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Population aging in the Asia-Pacific region

July 20, 2015

Asia health policy scholar Karen Eggleston (Center Right) learns about a digital health information system in a visit to a primary care center in Hangzhou, China in Oct. 2014.

Robin Yao

Population aging is one of the most global and significant trends in the 21st century. Although each society has different social and economic backgrounds that have resulted in demographic transformation, the older population is growing rapidly in general due to declining fertility rates and rising life expectancy. The Asia-Pacific region is where we witness the most rapid population aging. Because of the region’s population size and its rapid economic transformation, many scholars have conducted research on the Asia-Pacific region’s ongoing demographic shift and its future. The Office of International Affairs met with Karen Eggleston, one of the leading economists studying demographic transition in East Asia, to hear about her research collaborations and inspiration.

Q: Why are you specifically interested in aging issues in East Asia?

KE: As modern society has relatively stable birth and death rates, its aging population has created a whole set of interesting and challenging dynamics. What’s intriguing about East Asia is the rapidity with which these societies have gone through the demographic transition from high and fluctuating birth and death rates to relatively low and stable birth and death rates. In many western countries, this transition spanned a century, whereas in East Asia, it has happened largely since post World War 2 and was even more compressed in some countries. Thus, all of the issues in demographic transition have been compressed within one or two generations. That is what makes the issue quite interesting and challenging.

Demographic transition in the region is also closely related to many other issues that I have been studying. As a director of the Asia Health Policy Program within Walter H. Shorenstein Asia-Pacific Research Center (APARC), I have had the privilege to work with many outstanding scholars from various fields to study the region’s demographic transition through a multidisciplinary lens. I have collaborated with physicians, epidemiologists, demographers, political scientists, sociologists, anthropologists and others on issues of demographic change like population aging and gender imbalance (such as in China and India).  Many of my analyses seek to understand health and demographic changes and burdens on the health system. For example, one line of inquiry focuses on chronic disease management and the trajectory of health in middle and older ages. Population aging is closely related to epidemiological transition, the transition from infectious disease to chronic diseases like heart disease and diabetes as the primary burden of disease in the modern world.

Q: How do you approach demographic transition and aging in the region?

KE: I am an economist by training, so my approach is using health economic tools and ways of thinking to look at the demographic transitions, geographically focused on East Asia including China, Japan and South Korea in comparative perspective. My main focus is health, longevity and economic change. More specifically, some of my research has been looking at what’s called the “educational gradient” in health, the tendency of those with more education to have better health and survival. We measure how aging issues can influence life expectancy or figure out how people in different social status cope with the aging issues. In the end, we would like to empower people who are relatively disadvantaged to have the same opportunities for a long and healthy life.

"Our goal is to try to nudge health policy toward the direction that will benefit large groups of people so that the disadvantaged could have equal opportunity for a healthier and longer life."

Q: With whom have you collaborated at and beyond Stanford for your research?

KE: As part of its three-year old project, Shorenstein APARC and the Stanford Center on Longevity jointly hosted a conference and later published a book titled “Aging Asia: Economic and Social Implication of Rapid Demographic Changes in China, Japan and Korea” in 2011. With senior colleague Victor Fuchs, I studied “The New Demographic Transition: Most Gains in Life Expectancy Now Realized Late in Life” (Journal of Economic Perspectives.) I have also worked with Professor Jay Bhattacharya at the Center for Health Policy/ Center for Primary Care and Outcomes Research (CHP/PCOR) on adapting the Future Elderly Model (FEM) in Japan.

Beyond Stanford, I’ve collaborated with some other scholars including Professor David Bloom at Harvard specifically focused on economic aspects of aging in China and India and we have recently published special issues in the Journal of the Economics of Aging . We have oncoming collaboration as part of the The Next World Program, which is a joint initiative of Harvard University’s Program on the Global Demography of Aging, the World Demographic and Aging Forum, Stanford University’s AHPP, and Fudan University’s Working Group on Comparative Aging Societies. These institutions organize an annual workshop and a special issue in the Journal of the Economics of Aging on an important economic theme related to aging societies.

We also have various international collaborators in the Asia-Pacific region. For instance, in China, I have worked with a variety of academics including colleagues at Peking University, Tsinghua University, Fudan University and others. For gender balance issues, which are also a part of demographic transition, we also work with colleagues at Xi’an Jiao Tong University. In government, we’ve partnered with the Department of Health in Shandong Province and China’s National Center for Disease Control. Other projects involve colleagues at the University of Tokyo, Seoul National University, and the University of Hong Kong.

Q. Which country is the most rapidly aging society in East Asia? What do you find most fascinating about the country?

KE: Would you like to guess? It’s Korea. Several projects joint with Korean colleagues have focused on Korean health systems reform and strategic purchasing to make the health system sustainable in the light of aging and rapid technology diffusion. Other questions involve health, labor force participation, retirement, and long-term care. These issues can be fascinating because it’s not just a matter of figuring out how many children will be born or how long people need to work to afford one’s retired life but it’s also a question of a whole system of suppliers as well as demanders of health and long-term care services. For example, we try to examine  questions such as “how can policymakers structure incentives for physicians,  hospitals, and patients, to change their behaviors to make the whole system work better in light of population aging?” Doing this work alongside the economics of longer lives is more of a holistic approach to tackle how we can change incentives to align with new social and economic realities, for instance, healthy aging to enable later retirement while changing the way we pay hospitals and other providers to improve “value for money” and coordinate with long-term care for disabled and frail elderly.

Q. What differences in the demographic transition have you found in China and India?

KE: India and China are going through different phases of the demographic transition and thus are confronting slightly different sets of issues. India is a much younger society compared to China, and its population is aging less rapidly. One of the primary issues in India is to productively employ its large working age population to enable rapid economic growth. In China, by contrast, the working age population is declining and the age structure in more quickly changing towards older ages, and the whole economy has to adjust to be in sync with their new demographic reality.

Q. What has been your most interesting challenge while conducting research in the Asia-Pacific region?

KE: There are many different questions you can ask, especially regarding how societies can learn from the experiences of others yet adapt strategies to local realities -- although you also need to narrow down the research questions to ones for which you can get quality data. It often takes lots of investment to understand what is going on in the region. You need to talk to multiple potential collaborators and policy makers to figure out where policy-relevant research can make an important contribution. This process can be a challenge but it’s also inspiring and motivating.

Getting quality data about health, survival, economic behavior, and its influencing factors is almost always the biggest challenge for any research project. It is vital to acquire good data, modify a theory based on the data and to understand what they are telling you.

Q. What inspires you to move forward with your research? What is your ultimate goal?

KE: I am inspired daily by the excellent work and commitment of my colleagues at Stanford and peer institutions in the Asia-Pacific region. I am always impressed by their excitement to provide evidence to improve people’s lives. Another inspiration as an economist is to see the demographic transition from multi-disciplinary perspectives, but also to embrace the power of economic analysis to address key issues. Since each society is unique, it takes various angles to fully understand each society or program or institution that we may analyze. I also enjoy describing and educating fellow Americans about what’s going on in Asia.

Ultimately, our goal is to try to nudge health policy toward the direction that will benefit large groups of people so that the disadvantaged could have equal opportunity for a healthier and longer life.

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* Learn more about her research project and scholarly interests by visiting Stanford Profiles: Karen Eggleston’s Profile.