SHAPING THE FUTURE HOW CHANGING DEMOGRAPHICS CAN POWER HUMAN DEVELOPMENT

128
As societies age,
major causes of
death shift from
infectious to chronic
non-communicable
diseases
FIGURE 4.8:
Shifting practices mean many older people live
independently
Source: UN DESA 2013c.
live independently (Figure 4.8), among them, a
slightly higher proportion of men than women.
Cultural norms and/or men’s greater economic
independence may explain this phenomenon.
Although co-residence of older people with
adult children is higher in East Asia, Southeast
Asia and the Pacific, it has declined significantly
over time in some countries. In China the rate
for people ages 65 to 70 fell from 66 percent in
the early 1980s to roughly 43 percent by 2011.
In the Republic of Korea, the rate for people 65
years and older decreased from more than 80
percent in 1980 to below 30 percent by 2010. 35
Both Japan and the Republic of Korea have
experienced a pronounced attitudinal shift, with
diminishing acceptance of the idea that children
should be responsible for the care of older parents.
In Thailand, working-age adults anticipate
receiving less support from their offspring than
they have provided for their own parents. 36
INCREASING HEALTH-CARE NEEDS
AND COSTS
While longer life expectancy signals improved
well-being and human development progress,
maintaining good health at older ages can be
challenging. As societies age, major causes of
death and disability shift from infectious to
chronic non-communicable diseases. Globally,
85 percent of people aged 60 or above died from
these in 2008. They account for 90 percent of
deaths in Australia and New Zealand, and 80
percent in Japan, the Republic of Korea and
Singapore. 37 They caused 76 percent of deaths in
East Asia, Southeast Asia and the Pacific in 2008,
and the share is projected to rise to 85 percent
by 2030. 38 Since 2000, deaths from non-communicable
diseases have risen significantly in
larger developing countries, such as China,
India, Indonesia, Pakistan, the Philippines
and Thailand. In the Pacific, these diseases are
widespread as well, causing an increasing share
of premature death. 39 Particular difficulties in
the Pacific island countries relate to providing
intensive care and treatment for populations
scattered across different islands. 40
Health-care costs tend to escalate with
increasing shares of older people, since they
use more services 41 and require more expensive
treatment, including for non-communicable diseases.
42 A World Health Organization (WHO)
report on 23 low- and middle-income countries
estimated an economic loss of $83 billion from
heart disease, stroke and diabetes alone from
2006 to 2015. 43 Asia-Pacific’s health-care costs
have rapidly increased in recent years, 44 outstripping
even historically quick rises in income.
This exerts significant pressure on government
treasuries that will likely continue to grow,
especially without advances in more efficient
and affordable technologies. Several countries
have begun to stress prevention strategies, including
through promoting healthy lifestyles to,
for example, curtail obesity, which can lead to
high blood pressure, diabetes and other chronic
conditions.
Between 2000 and 2012, many Asia-Pacific
countries registered a rapid increase in per
person health-care spending at a rate far above
the world average. In high-income countries,
except Japan, costs rose by more than 200 percent.
They climbed even more dramatically in
middle-income countries—over 400 percent in
Viet Nam, for example—and skyrocketed nearly
10 times in Mongolia (Figure 4.9). Japan, on the
other hand, provides an excellent health-care
system where every individual is covered under
an insurance programme through their work
or a community insurer, and the Government