Chapter 8
Population Aging in China
Feinian Chen and Guangya Liu
Introduction
The proximate determinants of population aging in
China are fundamentally the same as those in any other
country. It is an inevitable consequence of the pro-
cess known as the “demographic transition” in which
declining fertility together with a rise in life expec-
tancy leads to a shift towards an older age structure
of the population. Yet, the story of population aging in
China is unmistakably unique, shaped by its distinct
historical, cultural, economic and political contexts.
The pace of its aging trend is by itself unparalleled,
with the proportion of older adults projected to grow
from 6.8 per cent to 23.6 per cent over the first half of
the twenty-first century (United Nations 2005). As the
most populous country in the world, this increase in
the population of elderly translates to an astounding
growth of 242 million people, which would qualify it
for the fourth largest population in the world today.
On the one hand, the rapid aging process in China
conforms to a global trend, with the forces of indus-
trialization, urbanization and associated changes in
value systems affecting the demographic dynamics.
On the other hand, no other country around the world
has had their government play such a pivotal role in
accelerating the aging transition. Among these influen-
tial governmental courses of action, perhaps the most
well-known is the “one-child” policy, without which
the decline in fertility would not have been so dras-
tic and abrupt. Preceding the drop of fertility in the
F. Chen (
)
Department of Sociology and Anthropology
North Carolina State University
Raleigh, NC, USA
E-mail: feinian_chen@ncsu.edu
P. Uhlenberg (ed.), International Handbook of Population Aging,
DOI 10.1007/978-1-4020-8356-3_8, © Springer Science+Business Media B.V. 2009
1970s was also the consistent and sustained decline of
mortality, which was a direct consequence of strong
government health intervention programs. The state
influence was also reflected by the divergent aging tra-
jectories of the urban and rural areas, arbitrarily aug-
mented by the Hukou system (a household registration
system that divides the population into “agricultural”
and “non-agricultural” sectors) and strict state control
on migration to a certain extent.
It is the purpose of this chapter to examine the multi-
faceted process of population aging in China, with par-
ticular attention to its socialist/communist background.
We begin by exploring the demographic determinants
and trends of population aging, highlighting the role
of state policies in facilitating the fertility and mortal-
ity declines. To address the issue of elderly caregiving,
we examine the traditional family support system and
the challenges it faces since the launch of the economic
reform policies in 1978. We then review the on-going
pension and health care reforms initiated by the gov-
ernment as strategies to meet the demands of an aging
population. In the conclusion, we discuss the dilemma
that the government faces in balancing economic
development and providing adequate old-age support.
Lastly, we review some alternative policy options and
potential opportunities China may have in addressing
this global population problem of the 21st century.
An Accelerated Model of
Mortality and Fertility Decline
As one of the oldest human societies in existence,
China’s population history up to the twentieth cen-
tury fits the description of the pre-transitional stage
157
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of the classic model of demographic transition.
Under a high fertility and high mortality regime, the
population fluctuated between 37 and 60 million in
size for over a thousand years prior to the 17th cen-
tury; then for the first time experienced rapid growth
and reached a size of over 400 million during the
reign of the Qing Dynasty (1749–1851); but then had
its growth slowed again between 1851 and 1949 as
a consequence of the social turmoil caused by civil
wars and imperialist invasions (Banister 1992). The
establishment of the People’s Republic of China in
1949 marked the beginning of its demographic transi-
tion, a process that distinguished China from the rest
of world due to its extraordinarily rapid declines of
mortality and fertility (see Fig. 8.1), neither of which
would have been possible without strong government
intervention.
The route to low mortality in China was deemed
“exceptional” by Caldwell (1986), because it achieved
world spotlight success in improving life expec-
tancy with a poor and non-industrialized economy
within a short period of time. Beginning from the
1950s, the state engaged in mass public health cam-
paigns against parasitic and infectious diseases, with
efforts including environmental clean-ups, expanded
immunization/vaccination programs, establishments
of Hygiene and Anti-Epidemic Stations around the
country and the introduction of “barefoot doctors”
(medical personnel with basic training to deal with
hygiene matters and medical practice in rural China)
(Cook and Dummer 2004; Lee 2004; Woo et al.
200
160
(per 1,000)
120
80
40
0 0
50
55
60
6
19
19
19
19
Fig. 8.1 Trends of fertility Source: United Nations (Population Division of the Department of Economic and Social
and mortality in China, Affairs of the United Nations Secretariat). 2005. World Population Prospects: The 2004
1950–2000 Revision Population Database. http://esa.un.org/unpp/.
F. Chen and G. Liu
2002). The results from these government sponsored
programs were impressive. Mortality first dropped
suddenly and continuously, except in the three fam-
ine years (1959–1961), achieving a low mortality
level (with crude death rates around 6.5 per 1000 in
the1970s) (see Fig. 8.1). The life expectancy at birth
rose from a low 41 in 1950 (5 years below the world
average) to 66 in 1980 (5 years above the world
average) (see Table 8.1). During the same time, the
infant mortality rate, a frequently used indicator for
national development, also dropped from as high as
195 per 1000 in 1950 to 52 per 1000 within a thirty
year period (see Fig. 8.1).
After the Chinese government launched its eco-
nomic reform policies in 1978, the public health
programs received less government investment (see
details in later discussion). However, mortality con-
tinued to decline at a moderate pace in the 1980s and
onward, with an overall decline in deaths caused by
infectious diseases but an increase in deaths from
chronic diseases (Cook and Dummer 2004). The life
expectancy in 2006 is estimated to be 70 for males
and 74 for females, well above the average level for
other less developed countries (64 for males and 67 for
females) and close to that of developed countries (73
for males and 80 for females) (Population Reference
Bureau 2006).
The onset of the fertility decline in China did not
start until the late 1960s, almost two decades after
the initial decline in mortality. The total fertility
rate was still as high as 5.6 in 1950, then fluctuated
10
crude death rate
8
crude birth rate
( total fertility rate
per woman)
infant mortality rate
6
total fertility rate
4
2
70
75
85
90
0
80
0
19
19
19
19
19
20
19