Promoting Old-Age Vitality in the People’s Republic of China

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Working with the People’s Republic of China to Pilot Public-Private Partnership in Elderly Care

In Asia, government assistance to the elderly in the form of noncontributory transfers or social pensions averages only 0.2% of aggregate gross domestic product, with only five countries – Maldives, the Republic of Korea, Thailand, Mongolia, and Nepal – spending more than that.

ADB is working with the People’s Republic of China to pilot public-private partnership in elderly care.

How to deal with the elderly is a pressing challenge for the People’s Republic of China with the number of the over 65s set to rise from 142 million in 2016 to 289 million, or 20% of the population, by 2034.

In the People’s Republic of China, ADB is working with the local government in Yichang, a third-tier city in the Yangtze River Economic Belt region, to structure a public-private partnership that will demonstrate how the government and private entities can work together to provide better elderly care services.

Li Zheng and his wife thought that his son and daughter-in-law would look after them when they got old but since they moved away, they will have to make other arrangements.

“When I reach the age when I have physical difficulties, I will definitely want to go to an old-age residential home,” said the 84-year-old Mr. Li, a retired engineer now living in central Beijing, in the People’s Republic of China (PRC). “I think a good elderly care system should include good surroundings, good facilities for entertainment, and good food, as well as easy access to hospital and healthcare.”

“Private sector technical and operational expertise as well as possible funding will be crucial to tackling the complexities of elderly care” Hiroko Uchimura Shiroishi, Senior Social Sector Specialist, East Asia Department.

The decisions facing Mr. Li and his wife are typical in the PRC which has seen the number of its elderly soar in recent decades even as their children, who in the past would have looked after them, are moving away in search of jobs.

How to deal with the elderly is a pressing challenge for the PRC too with the number of the over 65s set to rise from 142 million in 2016 to 289 million, or 20% of the population, by 2034 (ADB Briefs, 2018). The country will have some 98 million people aged 80 years or more by then too, up from just 18 million now (ADB Project). However, other countries in the region will also need to address this issue sooner or later.

By 2018, for example, 11.9% of Thailand’s population was aged 65 years or more, up from 6.5% in 2000, but even countries still enjoying a demographic dividend such as India, the elderly now makes up a larger 6.2% of the population and 5.9% in Indonesia (Key Indicators).

“Economies will slow if the region doesn’t deal with its greying population. Asia is unique in that it is aging much faster than other regions and so it needs new solutions specific to the region,” said Donghyun Park, Principal Economist with the Asian Development Bank’s (ADB) Economic Research and Regional Cooperation Department.

Governments though face numerous calls on their finances and have little experience providing elderly care. Needs can vary with some cities aging more rapidly than others. Some elderly need intensive care to tackle dementia or physical disabilities while others may need only intermittent care at home. Elderly care also needs to be coordinated with overall healthcare.

“Private sector technical and operational expertise, as well as possible funding, will be crucial to tackling this,” said Hiroko Uchimura Shiroishi, Senior Social Sector Specialist with ADB’s East Asia Department, noting that while spending on elderly care is going up, it isn’t rising as fast as it needs to. In Asia, government assistance to the elderly in the form of noncontributory transfers or social pensions averages only 0.2% of aggregate gross domestic product, with only five countries – the Maldives, the Republic of Korea, Thailand, Mongolia, and Nepal – spending more than that (Social Protection Index).

In the PRC, ADB is working with the local government in Yichang, a third-tier city in the Yangtze River Economic Belt region, to structure a public-private partnership (PPP) that will demonstrate how the government and private entities can work together to provide better elderly care services.  Under the PPP, the Yichang local government will build the elderly care facilities while the private entity will run them, providing different levels of care. An upcoming project in the southern Guangxi Zhuang Autonomous Region will build on this work to train and develop another PPP project in which the private sector partner will both build and run the elderly facilities and services.

Another PPP project in the pipeline in Xiangyang, Hubei Province will further help develop a range of care services, including residential care, daycare, rehabilitation, and geriatric medicine.

“Across developing Asia, there is a huge lack of knowledge within local governments about the intricacies of social sector PPP design, procurement, and contract management,” said Srinivas Sampath, Chief of ADB’s PPP thematic group. “Promoting a mechanism for genuine and transparent PPPs that can be replicated would allow the region to tackle the funding gap and the complex issues around elderly care.”

Services will focus around a three-tier system comprising options for elderly care in elderly residences, in the community, or from their home rather than simply building more old-age homes with more beds. This 3-pronged approach is in line with international trends which recognizes that delivering services to the elderly in their own home is both better for the older person, more cost-effective in the long-run, and allows family carers to return to the labor market.

And the projects will also help improve training for the large numbers of caregivers, nurses, physiotherapists, and others needed to ensure the elderly stay fit and healthy as long as possible.

This article is reproduced from Asian Development Bank.

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What Can ASEAN Learn from the People’s Republic of China’s Poverty Reduction Strategy?

Agriculture was the main driver for poverty reduction and growth in the People's Republic of China from 1978 to the mid-1980s. Photo credit: ADB

The experience of the People’s Republic of China shows that beyond economic growth, an adaptive and cooperative approach can help reduce poverty even at hard to reach places.

Introduction The People’s Republic of China (PRC) has experienced unprecedented economic growth and poverty reduction since 1978. Ravallion and Chen (2007)1, among many other researchers, concluded such transformation was largely due to agriculture growth, especially in the early stage of PRC’s reform era until the mid-1980s. Amid accelerated industrialization and urbanization, the PRC government launched poverty reduction programs for its under-developed western regions in the mid-1980s and rolled out national strategies for poverty alleviation since mid-1990s. When the country introduced an urban-rural coordination strategy in the new century, it also extended social protection schemes from the urban to rural areas in 2007. These programs have offset the moderating effects of slower economic growth in alleviating poverty and contain key lessons for countries considering poverty reduction strategies.
This article is adapted from an unpublished study, “Agricultural Development and Transformation-Led Growth and Poverty Reduction in the PRC: Key experiences and lessons to share with ASEAN Countries.”

Analysis

The PRC and Association of Southeast Asian Nations (ASEAN) member states differ in many respects, but also share similar experiences. Rapid economic growth, as well as social and economic transformations, have helped many to reduce poverty, but they also face similar challenges in rising inequality and lack of growth in the agricultural sector. Lessons from the PRC can guide the design and implementation of poverty reduction strategies in ASEAN countries.

Political and social stability, as well as a consistent development strategy, are important conditions for poverty reduction. Experiences from Cambodia, PRC, Indonesia, Malaysia, and Viet Nam suggest that poverty reduction benefits from long-term systematic government interventions. Improved poverty reduction performance boosts ruling parties’ legitimacy which in turn contributes to a stable political system necessary for implementing long-term development initiatives.

Economic growth is fundamental to poverty reduction. There are two main approaches to poverty reduction: investments in businesses that “trickle-down” to benefit all levels of society, or income redistribution schemes through government interventions. Experiences in the PRC suggest that economic growth can “trickle-down” and reduce poverty if growth occurs in sectors that benefit the poor. In addition, economic growth as a poverty reduction tool is most effective in countries that have relatively equal economic and social situations. As inequality increases, government interventions are needed to ensure the poor benefit from economic growth and to protect those left behind.

Agriculture is indispensable for achieving sustained rural poverty reduction. Agriculture is a primary driver for reducing rural poverty, particularly in countries where most of the population live in rural areas and engage in agriculture-based activities. Improving productivity in the agricultural sector through improved infrastructure, better access to markets, and availability of improved seed varieties and cultivation technologies directly reduce poverty in rural areas. In countries with limited land resources, raising productivity of existing fields is a key method for promoting growth in the sector.

Figure 1: Annual GDP Growth Rate, Annual Agricultural Growth Rate, and Poverty Incidence at National Absolute Poverty Line in the People’s Republic of China

Source: National Bureau of Statistics of the People's Republic of China.

Industrialization can be an effective pathway out of rural poverty. Non-agricultural employment can reduce poverty in rural areas by offering workers another source of income especially during periods of low employment in the cultivation cycle. Rural industrialization becomes increasingly important as agricultural activities decline in relative importance in the wider economy while also increasing rural laborers’ resilience to shocks by diversifying incomes. By offering employment opportunities in small and medium cities, non-agricultural rural enterprises can help slow the expansion of large cities that may not be able to accommodate large influxes of migrant workers.

Targeted governmental interventions can reduce poverty in places where economic growth cannot reach. PRC’s experience suggests that pro-poor interventions can be successful when the trickle-down effects of economic growth weaken and poverty rate is relatively low. The PRC government has channeled diverse resources to support targeted interventions that aim to address the country’s multi-dimensional extreme poverty. Targeted interventions can be industry-based, educational, and cash-transfer social protection approaches. Their selection will depend critically on the accurate identification of the poor, and diagnosis of poverty root causes.

Social protection programs for poverty reduction are more efficient when multi-dimensional poverty increases. In initial stages of economic growth, financial and organizational resources are often limited, thus, social protection programs can hardly be implemented. As growth continues, redistributing income becomes more feasible. And as poverty becomes multi-dimensional, it is increasingly difficult to overcome it merely through economic growth. While many rural families are not poor by the measure of income, they may still lack adequate education or health care that could help sever the inter-generational transmission of poverty. The PRC’s anti-poverty policy that shifts from a developmental approach to an approach combining development and social protection can thus shed some light on when to introduce and how to design pro-poor social protection programs.

Implications

Three approaches to reducing poverty are suggested, namely,

  1. Identify a strategy to eliminate rural absolute poor through a rapid economic transformation;
  2. Develop rural areas; and
  3. Adopt a cooperative approach to understand and address multi-dimensional poverty.

ASEAN countries’ high economic growth rates have been underpinned by robust foreign investments leading to strong employment gains in the manufacturing sector that help countries to reduce poverty. As many ASEAN countries continue to depend on agriculture, there is scope for improvements that will positively affect the rural poor. (World Development Indicators show 7 out of 10 ASEAN member countries have an agriculture sector that accounts for more than 20% of its total employment, and 5 countries have an over 10% agricultural GDP share in 2017). PRC’s experience shows boosting productivity, promoting the rural industry, and developing small cities are key poverty reduction initiatives.

On the other hand, ASEAN can also share useful lessons with the PRC. In particular, Malaysia’s, Singapore’s, and Thailand’s experiences in urban poverty reduction, social protection programs, and rural tourism can help the PRC design and implement better poverty reduction and rural transformation initiatives.

1 M. Ravallion, and S, Chen. 2007. China’s (uneven) Progress Against Poverty. Journal of Development Economics. 82(1). 1– 42.

References

X. Li. 2018. Growth Transformation and Poverty in the PRC and ASEAN. Presentation at 12th ASEAN-China Forum on Social Development and Poverty Reduction. Manila. 27-29 June.

National Anti-Poverty Commission, the Philippines. 2018. Philippine Experience on Poverty Reduction. Presentation at the 12th ASEAN-China Forum on Social Development and Poverty Reduction. Manila. 27-29 June.

M. Ravallion, and S. Chen. 2007. China’s (uneven) Progress Against Poverty. Journal of Development Economics. 82(1). 1– 42.

Authors
Picture of Xiaoyun Li

Xiaoyun Li

Distinguished Professor at College of Humanities and Development Studies of China Agricultural University

Picture of  Hsiao Chink Tang

Hsiao Chink Tang

Senior Economist, East Asia Department, Asian Development Bank

Picture of  Jin Xu

Jin Xu

Associate Professor and Assistant Dean, China Institute for South–South Cooperation in Agriculture

This blog is reproduced from Development Asia.

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