This Articles Was Published in Modern China Studies. Vol. 26, 2019 A
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This articles was published in Modern China Studies. Vol. 26, 2019 A Study on the Changing Trend of Health Indicators of the Elderly in Mainland China: 1998-2014 LU Jiehua, GUO Ran (Department of Sociology, Peking University, Beijing, 100871, China) Abstract: Along with the extending average life expectancy and the declining fertility rate, mainland China has experienced the much rapider process of population aging for the last two decades. Therefore, this paper uses Chinese Longitudinal Healthy Longevity Survey (CLHLS) data to measure and estimate the changing process of health indicators of the elderly in mainland China. By exploring seven wave data including some principal indicators about the elderly health, such as Activities of Daily Living (ADL), Self-Rated-Health (SRH), Mental Health (Mental), Cognitive Level (MMSE) and Frailty Index (FI), we can highlight the dynamic change of major health indicators of Chinese elderly between 1998-2014. Firstly, findings turn out that average health indicators in earlier years have no significant difference between the later ones. Further analysis about health indicators showed that age and cohort are two main interference factors to estimate the changing trend of health status of the elderly because of selectivity. After controlling these two factors, we can figure out a deterioration in health index when the elderly grow older. In addition, the health levels of people in same cohort decreased with age. Objective and comprehensive indicators in younger cohorts deteriorated slower than older elderly cohort. However, this trend turns to opposite when comes to subjective health 1 indicators. Key Words: Aging, Health Indicators, Trend, CLHLS About the authors: Jiehua Lu is a professor at sociology department, Peking University. His major research field is geriatric demography and economic demography. In recent years, he has focused on the health and pension of the elderly in the aging process of the mainland China. Ran Guo is a PhD candidate in sociology department, Peking University. His major research interest is economics of population and sociology of education. 1. Backgrounds Along with the extending average life expectancy and the declining fertility rate, 吗 mainland China has witnessed the much rapider process of population aging in 21st century. Nowadays, China is aging much faster than other low- and middle-income countries.(WHO, 2015) Both the quantity and proportion in total population are increasing rapidly. Data bulletin of the 1% national population sampling survey in 2015 illustrated that the number of people over the age of 60 reached 222 million, accounting for more than 16% of total population, while the number of people aged over 65 reached 144 million, accounting for more than 10%. Figure 1 shows vividly that the quantity and proportion in total population of people aged over 65 have been growing rapidly. At the same time, the elderly dependency ratio is also increasing at a high speed.(Lu and Guo, 2016) Figure 1. The size and proportion of elderly people aged over 65 and the elderly dependency ratio in China 2 The amount of elderly people in mainland China is not only increasing rapidly, but also getting older and older. In 2010, the average life expectancy in mainland China reached 74.83. But the number substantially improved 1.5 and then became 76.34 in 2015. (The State Council Information Office of the People's Republic of China, 2016)The fifth census data showed that in 2000 the total population of people aged 80 and above was only 7,745 thousand, accounting for 15.99% of the total elderly population (aged 65 and over). Ten years later, the total population of the 80 year old reached 20,990 thousand in national sixth census, accounting for 17.65% of the total elderly population. It is estimated that by the middle of twenty-first Century, the amount of the elderly population in China will reach 100 million, equivalent to the number of elderly people summarized in all developed countries.(The Drafting Group of General Report, 2015) 3 In order to cope with the aging of the population, WHO called for an active response to the aging population and put forward the goal of "healthy aging". There are three key components in WHO’s framework: intrinsic capacity, functional ability, and subjective well-being. (Beard et al, 2016; WHO, 2016) These three parts defined the analysis path of healthy aging for the health of the elderly from three levels: the internal, external and subjective dimension. As for the Chinese mainland which is rapidly moving towards an aging society, the health of the elderly has become a major issue that needs urgent attention. Ageing is not only multidimensional but also a cumulative effect of the life course. (Evenhuis et al, 2001) The body function of elderly people is gradually deteriorated and decreased, which not only greatly weakened their intrinsic capacity as long as brought pain and torment to the elderly, but also place a huge burden to the social welfare and public health system for whole country. Furthermore, it will have a negative effect on the implementation of national long-term economic and social development strategic objectives. Therefore, the attention and discussion of healthy aging also need to go back to the situation of time and space. In order to get better understanding of this progress, we use longitudinal data to observe the long-term health change. From the perspective of “Age-Period-Cohort”, we analyze the changing trend of health indicators of Chinese elderly in the past twenty years in accordance with different indicators. There are two advantages to doing so. Firstly, we can accurately grasp the dynamic health trends and differences of the Chinese elderly from different dimensions. Secondly, it is possible to find the time nodes of health changes of the Chinese elderly, which will 4 help to take targeted measures to cope with the aging process. In a word, attention to the dynamic changes of aged health in mainland Chinese is not only the need of scientific research, but also the significance of responding to the appeal of WHO for healthy aging. Also, it is an important premise to realize the goal of healthy China. 2. Literature review According to the definition of World Health Organization, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.(WHO, 1946) Therefore, health is a multidimensional concept of interaction between mind and body. In order to cope with the global trend of population aging and health issues of the elderly, the definition of "healthy aging" recently released by WHO includes three parts: intrinsic capacity, functional ability, and subjective well-being. WHO believes that healthy aging is the process by which older people develop and maintain functional abilities and enhance their subjective well-being. (Beard et al, 2016) Elderly health not only includes psychological and physiological indexes, but also includes social participation indicators. (Xie and Zhou, 2016) Therefore, the accurate estimation of the health level, the changing trend of health and health burden of elderly people depends on the accurate definitions, measurements and predictions of the major health indicators for the elderly.(Li and Zhang, 2014) In the practical study, we usually choose one to several representative indicators, and combine them with relevant social and economic factors to study the elderly health.(Zeng, 2010; Zeng et al, 2014) The first step in this study is to define the dimensions and extensions of health indicators of the elderly. Secondly, we need 5 to identify the dimensions and types of indicators so as to make them much more clear and accurate. Previous studies are usually based on two perspectives to investigate health indicators of the elderly: static and dynamic dimensions. From the static perspective, health indicators is usually divided into several categories, including objective indicators, subjective indicators, as well as comprehensive ones. For example, objective indicators usually include ADL, IDAL, mental health and cognitive ability, while self-rated health is usually included in the subjective indicators. What’s more, the integration of subjective and objective indicators turns out to be frailty index. From the dynamic perspective, health indicators, selected as the same way above, focus mainly on the changing trend of these health indicators in a certain period of time by using the individual panel data. Tracking studies are distinguished from cross-sectional studies. This method is usually based on long-term data and holds a dynamic perspective, through which the data used here are usually panel data. The type of data that can be tracked over a long period of time to a particular subject is explored to investigate the time-series changes in health indicators at different times and between cohorts. (Xue, 2015; Zeng et al, 2014) However, the distinction between the two perspectives is only from the aspect of tracking data, there is no significant difference in the selection of health indicators. The advantage that uses the perspective of dynamic changes in health is not only can overcome the malpractice of cross-sectional data, such as containing censored data, sample coverage error and causal inference problems, but also can more fully explore 6 the causal mechanism in health studies. With the collection and disclosure of all kinds of tracking data, studies of long-term trends based on this kind of data are gradually increasing, among which CLHLS data are very good representative.(Du and Wang, 2013; Li and Zhang, 2014) In CLHLS questionnaire, ADL generally consists of 6 indicators of eating, bathing, dressing, toileting, continence, indoor transfer. According to the previous literature, general active ability will be valued 0 and 1 respectively based on whether the completion of action depend on the others.