June 26, 2019 Reading Time: 5 minutes
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Over the course of 70 years, Asia has undergone a dramatic economic transformation1—reducing its high poverty levels, making technological advancements, and becoming less reliant on agriculture—developing into the global nucleus for manufacturing and services. This economic transformation was at first spurred by the postwar reconstruction of industry in Japan during the 1950s, and was followed by other East Asian countries, namely Singapore, Republic of Korea and Taiwan,2 which prospered by exporting technology. Rapid growth continued with the transformation of the Indian and Chinese economies during the late 20th century, when both countries opened their markets to foreign interests.3 These countries followed different economic trajectories—China sought to attract foreign direct investment into designated industrial zones, which later enabled them to develop their own export orientated manufacturing industry; while India became an exporter of information technology services.
The upward trajectory of these countries enabled the Asian region to act as a significant contributor to the achievement of a number of Millennium Development Goals; the foremost being the eradication of extreme poverty and hunger. Indeed, the top five contributors to this goal were in Asia (India, China, Indonesia, Pakistan and Viet Nam).4 This resulted in the proportion of people experiencing extreme poverty within the regions of East and South Asia falling from 80% in 1990 to slightly less than 60% in 2010.5 As a consequence, all Asian countries, apart from Nepal and Afghanistan, have transitioned to middle-income status.6 The economic rise of Asia is projected to continue into the next 40 years, leading experts to equate the 21st century with the economic juggernaut of Asia.7
This meteoric rise, however, comes with a corresponding cost as many formerly impoverished Asian countries face the prospect of dealing with rapidly ageing populations due to a decline in the rate of fertility and an improvement in life expectancy. Between 1960 and 2017, life expectancy increased from 44 to 76 years,8 while the fertility rate declined9 from 5.7 to 1.6 in China. Although this demographic transition could be perceived as being symptomatic of prosperity in the region coupled with the success of healthcare programmes; many policymakers argue that it could potentially pose a challenge to social and economic development. It is predicted that the number of economically dependent people may outstrip the number of those economically active in east and southeast Asia. For example, the dependence ratio has been projected to rise from 36% in 2010 to 45% in 2025 in China.10 Policymakers and experts have, therefore, used ominous metaphors of natural disasters, such as ‘silver tsunami’ and ‘gray dawn,’ to underline the significance of this demographic transition.11
It could be argued that the demographic transition towards an ageing population has been as unprecedented as that of the rapid ascension of the Asian economy. In wealthier European countries like France, this demographic transition occurred over a period of 150 years,12 giving them leeway to develop a set of ageing-related social and healthcare policies. In contrast, many Asian countries will have to adapt to an ageing population over the far shorter time period of 20 years or less. Thus, it has been predicted that many Asian countries, particularly China, will “grow old before getting rich.”13
Although Hui Liangyu, China’s Vice Premier, admitted that, ‘China has not adequately prepared to respond to the ageing population,’14 relatively little effort has been made to develop policies targeted15 towards ageing populations in middle-income Asian countries. Failure to develop ageing policies have emanated from false perceptions of the family unit, continued complacency on the scale of the issue and lack of action from international organisations. It is often expected that the family unit should be able to absorb the costs of providing and caring for elderly relatives, owing to perceptions that it remains cohesive through bonds strengthened by cultural norms of filial piety.16 This is compounded by the fact that scant attention has been paid to ageing by the UN, which has failed to incorporate ageing17 into any Millennium Development Goals.
Few policies exist to provide adequate support to ageing populations, instead, existing policies seek to either rebalance the demographic composition or continue to shift costs of caring to the family unit. These types of policies are particularly evident in China, which has aimed to shift this demographic trend by relaxing the one-child policy18 in 2013. Existing cultural obligations of familial care have been legally mandated, enabling elderly individuals to demand monetary maintenance from younger relatives.19 These punitive laws are rarely supplemented with the development of facilities,20 like respite care, or funded support, such as a carer’s allowance, which would enable younger family members to provide consistent care to their elderly relatives.
These policies have been built on the outdated assumption that many elderly people are too feeble to meaningfully contribute to their families or community. In reality, it has been well documented that grandparents in rural areas of China often reinforce the family unit through caring for their grandchildren or other young dependents while their children migrate to urban areas for work.21 In addition, epidemiological trends22 within ageing populations suggest that rates of severe disability among the elderly may have decreased due to medical intervention and lifestyle alterations.
It is, thus, recommended that middle-income Asian countries develop ageing-related policies in accordance with the WHO’s Global Strategy and Action Plan on Ageing and Health.23 This strategy adopts a two-pronged approach advocating for policies and programmes, focusing on the prevention of age-related illnesses and disabilities to enable ‘healthy ageing,’ as well as the provision of long term care.24 The first prong of the strategy can be addressed through the creation of ‘age-friendly’ environments through the advocacy of elderly people’s rights, the formation of preventative services and interventions, and construction of livable urban areas that encourage healthy behaviours. The second prong of the strategy could be tackled through the establishment of healthcare services addressing the needs and preferences of ageing populations, as well as the development of policies and facilities enabling families to care for elderly relatives, such as the provision of respite care.
This strategy could be supplemented through the exchange of knowledge between Asian countries. Prosperous East Asian countries have had longer to adapt their policies towards ageing populations; meaning that they could possibly offer a culturally applicable template. These countries have adopted innovative multisectoral solutions that use a combination of emerging forms of healthcare technology and existing infrastructure to enable elderly citizens to reach their full potential. For instance, Singapore developed a set of programmes focusing on the prevention of age-related diseases including obesity, by encouraging food stalls to list healthy options, and incentivising citizens to adopt healthy behaviours,25 such as increased physical activity and consumption of drinks with lower sugar content. These behaviours were recorded through a mobile app26 developed by the government. Meanwhile, in Taiwan, the government has provided wearable devices to monitor elderly patients’ vital signs,27 for example, their heart rate.
1Wignaraja G, Tyson J, Prizzon A, Te Velde D. (2018). Asia in 2025, Development prospects and challenges for middle-income countries. Overseas Development Institute. [Online] Available at: https://www.odi.org/sites/odi.org.uk/files/resource-documents/12434.pdf
6The World Bank. (2019). World Bank Country and Lending Groups. [Online] Available at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
7Wignaraja et al. (2018).
8The World Bank. (2019). Life expectancy at birth, total (years). [Online] Available at: https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=CN&name_desc=false
9The World Bank. (2019). Fertility rate, total (births per woman). [Online] Available at: https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=CN&name_desc=false
10Wignaraja et al. (2018).
11Iparraguirre, J. (2018). Economics and Ageing – Volume II: Policy and Applied. Palgrave Macmillan, Switzerland.
12The World Health Organization. (2018). Ageing and health. [Online] Available at: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
13Deloitte. (2017). Ageing Tigers, hidden dragons. [Online] Available at: https://www2.deloitte.com/insights/us/en/economy/voice-of-asia/sept-2017/demographics-ageing-tigers-hidden-dragons.html
14Economy Watch. (2013). Racing Against Time: Will Asia Grow Old Before Getting Rich? [Online] Available at: http://www.economywatch.com/economy-business-and-finance-news/will-asia-grow-old-before-getting-rich.12-04.html
15Shetty, P. (2012). Grey matter: ageing in developing countries. [Online] Available at: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2812%2960541-8
17Hylander, A. (2012). MDGs: No room for the world’s older people. [Online] Available at: https://www.helpage.org/blogs/anders-hylander-11964/mdgs-no-room-for-the-worlds-older-people-440/
18The Economist. (2013). Why is China relaxing its one-child policy? [Online] Available at: https://www.economist.com/the-economist-explains/2013/12/10/why-is-china-relaxing-its-one-child-policy
19Shetty, P. (2012).
20Shetty, P. (2012).
21Silverstein, M., and Zhang, W. (2019). Grandparents’ Financial Contributions to Grandchildren in Rural China: The Role of Remittances, Household Structure, and Patrilineal Culture. [Online] Available at: https://academic.oup.com/psychsocgerontology/advance-article-abstract/doi/10.1093/geronb/gbz009/5304471?redirectedFrom=fulltext
22The World Health Organization. (2011). Global Health and Aging. [Online] Available at: https://www.who.int/ageing/publications/global_health.pdf
23The World Health Organization. (2017). The Global strategy and action plan on ageing and health. [Online] Available at: https://www.who.int/ageing/WHO-GSAP-2017.pdf
25Government of Singapore, Ministry of Health. (2016). I Feel Young in My Singapore: Action Plan for Successful Ageing. [Online] Available at: https://sustainabledevelopment.un.org/content/documents/1525Action_Plan_for_Successful_Aging.pdf
26Deloitte. (2016). The Health Hub: Transformation for the New Normal. [Online] Available at: https://www2.deloitte.com/content/dam/Deloitte/sg/Documents/life-sciences-health-care/sea-lshc-health-hub-noexp.pdf
27National Population nd Talent Division, Singapore. (2018). Smart ageing strategies in Japan, Taiwan and Singapore. [Online] Available at: https://www.population.sg/articles/smart-ageing-strategies-in-japan-taiwan-and-singapore
*Dr. Priya Lall is a Visiting Research Fellow at the School of Geography, Queen Mary University of London. The opinions expressed in this piece are the author’s own and not the institutional views of LKI, and do not necessarily reflect the position of any other institution or individual with which the author is affiliated.