- Email: [email protected]
Comment on Smith et al., “Healthy Aging in China”
The Journal of the Economics of Ageing 4 (2014) 44–45
Contents lists available at ScienceDirect
The Journal of the Economics of Ageing journal homepage: www.elsevier.com/locate/jeoa
Comment on Smith et al., ‘‘Healthy Aging in China’’ Sanjay K. Mohanty International Institute for Population Sciences, India
Introduction Developing countries are currently experiencing a faster reduction in fertility than expected, as well as an increase in longevity. These demographic changes are leading to an altered population age structure whereby the size and share of the working population and the elderly population are growing. While the increasing size of the working age population is a welcome shift and a key factor for realizing a demographic dividend, the increasing share of the elderly population is generally perceived as a burden. A marked increase in the share of elderly population will exert pressure on pension and healthcare systems and necessitate greater public spending. Despite this prospect, with suitable policy interventions in place, ageing individuals have the opportunity to remain productive contributors to the labor force. Raising the retirement age in developing (and developed) countries could be one viable policy intervention that has the potential to retain older workers, improve their financial security, and sustain overall economic growth. Older workers contribute a diverse set of skills and professional experience to the labor force, which makes them uniquely qualified employees and valuable mentors for their younger colleagues. In turn, dynamic and efficient older professionals could continue contributing meaningfully to the workplace well beyond the traditional retirement age of 58 or 60 years (as practiced in many developing countries). The Chinese context The paper by Smith, Strauss, and Zhao is an impressive and useful blend of theory, evidence, and policy tailored to the Chinese context, and offers many valuable insights. First, the authors demonstrate how increasing the retirement age could be an effective way to balance the support ratio in coming years. In China, the current retirement ages of 60 for men, 50 for women, and 55 for female cadres (urban areas) is strikingly low by any standard. Postponing retirement to an older age would not only improve economic security among the elderly but could also accelerate economic growth. Second, Smith, Strauss and Zhao outline the age and gender differentials in cognitive health, physical health, and functional health among older adults using the rich and high quality CHARLS data. With respect to cognitive health, the study shows a E-mail address: [email protected] http://dx.doi.org/10.1016/j.jeoa.2014.10.008 2212-828X/Ó 2014 Elsevier B.V. All rights reserved.
decline in mental intactness and episodic memory with age for both men and women. Overall, the findings of this study did not suggest significant differentials in episodic memory by gender; however, women demonstrated lower mental intactness than men. Furthermore, the ADL/IADL, high depressive symptoms, and subjective health outcomes are poorer among women than men. Third, the study links the narrowing gender disparity in education to lower gender differentials in cognitive, functional, and physical health, which suggests that narrowing the gender disparity in education is beneficial for the reduction of gender disparity in cognitive, physical, and functional health in coming years. Fourth, although the authors categorize higher coverage of health insurance as a positive force, they highlight the limitations of provisioning insurance strictly at the county-level as disadvantageous for the elderly whose children migrant to urban areas. In the wake of increased rural–urban migration among younger individuals, insurance coverage policies that place less emphasis on the geographic location of the elderly should be considered to allow for more comprehensive familial support. Smith and colleagues also comment on the increasing rates of obesity among men and women and the marked amount of smoking among Chinese men, both of which are detrimental health trends for an ageing population. The Indian context India comprises 17% of the global population and is unique in size, regional diversity (with regard to social and economic development), intra-household inequality, and governance. The 2011 census in India counted 104 million elderly individuals (60 years and older), accounting for 8.6% of the country’s population and inhabiting over 35 states and union territories. From 2001 to 2011, the growth rate of the elderly population was 3.1% – a figure that is nearly twice the growth rate of the overall population (1.6%). About two-thirds of the Indian states are close to the replacement level of fertility, and there has been substantial improvement in the reduction of child and maternal mortality. Also notable here are the significant improvements the country has made in key areas of human development such as education, health, and income over the last two decades. With this background, I would like to highlight some Indian trends that mirror China’s experience and outline the key challenges to healthy ageing on India’s horizon. Like China, India is closing its gender gap in literacy and educational attainment;
S.K. Mohanty / The Journal of the Economics of Ageing 4 (2014) 44–45
showing poorer physical and functional health among women compared to men; maintaining an early retirement age; enduring increasing rates of obesity; and experiencing rural–urban migration among younger generations. Over the last two decades, male literacy has increased by 18 percentage points (64.1–82.1%); however, it is the marked increase in female literacy rates, which have improved by over 25 percentage points (39.3–65.5% during the same time period) that signal a reduction in the educational gender gap. With respect to health, the Longitudinal Aging Study in India (LASI) pilot conducted in 2010 and the 2004 National Sample Survey highlight poorer health among older women compared with men. In addition, the risk factors for non-communicable diseases such as obesity, alcohol consumption, high-fat diet, and tobacco consumption have gained strength over time. As Smith, Strauss, and Zhao demonstrate in the Chinese context, these factors are negative forces and they impede the process of healthy ageing throughout India as well. With respect to retirement, the central government in India established the retirement age to be 60 years, though it is lower in a number of states. On the other hand, in contrast to universal health coverage in China, India has lower health insurance coverage and an inadequate provision of medical care for indigent and disadvan-
45
taged populations. Studies suggest out-of-pocket spending on health is catastrophic for many individuals burdened by non-communicable diseases. Despite these negative forces, there has been a strong political commitment to improving population health in India, in part by providing health insurance on a greater, more inclusive scale. This is evidenced by the commitment of India’s Ministry of Health and Family Welfare and its Ministry of Social Justice and Empowerment to provide financial support toward pioneering health monitoring initiatives such as LASI for generating nationally representative high quality data on population health, social connections and living arrangements, and financial circumstances and economic well-being. While population ageing is an unavoidable reality, evidence-based policy can serve to promote healthy ageing and to mitigate many of the health and economic challenges that accompany this unprecedented demographic shift. Acknowledgment The author would like to thank Elizabeth Mitgang, Research Assistant at Global Health and Population, Harvard School of Public Health for her excellent editorial assistance.
Contents lists available at ScienceDirect
The Journal of the Economics of Ageing journal homepage: www.elsevier.com/locate/jeoa
Comment on Smith et al., ‘‘Healthy Aging in China’’ Sanjay K. Mohanty International Institute for Population Sciences, India
Introduction Developing countries are currently experiencing a faster reduction in fertility than expected, as well as an increase in longevity. These demographic changes are leading to an altered population age structure whereby the size and share of the working population and the elderly population are growing. While the increasing size of the working age population is a welcome shift and a key factor for realizing a demographic dividend, the increasing share of the elderly population is generally perceived as a burden. A marked increase in the share of elderly population will exert pressure on pension and healthcare systems and necessitate greater public spending. Despite this prospect, with suitable policy interventions in place, ageing individuals have the opportunity to remain productive contributors to the labor force. Raising the retirement age in developing (and developed) countries could be one viable policy intervention that has the potential to retain older workers, improve their financial security, and sustain overall economic growth. Older workers contribute a diverse set of skills and professional experience to the labor force, which makes them uniquely qualified employees and valuable mentors for their younger colleagues. In turn, dynamic and efficient older professionals could continue contributing meaningfully to the workplace well beyond the traditional retirement age of 58 or 60 years (as practiced in many developing countries). The Chinese context The paper by Smith, Strauss, and Zhao is an impressive and useful blend of theory, evidence, and policy tailored to the Chinese context, and offers many valuable insights. First, the authors demonstrate how increasing the retirement age could be an effective way to balance the support ratio in coming years. In China, the current retirement ages of 60 for men, 50 for women, and 55 for female cadres (urban areas) is strikingly low by any standard. Postponing retirement to an older age would not only improve economic security among the elderly but could also accelerate economic growth. Second, Smith, Strauss and Zhao outline the age and gender differentials in cognitive health, physical health, and functional health among older adults using the rich and high quality CHARLS data. With respect to cognitive health, the study shows a E-mail address: [email protected] http://dx.doi.org/10.1016/j.jeoa.2014.10.008 2212-828X/Ó 2014 Elsevier B.V. All rights reserved.
decline in mental intactness and episodic memory with age for both men and women. Overall, the findings of this study did not suggest significant differentials in episodic memory by gender; however, women demonstrated lower mental intactness than men. Furthermore, the ADL/IADL, high depressive symptoms, and subjective health outcomes are poorer among women than men. Third, the study links the narrowing gender disparity in education to lower gender differentials in cognitive, functional, and physical health, which suggests that narrowing the gender disparity in education is beneficial for the reduction of gender disparity in cognitive, physical, and functional health in coming years. Fourth, although the authors categorize higher coverage of health insurance as a positive force, they highlight the limitations of provisioning insurance strictly at the county-level as disadvantageous for the elderly whose children migrant to urban areas. In the wake of increased rural–urban migration among younger individuals, insurance coverage policies that place less emphasis on the geographic location of the elderly should be considered to allow for more comprehensive familial support. Smith and colleagues also comment on the increasing rates of obesity among men and women and the marked amount of smoking among Chinese men, both of which are detrimental health trends for an ageing population. The Indian context India comprises 17% of the global population and is unique in size, regional diversity (with regard to social and economic development), intra-household inequality, and governance. The 2011 census in India counted 104 million elderly individuals (60 years and older), accounting for 8.6% of the country’s population and inhabiting over 35 states and union territories. From 2001 to 2011, the growth rate of the elderly population was 3.1% – a figure that is nearly twice the growth rate of the overall population (1.6%). About two-thirds of the Indian states are close to the replacement level of fertility, and there has been substantial improvement in the reduction of child and maternal mortality. Also notable here are the significant improvements the country has made in key areas of human development such as education, health, and income over the last two decades. With this background, I would like to highlight some Indian trends that mirror China’s experience and outline the key challenges to healthy ageing on India’s horizon. Like China, India is closing its gender gap in literacy and educational attainment;
S.K. Mohanty / The Journal of the Economics of Ageing 4 (2014) 44–45
showing poorer physical and functional health among women compared to men; maintaining an early retirement age; enduring increasing rates of obesity; and experiencing rural–urban migration among younger generations. Over the last two decades, male literacy has increased by 18 percentage points (64.1–82.1%); however, it is the marked increase in female literacy rates, which have improved by over 25 percentage points (39.3–65.5% during the same time period) that signal a reduction in the educational gender gap. With respect to health, the Longitudinal Aging Study in India (LASI) pilot conducted in 2010 and the 2004 National Sample Survey highlight poorer health among older women compared with men. In addition, the risk factors for non-communicable diseases such as obesity, alcohol consumption, high-fat diet, and tobacco consumption have gained strength over time. As Smith, Strauss, and Zhao demonstrate in the Chinese context, these factors are negative forces and they impede the process of healthy ageing throughout India as well. With respect to retirement, the central government in India established the retirement age to be 60 years, though it is lower in a number of states. On the other hand, in contrast to universal health coverage in China, India has lower health insurance coverage and an inadequate provision of medical care for indigent and disadvan-
45
taged populations. Studies suggest out-of-pocket spending on health is catastrophic for many individuals burdened by non-communicable diseases. Despite these negative forces, there has been a strong political commitment to improving population health in India, in part by providing health insurance on a greater, more inclusive scale. This is evidenced by the commitment of India’s Ministry of Health and Family Welfare and its Ministry of Social Justice and Empowerment to provide financial support toward pioneering health monitoring initiatives such as LASI for generating nationally representative high quality data on population health, social connections and living arrangements, and financial circumstances and economic well-being. While population ageing is an unavoidable reality, evidence-based policy can serve to promote healthy ageing and to mitigate many of the health and economic challenges that accompany this unprecedented demographic shift. Acknowledgment The author would like to thank Elizabeth Mitgang, Research Assistant at Global Health and Population, Harvard School of Public Health for her excellent editorial assistance.