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National Research Council (US) Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Asia; Smith JP, Majmundar M, editors. Aging in Asia: Findings From New and Emerging Data Initiatives. Washington (DC): National Academies Press (US); 2012.

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Aging in Asia: Findings From New and Emerging Data Initiatives.

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1Introduction and Overview

and .

The 17 chapters in this volume have their origins in two “sister” conferences on the challenges and opportunities of population aging in Asia, one of which was hosted by the Chinese Academy of Social Sciences in Beijing and the other by the Indian National Science Academy in New Delhi.1 The chapters, which include contributions from China, India, Indonesia, Japan, and Thailand, cover the major subject areas relevant to population aging and can be grouped into four categories: (1) new and emerging data initiatives, (2) economic growth, labor markets, and consumption, (3) family roles and responsibilities, and (4) health and well-being (see Table 1-1).2 While we separate the chapters into these categories for summary purposes, it is important to note that a central point of new and emerging international data initiatives is that research and analysis should not be conducted solely within individual topic domains.

TABLE 1-1. Papers Organized by Subject Area.

TABLE 1-1

Papers Organized by Subject Area.

The need for integration is addressed by James P. Smith in “Preparing for Population Aging in Asia: Strengthening the Infrastructure for Science and Policy,” which describes the historical demographic and economic forces at work that made the development of data infrastructure projects to prepare for population aging so compelling in many countries. These surveys were all built on the recognition that the main domains of life—health, income, work, family, and cognition—had to be integrated into the same survey platform in order to understand and prepare for successful population aging. Smith’s essay also describes the history of international sister studies of the U.S. Health and Retirement Study (HRS), with special attention paid to the status and unique attributes of the six Asian countries that have adapted the HRS model—South Korea, Japan, China, India, Thailand, and Indonesia.

One key new Asian aging survey is the Longitudinal Aging Study in India (LASI), which had finished its fieldwork for its pilot study shortly before we held our second meeting in New Delhi. In their paper “Longitudinal Aging Study in India: Vision, Design, Implementation, and Preliminary Findings,” P. Arokiasamy, David Bloom, Jinkook Lee, Kevin Feeney, and Marija Ozolins summarize the main protocols of the field work and the development of the questionnaire content. As with the other Asian HRS surveys, the field results were uniformly encouraging, with very high response rates, a good understanding of the questions by respondents, and a set of results that highlighted the diversity of health and economic outcomes for the Indian elderly living in a very heterogeneous country.

Five of the chapters in this volume deal with issues related to economic resources and work in Asia. In their conceptual background paper “Population Aging, Intergenerational Transfers, and Economic Growth: Asia in a Global Context,” Ronald Lee and Andrew Mason develop a set of conceptually consistent National Transfer Accounts for many countries with aging populations, including those in Asia. These National Accounts are put through past and future country-, year-, and age-specific fertility and mortality distributions in order to evaluate the implications, magnitude, and directions of private and public transfers. Their simulations not only serve as a useful guide on what the advantages and disadvantages of population aging really are, but also highlight the timing of the main transitions that warrant a policy response.

David Wise’s paper “Facilitating Longer Working Lives: The Need, the Rationale, the How” also provides an important conceptual framework for how countries need to adjust to the important bounty of longer lives in terms of the length of their working lives. In the past 50 years, most of the countries of Europe and Asia gained an extra 5 to 10 years of life at age 65. In spite of those extra years, the labor force trends over the same period showed declining participation rates largely induced by high implicit taxes on work. In his essay, Wise makes a persuasive case that some of the bounty of longer lives must be allocated to prolonging the labor force participation of older workers.

The other three chapters in this section on work and income are case studies of work and retirement behaviors in China and Japan using the new HRS surveys in those countries. In their paper using data from the China Health and Retirement Longitudinal Study (CHARLS), “The Labor Supply and Retirement Behavior of China’s Older Workers and Elderly in Comparative Perspective,” John Giles, Dewen Wang, and Wei Cai emphasize the distinction between workers in the formal labor market where pensions are often quite generous and lead to relatively early retirement, and the informal (often rural) labor market where individuals work to very old age and rely primarily on their families for income and health support. In another paper in the Chinese context using the CHARLS data, “Relying on Whom? Poverty and Consumption Financing of China’s Elderly,” Albert Park, Yan Shen, John Strauss, and Yaohui Zhao examine how the Chinese elderly finance their consumption. One innovation of CHARLS is that it follows the lead of the Indonesia Family Life Survey (IFLS) and includes a detailed consumption module. In these settings, consumption by the elderly is well above their private income, and the authors show that the difference is largely due to transfers from family and government.

In “Retirement Process in Japan: New Evidence from the Japanese Study on Aging and Retirement (JSTAR),” Hidehiko Ichimura and Satoshi Shimizutani, two of the principal investigators of the Japanese HRS, use the panel aspects of the JSTAR survey to model work transitions. Until JSTAR, publicly available panel data on labor market transitions simply have not been available in Japan to either Japanese or foreign scholars. The authors report a sharp decline in the probability of remaining employed at age 60 for men, reflecting eligibility due to existing pension rules and a high degree of correspondence in spousal retirement decisions.

Four chapters in this volume deal with family roles and responsibilities—set in China, Indonesia, and India. “Patterns and Correlates of Intergenerational Nontime Transfers: Evidence from CHARLS,” by Xiaoyan Lei, John Giles, Yuqing Hu, Albert Park, John Strauss, and Yaohui Zhao, studies intergenerational transfers between adult children and their elderly parents. The authors report that the direction of transfers is decidedly upward in age—from children to their parents—and that these transfers form an important part of the economic resources of the parents. While all children tend to contribute to this support, married and better-off children are more likely to give financial support to their parents. The red flag for the future, of course, is the dwindling numbers of children of the future elderly, implying a higher per child cost or fewer total resources going to parents.

In his paper “Household Dynamics and Living Arrangements of the Elderly in Indonesia: Evidence from a Longitudinal Survey,” based on the longitudinal waves of the IFLS from 1993 to 2007, Firman Witoelar documents patterns of living arrangements of the elderly in Indonesia from the early 1990s to the late 2000s. In Indonesia, the percentage of those 55 and older living alone or as a couple in a household did not change much between 1993 and 2007. While these patterns in Indonesia have been stable, future demographic pressures will likely affect living arrangement as populations age further. This observation is important since, given lags in fertility, most of the challenging demographic changes centered around the family will occur in the next few decades.

“Social Networks, Family, and Care Giving Among Older Adults in India,” by Lisa F. Berkman, T.V. Sekher, Benjamin Capistrant, and Yuhui Zheng, describes the basic social networks and relationships of older Indian men and women across four states from the LASI pilot study. The authors report that the vast majority of both men and women are well connected in terms of their intimate family ties as well as more extended, weaker social networks. While only about 5% of participants lived alone and about 24% of women were widowed, it will be critical to monitor the ways in which informal social networks from both family and friends continue to support Indians well into old age as India continues to experience demographic and health transitions.

One of the primary concerns of older populations everywhere is how to delay, and then deal with, the consequences of cognitive decline at older ages. In “Effects of Social Activities on Cognitive Functions: Evidence from CHARLS,” Yuqing Hu, Xiaoyan Lei, James P. Smith, and Yaohui Zhao investigate the relationship between cognitive abilities and social activities for people aged 45 and older. Social activities are defined as participating in certain common activities in China such as playing chess, card games, or Mahjong; interacting with friends; and other social activities. There appear to be strong associations of memory with engagement in social activities. While the authors do not present causal estimates, they also report that having an activity center in the community is significantly related to higher episodic memory.

The final life domains covered by the chapters in this volume are health and overall well-being. Long life and better health during old age are relatively new phenomena in Asian countries and represent great improvements in human welfare. However, these successes come with a challenge—maintaining good health of, and providing medical care for, a population that was previously small and whose health needs were largely ignored. Reflecting the importance of health, six chapters in this volume deal with the health of the elderly in Asian countries.

In “Socioeconomic Success and Health in Later Life: Evidence from the Indonesia Family Life Survey,” Firman Witoelar, John Strauss, and Bondan Sikoki document long-term trends in the health of the Indonesian elderly using the IFLS. Many of the changes they find represent improvements in health, such as lower under-nutrition and communicable disease. Yet there are some disturbing signs as well—the increase in overweight and waist circumference, especially among women, and continuing high levels of hypertension. In addition, low hemoglobin, low HDL cholesterol, and high rates of undiagnosed hypertension seem to be inadequately addressed by the health system, and smoking among male Indonesians has continued unabated. These results raise serious questions regarding the ability of the health system in Indonesia to cope with the rapid aging of the population and the transition from infectious to chronic diseases.

In developing Asian countries, the availability of health insurance and access to healthcare for older populations has been very problematic. This situation, however, is in a rapid state of flux, with new programs being introduced to extend health insurance into rural areas. In “Healthcare and Insurance Among the Elderly in China: Evidence from the CHARLS Pilot,” John Strauss, Hao Hong, Xiaoyan Lei, Lin Li, Albert Park, Li Yang, and Yaohui Zhao take advantage of the CHARLS pilot data to model the probability of having health insurance and receiving care. Those with a lower probability of having health insurance (even with these new programs) are the poor, older women, and migrants. Reimbursement rates vary significantly by type of care and place of residence, reflecting the important role of communities in China in financing and organizing healthcare.

The Indian case is addressed in “Health of the Elderly in India: Challenges of Access and Affordability,” by Subhojit Dey, Devaki Nambiar, J.K. Lakshmi, Kabir Sheikh, and K. Srinath Reddy. As in other Asian countries, the Indian elderly face a unique set of health-related challenges owing to the dual burden of chronic and degenerative noncommunicable diseases and communicable diseases. Key challenges to access to health for this population include social barriers shaped by gender and other dimensions of social inequality (e.g., religion, caste, socioeconomic status, and stigma); physical barriers such as reduced mobility; declining social engagement; and the limited reach of the health system. Even as India aspires to move forward on a path towards universal health coverage, this chapter points out that stark data gaps persist for policy measures to improve access.

Two common attributes about health status in developing Asian countries are high rates of undiagnosed disease and great regional heterogeneity in health outcomes. In their paper “Markers and Drivers: Cardiovascular Health of Middle-Aged and Older Indians,” Jinkook Lee, P. Arokiasamy, Amitabh Chandra, Peifeng Hu, Jenny Liu, and Kevin Feeney report similar findings for India based on LASI pilot data. These findings are made even more compelling by the fact that they combine self-reports of health status with biomarkers. Given the high rates of undiagnosed disease in these developing Asian countries, these findings confirm that biomarkers are absolutely necessary in surveys of the elderly in Asia.

In “Aging, Health and Chronic Conditions in China and India: Results from the Multinational Study on Global AGEing and Adult Health (SAGE),” Paul Kowal, Sharon Williams, Yong Jiang, Wu Fan, P. Arokiasamy, and Somnath Chatterji compare health outcomes of the elderly in India and China. The authors report that 80% of cardiovascular disease deaths occur in lower- and middle-income countries, including China and India. There are important similarities between the two countries, including considerable underreporting of chronic diseases associated with older ages and high levels of disease comorbidity. The detection of underdiagnosis was possible by comparing self-reports and symptom-reporting, both of which are part of the SAGE survey protocols. China’s levels of treatment for chronic health conditions were generally higher than India’s, with the highest levels of treatment for angina and diabetes. Overall, though, and in particular for depression, healthcare coverage for patients with noncommunicable diseases is strikingly low in both countries.

In the final chapter in this volume, “Life Satisfaction of the Older Thai: Findings from the Pilot HART,” Dararatt Anantanasuwong and Udomsak Seenprachawong investigate the determinants of life satisfaction using the Thai version of the HRS, the Panel Survey and Study on Health, Aging, and Retirement in Thailand (HART). They report large urban and rural differences in life satisfaction in Thailand, with rural Thais being significantly less satisfied with their lives. Physical health has the strongest association with life satisfaction compared to other domains, and having friends and being engaged in social activities are also strongly positively associated with life satisfaction.

STRENGTHENING INSTITUTIONAL CAPACITY FOR AGING RESEARCH IN ASIA

The broad range of topics covered by the chapters in this volume exemplify the way in which investments in high-quality data and research can produce information and insights that may prove valuable to policymakers as they confront the challenges of aging populations. One important prerequisite to the production of useful scientific knowledge is to have in place well-designed institutions that facilitate innovation and collaboration.3

In the United States, government funding of social science research is relatively decentralized and generally uncoordinated (Calhoun, 2010). Within this pluralistic environment, the National Institute on Aging (NIA), which is one of 27 institutes and centers within the National Institutes of Health (NIH), plays a primary and pivotal role in supporting aging research. NIA conducts on-site “intramural” research and funds off-site “extramural” research on genetic, biological, clinical, behavioral, social, and economic topics related to aging processes, diseases, and conditions.4 NIA is also primarily responsible for funding the Health and Retirement Study (HRS), a nationally representative longitudinal survey of Americans over the age of 50 that collects information every two years about income, work, assets, pension plans, health insurance, disability, physical health and functioning, cognitive functioning, and healthcare expenditures.

Even though NIA is the main sponsor of the HRS, the study itself is designed, administered, and conducted by researchers in the academic community rather than by government statisticians (Juster and Suzman, 1995; National Institute on Aging, 2007). Such cooperative arrangements have proven to be fundamental to the success of studies that are longitudinal and model-based (as distinguished from cross-sectional surveys that may be more descriptive in nature). It is also important that such studies be sponsored by agencies—such as NIA—that are sufficiently involved in aging research across different scientific disciplines so as to be able to bring together the different kinds of expertise necessary for the design and management of those studies (Juster and Suzman, 1995).

HRS-type studies in Asia are, to an extent, beginning to develop along just such institutional lines. CHARLS and LASI, for example, are designed and managed by networks of academics (CHARLS by the China Center for Economic Research at Peking University; and LASI by the International Institute for Population Studies, Mumbai, and the School of Public Health at Harvard University). What remains to be seen in the longer term, however, is whether and how these surveys will find appropriate institutional support from their own national governments, comparable to that provided by NIA to the HRS. If, for example, the governments of China and India decided to lend their full support to CHARLS and LASI, the question as to which government agencies would actually fund and oversee those surveys is something that would require careful consideration.

These institutional issues are relevant not only to the future of HRS-type surveys in Asia, but also more generally to the overall quality of aging research in those countries. After all, a government agency that does not have the resources and expertise to support a sophisticated longitudinal survey is, by definition, an agency that will find it difficult to play a lead role in promoting high-quality aging research. This raises a number of additional questions about research infrastructures in Asian countries, the lessons that may be learned from the U.S. experience, and the variety of approaches (and the potential tradeoffs among them) that should be taken into account when thinking about institutional design. At least four issues are worth considering in more detail: (1) finding the optimal degree of centralization and coordination, (2) managing peer review, (3) facilitating interdisciplinary research, and (4) diversifying funding streams.

Finding the Optimal Degree of Centralization and Coordination

One fundamental issue is the extent of centralization within public institutions and the degree of coordination between them. The 27 institutes that make up NIH, for example, are organized around (among other things) specific diseases, life stages, and disciplines. These institutes generally enjoy considerable amounts of budgetary and operational autonomy, so much so that they have been characterized as “largely independent fiefdoms” (Cohen, 1993:1,675; Varmus, 2001). NIH can benefit politically and financially when the enthusiasm of supporters and advocacy groups is reflected in the creation of new institutes to which those constituency groups feel especially loyal. The drawback of the “proliferation of institutes,” however, is that they may result in “less flexibility, less managerial capacity, less coordination, and more administrative burden” for NIH as a whole (Varmus, 2001:1,905).

These political and bureaucratic dynamics can also have significant implications for relationships between different government agencies. In the United States, early supporters of the National Science Foundation (NSF) envisioned a strong central role for NSF as the major supporter of basic research. By the time NSF came into existence in 1950, however, NIH had already gained sizeable appropriations from Congress and had begun to establish enduring political constituencies for itself. NSF therefore had to coexist with the “extensive though disjointed” government-sponsored research system that was already in place (Mazuzan, 1994:5). The question of how these forces and factors will unfold across the different countries of Asia is an important one. (See Box 1-1 for an overview of some of the major scientific institutions in China, India, Indonesia, and Japan.)

Box Icon

BOX 1-1

Scientific Institutions in China, India, Indonesia, and Japan. The management and organization of research funding can vary greatly across different Asian countries. In China, the major government agencies in the field of science and technology are the (more...)

Managing Peer Review

Asian countries that are interested in expanding their investments in aging research may want to give some consideration to peer review processes. NIH has an elaborate peer review mechanism in place for funding extramural research. Peer review allows the quality of funding proposals to be evaluated rigorously and independently, and it makes NIH accountable for how funds are used (National Research Council, 2003). Peer review may also provide funding agencies with a measure of protection against politically motivated attacks on controversial research (Kaiser, 2003). One of the limitations of peer review when it becomes too conservative and establishment-oriented in its evaluation of science is that it may discriminate against novel, high-risk proposals and create a bias against young investigators and researchers (National Research Council, 2003). Striking an appropriate balance with peer review can sometimes be a challenge.

In China, the use of peer review for funding social science research has become increasingly common since the early 1980s. Since 2000, in response to perceived deficiencies in the peer review process, several measures have been taken, such as including more experts in the pool of referees and making their selection more standardized; making the evaluation process more anonymous and putting into place regulations to supervise panel meetings and make the project approval and evaluation systems more accountable; and making it easier for projects that are interdisciplinary, multidisciplinary, experimental, or controversial to be submitted to special panels of experts who are drawn from different fields of research (Lili, 2010). In Japan, similarly, there has been an increased emphasis on competitive funds allocated on the basis of merit (Sato, 2010).

Facilitating Interdisciplinary Research

The aging process is multifaceted and multidimensional, and it touches upon a broad range of biological and social issues. Aging research ought to span multiple disciplines and approach questions from a variety of perspectives. Therefore, Asian countries may want to think about the best ways of incorporating interdisciplinary principles into the design of public institutions. The research components of NIA, for example, include the Division of Aging Biology, Division of Behavioral and Social Research, Division of Neuroscience, and Division of Geriatrics and Clinical Gerontology. This organizational structure reflects the multidisciplinary and interdisciplinary mission of NIA, with the social and behavioral sciences housed in the same place as the biomedical and other sciences.

It is worth noting that the social and behavioral sciences have often had to struggle for equitable footing with the “hard” sciences. In the late 1950s, for example, the incorporation of the social sciences into NSF’s formal mandate was met with resistance (Mazuzan, 1994). In 2005, research expenditures on “social science and humanities” constituted 5.5% of “gross expenditure on R&D” in the United States, 4.6% in Japan, and 1.4% in China (Kahn, 2010).5

Diversifying Funding Streams

Although governmental institutions play a key role in supporting research and setting broad scientific priorities, their resources are also limited—perhaps now more than ever. In 2002, for example, around 30% of researchers submitting grant applications to NIA were successful (for any single deadline) in obtaining funding; by 2010, that figure had fallen to 8% (Wadman, 2010). Consequently, Asian countries may want to consider the role that could be played by private foundations in filling this gap. In India, for example, the Tata Trust, Birla Trust, and Ford Foundation have been longtime supporters of social science research, and a number of new foundations supporting social science research have been established by corporate firms (Krishna and Krishna, 2010). In Japan, similarly, academic research is supported by private organizations such as the Toyota Foundation and Mitsubishi Foundation.

In the United States, the research priorities and decision processes of private foundations are diverse and often idiosyncratic, and the research support that they provide may be less consistent and predictable than the support provided by governmental institutions. For example, of the 10 wealthiest foundations in the United States,6 only the MacArthur Foundation, with its Research Network on an Aging Society, has an organized research program that is explicitly focused on aging. As Asian countries strengthen their institutional capacity for aging research, they may want to think about ways of designing public institutions and forging public-private partnerships so that private resources are more likely to be mobilized and, subsequent to that, allocated in ways that are systematic, coordinated, and consistent with good science.

THE PATH FORWARD

Policymakers cannot address the challenges and opportunities of population aging without a strong evidentiary base. Science academies in China, India, Indonesia, Japan, and the United States have recognized the importance of data collection efforts that are nationally representative, internationally comparable, interdisciplinary, and publicly available (Chinese Academy of Social Sciences et al., 2010). The chapters in this volume are the product of new and emerging data initiatives that can facilitate informed decision-making well into the future. In order to derive maximal benefit from these efforts, national governments in Asia will need to support and invest in these data infrastructures and, more generally, ensure that appropriate institutional mechanisms are in place for encouraging high-quality research. The papers that follow provide new information on various social and economic aspects of population aging in Asia, and they are promising examples of the kinds of research and analysis that could help inform policy development in those countries.

REFERENCES

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  • Cohen J. Conflicting agendas shape NIH. Science. 1993;261:1674–79. [PubMed: 8378768]
  • Foundation Center. 50 Largest Foundations by Assets, 2008. 2010. Available: http:​//foundationcenter​.org/findfunders/statistics​/pdf/11_topfdn_type​/2008/top50_aa_all_08.pdf.
  • Juster FT, Suzman R. An overview of the Health and Retirement Study. The Journal of Human Resources. 1995;30:S7–S56.
  • Kahn M. World Social Science Report: Knowledge Divides. Paris: United Nations Educational, Scientific and Cultural Organization and International Social Science Council; 2010. Measure for measure: Quantifying the social sciences.
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Footnotes

1

See “Preface” for further details.

2

The chapters are meant to be stand-alone and may, for the convenience of the reader, repeat some background information (e.g., where and how surveys were conducted).

3

The discussion that follows is based in part on Majmundar (2011).

4

Grants to individual researchers, usually for three to five years, are the extramural grant type most commonly used by NIH. Other extramural grant types include grants to research centers and multi-project research projects, as well as exploratory grants and small grants.

5

In 2005, gross expenditure on all research and development constituted 2.6% of gross domestic product in the United States, 3.3% in Japan, and 1.3% in China (Kahn, 2010).

6

In 2009, the 10 largest U.S. foundations by asset size were the Bill and Melinda Gates Foundation, Ford Foundation, J. Paul Getty Foundation, Robert Wood Johnson Foundation, William and Flora Hewlett Foundation, W.K. Kellogg Foundation, David and Lucille Packard Foundation, John D. and Catherine T. MacArthur Foundation, John and Betty Moore Foundation, and the Lilly Endowment (Foundation Center, 2010).

Copyright © 2012, National Academy of Sciences.
Bookshelf ID: NBK109230

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