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.

Low Birth Rates and Unemployment: The Effects of Changing Demographics in Italy and Japan

As many already know, Japan has the largest population of people over 65 in the world at 25 percent in 2013. Since the Japanese are known for their longevity, this number may seem like an isolated phenomenon but the rest of the world is catching up. Almost every major country went through a birthing boom after World War II and people are starting to wonder how they are going to take care of the large number of elderly citizens. Italy already has a 65 and over population at 21 percent and by 2050, Americans aged 65 and above are expected to make up at least 21 percent of the population. As soon as 2025, the U.S. spending on Medicare, Social Security, and Medicaid is projected to double, which means there will be yet more strain on state and federal budgets.

If that is not food for thought, birth rates in Japan are at an all-time low. With decreased birth rates, there will be a hole in the future workforce when it comes time to take care of the elderly. Japan owns the second largest amount of U.S. debt, and with two economies so intimately connected, both can decline at the same time. The Japanese media has begun dubbing the citizenry’s lack of interest in the opposite sex as “celibacy syndrome.” While choosing a lifestyle outside of traditional marriage is a personal decision, so many people making this choice will eventually cause an economic downturn when it comes to needing resources for the elderly. Fewer babies were born in 2012 than any other year on Japanese record and not so funnily, adult diapers outsold baby diapers.

In Italy, there is a similar picture, not in terms of birth rates, but in terms of young adult employment. Unemployment is at a staggering 44.2 percent for people ages 15 to 24. An alarming statistic by itself, it is compounded by the fact that Italian pensions take up 15.6 percent of the country’s Gross Domestic Product. This rate is the highest in all of Europe and with jobs so scarce, young Italians are either moving abroad with their college degrees or have given up the job search entirely. Even those who are lucky enough to find jobs are not faring much better. The average salary for a person born post-1980s is a mere $1,375 a month, making it nearly impossible to afford home payments, car payments, and child payments. In addition, people are living in their parents’ homes longer and using their parents’ money as well. This postpones starting a family of one’s own and prevents the older generation from saving for retirement. With smaller retirement savings, older people are staying in jobs longer.

The only economies with less growth than Italy’s since 2001 are Haiti and Zimbabwe. Italy has the oldest working population out of any European nation and when that population retires, it puts enormous strain on the government because their tax base is exceedingly diminished with so many young people unemployed.

Jacob Edward is the Manager of Prime Medical Alert and Senior Planning in Phoenix, Arizona, USA. Jacob founded both companies in 2007 and has helped many Arizona seniors and their families navigate the process of long-term care planning. Senior Planning provides assistance to seniors and people with disabilities in finding and arranging assisted living in Phoenix, as well as applying for state and federal benefits.

Caring for the Needs of the Aging Workforce


As the American population continues to age, there is an opportunity and a need to adequately respond to the unique needs of older adults. Ensuring a social structure that considers the needs of the aging is important, particularly as it is projected that by 2030, the number of Americans 65 and older will double and comprise nearly 20% of the total population. Comprehensively responding to the needs of the aging should include measures that protect the health, well being, and quality of life of older adults.

Included among the social changes that have been observed within the aging population in the U.S. is that more older American adults are delaying retirement and choosing to remain in the workforce past the traditional retirement age of 65. The desire to remain employed stems from improved quality of life among the aging and the capacity to continue working. However, for many older Americans, there is also a need to continue working due to economic pressure. According to recent research, 75% of Americans that were nearing retirement in 2010 had less than $30,000 available in their retirement accounts. With dwindling access to Social Security funds and the projected extension of the eligibility age to receive Social Security funds to 67 years of age in 2017, financial insecurity for the aging is requiring older workers to remain employed beyond the time they may have considered retirement.

There are benefits to older adults remaining in the workforce – both individually and occupationally. It has been noted that among older adults who remain employed, their cognitive capacity is less likely to diminish as compared to their non-employed peers due to mental engagement within the workplace. Additionally, research has shown that employers value the presence, contribution, and input of older workers and report that older employees exhibit knowledge related to job tasks, respond resiliently to job-related stressors and changes, and are willing to learn new tasks quickly. Added financial resources are also a significant benefit for older Americans who remain employed beyond retirement age.

Recent economic crises, however, have left few immune to financial loss. For older adults, financial loss as a result of the “Great Recession” have led to this need to continue working and raise enough money on which to live after retirement. For older adults who lost their jobs during the recent economic downturn, many reported that they continued searching for employment with little luck due to hiring preferences in many industries for younger employees. This represents a persistent area of vulnerability for the aging, as financial uncertainty after retirement remains a reality for many.

Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.