However, the current and future burden and opportunities of this phenomenon will fall differently in different countries.
The “old-age dependency ratio” – the proportion of older people compared to people of working age – will rise sharply in all countries. Globally, Japan already has the highest ratio of all nations: 38 older people aged 65 and over per 100 persons of working age, with the ratio predicted to reach 74 in 2050 (according to the European Commission, 2010). Australia’s age dependency ratio is 22 in 2010 and is predicted to reach 41 in 2050.
The ratio of old-age dependency in China was 13 in 2010, and is predicted to reach 39 in 2050. But this is not the only reason why that country will be particularly affected by the ageing of its population. In addition:
- China has the largest absolute number of older people globally. The number of people aged over 60 reached 165 million in 2011 and this number is growing strongly.
- The rate of ageing is accelerating, and growth in older people within China is three times the rate of the overall national population increase. (This dynamic growth is in no small measure due to China’s very effective population growth strategy, especially the “one child” policy, which has resulted in major changes to its demography.)
- In China, the proportion of people aged 65 years or over has doubled in 30 years. This same change took 70 years in the USA and 130 years in France.
- Currently 13 per cent of the total Chinese population is aged 60 years and above (China population census and population statistics), with 8.2 per cent aged 65 years and above.
- China will experience the increase in ageing of its population well in advance of the levels of economic prosperity reached in developed countries that have had the same change. In such countries GDP per capita is much higher than in China.
China – and other countries significantly affected by ageing populations – will need an income and social support system, a health system and many other government policies and services that are able to handle these momentous changes.
We know that in China, and in all countries for that matter, older people use health services at a greater rate and incur higher health care costs than younger people. The growing rates of chronic illness globally have been described as a building “tsunami” for which all governments and societies will need to prepare.
If we do not change our approaches there may well be significant negative consequences. But with appropriate action the tsunami can be turned into a much smaller wave. When one examines the patterns of illness that may confront ageing populations, one can see that many are changeable. Mature onset diabetes, for example, is avoidable and can even be reversed with appropriate diet, exercise and social support regimens.
The Happy Life Club project is an example of such a social support approach. I am leading this project with my colleague Professor Tuohong Zhang from Peking University and my colleagues Dr Yang Hui and Professor Shane Thomas from Monash and the Fengtai District government, Beijing.
The Happy Life Club is a chronic illness management system based upon earlier Australian work conducted by us and our colleagues. The club trains doctors and nurses to change the behaviour of people with diabetes, and other chronic conditions such as heart disease, through the use of motivational interviewing techniques.
Initially the Happy Life Club intervention was conducted in Fangzhuang, a large residential area of Beijing. The program has now extended to the larger Fengtai district of Beijing with plans for further extension to other Chinese cities and other sites, including Malaysia.
Our large-scale research shows that the approach is highly effective. We are currently conducting the Chinese economic modeling, but the Australian modeling showed a net benefit of AUD $16,000 per annum for each participant due to improved health and lower use of services. Effective, targeted and proven prevention can save China (and other countries) a great deal of money and result in much higher quality of life for older people.
Our focus needs to change from curing disease once it has occurred, to preventing it and focussing on the quality of life for older people. We need to concentrate on how they may contribute to, rather than detract from, the prosperity of our society.
In China older people are much more highly respected than in Australia. While China has things to learn from us (and particularly our technology) we also have many things to learn from them.
Professor Colette Browning is Professor of Healthy Ageing at Monash University and Chair of Monash Research for an Ageing Society. Professor Browning is one of 9 Australians out of 251 foreigners since 1984 who have been awarded a prestigious Honorary Professorship at Peking University Health Sciences Centre in recognition of her work in Healthy Ageing.