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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 in Asia / [edited by] Jason L. Powell, Ian G. Cook.
p. cm.
Includes index.
ISBN 978-1-61728-131-0 (E-Book)
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


Introduction: Aging in Asia - A Contextual Opening 1

Part One. Aging in Asia Case Studies 5
Chapter 1 Aging, Life Expectancy and Changes in Life Style:
Situational Analysis of Pakistan 7
Ahmad Raza, Ashraf Khan Kayani and
Hasan Sohaib Murad
Chapter 2 Population Aging in Bangladesh: Trends and Challenges 19
Hafiz T. A. Khan
Chapter 3 Growing Old in a Global City: The Challenge of
Urbanization for Active Aging in Hong Kong 41
Helen Bartlett
Chapter 4 Active Aging and China: Perspectives and Issues 67
Sheying Chen and Elaina Y. Chen
Chapter 5 Aging in Nepal: Emerging Issues and Challenges 89
Sara Parker
Chapter 6 Changes in the Living Arrangements of the Elderly in
Korea 109
Ik Ki Kim
Part Two. Rethinking Aging in Asia 127
Chapter 7 Aging, Growth and Financial Markets Economic
Implications and Challenges Confronting East Asia 129
Takashi Kihara
vi Contents

Chapter 8 Rethinking Aging - the Selfless Consumer: Older

People, Risk and Uncertainty in Contemporary China 159
Steven Miles
Chapter 9 Patterns and Processes of Longevity in Asia 173
Ian G. Cook and Trevor J.B. Dummer
Index 201
In: Aging in Asia ISBN 978-1-60741-649-4
Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.


Jason L. Powell1 and Ian G. Cook2

University of Liverpool
Liverpool Jon Moores University

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
2 Jason L. Powell and Ian G. Cook

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
Inroduction 3

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


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 peoples 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 multi-
faceted 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
4 Jason L. Powell and Ian G. Cook

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.
In: Aging in Asia ISBN 978-1-60741-649-4
Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.

Chapter 1



Ahmad Raza, Ashraf Khan Kayani and

Hasan Sohaib Murad
University of Management and Technology/University of the Punjab

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.
8 Ahmad Raza, Ashraf Khan Kayani and Hasan Sohaib Murad

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
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).
Aging, Life Expectancy and Changes in Life Style 9

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 age-
distributions 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
10 Ahmad Raza, Ashraf Khan Kayani and Hasan Sohaib Murad

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 quasi-
stable 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


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
Aging, Life Expectancy and Changes in Life Style 11

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%

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.
12 Ahmad Raza, Ashraf Khan Kayani and Hasan Sohaib Murad

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 (%)

Age Group 0.0 0.5 1.0 1.5 2.0 2.5

65-69 4.90 4.20 3.55 2.97 2.45 2.0
70-74 4.01 3.35 2.77 2.25 1.82 1.45
75-79 2.93 2.39 1.92 1.53 1.20 0.93
80-85 1.81 1.44 1.13 0.88 0.67 0.51
85+ 1.31 1.00 0.75 0.56 0.41 0.30
Total 14.96 12.38 10.12 8.20 6.55 5.19
Source: United Nations (1990) Stable Population Age Distributions, Department of
International Economic and Social Affairs, New York, P.242.

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.

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.
Aging, Life Expectancy and Changes in Life Style 13

Table 4. Selected Demographic Indicators, Pakistan

Indicators Latest Available

Total Fertility Rate (TFR) 2005-06 3.8
Crude Birth Rate (CBR) 2005-06 26.1
Crude Death Rate (CDR) 2005-06 7.1
Population Growth Rate 1.8
Infant Mortality Rate (IMR) (2005-06) 76.7
Maternal Mortality Rate (MMR) (2004-05) 350-400
Life Expectancy at Birth (2005-06)* Male: 64 years
Female: 66 years
Source: Pakistan, Government of (2008): Pakistan Economic Survey, 2007-08, Finance
Division, Pakistan.

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.
14 Ahmad Raza, Ashraf Khan Kayani and Hasan Sohaib Murad

Table 5. United Nations Population Projections for Pakistan, 2000-2050

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.


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:
Aging, Life Expectancy and Changes in Life Style 15

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 familys 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 non-
productive 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
16 Ahmad Raza, Ashraf Khan Kayani and Hasan Sohaib Murad

action is implemented by these quarters to bring real social improvement. The

rapid nuclearizationof 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
Aging, Life Expectancy and Changes in Life Style 17

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 re-
integrated 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.

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,
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), Asias Family Planning Programs as Low Fertility
is Attained, Studies in Family Planning,Vol.33,No.1,pp-114-126.Available
at: on:25/11/2008.
Kirk, D. (1996), Demographic Transition Theory, Population Studies, Vol.50,
No.3, pp-361-367. Available at:
Accessed on: 25/11/2008.
Lopez, Alvaro (1961): Problems in Stable Population Theory, Princeton, New
Jersey, Office of Population Research.
18 Ahmad Raza, Ashraf Khan Kayani and Hasan Sohaib Murad

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: 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.
In: Aging in Asia ISBN 978-1-60741-649-4
Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.

Chapter 2



Hafiz T. A. Khan
University of Middlesex

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 worlds 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 worlds 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
20 Hafiz T. A. Khan

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).
Population Aging in Bangladesh 21


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 UNs 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 countrys 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.
P o p u la t io n in 1 9 5 0


5 5 -5 9

5 0 -5 4

4 5 -4 9

4 0 -4 4 M a le F e m a le
3 5 -3 9

3 0 -3 4

2 5 -2 9

2 0 -2 4

1 5 -1 9

1 0 -1 4

0 5 -0 9

0 0 -0 4

10 8 6 4 2 0 2 4 6 8 10
P o p u la t io n ( % )

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

P o p u la t io n in 2 0 0 0

6 0 +

5 5 -5 9

5 0 -5 4

4 5 -4 9

4 0 -4 4 M a le
F e m a le
3 5 -3 9

3 0 -3 4

2 5 -2 9

2 0 -2 4

1 5 -1 9

1 0 -1 4

0 5 -0 9

0 0 -0 4

1 0 8 6 4 2 0 2 4 6 8 1 0
P o p u la tio n ( % )

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

Figure 2. Trends of elderly population and growth rate.

24 Hafiz T. A. Khan

50 2.5

40 2

Growth rate (%)

Population (million)

30 1.5
20 1


10 0.5


3 .7


0 0
1950 1975 2000 2025 2050

Pop 60+ years Growth rate

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


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.
Table 1. Ageing in Bangladesh: 1950-2050

Population aged 60+ Population aged Ageing Index Median Age Sex Population
years (%) < 15 years (%) (%) Ratio 60+ (m)
1950 2000 2050 1950 2000 2050 1950 2000 2050 2000 2050 2000 2050 2050
Bangladesh 6.9 5.2 17.0 40.4 37.2 20.8 17.0 13.9 81.7 21.0 35.1 105 100 43.13
Afghanistan 4.5 3.8 5.6 42.6 47.3 33.7 10.5 8.3 16.6 16.3 23.0 107 107 4.45
Bhutan 4.3 6.7 23.3 43.8 40.2 17.9 9.8 16.6 130.1 19.3 39.9 102 103 0.21
India 5.4 7.1 20.2 37.5 35.0 18.2 14.4 20.2 110.9 22.7 38.6 107 104 335.48
Maldives 8.2 5.5 20.0 33.1 40.3 19.7 24.8 13.6 101.5 18.9 36.8 105 102 0.10
Nepal 6.6 5.5 14.1 38.4 40.9 23.1 17.2 13.4 61.0 19.3 32.5 98 96 7.24
Pakistan 8.2 5.7 16.5 37.9 41.8 21.8 21.6 13.6 75.6 18.8 34.1 106 104 48.11
Sri Lanka 5.5 9.3 29.0 40.9 26.8 16.7 13.4 34.7 173.6 27.5 43.4 99 90 5.42
Source: Calculated from World Population Prospects, United Nations (2007).
26 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
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).
Population Aging in Bangladesh 27

50 50
45 45
Child and total dependency ratios

40 40

Old-age dependency ratio

35 35

30 30
25 25

20 20

15 15
10 10

5 Child Elderly Total 5

0 0


















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: 1950-

Table 2. Percent of Population Aged 80+ in Selected Asian Countries

Countries 1950 2000 2050

Bangladesh 0.6 0.4 1.9
India 0.4 0.6 3.1
Sri Lanka 0.1 1.1 6.0
Pakistan 0.5 0.5 2.0
Nepal 0.4 0.4 1.4
Source: World Population Prospects database, United Nations (2007).

The following sections will discuss countrys key issues and challenges
relevant to ageing in Bangladesh.


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
28 Hafiz T. A. Khan

will expect to grow up to 39.3 percent by 2030 (UN, 2007). However, as such no
major change is appeared in countys 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.
Population Aging in Bangladesh 29

Table 3. Work participation rate among elderly by sex

Countries Male Female

Bangladesh 76.9 18.1
India 60.5 16.1
Sri Lanka 53.5 11.3
Source: Rajan et al., (2005).

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 Male Female

Bangladesh 32.2 7.7
India 40.7 12.7
Sri Lanka 88.5 68.6
Source: Rajan et al., (2005).
30 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 family-
size, and other socio-economic changes may adversely affect the traditionally old-
age support system in Bangladesh.

Table 5. Distribution of patterns of support from family members

Sex of older people (%)

Male Female
Treatment costs paid for by
Self 58.7 15.5 34.3
Son 39.5 64.6 53.7
Daughter 1.7 11.2 7.0
Grandchild 0 3.3 1.8
Others 0 5.2 1.8
Assistance obtained during illness
Self 0.9 20.9 11.1
Son/Daughter-in-law 53.6 43.7 73.1
Daughter/Son-in-law 26.0 69.5 48.1
Grandchild 1.1 25.8 13.6
Others 13.6 4.1 8.8
*Total percentages exceed 100 due to multiple responses.
Source: Khan and Leeson (2006).
Population Aging in Bangladesh 31

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--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 long-
stay 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).
32 Hafiz T. A. Khan


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
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


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. Governments made a plan to expand the coverage of old-age pension
among all the eligible 8 million elderly poor people (New Nation, 2004).
34 Hafiz T. A. Khan

Table 6. Receive any old allowance

Old allowance Frequency Percent

Yes 16 1.7
No 942 98.3
Total 958 100
Source: Khan and Leeson (2006).

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


A theoretical framework is proposed in this section as to how the socio-
economic 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,
Population Aging in Bangladesh 35

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.

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,
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,
36 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 others 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
Population Aging in Bangladesh 37

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
38 Hafiz T. A. Khan

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.

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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Dhaka: Centre for Policy Dialogue.
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Studies 52(2):201-13.
BDHS (2008). Bangladesh demographic health survey 2007, Main report, Dhaka:
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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):35-
CIA (2005). The world fact-book, rank order-population. US Central Intelligence
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. Asia-
Pacific Population Research Reports. Number 4. East-west Centre, Hawaii.
Population Aging in Bangladesh 39

Jejeebhoy, S.J. (1995). Womens 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,
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

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Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.

Chapter 3



Helen Bartlett
University of Queensland, Australia

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 two-
thirds of the worlds 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 regions population now reside in an urban setting (Hugo 2003). Rapid
urbanization in the region is having a major impact on peoples 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.
42 Helen Bartlett

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


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 worlds 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 entrept centre specializing in
Growing Old in a Global City 43

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).

Responding to the pressures of acute population growth and widespread
poverty, the Hong Kong Government started to provide public housing for low-
income 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
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 Kongs
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.
44 Helen Bartlett

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

Table 1. Changes in the Distribution of Hong Kongs Older Population

(Aged 65+), 1981-2006
Figures in bracket are % of total population in the district

People Aged 65+ Location

% of Change
District Council District Quotient*
1981 2006 1981-2006
Central and Western 22,300 (8.1) 30,900 (12.4) 1.0 +38.6
Wan Chai 19,697 (8.6) 22,600 (14.6) 1.2 +14.7
Eastern 30,761 (6.7) 82,900 (14.1) 1.1 +169.5
Southern 12,353 (5.7) 37,000 (13.5) 1.1 +199.5
Sham Shui Po 34,568 (7.6) 60,700 (16.5) 1.3 +75.6
Kowloon City 31,280 (6.5) 52,000 (14.4) 1.2 +66.2
Wong Tai Sin 32,479 (6.6) 74,500 (17.6) 1.4 +129.4
Kwun Tong 33,647 (5.5) 93,700 (16.0) 1.3 +178.5
Yau Tsim Mong 31,552 (7.7) 37,100 (13.3) 1.1 +17.6
Kwai Tsing 20,699 (5.0) 72,600 (13.9) 1.1 +250.7
Growing Old in a Global City 45

Table 1. (Continued)

People Aged 65+ Location

% of Change
District Council District Quotient*
1981 1981-2006
Tsuen Wan 8,944 (4.6) 33,600 (11.6) 0.9 +275.7
Tuen Mun 5,660 (4.8) 44,900 (8.9) 0.7 +693.3
Yuen Long 12,329 (6.6) 44,400 (8.3) 0.7 +260.1
North 9,182 (8.1) 28,600 (10.2) 0.8 +211.5
Tai Po 5,363 (7.3) 28,000 (9.5) 0.8 +422.1
Sha Tin 6,319 (5.5) 62,700 (10.3) 0.8 +892.2
Sai Kung 3,304 (7.9) 33,700 (8.3) 0.7 +920.0
Islands 4,616 (10.1) 12,200 (8.9) 0.7 +164.3
Total 325,053 (6.6) 852,100 (12.4) - +162.1

Broad Areas
Metro Area (85.6) (57.7) - +76.5
New Territories (14.4) (42.3) - +670.7
-New Towns - (37.7) - -
* Proportion of people 65+ in District Council District / proportion of people 65+ in Hong
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
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
46 Helen Bartlett

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.


Hong Kongs 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 age-
friendly 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).
Growing Old in a Global City 47

Table 2. Population Density and Median Household Income of District

Council Districts, 2006

Median Household
Household Income <
District Population Income $10,000
Council Area Density (persons (HK$ per (% of
District Population (km2) per km2) month) household)
Central and
Western 250,064 12.4 20,167 25,700 19.4
Wan Chai 155,196 9.8 15,836 28,000 20.8
Eastern 567,690 19.0 29,878 22,000 21.4
Southern 275,162 39.1 7,037 20,500 22.1
Sham Shui Po 365,540 9.5 38,478 13,700 34.8
Kowloon City 362,501 9.8 36,990 19,800 27.0
Wong Tai Sin 423,521 9.3 45,540 14,700 31.1
Kwun Tong 587,423 11.3 51,984 15,000 32.6
Yau Tsim
Mong 280,548 7.2 38,965 16,500 29.7
Kwai Tsing 523,300 19.9 26,297 14,600 31.4
Tsuen Wan 288,728 60.0 4,812 20,800 22.8
Tuen Mun 502,035 82.0 6,122 15,200 31.1
Yuen Long 534,192 144.3 3,702 15,000 31.2
North 280,730 140.0 2,005 17,000 27.4
Tai Po 293,542 147.0 1,997 18,500 25.0
Sha Tin 607,544 69.4 8,754 19,800 23.2
Sai Kung 406,442 126.8 3,205 21,600 18.2
Islands 137,122 168.0 816 17,800 25.6
Total 6,841,280 1,084.8 6,307 17,500 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.
48 Helen Bartlett

A study of urban density in Hong Kong discovered that peoples 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).


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 citys 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).
Growing Old in a Global City 49

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

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).
50 Helen Bartlett

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 up-
market private housing estates or big shopping malls.
Growing Old in a Global City 51

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
52 Helen Bartlett

of ageing in place and subjects older people to risks of social isolation and

Table 3. Projected Types of Housing Needs of the Elderly Households 2001-

2006, 2006-2011

Types of Housing intended to 2001-2006 2006-2011 (Projected)

move into
Public rental housing 10,498 14,923
Private owner-occupied 817 1,161
Private rental housing 350 497
Total 11,665 16,581
Source: Chiu and Ho (2006).

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
Growing Old in a Global City 53

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.

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.
54 Helen Bartlett

Table 4. Household Composition and Proportion of Older Persons by Living

Arrangement, 1996-2006 (%)

1996 2001 2006

Older Whole Older Whole Older Whole
Persons Population Persons Population Persons Population
Living Arrangement
Living alone 11.5 4.3 11.3 4.3 11.6 5.4
Living with spouse
32.1 34.4 32.1 34.4 30.4 32.9
and children
Living with spouse
16.2 9.0 18.4 9.3 21.2 10.6
Living with children
28.2 5.8 24.7 5.9 23.1 6.5
Living in non-
5.5 1.3 9.1 2.5 10.0 3.3
domestic household

One unextended
63.6 66.2 67.0
nuclear family
One vertically
extended nuclear 9.9 8.5 7.4
One horizontally
extended nuclear 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,

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
Growing Old in a Global City 55

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
worlds 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 low-
income 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;
56 Helen Bartlett

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 Kongs 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 large-
scale 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
Growing Old in a Global City 57

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.
58 Helen Bartlett

Table 5. Distribution of Private Residential Care Homes for Older People in

Hong Kong, 2008

No. of Private
District Board District % 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
emap.html (accessed on 8 May, 2008).

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
Growing Old in a Global City 59

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.


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
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
60 Helen Bartlett

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 peoples 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 aged-
friendly environment and to attain the policy goal of active ageing in Hong Kong.

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In: Aging in Asia ISBN 978-1-60741-649-4
Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.

Chapter 4



Sheying Chen1 and Elaina Y. Chen2

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

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 Peoples Republic of
China. Real progress of the countrys aging undertaking will be assessed, and
major issues will be highlighted for policy consideration along with a
discussion of the implications.
68 Sheying Chen and Elaina Y. Chen


In 2002, the World Health Organization (WHO) published a document
entitled Active Ageing: A Policy Framework, which was developed by WHOs
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 increasewhile 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,
Active Aging and China: Perspectives and Issues 69

spiritual and civic affairs, not just the ability to be physically active or to
participate in the labor force. Especially, the Policy Framework reiterates WHOs
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 years 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 (Dvila, 2002). The Group of 77 (an alliance of developing
countries) and China wanted the Second World Assembly on Aging to respond to
70 Sheying Chen and Elaina Y. Chen

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 (Dvila, 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.


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
Active Aging and China: Perspectives and Issues 71

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
The concept of successful aging reemerged in the late 1990s (Rowe and
Kahn, 1997), along with a new strategy called productive aging (Morrow-
Howell, 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
72 Sheying Chen and Elaina Y. Chen

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 Alzheimers 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 (, 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 self-
directed 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.
Active Aging and China: Perspectives and Issues 73


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.
Chinas 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 Peoples 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 Zhemings 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 governments 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 Chinas 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
74 Sheying Chen and Elaina Y. Chen

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 Chinas aging undertaking between the two
World Assemblies on Aging. The Ministries of Labor and Civil Affairs
Administration were the major players in Chinas 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
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
Active Aging and China: Perspectives and Issues 75

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 Peoples 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 Bangguos report to the 11th National Peoples Congress on behalf
of the NPC Standing Committee, 2008; PRC State Councils Priorities for 2008;
Chinas 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
76 Sheying Chen and Elaina Y. Chen

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 Womens 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 Peoples Republic of China, people
were more used to administrative directives than the laws. The governments 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
Active Aging and China: Perspectives and Issues 77

(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 Peoples 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., Peoples
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 Womens 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 countrys 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 countrys 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 countrys practice.


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-
78 Sheying Chen and Elaina Y. Chen

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 countrys 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 countrys 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 Chinas 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
Active Aging and China: Perspectives and Issues 79

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 peoples 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. frameworks 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 Asias development along with the rest
of the world.


Life expectancy in China has had a steady increase over the past half century
including recent years (see Table 1). On the other hand, Chinas 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.
80 Sheying Chen and Elaina Y. Chen

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
Male 39.3 64.5 68 70 72 76.7
Sources: WHO, 2008; Population Division of DESA, 2002.

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 wont
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 governments 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 governments 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 countrys 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
Active Aging and China: Perspectives and Issues 81

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
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 19802004, 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
82 Sheying Chen and Elaina Y. Chen

to 2004. On the other hand, according to WHO (2008), total expenditure on health
averaged about only 4.7% of Chinas 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 Chinas trends of
population change and economic development (see Table 2).
The other seemingly less active aspect of Chinas 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 countrys 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. Chinas 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 natl income per capita US$ 800 1490 2340 4110 4660
Source: WHO, 2008.
Active Aging and China: Perspectives and Issues 83


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 countrys GPP (general public policy) has headed
84 Sheying Chen and Elaina Y. Chen

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 Chinas 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 Chinas 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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Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.

Chapter 5



Sara Parker
Liverpool John Moores University and
Bijan Pant Liverpool University

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 Peoples 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
90 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

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
Aging in Nepal: Emerging Issues and Challenges 91

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.


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 60s cohort (see table 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.
92 Sara Parker

Table 1. Life expectancy at birth (years) in South Asian Countries

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
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.
Aging in Nepal: Emerging Issues and Challenges 93

Source WHOSEARO (2003).

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

Population by Age Group, Nepal, 1975-2025

Thousands of People

1975 2000 2025
<15 years 15-55 years >55 years
Source: Earth trends (2003).

Figure 2. Population by Age Group Nepal 1975-2025.

94 Sara Parker

Table 2. Comparative data on HDI. Life expectancy, literacy and probability

of survival for SAARC countries

HDI HDI Life Adult GDP Probability Probability

Rank value expectancy literac per of not of
2006 at Birth y rate capita surviving surviving
(years) (% (PPP past age past age
2006 ages US$) 40 65 female
15 and 2006 % cohort
Afghanistan na na 42.9 28.0 na na Na
Maldives 99 0.749 67.6 97.0 5,008 12.2 67.7
Sri Lanka 104 0.742 71.9 90.8 3,896 7.2 81.3
Bhutan 131 0.613 65.2 54.3 4,010 16.8 67.6
India 132 0.609 64.1 65.2 2,489 16.8 66.1
Pakistan 139 0.562 64.9 54.2 2,361 15.4 66.6
Nepal 145 0.530 63 55.2 999 17.4 61.3
Bangladesh 147 0.524 63.5 52.5 1,155 16.4 63.2
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 womens
health and aging issue remain virtually absent from mainstream development
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
Aging in Nepal: Emerging Issues and Challenges 95

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.


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
womens health are traditional customs. In most families women eat only after
96 Sara Parker

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 womens health, ADBs report notes:

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
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 womens reproductive needs as well as
addressing issues such as high infant mortality. As womens 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 womens 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.
Aging in Nepal: Emerging Issues and Challenges 97

Box 1.

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

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 gender-
discrimination in the labour force;
Care-giving responsibilities associated with motherhood,
grandmothering and looking after ones spouse and older parents that
prohibit or restrict working for an income and access to an employee-
based 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 womens 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. Womens 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
98 Sara Parker

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 als (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.


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).
Aging in Nepal: Emerging Issues and Challenges 99

Internal Life-time Migrants, Nepal, 2001

65 + Years

60-64 Years

Female 55-59 Years

50-54 Years

45-49 Years


35-40 Years

30-34 Years

25-30 Years

20-24 Years

15-20 Years

10-14 Years

5-9 Years

0-4 Years

8% 6% 4% 2% 0% 2% 4% 6%

Non-migrant Population in Nepal, 2001

65 + Years

60-64 Years

55-59 Years
Female Male
50-54 Years

45-49 Years


35-40 Years

30-34 Years

25-30 Years

20-24 Years

15-20 Years

10-14 Years

5-9 Years

0-4 Years

10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10%

Source: KC (2003: 131).

Figure 3. Population pyramids for internal migrants compared to non-migrant population,

Nepal 2001.
100 Sara Parker

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
Aging in Nepal: Emerging Issues and Challenges 101

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
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).


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.
102 Sara Parker

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

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
Aging in Nepal: Emerging Issues and Challenges 103

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
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.

104 Sara Parker


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 Nepals
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
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

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
Aging in Nepal: Emerging Issues and Challenges 105

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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2003 The Printhouse, Kathmandu.
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The Kathmandu Post April 3rd 2002 available at
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2003/pdf/hdr03_HDI.pdf..accessed 26/05/2003.
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In: Aging in Asia ISBN 978-1-60741-649-4
Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.

Chapter 6



Ik Ki Kim
Dongguk University, Korea

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).
110 Ik Ki Kim

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 out-
migration 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,
Changes in the Living Arrangements of the Elderly in Korea 111

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.



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
112 Ik Ki Kim

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.

Table 1. Living arrangements of the elderly by sex, marital status and

place of residence, 1980-2000 (Unit: %)

Total Male Female Unmarried Married Urban Rural

% living apart from child1 19.5 22.8 17.6 13.1 27.3 15.2 22.2
% in one-person household 4.8 1.5 6.8 8.1 0.9 3.3 5.8
% in couple-only household 10.1 18.0 5.4 - 22.0 6.5 12.3
% living with married child2 61.7 48.2 69.6 74.3 46.3 63.5 60.5
% living with unmarried
18.8 29.0 12.8 12.6 26.3 21.3 17.3
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
% living apart from child1 25.2 29.7 22.5 17.6 33.5 19.5 29.9
% in one-person household 6.7 2.3 9.4 11.8 1.3 5.2 8.0
% in couple-only household 13.2 23.2 7.2 - 27.2 8.7 16.9
% living with married child2 57.4 44.6 65.2 70.3 43.6 60.5 54.9
% living with unmarried
17.3 25.7 12.3 12.1 23.0 20.0 15.2
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
% living apart from child1 31.8 38.4 27.9 22.5 41.9 24.2 40.5
% in one-person household 9.5 3.5 13.1 17.3 1.1 7.0 12.4
% in couple-only household 17.5 30.9 9.6 - 36.5 12.3 23.6
% living with married child2 51.5 38.5 59.2 65.0 36.8 56.7 45.6
% living with unmarried
16.7 23.1 12.9 12.5 21.3 19.1 13.9
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Changes in the Living Arrangements of the Elderly in Korea 113

Table 1. (Continued)

Total Male Female Unmarried Married Urban Rural

% living apart from child1 43.1 50.6 38.6 31.6 55.6 33.6 55.5
% in one-person household 13.8 4.9 19.1 25.4 1.2 10.2 18.6
% in couple-only household 24.0 41.4 13.8 - 50.0 17.7 32.3
% living with married child2 43.6 30.4 51.4 58.9 27.0 50.4 34.7
% living with unmarried
13.3 19.0 10.0 9.5 17.5 15.9 9.9
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
% living apart from child1 50.9 58.1 46.6 39.0 61.9 42.5 62.6
% in one-person household 16.8 5.9 23.5 33.7 1.4 13.8 21.0
% in couple-only household 29.2 47.5 18.0 - 55.8 23.5 37.1
% living with married child2 35.7 24.3 42.7 50.6 22.0 41.0 28.3
% living with unmarried
13.4 17.6 10.8 10.4 16.1 16.5 9.1
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
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

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.
114 Ik Ki Kim

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
Changes in the Living Arrangements of the Elderly in Korea 115

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.


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 urban-
rural 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:


Living arrangements Whole Urban areas Rural areas

Living alone 137(12.1) 55( 9.1) 82(15.5)
Living with spouse only 433(38.4) 175(29.2) 258(48.7)
Living with unmarried child 168(14.9) 108(18.0) 61(11.4)
Living with married child 391(24.6) 262(43.7) 130(24.4)
Total 1130(100.0) 599(100.0) 531(100.0)
2 = 75.50 P = 0.000.
116 Ik Ki Kim

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: %

Region Living arrangements Age

Below 65 - 69 70- 74 75 years 2 P
64 years and over
Whole Living alone 8.0 10.2 15.7 18.4
Living with spouse 51.8 39.8 33.1 17.6
only 20.5 17.3 11.7 5.0 157 0.00
Living with unmarried
child 19.6 32.7 39.5 59.0
Living with married 404(100) 288(100) 205(100) 232(100)
Urban Living alone 8.1 4.8 15.9 9.4
areas Living with spouse 41.9 30.6 21.8 11.0
only 24.2 12.8 15.3 5.3 98.0 0.00
Living with unmarried
child 25.8 42.7 47.1 74.3
Living with married 223(100) 134(100) 117(100) 123(100)
Rural Living alone 8.0 14.8 15.5 28.7
areas Living with spouse 64.0 47.9 48.1 25.0
only 16.0 13.4 7.0 4.6 75.5 0.00
Living with unmarried
child 12.0 23.9 29.5 41.7
Living with married 180(100) 142(100) 129(100) 216(100)
Changes in the Living Arrangements of the Elderly in Korea 117

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:


Region Living arrangements Sex 2 P

Male Female
Whole Living alone 31( 5.4) 106(19.0)
Living with spouse only 284(49.9) 149(26.8)
Living with unmarried child 111(19.5) 57(10.3) 126.5 0.000
Living with married child 144(25.3) 245(44.0)
Total 570(100.0) 558(100.0)
Urban Living alone 11( 4.0) 43(13.9)
Areas Living with spouse only 111(39.0) 64(20.4)
Living with unmarried child 74(25.9) 34(10.8) 71.7 0.000
Living with married child 89(31.1) 171(54.8)
Total 285(100.0) 311(100.0)
Rural Living alone 20( 6.9) 63(25.4)
Areas Living with spouse only 173(60.7) 86(34.8)
Living with unmarried child 37(13.0) 24( 9.6) 55.3 0.000
Living with married child 55(19.4) 75(30.3)
Total 285(100.0) 246(100.0)
118 Ik Ki Kim

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 Living arrangements Marital status 2 P

Currently Widowed
Whole Living alone 12( 1.6) 120(31.7)
Living with spouse only 429(58.1) -
Living with unmarried child 129(17.5) 39(10.4) 526.9 0.000
Living with married child 168(22.8) 218(57.9)
Total 738(100.0) 377(100.0)
Urban Living alone 1( 0.2) 53(23.0)
Areas Living with spouse only 174(48.1) -
Living with unmarried child 83(23.0) 25(10.6) 253.7 0.000
Living with married child 104(28.7) 154(66.5)
Total 361(100.0) 232(100.0)
Rural Living alone 11( 3.0) 46(45.6)
Areas Living with spouse only 255(67.7) -
Living with unmarried child 46(12.2) 15(10.5) 271.5 0.000
Living with married child 64(17.1) 64(44.2)
Total 376(100.0) 145(100.0)
Changes in the Living Arrangements of the Elderly in Korea 119

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

Living Education
Regio arrange- 2 P
n ments Illiterate Literate Elementary Middle College
school and High andabove
Whole Living 19.9 17.1 9.0 5.6 13.2
alone 19.3 40.1 41.9 46.6 40.8
Living with 71.7 0.00
spouse 13.5 10.2 16.1 18.7 14.4
Living with 47.3 32.7 33.1 29.1 31.6
unmarried 47(100)
child 206 231 398 (100) 248
Living with (100) (100) (100)
Urban Living 15.8 15.0 7.3 2.3 13.9
areas alone 12.2 22.0 31.0 39.9 37.9
Living with 51.9 0.00
spouse 12.2 16.0 18.0 23.6 15.7
Living with 59.8 47.0 43.6 34.2 32.5
child 97 100 208 (100) 154 40 (100)
Living with (100) (100) (100)
Rural Living 23.6 18.8 10.8 10.8 14.2
areas alone 25.8 53.6 53.8 57.7 57.1
Living with 37.9 0.00
spouse 14.5 6.0 13.9 10.8 14.2
Living with 36.1 21.7 21.5 20.7 28.5
child 109 131 190 (100) 94 (100) 7 (100)
Living with (100) (100)

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
120 Ik Ki Kim

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

Table 7. Living arrangements of the elderly by employment status and region

Unit: Number(%)

Region Living arrangements Employment status 2 P

Employed Unemployed
Whole Living alone 39( 8.6) 94(14.1)
Living with spouse only 246(53.9) 188(28.3)
Living with unmarried child 88(19.2) 81(12.1) 119.5 0.000
Living with married child 83(18.3) 301(45.4)
Total 456(100.0) 663(100.0)
Urban Living alone 9( 6.2) 42( 9.5)
Areas Living with spouse only 58(39.7) 117(26.4)
Living with unmarried child 40(27.1) 68(15.4) 28.2 0.000
Living with married child 39(27.0) 215(48.7)
Total 146(100.0) 442(100.0)
Rural Living alone 30( 9.8) 52(23.4)
Areas Living with spouse only 188(60.5) 71(32.1)
Living with unmarried child 48(15.5) 13( 5.7) 80.1 0.000
Living with married child 44(14.2) 86(38.8)
Total 310(100.0) 221(100.0)
Changes in the Living Arrangements of the Elderly in Korea 121

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.

Table 8. Living arrangements of the elderly by home ownership and region

Unit: Number(%)

Region Living arrangements Home ownership 2 P

Elderly Child, living
(spouse) together or not
Whole Living alone 72(10.1) 20( 7.5)
Living with spouse only 375(53.0) 22( 8.1)
Living with unmarried child 131(18.6) 15( 5.4) 324.9 0.000
Living with married child 130(18.3) 212(78.9)
Total 708(100.0) 269(100.0)
Urban Living alone 24( 7.6) 5( 3.0)
Areas Living with spouse only 137(43.5) 13( 7.2)
Living with unmarried child 78(24.8) 11( 6.4) 160.2 0.000
Living with married child 76(24.1) 145(83.4)
Total 314(100.0) 174(100.0)
Rural Living alone 48(12.2) 15(15.8)
Areas Living with spouse only 238(60.6) 9( 9.8)
Living with unmarried child 54(13.6) 3( 3.6) 146.2 0.000
Living with married child 54(13.6) 67(70.7)
Total 394(100.0) 95(100.0)

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
122 Ik Ki Kim

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: %

Region Living arrangements Health status 2 P

Good Neither Bad
nor bad
Whole Living alone 9.2 8.2 17.5
Living with spouse only 44.0 16.1 32.1 33.3 13.6
Living with unmarried child 14.1 33.8 0.00
Living with married child 30.7 35.6
Total 554(100) 45.6 415(100)
Urban Living alone 6.0 5.4 15.2
Areas Living with spouse only 37.6 15.6 22.5
Living with unmarried child 17.3 21.7 17.5 34.7 0.00
Living with married child
Total 39.1 57.2 44.8)
303(100) 86(100) 206(100)
Rural Living alone 13.1 11.5 19.7
Areas Living with spouse only 51.7 52.1 44.0
Living with unmarried child 14.6 4.8 9.8 14.5 0.000
Living with married child
Total 20.6 31.6 26.5
251(100) 70(100) 209(100)
Changes in the Living Arrangements of the Elderly in Korea 123

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

Whole Urban areas Rural areas

Independent variable B P B P B P
Age 0.028 0.098 0.023 0.367 0.038 0.100
Sex(Male) 0.449 0.097 0.783 0.066 0.371 0.318
Marital status(currently -0.830 0.001 -1.275 0.001 -0.662 0.037
Education(Middle -0.363 0.159 -0.407 0.293 -0.357 0.338
school and above)
Home-ownership -0.699 0.004 -0.557 0.121 -0.945 0.006
(elderly own)
Health(good) 0.021 0.918 -0.463 0.152 0.366 0.172
Income 0.024 0.000 0.026 0.000 0.020 0.000
Pocket money -0.045 0.000 -0.065 0.000 -0.019 0.151
Employment -0.198 0.375 0.083 0.829 -0.103 0.738
Constant -2.845 0.030 -0.781 0.578 -3.867 0.034
2=345.9 2 = 193.3 2 = 115.6
P= 0.000 P = 0.000 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.

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
124 Ik Ki Kim

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
Changes in the Living Arrangements of the Elderly in Korea 125

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

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 1960-
2000. 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.
126 Ik Ki Kim

Kim, Ik Ki et al. 1997. Survey on Family Structure and Life Quality of the Korean
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.
In: Aging in Asia ISBN 978-1-60741-649-4
Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.

Chapter 7



Takashi Kihara
Kyushu University, Japan


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).

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)).
130 Takashi Kihara

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

Countries/ Elderly Elderly Doubling Countries/ Elderly Elderly Doubling

Economies Ratio> Ratio>1 Years Economies Ratio> Ratio> Years
70 40 70 140
Brunei 2024 2048 24 Lao PRD 2037 (After
7.28 14.26 7.03% 2050)
Cambodia 2040 (After Malaysia 2020 2043 23
7.07 2050) 7.11 14.02
China 2001 2026 25 Myanmar 2018 2038 20
7 14.08 7.07% 14.16%
Hong 1983 2014 31 Philippines 2028 (After
Kong 7.05 14.01 7.06% 2050)
Indonesia 2018 2039 21 Singapore 2000 2016 16
7.08 14.27 7.15% 14.24%
Japan 1970 1994 24 Thailand 2002 2024 22
7.07 14.01 7.14% 14.42%
Korea 2000 2017 17 Vietnam 2020 2038 18
7.36 14.14 7.03% 14.24%
Source: United Nations (2007) and the authors 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 1564) 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.
Aging, Growth and Financial Markets 131

Source: United Nations (2007).

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).


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.
132 Takashi Kihara

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 195055 to 200005 and from 2000
05 to 204550 are depicted in Figures 3 and 4. According to the United Nations
(2007), the TFR of the world declined from 5.02 in 195055 to 2.65 during the
200005 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 200005.

Source: United Nations (2007).

Figure 3. Total Fertility Rates (TFR) and Life Expectancy at birth (LE) (lower right: 1950-
550 middle;2000. 05. upper left:2045. 50.

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.
Aging, Growth and Financial Markets 133

South Eastern Asia

Africa 2050

Eastern Asia 1950

ub-Saharan Africa 1950

Source: United Nations (2007).

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.
134 Takashi Kihara

Source: World Bank (2008).

Note: GDP per capita is measured in terms of Purchasing Power Parity (PPP) US dollars of

Figure 5. Eldery Ratios and Per Capita GDP in East Asia 1975-2006).



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 19601995 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 steady-
state 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=(X+ p + w0 - y0) + gw

In that equation, is the rate of convergence and is the coefficient vector of

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

Explanatory Variables/ (i) OLS (ii) 2SLS (iii) OLS (iv) 2SLS (v) 2SLS (vi) 2SLS (vii) 2SLS (viii) 2SLS
Estimated Methods
Constant -0.018 -0.0002 -0.026 -0.019 0.057 0.059 0.035 0.052
(-0.49) (-0.005) (-0.65) (-0.41) (1.32) (1.38) (0.52) (1.16)
Log (Initial working-age 0.081*** 0.090*** 0.076*** 0.079*** 0.086*** 0.078*** 0.104*** 0.073***
population ratio) (5.43) (5.38) (4.85) (4.51) (5.69) (4.81) (4.92) (4.18)
Growth of working-age 0.818*** 1.589*** 0.745*** 1.496*** 1.724*** 1.624*** 0.793 1.323*
population ratio (3.77) (4.21) (3.32) (3.49) (3.15) (2.83) (0.93) (1.92)
Log (Initial GDP per -0.010*** -0.011*** -0.011*** -0.011*** -0.012*** -0.012*** -0.011*** -0.012***
capita) (-7.25) (-7.05) -7.16 -6.32 (-5.60) (-5.91) (-4.33) (-5.30)
Log(Initial life 0.039*** 0.037*** 0.043*** 0.042*** 0.023** 0.022** 0.032** 0.023**
expectancy) (4.84) (4.26) (4.50) (4.14) (2.19) (2.16) (2.03) (2.15)
Log (1+CPI Inflation) -0.031*** -0.030*** -0.030*** -0.029*** -0.031*** -0.030*** -0.0312*** -0.031***
(-6.23) (-6.21) (-6.18) (-6.13) (-7.15) (-7.23) (-6.98) (-7.12)
East Asia 0.019*** 0.017*** 0.021*** 0.018*** 0.006 0.008 0.003
(6.37) (4.87) (6.92) (5.24) (1.20) (0.99) (0.46)
Tropics -0.005** -0.006** -0.011*** -0.011*** -0.007* -0.011***
(-2.25) (-2.16) (-2.71) (-2.82) (-1.74) (-2.88)
Openness 0.031*** 0.029*** 0.029***
SachsWarner (12.26) (11.03) (10.99)
Openness growth of 2.879*** 0.619
working-age ratio (2.62) (0.70)
Adj. R2 0.466 0.469 0.479 0.487 0.808 0.813 0.933 0.803
No. of Observations/ 380/60 348/60 380/60 348/60 149/45 149/45 149/45 149/45
Source: The authors estimates.
Note: Figures in parentheses are t values.***, ** and * respectively signify a 1%, 5% and 10% significance level.
136 Takashi Kihara

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
19732004 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 (0.81.7), 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

Data for Growth rate of real GDP per capita , Working Age (1564 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.
Increase in working age population ratio from 50% (0.5) to 60% (0.6) is expected to raise the per-
capita growth rate by about 1.8% ((log(0.6)-log(0.5))0.1=0.0182).
Aging, Growth and Financial Markets 137

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 12% (0.01 0.02) higher than average, whereas a country
located in tropical areas has a 0.51% (-0.005 to -0.01) lower growth rate than
(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 (23% 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.

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).
An increase in the Inflation rate from 0% to 10% is expected to reduce the growth rate by 0.3%
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).
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).
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 variablesOpenness and Openness times growth of working age
population ratioare 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.
138 Takashi Kihara

Source: The authors estimates from all samples of growth regression shown in Table 2.

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

Source: United Nations (2007) and the authors estimates.

Figure 7. Growth rate of working age population ratio in East Asia.

Aging, Growth and Financial Markets 139


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 19461964, have moved to their prime saving years i.e. ages 4064, 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 4064) 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 rates15 . 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 persons
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

IMF (2004) p.150
IMF (2004) p.150
Horioka, 2007 Abstract.
140 Takashi Kihara

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 4050 (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 19732004, 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

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 4064 during the prime saving
period over working age population (aged 1564), 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.
The coefficients of GDP per-capita growth rate and of its lagged variable are both positive and
remain constant at around 0.20.7. These coefficients estimated in Bosworth and Chodorow-
Reich (2007) are 0.31.0.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.
Aging, Growth and Financial Markets 141

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 third-
order polynomial approximation of the age distribution.

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)

Explana- GLS (Country Weights) GLS (Time Weights)

Variables I II III IV V VI
Constant -0.560*** -0.938*** -0.563*** -0.682*** -0.739*** -0.202
(-20.30) (-12.64) (-6.35) (-9.41) (-3.93) (-1.04)
High 0.500*** 0.405*** 0.426*** 0.775*** 0.773*** 0.379
Saving (4.02) (3.35) (4.06) (2.97) (2.95) (1.49)
(ages 40
Elderly -2.097*** -2.137*** -2.600*** -2.813*** -2.848*** -2.698***
Ratio (-7.46) (7.72) (-12.28) (-4.72) (-4.69) (-4.71)
(age 65
Per- 0.654*** 0.564*** 0.466*** 0.568*** 0.556*** 0.350*
capita (7.10) (6.37) (5.11) (2.78) (2.68) (1.76)
142 Takashi Kihara

Table 3. (Continued)

Explana- GLS (Country Weights) GLS (Time Weights)

Lagged 0.448*** 0.405*** 0.235*** 0.244 0.231 0.012
per- (4.55) (4.25) (2.67) (1.11) (1.03) (0.05)
Log(GD 0.096*** 0.084*** 0.076*** 0.103*** 0.101*** 0.094***
P per (22.93) (17.15) (15.84) (10.98) (8.77) (8.65)
Log(Life 0.116*** 0.036 0.019 -0.083
Expectan (4.85) (1.37) (0.33) (-1.45)
East Asia 0.124*** 0.160***
(13.04) (6.75)
Adjusted 0.790 0.810 0.882 0.345 0.343 0.415
Countries 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 0.40.8, 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
0.40.8 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.
Aging, Growth and Financial Markets 143

(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 households surplus,
which equals income minus expenditure, and which is allocated either to deposits,
insurance, or securities, is the largest for household heads of ages 4049; 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 4064, 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

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.
144 Takashi Kihara

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

Source: United Nations (2007).

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

Aging, Asset Prices and Return on Assets Asset Market Meltdown


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 investors age.

From the demand function for capital assets qtKt+1 = Nt s and the supply function of capital assets
Kt+1 = Ktqt. Abel (2001) derives the following asset price equation: log 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.
Aging, Growth and Financial Markets 145

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 (2064) population (age 4064 in
particular). They also show that real bond yields rise with the share of age 2039
population, while the yields fall with the share of age 4064 population because
high-saving households (ages 4064) wish to keep long-term bonds in their
investment portfolio.
Park and Rhee (2005), using panel data from 25 countries for the period of
19802002, 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 4064-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 4064) relative to the whole working-age population
(ages 1564), 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.

They argued that this evidence implies that the elderly population tends to prefer safe assets such
as bonds.
Data 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 (19502004, 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 4064 to the population of 1564.
Stock Price-Earnings Ratios, which Park and Rhee (2005) used as one explanatory variable, are
not used here because of a lack of data.
146 Takashi Kihara

Table 4. Estimated results of Prices and Returns of Financial Assets

Dependent (I) (Log) Stock Price Indices s (II) Real Yield to Maturity
Explanatory (1) (2) (3) (1) (2) (3)
Log(Elderly -0.289 -0.277 -0.914* 7.524*** 6.874** 6.958***
Ratio) (-0.40) (-0.48) (-1.77) (3.87) (2.00) (3.74)
Log(High 2.608** 2.531*** 2.354*** -7.057*** -19.847*** -7.692***
Saving Gen. (2.08) (3.35) (3.24) (-4.28) (-4.64) (-3.88)
Real GDP 0.083*** 0.107*** 0.029 -0.010
growth rate (3.50) (7.27) (0.32) (-0.08)
Real Yield to -0.043***
maturity (-2.78)
Inflation -0.042*** -0.0001
Rate (CPI) (-3.32) (-0.50)
Log(Money/ -0.890*** -1.103** -0.902***
GDP) (-2.74) (-2.33) (-3.35)
Log(GNI per 0.642
capita) (0.74)
Log(Real 2.695*** 0.807
GDP per (4.33) (0.96)
AR(1) 0.490*** 0.767*** 0.759***
(4.02) (13.62) (16.24)
Adjusted R 2 0.722 0.822 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
Aging, Growth and Financial Markets 147

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 generations 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.

Baby Boomers in East Asia Possibility of an Asset Market


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 4064 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.
148 Takashi Kihara

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.

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".
Aging, Growth and Financial Markets 149

Table 5.The ratio of the population of age 65 or over /the population of ages
4064 in East Asia

Country In 2005 In 2030 In 2050 Country In 2005 In 2030 In 2050

/Area /Area
Eastern South
19.56% 32.14% 58.78% 14.84% 21.44% 37.29%
Asia Eastern Asia
Japan 41.28% 70.54% 105.13% Thailand 16.03% 33.47% 53.36%
China 17.12% 28.90% 55.28% Malaysia 11.16% 22.13% 33.89%
Korea 17.68% 42.33% 84.30% Philippines 12.10% 17.90% 27.05%
Singapore 14.58% 57.33% 81.96%
Source: United Nations (2007) and the authors estimates.


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
150 Takashi Kihara

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) . 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

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.
Aging, Growth and Financial Markets 151

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

Source: World Bank (2007).

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 regions financial markets are weak, undeveloped,
152 Takashi Kihara

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.


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

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
Related references are Visco (2005), Park and Rhee (2005) and Kihara (2008).
Aging, Growth and Financial Markets 153

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
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

IMF (2004) pp.157-162
Park and Rhee (2005) p.44
Kihara (2008) p.115.
154 Takashi Kihara

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
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

Park and Rhee (2005) 0.45
Park 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.
Aging, Growth and Financial Markets 155

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
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.

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 AsiaRegional Cooperation and Policy
Responses, MOF/Japan and ADBI.

Blanchard(2008)(p.8) noted in December 2008 the global economy is facing its worst crisis in
In 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, longer-
term financial reforms to strengthen Asias financial system, such as further development of
local bond markets, to be implemented
156 Takashi Kihara

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
Bosworth, Barry and Gabriel Chodorow-Reich, (2007). Saving and Demographic
Change: The Global Dimension Center for Retirement Research at Boston
Bryant, R.C., (2004). Demographic Pressures on Public Pension Systems and
Government Budgets Brooking Discussion Papers in International
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.173-
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.
Aging, Growth and Financial Markets 157

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
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.
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In: Aging in Asia ISBN 978-1-60741-649-4
Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.

Chapter 8



Steven Miles
University of Liverpool

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 peoples 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
160 Steven Miles


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
Rethinking Aging - the Selfless Consumer 161

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 persons 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 peoples 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 persons
status in a consumer society.
As Heine (2001) suggests East Asian relationships are essentially self-
defining. From this point of view Social actions follow not from volition,
sentiments or needs as they do from perceptions of ones 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
162 Steven Miles

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 Partys use of group identities to control individuals in what is
essentially a passive relationship between the individual and the state (Pye 1991).

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
Rethinking Aging - the Selfless Consumer 163

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 individuals private life
insofar as lifestyles and living standards were no longer as homogenous as they
had been in the past. As a result the individuals relationship to the state was also
altered in that the individuals sociability was inevitably becoming increasingly
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 Chinas 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
164 Steven Miles

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,

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 consumers 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 persons ability to adjust to the tensions created
Rethinking Aging - the Selfless Consumer 165

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.


In order to better understand the sorts of tensions that older people may
experience I want to consider the suggestion that older peoples 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 Becks (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
166 Steven Miles

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 self-
supporting 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:

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.
Rethinking Aging - the Selfless Consumer 167

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 individuals
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.


I will now go on to consider the particular aspects of older peoples
consumption that may contribute to the sorts of uncertainties and
unpredictabilitys associated with a risk society before concluding with some
168 Steven Miles

suggestions some thoughts as to the effect of older peoples 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 leisure-
time 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 peoples 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
Rethinking Aging - the Selfless Consumer 169

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 persons family is their life insurance.

The long-term consequences of the emergence of a consumer society upon
older peoples 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. Chinas 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
170 Steven Miles

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 peoples 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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Consumer Revolution in Urban China, London: University of California
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In: Aging in Asia ISBN 978-1-60741-649-4
Editor: J. L. Powell and I. G. Cook 2009 Nova Science Publishers, Inc.

Chapter 9



Ian G. Cook and Trevor J.B. Dummer

Liverpool John Moores University and
IWK Health Centre/ Dalhousie University

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.
174 Ian G. Cook and Trevor J.B. Dummer

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:

Towards silver surfers and golden oldies

Opposites to longevity: birth rates and life expectancy in selected
Urbanisation and the elderly
Traditional Malthusian checks today
Neo-Malthusian constraints on longevity

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 nations changing mortality and
morbidity profile, which affects death rates, with the population and socio-
economic 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
Patterns and Processes of Longevity in Asia 175

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,


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, Chinas 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.
176 Ian G. Cook and Trevor J.B. Dummer

Box 1. Factors influencing demographic change

(Bloom and Canning 2006: 9-10)

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 1950-
55 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 worlds 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 worlds
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.

These factors relate to features of the demographic and epidemiological

transitions: declining fertility rates, with its corresponding reduction in birth rates;
Patterns and Processes of Longevity in Asia 177

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

Population aged 60 years and older Potential Retire- expectancy
(000) Sex ratio support ratio ment age at 60
No. No. % % Men / Men /
Country or area 2006 2050 2006 2050 Aged 60+ 2006 2050 Women Women
More developed regions 247,753 400,029 20 32 72 4 2 - 19 / 23
Less developed regions 440,170 1,568,124 8 20 88 11 4 17 / 19
Asia 374,802 1,231,237 9 24 88 10 4 - 17 / 20
Japan 34,751 46,748 27 42 78 3 1 65 / 65 22 / 27
Georgia 795 1,077 18 36 67 5 2 65 / 60 17 / 20
Cyprus 144 349 17 30 84 6 3 65 / 65 20 / 23
Russian Federation 24,282 34,755 17 31 51 5 3 60 / 55 14 / 19
China, Hong Kong SAR 1,118 3,577 16 39 91 6 2 65 / 65 22 / 26
Armenia 434 833 14 33 67 6 3 63 / 59.5 17 / 20
Republic of Korea 6,795 18,401 14 41 77 7 2 60 / 60 18 / 23
Israel 921 2,561 13 25 77 6 3 65 / 60 21 / 24
Singapore 561 1,983 13 38 89 8 2 55 / 55 20 / 23
Dem. People's Rep. of Korea 2,595 5,622 11 23 78 10 4 .. 13 / 17
China 147,799 431,532 11 31 92 9 3 60 / 60 17 / 20
Kazakhstan 1,653 3,600 11 28 60 8 3 63 / 58 14 / 19
China, Macao SAR 51 214 11 41 89 10 2 .. 21 / 24
Sri Lanka 2,284 6,919 11 29 88 9 3 55 / 50 17 / 21
Thailand ,,945 20,702 11 28 83 10 3 55 / 55 17 / 20
Population aged 60 years and older Potential Retire- expectancy
(000) Sex ratio support ratio ment age at 60
No. No. % % Men / Men /
Country or area 2006 2050 2006 2050 Aged 60+ 2006 2050 Women Women
Lebanon 372 1,147 10 24 85 9 4 64 / 64 17 / 19
Azerbaijan 777 2,591 9 27 71 9 3 62 / 57 17 / 21
Indonesia 19,049 67,355 8 24 82 12 4 55 / 55 16 / 18
Turkey 5,988 23,056 8 23 83 12 4 60 / 58 16 / 18
India 89,922 329,683 8 21 91 12 5 58 / 58 16 / 18
Myanmar 3,926 15,521 8 24 86 13 4 .. 17 / 18
Kyrgyzstan 401 1,481 8 22 68 10 4 62 / 57 16 / 20
Viet Nam 6,358 29,768 7 26 88 12 3 60 / 55 18 / 20
Malaysia 1,847 8,405 7 22 91 14 4 55 / 55 17 / 19
Bhutan 156 646 7 15 92 12 7 .. 17 / 18
Iran (Islamic Republic of) 4,562 26,393 6 26 95 15 4 65 / 60 17 / 18
Philippines 5,221 25,387 6 20 85 15 5 60 / 60 17 / 19
Turkmenistan 301 1,437 6 21 70 14 5 62 / 57 15 / 19
Uzbekistan 1,653 8,153 6 21 77 13 5 60 / 55 16 / 20
Pakistan 9,445 46,745 6 15 96 15 7 60 / 55 17 / 17
Nepal 1,608 7,225 6 14 77 16 7 55 / 55 15 / 17
Mongolia 153 863 6 24 83 17 4 .. 15 / 18
Cambodia 821 3,905 6 15 58 17 7 .. 16 / 18
Bangladesh 8,264 40,672 6 17 93 17 6 57 / 57 15 / 17
Lao People's Dem. Republic 321 1,520 5 13 84 15 8 60 / 60 16 / 17
Jordan 303 1,932 5 19 104 18 5 60 / 55 17 / 19
Table 1. (Continued)

Population aged 60 years and older Potential Retire- expectancy
(000) Sex ratio support ratio ment age at 60
No. No. % % Men / Men /
Country or area 2006 2050 2006 2050 Aged 60+ 2006 2050 Women Women
Tajikistan 333 1,710 5 16 86 15 7 .. 17 / 20
Maldives 17 102 5 15 112 16 7 .. 16 / 17
Dem. Republic of Timor- ..
Leste 50 278 5 9 97 19 12 14 / 16
Brunei Darussalam 18 136 5 20 122 21 5 55 / 55 18 / 22
Syrian Arab Republic 929 7,003 5 19 85 19 5 60 / 55 17 / 19
Bahrain 34 267 5 23 105 23 4 60 / 55 18 / 20
Saudi Arabia 1,163 8,106 5 16 110 20 6 60 / 55 17 / 19
Iraq 1,338 8,318 5 13 88 20 8 60 / 55 15 / 16
Occupied Palestinian ..
Territory 170 1,118 4 11 76 17 9 17 / 19
Afghanistan 1,365 6,253 4 6 98 19 16 60 / 55 14 / 15
Oman 111 976 4 20 110 24 5 60 / 55 18 / 20
Yemen 790 5,249 4 9 92 23 12 60 / 55 15 / 17
Kuwait 89 1,280 3 24 144 40 3 50 / 50 19 / 22
Qatar 22 326 3 25 235 59 3 .. 18 / 20
United Arab Emirates 77 2,115 2 23 145 72 4 .. 20 / 23
Patterns and Processes of Longevity in Asia 181

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 (; 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.
182 Ian G. Cook and Trevor J.B. Dummer

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

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.
Ian G. Cook and Trevor J.B. Dummer 183

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 Japans 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
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%.
184 Ian G. Cook and Trevor J.B. Dummer

Table 2. Demographic Change Over Two Decades

Census Total % % Total % 21st Century

Country Year Population 60-74 75 + 60+ Notes Total % 60+
Japan 1980 117 9.8 3.1 12.9 23.4
USSR, 1980
Russia 1979 262.4 9.6 3.4 13 est. 18.5
Israel 1983 4 9.4 3.1 12.5 13.1
Hong Kong 1981 5 8.2 2 10.2 14.9
Lebanon 1970 2.1 7.7 7.7 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 12
Thailand 1980 47 5.5 5.5 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 13.7
Vietnam 1979 52.7 4.9 0.9 5.8 1980 est. 8
Indonesia 1980 147.5 4.5 1.1 5.6 7.2
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 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
Ian G. Cook and Trevor J.B. Dummer 185

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),
Dhakas 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
186 Ian G. Cook and Trevor J.B. Dummer

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).

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.


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
Ian G. Cook and Trevor J.B. Dummer 187

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
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 ones aging parents.
Another feature of urbanism is the mobility and spatial disjuncture noted
above by Rigg. The fact that half the worlds 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
188 Ian G. Cook and Trevor J.B. Dummer

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 worlds 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
Ian G. Cook and Trevor J.B. Dummer 189

(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 owners death. Sons and daughters who inherit such
property are often forced to sell it to pay the citys 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 spouses 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 Japans 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
190 Ian G. Cook and Trevor J.B. Dummer

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?


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
Ian G. Cook and Trevor J.B. Dummer 191

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
Peoples Republic, are the wide range of environmental pressures noted in Table
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,
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.
192 Ian G. Cook and Trevor J.B. Dummer

Table 3. Regional Environmental Pressures in China

Region Main Environmental Pressures

1. Temperate Humid Water pollution; Soil pollution; Frost.
and Subhumid
Northeast China
2. Warm Temperate Water pollution; Soil pollution;Lowering of
Humid and groundwater table;Drought; Desertification;
Subhumid North Floods;Soil erosion (Loess Plateau); Locusts (North
China China Plain);Salinisation (North China Plain);Tidal
3. Subtropical Humid Air pollution; Frost; Drought; Floods;
Central and South Soil erosion (Mountains); Leaching (South
China West);Tidal waves and tsunami.
4. Tropical Humid Typhoons; Frost; Floods; Soil Erosion (Mountains);
South China Leaching; Earthquakes and avalanches (Mountains).
5. Temperate Inner Drought; Desertification (Ordos Plateau);Rats.
Mongolia Grasslands
6. Temperate and Drought; Salinisation;Rats (Pastoral Area).
Warm Temperate
Desert of Northwest
7. Tibetan Plateau Frost; Hailstorms; Rats.
Source: Cook, I.G. and Murray, G. (2001), Chinas 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 populations 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
Ian G. Cook and Trevor J.B. Dummer 193

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.


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
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
194 Ian G. Cook and Trevor J.B. Dummer

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

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
Ian G. Cook and Trevor J.B. Dummer 195

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 Bangladeshs 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
196 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 hard-
core 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.

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
Ian G. Cook and Trevor J.B. Dummer 197

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.

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153, 154, 163, 166, 168, 170, 171, 174,

A 176, 177, 178, 179, 180, 181, 183, 188,
196, 198
absorption, 195
ageing, 7, 12, 14, 19, 20, 21, 24, 26, 27, 28,
academics, 78
34, 35, 37, 38, 39, 40, 41, 42, 46, 52, 59,
acceleration, 167
60, 61, 64, 68, 70, 71, 72, 85, 86, 87, 103,
accommodation, 34
105, 108, 165, 198, 199
accountability, 32
ageing population, 14
activity theory, 71
agent, 53, 70, 163
acute, 43, 105
agents, 162, 166
ADA, 102, 103
aging, 1, 2, 3, 4, 8, 9, 39, 40, 67, 68, 69, 70,
addiction, 71
71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81,
adequate housing, 29
82, 83, 84, 85, 86, 87, 89, 91, 94, 95, 101,
adjustment, 71
102, 104, 105, 124, 129, 130, 131, 132,
administrative, 32, 34, 73, 74, 76
133, 134, 139, 142, 145, 147, 149, 151,
ADP, 34
152, 153, 154, 155, 156, 168, 171, 174,
adult, 26, 27, 28, 30, 55, 177
181, 183, 184, 187, 188, 196, 197, 198
adults, 20, 53, 56, 72, 87, 105, 124
aging identity, 4
advertising, 168
aging population, 2, 3, 83, 91, 94, 101, 102,
advocacy, 102
104, 181, 183, 184, 197
affiliates, 74
aging process, 9
Afghanistan, 25, 92, 94, 180, 192
aging society, 2, 80
Africa, 63, 132, 135, 136, 140, 141, 176, 177,
agrarian, 28, 174
181, 191
agricultural, 100
age, 1, 7, 8, 9, 10, 11, 12, 13, 16, 17, 18, 20,
agriculture, 19, 28
21, 24, 27, 30, 32, 33, 34, 35, 36, 41, 46,
aid, 30, 95, 156, 183
52, 53, 54, 68, 70, 71, 72, 73, 79, 80, 83,
AIDS, 194
84, 85, 88, 92, 94, 95, 96, 97, 98, 100, 103,
air, 48, 49, 62, 63, 191, 194
104, 105, 111, 115, 116, 117, 129, 131,
air pollutant, 48, 63
134, 135, 136, 137, 138, 139, 140, 141,
air pollution, 48, 49
142, 143, 144, 145, 147, 149, 150, 151,
air quality, 48, 62
202 Index

air travel, 194 Australia, 41, 125

Al Qaeda, 192 Austria, 39
alcohol, 71 authority, 30
alienation, 54, 55 autonomy, 39
alluvial, 175 availability, 28, 59, 181, 185
alternative, 166, 168 avian influenza, 195
Alzheimers disease, 72, 81 awareness, 33, 34, 35, 37, 165
ambiguity, 77, 83 Azerbaijan, 179
ambivalent, 160
Antarctic, 195
anxiety, 101 B
APEC, 154, 157
babies, 150
Arabia, 180
baby boom, 8, 139, 144, 147, 188
Arctic, 195
baby boomers, 139, 144, 147
argument, 163
back, 32, 80, 100, 189
armed conflict, 108
back pain, 32
Armenia, 178
bacteria, 193, 195
arrhythmias, 48
Bahrain, 180
arthritis, 32
Bangladesh, 2, 3, 19, 20, 21, 22, 24, 25, 26,
ASEAN, 129, 132, 154
27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37,
Asia, 1, 2, 3, 4, 5, 19, 26, 31, 38, 39, 40, 41,
38, 39, 40, 94, 174, 175, 179, 184, 185, 196
55, 60, 63, 64, 65, 84, 87, 90, 91, 103, 125,
Bangladesh Demographic and Health Survey,
127, 129, 130, 131, 132, 133, 134, 135,
136, 137, 138, 140, 141, 142, 143, 144,
banking, 153, 154
147, 148, 149, 150, 151, 152, 154, 155,
banks, 152, 186
156, 157, 170, 173, 175, 177, 178, 181,
barrier, 193
182, 183, 184, 188, 191, 194, 195, 196,
barriers, 20, 87
197, 198, 199
basic needs, 82
Asian, 1, 2, 3, 10, 11, 12, 16, 20, 24, 27, 39,
basic services, 94
61, 62, 63, 70, 91, 92, 107, 129, 130, 131,
BDHS, 21, 38
132, 133, 137, 140, 143, 149, 150, 151,
behavior, 15, 60, 78, 83, 95
152, 154, 155, 156, 160, 161, 170, 173,
Beijing, 77, 85, 125, 187, 199
177, 178, 181, 182, 186, 187, 188, 189,
benefits, 56, 80, 83, 150, 151, 154, 163, 166,
191, 192, 195, 198
169, 186
Asian countries, 1, 2, 10, 129, 130, 131, 137,
Best Practice, 60
150, 151, 160, 174, 177, 178, 181, 182,
Bhutan, 25, 26, 94, 179, 184
190, 191
bias, 79, 91, 181
Asian values, 187
birth, 2, 8, 9, 10, 12, 80, 82, 92, 96, 101, 109,
Asia-Pacific Economic Cooperation, 154
132, 133, 174, 176, 177, 181, 183, 184,
aspiration, 52, 163
185, 186
assets, 20, 133, 139, 144, 145, 146, 147, 148,
birth control, 82
151, 152, 153, 154, 155, 188
birth rate, 2, 8, 10, 109, 174, 176, 181, 184
assumptions, 10
black market, 137
asthma, 32, 48
blocks, 163
attitudes, 15, 91, 97, 162, 163
blood, 32
Index 203

blood pressure, 32 Central Asia, 177

blue-collar workers, 79 Central Bank, 154
bond market, 152, 153, 154, 155 Central Intelligence Agency, 38
bonds, 145, 147, 152, 153, 155, 169 Central Provident Fund, 186
Boston, 156 changing environment, 195
bottom-up, 102 changing population, 89
bovine, 193 chicken, 193
boys, 181 chickens, 156
brain drain, 153, 190 child mortality, 96, 176, 185
breakdown, 17, 28, 101, 169 childbirth, 96
buildings, 42, 49, 50, 64, 160, 190 childcare, 101
Bureau of the Census, 181 childhood, 97
bureaucracy, 20 childless, 188
burning, 191 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,
C 185, 187, 190, 198
China, vi, 2, 3, 19, 43, 58, 59, 61, 63, 64, 67,
cadmium, 49
68, 69, 73, 74, 75, 76, 77, 78, 79, 80, 81,
Cambodia, 129, 130, 179, 184
84, 85, 86, 87, 88, 129, 130, 132, 133, 143,
campaigns, 194
149, 159, 160, 161, 162, 163, 167, 168,
Canada, 68
169, 170, 171, 174, 175, 177, 178, 181,
cancer, 37
182, 183, 184, 185, 187, 188, 190, 191,
capacity building, 102, 153
192, 194, 196, 198, 199
capital accumulation, 3
China Daily, 85
capital flows, 156
chloroquine, 194
capital goods, 137
cholera, 193, 195
capital inflow, 143, 150, 153
chronic diseases, 197
capital markets, 153
chronic illness, 174
capitalism, 187
chronic obstructive pulmonary disease, 48, 63
capitalist, 162
CIA, 19, 38
caregivers, 82, 84
circulatory disease, 48, 66
caretaker, 28
citizens, 56, 60, 71, 94, 103, 105, 162
carrier, 194
citizenship, 42, 162, 166, 170
case study, 3, 64, 65
civil servants, 103
cataract surgery, 97
civil society, 104
categorization, 1
classes, 139
category b, 92
classical, 134
causal relationship, 47
classification, 136
CBS, 105
cleaning, 101
CDR, 13
climate change, 193, 194
cell, 130
clinics, 32
cement, 161
coal, 20, 191
Census, 43, 45, 47, 54, 58, 61, 82, 108, 125,
cohort, 21, 35, 91, 92, 94, 100, 147
126, 181, 184
colleges, 79, 81
Census Bureau, 108
204 Index

combined effect, 27 correlations, 105

commerce, 106 corruption, 20, 190
commercial bank, 152, 154 costs, 30, 62, 70, 181, 189
commodities, 164 couples, 189
communication, 98 covering, 78, 140
Communism, 192, 198 CPC, 74, 75, 86
Communist Party, 74, 162 CPI, 135, 136, 137, 145, 146
Communist Party of China, 74 credit, 102, 154, 155, 173, 182, 188
communities, 36, 50, 69, 72, 100, 101 crimes, 191
community, 31, 46, 50, 53, 54, 60, 62, 64, 65, critical analysis, 4
71, 78, 81, 82, 83, 84, 102, 104 critical thinking, 75
community service, 78 criticism, 72
competition, 82 cross-border, 2, 58
complications, 32, 81 cross-country, 153, 198
composition, 15, 36, 39, 91, 110, 184, 193 cross-cultural, 39
concentration, 45, 46, 50, 185 cultural factors, 186
conception, 72 cultural influence, 43, 82
concrete, 15, 60, 190 Cultural Revolution, 82
conflict, 26, 48, 89, 91, 94, 96, 98, 100, 104, cultural transformation, 15
106, 107, 108, 161, 192 cultural values, 16
conformity, 162 culture, 1, 18, 75, 82, 164, 169
Confucianism, 162, 171 currency, 152, 154, 155
confusion, 83 current account balance, 134
Congress, 75, 86, 87, 125 curriculum, 37
conjecture, 169 cyberspace, 79
consciousness, 15, 167, 168 cycles, 167
constraints, 167, 174, 186, 193 cyclones, 20, 195
construction, 162, 169 Cyprus, 177, 178
constructionist, 85
Consumer Price Index, 137
consumerism, 164, 168, 171 D
consumers, 144, 159, 163
danger, 164, 193
consumption, 4, 139, 143, 162, 163, 165, 166,
database, 24, 27, 38, 40, 181
167, 169, 170, 188
death, 8, 10, 12, 96, 100, 173, 174, 177, 183,
contamination, 64
189, 190, 191, 193
contingency, 193
death rate, 8, 10, 174, 177, 183
continuity, 67, 73, 76, 77, 83
deaths, 174, 176, 177, 193
contracts, 190
debates, 31, 162
control, 70, 82, 162, 166, 167, 190, 199
debt, 70, 150
convergence, 134, 136
decay, 50
cooking, 101
decentralization, 43
COPD, 48
decision-making process, 31
coping, 197
decisions, 76, 163
copper, 49
deficits, 151
correlation, 145, 146, 147, 163
definition, 12, 15, 68, 147, 163, 168
Index 205

de-industrialization, 66 discriminatory, 91
delinquency, 55 diseases, 30, 37, 48, 174, 193, 194, 195, 196,
delivery, 32, 96 197
dementia, 72, 81, 85 dislocation, 51
democracy, 89, 105 disorder, 17
demographic change, 1, 20, 27, 35, 39, 69, displacement, 53, 65
149, 152, 156, 168, 176, 183 dissaving, 139
demographic characteristics, 177 disseminate, 154
demographic data, 92 distortions, 177
demographic factors, 28 distress, 33
demographic structure, 197 distribution, 8, 9, 10, 11, 12, 21, 28, 29, 43,
demographic transition, 8, 16, 20, 21, 46, 109, 45, 46, 66, 78, 86, 115, 141, 174, 175, 176,
110, 153, 174, 183, 197 177, 181, 182
demographics, 2, 3 diversity, 90
demography, 8, 34, 40 division, 34
density, 42, 46, 47, 48, 60, 61, 62, 63, 64, 65, divorce rates, 189
175 doctors, 32, 185, 190
dependency ratio, 20, 26, 27, 43, 140 dominance, 100
dependent variable, 145 donor, 104
deposits, 143 double jeopardy, 95
depression, 55 download, 105
deprivation, 65 draft, 102, 105
derivatives, 152 drainage, 185
desert, 191 drought, 191, 192, 195
destruction, 54 droughts, 173
developed countries, 28, 29, 68, 69, 151, 153, drugs, 194
176, 181 duration, 152
developed nations, 196 dusts, 49, 64
developing countries, 2, 8, 39, 40, 68, 69, 94, duties, 31, 74
136, 140, 150, 176, 194
developing nations, 10, 73, 83, 140, 196
development banks, 152 E
diabetes, 32
early retirement, 80, 81, 154
diarrhoea, 32, 185
early warning, 191
dietary, 37
earnings, 56, 188
dignity, 33, 60, 69, 102
ears, 80, 92, 193
directives, 75, 76
earthquake, 190, 191
disability, 52, 71, 72, 92, 107
East Asia, 1, 3, 65, 125, 129, 130, 131, 132,
disabled, 26, 53, 69
133, 134, 135, 136, 137, 138, 140, 142,
disaster, 191
143, 144, 147, 148, 149, 150, 151, 152,
discipline, 8
154, 155, 156, 157, 160, 161, 170, 182,
disclosure, 152
194, 196, 199
discourse, 42, 191, 198
East Timor, 132
discretionary, 168
eastern cultures, 160
discrimination, 37, 80, 87, 96, 97, 104
ecological, 195
206 Index

economic activity, 28 epidemiology, 199

economic change, 30, 162, 174 equality, 71
economic cycle, 167 equilibrium, 144
economic development, 34, 35, 42, 82, 109, equity, 145, 149
115, 131, 133, 182, 184, 191, 194, 195 erosion, 53, 191, 192
economic efficiency, 81 estates, 50
economic growth, 133, 134, 137, 149, 198 estimating, 9
economic growth rate, 149 estimators, 136, 142
economic integration, 58 ethical issues, 190
economic performance, 1 ethics, 14, 171
economic policy, 3 ethnic groups, 90, 174
economic problem, 176 Europe, 14, 73, 87, 129, 131, 181, 187, 190
economic reform, 20, 80, 84 Europeans, 189
economic security, 177 evacuation, 191
economic status, 95 evolution, 198
economic sustainability, 15 exchange rate, 137
economic systems, 16 exclusion, 52, 59, 71, 95, 104
economically disadvantaged, 91, 196 exercise, 49, 72
education, 29, 73, 74, 76, 88, 107, 108, 119, expenditures, 150, 154
123 expertise, 17
educational attainment, 111, 120 exports, 137
elderly population, 20, 23, 24, 26, 28, 45, 63, externalities, 154
66, 81, 82, 85, 92, 98, 100, 103, 104, 106, eye, 32
110, 145, 147, 150, 184, 186, 187, 188, 196
elders, 28, 30, 31, 35, 63, 86, 101, 168
emerging issues, 37 F
emotional, 36, 37, 101, 110, 124
fabric, 54
emotional health, 37
failure, 48
employees, 33, 79
faith, 169
employment, 36, 55, 69, 79, 86, 100, 111,
familial, 31, 53, 168
120, 124
family, 3, 8, 15, 16, 20, 26, 28, 29, 30, 31, 32,
employment status, 111, 120, 124
33, 35, 36, 39, 40, 42, 53, 54, 55, 59, 63,
empowerment, 102
68, 71, 78, 81, 82, 83, 84, 91, 92, 96, 97,
energy, 20, 168
101, 109, 110, 113, 124, 125, 161, 163,
England, 198
164, 166, 167, 168, 169, 181, 183, 186,
entertainment, 43, 73
187, 188, 189, 197
environment, 33, 42, 46, 48, 53, 55, 59, 60,
family environment, 33
61, 102, 137, 153, 168, 176, 185, 186, 193,
family life, 16, 28, 97, 164, 169
family members, 30, 31, 36, 40, 110, 124,
environmental change, 195, 197
163, 183, 187, 189
environmental conditions, 48, 194, 195
family planning, 16, 109
environmental factors, 72
family structure, 3, 15, 28, 30, 42, 53, 68, 84,
environmental issues, 59
92, 101, 163
epidemic, 83, 193
family support, 36, 78, 82, 124
epidemics, 174
family system, 8, 15, 16, 36
Index 207

family violence, 55 fulfillment, 69

famine, 174 funding, 77, 104
fear, 50, 165, 190 funds, 151, 152, 153
fears, 186
February, 60, 75, 107
feelings, 37, 101 G
fees, 57
gas, 20, 193
feet, 169, 196, 197
Gaza, 192
females, 10, 11, 21, 24, 30, 34, 92, 97, 98,
GDP per capita, 94, 133, 134, 135, 136, 140,
100, 109, 177
142, 145, 146
fertility, 8, 9, 10, 12, 13, 14, 15, 17, 20, 21,
geese, 177
38, 39, 109, 124, 132, 147, 150, 174, 176
gender, 3, 91, 95, 96, 97, 104, 108
fertility rate, 14, 15, 17, 21, 132, 147, 150,
gender inequality, 96
generation, 15, 31, 36, 37, 48, 54, 55, 56, 110,
Fiji, 126
139, 140, 142, 143, 144, 145, 146, 147,
filial piety, 53, 62, 64, 124, 165, 169
154, 155, 163, 168, 188, 189
finance, 60, 188
genetic factors, 72
financial crisis, 152, 153, 154, 155
Geneva, 108
financial institution, 37
geography, 134
financial markets, 151, 153, 154, 155, 156,
Georgia, 177, 178
geriatric, 73, 78
financial resources, 56, 195
Germany, 78
financial support, 28, 33, 36, 82, 103, 110,
gerontology, 39, 59, 70, 73, 78
girls, 95, 181
financial system, 155
glaciers, 195
financial vulnerability, 173
global economy, 152, 155, 156, 186
financing, 33, 50, 154
global leaders, 14
First World, 69, 73, 74, 75, 77
global warming, 193, 194, 195
fiscal deficit, 151
globalization, 2, 60, 61, 65
fishing, 42
goals, 46, 55, 59, 73
fitness, 72
God, 15, 18
flexibility, 52, 77
government, 17, 20, 32, 33, 34, 35, 36, 37, 41,
flooding, 191
43, 50, 60, 67, 70, 74, 75, 76, 77, 78, 80,
flow, 100
82, 83, 89, 96, 101, 102, 104, 125, 139,
focusing, 2, 42, 98
145, 150, 152, 153, 154, 173, 190, 192
food, 16, 34, 36, 97
government expenditure, 82
forced migration, 189
government policy, 43
Foreign Direct Investment (FDI), 182, 185
GPP, 80, 83
formal education, 79, 81, 97
grandparents, 31, 37
Fox, 168, 170
Gross Domestic Product (GDP), 19, 82, 90,
fragmentation, 55, 59
94, 101, 133, 134, 135, 136, 137, 138, 140,
France, 68, 189
141, 142, 145, 146, 151
freedom, 160, 162, 164, 171
groundwater, 192
freedoms, 160, 162, 163
groups, 8, 9, 10, 11, 20, 55, 84, 91, 117, 120,
frustration, 32
139, 143, 167, 174, 188, 198
208 Index

growth, 2, 3, 7, 8, 10, 11, 12, 13, 17, 19, 20, helplessness, 101
21, 23, 24, 35, 42, 43, 82, 90, 94, 133, 134, heterogeneity, 53
135, 136, 137, 138, 140, 141, 142, 143, heteroskedasticity, 142
145, 146, 149, 153, 154, 156, 176, 177, Higgs, 165, 166, 170
183, 184, 185, 190, 193, 198 high risk, 48, 106
growth rate, 3, 7, 8, 10, 11, 12, 13, 21, 23, 35, high school, 120
43, 82, 90, 94, 134, 136, 137, 138, 140, high temperature, 194
145, 146, 149 higher education, 84
Guangdong, 58 hip, 14, 124, 189
guidance, 35, 83 HIV, 176, 194
guiding principles, 60 HIV/AIDS, 194
guilty, 191 holistic, 3
home ownership, 111, 121, 122, 123, 124
homeless, 195, 196
H homogenous, 163
Hong Kong, 2, 3, 41, 42, 43, 44, 45, 46, 47,
Hamas, 192
48, 49, 50, 51, 52, 53, 54, 55, 56, 58, 59,
hanging, 154
60, 61, 62, 63, 64, 65, 66, 86, 130, 174,
happiness, 37, 71, 72
178, 182, 183, 184, 189
harm, 15, 161, 198
hospital, 48, 63, 66, 91, 186, 189
harmony, 15, 161, 198
hospital care, 189
harvest, 193
hospitals, 31, 32, 106
Hawaii, 38
host, 150, 189
hazards, 191, 192
host population, 150
health, 2, 3, 4, 14, 20, 21, 26, 29, 30, 32, 33,
household, 16, 28, 29, 31, 47, 53, 54, 96, 101,
35, 36, 37, 38, 39, 40, 41, 42, 46, 48, 50,
112, 113, 139, 143, 160
61, 65, 68, 69, 70, 71, 72, 78, 81, 83, 84,
households, 28, 30, 36, 53, 56, 143, 145, 151
87, 89, 90, 91, 92, 94, 95, 96, 97, 98, 100,
housing, 29, 36, 42, 43, 50, 52, 55, 56, 61, 66,
101, 102, 103, 106, 107, 108, 111, 121,
69, 76, 83, 162
122, 124, 150, 151, 154, 173, 176, 181,
Housing and Urban Development, 64
184, 185, 186, 189, 194, 196, 197, 198, 199
hub, 49
health care, 3, 14, 26, 29, 35, 36, 41, 68, 72,
human, 14, 29, 32, 35, 36, 70, 85, 95, 105,
81, 90, 91, 94, 96, 97, 103, 150, 154, 189,
107, 136, 165, 173, 177, 187, 190, 191,
195, 196, 197
193, 194, 195, 199
health care system, 154, 196, 197
human capital, 36, 136
health education, 37
Human Development Report, 95, 106, 108
health expenditure, 151
human resources, 32, 85
health insurance, 2, 82, 101, 102, 151
human rights, 95, 107
health problems, 32, 37, 83
human values, 187
health services, 32, 92, 95, 96, 185
humans, 193, 194, 195
health status, 30, 38, 111, 121, 122, 124
humidity, 193, 194
healthcare, 72, 73, 76, 104, 186
humiliation, 187
heart, 37, 48, 165, 175
husband, 161
heart disease, 37
hygiene, 100
heart failure, 48
hypothesis, 30, 139, 143
height, 95
Index 209

industrial, 33, 43, 49, 50, 174, 176, 182

I industrialisation, 191
industrialization, 28, 43, 46, 54, 66, 111
ice, 37, 195
industrialized countries, 33, 140
identification, 165
industrialized societies, 56
identity, 3, 160, 161, 162, 164, 166, 167, 168,
industry, 194
170, 171
inequality, 29, 55, 56, 60, 90, 96, 104, 154
imagery, 17, 168
infant mortality, 96, 176, 177
images, 164, 168, 169
infant mortality rate, 177
imbalances, 2
infants, 97
IMF, 139, 145, 149, 150, 153, 154, 155, 156
infections, 185
immigrants, 153, 188
infectious, 173, 174, 195, 196, 199
immigration, 149, 150, 189
infectious diseases, 173, 174, 195, 196, 199
immortal, 166
inflation, 134, 136, 137, 145, 150, 152
immortality, 166
influenza, 195
implementation, 20, 34, 72, 78, 104, 109
influenza a, 195
imports, 137
information sharing, 153
incentives, 81, 189
Information System, 87
incidence, 195
infrastructure, 3, 21, 56, 150, 152, 153, 182,
inclusion, 42, 61, 71, 77
185, 196, 197
income, 2, 20, 29, 43, 50, 55, 56, 69, 76, 78,
inheritance, 189
82, 83, 90, 94, 97, 102, 106, 111, 122, 123,
inheritance tax, 189
124, 133, 134, 136, 139, 140, 143, 148,
inhuman, 191
152, 153, 155, 187, 189
initiation, 73, 109
income distribution, 29
injuries, 164
income inequality, 55, 56
inmates, 34
income support, 83
insecurity, 59, 164
incomes, 59, 97, 190
insight, 37, 91
incompatibility, 159
instability, 53, 89
independence, 69, 160
institutions, 26, 28, 167
India, 19, 25, 26, 27, 29, 40, 94, 175, 177,
instruction, 73, 81
179, 181, 183, 184, 185, 189, 192, 193,
instruments, 75, 77
194, 198, 199
insurance, 2, 82, 101, 102, 111, 143, 151, 169,
Indian, 33, 38, 40, 175, 184, 190, 191
Indian Ocean, 191
integration, 2, 15, 58, 60, 62, 126
Indiana, 67
intentions, 162
indication, 10
interaction, 8, 47
indicators, 12, 108, 137
interactions, 31
indices, 24, 145
interdependence, 165
indigenous, 32, 65, 90, 185
interest groups, 20
individual rights, 162
interest rates, 145, 147, 148
individualism, 159, 169
intergenerational, 31, 35, 37, 79, 125, 154,
individuality, 161, 162
163, 164, 171
individualization, 166
International Labour Office, 181
Indonesia, 19, 129, 130, 133, 143, 175, 177,
International Monetary Fund, 156
179, 184, 191
210 Index

international standards, 55
international trade, 130, 183
internet, 79, 181
labor, 1, 2, 20, 28, 33, 68, 69, 97, 134, 149,
interpersonal relationships, 161
150, 152, 153, 167, 177, 181, 182, 188
interval, 136, 147
labor force, 1, 69
intervention, 190
labour force, 20, 28, 33, 97, 134, 150, 152,
intrinsic, 8, 193
investment, 1, 56, 130, 134, 141, 142, 143,
labour market, 150, 153
145, 147, 149, 153, 154, 164, 168
land, 50, 57, 90, 91, 100, 101, 189, 191
investment rate, 1
language, 95, 102
ions, 18
Laos, 184
Iran, 179
large-scale, 56, 78, 190, 191
Iraq, 180, 192
later life, 36, 56, 71, 84
Islamic, 152, 179, 192
Latin America, 140
isolation, 48, 52, 54, 55, 59, 97, 101, 160
law, 8, 30, 36, 100, 187
Israel, 178, 183, 184, 192
laws, 75, 76, 187, 189
leadership, 14, 15, 17, 80
J learning, 70, 72, 73, 81
Lebanon, 179, 184, 192
Japan, 2, 14, 19, 43, 129, 130, 132, 133, 143, legislation, 103
149, 155, 157, 174, 175, 177, 178, 182, leisure, 31, 168
183, 184, 188, 189, 193, 196 leisure time, 31
Japanese, 143, 156, 157, 189, 199 liberalization, 2, 153
Java, 175 liberation, 163
job training, 81 life course, 71
jobs, 8, 55, 68, 197 life expectancy, 3, 4, 7, 9, 10, 11, 12, 21, 69,
joining, 78 94, 95, 96, 104, 109, 117, 132, 134, 135,
joint ventures, 50, 81 136, 174, 177, 181, 183, 184, 196, 197
Jordan, 179, 181 life experiences, 189
Jun, 85 life span, 173, 192
life style, 7, 37
lifestyle, 3, 16, 70, 72, 77, 78, 83, 87, 163,
K 171, 174, 188
lifestyle changes, 72
Kazakhstan, 177, 178, 184 lifestyles, 28, 163, 167, 169
Kenya, 65 lifetime, 71, 139
kinship network, 31 likelihood, 169, 188, 195
Korea, 2, 3, 43, 109, 110, 111, 113, 114, 115, limitations, 186, 198
121, 124, 125, 126, 129, 130, 132, 133, linear, 140
143, 149, 177, 178, 182, 183, 184 linguistic, 91
Korean, 110, 111, 124, 125, 126 liquidity, 152
Kuwait, 180, 181 literacy, 20, 29, 94, 97
Kyrgyzstan, 179 literacy rates, 97
Index 211

living arrangements, 3, 20, 28, 38, 40, 53, markets, 3, 66, 151, 152, 153, 154, 155, 156,
110, 111, 113, 114, 115, 116, 117, 118, 157, 167
120, 121, 122, 123, 125 marriage, 78, 97
living conditions, 47, 50, 56, 58 marriages, 8, 163
living environment, 46, 55, 59, 61 mass media, 37
living standards, 163 maternal, 96
lobby, 104 meanings, 165
lobbying, 102 measures, 125, 185
local community, 53 media, 15, 37, 98, 103, 168
location, 39, 166, 187 median, 24, 56
London, 40, 43, 61, 125, 156, 170, 171, 192, medical care, 73, 100
198, 199 medicine, 37, 70, 73, 78, 199
loneliness, 48, 61, 98, 101, 105, 160 Mediterranean, 189
long distance, 55 melt, 195
long period, 8, 9 memory, 17
longevity, 2, 69, 91, 92, 152, 173, 174, 175, men, 20, 28, 29, 32, 33, 40, 56, 79, 92, 95, 96,
176, 177, 181, 183, 184, 185, 188, 193, 97, 98, 100, 177, 181, 186, 196
194, 196 mental health, 50, 78, 81, 83
long-term bond, 145, 147, 152 mental illness, 63
losses, 148 messages, 80
love, 164 meta analysis, 81
low-income, 2, 43, 55, 56 metropolitan area, 43, 194
Mexico City, 176
middle class, 52, 55, 162
M Middle East, 177
middle-aged, 61
Macao, 87, 178, 183
midwives, 185
macroeconomic, 133, 142, 149, 150, 154
migrant, 98, 99
macroeconomic policies, 150, 154
migrant population, 98, 99
Mainland China, 43
migrants, 50, 98, 99, 150
mainstream, 79, 94
migration, 7, 8, 30, 31, 38, 39, 58, 59, 60, 61,
maintenance, 161, 162, 186
68, 98, 100, 101, 105, 106, 110, 111, 115,
major cities, 16, 55, 60
124, 168, 177, 185, 189
malaria, 193, 194, 195
military, 74, 103, 190
Malaysia, 126, 129, 130, 149, 179
military government, 190
males, 21, 30, 34, 95, 97, 109, 177, 187
Ministry of Education, 74
management, 15, 16, 57, 59, 153, 155
Minnesota, 171
mandatory retirement, 80
MLD, 103
manpower, 36
mobility, 53, 59, 64, 82, 152, 163, 177, 183,
marital status, 111, 112, 114, 118, 122, 123,
model specification, 136
market, 2, 49, 50, 52, 80, 82, 96, 137, 139,
models, 123, 137, 140
143, 144, 147, 150, 152, 153, 162, 163,
modernization, 15, 16, 17, 28, 31, 82, 115,
164, 167, 168, 169, 170, 183, 186
124, 163, 183
market economy, 163, 164
momentum, 153
marketing, 168
212 Index

money, 14, 29, 36, 122, 123, 124 Nepal, 2, 3, 25, 27, 89, 90, 91, 92, 93, 94, 95,
Mongolia, 132, 179, 192 96, 97, 98, 99, 100, 101, 102, 103, 104,
monopoly, 137 105, 106, 107, 108, 174, 179, 184, 192
monsoon, 175, 196 Netherlands, 106, 198
Moon, 110, 126 network, 16, 31, 43, 52, 53, 75, 77, 197
morbidity, 174 New Jersey, 17
mortality, 8, 9, 10, 12, 20, 21, 48, 90, 96, 109, New York, 2, 14, 18, 40, 43, 65, 85, 86, 108,
166, 174, 176, 177, 185, 198 125, 176, 199
mortality rate, 90, 96, 177 next generation, 37
mortgage, 155, 186 NGO, 98, 104, 107
mosquito vector, 194 NGOs, 32, 36, 37, 90, 95, 98, 102, 103, 104
mosquitoes, 194, 195 nitrogen dioxide, 48
motherhood, 97 nitrous oxide, 185
mothers, 186 noise, 16, 61
motion, 60 nongovernmental, 82
mountains, 90 normal, 29, 91, 183, 184
mouth, 193, 196 North Africa, 177
movement, 34, 188 North America, 8, 14, 131, 170, 187, 189
MPI, 78 North Korea, 132
multilateral, 152, 154 Northeast, 129, 192
multiple factors, 81 Northeast Asia, 129
Muslim, 14, 15, 18 novelty, 189
Muslims, 15 NRC, 98
mutual funds, 152 nuclear, 15, 16, 28, 36, 53, 54, 101, 167
mutual respect, 35 nuclear family, 15, 53, 54, 101, 167
Myanmar, 129, 130, 179, 190, 192 nurses, 96, 190
nursing, 31, 56, 59
nursing home, 56, 59
N nutrition, 29, 87, 92

narcissism, 164
nation, 3, 84, 101, 181 O
nation states, 3
National Peoples Congress, 75, 87 obesity, 71
national saving, 139, 150 obligation, 31, 35, 165, 166, 170, 187
natural, 7, 10, 20, 21, 32, 35, 71, 95, 140, 160, obligations, 1, 161, 187
182, 191, 196 observations, 60, 62, 137
natural disasters, 20, 196 obsolete, 53, 57
natural gas, 20 occupational, 55, 91
natural resources, 182 OECD, 59, 64, 145, 156, 157
NCA, 75 oil, 192
negative influences, 133 old age, 8, 21, 32, 33, 36, 41, 65, 68, 70, 71,
negative relation, 124, 145 72, 83, 84, 92, 96, 97, 100, 103, 104, 173,
neglect, 54, 96 177, 181, 188, 196
neighbourhoods, 50 older adults, 20, 53, 71, 72, 105
Index 213

older people, 1, 2, 3, 4, 13, 15, 16, 20, 28, 29, pendulum, 189
30, 31, 33, 39, 41, 42, 43, 45, 46, 47, 48, pension, 16, 33, 36, 78, 80, 85, 97, 103, 104,
50, 51, 52, 53, 54, 55, 56, 58, 59, 60, 61, 150, 151, 153, 154, 157, 168, 173
65, 66, 68, 70, 71, 79, 81, 82, 83, 94, 101, pension plans, 33
102, 104, 107, 110, 159, 160, 161, 163, pension reforms, 151
164, 165, 166, 167, 169, 174, 181, 183, pension system, 103, 151, 153, 157
187, 189 pensions, 2, 33, 40, 41, 56, 103, 104
Oman, 180, 181 peptic ulcer, 32
online, 105, 108 per capita, 82, 90, 94, 133, 134, 135, 136, 140,
open economy, 137 142, 145, 146
optimism, 183 per capita income, 90
oral, 98 perception, 48, 75
Organisation for Economic Co-operation and perceptions, 161
Development, 64 personal wealth, 162
orientation, 84 personality, 169
oversight, 78 pesticides, 194
overtime, 24 pharmaceutical companies, 194
ownership, 111, 121, 122, 123, 124 pharmaceutical industry, 194
oxides, 185 Philippines, 126, 129, 130, 149, 179, 184, 192
ozone, 48, 66 physical abuse, 36
physical activity, 72
physical health, 37, 46, 72
P physiological, 166
pigs, 193
Pacific, 38, 39, 40, 60, 62, 70, 87, 103, 125,
pilots, 107
136, 154, 181, 191, 198, 199
planning, 21, 28, 34, 45, 52, 55, 66, 71, 109,
Pacific Region, 40
166, 181
pain, 32
plants, 48
Pakistan, 2, 3, 7, 12, 13, 14, 18, 19, 25, 27, 94,
play, 16, 29, 31, 35, 68, 101, 102, 103, 161,
175, 179, 184, 199
Pakistani, 14, 15, 16
pleasure, 160
pandemic, 193
pneumonia, 185
paradigm shift, 41
polarization, 55, 56, 59, 64
parasites, 194
police, 103
parents, 15, 16, 28, 30, 31, 36, 50, 53, 96, 97,
policy choice, 151
124, 187
policy instruments, 75, 77
Paris, 43, 64
policy makers, 17, 37, 41, 60, 79, 80, 84, 154
particulate matter, 185
policy making, 78, 83
passive, 54, 71, 162
political instability, 89
pathogens, 194
political parties, 89
patients, 48
politics, 199
pay-as-you-go, 150
pollutant, 48
Pearl River Delta, 48, 58
pollutants, 63, 185
pedestrian, 52
pollution, 42, 48, 49, 59, 185, 186, 191, 192
peer review, 154
polynomial, 140, 141
penalties, 154
214 Index

poor, 19, 29, 32, 33, 34, 36, 48, 50, 51, 55, 56, profit margin, 194
57, 58, 59, 60, 90, 95, 97, 102, 106, 184, prognosis, 4, 194
185, 186, 188, 196 program, 20, 109
poor health, 95, 97, 106 property, 49, 162, 186, 189
population density, 42, 46, 63 property rights, 162
population growth, 7, 12, 13, 16, 21, 42, 43, protection, 56, 83
190, 193 prototype, 196
Population Growth Rate, 12, 13 psychological stress, 17
population pyramid, 21, 23, 92 psychological well-being, 50, 63, 64
population size, 26 public, 14, 17, 20, 21, 30, 33, 43, 52, 57, 75,
portfolio, 144, 145 80, 81, 83, 84, 85, 86, 97, 150, 151, 153,
portfolios, 147, 151 154, 164, 168, 185, 186, 187, 195, 197
positive correlation, 147 public debt, 150
positive relation, 136, 137 public funds, 151
poverty, 29, 43, 55, 63, 82, 87, 90, 94, 95, 98, public health, 21, 81, 151, 185, 195
102, 104, 174, 184, 194 public housing, 43
poverty line, 29 public pension, 33, 151, 153, 154
poverty rate, 82, 90 public policy, 17, 80, 82, 83, 84, 85
poverty trap, 55 public sector, 20, 185
power, 10, 20, 48, 54, 70, 106, 166, 168, 190, pulses, 195
power plants, 48
PPP, 94, 133, 134, 136 Q
preference, 29, 52, 95, 101, 177, 186
Qatar, 180
pregnancy, 96
quality of life, 19, 33, 62, 64, 65, 68, 72, 84
pregnant women, 96
premium, 137
preparedness, 2 R
president, 73
press, 15, 56, 86, 170 radius, 46
pressure, 32, 80, 98, 150, 154, 155, 188 rainfall, 195
prestige, 54, 70 random, 193
prevention, 68 range, 2, 31, 59, 96, 119, 174, 183, 185, 186,
preventive, 37, 70 191
PRI, 157 rate of return, 154
price index, 146 rating agencies, 152, 154
prices, 57, 133, 139, 144, 145, 146, 147, 148, rational expectations, 144
151, 155, 186 raw materials, 169
privacy, 48, 160 real estate, 49
private, 8, 48, 50, 52, 53, 57, 66, 82, 97, 139, real income, 56
150, 154, 163, 164, 173, 185, 186, 189 real terms, 139
private sector, 8, 50, 154, 173, 185 reality, 37, 46, 73, 79, 90, 100, 160
probability, 94 recession, 186
production, 32, 43, 101 reciprocal relationships, 169
productivity, 80, 81, 149, 150 reciprocity, 53, 164
Index 215

recognition, 168 retirement, 12, 28, 52, 56, 58, 61, 71, 72, 79,
reconstruction, 49 80, 81, 85, 88, 139, 140, 144, 146, 148,
recreation, 160 150, 151, 154, 168, 187, 188, 189
recreational, 49, 55 retirement age, 71, 72, 79, 80, 81, 85, 88, 150,
recreational areas, 49 151, 154, 188
recurrence, 152 returns, 35, 145, 157
redevelopment, 50, 51 revolutionaries, 89
reforms, 20, 60, 150, 151, 154, 155 rewards, 160, 164
refuge, 101 rhetoric, 15, 70
regenerate, 50 rhythm, 167
regional, 2, 26, 43, 97, 101, 133, 152, 153, rice, 19
154, 187 rings, 160
regional cooperation, 153 risk, 4, 48, 50, 54, 55, 104, 106, 139, 152,
regional economies, 152 155, 159, 160, 165, 166, 167, 169, 193, 194
regional integration, 2 risk management, 155
regression, 111, 122, 136, 137, 138, 139, 141, risk society, 159, 160, 165, 166, 167, 169
147 risks, 10, 48, 52, 59, 95, 122, 123, 124, 153,
regression analysis, 111 154, 165, 169
regressions, 140 rivers, 100
regular, 187 rural, 16, 26, 28, 29, 32, 38, 39, 43, 46, 90, 91,
regulatory framework, 153 94, 96, 97, 98, 100, 101, 105, 106, 110,
relationship, 28, 31, 35, 47, 63, 83, 124, 125, 111, 113, 114, 115, 116, 117, 118, 119,
161, 162, 163, 168, 169 120, 121, 122, 123, 124, 125, 153, 185,
relationships, 9, 16, 31, 55, 69, 161, 164, 167, 187, 194, 196
169 rural areas, 32, 43, 46, 90, 91, 94, 96, 98, 100,
relative size, 24 105, 110, 111, 115, 116, 117, 118, 119,
relatives, 29, 31, 32, 36, 59, 113, 186 120, 121, 122, 123, 124, 153, 185, 187
relevance, 19, 71, 77 rural communities, 101
remittances, 28, 100 rural population, 94, 110, 187
Renaissance, 160 rural women, 96
rent, 52, 57 Russia, 177, 183, 184, 196
replacement rate, 151, 154 Russian, 178
reproduction, 10, 166
residential, 31, 50, 56, 57, 59, 64
residential buildings, 50 S
resistance, 194
sadness, 101
resources, 15, 19, 24, 32, 35, 42, 56, 70, 79,
safety, 35
85, 92, 94, 182, 185, 188, 195, 197
sample, 82, 111, 113, 140
respiratory, 185
sample survey, 82
responsibilities, 28, 33, 72, 74, 95, 97, 103,
sanitation, 194
163, 187
SAR, 178
restructuring, 60
Sarin, 193
retirees, 152, 154, 189, 199
SARS, 193, 195
satisfaction, 48, 50
Saudi Arabia, 180
216 Index

saving rate, 139, 140, 142, 144 significance level, 135, 142, 146
savings, 36, 168 signs, 136, 137, 186
scarcity, 195 silver, 174, 183, 188
schistosomiasis, 194 Singapore, 43, 129, 130, 133, 143, 149, 174,
school, 8, 37, 119, 120, 123, 190 177, 178, 182, 183, 184, 186, 188, 189, 198
SCN, 87 sites, 107
sea level, 196 skills, 101, 102
search, 68, 75, 100, 196 sleeping sickness, 194
Second World, 63, 69, 70, 74, 75, 84, 85, 87, slums, 185
101 smog, 48
secretariat, 75 smoking, 83
securities, 143, 152, 155, 167 sociability, 163
security, 16, 30, 33, 35, 40, 42, 56, 68, 69, 72, social attitudes, 15
76, 78, 81, 83, 100, 101, 150, 151, 154, social behavior, 60
161, 164, 166, 168, 173, 177, 185, 189, 198 social care, 3, 33
segmentation, 160 social change, 4, 7, 53, 61, 84, 160, 161, 165,
segregation, 55, 56 167
self, 30, 170, 171 social class, 167
self-care, 168 social consequences, 1, 16
self-definition, 168 social construct, 12, 18, 85
self-discovery, 170 social contract, 162
self-report, 40 social control, 167
senior citizens, 15, 56, 103 social development, 98
sensitivity, 2 social distance, 186
separation, 160 social exclusion, 60, 71
series, 136, 145 social expenditure, 150
services, 32, 34, 43, 52, 58, 60, 64, 81, 83, 92, social gerontology, 70, 78
94, 95, 96, 98, 100, 103, 104, 151, 152, social group, 167
153, 185 social impacts, 197
settlements, 100, 185, 189 social infrastructure, 56, 153
sex, 29, 39, 95, 96, 111, 112, 117, 163, 171, social integration, 15, 126
177, 181, 199 social isolation, 48, 52, 54, 55, 59, 97
sex differences, 95 social life, 163
sex ratio, 96, 177, 181, 199 social network, 53
sexism, 95 social participation, 41, 42
shame, 187, 189 social policy, 17, 24, 78, 167, 198
Shanghai, 77, 79, 84, 86, 87, 88, 186 social problems, 1
shape, 166 social relations, 164
shaping, 15 social security, 16, 30, 33, 40, 56, 58, 66, 68,
sharing, 31, 37, 102, 153 74, 76, 77, 78, 81, 101, 150, 151, 154, 156,
shelter, 36, 191 157, 173, 181
shortage, 85 social services, 73, 81, 151
short-term, 155, 162 social structure, 168
shy, 98 social support, 20, 26, 38, 98, 105, 195, 196,
sign, 124 197
Index 217

social support network, 196 statutory, 79, 154

social transition, 17 steady state, 144
social welfare, 59, 69, 103, 181 steel, 190
social work, 36, 37, 78 stigma, 189
social workers, 36 stigmatized, 50
socioeconomic, 17, 20, 34, 35, 67, 82, 83, stock, 139, 144, 145, 146, 147, 153, 155, 188
111, 124, 176 stock markets, 153
socioeconomic conditions, 124 stock price, 139, 144, 145, 146, 147, 155
sociological, 4, 165 stomach, 32
sociologists, 53, 159 strains, 196
sociology, 78 strategic planning, 71
soil erosion, 191 strategies, 17, 36, 41, 98
soils, 49, 64 strength, 16, 190
South Africa, 63 stress, 17, 55, 101, 150
South Asia, 10, 11, 12, 40, 90, 91, 92, 106, stretching, 175
136 stroke, 37
South Asian Association for Regional subjective, 105, 164
Cooperation, 91 subjective well-being, 105
South Korea, 43, 125, 129, 132, 133, 182, sub-prime, 155, 186
183, 184 Sub-Saharan Africa, 132, 135, 136, 140, 141,
Southeast Asia, 1, 2, 183, 199 176
Soviet Union, 176, 192 subsistence, 28, 56
Spain, 68, 84, 101 suburbs, 51, 188
spatial, 45, 46, 55, 59, 66, 182, 183, 187 successful aging, 71, 72, 78, 83, 84
specialization, 105 suffering, 32, 100, 194
species, 193, 194 suicidal behavior, 63
spectrum, 17, 188 suicide, 54, 81, 187, 192
speech, 87 suicide rate, 54
speed, 4, 21, 129, 173 Sumatra, 191, 192
spheres, 104, 133, 149 summer, 189
spiritual, 69, 72 supervision, 31
spouse, 31, 53, 54, 97, 111, 113, 114, 115, supplemental, 150
116, 117, 118, 119, 120, 121, 122, 123, supply, 144, 149, 150
173, 188 surgery, 97, 190
squatter, 100, 185 surplus, 143
Sri Lanka, 25, 26, 27, 29, 33, 40, 94, 175, 178, surpluses, 150
184, 191, 192 surveillance, 154
stability, 161 survival, 28, 31, 71, 94
staffing, 75 survival rate, 28
stages, 8, 80, 96, 153, 175, 186 surviving, 94
stakeholders, 14, 17 sustainability, 15, 78, 198
standards, 55, 154, 163 swamps, 191, 195
State Council, 73, 74, 75, 87 symbols, 168
state-owned enterprises, 20, 79 sympathy, 35
statistics, 106, 181 syndrome, 189
218 Index

transnational, 199
T transport, 42, 52, 55
transportation, 20, 176
Taiwan, 43, 182, 184
travel, 55, 59, 194, 199
Tajikistan, 180
trees, 191
Taliban, 192
tribal, 192
Taoism, 171
tropical areas, 137
targets, 38, 43, 71
tsunami, 191, 192
task force, 102
tuberculosis, 185, 193
tax base, 154
Turkey, 179, 184
tax collection, 153
Turkmenistan, 179
taxation, 154
turnover, 53, 152, 165
technical assistance, 153, 154
typhoid, 194
temperature, 193, 194, 195
tenure, 185
territorial, 164 U
territory, 42, 48, 49, 53, 54, 58
Thailand, 39, 129, 130, 133, 143, 149, 178, ulcer, 32
182, 184, 189, 191 uncertainty, 4, 151, 165
thinking, 3, 75, 163 unemployment, 1, 56, 79, 80, 81, 84
threat, 17, 154, 159, 191, 193, 194 UNESCO, 69, 73, 87
threats, 16, 193 UNFPA, 108
threshold, 133, 189 unions, 20
Tiananmen Square, 162 United Arab Emirates, 180
tiger, 63, 199 United Nations, 3, 7, 11, 12, 13, 14, 24, 25,
time periods, 185 27, 38, 40, 55, 65, 68, 69, 87, 90, 108, 129,
timing, 21, 38, 84, 147 130, 131, 132, 133, 138, 144, 145, 147,
Tokyo, 43, 61, 156, 176, 188, 198 148, 149, 157, 181, 183, 197, 199
tourism, 199 United Nations Development Program
tourist, 191 (UNDP), 39, 90, 95, 106, 108
Toyota, 189, 199 United Nations Development Programme, 90,
trade, 43, 130, 154, 183 108
trading, 152, 153 United States, 139, 181, 189
tradition, 15, 81, 97, 124, 161, 177 universities, 8
traffic, 48, 186 urban areas, 27, 41, 42, 45, 46, 50, 51, 52, 55,
training, 32, 81, 102 56, 59, 63, 90, 98, 100, 101, 110, 115, 116,
transactions, 49 117, 118, 119, 120, 121, 122, 123, 124, 188
transfer, 31, 56, 80, 81, 153 urban centers, 15, 98, 183
transfer payments, 56 urban population, 59, 110
transformation, 15, 42, 46, 124, 162, 165, 187 urban renewal, 50, 54, 64, 65
transition, 8, 16, 17, 20, 21, 39, 42, 46, 84, urbanization, 3, 15, 16, 17, 27, 28, 31, 41, 42,
109, 110, 153, 161, 169, 174, 182, 183, 46, 53, 59, 110, 111, 115, 176, 177, 194,
194, 197, 198, 199 197, 198
transitions, 132, 167, 170, 176 USAID, 97, 108
translation, 73, 75 USSR, 183, 184
transmission, 195 Uzbekistan, 179
Index 219

welfare state, 84
V welfare system, 56, 103, 173
well-being, 15, 20, 29, 35, 37, 42, 50, 53, 63,
vaccination, 194
64, 68, 70, 98, 105, 110, 169, 185
values, 16, 28, 42, 53, 59, 71, 135, 136, 137,
wellness, 72
140, 141, 142, 146, 162, 163, 165, 187
Western countries, 8
variability, 188
Western Europe, 187, 189
variables, 111, 122, 123, 124, 134, 136, 137,
Western societies, 80
139, 140, 141, 142, 145, 146, 147
wildlife, 195
variance, 136
windows, 36
variation, 142, 184
winter, 189
vascular dementia, 81
wisdom, 16, 183
vector, 134
women, 20, 28, 29, 32, 33, 40, 56, 63, 68, 78,
vein, 189
79, 91, 94, 95, 96, 97, 98, 100, 101, 104,
victims, 54
150, 153, 164, 167, 177, 185, 186, 187, 196
Vietnam, 39, 129, 130, 143, 182, 184, 192
workers, 36, 43, 79, 81, 82, 95, 149
Vietnam War, 192
workforce, 30, 68, 80, 81
village, 32, 42, 163
working population, 1, 130
violence, 54, 55, 97
World Bank, 90, 108, 134, 136, 145, 151, 157
viruses, 193
World Development Report, 108
visible, 39
World Health Organization (WHO), 41, 59,
vision, 12, 68, 160, 165
66, 68, 69, 70, 72, 73, 80, 82, 83, 87, 95,
volatility, 151
97, 108
vulnerability, 54, 97, 173, 188, 191
World War II, 8
writing, 102, 175, 186, 190
wages, 151
war, 26, 107, 145, 188, 192
Yemen, 180
warrants, 92, 98, 101
yield, 145
water, 100, 185, 191, 194, 195
yuan, 188
weakness, 32
wealth, 17, 20, 31, 55, 68, 162, 163, 168, 184
web, 108 Z
welfare, 2, 20, 37, 46, 56, 58, 59, 60, 62, 63,
69, 80, 81, 84, 103, 125, 166, 173, 181 zinc, 49
welfare reform, 60, 80 zoonosis, 195
welfare reforms, 60