East and Southeast Asia Aging the Fastest

In only one-quarter century—from 1970 to 1996—the percent of the population aged 65 and over in Japan increased from seven to fourteen percent. Similarly swift increases are expected in China, beginning around the turn of the century, and elsewhere in East and Southeast Asia (South Korea, Taiwan, and Thailand) fueled by dramatic drops in fertility levels...(Kinsella & Velkoff, 2001, p. 13).

Introduction

Asia, home to some of the most populous nations in the world, has aged rapidly over the second half of the 20th century. Beginning with Japan, the most developed Asian nation, the graying of Asia’s population has proceeded apace among the less developed countries as well, such that the latter are likely to outstrip the former in the speed of population aging (see above). These developments have taken place within a region of great diversity, not only in terms of their social and economic development but also in terms of their culture, language and religion. Thus, while the East Asian countriesFootnote 1 such as Japan, China, and South Korea share a common Confucian heritage, they are also at differing stages of economic and social development. On the other hand, while Singapore is physically located in Southeast Asia, the majority of its population is ethnic Chinese, and so it is commonly located within the East Asian cultural sphere. It is also the most developed of the Southeast Asian countries, second in Asia only to Japan in terms of per capita income. Within Singapore, there is a substantial Malay minority that is more akin culturally to the rest of Southeast Asia. There is also an Indian ethnic minority, who are migrants and descendants of migrants from South Asia. Other ethnic minorities, including tribal communities, can be found in most of the other Asian countries. While not all are aging at the same rate (due to differences in the level and timing of their demographic transitions), the shift towards ever older populations is quite clear.

Regardless of where they stand in terms of their cultural or socioeconomic development, the peoples of East and Southeast Asia are also everywhere subject to the forces of globalization and change. While globalization is not a new phenomenon, it accelerated in the 1990s with rapid developments in information and communication technology (ICT). In this regard, not only can basic medical technology be brought to even the most remote villages to bring about swift fertility and mortality declines, but the ICT revolution has also shrunk the distance between cultures and societies, not to mention integrating their economies. Changing values regarding marriage, family sizes, and roles and relationships within the family are some likely consequences of this development. Greater mobility and new modes of economic production under the new global division of labor represent other factors that affect the way of life of individuals, families, and communities. While some may readily embrace these new realities, others have had these changes imposed on them. The elderly are not exempt from these developments. Globalization presents new challenges for the aged, their families, and communities, as well as new opportunities. The papers presented in this volume range from discussion of broad issues of support for the elderly and policy directions to specific concerns relating to their activity, intergenerational relationships, and care.

Caregiver issues are major concerns in Asian societies. Chronological aging brings certain life cycle changes, some of which are physically imposed, while others are culturally defined or set by statutes. Among these life cycle changes are declining health status, retirement, and declining roles and status in family and society. Thus, old age often brings with it dependency and disengagement, and everywhere, including in Asia, people and governments are concerned about the provision of care for the growing number and proportion of the aged. A major emphasis in the following papers is the role of the family in the care for elderly. Family members have often been identified as the care providers of choice by individuals and governments, but one is forced to ask whether family care is a sustainable option given various demands on the family and declining family sizes in Asia. Further, as Park, Phua, McNally, and Sun’s paper on elderly parents and adult children relations in Korea shows, the fluid and complex nature of intergenerational relationships diversifies family relations and affects family support and care of aged relatives.

Given the developments in health care, the elderly are also likely to live an increasing number of years post-retirement in a relatively healthy state. They may also have fewer traditional roles such as grandparenting, either by choice or by default (see Usui, 2003, for example). The growing number of healthy old will contribute to rising demand for leisure activities and programs to keep their bodies and minds occupied (see Thang in this volume).

To substantiate and provide a background to an understanding of “Aging in Asia,” this introduction presents an overview of population aging in Asia, focusing on demographics. As Mason (2002) has noted, the elderly have been the fastest growing demographic group in Asia, and “the development of institutions and programs that will meet the needs of the elderly in a sustainable way requires time” (p. 27). Commentators have also noted that whereas the more advanced countries were developed before they aged, countries in Asia are aging before they develop (see Mason, 2002, and Jackson, 2002, for example). Thus, questions have been raised as to whether they will be able to provide for the growing elderly population. On the other hand, Asia has also been characterized as a region where culture and tradition promote veneration and strong support for the old by family and community. However, the influence of these cultural props is also being eroded by internal and external forces, such as globalization.

In the following, we examine the state of population aging in Asia by discussing the numbers and proportions of the old, the speed and timing of change, as well as changes in the implied dependency burden. The latter is typically measured by the dependency ratio, a useful though oft-criticized demographic measure (see below). New opportunities offered by globalization and the rising socioeconomic characteristics of the elderly are also discussed. (These points are discussed further in Chan’s paper in this volume, which assesses the current well-being of older persons through a review of the current state of informal and formal support for the old in Southeast and East Asia.)

The Demographics of Aging in Asia

Unless otherwise stated, the data used are based on the United Nations’ World Population Aging 1950–2050, published in 2002. This draws, in turn, on the year 2000 revision of official UN projections. The nomenclature used with respect to the geographical regions will also, in the main, follow that of the United Nations. On occasion, different nomenclatures may be used in citations drawn from other research work, but their point of reference should be obvious from their contexts.

Magnitude of the Aged Population in Asia

Table 1 shows that whereas Asia was home to about 95 million elderly aged 60 and over in 1950, this number more than tripled over the next 50 years, to 322 million in 2000. This rate of growth far exceeds that of Europe (where the number approximately doubled from 66 million to 147 million) and also the growth rate worldwide (which was approximately 2.9 times, from 205 to 605 million). The growth in the number of Asia’s elderly is expected to accelerate over the next 50 years, to 1.2 billion in 2050 (or 3.8 times its size in 2000). In proportionate terms, Asia’s elderly will grow from about half to 62% of the world total, whereas Europe will see a decline from 24 to 11%, due to slower growth in the number of the old (see Table 1). Europe will, however, remain the oldest region in the world, as it has been for the past half-century.

Table 1 The aging of Asia: Numbers, rates and proportions.
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Within the Asian region as well, noticeable differences may be found between East and Southeast Asia. About half of Asia’s elderly in 2000, 167 million, lived in East Asia while about 11%, 37 million, lived in Southeast Asia. This proportion is set to change, however, with East Asia’s share declining to 42% in 2050 while Southeast Asia’s share increases to 14%. This is due to more rapid growth in the number of the old projected for Southeast Asia, particularly over the next 25 years when the baby boom cohorts reach old age. In absolute terms, the number of the elderly in Southeast Asia in 2050 (176 million) will approach that of Europe (221 million), even though these regions are currently at very different levels of development. East Asia, however, will outnumber both these regions with more than 511 million older adults.

Concerns over population aging are not only about the number of the old but also the relative proportion of the aged in the population, especially the balance between the old and those in the working ages, typically measured by the dependency ratio. This has to do with the implied “dependency burden,” which has gained the attention of governments the world over even though, as mentioned, the challenge it poses is not uniformly imminent. Admittedly, the actual dependency burden is determined not just by the sizes of the various functional age groups, but also by a host of social, cultural, and institutional factors that affect health, employment, and other resources available to the old and the young, males and females. These will be mentioned only briefly at this point as they will be examined in greater detail in the remaining articles of this volume.

Proportion of the Old

As Table 1 also shows, Asia’s population in 2000 is still relatively young, with only 8.8% of the total population aged 60 and above. This compares to 20% for Europe and 10% worldwide. In 2050, however, this proportion is projected to rise to nearly 23%—at which time Asia’s elderly proportion would be above the world average but still considerably lower than Europe’s. The relative youth of Southeast Asia, with only 7% of its population aged 60 and over in 2000, reflects the recency of its fertility decline. In comparison, East Asia (which includes Japan, where fertility decline began earlier and dipped below replacement level longer than elsewhere in Asia) already had a considerably older population, with 11% elderly. Despite more rapid growth in the projected number of old, Southeast Asia’s population will remain relatively younger than East Asia’s in 2025 and 2050 (see figure 1).

Figure 1
figure 1

Total fertility rates.

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Dependency and Support Ratios

The dependency ratio and its obverse, the support ratio, measure the balance between the working-age population and the old—respectively, the potential providers and recipients of care and support. Critics have questioned the usefulness of the dependency ratio for its apparent simplistic equation of age with dependency (see, for example, Schulz, 1999). On the other hand, Yeon (2000) has noted that in the case of Korea, dependency in old age is traditionally seen as normal, and independence is not the ideal for an older person, attributing the latter as a Western concept (p. 28). Moreover, the majority of Asia’s current elderly are also likely to face problems such as a lack of personal human capital (due to their lower educational attainment) to exploit opportunities to live independently. Moreover, in most Asian countries, the programs and institutions for independence in old age are still lacking (see Jackson, 2002, for example). The problem of dependency will likely be alleviated in the future as educational attainment rises, and more reach old age with better health and histories of labor force attachment.

As Table 2 shows, dependency ratios for the aged have risen only gradually in East and Southeast Asia over the past 50 years. Even as the number and proportion of the aged grew, the populations in the working ages grew, also, as more of the large cohorts born in the 1950s and 1960s survived to adulthood. However, this growth in the working-age population is set to peak, mostly around the turn of the century in East Asia and around 2025 in Southeast Asia, after which they will form a diminishing proportion of the population. Some notable exceptions in the general pattern are Japan where the working-age population peaked and stabilized earlier (1975–2000), and Singapore, which resembles the East Asian pattern (with the working-age population peaking around 2000, rather than 2025 as projected for the rest of Southeast Asia). For Japan and Singapore, the potential problem of rising old age dependency is thus rather more imminent than elsewhere in their regions. China resembles Southeast Asia in this regard.

Table 2 Dependency and support ratios.
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Rising old age dependency is likely to offset declines in youth dependency by 2025 in East Asia and 2050 in Southeast Asia, raising the total dependency burden on the middle generation. The dependency burden in Asia will not, however, in any way approach the European level. By 2050, there will be fewer than two Europeans of working age to support each older adult, as compared to 2.5 in East Asia and four in Southeast Asia.

Two other aspects of population aging that potentially impact the dependency burden ought to be mentioned. These are the growing population of the old-old and the disproportionate proportion of women among the old.

The Old-Old

As elsewhere in the world, not only are there more aged people in Asia, but the old are also living longer. As a result, the proportion of the old-old, aged 80 and over, which has been quite minimal (less than 1% of the total population) to date, is projected to rise to over 4% in 2050. East Asia—which includes Japan, the country with the longest life expectancy in the world—is projected to see its proportion of the old-old rise from 1.2 to 7.4%, while Southeast Asia will see its share rise from 0.6 to 3.5%. As Table 2 (above) shows, the number of old-old to be supported by those nearing retirement age is on the rise, particularly in East Asia, but this will be nowhere near the European level, with a parent support ratio of 17.2 and 26.7, respectively.

As Kinsella and Velkoff (2001) have noted, “(a)s individuals live longer, the quality of that longer life becomes a central issue for both personal and social well-being. Are we living healthier as well as longer lives, or are we spending an increasing portion of our older years with disabilities, mental disorders, and in ill health? In aging societies, the answer to this question will have a profound impact on national health, retirement, and family systems, and particularly on the demand for long-term care” (p. 38). They noted further that while the cost of services used may not be higher, per capita health expenditures of the elderly are higher than for the non-elderly because of higher usage rates (p. 45, based on OECD).

Female Share of Elderly

As elsewhere in the world, the elderly in Asia are predominantly women. However, as Table 3 shows, the sex ratios are less skewed, age for age, than in Europe. A review of the data on the gender differentials in life expectancy shows that the gender gap in life expectancy is smaller in Asia. Put differently, the large female advantage in life expectancy over men (more than 5 years) found in the more developed European region has not been replicated in Asia to date, probably because of the relatively lower status of women in this region. On the other hand, this also means that more elderly Asian women are likely to have a surviving spouse, and fewer are likely to live in years of prolonged widowhood as compared to their European counterparts. They may, however, also be burdened with the care of an aged spouse, given the Asian predilection for family care and the relative scarcity of institutional care provisions.

Table 3 Sex ratios (number of men for every 100 women).
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The dependency of older Asian women is also likely reinforced by cultural limitations on the appropriate roles of women in the family as nurturers and caregivers. This affects their labor force participation and thus, their ability to accumulate assets for old age (Mehta & Blake, 1997). According to Chow, “... women in Asia are already occupying a lower status in society and when they become old, they usually have a weaker claim than their male counterpart to the utilization of family and community resources” (1997, pp. 15–16).

Speed and Timing Issues

As has been noted elsewhere, the speed of aging of Asian populations is unprecedented. According to estimates by the U.S. Census Bureau (Kinsella & Velkoff, 2001), Japan, currently acknowledged to be the most rapidly aging country in the world, took only 26 years (1970–1996) to increase its proportion of elderly aged 65 and over from 7 to 14%. This is a process that took early developers such as Sweden, Australia, Canada, and the United States at least half a century and France 115 years to achieve. The time frame for currently developing countries is expected to contract even more rapidly, e.g., to 22 years for both Thailand and South Korea (Yeon, 2000). According to Kinsella and Velkoff, “(s)uch rapidly aging societies are soon likely to face the often-fractious debates over health care costs, social security, and intergenerational equity that have emerged in Europe and America” (ibid.).

As noted earlier, demographers have noted that population aging “will occur in some Asian countries at a much earlier stage of economic development” (East West Center, 2002, p. 83). This phenomenon is perhaps best summarized in the following quote from a Chinese writer published in a report, The Global Aging Crisis, by the Center for Strategic and International Studies (CSIS) in the United States: “(w)hereas the now developed countries first got rich and then got old, China will first get old” (Jackson, 2002, p. 67). This raises questions of Asian readiness to cope. According to Mason (2002, p. 28), “(T)he problem is not just one of affording a large, dependent, elderly population. Perhaps more important is that (developing member countries of the Asian Development Bank) may not have the necessary political and economic institutions in place that are essential in aging societies, including efficient and secure pension systems, well-run financial institutions, regulatory and accounting practices that meet international standards, and health care systems that can provide quality care to the elderly. No challenge is greater than assuring the economic and social security of the region’s future elderly” (emphasis added).

Issues and Challenges

It would be fair to say that few of the Asian countries have, to date, developed the necessary infrastructure and institutions to provide for their elderly. In fact, according to Phillips and Chan (2002), not all countries even have a clear policy on aging (p. 17). Where formal systems exist, the coverage may be limited to selected groups such as civil servants, workers of state enterprises, and members of armed forces (Asher, 2002). As Jackson (2002) has noted, most countries in Asia continue to rely heavily on informal family networks to support the elderly. Indeed, the family is considered the “expected” and most appropriate provider of care (Phillips & Chan, 2002). However, many questions have been raised about the sustainability of this model of care (see Goodman, White, & Kwon, 1998 )and various articles in this volume). In China, for example, the deliberate government policy limiting couples to one child, particularly in the urban areas, is causing its leaders to worry that in the future many children will eventually have to support two aged parents and four grandparents, or what is commonly known as the “1–2–4 problem” (Jackson, 2002). Elsewhere, including in traditional Confucianist societies such as Korea and Taiwan, more elderly are living on their own. According to Mason (2002, p. 28), “(i)n Korea, only 8% of women surveyed in 1997 said they wanted to live with their children in old age, while 70% did not want to. In Taipei, China, the proportion of 60-year-olds living with their adult children has declined substantially and the elderly are much slower than they used to be in moving in with their children as they age.” Surveys in Korea and Japan show an increasing proportion of middle-aged who did not expect or even want to live with their children (Phillips & Chan, 2002, pp. 19–20). Elderly who are single, who form a growing proportion of the population, may not have any children on whom to depend.

Globalization is likely to have an impact on the family in a number of ways. The new global division of labor and ease of mobility increases the likelihood of younger generations migrating elsewhere in search of better job opportunities. Job losses and uncertainty associated with shorter, sharper business cycles are likely to affect fertility decisions as well as the willingness and ability of the younger adult generation to provide for the old. In some Asian countries as well, health epidemics such as HIV/AIDS have taken their toll on the middle generation.

Opportunities

It is not the intention here to be alarmist or to paint a gloom and doom picture of the future of Asia. As has been noted elsewhere, population aging is after all the result of human development and public health success. Indeed, there are many testaments to the successful development of the Asia-Pacific region, as Mason (2002) has noted. These include the rising school enrollment and literacy among both men and women, raising the productivity of workers (p. 1). These have important implications for the future well-being of Asia’s elderly. Being better educated, future aged are likely to have held better paying jobs and be better prepared financially for their retirement. They are also likely to be fitter, having been beneficiaries of better education and better health care. More importantly, they are likely to be better positioned to take advantage of the new opportunities and new modes of work offered by globalization and the ICT revolution. Kumagai’s (2000) study of Japanese elderly in the information age society proposes that the internet will be one of the essential infrastructures to help seniors attain independent lifestyles. Existing institutions such as mandatory retirement would, however, have to be revised in tandem.

New institutional arrangements would also have to be developed to cater for the growing number of healthy aged who are likely to live longer in retirement. The ICT revolution could also be exploited to assist the elderly to remain socially engaged.

Conclusion

Asia is aging rapidly, and this poses challenges of providing for the growing number who are likely to require support. Population aging is taking place in a context where the traditional support base is being eroded, by demographic processes as well as forces induced by globalization. However, there are also new opportunities to be exploited. Future developments would depend on the speed at which institutions can be adjusted to meet the challenge. However, some Asian countries will have more time than others to make the necessary adjustments.