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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
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ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the
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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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