Ageing in Asia

Contemporary Trends and Policy Issues

Kai Hong Phua, Lee Gan Goh;Mui Teng Yap

• Publisher: WSPC
• Year: 2019
• ISBN:
  9789813225565
• Topic: Politics & International Relations
• Subtopic: Social Policy
• Index: Politics & International Relations

Ageing in Asia contains a selection of leading social systems and programs, with interesting case-studies offering innovative and useful lessons. The book covers ageing and related developments occurring in the most dynamic industrializing and urbanizing societies of emerging Asia. It includes topical issues such public policies and responses to current challenges from the growing needs of an ageing population due to rise of chronic non-communicable diseases, amidst rapidly changing social, cultural, economic and political changes in the region. The main purpose of the book is to provide useful comparisons of social care systems undergoing rapid transitions, and to offer some examples of best practices and lessons to respond to the changing needs due to population ageing.

Contents:

• Introduction: Regional Trends and Issues (Phua Kai Hong, Goh Lee Gan and Yap Mui Teng)
• Demography (Yvonne Arivalagan)
• Economic Development (Aris Ananta and Evi Nurvidya Arifin)
• Gender and Old-Age Economic Security (Cynthia Chen, Elaine Kempson, Donghyun Park and Joanne Yoong)
• Epidemiology of Non-Communicable Diseases (Kavita Venkataraman and Fong Ngan Phoon)
• Active and Productive Ageing (Thelma Kay and Marie Nodzenski)
• Social–cultural Aspects: Family and Filial Support (Thang Leng Leng)
• Income Security (Christopher Gee and Joelle H Fong)
• Urban Environment (Fung John Chye, Heng Chye Kiang and Yeo Su-Jan)
• Health and Healthcare (Goh Lee Gan and Marie Nodzenski)
• Mental Health (Kua Ee Heok)
• Long-Term Care (Phua Kai Hong, Winston Chin, Jessica Loo and Puttiporn Soontornwipart)
• Palliative Care (Goh Lee Gan)
• Technology and Social Innovations (Paul Kowal, Loïc Garçon, Alex Ross and Paul Ong)

Readership: It will be of great interest to policy-makers and practitioners from both the public and private sectors, as well as scholars and students who are interested in ageing and development issues occurring in the leading ageing societies of Asia.Ageing;Ageing Society;Asia;Development;Policy;Public Policy0 Key Features:

• The chapters of the book will cover key areas of public policy and social care issues associated with Asia's rapid growth, socio-economic development and quality of life for its ageing population, the liveability of societies in rapid ageing Asia and the concept of ageing in place for populations in Asia. The unique understanding of the issues in the public policy process and the instruments applied and the new knowledge generated for both the academic community and policy makers on the variables influencing the social policy process and preconditions for effectiveness of social systems would contribute to thinking and policy formulation in eldercare policy and related research
• Comparative studies of social policies will provide the evidence base to inform future policy formulation to improve care-giving for the elderly across the continuum of preventive, curative, rehabilitative, long-term and terminal care in Asian countries with different systems of provision, financing and regulation. Experiences and contexts could be studied for their transferability from the experiences of the more aged societies to other ageing countries of Asia
• These would include the comparisons of cultural forms of social capital and social support in relation to the aged on a comparative basis in Asian social systems with different levels of public-private participation in social services. These could thus provide valuable insights for improved public policies to address the rising challenges of population ageing across the diverse systems and cultural contexts in Asia
• The book will provide useful comparisons of social care systems undergoing rapid transitions, so as to offer some examples of best practices and lessons to respond to the changing needs due to population ageing. Thus it will of great interest to policy-makers and practitioners from both the public and private sectors, as well as scholars and students who are interested in ageing and development issues occurring in the leading ageing societies of Asia, a region of great diversity and rapid transformation

CHAPTER 1

DEMOGRAPHY

Yvonne Arivalagan

1.1. INTRODUCTION

In the 1950s, Asia was among the youngest regions in the world, with just 6.8% of its population aged 60 or older. Having entered the demographic transition towards lower fertility and increasing longevity in the early twentieth century, Europe and Northern America were the world’s oldest regions in the 1950s, with 12.1% and 12.4% of their populations aged 60 or over respectively. However, since the 2000s, Asia has become one of the world’s most rapidly ageing regions, outpacing the rate of ageing in Europe and Northern America. In fact, it will take Asia just 30 years from now to double its percentage of older people, a feat that took Europe and Northern America between 60 and 100 years to achieve (Cheng et al., 2015).

As of 2015, about 508 million people in Asia, or 11.6% of the Asian population, were aged 60 or older. This constituted more than half of the world’s older population. Despite these gains, Europe and Northern America continue to be the most aged regions in the world, with about 24% and 21% of their populations aged 60 or over in 2015 respectively. By 2050, 1.3 billion people, or a quarter of the Asian population, are expected to be aged 60 or older and Asia is expected to be the world’s fourth oldest region, behind Europe, Northern America and Latin America, and the Caribbean.

This chapter will provide an overview of the fundamental demographic trends contributing to and resulting from rapid population ageing in Asia from 1950 to 2050. Key indicators used include the size and structure of the aged population, the speed of ageing, total fertility rate (TFR), life expectancy, sex ratio, old-age dependency ratio (OADR), potential support ratio (PSR) and the proportion of older persons in rural and urban areas.

Some newer measures of ageing will also be used. Scherbov et al. (2016) argue that traditional definitions of “old” and “dependent” have become increasingly anachronistic, as the roots of the OADR lie in the Bismarckian or early 20^th century idea of dependency being linked to pension entitlement, which, in turn, was linked to the onset of decrepitude. The retirement age of 65 thus came to signify the threshold to old age and dependency. However, this notion of dependency is problematic given varying rates of olderage labour force participation in many countries today.

Conventional measures of ageing based on chronological age are also insufficient as they assume that a 60-year-old person in the year 1900 was just as “old” as a 60-year-old in 2000 because each has lived the same number of years. However, the 60-year-old in 2000 is likely to have many more remaining years of life. Remarkable improvements in access to healthcare have led to the lowering of mortality in many parts of the word. Life expectancies in many Asian countries and regions, particularly Hong Kong, Macao, Japan, Singapore and South Korea, have exceeded 80 years. The proportion of those aged 80 or older is also rising fast in countries like Bangladesh, Indonesia and Vietnam. These developments call for new measures of dependency that take into account improvements in life expectancy.

Sanderson and Scherbov (2005) suggested defining the threshold of old age based upon a fixed remaining life expectancy (RLE), rather than a fixed number of years already lived. RLE is then used to produce a new forward-looking definition of age, called “prospective age”. Everyone with the same prospective age has the same expected remaining years of life. Prospective age has subsequently been used to produce new “old-age” thresholds, new proportions of the population who are “old,” new old-age dependency ratios and new median ages. These measures will be included in this chapter.

Scherbov and Sanderson (2016) also suggested basing the threshold of old age on an RLE of 15 years as this was the remaining life expectancy of 65-year-olds in many low-mortality countries in the 1960s. The fixed age at which RLE is 15 years or less in any particular country and the proportion of the population at ages with a RLE of 15 years or less are hence useful new tools to measure ageing. From here, it is also possible to calculate the prospective old-age dependency ratio (POADR). The POADR measures the proportion of people above the old-age threshold — the age at which remaining life expectancy is 15 years or fewer — relative to the number of people aged between 20 and the old-age threshold.

Lutz et al. (2008) and Sanderson and Scherbov (2007) further proposed the use of the prospective median age (PMA), which accounts for longevity improvements in measuring the median age of the population. While the median age of a population is the age that divides the population into two numerically equal groups, the PMA is defined as the prospective age of a person at that median age. The PMA for any particular country is the age in a fixed base year (usually 2000) where remaining life expectancy is the same as at the median age in the indicated year for the same country. For instance, if the median age of a population in 1950 was 30 and the prospective age of a 30-year-old in that year was 35 (using the year 2000 as a base), then the population’s prospective median age in 1950 would be 35.

In general, these new measures of ageing show a slower pace of ageing across Asia. This is particularly significant for East Asian societies like Taiwan, South Korea, Macao, Hong Kong, Singapore and Japan which are expected to age very rapidly in the future under conventional measures of ageing (Lutz et al., 2008; Scherbov et al, 2016). While population ageing will continue to be a feature of their demographic landscape in the 21st century, prospective measures of age suggest that the increases in dependency will be less dramatic than has been implied by traditional measures.

In addition, this chapter will provide an overview of some health trends in Asia. While life expectancy is rising throughout Asia, it is also important to consider how increasing longevity affects the health status of the elderly. In general, population ageing is contributing to a health transition occurring at different rates around the world, defined as a shift in the global burden of disease from infectious diseases to noncommunicable diseases. The prevalence of non-communicable diseases in the elderly population has thus increased over time. A rise in the prevalence of heart disease, arthritis, diabetes, cancer, and other forms of physical and psychological distress have been reported in many developed ageing populations (Christensen et al., 2009).

In this chapter, the prevalence of Alzheimer’s disease and other dementias, cardiovascular diseases¹ and cerebrovascular diseases² among the elderly in Asia will be examined and compared within and between regions as they are among the leading causes of death and disability for older persons (UNDESA, 2015b). The prevalence of tuberculosis, diarrhea, lower respiratory and other common infections³ among the elderly will also be examined and compared.

Data on Asian countries generally suggests that the prevalence of non-communicable diseases among older cohorts of seniors aged 70 and above in high-income countries like Brunei, Japan and South Korea is declining compared to lower-income countries. In contrast, older cohorts of seniors in lower-income Asian countries are experiencing an increasingly higher prevalence of these diseases. This is an important consideration given that in many countries with inadequate pension or social security coverage, including several in Asia, older people are more likely to live in poverty than younger persons are (UNDESA, 2015b). However, even in some lower-income countries like Myanmar, Vietnam, Laos and Cambodia, data shows that the prevalence of these diseases among younger cohorts of seniors aged between 50 and 69 is diminishing compared to older cohorts. In some lower-income Asian countries, the prevalence of infectious diseases such as tuberculosis, malaria, lower respiratory and gastrointestinal infections is still relatively high among older persons, thus contributing to a “double burden” of both infectious and noncommunicable diseases among the elderly.

1.2. SOURCE OF DATA

Unless otherwise stated, population ageing figures for selected countries and regions in Asia, including East, Southeast and Southern Asia, are obtained from “World Population Ageing 1950–2050,” “World Population Ageing 2015,” and “World Population Prospects: The 2015 Revision” all published by the Population Division of the United Nations Department for Economic and Social Affairs (UNDESA 2015a, 2015b). Figures for the age at which RLE is 15 years or less, percent of the population at ages with RLE of 15 years or less, prospective old-age dependency ratio, median age, and prospective median age are based on data produced by the United Nations for the 2012 volume of World Population Prospects (International Institute for Applied Systems Analysis, 2017). Data on the prevalence of Alzheimer’s disease and other dementias, cardiovascular diseases, cerebrovascular diseases, tuberculosis, diarrhea, lower respiratory and other common infections have been obtained from the Global Burden of Disease (GBD) study.

East Asia covers China, Hong Kong, Macao, the Republic of Korea, the Democratic People’s Republic of Korea, Japan, Mongolia, and other non-specified areas. Southeast Asia encompasses Brunei Darussalam, Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste, and Vietnam. Southern Asia refers to Afghanistan, Bangladesh, Bhutan, India, Iran, Maldives, Nepal, Pakistan, and Sri Lanka. Data from the 1950–2050 period will be used for all regions and countries except Southern Asia, for which UN demographic records begin from 1980. Tables for the data provided can be found in the appendix. Data from the GBD study will cover the period between 1990 and 2016.

1.3. EAST ASIA

1.3.1. Magnitude and Structure of the Aged Population

East Asia is the first Asian sub-region to enter the demographic transition as rapid industrialisation over the last several decades has led to low fertility levels and increasing longevity. As of 2015, three East Asian countries — China, Hong Kong, and South Korea — were among the ten countries with the lowest fertility rates in the world. Japan and Hong Kong were among the ten most aged countries in the world in 2015.

In 1950, East Asia was home to about 50 million people aged 60 and above. This number grew to around 270 million in 2015 and is expected to more than double to 578 million in 2050, when just under half of Asia’s population aged 60 and above will be residing in East Asia. The proportion of people aged 60 and above in East Asia has risen from 7.4% of the total population in 1950 to 16.7% in 2015 and is estimated to jump to over a third of the total population, or 36.9%, in 2050.

The ageing trends in East Asia have been propelled by declining birth rates and rising life expectancy in the region’s most populous country, China. The total fertility rate (TFR) in China dipped from 3.01 in the late 1970s to 1.55 by 2015, making it one of the largest countries in the world with below replacement fertility (UNDESA, 2015a). Of the approximately 270 million people aged 60 and above in East Asia in 2015, close to 210 million resided in China. By 2050, China w...

Table of contents

• Cover page
• Title page
• Copyright
• Preface
• About the Editors
• About the Contributors
• Introduction: Regional Trends and Issues
• Contents
• Chapter 1 Demography
• Chapter 2 Economic Development
• Chapter 3 Gender and Old-Age Economic Security
• Chapter 4 Epidemiology of Non-Communicable Diseases
• Chapter 5 Active and Productive Ageing
• Chapter 6 Social–cultural Aspects: Family and Filial Support
• Chapter 7 Income Security
• Chapter 8 Urban Environment
• Chapter 9 Health and Healthcare
• Chapter 10 Mental Health
• Chapter 11 Long-Term Care
• Chapter 12 Palliative Care
• Chapter 13 Technology and Social Innovations
• Reference