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International Journal of
Population Studies Health disparities and older adults well-being in China

highest since 2000. Nevertheless, by 2022, the number of development. However, in the pursuit of economic growth,
births had sharply declined to 9.56 million, nearly halving the Chinese government implemented the one-child policy
in less than a decade since the policy change (Figure 1). to intervene in fertility for a prolonged period (1979 – 2015),
This precipitous drop in newborns within such a brief causing the birth rate to decline earlier and more rapidly than in
timeframe poses a substantial threat to the stability of any other country. At the same time, advancements in China’s
the long-term demographic structure, with far-reaching public health system and the adoption of medical treatments
implications for future government policies and even from abroad have reduced the infant mortality rate, hastening
industrial restructuring. the demographic transition process. This acceleration has
Population aging is not solely a concern for developed greatly exceeded the corresponding level of economic
nations; it is gradually becoming a global reality. This trend development in contemporary society, and insufficient wealth
is rooted in advancements in medical standards following accumulation has led to the problem of “getting old before
economic development, a decline in infant mortality rates, getting rich.” Consequently, households in China lack sufficient
and a substantial increase in life expectancy, resulting in time to accumulate enough wealth to support retired older ages
a growing older people population. The primary driver of members, and the social security system is inadequate to meet
population aging is the rapid decline in the total fertility the medical and care needs of the large older-aged population.
rate, leading to an exacerbation of the proportion of old- A clear observation from Figure 2 is the continuous
age individuals relative to the total population. The pace reduction in the base of China’s population pyramid since
of this demographic transition varies from one country 1980, signifying a substantial decrease in the proportion
to another (Bloom & Williamson, 1998; Lee & Mason, of children in a short span, while the corresponding
2010). proportion of the older adults population has witnessed

In contrast to other nations, China faces particularly rapid growth. This intricate interplay between economic
acute challenges of population aging due to previous development and demographic shifts in China underscores
policies of government. The implementation of strict family the need for a comprehensive analysis of their complex
planning during the early stages of economic development relationship and their implications for China’s future
led to an abrupt drop in birth rates (Cai, 2010; Jiang et al., trajectory.
2023). Furthermore, China experienced a significantly Over the past three decades, China’s economy has
shorter timeframe for fertility rate decline relative to witnessed significant growth, resulting in soaring housing
economic development compared to developed nations, prices and a rapid increase in the cost of raising children.
and even shorter than East Asian countries such as Japan At present, it has become challenging for ordinary middle-
and South Korea, which embarked on their economic class families to afford the expenses associated with raising
development post-World War II. Wu et al. (1991) argued a second child. The high cost of marriage and parenting,
that China’s population aging is primarily due to the rapid coupled with the high unemployment rate among the young
decline in the birth population, resulting in the shortening population (16 – 24) (Figure 3), has created a situation
of the population pyramid’s base. where individuals of working age struggle to marry and are
According to development economics, a country’s hesitant to start families. Despite the Chinese government’s
population usually matches its level of social and economic announcement in 2021 of a new population policy allowing
three children per couple, there is little interest among the
younger generation. Birth rates in 2022 fell below 10 million,
and based on marriage registration figures from that year, it
is predicted that births in 2023 may drop below 8 million.
Since the outbreak of the pandemic, economic downturns,
coupled with a 3-year zero-COVID policy, have heightened
pessimism among most people regarding the future of the
Chinese economy. Therefore, in the short term, reversing
the declining birth rate trend proves difficult. Moreover, data
from the National Bureau of Statistics of China indicate that
in the next 15 years, from 2023, approximately 25 million
baby boomers (born 1962 – 1976) will retire annually, exiting
the labor market. If the current retirement policy (60 years
Figure 1. Annual number of births in China old for men and 55 years old for women) remains unchanged,
Source: United Nation (2022), World Population Prospects. a substantial labor force shortage will loom in the future.

Volume 11 Issue 4 (2025) 85 https://doi.org/10.36922/ijps.2035