In little more than half a century the average Chinese life span has almost doubled. Life expectancy in China is now 76 years, nearly on par with the U.S.’s 79 years. Yet this tremendous boon comes with a dark side: an aging population.
China’s one-child policy throttled population growth so successfully that the proportion of elderly Chinese is now soaring. A 2011 report from the Chinese Academy of Social Sciences predicts that the percentage of the population that is 65 or older will triple between 2000 and 2050. With an aging population comes a greater burden of diseases, chief among them neurodegeneration. Already China has more than nine million people with some form of dementia and more cases of Alzheimer’s disease than any other country, according to a 2013 paper in The Lancet. Its authors dubbed dementia “the single largest challenge to health and social care systems” in China.
The consequences of this trend are profound, and the country has only recently begun to prepare for them. In 2009 the government committed $124 billion to overhauling health care, with a goal of providing basic health insurance for 90 percent of its citizens. The plan also highlighted mental health services as a top priority for the first time. Last year China implemented its first mental health law, which expands psychiatric services throughout the country. Although the policy does not explicitly mention dementia, it underscores the urgent need for community mental health clinics, which could end up aiding families struggling to cope with a relative’s dementia.
To find out more about the implications of China’s demographic shift and the steps the country can take to buffer itself, Scientific American spoke with Michael Phillips, a psychiatrist who has lived in China for 30 years, during the annual meeting of the American Psychiatric Association last week. Phillips has dual appointments at Shanghai Jiao Tong University School of Medicine and the Collaborative Center for Global Mental Health at Emory University.
[An edited transcript of the interview follows.]
What is the main challenge for China today regarding its elderly population?
Dementia is a juggernaut that’s coming down the pike. The big question is where people with dementia are going to be cared for. Right now there are no nursing homes that provide medical care. The ones that exist in urban areas are rest facilities. If your parents have a serious medical problem, the homes are not willing to take them because they have no medical staff. So your options if you live in an urban area are to hire someone from the countryside to take care of your parents or to send them to a psychiatric hospital.
What kind of psychiatric hospital are we talking about?
Geriatric wards are opening up in the psychiatric hospitals in major urban centers, but that is a very expensive method of treatment. As the numbers increase it will become even more expensive.
What about in rural areas?
Most of the young people have moved to cities and the elderly are left on their own. With an increasing proportion of children living in different cities or overseas, it becomes more difficult for them to provide services for needy elderly. The obvious answer is nursing homes, but right now the biggest obstacle is that China doesn’t have the medical staff to man them.
Why do nursing homes lack sufficient medical staff?
Nursing is such a low-status job in China, that’s one problem. So is psychiatry, so attitudes need to change. Another problem is that people have resisted the idea of services for the elderly. About 50 years ago Shanghai, which is always ahead of the curve, set up nursing homes but the elderly refused to go there. The city was trying to get ahead of the trend but it ended up giving up on the initiative.
How does the Chinese virtue of filial piety play into this demographic issue?
Parents expect that their children will take care of them, though that tradition is now weakening. The government is trying to reassert those responsibilities for the family, because the state knows it can’t take care of this whole population. Last year it implemented a law mandating that all adult children must visit their parents frequently. If they don’t, parents now have grounds on which to sue.
What can China do to prepare for a burgeoning aging population?
Social change needs to occur on both sides. China needs to provide a network of services with a sufficiently competent medical staff. Families need to find a way to embrace the idea of nursing homes—not to mention there are a couple Nobel Prizes to be won for curing Alzheimer’s. China should devote more money to researching the disease.
How would you like to see the psychiatric profession evolve in China in the next few decades?
In the last 10 years, especially with the new mental health law, things have accelerated faster than one could have imagined. Still there are a couple things I’d like to see happen that aren’t happening. I get the sense that physicians and psychiatrists need to become more compassionate. They see themselves as mechanics of the body or brain. There is wholehearted acceptance of the biological view of psychiatry, but the compassionate side is often lacking in China. Yet compassion is our most important tool.