accounting for 14.9% of the national population) (National Bureau of Statistics of China, 2023). According to projections, the number of people aged 60 and above will exceed 300 million in 2024, 500 million in 2048, and reach a peak of 524 million in 2052, and the number of people aged 65 and above is expected to exceed 300 million in 2033, exceed 400 million in 2050, and reach a peak of 436 million in 2057 (Chen, 2022). According to the data of the Seventh National Population Census (hereinafter referred to as the “Seventh Census”), in 2020, although the number of urban elderly has exceeded that of rural areas, the number of rural elderly is still growing, and the proportion of the elderly population is 7.99% points higher than that of urban areas. In addition, the 80-year-old and over age group accounted for 13.56% of the elderly population in 2020. Compared with the results of the 2000 and 2010 censuses, only the proportion of the 80-year-old and over group continued to increase. The overall health status of the elderly is improving. In 2020, for the first time, more than half of the elderly self-reported health status is healthy.

3 China’s research focuses on population and development

3.1 High-quality development of population

As a new concept, high-quality development of population was proposed under the new population development situation and has become the focus of recent research and work. This idea is of extreme importance and urgency to support Chinese modernization. Under the current new situation of population development, the high-quality development of population focuses on four aspects: improving the overall quality of the population, strengthening the comprehensive competitiveness of the population; achieving a moderate fertility level, promoting sustainable population development; achieving a reasonable and balanced population age and gender structure, achieving an effective supplement of labor resources; promoting a more active flow of population and labor between urban and rural areas, and between regions, and forming a smooth, orderly, reasonable and fair population flow and distribution pattern (Central Finance Office Study Group, 2023).

3.2 Implementing the national strategy in active response to population ageing

Actively responding to population ageing, as China’s main strategy to cope with population ageing, was proposed as early as in the national “Eleventh Five-Year Plan” in 2006, and it also has significant significance for the current demand for high-quality development of population. In October 2020, the implementation of the " national strategy in active response to population ageing " was officially proposed. In the “14th Five-Year Plan for National Economic and Social Development and Outline of Long-term Objectives for 2035”, there is a chapter detailing how to implement it. The specific content mainly includes three aspects: achieving a moderate fertility level, improving infant and child development policies, and improving the elderly care service system.

3.3 Carrying out healthy China action

The Healthy China Initiative is a strategy proposed in 2017. In the Healthy China Operation released in 2019, the elderly were listed as one of the key priorities. The Healthy China strategy focuses on four aspects: improving the health support system for the elderly, improving the level of health services and management for the elderly, strengthening long-term care services and guarantees for the disabled elderly, and further promoting the integration of medical care and nursing care. Lay the foundation for healthy aging by strengthening health interventions throughout the life cycle.

3.4 Improving the life quality of the elderly

The shrinking family size is a major trend in China’s population development at present, and how to support the elderly care of the family under this background is a major focus of attention at present. According to the Seventh Census data, compared with previous census data, the proportion of elderly people living with their children is decreasing, while the proportion of elderly living alone and only with their spouses is increasing. Elderly households living alone and empty-nest couple households accounted for more than 40%, an increase of 12.18% points from 2010. Usually, the elderly in single-living households often have more prominent needs in terms of elderly care and spiritual comfort, and they are groups that should be paid close attention to by social policies and services. In addition, the proportion of two or three elderly households has increased, indicating that the care burden faced by a single family is quietly rising, and such families also need to receive corresponding attention.

4 Establishing the Basic Senior Care Service System

One of the characteristics of China’s population is the imbalance between urban and rural areas and regions in the process of rapid urbanization. How to ensure that more than 200 million elderly people can fully enjoy various public services including health, medical care, elderly care, transportation, and culture is China’s current challenge. At present, the government is focusing on developing inclusive elderly care services to ensure that every elderly person can obtain basic elderly care services. In May 2023, the “Opinions on Promoting the Construction of the Basic Elderly Care Service System” is issued, basic elderly care refers to essential and inclusive services that meet the people’s basic elderly care needs. And the “National Basic Elderly Care Service List” has been officially released to provide the elderly with three types of basic inclusive services, including material assistance, nursing services, and caring services. In addition, the development of the long-term care system is also a current focus. Accumulate experience through the pilot long-term care insurance system, and then gradually establish a long-term care security system that connects insurance, welfare, and assistance. So far, pilot projects have been launched in 49 cities, covering 145 million people.

5 Promoting multiple subjects to share the responsibility for elderly care

Encourage multiple subjects to share the responsibility for the elderly, in other words, after clarifying the boundaries of government responsibilities, encourage society and the market to develop their roles in the elderly care industry. Specifically, the responsibility for elderly care is positioned as shared by the government, society, market, family, and individuals. The government clarifies the boundaries of responsibilities and no longer dominates all elderly care provision. The market mainly promotes the market-oriented operation of elderly care services by introducing market mechanisms. For society, it is necessary to encourage social forces to intervene and participate in the formulation of rules and service delivery for elderly care services; finally, families and individuals participate as the main body of elderly care.

Another reason to encourage the functioning of the market and society is the huge heterogeneity of China’s large elderly population, which is reflected in various aspects of region, urban and rural areas, income, health and cultural level. As far as the government is concerned, it can only meet the basic elderly care service needs of the elderly, while personalized elderly care needs need to be met by the market.

Bridging the gap between urban and rural areas in China is a long-term goal of promoting high-quality population development under the new situation of population development. Due to the unbalanced economy of urban-rural, the income gap between urban and rural elderly is particularly prominent. Statistics from the Seventh Census show that the top three sources of livelihood for the elderly in China are pensions, support from other family members, and labor income. Although compared with previous censuses, pensions ranked first for the first time, but the proportion of elderly people who rely on family members for support is still close to 30%, indicating that there are still many elderly people who cannot be financially independent. In addition, there is a clear disparity in the income of urban and rural elderly people. More than two-thirds (69.8%) of the elderly in cities mainly rely on pensions, which is much higher than that of the elderly in towns and villages. Some scholars have found that the pension income of the urban elderly can be as high as 11.3 times that of the rural elderly (Xia Huizhen & Wang Yake, 2021), while the per capita annual income of the urban elderly can reach 4 times that of the rural elderly (Huang Zongye & Zhao Jingjing, 2021).

The huge difference in the income of the elderly between urban and rural areas reflects to a certain extent that although the current “three-pillar” social security system in China has basically achieved the goal of ensuring the life of the elderly, there are still imbalances. In response to these gaps, China is currently accelerating the construction of a multi-level social insurance system for the elderly. Expand the coverage of the second-pillar occupational annuity and officially launch the personal pension insurance in 2022, and gradually improve the three-pillar pension insurance. In addition, the non-contributory social assistance system plays a supporting role to ensure that the basic life of low-income groups is guaranteed.

6 Comparison with other countries in the world

When discovering how China can learn from the world in coping with negative population growth and population ageing, it is necessary to first understand the similarities and differences between China and other countries. In the modernization history of various countries, the population base of Chinese modernization is unprecedented. In the United Kingdom, the United States, and other modernized countries, although their population size has achieved rapid growth in the process of modernization, their population size has not reached the size of China. In addition, although the number of elderly people in developed countries is larger than that in China, it is estimated that by 2030, the total number of elderly people in China will exceed the sum of developed countries. Therefore, it can be thought that Chinese modernization and China’s population ageing will profoundly change the pattern of the world’s response to population ageing (Du, 2022).

China is not the country with the highest degree of population ageing, nor is it the country with the fastest ageing population. The Republic of Korea’s population is ageing faster than China’s. According to data released by Statistics Korea, the proportion of the Republic of Korea’s population aged 65 and over was 17.5% in 2022. It is estimated that by 2044, the proportion of the elderly will reach 36.7%, exceeding Japan (36.5%) to become the country with the highest ageing population in the world. Meanwhile, the fertility rate of Korea is currently at the lowest level in the world, and the negative population growth has continued for several years. Japan is the country with the highest proportion of elderly population in the world. In 2022, the proportion of 65 years old and above is 29.1%, and it is expected to reach 37.7% by 2050. China is expected to reach 30.7% by 2050. It is basically equivalent to the current level of Japan, which is 7% points lower than that of Japan and Korea. Therefore, among the three countries in East Asia, the policies and experiences of Japan and Korea which the population ageing earlier and faster than that of China, and also faced negative population growth earlier, have important reference significance.

A comparison of population aging in India and China is also necessary. China is not the only country in the world with an elderly population of over 100 million. The number of elderly people in India has also exceeded 100 million, reaching 140 million. However, with a similar total population, there is an obvious gap between the number of elderly people in India and China. India’s elderly people is more than 140 million less than that in China. According to the projection from the United Nations, China will still be the country with the largest elderly population in the world in the next 50 years or so. It is predicted that by 2068, the total elderly population in India will reach 490 million, exceeding that of China, but the proportion of the elderly population will be around 29%, which is still much lower than that of China.

It is also significant to make a comparison with Russia, which has experienced negative population growth. Russia experienced a natural negative population growth from 1994 to 2007. It once jumped out of the negative population growth in 2008 and continued the positive growth for a long period until 2020 when the population began to negative grow again. In 1994, when Russia experienced negative population growth for the first time, the proportion of elderly people aged 60 and above was 16.7%, while in 2022, when China experienced natural negative population growth, the proportion was 19.8%, which is relatively close. Looking recently, when Russia’s population negatively growing again in 2020, the proportion of elderly people aged 60 and over is 22.2%, which is slightly higher than that of China in the same period but also very close. The degree of population ageing in China and Russia is similar when there is a natural negative population growth, which makes Russia’s experience more meaningful for China.

7 Overview of papers in the special issue

This special issue presents 4 original research from Russia, Korea, Singapore and China. The paper from Russia shows the status of population ageing, the health status, and quality of life of the elderly in Russia from a macro level, and can provide a reference for China’s strategy to deal with population ageing under the background of negative population growth. The paper from Korea analyzes the impact of age and other factors on life expectancy in China and Korea from a comparative perspective, providing an empirical basis for shifting the focus of work from reducing mortality to improving health from the perspective of the entire life cycle. The paper from Singapore analyzes the various efforts made by the government to promote the role of the family in supporting the elderly and provides a reference for China to promote the sharing of multiple subjects in the responsibility of the elderly. The last empirical paper from China focuses on the factors that affect the migrant population’s access to medical services and provides an important reference value for how to safeguard the rights and interests of the floating population and strive to narrow the urban-rural gap.

Aleksandr Vladimirovich Zubko et al. provide a comprehensive exploration of demographic aging, health, and life quality of the elderly in Russia. It presents a nuanced understanding of the impact of social, political, and historical factors on Russia’s distinctive aging demographics. The paper’s emphasis on the role of chronic diseases, particularly cardiovascular diseases, on the life quality of the elderly, is both illuminating and crucial. The findings of this paper provide important insights into the challenges of coping with population aging and the Russian healthcare system and policies related to older people.

Siying Lyu et al. offer a detailed analysis of age and cause-specific contributions to life expectancy. Applying Arriaga’s decomposition method to data from the United Nations and the Global Burden of Disease Study, this research reveals intriguing mortality patterns and chronic disease burdens in an aging society. The identification of non-communicable diseases, particularly cardiovascular diseases among the elderly, as a key driver of the life expectancy gap, along with the convergence of mortality patterns among younger age groups, provides vital cues for targeted public health policies.

The role of the family in coping with population aging in East Asian countries has always been one of the hot issue of researchers. Shaohua Zhan and Lingli Huang introduce the concept of state familism to articulate Singapore’s multifaceted efforts to foster the family’s role in old-age support. While drawing criticism for potentially reducing government responsibility, state familism has been instrumental in promoting intergenerational support and ensuring comprehensive care for the elderly in Singapore. The lessons derived from this research could well serve as a blueprint for other countries grappling with similar demographic shifts.

Luchan LIU et al. delve into the healthcare challenges faced by migrants, an often-overlooked demographic crucial to the nation’s socio-economic development. The paper innovatively uses comparative data to verify the disparities between migrants and registered local residents in terms of healthcare access. The authors’ use of the binary Logit model provides compelling evidence that health education significantly influences medical treatment seeking behaviors. The emphasis on the social participation factor in this mechanism underlines the intertwined relationship between healthcare, social integration, and overall wellbeing.