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AGING IN ASIA

FINDINGS FROM NEW AND EMERGING
DATA INITIATIVES

Panel on Policy Research and Data Needs to
Meet the Challenge of Aging in Asia

James P. Smith and Malay Majmundar, Editors

Committee on Population

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL
                             OF THE NATIONAL ACADEMIES



THE NATIONAL ACADEMIES PRESS
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AGING IN ASIA FINDINGS FROM NEW AND EMERGING DATA INITIATIVES Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Asia James P. Smith and Malay Majmundar, Editors Committee on Population Division of Behavioral and Social Sciences and Education

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by the National Institute on Aging’s Division of Behavioral and Social Research through Contract No. NO1-OD-4-2139, Task Order Numbers 92, 226, and 260 between the National Academy of Sciences and the U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number-13: 978-0-309-25406-9 International Standard Book Number-10: 0-309-25406-X Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Research Council. (2012). Aging in Asia: Findings from New and Emerging Data Initiatives. J.P. Smith and M. Majmundar, Eds. Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Asia. Com - mittee on Population, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal govern - ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstand - ing engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the fed - eral government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineer- ing communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PANEL ON POLICY RESEARCH AND DATA NEEDS TO MEET THE CHALLENGE OF AGING IN ASIA JAMES P. SMITH (Chair), RAND Corporation, Santa Monica, California PERIANAYAGAM ARIOKIASAMY, International Institute for Population Sciences, Mumbai, India DAVID E. BLOOM, Department of Global Health and Population, Harvard University DANIEL COTLEAR, Human Development Network, The World Bank, Washington, DC HIDEHIKO ICHIMURA, Graduate School of Economics, University of Tokyo, Japan DANIEL L. MC FADDEN, Department of Economics, University of California, Berkeley K. SRINATH REDDY, Public Health Foundation of India, New Delhi, India DAVID R. WEIR, Institute for Social Research, University of Michigan YAOHUI ZHAO, China Center for Economic Research, Peking University, Beijing, China XUEJIN ZUO, Shanghai Academy of Social Sciences, Shanghai, China BARNEY COHEN, Study Director MALAY MAJMUNDAR, Program Officer JACQUELINE R. SOVDE, Program Associate (until December 2011) DANIELLE JOHNSON, Senior Program Assistant v

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COMMITTEE ON POPULATION 2011 LINDA J. WAITE (Chair), Department of Sociology, University of Chicago CHRISTINE BACHRACH, Social Science Research Institute, Duke University and School of Behavioral and Social Sciences, University of Maryland EILEEN M. CRIMMINS, Department of Sociology, University of Southern California PETER J. DONALDSON, Population Council, New York, NY BARBARA ENTWISLE, Department of Sociology, University of North Carolina, Chapel Hill JOSHUA R. GOLDSTEIN, Max Planck-Institute for Demographic Research, Rostock, Germany CHARLES HIRSCHMAN, Department of Sociology, University of Washington BARTHÉLÉMY KUATE-DEFO, Department of Demography, University of Montreal WOLFGANG LUTZ, World Population Program, International Institute for Applied Systems Analysis, Laxenburg, Austria DUNCAN THOMAS, Economics Department, Duke Global Health Institute, Duke University BARBARA B. TORREY, Independent Consultant, Washington, DC MAXINE WEINSTEIN, Center for Population and Health, Georgetown University BARNEY COHEN, Director BARBARA BOYD, Administrative Coordinator vi

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Preface T he population of Asia is growing both larger and older. Demograph- ically the most important continent in the world, Asia’s popula- tion, currently estimated (by the Population Division of the United Nations) to be 4.2 billion, is expected to increase to about 5.9 billion by 2050. At that time, the number of Asians aged 65 and older will have grown four- fold, from about 250,000,000 today to about 1 billion by 2050. Rapid declines in fertility, together with rising life expectancy, are altering the age structure of the population so that in 2050, for the first time in history, there will be roughly as many people in Asia over the age of 65 as under the age of 15. This demographic transformation, from a youthful to a more mature society, is occurring far more rapidly in Asia than in today’s more indus- trially advanced countries. Changes in the population age structure that played out over more than 140 years in Western Europe are occurring in countries such as China in less than 25 years. And while some Asian countries are experiencing rapid economic development, reflecting their integration in the world’s economy, other countries are developing con - siderably more slowly. Although population aging can be considered a triumph of social and economic development, public health, and modern medicine, it also creates major challenges for Asian governments that strive to provide social and economic security for their older populations. The projected growth in the proportion of the population aged 65 and older also has significant implications for families and kinship networks in Asia, given that the responsibility for economic support for older persons still rests vii

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viii AGING IN ASIA almost entirely with their immediate and extended family members. All too often, older people represent a population that is vulnerable and invisible, missed by interventions to eliminate poverty or improve health and well-being. The Committee on Population’s interest in aging issues goes back at least to the early 1990s, when it published the report Demography of Aging.1 Since then, the committee has taken up many issues relating to international demography and the challenges associated with popula- tion aging that have led to several reports, including Preparing for an Aging World: The Case for Cross-National Research,2 Aging in Sub-Sahara Africa: Recommendations for Furthering Research,3 International Differences in Mortality at Older Ages,4 and Explaining Divergent Levels of Longevity in High-Income Countries.5 It is against this backdrop that the Division of Behavioral and Social Research at the U.S. National Institute on Aging (NIA) asked the National Research Council (NRC), through the Committee on Population, to under- take a project on advancing behavioral and social research on aging in Asia. The Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Asia was appointed to carry out this project. The first of the project’s two activities was a collaborative effort with the Chinese Academy of Social Sciences, the Indian National Science Academy, the Indonesian Academy of Sciences, and the Science Council of Japan to develop a report on strengthening the scientific basis for developing policies to meet the challenges of population aging in Asia. That effort—the first ever collaboration between all five organizations— resulted in Preparing for the Challenges of Population Aging in Asia: Strength- ening the Scientific Basis of Policy Development, published in 2011.6 The second part of the project included two conferences and this publication. Following a planning meeting that was hosted by the Indian National Science Academy in New Delhi on May 3-4, 2010, the first con - ference was in Beijing, hosted by the Chinese Academy of Social Sci- ences, on December 9-10, 2010; the second was in New Delhi, hosted by the Indian National Science Academy, on March 14-15, 2011. These conferences provided an opportunity for Asian and other researchers to discuss important data collection initiatives (at different stages of evolu - tion and development) taking place throughout the region, exchange knowledge, share common experiences, and engage with policy makers. 1 Available: http://www.nap.edu/catalog.php?record_id=4553 [February 2012]. 2 Available: http://www.nap.edu/catalog.php?record_id=10120 [February 2012]. 3 Available: http://www.nap.edu/catalog.php?record_id=11708 [February 2012]. 4 Available: http://www.nap.edu/catalog.php?record_id=12945 [February 2012]. 5 Available: http://www.nap.edu/catalog.php?record_id=13089 [February 2012]. 6 Available: http://www.nap.edu/catalog.php?record_id=12977 [February 2012].

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ix PREFACE Subsequently, selected papers from the conferences were reviewed and revised for inclusion in this volume. This project would not have been possible without a great deal of effort, good will, and cooperation on the part of a large number of people. Particu- lar thanks go to Dr. Richard Suzman of NIA for providing intellectual sup- port and encouragement for the project. We are also especially grateful to members of the organizing committees appointed by our sister academies in Asia for their assistance in planning the two conferences: see Box P-1. This project also would not have been possible without financial sup- port from many organizations. First and foremost, we gratefully acknowl- edge the Division of Behavioral and Social Research at NIA for providing the principal source of financial support for the project. Thanks also go to the Carnegie Foundation, for providing funding for the 2010 planning meeting in New Delhi; to the Chinese Academy of Social Sciences, for BOX P-1 CHINESE ACADEMY OF SOCIAL SCIENCES Zhenzhen Zheng (Chair), Institute of Population and Labor Economics Fang Cai, Institute of Population and Labor Economics Yang Du, Institute of Population and Labor Economics Guangzhou Wang, Institute of Population and Labor Economics INDIAN NATIONAL SCIENCE ACADEMY P.N. Tandon (Chair), National Brain Research Centre, Haryana Moneer Alam, Population Research Centre, Institute of Economic Growth, New Delhi P. Arokiasamy, Department of Development Studies, International Institute for Population Sciences, Mumbai A.B. Dey, All India Institute of Medical Sciences, New Delhi INDONESIAN ACADEMY OF SCIENCES Mayling Oey-Gardiner (Chair), Faculty of Economics, University of Indonesia R. Sjamsuhidajat, School of Medicine, University of Indonesia SCIENCE COUNCIL OF JAPAN Hiroko Akiyama, Institute of Gerontology, University of Tokyo

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x AGING IN ASIA hosting and cofunding the Beijing conference; to the Indian National Sci - ence Academy, for hosting and cofunding the New Delhi conference; and to the United Nations Population Fund, for supporting the participation of a number of researchers from around India to attend the New Delhi conference. Special thanks are also due to James P. Smith, chair of the panel that helped organize the Beijing and New Delhi conferences and that oversaw this volume, and to Malay Majmundar, who provided key staff support for the panel’s work. Thanks are also due to other NRC staff—to Danielle Johnson for her help in preparing the report for production, Jacqui Sovde for providing administrative support, and to Yvonne Wise for overseeing the production process. Thanks, too, to Paula Whitacre for her skillful editing. This project was carried out under the general direction of Barney Cohen, director of the Committee on Population. The papers in this volume have been reviewed in draft form by indi - viduals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the NRC. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its pub - lished volume as sound as possible and to ensure that the volume meets institutional standards for objectivity, evidence, and responsiveness to the study charge. We thank the following individuals for their review of these papers: Yukiko Abe, Graduate School of Economics and Business Administration, Hokkaido University; Emily Agree, Department of Population, Family, and Reproductive Health, Johns Hopkins University; Kathleen Beegle, Development Research Group, World Bank; Charles C. Brown, Depart- ment of Economics, University of Michigan; Lisa Cameron, Department of Econometrics, Monash University; Angelique Chan, Department of Sociol- ogy, National University of Singapore; Amitabh Chandra, John F. Kennedy School of Government, Harvard University; Courtney Coile, Department of Economics, Wellesley College; Donald Cox, Department of Economics, Boston College; Eileen Crimmins, Davis School of Gerontology, University of Southern California; Sonalde Desai, Department of Sociology, Univer- sity of Maryland; William H. Dow, School of Public Health, University of California, Berkeley; Andrew Foster, Department of Economics, Brown University; Peter Gardiner, consultant; John Giles, Development Research Group, World Bank; Dana Glei, Center for Population and Health, George- town University; Noreen Goldman, Woodrow Wilson School, Princeton University; Tara Gruenewald, Department of Medicine, University of Cali- fornia, Los Angeles; Mark Hayward, Department of Sociology, University of Texas at Austin; Charles Hirschman, Department of Sociology, Univer- sity of Washington; Charles Yuji Horioka, Institute of Social and Economic

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xi PREFACE Research, Osaka University; Arun Karlamangla, School of Medicine, Uni- versity of California, Los Angeles; Cynthia Kinnan, Department of Eco- nomics, Northwestern University; Ronald Lee, Center on the Economics and Demography of Aging, University of California, Berkeley; Xiaoyan Lei, China Center for Economic Research, Peking University; Ajay Mahal, Fac- ulty of Medicine, Nursing, and Health Sciences, Monash University; Manoj Mohanan, Global Health Institute, Duke University; Xin Meng, College of Business and Economics, Australian National University; Olivia Mitchell, Wharton School, University of Pennsylvania; Mayling Oey-Gardiner, Fac- ulty of Economics, University of Indonesia, Jakarta; Mary Beth Ofstedal, Institute for Social Research, University of Michigan; Albert Park, School of Humanities and Social Science, Hong Kong University of Science and Technology; Krislert Samphantharak, Department of Economics, Univer- sity of California, San Diego; Sam Schulhofer-Wohl, Federal Reserve Bank of Minnesota; Grant Scobie, New Zealand Treasury; Alessandro Tarozzi, Department of Economics, Duke University; Barbara Torrey, consultant: Emily E. Wiemers, Department of Economics, University of Massachusetts Boston; Richard Wight, School of Public Health, University of California, Los Angeles; Jean Yeung, Department of Sociology, National University of Singapore; Julie Zissimopoulous, Department of Clinical and Pharmaceu- tical Economics and Policy, University of Southern California; and Xuejin Zuo, Shanghai Academy of Social Sciences. Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the content of any of the papers, nor did they see the final version of any paper before this publication. The review of this volume was overseen by Duncan Thomas, Department of Economics, Duke University. Appointed by the NRC, he was responsible for making certain that an independent examination of the papers was carried out in accordance with institu- tional procedures and that all review comments were carefully consid- ered. Responsibility for the final content of this report rests entirely with the authors. Linda J. Waite, Chair Committee on Population

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Foreword S cience academies are in a unique position to draw on the expertise of scholars from a variety of disciplines and to help lay a solid evi- dentiary foundation for policy. Science academies can synthesize relevant research results in nontechnical language and can use rigorous, apolitical procedures to produce objective and unbiased analysis. Conse- quently, science academies can generate authoritative, credible, evidence- based findings and recommendations for policy makers. Most countries around the world are experiencing a rapid increase in the proportion of their populations who are over the age of 65, because people are living longer and because many couples are choosing to have smaller families than their parents had. The world’s population aging reflects great social, economic, and medical progress over the last 100 years, but it raises major challenges for governments in almost all areas, most especially related to health, pension, and employment policies. Perhaps nowhere in the world is this demographic transition as stark as in parts of Asia, where rapid population aging is occurring at the same time as a dramatic economic transformation. In the face of these rapid social, economic, and demographic changes, there is a clear need to enhance our understanding of how they will affect the well-being of older people and, particularly, how they will influence long-standing societal and familial arrangements that have been a vital part of the economic support of older people in the region. Although the scientific basis for formulating evidence-based policy to address population aging is relatively underdeveloped in many Asian xiii

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xiv AGING IN ASIA countries, there is still time for them to mobilize resources and make investments in research and data collection that can have long-term ben- efits. The countries in Asia can learn from the experiences of countries in other parts of the world, and cross-national collaboration and coordina- tion can further multiply the returns on investment in scientific infrastruc- ture made by individual countries. To contribute to that understanding, the national science academies of China, Japan, India, Indonesia, and the United States sponsored two conferences on policy research and data needs to meet the challenges of population aging in Asia. The first, hosted by the Chinese Academy of Social Sciences, was held in Beijing on December 9-10, 2010; the sec - ond, hosted by the Indian National Science Academy, took place in New Delhi on March 14-15, 2011. A third conference, organized indepen- dently by the Indonesian Academy of Sciences, took place in Bali on October 11-12, 2011. The current volume contains selected papers from the first two of these conferences. Papers from the third conference will be published separately. We hope that this volume of papers and the intellectual ferment they represent can contribute to the long-term well-being of older people in Asia. Chen Jiagui Krishan Lal Former Vice President President Chinese Academy of Social Sciences Indian National Science Academy Sangkot Marzuki Ichiro Kanazawa President President Indonesian Academy of Sciences Science Council of Japan Ralph J. Cicerone President U.S. National Academy of Sciences

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Contents 1 Introduction and Overview 1 James P. Smith and Malay Majmundar NEW AND EMERGING DATA INITIATIVES 2 Preparing for Population Aging in Asia: Strengthening the Infrastructure for Science and Policy 17 James P. Smith 3 Longitudinal Aging Study in India: Vision, Design, Implementation, and Preliminary Findings 36 P. Arokiasamy, David Bloom, Jinkook Lee, Kevin Feeney, and Marija Ozolins ECONOMIC GROWTH, LABOR MARKETS, AND CONSUMPTION 4 Population Aging, Intergenerational Transfers, and Economic Growth: Asia in a Global Context 77 Ronald Lee and Andrew Mason 5 Facilitating Longer Working Lives: The Need, the Rationale, the How 96 David Wise xv

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xvi CONTENTS 6 The Labor Supply and Retirement Behavior of China’s Older Workers and Elderly in Comparative Perspective 116 John Giles, Dewen Wang, and Wei Cai 7 Relying on Whom? Poverty and Consumption Financing of China’s Elderly 148 Albert Park, Yan Shen, John Strauss, and Yaohui Zhao 8 Retirement Process in Japan: New Evidence from the Japanese Study on Aging and Retirement (JSTAR) 173 Hidehiko Ichimura and Satoshi Shimizutani FAMILY ROLES AND RESPONSIBILITIES 9 Patterns and Correlates of Intergenerational Nontime Transfers: Evidence from CHARLS 207 Xiaoyan Lei, John Giles, Yuqing Hu, Albert Park, John Strauss, and Yaohui Zhao 10 Household Dynamics and Living Arrangements of the Elderly in Indonesia: Evidence from a Longitudinal Survey 229 Firman Witoelar 11 Social Networks, Family, and Care Giving Among Older Adults in India 261 Lisa F. Berkman, T.V. Sekher, Benjamin Capistrant, and Yuhui Zheng 12 Effects of Social Activities on Cognitive Functions: Evidence from CHARLS 279 Yuqing Hu, Xiaoyan Lei, James P. Smith, and Yaohui Zhao HEALTH AND WELL-BEING 13 Socioeconomic Success and Health in Later Life: Evidence from the Indonesia Family Life Survey 309 Firman Witoelar, John Strauss, and Bondan Sikoki 14 Healthcare and Insurance Among the Elderly in China: Evidence from the CHARLS Pilot 342 John Strauss, Hao Hong, Xiaoyan Lei, Lin Li, Albert Park, Li Yang, and Yaohui Zhao

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xvii CONTENTS 15 Health of the Elderly in India: Challenges of Access and Affordability 371 Subhojit Dey, Devaki Nambiar, J.K. Lakshmi, Kabir Sheikh, and K. Srinath Reddy 16 Markers and Drivers: Cardiovascular Health of Middle-Aged and Older Indians 387 Jinkook Lee, P. Arokiasamy, Amitabh Chandra, Peifeng Hu, Jenny Liu, and Kevin Feeney 17 Aging, Health and Chronic Conditions in China and India: Results from the Multinational Study on Global AGEing and Adult Health (SAGE) 415 Paul Kowal, Sharon Williams, Yong Jiang, Wu Fan, P. Arokiasamy, and Somnath Chatterji 18 Life Satisfaction of the Older Thai: Findings from the Pilot HART 438 Dararatt Anantanasuwong and Udomsak Seenprachawong Biographical Sketches of Contributors 451

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