Category Archives: Asia

Asia is the largest and most populous continent with a blend of many different climates. It varies greatly across and within its regions concerning ethnic groups, cultures, environments, economics, historical ties and government systems. Many of the world’s major religions have their origins in Asia.

Hong Kong plans for a city that’s growing older

Today, about 16 percent of Hong Kong’s population is age 65 or older. By 2064, that is expected to be 36 percent.
HONG KONG — For decades, this city of more than 7 million has been one of Asia’s most dynamic places, filled with a youthful energy that drove rapid growth in both the population and the local economy.

Planners here still see Hong Kong that way. But they also are looking at the long-term trends, and grappling with a force they cannot stop: Hong Kong is getting older. That’s true of both the city’s people and its built environment — a phenomenon planners here call “double ageing”.

Today, about 16 percent of Hong Kong’s population is age 65 and over. By 2064, that’s expected to be 36 percent — and one in ten residents will be over the age of 85.

Meanwhile, housing stock that appears middle-aged today will become outdated tomorrow. By 2047, some 326,000 private housing units will be more than 70 years old. Many of them feature long flights of stairs unfriendly to older people. More than a third of seniors live in public housing, but the two-year wait list is bound to grow longer as citizens age.

The double-ageing problem is just one issue that Hong Kong’s planners are trying to figure out as they write a comprehensive plan called Hong Kong 2030+. The plan aims to take future demographic and economic trends into account while charting a path for improving quality of life in one of the world’s most densely settled cities.

Phyllis Li Chi Miu, deputy director of the city’s territorial planning department, says buildings, roads, parks and public transport all will need rejuvenation to make the city age-friendly. “It’s a challenging task,” she says.

Alignment with New Urban Agenda

Planners are also looking at how they can align the 2030+ plan with the New Urban Agenda. That’s the 20-year plan for sustainable urbanization that nations agreed to last October at the U. N.’s Habitat III conference in Quito, Ecuador.

Alignment was the main topic of conversation at a recent “Urban Thinkers Campus” conference here. At the event, Li noted that the 2030+ plan already stresses key elements of the New Urban Agenda such as social inclusion and environmental protection.

However, there was some debate about the New Urban Agenda’s relevance in the context of a city-state like Hong Kong. Paul Zimmerman, an environmentalist and elected councilor, said that some notable issues mentioned in the New Urban Agenda, such as increasing numbers of cars on the road, growth of slums and poor utility services, are not problems in Hong Kong.

“Hong Kong is a city and also a country,” Zimmerman said. “It’s a city in which hyper-density and wilderness co-exist. Other mega-cities have no space in their periphery, while Hong Kong has a massive open space in its periphery.”

However, Professor NG Mee Kam of the urban studies programme at the Chinese University of Hong Kong, told Citiscope that the 2030+ plan “needs to strongly align with the New Urban Agenda to plug in crucial policy gaps.” For example, she said, Hong Kong’s plan could take a cue from the New Urban Agenda’s focus on the informal sector and the importance of cultural heritage.

Retrofitting and reclaiming

The 2030+ plan proposes three “building blocks” for implementation — planning for a liveable high-density city, embracing new economic challenges, and creating capacity for sustainable growth.

A major focus, particularly when it comes to dealing with the double-ageing problem, is retrofitting districts with the most old buildings. Tall buildings are likely to be renovated, while many smaller buildings will likely be demolished to make way for new construction and open space. Retrofitting public spaces is also a priority. The city intends to add curb-cuts at sidewalks to make it easier for seniors to walk, and aims to increase the amount of public space from 2 square metres per person to 3.5 square metres.

The plan also aims for compact urban growth that is highly integrated with public transport. Homes and offices are to be within 200 to 300 metres of transit; open spaces within 400 metres; and community facilities, railway stations and educational institutes within a range of 500 metres.

“We are looking at optimum land use through retrofitting,” Li said.

The plan also envisions reclaiming a good bit of land from the sea. That’s a strategy that Hong Kong has long relied on to create room for the city to grow — the city’s airport and Hong Kong Disneyland resort are both located on reclaimed land.

Under the 2030+ Plan, Hong Kong would add another 4,800 hectares (nearly 12,000 acres) of land — a little less than the area of Manhattan. The land would be used for housing, industry, transport facilities and open space. These would include a few large urban extensions such as the East Lantau Metropolis, which is to be home to as many as 700,000 people.

Work on the 2030+ plan started in 2015 and is in the fourth of six phases of public consultation. The final plan is expected to be released next year.


Open Your Eyes: A Journey from Darkness to Sight

Open Your Eyes is a recently produced documentary on the impact of cataract surgery in Nepal. The film shows the transformation of health-related quality of life for older adults with access to medical care. In the film, Manisara and Durga make the long journey to get cataract surgery. Both husband and wife are blind and depend on family members for their most basic needs. Despite being blind, Manisara and Durga help care for their grandchildren and have an important place in the family. Their journey to the city is filled with nervous trepidation, but after the surgery, both are able to see their grandchildren and contribute to valuable work that benefits the entire family and community.

Open Your Eyes highlights the successful use of foreign funds to combat treatable diseases. The funding helps develop sustainable infrastructure and pays for many public health interventions such as cataract surgeries. In a previous article titled Hoping to Health, Global Health Aging reviewed the impact of NGO’s working on health including the effect of global health volunteering. Such efforts look very different in the Lions Club of Nepal – a club established by the service membership organization Lions Clubs International – where medical volunteers are Nepali citizens.

Overall, some questions were not addressed in the documentary. It was unclear if there was adequate follow-up care to prevent infection. And while Manisari and Duraga had no complications, both would have been virtually unreachable if they needed medical attention after they returned home. Cataract surgeries have a positive health impact due to their low complication rate and high degree of efficacy. It is not clear, however, that this model would translate for more risky procedures. In the end, Open Your Eyes does not discuss the challenges of bringing medical care to rural areas. Instead, it makes a compelling case for older adults as valued members of society who deserve quality care. Check out the trailer!


Grace Mandel is a project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (B’FRIEND) at the Baltimore City Department of Health.

One Child: The Story of China’s Most Radical Experiment

One Child: The Story of China’s Most Radical Experiment by Mei Fong presents a compelling analysis of the impact of China’s “One-Child Policy” on older adults. The one-child policy, a compelling story of population control for economic growth, has long term implications that are only now apparent. Fong describes the challenges of a rapidly aging population as she focuses on families who are struggling to care for older adults, and those who have no children to care for them in old age.

Published November 2015

One of the book’s most gripping stories is of parents during the 2008 Sichun earthquake. According to official reports, “eight thousand families lost their only children in the disaster.” (p.3) These parents, and other parents who have lost their only children, face barriers in accessing nursing homes, health care, and burial plots. Fong notes, “they are also more financially vulnerable than ordinary retirees, and more prone to depression, studies show.” (p. 41) While these challenges are tangible, the emotional challenges of losing support systems in old age is also a prominent problem. Fong addresses the growth of China’s hospice industry, stating that many older adults without family feel unable to contribute to society. (p.151)

The book also digs into the cultural complexities in aging and filial obligation. In one notable story, that received national acclaim in china, Liu Ting brought his mother with him to college, when she was too ill to care for herself. His mother suffered from kidney disease and uremia. Although Ting received fame and attention, his job opportunities after college were limited at the expense and time required to properly care for his mother. (p. 92)

While Fong discusses other implications of China’s one-child policy such as rise in adoptions, increase in bride prices to compensate for the greater number of men than women, and the further consequences of sex-selective abortions, the primary implications of the policy relate to the care and treatment of older adults. With only one child per two aging parents, the traditional way of caring for Chinese parents will cause economic slow down, and place burdens on the younger generation.

Fong is at the forefront of a wave of journalism that will detail the challenges of aging in China. She acknowledged that it could be difficult to find many children who were burdened by caring for aging parents, as more parents of children from this time period are in their 50’s and 60’s (p. 86) However, her book is at the forefront of a problem that will only become more prominent in the coming decades.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.

Japan Confronts Crime Wave With Aging Population

“It wasn’t great to get caught, but I just didn’t give a damn…” Fumio Kageyama

A crime wave among older people is underway in the world’s greyest nation. Just last year in Japan, the number of criminals over 65 overtook the number of teenage criminals for the first time since the country started publishing age-related crime statistics in 1989. Over a third of shoplifting crimes are committed by those over 60, and 40 percent are repeat offenders. Criminal offenses by those age 60 and over have also quadrupled between 1994 and 2014.

Photo Credit: Geoff Stearns
Photo Credit: Geoff Stearns

This curious phenomenon has its roots in the age-old problem of poverty and loneliness. Japan is an expensive place to live in, with even a frugal lifestyle costing 25 percent higher than the basic state pension. The cost of living simply does not match the pension rates of the elderly. Hence older people are committing crimes that result in imprisonment but assure them of food, shelter and healthcare. Loneliness is another factor that encourages crime among older people. About 40 percent of the elderly population live alone. Once released from prison, many do not have access to money, food or shelter, which perpetuates the vicious cycle of crime.

The rise in elderly crime is set against the gloomy national economy of the country. ‘Abenomics’ is a set of economic policies that are currently in place to revive Japan’s stagnant economy, and provide much-needed context to this crime wave. The impetus for these economic policies has been the two decade long stagnant national economy. Japan’s stock market and property bubble burst in the early 1990s, leading to long-term stagnant wages and markedly reduced spending. For the past two decades, the country has not seen any major economic improvement. Worsening the situation were the nuclear meltdown and natural disasters of 2011. Now Japan is caught between reducing the national debt and dealing with roughly 30 percent pensioner population.

‘Abenomics’ is a three-pronged strategy, encouraging monetary easing, government spending, and business deregulation. So far, critics remain unconvinced about the impact of these regulations, and current crime cases reiterate the ineffectiveness of these policies regarding the elderly population. The Japanese government has responded to the crime wave among older people with a short-sighted measure to increase prison capacity by a whopping 70 percent. This does little to address the crime spree that is embedded in poverty and lack of economic security. Furthermore, it takes a huge amount of resources to maintain a prison full of pensioners. A 2-year prison sentence can cost as much as USD 74,700 in a Japanese prison, compared to USD 6,900 on pension annually.

Inmates with health problems can even increase prison costs. In fact, a 2012 Justice Ministry report found that two-thirds of inmates had at least one health condition, including cardiovascular diseases, mental health illnesses, and behavioral disorders. This has resulted in prison guards often going above their disciplinary duties by changing diapers, cleaning inmates and helping them to walk. Japan can respond with long-term measures, such as prison reform, to prevent prisons from turning into dysfunctional nursing homes.

Namratha Rao recently graduated with a Master of Science in Public Health in Social and Behavioral Interventions from the Johns Hopkins University Bloomberg School of Public Health.

The Not-so-Novel Concept of Elderly Homes in Asia

Photo Credit: elvisinchina
Photo Credit: elvisinchina

Old age homes are no longer a taboo! The waiting lists of nursing homes in Korea are at three times their capacity and the number of elder care homes in Nanjing, China has increased from 27 in 1990 and 52 in 2000 to 148 in 2009!

In Asia, people are seeing a shift in the traditional roles for elderly care. Changes in family structure, urbanization, and other factors of contemporary lifestyles often compel older members to seek care outside of the family. Elderly residential facilities, such as old age homes, retirement villages, and other forms of institutionalized care for the elderly, have become increasingly popular in Asia. Given the high demand for such facilities, there is a need to monitor its growth and the quality of care provided.

Thailand, Malaysia, and Sri Lanka are among the Asian countries that offer renewable visas to older expatriates. Private companies and developers in India and Malaysia are investing in senior citizen villages and assisted living infrastructure such as temples, spas and golf courses to attract the wealthy older population. There are some financially well-off older adults who choose to retire in such elderly villages. However, not many can afford this kind of lifestyle.

Two cross-sectional studies from India surveyed elderly residents of old-age homes to understand their reasons for opting to live in one. It is interesting to note that poor health was not cited as a reason explicitly. The cross-sectional study in Madhya Pradesh, India reported that the top reasons for the elderly to opt for old age homes are because there was no one to look after them (68.2 percent), they did not have a place to live (56.4 percent) and to meet like-minded people (53.8 percent). The other cross-sectional study in Uttar Pradesh, India found that the two most common reasons were misbehavior by son and/or daughter-in-law (29.8 percent) and poverty (29.3 percent). This survey data hints that moving to an old age home was more a necessity than a voluntary life choice.

In addition to lifestyle changes, the surge in dementia and other health conditions among the elderly is driving the need for high quality care. Caring for such long-term conditions places huge emotional, physical and financial burdens on families. For instance, the symptoms of dementia can include hallucinations and depression which require swift and expert medical care. Many institutions are hence better able and equipped to provide timely care and rehabilitation.

Asian countries can learn a lot from studying trends in elderly residential facilities in developed nations of the Western world. A study in the UK reported that the overall standard of care in both nursing and residential homes was highly deficient when judging against quality indicators. This study serves as a warning to the rapidly aging countries in Asia: Provide adequate regulation to ensure a high standard of quality care in elderly residential facilities.

Namratha Rao recently graduated with a MSPH in Social and Behavioral Interventions from the Johns Hopkins University Bloomberg School of Public Health.

Elderly Refugees: The Experiences of Cambodian populations under the Khmer Rouge

Photo Credit: Extraordinary Chambers in the Courts of Cambodia
Photo Credit: Extraordinary Chambers in the Courts of Cambodia

War, natural disaster and fear of persecution often result in the tragic displacement of people far away from their homes. These people, refugees, live in uncertainty and under significant psychological and physical stress. Among these refugees are the elderly who are a particularly vulnerable group. Aging is not limited to disease and disability, but also the sudden change and a loss of belonging. The experiences of Cambodian elderly refugee populations is a clear example.

The Khmer Rouge took over Cambodia in the 1970s, prompting several years of genocide and a mass exodus of Cambodians into Thailand, US and other countries. By 1979, there were 160,000 Cambodians in refugee camps in Thailand.

A 10 year study sought to capture the experiences of Cambodian Americans in Northern California. Most Cambodian Americans lived in run down neighborhoods with a high prevalence of criminal activity. Elderly immigrants were at high risk of occupying poor housing conditions. Despite this fact, some refugees chose to move back into inner city neighborhoods as they aged to be a part of the community they once were as recent immigrants. In the case of this refugee population, many elderly people did not want to return to Cambodia given the turmoil which influenced their flight. Of those who did, they were constantly reminded of the differences in living conditions between the two countries.

Many Cambodian refugees in the US had poor education. With low income and little to non-existent English skills, elderly refugees constantly needed support from other immigrant populations, their children, and resources from the government. One woman says, “At my age, I’ve nothing to do, but pray for my children. I know that now I am their pillar, but later when they all grow up and leave, I will be alone with only myself to rely on.”

The past experiences with the hardships of the Khmer Rouge are constantly woven into their current narratives. For instance, many elderly complain of diseases such as high blood pressure or sleeplessness, and attribute such ailments to the harsh lives under the the Khmer regime. Post-traumatic stress disorder and depression are also common among Cambodian refugees. According to one study, family-related anger is prevalent among refugee families because of the cultural gap between refugees and the general population, as well as between refugees and their children who are much better adjusted to American lifestyle.

There are many organizations working towards improving the lives of elderly immigrants. The International Rescue Committee (IRC), one of the world’s leading organizations for refugees, has an Elderly Refugee Program. This program provides English as a Second Language classes, and assists in part-time employment and obtaining citizenship.

Yet the question remains – What can be done about the sense of loss of loved ones, one’s home, country and citizenship?

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

India is Diabetes Capital of the World

Photo Credit: Pixabay
Photo Credit: Pixabay

P Pushpam, a resident of Chennai, India, was denied her job appointment with the Indian Railways on the grounds that she was a chronic diabetic. The court ruled in her favor and pointed out the impracticality of discriminating against people suffering from diabetes in a country that has over 40 million diabetics.

As India makes its demographic transition toward lower birth rates and higher life expectancy, the prevalence of non-communicable diseases is on the rise. India is the “Diabetes Capital of the World” with over 60 million diabetics in the country, that is projected to at least double by 2030. The country ranks second, between China with 90 million and USA with 24 million diabetics. About 17% of the country has diabetes and about 77 million are considered to be pre-diabetic, which refers to those individuals who have higher than normal blood glucose levels, but not high enough to categorize them as diabetic.

Disability-adjusted life years (DALYs) is a measure of the burden of a specific disease in a population. A study shows that the DALYs attributed to communicable diseases in India such as malaria and TB will decrease. However, the DALYs associated with diabetes and other non-communicable diseases will increase. When compared to China, another country with a large and rapidly aging population, one sees a decrease in the DALYs for both communicable and non-communicable diseases.

Smoking, poor physical activity and alcohol use are some pertinent risk factors of diabetes in India. A survey revealed that close to 40% of Indian men are daily smokers and approximately 18% of the study respondents had poor physical activity levels. The survey also suggested that in addition to these individual level risk factors, environmental factors, specifically indoor air pollution contributes to the increasing prevalence of diabetes. The incidence of solid fuel use, contributing to air pollution in India is 83.5%. An urban lifestyle, and increasing strength of the food, fertilizer, pharmaceutical and beverage industries in the past decades, also contributes to a higher prevalence of diabetes.

A major obstacle to diabetes in elderly health is the lack of awareness of one’s status. A study in the urban slum of New Delhi reported that only 36% of their respondents were aware of their diabetic status. Low awareness among the elderly is linked with difficulties in screening, diagnosis and treatment abilities. Elderly patients tend to have lower mobility and are more likely to be dependent on their family members, delaying their ability to seek care.

The increasing prevalence of diabetes management among the elderly places a huge burden on the Indian health care system. While lifestyle modification is the most cost-effective solution to this growing epidemic, a more intense plan of management and care for elderly diabetics is needed.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

What Does Elderly Health Mean in the UAE?

They think they are elderly and it is a normal consequence of ageing to be in bed,” says Dr Al Suwaidi.

The United Arab Emirates (UAE) is a small country in the Middle East, nestled between Saudi Arabia to the West, Oman to the East and Iran to the North. A cross-sectional study reported that 95% of its participants, all adults over the age of 65 years, rated their health as satisfactory or higher. There is a general perception of good health among the elderly. Despite this fact, the UAE has the 2nd highest incidence of diabetes in the world, and 4th highest rate of glucose intolerance in its population. Very little in known about elderly health in the UAE and even less is known about elderly health beliefs in this population.

Dubai, United Arab Emirates. Photo by Paolo Margari.

Dr. Al Suwaidi, Director of Geriatrics at Dubai Health Authority, provides insight into what elderly health could be. She suggests the norm to be a passive acceptance of poor health during aging. Religion also plays a significant role in health care seeking behavior. A recurrent theme is the idea that ‘Health is from God‘, discouraging individuals to take action for better health which can imply going against the will of God. Another factor influencing health care seeking behavior is the presence of symptoms. Good health is equated with lack of visible disease, making it less likely to seek care for silent or underlying cases such as diabetes and hypertension.

There is a high regard for elders within the family structure. Common features of the family structure include a practice of traditional values, religion and high economic resources. Understanding the role of elders within the family is essential to providing adequate geriatric care. Dr. Al Suwaidi suggests that there is a greater need for day care centres than long term nursing homes since families would not be receptive to placing their elders in old-age living facilities. This shows the importance of encouraging families and increasing geriatric care that focuses on home-based elderly care.

Geriatric care is a relatively new branch of medicine in the UAE. There is a high disparity of geriatric care provided between the seven emirates, or regions, of the country. The emirates of Umm Al Quwain and Fujairah have relatively poor geriatric care facilities. This is because different governmental bodies govern and offer different services to their respective elderly population. In addition to disparity by location, there is also disparity by citizenship. UAE has one of the world’s highest proportions of an expatriate population, accounting for close to 90% of the country’s total population. This vast majority have limited access to health insurance and social welfare programs.

Current government initiatives include the Elderly Happiness Initiative (EHI) and Weleef. EHI aims to improve the quality of life of elders living alone by providing funding for health care workers to visit and provide home-based care. Weleef is a program that imparts knowledge on best practices to health care providers on a regular basis. Both programs operate in the Emirate of Dubai and are accessible only to UAE nationals or Emiratis. In Dubai, the elderly population, constituting 0.5% of the total population, accounts for 5% of out-patient visits. In addition to improving health, revisiting the current situation of elderly health can also help defray the costs of aging. The UAE needs an inclusive geriatric care model that incorporates local ideas on elderly health. The UAE needs an inclusive geriatric care model that takes local models of elderly health into account

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

How Robot Technology is Caring for the Elderly

Japan faces a rapidly aging population. As more and more of the population greys, fewer and fewer young people are available to care for the elderly. There is a particular shortage of health care workers who work with the elderly therefore the demand for elderly health care is not being met. Among health care workers, there is a high turnover rate which was close to 17% in 2013. Japan’s answer to this shortage is research in robot technology to assist in elderly health care.

A prototype robot, Robear, has been developed. Designed by Riken, a Japanese research institute, this robot is a polar bear cub look-alike that aids health care workers. The Robear is the successor of two previous heavier robots, RIBA and RIBA-II. Robear helps in lifting patients from beds and supporting them in walking. Apart from research in the robot’s abilities, research into understanding the needs of the elderly has also been done, especially in the appearance of the robot. Researcher Mukai says, “The polar cub-like look is aimed at radiating an atmosphere of strength, geniality and cleanliness at the same time.”

Another robot being developed in the country is the ChihiraAico, a 32-year-old Japanese woman look-alike that is supposed to ease communication between humans and non-humans. The creators at Toshiba are aiming to use ChihiraAico with patients with dementia to help them connect with counselors and medical staff with ease. On the other side of the Pacific, the USA is developing PARO, a robotic pet. There is evidence to show that pets can effectively combat loneliness among the elderly and PARO currently shows promising results. A pilot test in a home suggested that elderly residents feel calmer and less anxious after interacting with these robotic pets.

Robotic technology in Japan is not limited to health care, and has expanded to a range of end-of-life services. As more and more elderly people take charge of their funerals, Japan’s end-of-life industry has come up with ‘skyscraper graveyards’. Traditionally, the Japanese cremate the dead and store the ashes in the family crypts in cemeteries. Due to the space constraints, ‘skyscraper graveyards’ have become increasingly popular. Relatives are given identity cards and robotic arms assist them in retrieving the urns stored in vaults deep underground.

Using robots for elderly health care has advantages and disadvantages. On the one hand, robots can effectively aid in the under-staffed health care system in Japan by assisting in hospitals and elder care units. It can also be placed in individual homes and provide remote monitoring of the individual. Moreover, it can help combat loneliness. On the other hand, the use of such expensive technology raises questions on the lack of human relationships and its impact on family dynamics.

Is robot technology the future of elderly health care? What is the scope for robots outside of high income countries like Japan and USA? What, if any, impact will the high dependability on robots have on human-to-human interaction? Only time can answer these questions. Japan’s experiments with robots are promising, and if this technology proves to decrease the burden of aging on Japan’s health care, there will only be more demand and a greater space for robotic technology.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health. 

Why China Needs More Skilled Health Workers for the Aging Population

China’s workforce is aging. Of special relevance here, and a pressing issue for the country, is the aging of its healthcare workforce. These include China’s barefoot doctors who are rapidly aging. Barefoot doctors are farmers who receive basic and minimal medical training and work as health care providers in the rural areas of China.

Xu et al.
highlights three main implications of aging barefoot doctors. The first implication is a high risk of healthcare workforce shortage in the immediate future, leaving many rural residents without basic healthcare. This will create a huge burden on China’s healthcare system, hindering any plans for health reform. The second implication is that aging barefoot doctors currently have lower education levels, are less susceptible to change and technology and lack the formal training of younger counterparts, which might deter rural residents to seek care from them. The third implication is that the very same characteristics of aging barefoot doctors can lead to poor treatment and provision of facilities, especially for non-communicable diseases. While data on urban health care providers and other types of health personnel such as nurses is scarce, the general trend toward a graying population in China tends to suggest that these types of workforce are also aging.

China has one of the highest proportion of aging population at over 9%. At the current rate, this proportion is expected to increase to 25% by 2050. The aging population is a result of population control strategies in the 1970s and 80s as the government promoted the “later, longer, fewer” lifestyle. Moreover, the government instated the controversial one-child policy which restricted families to having only one child. There are several consequences and impacts of an aging population that require a focus on chronic, non-communicable diseases. Close to two-thirds (60%) of the disease burden in China is non-communicable diseases such as cardiovascular diseases and diabetes, among those of 45 years and older.

The healthcare industry is not alone in facing an aging workforce. The increasing age of the workforce decreases productivity, while raising the average wage level. On a global level, this will make a dent in China’s manufacturing might and other labor-intensive industries, threatening the country’s economic growth rate. At the current rate, India and Indonesia are poised to overtake China in terms of economic growth by 2020. The trends are also seen in the Chinese migrant workforce, a population of about 245 million migrant workers at the end of 2013. The average age increased from 33.1 years in 2011 to 33.7 years in 2013.

However, the situation is not all bleak. An aging population provides great potential for a booming healthcare industry that needs to account for chronic diseases as well as elderly living options due to rapid urbanization and changing family dynamics. There is documented need and much scope for growth in China’s healthcare industry, particularly catering toward the elderly. However, the needs for the younger generations who may be facing lack of adequate healthcare should not be ignored.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.