China is set to make a significant change to its family planning policies in the coming year by shifting to a nationwide two-child policy. The hope is that an increase in births will ameliorate a looming demographic disaster in a nation with too many men, too many old people, and too few workers.
However, the two-child move is a limited solution for China’s demographic woes. Even if Chinese couples were to become enthusiastically fruitful, it will provide little relief for the graying of the country’s population—arguably the most severe consequence of the one-child policy.
As the world’s most populous nation, it is perhaps no surprise that China also has a gargantuan share of the elderly. However, the peculiar element that singles China out from the global graying herd is not so much the size of its aging population, but the speed at which it is aging.
I do not, of course, mean that the Chinese are somehow growing old at a faster rate. I am speaking of proportion: China’s number of retirees is fast outstripping its number of workers.
Currently, the Middle Kingdom has the kind of worker-to-retiree ratio that warms the heart of its economic planners: a 5 to 1 ratio. That means lots of productive, tax-paying workers to pay for retirees.
But by 2040, if birthrates continue at their current pace, China’s attractive 5:1 ratio would shift to 1.6 to 1. That spells shrunken tax coffers, reduced consumption spending, and all-around diminished productivity. This kind of transition—more older people, fewer young—is happening almost everywhere in the world. We now live longer and, on balance, have fewer children than people did a century ago.
At least in the West, this transition took over 50 years to take shape. Consequently, countries there have had more time to stock up for the gray years ahead, both economically and socially. (Some might argue that even these preparations are inadequate.) In China, the aging transition will happen in just one generation, and the cupboard is woefully bare.
Other side effects of China’s one-child policy are still in the realm of speculation. The policy has has created a gender imbalance, which some academics suggest could make China more warlike or unstable—but such a result is far from certain. The one-child policy has also created a cohort of “Little Emperors”—single children—which various social studies suggest has created a generation of pessimistic, solipsistic low-risk takers that could potentially dampen China’s economic dynamism. But again, this is unproven.
What is certain is, short of some cataclysmic plague or war, is that China’s vast cohort of workers will grow old. Right now, if you were to stroll through urban parks in China, you might well conclude that aging in the country is a pleasant affair. China has one of the earliest retirement ages in the world—as early as 55 years old for women, and 60 for men. As a result, China’s parks are filled with vigorous pensioners engaged in picturesque activities: dancing, tai chi, sword fighting, kite flying, and, my particular favorite, a form of geriatric graffiti that involves tracing Chinese calligraphy on pavements using water and brushes, which dry and leave no trace. Public spaces are filled with irrepressible “dancing grannies” who fill the air with music from huge boom-boxes. IKEA cafeterias have become a hot singles scene for the over-sixty set.
But this lifestyle may soon change. There are two things that help make old age more tolerable. The first is money, which pays for comforts, medical treatments and necessities at a time when people can no longer work. The second is family, or family substitutes, for emotional support as well as physical care. In China’s future, both will be hard to achieve in adequate amounts.
China’s economy is slowing down, and an aging demographic will add significant headwinds. And despite becoming the world’s largest economy by size, its per capita GDP is just a sixth of South Korea’s, and one-ninth the level of the United States’.
Having family usually helps reduce the pains of aging. But even assuming the two-child policy results in a significant uptick in births, this will do nothing to smooth over the next two decades’ problems. Babies need time to grow into caregivers, after all. The one-child policy significantly reduced the number of caregivers for China’s elderly not just in quantity, but in quality. The coupling of a one-child policy and a son-loving culture has led to China have about 50 million “‘missing”’ women—and that means fewer daughter-in-laws, the traditional caretakers of elderly China.
That said, China is taking steps to deal with population changes by raising the retirement age and reforming a clunky pension system. There’s no doubt that China’s social safety net is growing quickly. In 2011, rural pension schemes covered only a quarter of the rural population. In 2013, this expanded to half. By the end of 2015, three-quarters of the population will be covered.
Meanwhile, China only began healthcare reforms in earnest in 2009, but they have swiftly evolved. Healthcare premiums have risen quickly in the past five years, significantly reducing out-of-pocket expenses. Unfortunately, China’s institutional care leaves much to be desired. A recent index by the Economist Intelligence Unit that ranks the quality of care for the dying puts China close to the bottom on almost every metric: quality, affordability, availability.
In his book Being Mortal, American physician Atul Gawande writes about end-of-life care in America. Most old people want to avoid the indignities and loss of control that comes with institutionalized care, he says, but “your chances of avoiding the nursing home are directly related to the number of children you have.”
Again, that’s bad news for China.
In Gawande’s America, having children may help you stay out of the nursing home. In China, not having children could shut you out.
In China, the term for parents who’ve lost their only child is “shidu.” Many nursing homes will not admit shidu couples because they have no progeny to authorize treatments or act as payment guarantors. This form of discrimination appears to extend beyond the grave. Some shidu parents complain that cemeteries won’t sell burial plots for them or their deceased children, concerned there will be nobody to pay for future upkeep.
There are currently one million shidu parents in China, with an additional 76,000 joining their ranks yearly. They’ve petitioned Beijing—to little avail—for more financial help and priority in adoptions. They argue, with some justification, that since Beijing has made money off fines from one-child violators, it should compensate families who observed the laws, only to lose out financially and emotionally with the death of their only child.
Shidu parents have even asked for nursing homes exclusively for their kind. One reason: visiting days. “Seeing other people with their families…it’s just unbearable,” said one parent. It’s a pain that no dramatic policy announcement can ease.