Decoding China: An aging population has to be a positive and healthy one
Updated 17:35, 23-Oct-2023
Decision Makers

Editor's note: Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era is China-centered, and internationally applicable; it caters to the present and is geared toward the future. In CGTN's Decoding China series, domestic and international high-profile officials and experts from various fields share their experiences on working with and working in China. In this episode, we've talked to Dr. Justine Coulson, United Nations Population Fund Representative in China, about the aging population and the challenges and opportunities it presents.

CGTN: Justine, two years ago, this month, Chinese President Xi Jinping urged Party committees and governments at all level to attach great importance to the work on aging population. He specifically noted that the comprehensive measures should be taken to ensure that elderly live their lives positively and healthily.

The aging problem is not something that's unique to the Chinese society. The Asia-Pacific region is one of if not the most rapidly aging parts of the world. So, from your work with the Chinese government, with the Chinese society and also acting in an international capacity, do you see some kind of a best solution to this problem?

Justine Coulson: So, I think first of all, we shouldn't actually just posit the aging population as a problem that needs a solution. I think we need to recognize that, in the context of China and other countries, when you see this aging population happen, that's actually a positive outcome of successful socioeconomic development. It means that these people who are now living longer lives. They're living longer lives because they have better nutrition, better health care, better education than previous generations. And we really need to celebrate that as one of the success stories of China's phenomenal socioeconomic development we've seen in recent decades.

But I think also we need to recognize that old people are not just people who need to benefit from care. They are in their own right active members of our communities, of our societies, of our families. Even living in Beijing, I look out and I see older people as grandparents looking after the children. I can see older people volunteering in their communities, running businesses. We need to recognize that just because you're older, doesn't mean that you just need looking after. You actually need to live in a society where your desire to contribute is supported and enabled.

So, I think when we look at countries with aging populations, what we need to look at is whether that is healthy aging. This is what's really important. So, for governments that are, and I think with your opening question, I think President Xi has recognized this when he talks about positive, healthy aging.

So, for countries that are grappling with an aging population, what's very important is making this very purposeful investment in extending healthy life years. So that is both in terms of maybe preventative health interventions before people even become older. We also need to recognize that you accumulate inequality over a lifetime, yes? So, it's not that you suddenly become 65 and you're poor, or you become 65 and you have a health problem. We can actually track that right back to when you're born, when you're an adolescent, when you're an adult, and you accumulate these inequalities over your life. And then when you reach old age, you are suffering from those.

So, it's not just about preventative health interventions for older people. It's also about looking at ensuring that you have social investment policies from an early age that are really addressing inequalities in your population so that everybody has an equal opportunity to reach old age in good health.

I think the other aspect we need to look at is around the need to invest in quality, affordable social care. Even though older people may now live a longer life, and let's hope they have these healthy life years, we also know that inevitably, for many of us, unfortunately, that last stage of our life will always be one where the sickness or frailty [comes] and we will need care.

And so, it's important as well that it's not just the wealthiest that can access to the care they need. And we also need to make sure that when older people need care, families with less income aren't plunged into economic crisis, or they don't have to deplete their entire life savings on order to provide the care they need for their loved ones. And so, investment in affordable social care is important.

CGTN: Speaking of being healthy and providing care, I'd like to run some data by you. By the end of 2022, nearly 19,500 primary medical and health institutions were built that are suited for providing elderly patients cares. In May this year, China released a set of guidelines to facilitate the building of basic elderly care system. From a policy and the government's perspective, are we moving fast enough on this?

Justine Coulson: What I've really noticed in China is that very often when we talk about older people and aging populations, we see the picture of an elderly lady with a walking stick and we see pictures of care homes.

But actually, that isn't necessarily what all older people need. So, in China at the moment, we have just over 5 million beds available in institutionalized care for older people, but currently less than 45 percent of those are occupied.

So, on one hand, I think we can say that China is moving quickly enough in terms of creating future capacity for this growing older population, but we also need to recognize that institutionalized care is not the only care option that older people need. So, what we see globally as many older people don't want to move into a care home. They'd like to stay in their community. They'd like to stay within their family. They'd like to retain some level of independence. And so when we look at a comprehensive care response to an aging population, yes we may need institutionalized care for the very old that are frail and infirm as I mentioned earlier. But I think we also need to look at maybe more innovative care models that will allow older people to retain some level of independence and actually remain in the communities as they wish.

CGTN: Do you think we need to do more education here in China about this elderly care image? Because as you said, when we say elderly people, most often think about the lady with a walking stick. Do you think that there needs to be more education around this area?

Justine Coulson: So, I think one of the interesting things when I came to China and I really noticed it, when the first day I went out jogging and I went to Chaoyang Park and there were hundreds of older people out doing exercise, dancing, walking the dog. And it really struck me because it's not something I've seen anywhere else in the world. And I have lived in many different places.

So, on one hand, I do think that China, in that way, is actually very enabling of older people in that older people are visible in society, being active, taking on responsibility, which is a very positive thing. On the other hand, I do think that sometimes when younger people think about older people, it is in this sort of passive care recipient model. And I do think that we need to look much more at intergenerational interactions between older people and younger people, so there's a much better understanding of how much older people can do and contribute to society.

And interestingly, actually, last year, we had a photo exhibition for young people, and it was simply generally about women in Chinese society. We didn't put a specific theme on it. But when the entries came in, the majority of them were actually photographs of older Chinese women being incredibly active in their society. So, one entrant was a beautiful set of photographs of an older woman in rural China thatching her roof. We had older women running their businesses, their market stalls, a whole range of ways in which older women in Chinese society contribute to their families and communities. So, I do think there is something intrinsic in Chinese culture that really does value older people. But there is something that happens when we maybe communicate specifically in the media as well that instantly jumps to these quick images of frailty and the need for institutionalized care.

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