Aging

This study aimed to better understand the dramatic health improvements in Maoist China and the age-related health disparities that it may have generated. The investigators validated official Chinese health statistics to establish the magnitude of China’s mortality decline between 1950 and 1980; and identified the proximate determinants correlated with China’s mortality decline, using data on regional variation in such factors as primary healthcare infrastructure, drinking water quality, sanitation, nutrition, and childhood vaccination rates.

Authors
News Type
News
Date
Paragraphs

On October 2, 2008, Dr. Marcus Feldman of Stanford's Biology department delivered the first colloquium in the series on "The Implications of Demographic Change in China," co-sponsored by the Asia Health Policy Program and the Stanford China Program. Dr. Feldman discussed the sex-ratio imbalance and gender studies in China.

As Dr. Feldman noted, the total fertility rate in China has dropped dramatically in recent years, due in large part to the Chinese government's One Child Policy, which was introduced in 1979. In the early 1970s, the fertility rate averaged almost 6 births per woman, dropping to about 1.6 after the year 2000. China's sex ratio of males to females at birth (SRB), meanwhile, has risen. In 1975, the SRB was about 106 male births per 100 female births, and in 2005 had climbed to over 120 male births per 100 female births. When parity (birth order) is taken into account, the ratio becomes even more startling; for the first birth, the ratio is close to even (about 108 in the year 2005), but exceeded 145 in 2005 for the second birth and even higher for the third birth (almost163 in 2005). Research indicates that the imbalanced SRB is largely concentrated in the lower coastal regions of mainland China, where the population is predominantly Han. Shaanxi, Anhui and Jiangxi Province have the highest ratio of male to female births.

Evidence of gender imbalance is not merely limited to the ratio at birth; high ratios of male to female children are seen through ages 0-4, indicating that son preference affects not only which children survive birth, but also the survival rate of females in early childhood. In fact, research indicates that while excess girl child mortality (EGCM) has decreased for infants less than a year old in the period between 1973 and 2000, it has become increasingly pronounced for children between the ages of 0-4 and 5-9, with EGCM rates increasing every year.

Two Studies

Two studies were carried out in 1997 and 2000 by the Institute for Population and Development Studies of Xi'an Jiaotong University to investigate the causes of gender imbalance. The 1997 study focused on the cultural transmission of son preference, and the 2000 study on marriage form and old age support.

Three counties were chosen as sites, and the studies were a combination of surveys, in-depth interviews and focus group discussions. The first county, Sanyuan () in Shaanxi province, is a medium-developed region whose principal agricultural product is wheat. Fertility is high in Sanyuan, which is characterized by the dominance of virilocal marriage (in which the bride joins the family of her husband) and strict patrilineal family systems. The second county, Lueyang () in Shaanxi province is an underdeveloped mountainous region in which the patrilineal family system is more relaxed, fertility is lower than in Sanyuan, and there are diversified forms of marriage. The third site, Songzi () in Hubei province, is a well-developed rice- and cotton-producing plains region, with low fertility, relaxed family systems and diversified marriage. The results of household surveys showed a strong preference among parents in both Sanyuan and Lueyang to live with their sons in old age, which was not surprising, but a surprising result was found when parents were asked about the primary benefits of having a son. The most-reported reason was for carrying on the family name, which shows that traditional (Confucian) values played a bigger role in son preference than practical considerations such as labor or old age support. Overall, Lueyang was shown to have a much higher rate for transmitting no son-preference than Sanyuan, with older women slightly more likely to transmit no son-preference.

The marriage study found that rates of uxorilocal marriage (in which the groom joins the family of his wife) have, for the most part, been dropping in both Lueyang and Songzi since the 1970's. In Sanyuan, where uxorilocal marriage has been traditionally uncommon, the rates have remained steady at around 5 percent since the 1950's. The researchers calculated children's odds ratios of providing financial help to parents based on marriage form, and found the net ratios highest for women in virilocal marriages and sons in uxorilocal marriages.

Mechanisms of gender imbalance

There are several likely factors for the imbalanced sex ratio at birth in China. Underreporting of female births, infanticide, and sex-selective abortion (post-pre-natal gender testing) all contribute to this syndrome. Furthermore, poor nutritional and medical care for girls in their younger years can further skew the gender balance by exacerbating excess female child mortality. At the basic source of this issue, however, remains a fundamental gender bias that dates back historically and philosophically through Confucian culture and traditional patriarchal structures.

If the SRB, EFCM, TFR (total fertility rate) were all to remain at their early 2000s levels, then by 2030 the total population of China would be 84.2% of what would normally be expected at the current fertility rate (potentially causing economic welfare issues for the elderly, along with a work force deficiency). Moreover, there would be an excess in the male population of 20-21% (relative to females), essentially making it mathematically impossible for this proportion of the male population to marry. Needless to say, the possibility of such a severe "marriage squeeze", and the general top-heavy ratio of aging population to young working population are very problematic prospects for China's population and for the government's endeavors to promote both economic growth and social stability.

Examples of government efforts

The government is considering several policy options to try to avert this potential crisis. Stronger punishments were suggested at the 2008 National People's Congress (NPC) and Chinese People's Political Consultative Conference (CPPCC) for non-medical sex identification and sex-selection abortions (both of which can be obtained for relatively cheap rates within the country, despite being illegal). More proactively, an experimental program called "Care For Girls" was implemented in 2000 in Chaohu (a city in Anhui province). This program includes: financial help for 1- and 2-daughter families; sponsoring of girls' educational fees and increased pensions to families with daughters; and the promotion of uxorilocal marital structures. Since the introduction of the program, the local SRB went from 125 in 1999 to 114 in 2002. In response to this apparent success, the government expanded the "Care For Girls" program to 24 counties with high SRB rates in 2003-2004, and saw the average SRB in those counties drop from 133.8 in 2000 to 119.6 in 2005. Stipulation and initiation of a national "Care For Girls" campaign occurred in January 2006 - July 2006, with the goal of bringing the national SRB average to normal levels within 15 years. In January 2008, the government expanded on this effort by launching the "Care For Girls Youth Volunteer Action", beginning with more than 1000 students (mostly at the university level) directed at engaging in promotional activities and data collection (under the Chinese Communist Youth League). These policies are part of a comprehensive aspiration on the part of the PRC government towards the "construction of a new reproductive culture."

Son preference among migrant workers in Shenzhen

With the Chinese economic reform of the early 1980s, millions of laborers have been migrating from rural to urban areas. After migration, rural-urban laborers have to familiarize themselves with the rules and customs of their new locations, rebuilding their social networks in the process of adapting to their new occupations and habitation. But how do individual characteristics (i.e. gender, education level and the time of residency), restructured social networks, and the experiences of migration influence migrants' attitudes and behaviors regarding son preference? These questions were examined in a 2005 study conducted in Shenzhen.

Shenzhen is the first Special Economic Zone in China to implement economic reform and has since developed from a small fishing village into a modern coastal city. According to the 2000 Population Census, the total population of Shenzhen is 7,008,800, and the ratio of migrants to permanent urban residents is 4.77:1.

The Shenzhen study seemed to indicate initially that only a small minority of migrants (7% of total respondents) expressed a strong attitude towards son preference. However, the actual childbearing behavior of rural-urban migrants was remarkably different compared to their reported attitudes. The sex ratio of migrant children is as high as 163 male births per 100 female births, and the later in the birth order, the higher the sex ratio for the child, i.e., the sex ratio is 1.52 for the first birth and rises steeply to 1.80 for the second birth, peaking at 1.94 for the third and above birth. Thus the results suggest that migrants' childbearing behaviors actually suggest a strong son preference.

The Shenzhen study also found that three major determinants, namely social networks, migration history, and individual factors, all have significant effects on son preference among rural-urban migrants.

First, weak ties (formed by friends, bosses, and fellow workers) in social networks affect the attitude of son preference among rural-urban migrants. That is, the risk of having son-preference tends to decrease when the overall influence of network members is positive (without son preference). Moreover, increasing social contacts with network members will reduce the dependence upon strong ties (formed by family members and kin) and thus decrease the traditional culture of "rearing a son to support parents in their old age" and familial pressures to have more children.

Second, the duraction of residency in an urban area has a significant effect on the attitude of son preference among rural-urban migrations. The longer the migrants live in an urban area, the more likely that their attitudes of son-preference will adapt to urban reproductive norms. For example, the data indicated that ratio of male and female birth is more balanced among those living in urban areas for 8 years or longer. However, rural-urban migrants still exhibit a strong overall behavior of son preference. In other words, the change in childbearing behavior in terms of birth patterns still lags far behind the apparent change of attitudes.

Age and education are identified as factors affecting son preference among rural-urban migrants. For instance, an increase in age relative to initial migration will often decrease the imbalance in the sex ratio.

An additional study on rural-urban migrants examined the relationship between the gender of married migrants and their provision of financial support to parents and parents-in-law post-migration. The results showed, in fact, that female migrants are more likely to give financial support to their parents-in-law after migration.

Even today, the patrilineal conception of support for elderly family members is still very prevalent in rural China. Sons are expected to provide fundamental support to their parents, while daughters tend to provide supplementary and emotional support. This traditional old-age support pattern of reliance on sons can often intensify the syndrome of son bias among rural or traditional Chinese. However, the results here proved that if aging parents are more likely to receive sustenance from married daughters compared to married sons, the dominant son-preference in rural China could be logically undercut and eventually the traditional patrilineal conception of old-age support, and resulting gender bias, could be ameliorated and even eliminated.

All News button
1
-

Dr. Shea will talk with us about her research on menopause and aging among Chinese women and issues surrounding romance, sex, and marriage in later life in mainland China, as part three of the colloquium series on "The Implications of Demographic Change in China," co-sponsored by the Stanford China Program and the Asia Health Policy Program. 

A sociocultural anthropologist who specializes in medical and psychological anthropology and Chinese culture, Dr. Shea's research interests include gender issues, health and healing, aging and the lifecycle, and intergenerational issues. She has spent three cumulative years living, studying, and doing research in the People's Republic of China.

Dr. Shea earned a B.A. in Asian Studies from Dartmouth College in 1989, followed by an M.A. and Ph.D. in Anthropology from Harvard University in 1994 and 1998.

Philippines Conference Room

Jeanne Shea Associate Professor, Department of Anthropology Speaker University of Vermont
Seminars
-

The first in a series entitled "The Implications of Demographic Change in China," this colloquium features Professor Feldman speaking to us about his research program on demographic issues and statistics concerning the sex ratio in China. His joint research with scholars from Xi’an Jiaotong University is focused on the role of son preference in marriage customs. He will also talk about recent work on rural-urban migrants and how this migration affects the well-being of both the migrants and their elderly parents who remain in the rural areas. Gender is a factor in both migration and the pattern of remittance.

Marcus Feldman is the Burnet C. and Mildred Finley Wohlford Professor of Biological Sciences and director of the Morrison Institute for Population and Resource Studies at Stanford University. He uses applied mathematics and computer modeling to simulate and analyze the process of evolution. He helped develop the quantitative theory of cultural evolution, which he applies to issues in human behavior, and also the theory of niche construction, which has wide applications in ecology and evolutionary analysis.

Philippines Conference Room

Marcus W. Feldman Burnet C. and Mildred Finley Wohlford Professor of Biological Sciences Speaker Stanford University
Seminars
-

The demographic billionaires China and India are experiencing rapid population changes and social shifts, fast economic growth, poverty decline, a booming modern business sector, and rising human capital in the labor force age groups.  Because 37% of the entire world population lives in these two countries, the breathtaking transformations in India and China are causing major dislocations in the global economy and big changes in measures of world development.  This colloquium will highlight the most important demographic, social, and economic trends happening in China and India today, will compare and contrast the current situations and future prospects of these two powerhouses, and will focus on implications for Asia and the world today and in the coming decade.

Dr. Judith Banister is the director of Global Demographics for The Conference Board, the world’s premier business research and business membership organization, with offices in New York, Brussels, Beijing, Hong Kong, and New Delhi.  She is an expert on the demography of China and received her Ph.D. in demography and development from Stanford.

Philippines Conference Room

Judith Banister Director of Global Demographics Speaker The Conference Board
Seminars
News Type
News
Date
Paragraphs

The Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center is pleased to announce that Dr. Young Kyung Do has been awarded the %fellowship1% for 2008-2009.

Dr. Do is currently completing his Ph.D. in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health. He is particularly interested in policy challenges associated with rapid population aging in East Asia. His dissertation examines informal care in South Korea and its effects on health care use and caregivers’ labor force participation. Dr. Do has also earned M.D. and Master of Public Health degrees from Seoul National University (in 1997 and 2003, respectively). He earned board certification in preventive medicine from the Korean Medical Association in 2004. While at the University of North Carolina at Chapel Hill, Dr. Do has participated in several research projects and published collaborative research on topics ranging from methodology for causal inference to empirical analysis of disparities in health care use.

While at Shorenstein APARC, Dr. Do will undertake comparative study of public long-term care insurance in Japan and South Korea. He will also begin comparative empirical analysis of the effect of long-term care insurance on informal caregiving, elderly health care, and informal caregivers’ labor force participation in Japan and South Korea. Dr. Do will work closely with the Center’s program on Asian health policy on such activities as the colloquium series on health and aging in the Asia-Pacific and an “Aging Asia” conference.

All News button
1
-

Rapid population aging in many Asian countries poses an increased burden of care for elderly people with disabilities. Traditionally, care for the disabled elderly was provided by family members co-residing or living nearby. However, declining fertility rates, eroding social norms, and growing rates of labor force participation among females have changed the overall picture of informal care. 

One important policy question is whether informal caregiving affects caregivers' labor force participation. This question is particularly relevant for rapidly developing economies including newly industrialized countries, because a shrinking working-age population is another major concern with population aging. Providing different answers to this question leads to different policy implications for long-term care policy and labor market policy. 

Most of the existing literature on this issue comes from the United States and Europe. Using data from the first wave of the "Korean Longitudinal Study of Aging", Do's research not only provides results from a less-studied Asian society, but also takes into account different patterns of living arrangements and labor force participation. His talk will deal with the methodological issue of endogeneity between informal caregiving and labor force participation, and explore gender and age group differences.

Young Kyung Do is currently completing his PhD in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health. He has also earned both an MD and a master of public health degrees from Seoul National University (in 1997 and 2003, respectively). Young earned board certification in preventive medicine from the Korean Medical Association in 2004.

Daniel and Nancy Okimoto Conference Room

0
Postdoctoral Fellow in Asia Health Policy Program, 2008-09
Do.JPG MD, PhD

Young Kyung Do is the inaugural Postdoctoral Fellow in the Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center. He completed his Ph.D. in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health in August 2008. He has also earned M.D. and Master of Public Health degrees from Seoul National University (in 1997 and 2003, respectively). He earned board certification in preventive medicine from the Korean Medical Association in 2004. His research interests include population aging and health care, comparative health policy, health and development, quality of care, program evaluation, and quantitative methods in health research.

He received the First Prize Award in the Graduate Student Paper Competition in the Korea Labor and Income Panel Study Conference in 2007. He also is the recipient of the Harry T. Phillips Award for Outstanding Teaching by a Doctoral Student from the UNC Department of Health Policy and Administration in 2007. In May 2008, he was selected as a New Investigator in Global Health by the Global Health Council.

Date Label
Young K. Do Speaker
Seminars

The Asia Health Policy Program works with other researchers at Stanford and several countries of the Asia-Pacific to analyze prominent issues in population aging, child health, and control of infectious disease. Examples include comparative study of long-term care insurance and informal caregiving; collaborative study of health and healthcare access for children with special health needs; and a research project focusing on controlling tuberculosis and multi-drug resistant tuberculosis in Northeast Asia.

Subscribe to Aging