Aging
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Life expectancy at aged 65 is remarkably similar in the three Chinese cities of Hong Kong, Shanghai, and Taipei, even though the cities differ in levels of socioeconomic development, health systems, and other factors. Edward Jow-Ching Tu will discuss research that aims to understand this phenomenon. Despite unprecedented increases in life expectancy and attainment of similar current levels of life expectancy, the cities differ in the contributions of changes in major causes of death to the improvements in life expectancy among the elderly. Tu and colleagues have explored several possible determinants of these different patterns and trends in the three cities, including socioeconomic development, health service delivery systems, cause-of-death classification systems, and competing risks from cardiovascular disease and other diseases. Their analysis suggests that the effect of equity of health service delivery has become more important over time.

Edward Jow-Ching Tu is a senior lecturer of demography in the Division of Social Science at Hong Kong University of Science and Technology. His work is focused on the impact of fertility, mortality, and migration on socio-economic changes in East Asia countries with special emphasis on nations experiencing a transition from planned economy to market economy; on causes and impacts of mortality changes and health transition on aging societies; and on the causes of lowest-low fertility in many East Asia countries. He has several active research projects ongoing in China, Japan, Taiwan, Hong Kong, and Singapore. He holds graduate degress from West Virginia University, the University of Pennsylvania, and the University of Tennessee (Knoxville). Tu has worked extensively in Asia, and has served as an adjunct professor and taught in many universities in China, including Peking University, Peoples University, Nankai Univerity, and Fudan University. He had served as a senior research scientist at the New York State Health Department and as a research fellow (full professor) at the Institute for Social Sciences and Philosophy at Academia Sinica. Tu has also taught at the State University of New York in Albany.

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Edward Jow-Ching Tu Senior Lecturer of Demography at the Division of Social Science Speaker Hong Kong University of Science and Technology
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The physiological factors underlying links between health and socioeconomic position in the Russian population are important to investigate. This population continues to face political and economic challenges, has experienced poor general health and high mortality for decades, and has exhibited widening health disparities. Dr. Dana A. Glei and colleagues used data from a population-based survey of Moscow residents 55 and older to investigate whether physiological dysregulation mediates the link between socioeconomic status and health. She will discuss the the results of their study, which revealed large educational disparities in health outcomes and physiological dysregulation, especially in men.

Dana A. Glei is a senior research investigator at Georgetown University and has worked on the Social Environment and Biomarkers of Aging Study (Taiwan) since 2001. From 2002 to 2009, she also served as project coordinator for the Human Mortality Database, a collaborative project involving research teams at the University of California, Berkeley and the Max Planck Institute for Demographic Research. Over the past 18 years, she has published articles on a variety of topics related to health, mortality, marriage and the family, and poverty. Her current research focuses on sex differences in health and mortality, the impact of stressors on subsequent health, and how bioindicators mediate the links between psychosocial factors and health outcomes. She has an MA from the University of Virginia and a PhD from Princeton University.

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Dana A. Glei Senior Research Investigator Speaker Georgetown University
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Nearly a year has passed since an earthquake triggered a tsunami that swept away entire communities on Japan’s northeastern coast, leading to a series of accidents at the Fukushima nuclear complex. Since the March 11 disaster, Japan is experiencing a growing sense of community, and it faces a potential opportunity for innovation in the energy industry and economy. Masahiko Aoki and Kenji E. Kushida discuss post-March 11 developments, and a related conference at Stanford scheduled for February 27.

Aoki is the Henri and Tomoye Takahashi Professor Emeritus of Japanese Studies, and director of the Japan Studies Program at the Shorenstein-Asia Pacific Research Center at Stanford University.

Kushida is the Takahashi Research Associate in Japanese Studies at Shorenstein APARC, and a Stanford graduate (BA ’01, and MA ’03).

One Year After Japan's 3/11 Disaster will bring together experts from Stanford, Japan, and Europe for a discussion of the major economic, political, energy, and societal challenges and growth in post-Fukushima Japan.   

Looking back a year later, what do you think are important lessons we can learn from March 11?

Masahiko Aoki: Japan has often faced disasters leading to the complete destruction of cities and enormous losses of life. In the last century alone, there was the great Tokyo earthquake of 1923; wartime damage in Hiroshima, Nagasaki, and other metropolitan areas; the Kobe earthquake of 1995; and so on. Each time, Japan rebuilt its life and infrastructure anew. Accepting the reality of a disaster and making efforts to rebuild is in a sense deeply embedded in Japan’s collective DNA. However, the March 11 disaster was not only just a natural disaster. People are now well aware that there were lots of elements of human and institutional error in terms of preparing for and coping with natural disasters. Recent geographical studies and historical documents reveal that large-scale earthquake-tsunami disasters comparable to March 11 have occurred four times in the last 4,000 years. It provides Japan with a good opportunity for thinking about how to build sustainable societies and cities.  

Kenji Kushida: Big shocks always cause big changes, and the type of change depends on the kind of shock. With March 11, there was the human tragedy of people literally getting washed away. It also raised the question of how to restructure energy markets, which is an area where outcomes in Japan can affect worldwide restructuring. This particular shock then is triggering a whole set of fairly slow moving, but very transformative changes that could take place over the next few years.

What trends are we seeing in Japan’s energy industry now, and what are the implications for Japan’s future energy policy?

Aoki: When I flew into Tokyo the day after the great earthquake, the city was quite dark. But by the summertime, it was not only lit up, but there was a blue hue to the light—this was due to the wide adoption of energy-efficient LED lighting. Even with the nuclear plants down and 25 percent of the electric capacity gone, there were no major blackouts thanks to energy-saving measures. This kind of incident motivates people to explore ways to innovate the energy industry. For example, Japan’s energy-efficient auto industry took off in the late 1970s in reaction to the Oil Shock.

Japan’s energy industry is currently run by regional monopolies. Tokyo Electric Power Company (TEPCO), for example, monopolizes everything from power generation to retail distribution. In the past, there had been an attempt to break up the different parts of the power monopolies into separate entities. But only a bit of reform was made because of very strong resistance from TEPCO. Now TEPCO is on the verge of insolvency, so Japan has a very good chance to restructure its power industry. People are again starting to think about breaking up the regional monopolies and about innovation, which several experts will discuss during our conference.

Kushida: We will also draw on Stanford’s being in California to think about how to prevent Enron-style market manipulation and rolling blackouts from happening in Japan. A lot of it has to do with the rules and regulations that create an energy market. In the tsunami-devastated areas of Japan, there is also a tremendous opportunity for ground-up investment in new forms of energy. Silicon Valley technologies and companies can help design the next generation of renewable, sustainable energy systems in those areas.
In Japan, there is a sense that people have rediscovered their ties to one another after the disaster.

-Masahiko Aoki, Director, Japan Studies Program


During the recovery, many Japanese citizens demonstrated a remarkable strength and collaborative spirit. Has this changed?

Aoki: Annually on New Year’s Day in Japan, a high-level Buddhist priest writes the calligraphy for a word representing the spirit of the people. This year he wrote “絆”“bond” (kizuna)signifying the ties both among Japan’s citizens, and between Japanese and the generous help and aid that poured in after March 11.

In Japan, there is a sense that people have rediscovered their ties to one another after the disaster. Before March 11, there was some worry that young people were not so concerned about others and about tradition. Many young people now want to become volunteers, and there is also a better sense of community.

What has the impact been on Japan’s economy, and what are the prospects for recovery?

Aoki: There is an increasing awareness that Japan cannot sustain the same kinds of export-oriented, manufacturing-based industrial structures it has over the past decades.

Since 2007, Japan’s net foreign exchange receipts from royalties, investments, and the like have exceeded those from trade. The economic structure is becoming less export oriented, so the March 11 disaster might trigger the acceleration of a more domestic-oriented economy. It might also lead to an increase in foreign direct investment, prompted in part by population aging and partly by appreciation of the yen. Japan will become more domestic market oriented, while at the same time more internationally active. A lot next year depends on what will happen with Europe’s economy, but otherwise the prospect for Japan’s GDP is not bad because of reconstruction demand.

Kushida: Recovering from March 11 presents a potentially more productive experience than the 2008 global financial crisis. In 2008, Japan’s exports dropped dramatically for a few months and then there was a sharp recession that recovered quickly. There was not a whole lot that people or companies could do, other than adjust to the potential decline. March 11 provides more opportunities for innovation at the company and individual level. 

As it is finding growth in the domestic market, Japan has been criticized lately for being “inward-looking.” But two things from this latest crisis are contributing to looking outward a little more. One is the sense of vulnerability and transience, so strengthening Japan’s economic base becomes a much more urgent matter. The second is that in the aftermath of the euro crisis, the very strong yen has also led to a huge move toward outward acquisitions that are becoming integrated with the domestic economy.

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Workers prepare to install solar panels on a Japanese house, Jan. 2011.
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For the past two decades China has been a poster child of successful globalization, integrating with the world and in the process lifting millions of citizens out of poverty. But China’s integration into the world economy and global trends drive and constrain Beijing’s ability to manage growing social, economic and political challenges. 

Global trends affect all nations, but China may be uniquely vulnerable to developments beyond its borders and beyond its control. Chinese leaders recognize the diversity and complexity of the challenges they face but appear determined to confront them individually and incrementally. How – and how well – they respond to those challenges will have significant consequences of China and the world. 

Many of these challenges center on rising expectations in the face of increasing competition.

Thanks to a fortuitous combination of wise decisions and good timing, China has made phenomenal progress in the three decades since Deng Xiaoping launched the policy of reform and opening to the outside world in 1978. More Chinese citizens live better today than ever before and many more expect to join the privileged ranks of the middle class. Aspirations and expectations have never been higher. That’s a very good situation to be in, but it also entails enormous challenges for China’s leaders because several trends indicate that meeting expectations could become increasingly difficult.

Chinese aspirations have never been higher, but meeting expectations could get increasingly difficult.

Specifically, China will find it increasingly difficult to sustain past rates of growth and improvements in living standards.

One visible trend results from the strategic decision to take on the easiest tasks first in order to produce an “early harvest” of tangible benefits that build experience and confidence to tackle the next set of challenges. By design, each successive set of challenges is more difficult than the ones that preceded it. There are many different manifestations of this phenomenon, including the decision to focus on the more developed coastal areas and move inward to less-developed regions characterized by less infrastructure, poorer nutrition and less education. Other manifestations include the consequences of joining international production chains as low-cost assemblers of goods that are designed, manufactured and marketed elsewhere. Sustained success requires moving up technical and managerial ladders to perform more demanding and better paying tasks. Other daunting challenges result from policies that have deliberately constrained domestic demand with predictable consequences that include increasing inflationary pressures and a nationwide property bubble.

A second category of challenges results from the fact that China now has, and will continue to have, more competition than in the past. When Deng announced the decision to pursue the longstanding goal of self-strengthening by following the model of Japan, Taiwan and other rapid modernizers, he was responding to a de facto invitation from the Carter administration for China to take advantage of “free world” economic opportunities without becoming an ally or having to change its political system. This gave China a 10-year head start with virtually no competition until the Soviet Union collapsed and the Cold War ended. China made good use of this opportunity and has since taken advantage of experience and ties forged with foreign partners before Central European states and the states of the former Soviet Union joined the game. 

India, Brazil, Indonesia and other “non-aligned” states stayed out of the game for a few years longer, thereby increasing China’s advantages. Now there are more players and potential competitors climbing the learning curve more rapidly than they otherwise might have done because they can learn from China’s experience. Foreign investors and international production chains now have far more options than they did when China was essentially the only large developing country in the game.

China now has, and will continue to have, more competition than in the past from other emerging economies.

A third set of challenges centers on demographic trends and implications. One is the oft-cited but nonetheless extraordinary challenge of being the first country in history to have a population that becomes old before it becomes rich. Many countries have graying populations – Japan and South Korea in Northeast Asia and most of Western Europe – but the others are much more highly developed than China and have extensive social safety nets to meet the needs of their senior citizens. China’s one-child-per-couple-policy has accelerated a demographic shift that normally occurs in response to higher standards of living, greater educational and employment opportunities for women, and the independent choices of millions of people. 

China must put in place an extensive and costly system to support its elderly – reducing the amount of money and other resources available for other goals – or live with the consequences of making individuals and couples responsible for the wellbeing of parents and grandparents. This challenge is compounded by the broader consequences of becoming a society in which there are few siblings, cousins, aunts, uncles or other relatives beyond the nuclear family.

A fourth challenge derives from the highly centralized character of China’s political system. For three decades, China arguably has been able to develop as quickly as it has because it is a unitary state – not a federal system in which the provinces have significant independent authority – with a single-party regime. This facilitates timely and decisive action in response to perceived needs and opportunities and makes it easier to coordinate multiple components of an increasingly complex system. There are advantages to this type of system, but also risks and costs. One set of risks results from the fact that “all” key decisions must be made at the apex of the system by a relatively small number of officials who have only finite time, attention and knowledge. As China has become more modern and prosperous, it has also become more diverse. Different locales, sectors of the economy, interest groups and other constituencies have diverse expectations of the political system. Keeping the many concerns and requirements straight, and successfully juggling and balancing competing demands, will continue to become more complex and difficult.

Looming challenges are under study, increasing the likelihood of avoiding the most negative consequences.

As this happens, it will intensify another challenge, namely, the challenge of being “right” most of the time with little to no cushion for error. Systems with distributed authority are more cumbersome, but they avoid single points of failure. The danger of single-point failure increases as the complexity of issues, number of competing viewpoints and volume of information increases. Logically, the chance of mistakes increases as decisions become more demanding. Theoretically, there exists a point in any system at which the system can be overwhelmed by the magnitude of the task. The eurozone crisis may be a cautionary example.

Recognizing these challenges should not be read as a pessimistic prediction of inevitable failure. Indeed, the fact that looming but not yet imminent challenges are already the subject of study, deliberation and debate around the world increases the likelihood of avoiding the most negative or disruptive consequences; mitigating those that cannot be avoided entirely; and capitalizing on the many positive trends toward greater cooperation, acceptance of interdependencies and ability to learn from others’ experiences. 

Clearly discernible trends point to common interests and opportunities for cooperation as well as to challenges of unprecedented complexity. Whether China continues to eschew active engagement to address challenges at the global level in order to concentrate on domestic problems will shape possibilities for international cooperation. So, too, will actions of other nations that help or hinder China’s ability to solve its problems.

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Asia’s demographic landscape is changing in a big way. Japan’s population is shrinking, as people are living longer, marrying later, and choosing to have fewer or no children. Korea is moving in the same direction, while China and the countries of South and Southeast Asia face similar issues in the coming decades. As this takes place, more people are moving to, from, and across Asia for job, education, and marriage opportunities.

These demographic changes present policymakers with new challenges and questions, including: What are the interrelationships between population aging and key macroeconomic variables such as economic growth? How will it impact security? What are the effects on employment policy and other national institutions? How have patterns of migration affected society and culture? What lessons can Asia, the United States, and Europe learn from one another to improve the policy response to population aging?

The Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) focused its third annual Stanford Kyoto Trans-Asian Dialogue on addressing the possible economic, social, and security implications of Asia’s unprecedented demographic transition. Thirty scholars, government figures, journalists, and other opinion leaders from Stanford, the United States, and countries across the Asia-Pacific region gathered September 8–9, 2011, in Kyoto, Japan, to discuss key issues related to the question of demographic change.

Comparative Demographics and Policy Responses

Japan’s shrinking workforce calls for labor policy changes, stressed presenters during the opening Dialogue session. Stanford Center for Population Research director Shripad Tuljapurkar stated that Japan’s population could decrease by as much as 25 percent and that its government has a window of approximately 40 years in which to act. In describing Japan’s demographic shift, Ogawa Naohiro, director of the Nihon University Population Research Institute, also emphasized the importance of good financial education for individuals as life expectancy increases.

Macroeconomic Implications

Economists Masahiko Aoki and Cai Fang addressed changes to East Asia’s economic landscape. Aoki, an FSI senior fellow, spoke of the transition from agriculture to industry that has occurred at different stages in Japan, Korea, and China and of the increasing cost of human capital that has followed. Cai, a Chinese Academy of Social Sciences labor and population expert, stated that after several decades of industrial growth China is now at a turning point in terms of its global competitiveness.

Labor and Migration

Scott Rozelle, codirector of Stanford’s Rural Education Action Program (REAP), opened the next day with a discussion of China’s rural human capital investment. Offering Mexico’s situation after the mid-1990s peso crisis as a comparison, he emphasized the immediate need for allocating more health and education resources to China’s rural areas. Ton-Nu-Thi Ninh, president of Tri Viet University, discussed the socioeconomic and cultural aspects of labor migration—a growing trend in Asia—and advocated that governments factor it more into their foreign policy development.

Security

The security impact of Asia’s demographic transition will take several decades to understand, but it will eventually lead to the need for significant policy re-strategization, stated Yu Myung Hwan, Korea’s former minister of foreign affairs and trade, during the closing Dialogue session. He suggested focusing on impacts that could result from the major changes taking place in fertility, urbanization, and migration. Concurring with many of Yu’s views, Stanford’s Shorenstein Distinguished Fellow Michael H. Armacost also noted the current lack of literature on the link between security and demography. In addition, he emphasized the need for the United States to continue pursuing good relations with China and Russia during this time of transition.

“Low fertility rates are not because women are all out there working. In fact, a number of countries have lots of females in the labor force and have achieved a resurgence of fertility. Achieving work-life balance is important, not just for women, but for men as well, and might play a role in lessening the gap in life expectancy between men and women.”

-Karen Eggleston, Director, Asia Health Policy Program

Throughout the event, Dialogue participants unanimously acknowledged the serious challenges facing policymakers as they look for ways to meet the evolving needs of individuals, families, and organizations. The demographic outlook is not entirely gloomy, however. Numerous participants also pointed to the potential for exciting advances and innovations in technology and international cooperation.

As in previous years, the event concluded with a lively public symposium and reception attended by students from Stanford and local universities, Shorenstein APARC guests and affiliates, and members of the general public. Speaking during the reception, Kadokawa Daisaku, mayor of Kyoto, and Kim Hyong-O, member and former speaker of the Korean National Assembly, acknowledged the significance of the Stanford Kyoto Trans-Asian Dialogue as a forum for addressing issues of mutual importance to the United States and Asia.

The Dialogue is made possible through the generosity of the City of Kyoto, FSI, and Yumi and Yasunori Kaneko. To read the final report from this and previous Dialogues, visit the event series page below.

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A worker stands on steel rods at a superblock construction site in Jakarta in February 2010. Increasing urbanization is one of many aspects of Asia's demographic change.
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Japan leads, chased closely by South Korea, with China, on a vastly larger scale, not far behind. Not as mercantilist development states nor as threats to America’s high-tech industry, but rather as the world’s most rapidly aging societies.

A wave of unprecedented demographic change is sweeping across East Asia. The region is at the forefront of a trend towards longer life expectancy and declining birthrates, which, combined, yield a striking rate of aging. Japan already confronts a shrinking population. Korea is graying even more quickly. And although China is projected to grow for another few decades, demographic change races against economic development. Could China become the first country to grow old before growing rich? In Southeast Asia, Singapore also confronts a declining birthrate and an aging society. Increasingly, Asia’s aging countries look to its younger societies, such as Vietnam, Indonesia, and India, as sources of migrant labor and even wives. Those countries in turn face their own demographic challenges, such as how to educate their youth for a globally competitive
economy.

Held September 8–9, 2011 in Kyoto, Japan, the third Stanford Kyoto Trans-Asian Dialogue focused on demographic change in the region and its implications across a wide range of areas, including economies, societies, and security. Asia’s experience offers both lessons and warnings for North America and Europe, which face similar problems. Questions addressed included:
 

  • What are the interrelationships between population aging and key macroeconomic variables such as economic growth, savings rates, and public and private intergenerational transfers?
     
  • How and why do policy responses to population aging differ in Japan, South Korea, and across different regions of China?
     
  • What are the effects of demographic change on national institutions such as employment practices, pension and welfare systems, and financial systems?
     
  • What policies can or should be pursued to influence future outcomes?
     
  • How will demographic change affect security in the Asia-Pacific region?
     
  • How have patterns of migration impacted society and culture in East Asia, in comparative perspective?
     
  • How will demographic change influence the movement of people across the region and the prevalence of multicultural families?
     
  • What lessons can Asia, the United States, and Europe learn from each other to improve the policy response to population aging?
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Established in 2007, the Asia Health Policy Program (AHPP) promotes a comparative understanding of health and health policy in the Asia-Pacific region through research, collaboration with scholars throughout the region, a colloquium series on health and demographic change in the Asia-Pacific, and conferences and publications on comparative
health policy topics.

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As lifestyles in China are changing, so too is the ability for people to care for their elderly family members at home. American healthcare companies are beginning to eye China as a potential market for senior residential facilities. Asia Health Policy Program director Karen Eggleston spoke with NPR about possible models for providing affordable, quality care for China's elderly.
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Chinese families, including the elderly, are impacted by lifestyle changes.
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Walter H. Shorenstein
Asia-Pacific Research Center
616 Serra St C335
Stanford University
Stanford, CA 94305-6055

(650) 724-5668 (650) 723-6530
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2011-12 Asia Health Policy Fellow
SunAng_Profile.jpg MA, PhD

Ang Sun joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) from Brown University’s department of economics where she recently received her PhD.

Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families. During her time at Shorenstein APARC, Sun will participate in an interdisciplinary study of the impact of the aging process in Asia on economic growth.

Sun holds a PhD and an MA in economics from Brown University, and an MA from the China Center of Economic Research. She also received a BA in economics and a BS in information and computer science from Beijing University.

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