Over the past 20 years, the number of elderly people over 65 in China has increased by 1.16 times. The rapid aging has posed new challenges to the construction of China's elderly care service system.
Recently, the aging Finance Branch of the Chinese society of Gerontology and geriatrics, together with the silver economy and health wealth index research group of Tsinghua University and other institutions, released the blue book on China's elderly care services (2012-2021) (hereinafter referred to as the blue book). According to the blue book, China's population aging is characterized by a large base, fast speed, aging before getting rich and large regional differences. The demand for first aid and disability and dementia care will grow rapidly.
China has made active response to population aging a national strategy. Recently, the State Council issued the national plan for the development of the cause of aging and the elderly care service system in the 14th five year plan, which put forward a number of goals, including the effective enhancement of family elderly care capacity, the improvement of comprehensive elderly care services, and the continuous expansion of inclusive elderly care service resources.
the speed of population aging accelerated
Internationally, according to the report of the United Nations, the process of population aging is defined by the proportion of the population aged 65 and over in the total population. The standard of the primary population aging society is 7%; The standard for a deeply aging society is 14%, and the standard for a highly aging society is 20%.
In 2000, China's population over 65 accounted for 7% and entered an aging society; In 2020, the data of the seventh national census showed that the population over 65 accounted for 13.5%; During the 14th Five Year Plan period, China entered a deep aging society; It will enter a highly aging society before 2035.
The primary characteristics of China's aging are its large population base and fast aging speed. The blue book shows that the number of people over 65 in China has increased from 88.21 million in 2000 to 190.64 million in 2020, an increase of 1.16 times; The proportion of the elderly population increased from 6.96% in 2000 to 13.5% in 2020.
The results of the seventh national census show that among the national population, the population aged 0-14 is about 250 million, accounting for 17.95%; The population aged 16-59 is about 890 million, accounting for 63.35%; The population over 60 years old is about 260 million, accounting for 18.70%, of which the population over 65 years old is about 190 million, accounting for 13.5%.
Compared with the fifth national census in 2000, the number of people aged 0-14 decreased by 36.41 million, accounting for 4.94 percentage points; Compared with the sixth national census in 2010, the number of people aged 0-14 increased by 30.92 million, accounting for an increase of 1.35 percentage points.
In the 20 years from 2000 to 2020, the number and proportion of the working age population aged 16 to 59 showed an upward trend first and then a downward trend; The population aged 13.38 million in 2020, an increase of 26.48 percentage points over that in 2020, accounting for more than 86.5 percentage points over that in 2000.
From the perspective of the speed of population aging, the population over 60 and over 65 increased by 46.89 million and 30.72 million respectively from 2000 to 2010, and 86.37 million and 71.81 million from 2010 to 2020, indicating that the speed of population aging has accelerated significantly after 2010.
According to the latest data of 2021 released by the National Bureau of statistics, the population aged 65 and over is 200.56 million, accounting for 14.2% of the national population. This is the first time that the proportion of China's population aged 65 and over has exceeded 14%.
The second characteristic of China's aging is that it gets old before it gets rich and has a low fertility rate. Tao Hongwu, director of the aging Finance Branch of the Chinese society of Gerontology and geriatrics, said that at the end of 2021, China's population over the age of 65 accounted for 14.2%. China entered the deep aging society ahead of schedule. From the experience of developed countries, their per capita GDP exceeded US $20000 when entering the deep aging society, and our country's per capita GDP exceeded US $11000 in 2021.
Relevant data from major OECD countries show that when some developed countries enter a moderately aging society, the average total fertility rate drops to 1.76 When China entered a moderately aging society, the total fertility rate fell to 1.3.
The third feature of China's aging is that there are great regional differences. In terms of population aged 65 and above, the top three provinces are Shandong, Sichuan and Jiangsu, with an elderly population of 15.36 million, 14.17 million and 13.37 million respectively. Shandong is the only province with a population of more than 15 million over the age of 65.
In terms of the proportion of the elderly population, there are 12 areas where the proportion of the population aged over 65 exceeds 14%, namely Hubei, Tianjin, Hunan, Anhui, Shandong, Jilin, Heilongjiang, Jiangsu, Shanghai, Sichuan, Chongqing and Liaoning; The highest is Liaoning, up to 17.42%. These areas belong to the stage of entering a deep aging society but not reaching a high aging society.
addressing the opportunities and challenges of aging
To Hongwu believes that China's aging faces two opportunities: first, after entering a deep aging society in 2021, the working age population is relatively large. The per capita GDP has exceeded 10000 US dollars and the urbanization rate has exceeded 60%, which are the basis for actively coping with the aging of the population; Second, the national education level is relatively high, and the development speed of health industry is accelerated.
According to the blue book, through public policy regulation and public service support to release fertility potential, China can still strive to achieve the goal of approaching the total fertility rate of 1.8 and ensuring 1.5.
With the rapid increase of the elderly population, especially after the "63 baby boomers" generation retires and enters the ranks of "65 +" elderly people, the demand for care, first aid and disability and dementia of the elderly in China will increase significantly. The supply of elderly care services needs to be prepared in advance.
According to the blue book, the number of beds in China's elderly care institutions reached a maximum of 4.937 million in 2013, then decreased to 3.581 million in 2015 and increased to 4.831 million in 2020. Affected by the accelerated aging of the population, although the number of beds in elderly care institutions is increasing, the number of beds in elderly care institutions per 100 elderly people (aged 65 and over) is still at a low level.
According to the national plan for the development of the cause of aging and the elderly care service system in the 14th five year plan, during the 13th Five Year Plan period, the number of various elderly care service institutions (including elderly care institutions and community elderly care service institutions) and facilities in China increased from 116000 to 329000.
With the weakening of the function of family elderly care service, home-based elderly care embedded in social services has become the mainstream. The Blue Book Research Group carried out research on pension needs in 20 first, second and third tier cities. The results showed that the top three main puzzles of elderly care of the surveyed residents were worried that sudden diseases could not be treated in time; Nursing staff are not professional / good, reliable nursing staff are difficult to find; "One bed is hard to find" in elderly care institutions with good medical and nursing services. It can be seen that emergency first aid is the greatest need and concern of residents for the elderly.
Yang Yansui, director of the employment and social security research center of Tsinghua University, believes that for the elderly living at home, the need for emergency first aid is higher than other needs. Cardiovascular and cerebrovascular diseases and falls require a 15 minute first aid circle. Taking basic health care (including emergency first aid) as the infrastructure of people's livelihood security should be embedded in the community, which is an arduous task to improve China's elderly care system.
When answering a reporter's question on the "14th five year plan" for the development of the national cause of aging and the elderly care service system, the relevant heads of the national development and Reform Commission and other four departments said that the "14th five year plan" period is an important strategic opportunity for the development of elderly care services. In response to the expectation of the elderly to live near home for the elderly, the Ministry of civil affairs, together with relevant departments, will strive to solve the problem of "the last mile" of elderly care services, guide community elderly care service institutions to provide integrated medical and elderly care services through signing cooperation and adjacent construction with medical institutions, so as to meet the dual needs of the elderly for elderly care services and medical and health services.
