The Graying of China and Japan: A Comparative Study of Elder Care Attitudes and Policy Implications

Abstract

Fertility decline coupled with increasing life expectancy has resulted in population aging in many developed countries, including China and Japan, East Asia’s two economic and sociopolitical giants. In Japan, fertility decline beginning in the postwar period, improved population health, and increasing opportunity costs of having children have resulted in growing age-dependency ratios. In China, fertility decline began gradually in the 1970s whereas the One-Child Policy in 1979 further lowered fertility, imposing a heavier burden of elder care on younger generations. With these demographic shifts, elders in China and Japan are much less likely to coreside with their children—a traditional living arrangement tied to Confucian customs—than to live alone or with their spouses. Given these shifts in fertility, age structure, and living arrangements in China and Japan, this thesis seeks to explore how each generation’s perceptions of elder care have evolved over time in these countries. Attitudinal surveys collected from the elderly and current potential caregivers are examined from each country, in addition to surveys of the youth population in China. The surveys are then synthesized to uncover unmet needs in elder care that prompt policy discussions. Observed attitudes toward elder care have shifted between generations and between China and Japan. In both countries, coresidence has become less desirable, elders seek alternatives to traditional forms of elder care, and filial obligation among the caregiving and younger generation is diminishing. However, elders in China and Japan have slightly different expectations for alternative forms of elder care. To address these unmet needs, government intervention is recommended in additional to familial caregiving. Japan has universal healthcare, long-term care, and pension systems in place that offer elders affordable and accessible care. China’s systems, on the other hand, are much more fragmented and exhibit disparities in access by region and income. Thus, community-based care in conjunction with greater utilization of information communication technologies as implemented in Japan may be a model for China to consider in the future.