Aging Asia

Karen Eggleston and Shripad Tuljapurkar, Editors
The Walter H. Shorenstein Asia-Pacific Research Center
ISBN: 1931368201
A Review by Susan Froetschel

The spurt that put the global population on a trajectory to reach 9 billion is beginning to slow. The global population enjoys longer lifespans, and women are generally choosing to bear fewer children. These trends promise big changes for the global economy, and nations are stepping up to the challenges in varying ways, according to Aging Asia: The Economic and Social Implications of Rapid Demographic Change in China, Japan and South Korea, edited by Karen Eggleston and Shripad Tuljapurkar.

Eggleston leads the Walter H. Shorenstein Asia-Pacific Research Center’s Asia Health Policy Program. Tuljapurkar directs demographic programs at Stanford’s Center for the Demography, Economics, and Health of Aging, and the Stanford Center for Population Research in the Institute for Research in the Social Sciences.

Early preparation and flexibility could mitigate poverty and other crises, and this collection offers a glimpse into changing demographics along with an array of policies that increase social investments and reduce uncertainties and costs.

The kinship network is subsiding throughout Asia. For example, one survey showed that 21 percent of Japanese over age 65 lived in three-generation households in 2005, down from 41 percent recorded in 1981, according to population economists and researchers Naohiro Ogawa, Amonthep Chawla and Rikiya Matsukura. But because Asian perspectives combine such traditions with modernizing elements, Japan, South Korea, China and others like Singapore could become models for how societies manage conflicting goals – resentment about cultural changes versus welcome for young migrant workers; technological gains that lead to marginal benefits; prosperity for women who limit the number of children versus reduced economic growth; the joy of a long life versus mounting health care costs.

To its credit, the book does not take an alarmist approach. Instead, the writers suggest that with good planning, population aging could contribute to economic growth. “In assessing the consequences of population change…, alarmist literature tends to assume that age-specific behavior will remain constant with respect to earnings, employment, and savings,” writes David E. Bloom, chair of the Department of Global Health and Population at the Harvard School of Public Health, and faculty director of Harvard University’s Program on the Global Demography of Aging, in an essay that establishes the book’s tone that aging isn’t necessarily negative.  

An aging society doesn’t necessarily lead to devastating economic consequences as long as societies and individuals continue to learn, adapt and innovate. Consider that Johannes Gutenberg invented the printing press in his 40s, Wilhelm Conrad Röntgen invented X-rays in his 50s, Thomas Edison invented the talking motion picture and perfected steel alkaline storage batteries in his 60s, Benjamin Franklin came up with bifocals in his 70s. As Edison noted, necessity is the mother of invention.

Yes, the elderly are representing a larger share of the global population, from 10 percent today to a projected 22 percent by 2050. And yes, aging could lead to less consumption, less saving, more investments in health and long-term care.

But people, even the very old, have a knack for quick adaptation, especially if new behaviors lead to direct improvements in their immediate circumstances. That’s why a favorite quick fix by many governments – encouraging more childbirth – doesn’t work. Many women refuse to cooperate, lured by education, careers and opportunity to devote resources toward one or two children whose chances of surviving into adulthood in most countries have never been better. “Fewer children mean healthier, smarter, and better-educated children,” contends Bloom. “As health, cognition, and education translate into higher adult productivity, lower fertility is tantamount to an increase in the effective labor force.”

Trends for fertility and aging contribute to gender imbalances in some nations; disparities in rural-urban opportunities, education and occupations that serve certain age cohorts; and inequalities of income, wealth, and human capital, explains Tuljapurkar.

Human population decline is unprecedented, but the world has managed with fewer humans.

The essay collection and its graphs, too many poorly executed, do not offer systematic, across-the-board comparisons of the three countries’ health care systems or financing mechanisms. The book often brings in program examples from other countries, including frequent criticisms of the United States. Some readers might take issue with scant references to India, poised to overtake China as the most populated country before 2025, and how it manages its demographic dividend of a young labor force.

The collection cautions that societies should take action before fiscal and social crises emerge and could learn from the experiences and debates among Asia’s heavily populated states: introducing ongoing education programs that emphasize disease prevention and independence; gradually increasing retirement ages and instituting portable pensions; introducing part-time work opportunities and formalizing arrangements with grandparents caring for grandchildren or neighbors caring for neighbors; expanding social networks beyond children; targeted reductions on procedure fees and drug prices; subsidizing treatments that provide quality of life; reducing administrative costs by eliminating individual negotiations between insurance plans and providers; separating health care and long-term care and demedicalizing the latter.

The debates are not easy. Elders vehemently resist exorbitant investments in end-of-life care and discriminatory two-tier care systems. Societies with a greater proportion of elders must cope with more dementia cases, an aspect of aging that has no positive spin. China has near one-fifth of the world’s dementia cases, though the illness is often under-reported, because of shame associated with mental illness, writes Dolores Gallagher-Thompson, clinical psychologist, and a team of writers. Families provide much of the care, and the government is building long-term facilities. With these serving up to 4 percent of known cases in China, demand exceeds capacity.                

Singapore has a knack for anticipating change and adapting swiftly, gearing up for its “silver tsunami,” writes Meng Kin-Lim, public health director of the Association of Pacific Rim Universities World Institute, in the concluding essay. Financing of Singapore’s universal health-care system is guided by cost-sharing, with hefty co-pays that discourage waste or overuse. The system requires lifelong saving for old age and insuring against major medical illnesses in a policy-balancing act that innovates and targets cost efficiency. On the one hand, “the government assiduously avoided policies that would transfer the financial burden to future generations,” Meng writes, and on the other, “With the passage of the Maintenance of Parents Act (1996), Singapore became the world’s first country to require grown-up children to care for their aging parents.”

For filial responsibility, dementia, long-term care, management of chronic diseases or end-of-life programs, Aging Asia offers essential advice for policymakers: don’t wait for crises to hit. Gradual implementation of innovative age-related programs can reduce economic and political shocks.

Asian nations respond to these shifting demographics, combining modern elements of health care with traditional perspectives.
Copyright © 2012 Yale Center for the Study of Globalization