A man walks past an advertisement promoting elderly services in Beijing on January 22. Given the fast pace of life and families often living apart, the centuries-old Chinese practice of family-based senior care has become increasingly untenable. Photo: EPA-EFE
Opinion
The View
by Winston Mok
The View
by Winston Mok
Ageing China must plug urban-rural gap for a dignified old age for all
From pensions to medical care, China’s rural-urban divide must be urgently addressed. Or just about everyone outside the rich middle class will be left out of the silver economy
As the Lunar New Year approaches, China’s senior citizens, grateful to have survived the vicissitudes of Covid-19, will look forward to seeing their children. For many, the traditional hopes of seeing them get married and produce grandchildren may be disappointed again this year, as marriage and birth rates plummet.
China saw half as many babies born last year as in 2016. Traditional values are no match for the increasing pressures of modern life. Despite being widely seen as the most Confucian society in the world, South Korea has the lowest fertility rate – with China not too far behind, at an estimated fertility rate of close to 1 last year.
Addressing the needs of a growing population of senior citizens with a diminishing workforce presents China with a challenging but surmountable balancing act.
The Lunar New Year festival is the traditional occasion for family reunions. In China, perhaps no different from elsewhere, the lot of every senior person can vary widely. For those in the rural areas, it can be the one time of the year when they see their children who normally toil in urban centres far away.
Those in cities such as Shanghai are more likely to be able to see their children all the time – provided they are not too busy with work, have taken up assignments elsewhere or migrated overseas. Many urban families – sometimes comprising three generations – may even make use of the holiday to travel. This fortunate group includes those whose children have made good in the cities and arranged for their parents to leave their rural homes to live with them.
Retirees in the big cities, particularly those who worked in the government or state-owned enterprises, usually receive decent pensions. Not so for rural folk, many of whom still depend on subsistence farming. The urban-rural pension gap must be narrowed – although, realistically, not closed as most urban folks do not have the benefit of land resources.
05:41
Why China's elderly farmers can't afford to retire
Why China's elderly farmers can't afford to retire
In an ageing society, the silver economy offers both opportunities and services, but the consumers tend to be those better off.
Given the fast pace of life, and families often geographically scattered across generations, the centuries-old Chinese practice of family-based senior care has become increasingly untenable. Senior care will inevitably become more institutionalised, either commercially or by the state. The state may operate premises or buy services from private operators, including NGOs.
For those with the means, a wide range of senior living facilities have come up. Those still healthy and mobile can live in retirement villages which provide a community with activities. For the infirm, there are always the traditional elderly homes. Some of the surplus (even uncompleted) stocks of unsold properties may be repurposed for senior accommodation. Such commercial offerings are most relevant for big-city dwellers.
Rural folks, except those supported by successful children, are largely on their own. There would be mutual support in the villages. And there are some state-run elderly homes. But affordable elder care must be extended to the rural areas – through public-private partnerships.
Permanent residents of Beijing and Shanghai enjoy world-class medical care, unlike most in rural China. Beyond large public hospitals, community-based clinics – networked to large hospitals through telemedicine – should be widely expanded. Beyond basic medical security, voluntary medical insurance schemes – whether public or private (such as the experiences of Singapore and Australia) – may be promoted.
Beyond highways and high-speed trains, medical facilities represent the most important frontier of infrastructure development in China. The highly uneven provision of medical services needs to be rebalanced.
Amid a population decline in the northeast, Meihekou in Jilin province witnessed a spectacular population growth from 300,000 in 2016 to 700,000 now. A catalyst of its economic and population growth is its top-tier hospital, which provides advanced healthcare services that attract residents and, in turn, stimulate related industries.
01:56
Chinese city of Meihekou sees population growth, bucking national trend
Chinese city of Meihekou sees population growth, bucking national trend
In China, major employers often provide staff with annual health screenings. With retirement and advancing age, annual health checks become more important – even if they may need to be self-funded. Private health screening centres often provide better services than in public hospitals.
All kinds of health-related and well-being services will grow. Amid high youth unemployment, healthcare offers growing employment opportunities, including for nurses, health screening technicians and geriatric care professionals.
The landscape of elderly care in China is undergoing a revolutionary transformation through technology, from the telemedicine and remote health monitoring that bridge distances in rural areas, to the artificial intelligence and robotics that support daily living and provide companionship.
Smart homes equipped with automated safety features and emergency alerts empower senior citizens with independence, while digital platforms offer vibrant social connections and access to lifelong learning. Wearables and virtual reality extend the boundaries of health and leisure.
China can harness and tailor these innovations to ensure that every senior citizen can be enriched by technology and move towards a life of good health, engagement and autonomy.
As China’s population decline hastens, the stark urban-rural and socioeconomic divides necessitate Beijing’s urgent action. In its pursuit of common prosperity, China must ensure equitable social development by fostering a society that supports the well-being of all its elderly citizens, not just the privileged few.
Amid the societal contrasts in China’s demographic tapestry, its ageing population does not automatically translate into a burgeoning silver economy. If nothing is done, the growth of such an economy will predominantly be propelled by the affluent urban class. The state needs to implement a progressive, realistic and determined plan to address the needs of the elderly, ensuring that all can have a dignified old age.
Winston Mok, a private investor, was previously a private equity investor
