Nov 20, 2017

Growing Old in China

Managing an ageing population is no easy feat. In Australia, we have around 5 million people aged 60 and over. This is set to grow as life expectancy rises and the baby boomers push up Australia’s average age.

But, if we shift our gaze to China, we find around 225 million people aged 60 and over. As the generations preceding the One Child Policy grow older, there are fewer children to care for ageing parents and grandparents. This creates a “4-2-1 phenomenon” where one child of working age could have the burden of caring for two parents and four grandparents.

How is China managing their ageing population?

I recently traveled to China conducting research for my Master’s degree. This research included household interviews in a number of cities and rural towns, where I learnt much about how China’s older generations live, and the expectations that come with growing old.

Self-sufficiency and the pension.

The families I visited in rural areas live very simply. Each has a plot of land from the government, and grows vegetables in their garden. They fish, they own chickens, they make soy sauce and canola oil, they grow rice and their needs are few. They have solar hot water systems, woks fueled by fire, and sometimes solar energy panels (solar PV). Each day, no matter their age, they care for their crops and animals, and join friends for square dancing and mahjong.

On top of this, retired Chinese people – rural and urban – receive government pensions equal to their contributions to state run enterprises, national food production and/or the Communist Party. For many, particularly those in the city, these pensions are significant. They are a hangover from times of government control prior to the opening up of China to private enterprises in the 1980s and 90s.

But the retirees of tomorrow may not be so lucky. In a time of transition, China is navigating how to structure pensions for the next generation with fewer people at working age than retirement age – a question of inter-generational debt also being faced in Australia.

Social and cultural expectations of caring.

China’s older people receive significant support from their families, which eases reliance on pensions and care services.

With strong Confucian roots, traditional Chinese values emphasise the importance of family and respect for parents and ancestors. In most cases, children and grandchildren visit every week, if not every day. They clean, cook and run errands. They take on the role of an in-home carer.

When parents or grandparents become too frail, the expectation is they will live with their son. Traditional Chinese homes are designed with a courtyard surrounded by living areas on all four sides to house the extended family. The family falls into an internal care system, and women take on the caring role at home.

This is vastly different to Australia, where nuclear families rarely live alongside older generations. Instead, our care system is built on providing the services that Chinese families source internally.

Changing dynamics and demographics.

But it’s not that simple.

Older Chinese generations are concerned about the impact of caring on their children, with only children balancing competing obligations. For families with one daughter, it becomes challenging for daughters to provide care for her elders as well as her husband’s elders.

Moreover, the rise of Western pop culture is exerting pressure on traditional values, eroding reverence for family hierarchy. Work pressures and insecurity are fracturing family ties. And younger generations are seeking better employment and financial opportunities away from home.

At the same time, rapid urbanisation and urban development is increasing population density in cities.

For instance, Shanghai holds the entire population of Australia in a land area smaller than Melbourne.

Multigenerational family homes are being replaced by high-rise apartments. The natural structure of family assistance and inclusion is being undermined.

And, as a result, elderly parents are increasingly left behind to fend for themselves.

Legal obligation to care.

Authorities in China continue to be alarmed by resulting stories of old people dying unnoticed in their apartments. In response, the government introduced a law that requires children to provide for the emotional and physical needs of their parents. This includes visiting them often or facing fines and potential jail time.

One woman who was found negligent in visiting her 77-year-old mother was charged under the Law on Protection of the Rights and Interests of the Elderly and was ordered to visit her mother at least once every two months, and on at least two national holidays a year.

Still, authorities were recently alarmed by stories of old people dying unnoticed in their apartments.

Although difficult to legislate, it provides an avenue for parents to ask for better care. Whilst unlikely in practice, imagine a similar law in Australia – would it encourage children to become more active advocates for their parents earlier on? In the absence of cultural norms to provide eldercare, could legislation also be a tool to overcome the stigma of old age?

When there are no children to do the caring.

Still, China has not addressed the root of the problem: an ageing population with fewer children providing care. More aged care homes are being built across China, but these are often state owned and of low quality.

In 2015, China had 6.7 million aged care beds, representing an increase of 176 per cent from 2012.

I visited an aged care home whilst there: simple dorm rooms often shared between many, no doors on rooms, shared bathrooms, low hygiene and minimal care staff. But the residents still seemed happy, and one performed a provincial opera song for the onlooking villagers.

These homes are more of a social support than a comfortable option for older people. The residents, mostly divorced men, are often disabled or childless, with no one to care for them. They aren’t there by choice.

Growing affluence, growing demand.

China’s ballooning middle class is demanding more options and better services. This is making China the ideal market for established Western companies to enter, bringing their expertise from societies that have been outsourcing care for many decades. The market is in its infancy, but moving quickly to meet growing demands.

In support of expanding the market, the Chinese government is introducing policies to attract investment and capital. Companies such as Baptcare have already made a move.

Yet, in a country of 23 million, the biggest challenge is scale. Will the country be able to look after 400 million people over 65 by 2050?

In Australia, we can learn and benefit from China’s social, political and economic situation.

  • Socially, China’s respect for elders provides stark comparison to our often-stigmatising attitudes towards older Australians. Further to this, exercising autonomy and self-sufficiency in old age is important in leading a fulfilling life. Wellbeing hinges on social attitudes that empower rather than devalue.
  • Politically, Australia can learn from China’s evolving approach to the pension system and eldercare legislation.
  • And economically, the Australian market can benefit from the opportunities presented by increased demand for care services and market growth.

This content was originally published at Ellis Jones website

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