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P95/01-1

An Aging World: 2001 Issued November 2001

P95/01-1

International Population Reports By Kevin Kinsella


and Victoria A. Velkoff

An Aging World: 2001


International Population Reports
USCENSUSBUREAU

Demographic Programs

U.S. Department of Health and Human Services U.S. Department of Commerce


National Institutes of Health Economics and Statistics Administration
NATIONAL INSTITUTE ON AGING U.S. CENSUS BUREAU
ACKNOWLEDGMENTS This report was prepared by and activities of the Census Bureau (as
Kevin Kinsella and Victoria A. well as to many other agencies in the
Velkoff under the general direction of United States and worldwide) for the bet-
Peter O. Way, Chief, International ter part of two decades.
Programs Center (IPC), Population
Within the IPC Aging Studies Branch,
Division, Census Bureau. Research for
Valerie Lawson was instrumental to
and production of this report were sup-
the completion of myriad tasks involving
ported under an interagency agreement
data compilation, verification, table and
with the Behavioral and Social Research
graph production, and general report
Program, National Institute on Aging,
preparation. Branch members Wan He
Agreement No. Y1-AG-9414-01.
and Jennifer Zanini also contributed to
For their review of and/or suggestions this report.
regarding this report, the authors are
Frances Scott, Janet Sweeney,
grateful to Emily M. Agree, Department
Barbara Adams, and Arlene C. Butler
of Population Dynamics, Johns Hopkins
of the Administrative and Customer
University; Nikolai Botev, Population
Services Division, Walter C. Odom,
Activities Unit, Economic Commission for
Chief, provided publication and printing
Europe; Richard V. Burkhauser,
management, graphics design, and com-
Department of Policy Analysis and
position and editorial review for print
Management, Cornell University;
and electronic media. General direction
James C. Gibbs, Assistant Center Chief,
and production management were pro-
IPC; Albert I. Hermalin, Institute for
vided by Michael G. Garland, Assistant
Social Research, University of Michigan;
Chief, and Gary J. Lauffer, Chief,
Linda Hooper, Aging Studies Branch,
Publications Services Branch.
IPC; Rose Maria Li, Behavioral and
Social Research Program, National Thanks also are due to Lorraine Wright
Institute on Aging; Jean-Marie Robine, of the Bureau’s Information and
Equipe INSERM Demographie et Sante, Resources Services Branch, who cheer-
Montpellier; Beth J. Soldo, Population fully and efficiently handled the acquisi-
Studies Center, University of tion of a multitude of necessary sources
Pennsylvania; Richard M. Suzman, and references.
Behavioral and Social Research Program,
Finally, we would like to thank those
National Institute on Aging; Peter O.
international organizations and associa-
Way, Chief, IPC, Loraine A. West,
tions engaged in the collection, tabula-
Eurasia Branch, IPC; and
tion, analysis and dissemination of data
Richard Woodbury, National Bureau
relevant to the aging of the world’s pop-
of Economic Research. We also thank
ulation. In particular, we would like to
David Rajnes, Housing and Household
acknowledge the efforts of the Economic
Economic Statistics Division, U.S. Census
Commission for Europe, the International
Bureau, who provided useful data and
Labour Office, the International Network
other information regarding retirement
on Healthy Life Expectancy, the
and pensions.
International Social Security
A very special debt of gratitude is owed Administration, the Organization for
to George C. Myers, former director of Economic Co-Operation and
the Center for Demographic Studies at Development, the Statistical Office of the
Duke University, who passed away in European Union, the United Nations
2000. Not only did Dr. Myers offer Population Division, the United Nations
instructive comments on this report, but Statistical Office, and the World Health
he also provided invaluable advice and Organization.
guidance to the aging-related products
An Aging World: 2001 Issued November 2001

P95/01-1

U.S. Department of Commerce


Donald L. Evans,
Secretary

Economics and Statistics Administration


Kathleen B. Cooper,
Under Secretary for Economic Affairs

U.S. CENSUS BUREAU


William G. Barron, Jr.,
Acting Director
Suggested Citation
Kinsella, Kevin and Victoria A. Velkoff,
U.S. Census Bureau, Series P95/01-1,
An Aging World: 2001,
U.S. Government Printing Office,
Washington, DC, 2001.

ECONOMICS
AND STATISTICS
ADMINISTRATION

Economics and Statistics


Administration

Kathleen B. Cooper,
Under Secretary for Economic Affairs

U.S. CENSUS BUREAU


William G. Barron, Jr.,
Acting Director
William G. Barron, Jr.,
Deputy Director
John H. Thompson,
Principal Associate Director for Programs
Nancy M. Gordon,
Associate Director for Demographic Programs
John F. Long,
Chief, Population Division

For sale by the Superintendent of Documents, U.S. Government Printing Office


Internet: bookstore.gpo.gov Phone: toll free 866-512-1800; DC area 202-512-1800
Fax: 202-512-2250 Mail: Stop SSOP, Washington, DC 20402-0001
20 Questions About Global Aging
(to test your knowledge of global population aging at the turn of the century)

Answers appear on next page.

1. True or false? In the year 2000, children under the 11. True or false? Today in some countries life expectancy
age of 15 still outnumbered elderly people (aged 65 at birth is less than 40 years.
and over) in almost all nations of the world.
12. What are the leading killers of elderly women in
2. The world’s elderly population is increasing by approx- Europe and North America?
imately how many people each month? a. Cancers b. Circulatory diseases
a. 50,000 b. 300,000 c. 500,000 d. 800,000 c. Respiratory diseases d. Accidents

3. Which of the world’s developing regions has the 13. True or false? Elderly women outnumber elderly men
highest aggregate percent elderly? in all developing countries.

a. Africa b. Latin America 14. There are more older widows than widowers in virtu-
c. The Caribbean d. Asia (excluding Japan) ally all countries because:

4. China has the world’s largest total population (more a. Women live longer than men
than 1.2 billion people). Which country has the b. Women typically marry men older than themselves
world’s largest elderly (65+) population? c. Men are more likely than women to remarry after
divorce or the death of a spouse
a. Japan b. Germany c. China d. Nigeria d. All of the above

5. True or false? More than half of the world’s elderly 15. In developed countries, recent declines in labor force
today live in the industrialized nations of participation rates of older (55 and over) workers are
Europe, North America, and Japan. due almost entirely to changing work patterns of
a. Men b. Women c. Men and women
6. Of the world’s major countries, which had the highest
percentage of elderly people in the year 2000?
16. What proportion of the world’s countries have a public
a. Sweden b. Turkey c. Italy d. France old-age security program?
a. All b. Three-fourths c. One-half d. One-fourth
7. True or false? Current demographic projections sug-
gest that 35 percent of all people in the United States
17. Approximately what percent of the private sector
will be at least 65 years of age by the year 2050.
labor force in the United States is covered by a private
pension plan (as opposed to, or in addition to, public
8. True or false? The number of the world’s “oldest old” Social Security)?
(people aged 80 and over) is growing more rapidly
than that of the elderly as a whole. a. 10 percent b. 25 percent
c. 33 percent d. 60 percent

9. More than one-third of the world’s oldest old live in 18. In which country are elderly people least likely to live
which three countries? alone?
a. Germany, the United States, and the a. The Philippines b. Hungary c. Canada d. Denmark
United Kingdom
b. India, China, and the United States
19. True or false? In developing countries, older men are
c. Japan, China, and Brazil
more likely than older women to be illiterate.
d. Russia, India, and Indonesia
20. True or false? In most nations, large cities have
10. Japan has the highest life expectancy at birth among
younger populations (i.e., a lower percent elderly) than
the major countries of the world. How many years
the country as a whole.
can the average Japanese baby born in 2000 expect
to live?
a. 70 years b. 75 years c. 81 years d. 85 years

U.S. Census Bureau An Aging World: 2001 iii


Answers
1. True. Although the world’s world’s growth rate for the 80+ But because older men work in
population is aging, children still population from 1999 to 2000 much greater numbers than do
outnumber the elderly in all was 3.5 percent, while that of older women, increases in
major nations except six: the world’s elderly (65+) popula- female participation were more
Bulgaria, Germany, Greece, Italy, tion as a whole was 2.3 percent than offset by falling male partic-
Japan, and Spain. (compared with 1.3 percent for ipation.
the total (all ages) population).
2. d. The estimated change in the 16. b. Of the 227 countries/areas
total size of the world’s elderly 9. b. India has roughly 6.2 million of the world with populations of
population between July 1999 people aged 80 and over, China at least 5,000, 167 (74 percent)
and July 2000 was more than has 11.5 million, and the United reported having some form of
9.5 million people, an average of States 9.2 million. Taken togeth- an old age/disability/survivors
795,000 each month. er, these people constitute nearly program circa 1999.
38 percent of the world’s oldest
3. c. The Caribbean, with 7.2 per- 17. d. The share of the private sec-
old.
cent of all people aged 65 or tor U.S. labor force covered by
older. Corresponding figures for 10. c. 81 years, up from about 52 private pension plans was about
other regions are: Asia (exclud- in 1947. 60 percent in the mid-1990s.
ing Japan), 5.5 percent; Latin However, not all employees who
11. True. In some African countries
America, 5.3 percent; and Africa, are covered by such plans actu-
(e.g., Malawi, Swaziland, Zambia,
3.1 percent. ally participate in them.
and Zimbabwe) where the
4. c. China also has the largest HIV/AIDS epidemic is particularly 18. a. The Philippines. The percent
elderly population, numbering devastating, average life of elderly people living alone in
nearly 88 million in 2000. expectancy at birth may be as developing countries is usually
much as 25 years lower than it much lower than that in devel-
5. False. Although industrialized
otherwise would be in the oped countries; levels in the lat-
nations have higher percentages
absence of HIV/AIDS. ter may exceed 40 percent.
of elderly people than do most
developing countries, 59 percent 12. b. Circulatory diseases (especial- 19. False. Older women are less
of the world’s elderly now live in ly heart disease and stroke) typi- likely to be literate. In China in
the developing countries of cally are the leading cause of 1990, for example, only 11 per-
Africa, Asia, Latin America, the death as reported by the World cent of women aged 60 and
Caribbean, and Oceania. Health Organization. In Canada over could read and write, com-
in 1995, for example, 44 percent pared with half of men aged 60
6. c. Italy, with 18.1 percent of all
of all deaths occurring to women and over.
people aged 65 or over. Monaco,
at age 65 or above were attrib-
a small principality of about 20. We do not know. Data for
uted to circulatory disease. The
32,000 people located on the selected cities/countries are pre-
percentage was virtually the
Mediterranean, has more than sented in Chapter 5. Some liter-
same for elderly men.
22 percent of its residents aged ature from developed countries
65 and over. 13. False. Although there are more suggests that the statement is
elderly women than elderly men false; evidence from certain
7. False. Although the United
in the vast majority of the developing countries suggests
States will age rapidly when the
world’s countries, there are that it is true. Both the Census
Baby Boomers (people born
exceptions such as India, Iran, Bureau’s International Programs
between 1946 and 1964) begin
and Bangladesh. Center and the National Institute
to reach age 65 after the year
on Aging’s Behavioral and Social
2010, the percent of population 14. d. All of the above.
Research Program would be
aged 65 and over in the year
15. a. From the late 1960s until most interested in empirical
2050 is projected to be slightly
very recently, labor force partici- input from interested parties.
above 20 percent (compared
pation rates of older men in Understanding global aging is a
with about 13 percent today).
developed countries were declin- dialectical process.
8. True. The oldest old are the ing virtually everywhere, where-
fastest-growing component of as those for women were often
many national populations. The holding steady or increasing.

iv An Aging World: 2001 U.S. Census Bureau


Contents

20 Questions About Global Aging . . . . . . . . . . . . . .iii 3. Average Annual Growth Rate and Percent
Change Over Time for Older Age Groups:
Chapter 2000 to 2015 and 2015 to 2030 . . . . . . . . . .130
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . .1
4. Median Population Age:
2. The Demographics of Aging . . . . . . . . . . . . . . . .7 2000, 2015, and 2030 . . . . . . . . . . . . . . . . . .132

3. Life Expectancy and Changing Mortality . . . . . .23 5. Total and Elderly Urban Population by Sex:
Available Data From 1970 to the Present . . . .133
4. Health and Disability . . . . . . . . . . . . . . . . . . . .37
6. Sex Ratio for Population 25 Years and
5. Urban and Rural Dimensions . . . . . . . . . . . . . .49 Over by Age: 2000 and 2030 . . . . . . . . . . . . .136
6. Sex Ratios and Marital Status . . . . . . . . . . . . . .57 7. Marital Status of Older Persons by Sex:
7. Living Arrangements . . . . . . . . . . . . . . . . . . . .65 Selected Years 1970 to 1995 . . . . . . . . . . . . .137

8. Family and Social Support of Older People . . . .73 8. Support Ratios: 2000, 2015, and 2030 . . . . . .154

9. Educational Attainment and Literacy . . . . . . . . .85 9. Parent Support Ratios: 1950,


2000, and 2030 . . . . . . . . . . . . . . . . . . . . . .155
10. Labor Force Participation and Retirement . . . . .93
10. Labor Force Participation Rates by Age and
11. Pensions and Income Security . . . . . . . . . . . .115 Sex: Selected Years, 1970 to 1999 . . . . . . . . .156
Appendix A. Appendix B.
Detailed Tables . . . . . . . . . . . . . . . . . . . . . . .125 Sources and Limitations of the Data . . . . . .163

Table Appendix C.
International Comparison of
1. Total Population, Percent Elderly, and Percent Urban and Rural Definitions . . . . . . . . . . . . .167
Oldest Old: 1975, 2000, 2015, and 2030 . . . .126
Appendix D.
2. Population by Age: 2000 and 2030 . . . . . . . . .128 References . . . . . . . . . . . . . . . . . . . . . . . . . . .169

U.S. Census Bureau An Aging World: 2001 v


CHAPTER 1.
Introduction

The United Nations designated 1999 poses myriad challenges to policy- of the total population in each cate-
as "The Year of the Older Person,” makers in many societies. After the gory). The developing world, by
thereby recognizing and reaffirming year 2010, the numbers and propor- contrast, still had a high proportion
what demographers and many others tions of elderly, especially the oldest of children (35 percent of all people
have known for decades: our global old, will rise rapidly in most devel- under age 15) and a relatively low
population is aging, and aging at an oped and many developing coun- proportion of older people (10 per-
unprecedented rate. Fertility decline tries.2 The projected increase is pri- cent aged 55 and over).
and urbanization arguably have been marily the result of high fertility after
What is less widely appreciated is
the dominant global demographic World War II. It is secondarily, but
that absolute numbers of elderly in
trends during the second half of the increasingly, the result of reduced
developing nations often are large
twentieth century, much as rapid death rates at all ages; in most
and everywhere are increasing.
improvements in life expectancy nations of the world, there have been
Well over half of the world’s elderly
characterized the early 1900s. As we major reductions in the prevalence of
(people aged 65 and over) now live
begin the twenty-first century, popu- infectious and parasitic diseases,
in developing nations (59 percent,
lation aging is poised to emerge as a declines in infant and maternal mor-
or 249 million people, in 2000). By
preeminent worldwide phenomenon. tality, and improved nutrition during
2030, this proportion is projected
The confluence of lowered fertility the 1900s. One focus of this report
to increase to 71 percent (686 mil-
and improved health and longevity is a look at the numbers, propor-
lion).3 Many developing countries
has generated growing numbers and tions, and growth rates (past, cur-
have had or are now experiencing a
proportions of older population rent, and projected) of the elderly
significant downturn in their rate of
throughout most of the world. As population.
natural population increase (births
education and income levels rise,
Most people, for good reason, asso- minus deaths) similar to what previ-
increasing numbers of individuals
ciate the growth of elderly popula- ously occurred in most industrial-
reach "old age” with markedly differ-
tions with the developed, industrial- ized nations. As this process accel-
ent life expectancies and personal
ized countries of Europe and North erates, age structures will change.
expectations than their forebears.
America. Most developed nations The elderly will be an ever-larger
Population aging represents, in one are in fact the demographically old- proportion of each nation’s total
sense, a human success story; soci- est in the world today, and some
eties now have the luxury of aging. may have more grandparents than 3
Throughout this report, projections of pop-
However, the steady, sustained children before the middle of the ulation size and composition come from the
growth of elderly1 populations also twenty-first century. In the early International Programs Center, Population
Division, U.S. Census Bureau, unless otherwise
1990s, developed nations as a whole indicated. As discussed further in Appendix B,
1
There is a growing awareness that the these projections are based on empirical analy-
had about as many children under
term “elderly” is an inadequate generalization ses of individual national population age and
that conceals the diversity of a broad age 15 years of age as people aged 55 sex structures, components of population
group, spanning more than 40 years of life. For change (rates of fertility, mortality, and net
cross-national comparative purposes, however,
and over (approximately 22 percent migration), and assumptions about the future
some chronological demarcation of age cate- trajectories of fertility, mortality, and migration
gories is required. This report uses the follow- 2
The “developed” and “developing” country for each country.
ing terms for component age groups: the elder- categories used in this report correspond direct- Projections, strictly speaking, are neither
ly (65 and over); the young old (65 to 74 ly to the “more developed” and “less developed” forecasts nor predictions. Projections are “cor-
years); and the oldest old (80 years and over). classification employed by the United Nations. rect” in the sense that they are actual results of
In some contexts (e.g., older people in the labor Developed countries comprise all nations in mathematical calculations based on specified
force), it may be most useful or necessary (due Europe (including some nations that formerly assumptions. Forecasts are projections that
to data restrictions) to refer to the “older popu- were part of the Soviet Union) and North analysts judge to be the most probable end
lation,” those 55 years and older. The term America, plus Japan, Australia, and New results. There can be alternative projections,
“frail elderly” refers to people 65 years or older Zealand. The remaining nations of the world but it would be contradictory to make alterna-
with significant physical and cognitive health are classified as developing countries. While tive forecasts. It may, however, be appropriate
problems. This term is used to emphasize the these categories commonly are used for com- to develop numerical ranges for forecast values.
fact that a majority of the elderly, especially the parative purposes, it is increasingly evident that Predictions have no formal statistical meaning;
young old, do not have serious health prob- they no longer accurately reflect developmental they are related more to forecasts than to pro-
lems. differences between nations. jections.

U.S. Census Bureau An Aging World: 2001 1


population. Elderly populations responsibilities change considerably the IPC and is funded in part by the
also have grown because of world- with increased age. Behavioral and Social Research
wide improvements in health servic- Program of the U.S. National
An Aging World: 2001 is the sev-
es, educational status, and econom- Institute on Aging. IDB contents are
enth major cross-national report in
ic development. The characteristics readily available from the Census
a Census Bureau series on the
of the elderly are likely to be Bureau’s Web site; the direct access
world’s elderly/older populations.
increasingly heterogeneous within address is www.census.gov/ipc/
The first two reports, An Aging
nations. Thus, a second focus of www/idbnew.html
World (1987) and Aging in the
An Aging World: 2001 is to summa-
Third World (1988), used data pri- Appendix B provides more informa-
rize socioeconomic statistics for
marily from the 1970 and 1980 tion about the sources, limitations,
both developed and developing
rounds of worldwide censuses and availability of IDB files and
nations. This report shows such
(those taken from 1965 to 1974 report data in general. There are
data for 52 nations when available
and 1975 to 1984, respectively), vast differences in both the quantity
and reasonably comparable. In
as well as demographic projections and quality of statistics reported by
2000, these 52 nations (listed in
produced by the United Nations various countries. The United
Appendix A, Table 1) contained
Population Division from its 1984 Nations has provided international
77 percent of the world’s total pop-
assessment of global population. recommendations for the standardi-
ulation, and are referred to as
Subsequent reports — Population zation of concepts and definitions
“study countries” at various points
and Health Transitions (1992); of data collected in censuses and
in the text.4
Aging in Eastern Europe and the surveys. Nevertheless, there are
This report focuses primarily on Former Soviet Union (1993); An still wide discrepancies in data col-
people aged 65 years old and over. Aging World II (1993); Older lection and tabulation practices
As is true of younger age groups, Workers, Retirement and Pensions because of legitimate differences in
people aged 65 and over have very (1995); and the current report — the resources and information
different economic resources, health include historical data from the needs among countries. As a
statuses, living arrangements, and earlier reports, available data from result, any attempt to compile stan-
levels of integration into social life. the 1990 and 2000 rounds of cen- dard data across countries requires
An Aging World: 2001 acknowl- suses, information from national consideration of whether and how
edges this diversity by disaggregat- sample surveys and administrative the reported data should be ana-
ing statistics into narrower age records, historical and projected lyzed to achieve comparability.
groups where possible. Such exam- data from the United Nations, and
The demographic data in this report
ination may reveal important demo- data from component population
have been judged by Census Bureau
graphic, social, and economic differ- projections prepared by the
analysts to be as representative as
ences that have direct bearing on International Programs Center
possible of the situation in a given
social policy now and in the future. (IPC), Population Division, U.S.
country. The data are internally con-
For example, the fastest growing Census Bureau. Differences among
sistent and congruent with other
portion of the elderly population in reports in projected data may
facts known about the nations.
many nations are those aged 80 reflect either a change in the
These demographic data also have
and over, referred to as the oldest source of the projections or, more
been checked for external consisten-
old. Rapidly expanding numbers of importantly, revised demographic
cy, that is, compared with informa-
very old people represent a social insights based on the most recent
tion on other countries in the same
phenomenon without historical information.
region or subregion and with those
precedent, and one that is bound to
Many of the data included in this elsewhere at approximately the
alter previously held stereotypes of
report are from the Census Bureau’s same level of socioeconomic devel-
older people. The growth of the
International Data Base (IDB). The opment. The socioeconomic data,
oldest old is salient to public policy
tabular statistics provided in by contrast, typically are as reported
because individual needs and social
Appendix A represent only a small by the countries themselves.
portion of the total IDB files. The Although Census Bureau analysts
4
In some parts of the text, data from addi-
tional countries have been included. IDB is maintained and updated by have not directly evaluated these

2 An Aging World: 2001 U.S. Census Bureau


data, analysts have attempted to proportion of the world’s population increasingly, biologic and genetic.
resolve discrepancies in reported fig- that is elderly (Figure 1-2). The The IDB and this report are an effort
ures and to eliminate international coming growth, especially of the to contribute to a consistent, sys-
inconsistencies; data with obvious oldest old, will be stunning. As tematic, quantitative comparison of
incongruities are not included. their numbers grow, there is a older populations in various coun-
heightened need to understand the tries. Information is the first step
We are all part of an increasingly
characteristics of older populations, toward a better understanding of
interdependent and aging world
their strengths, and their require- the effects of population aging with-
(Figure 1-1). Current growth of eld-
ments. The effects will be felt not in and across national boundaries.
erly populations is steady in some
just within individual nations but As individuals, as nations, and as an
countries and explosive in others.
throughout the global economy. international community, we face
As the World War II baby-boom
Understanding the dynamics of the challenge of anticipating the
cohorts, common to many coun-
aging requires accurate descriptions changing needs and desires of an
tries, begin to reach their elder
of the elderly from interrelated per- aging world in a new millennium.
years after 2010, there will be a
spectives including demographic,
significant jump by 2030 in the
social, economic, medical, and

U.S. Census Bureau An Aging World: 2001 3


4 An Aging World: 2001

Figure 1-1.
Percent Aged 65 and Over: 2000

Less than 3.0


3.0 to 7.9
U.S. Census Bureau

8.0 to 12.9
13.0 or more

Source: U.S. Census Bureau, 2000a.


U.S. Census Bureau

Figure 1-2.
Percent Aged 65 and Over: 2030
An Aging World: 2001 5

Less than 3.0


3.0 to 7.9
8.0 to 12.9
13.0 or more

Source: U.S. Census Bureau, 2000a.


CHAPTER 2.

The Demographics of Aging

The current level and pace of popula- Projections of older populations developed countries during and
tion aging vary widely by geographic may be more accurate than projec- after World War I. A second, less
region, and usually within regions as tions of total population, which severe, decline in the rate of
well. But virtually all nations are now must incorporate assumptions growth began in the mid-1990s
experiencing growth in their num- about the future course of human and will be most noticeable in the
bers of elderly residents. Developed fertility. Short-term and early 2000s. This decline corre-
nations have relatively high propor- medium-term projections of tomor- sponds to lowered fertility during
tions of people aged 65 and over, but row’s elderly are not contingent the Great Depression and World
the most rapid increases in elderly upon fertility, because anyone who War II. These drops in growth rate
population are in the developing will be aged 65 or over in 2030 has highlight the important influence
world. Even in nations where the already been born. When projecting that past fertility trends have on
elderly percentage of total population the size and composition of the current and projected changes in
remains small, absolute numbers world’s future elderly population, the size of elderly populations.
may be rising steeply. Everywhere, human mortality is the key demo-
The current aggregate growth rate
the growth of elderly populations graphic component. As discussed
of the elderly population in devel-
poses challenges to social institutions in the next chapter, current and
oping countries is more than double
that must adapt to changing age future uncertainties about changing
that in developed countries, and
structures. mortality may produce widely diver-
also double that of the total world
gent projections of the size of
WORLD’S ELDERLY population. The rate in developing
tomorrow’s elderly population.
POPULATION INCREASING countries began to rise in the early
795,000 EACH MONTH ELDERLY POPULATION 1960s, and has generally continued
The world’s elderly population has GROWING FASTEST IN to increase until recent years. After
DEVELOPING COUNTRIES a brief downturn — again related to
been growing for centuries. What is
new is the rapid pace of aging. The Population aging has become a lower wartime fertility — the elderly
global population aged 65 and over well-publicized phenomenon in the growth rate in developing countries
was estimated to be 420 million industrialized nations of Europe is expected to rise beyond and
people as of midyear 2000, an and North America. What is not remain above 3.5 percent annually
increase of 9.5 million since widely appreciated is the fact that from 2015 through 2030 before
midyear 1999. The net balance of developing countries are aging as declining in subsequent decades.
the world’s elderly population grew well, often at a much faster rate
EUROPE STILL THE “OLDEST”
by more than 795,000 people each than in the developed world. WORLD REGION, AFRICA THE
month during the year. Projections Seventy-seven percent of the “YOUNGEST”
to the year 2010 suggest that the world’s net gain of elderly individu-
Europe has had the highest propor-
net monthly gain will then be on als from July 1999 to July 2000 —
tion of population aged 65 and over
the order of 847,000 people. In 615,000 people monthly —
among major world regions for
1990, 26 nations had elderly popu- occurred in developing countries.
many decades and should remain
lations of at least 2 million, and by Figure 2-2 shows the different pat-
the global leader well into the
2000, 31 countries had reached the terns of growth in developed ver-
twenty-first century (Table 2-1).
2-million mark. Projections to the sus developing countries. Most
Until recently, this region also had
year 2030 indicate that more than notable in developed countries is
the highest proportions of popula-
60 countries will have 2 million or the steep plunge in growth in the
tion in the most advanced age cate-
more people aged 65 and over early 1980s. The slowing of the
gories. But in 2000, the percentage
(Figure 2-1). growth rate was the result of low
of population aged 80 and over in
birth rates that prevailed in many

U.S. Census Bureau An Aging World: 2001 7


8 An Aging World: 2001

Figure 2-1.
Countries With 2 Million or More Elderly People: 2000 and 2030

2000
U.S. Census Bureau

2030

Source: U.S. Census Bureau, 2000a.


North America was equal to that of
Figure 2-2. Europe as a whole, probably as a
Average Annual Percent Growth of Elderly result of small European birth
Population in Developed and Developing Countries cohorts around the time of World
War I. By 2015, however, these per-
Percent growth
5 centages are again expected to be
highest in Europe; in 2030, nearly
Developing countries, 65 years and over 12 percent of all Europeans are pro-
4 jected to be over the age of 74 and
7 percent are projected to be over
the age of 79.
3 North America and Oceania also
have relatively high aggregate per-
Developed countries, 65 years and over centages of elderly, and these are
2 projected to increase substantially
between 2000 and 2030. Levels for
2000 in Asia and Latin
1 America/Caribbean are expected to
more than double by 2030, while
Total world, all ages
aggregate proportions of elderly
0 population in Sub-Saharan Africa
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 will grow rather modestly as a
Source: United Nations, 1999. result of continued high fertility in
many nations.

Two important factors bear mention


Table 2-1. when considering aggregate elderly
Percent Elderly by Age: 2000 to 2030
proportions of regional populations.
65 years 75 years 80 years The first is that regional averages
Region
Year and over and over and over
often hide great diversity.
Bangladesh and Thailand may be
Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000 15.5 6.6 3.3
2015 18.7 8.8 5.2 close geographically, but these
2030 24.3 11.8 7.1 countries have divergent paths of
expected population aging.
North America . . . . . . . . . . . . . . . . . . . . . . 2000 12.6 6.0 3.3
2015 14.9 6.4 3.9 Likewise, many Caribbean nations
2030 20.3 9.4 5.4 have high proportions of elderly
Oceania . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000 10.2 4.4 2.3 population (the Caribbean is the
2015 12.4 5.2 3.1 “oldest” of all developing world
2030 16.3 7.5 4.4
regions) in relation to their Central
Asia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000 6.0 1.9 0.8 American neighbors. Secondly and
2015 7.8 2.8 1.4 more importantly, percentages by
2030 12.0 4.6 2.2
themselves may not give a sense of
Latin America/Caribbean . . . . . . . . . . . . . 2000 5.5 1.9 0.9 population momentum. Although
2015 7.5 2.8 1.5
2030 11.6 4.6 2.4 the change in percent elderly in
Sub-Saharan Africa from 2000 to
Near East/North Africa . . . . . . . . . . . . . . . 2000 4.3 1.4 0.6
2015 is barely perceptible, the size
2015 5.3 1.9 0.9
2030 8.1 2.8 1.3 of the elderly population is expect-
ed to jump by 50 percent, from
Sub-Saharan Africa . . . . . . . . . . . . . . . . . . 2000 2.9 0.8 0.3
2015 3.2 1.0 0.4 19.3 million to 28.9 million people.
2030 3.7 1.3 0.6

Source: U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 9


ITALY NOW THE WORLD’S
“OLDEST” MAJOR COUNTRY Figure 2-3.
The percent of population aged 65 The World's 25 Oldest Countries: 2000
and over ranged from 12 to 16 per- (Percent of population 65 years and over)

cent in 2000 in most developed


countries. For many years Sweden Italy 18.1

had the highest such proportion, Greece 17.3


but recently Italy became the demo- Sweden 17.3
graphically oldest of the world’s Japan 17.0
major1 nations. Over 18 percent of Spain 16.9
all Italians are aged 65 or over, with Belgium 16.8
levels approaching or exceeding Bulgaria 16.5
17 percent in Greece, Sweden, Germany 16.2
Japan, Spain, and Belgium. With France 16.0
the exception of Japan, the world’s United Kingdom 15.7
25 oldest countries are all in Europe Portugal 15.4
(Figure 2-3). The United States, Austria 15.4
with an elderly proportion of less Norway 15.2
than 13 percent in 2000, is rather Switzerland 15.1
young by developed-country stan- Croatia 15.0
dards, and its proportion elderly Latvia 15.0
will increase only slightly during the Finland 14.9
next decade. However, as the large Denmark 14.9
birth cohorts of the baby boom Serbia 14.8
(people born from 1946 through Hungary 14.6
1964) begin to reach age 65 after Estonia 14.5
2010, the percent elderly in the Slovenia 14.1
United States will rise markedly,
Luxembourg 14.0
likely reaching 20 percent by the
Ukraine 13.9
year 2030. Still, this figure will be
Czech Republic 13.9
lower than in most countries of
Western Europe. Source: U.S. Census Bureau, 2000a.

1
Some small areas/jurisdictions have very
high proportions of elderly population. In
2000, three of the world’s seven highest esti-
mated percentages of elders were in the
European principality of Monaco (more than 22
percent), Guernsey (17 percent) and the Isle of
Man (more than 17 percent).

10 An Aging World: 2001 U.S. Census Bureau


SOME ELDERLY POPULATIONS
Figure 2-4. TO MORE THAN TRIPLE BY 2030
Percent Increase in Elderly Population: 2000 to 2030 During the period 2000-2030, the
projected increase in elderly popu-
Developed countries
Developing countries lation in the 52 study countries
ranges from 14 percent in Bulgaria
Singapore 372 to 372 percent in Singapore (Figure
Malaysia 277 2-4). Today’s “older” nations will
Colombia 258
Costa Rica
experience relatively little change
250
Philippines 240 compared with many developing
Indonesia 240 nations; in countries as diverse as
Mexico 227
Malaysia and Colombia, elderly
South Korea 216
Egypt populations are expected to
210
Bangladesh 207 expand to more than three times
Peru 206 their size in 2000.
Thailand 197
Guatemala 196
Morocco 193
Brazil 192
Chile 183
Sri Lanka 178
Turkey 177
India 174
Tunisia 171
China 170
Liberia 160
Pakistan 153
Jamaica 134
Canada 126
Kenya 117
Australia 108
Israel 102
United States 102
New Zealand 92
Luxembourg 87
Argentina 81
Poland 75
Austria 67
Denmark 64
Czech Republic 63
Germany 63
Norway 62
France 56
United Kingdom 55
Japan 54
Belgium 50
Russia 48
Uruguay 48
Sweden 45
Zimbabwe 45
Italy 43
Greece 43
Malawi 41
Hungary 37
Ukraine 21
Bulgaria 14

Source: U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 11


THE LEGACY OF
FERTILITY DECLINE
Figure 2-5.
The most prominent historical fac- Total Fertility Rate: 2000
tor in population aging has been (Births per woman)
fertility decline. The generally sus-
Western Europe
tained decrease in total fertility
Austria 1.4
rates (TFRs) in industrialized nations Belgium 1.6
since at least 1900 has resulted in Denmark 1.7
France 1.8
current levels below the population
Germany 1.4
replacement rate of 2.1 live births Greece 1.3
per woman in most such nations Italy 1.2
Luxembourg 1.7
(Figure 2-5). Persistent low fertility
Norway 1.8
since the late 1970s has led to a Sweden 1.5
decline in the size of successive United Kingdom 1.7
birth cohorts and a corresponding Eastern Europe
Bulgaria 1.1
increase in the proportion of older 1.2
Czech Republic
relative to younger population. Hungary 1.3
Poland 1.4
Fertility change in the developing Russia 1.3
world has been more recent and Ukraine 1.3
Other Developed
more rapid, with most regions hav- 1.8
Australia
ing achieved major reductions in Canada 1.6
fertility rates over the last 30 years. Japan 1.4
New Zealand 1.8
Although the aggregate TFR 2.1
United States
remains in excess of 4.5 children Asia
per woman in Africa and many Bangladesh 2.9
China 1.8
countries of the Near East, overall
India 3.1
levels in Asia and Latin America Indonesia 2.6
decreased by about 50 percent Israel 2.6
Malaysia 3.3
(from 6 to 3 children per woman)
Pakistan 4.6
during the period 1965 to 1995. Philippines 3.5
Total fertility in many developing Singapore 1.2
countries — notably China, South South Korea 1.7
Sri Lanka 2.0
Korea, Thailand, and at least a 1.9
Thailand
dozen Caribbean nations — is now Turkey 2.2
at or below replacement level. Latin America/Caribbean
Argentina 2.5
Brazil 2.1
Chile 2.2
Colombia 2.7
Costa Rica 2.5
Guatemala 4.7
Jamaica 2.1
Mexico 2.7
Peru 3.0
Uruguay 2.4
Africa
Egypt 3.2
Kenya 3.7
Liberia 6.4
Malawi 5.3
Morocco 3.1
Tunisia 2.0
Zimbabwe 3.3

Source: U.S. Census Bureau, 2000a.

12 An Aging World: 2001 U.S. Census Bureau


fractious debates over health care
Figure 2-6. costs, social security, and intergen-
Speed of Population Aging erational equity that have emerged
(Number of years required or expected for percent of population aged 65
in Europe and North America.
and over to rise from 7 percent to 14 percent)

Developed countries
AN AGING INDEX
France (1865-1980) 115 An easily understood indicator of
Sweden (1890-1975) 85 age structure is the aging index,
Australia (1938-2011) 73 defined here as the number of peo-
United States (1944-2013) 69 ple aged 65 and over per 100
Canada (1944-2009) 65 youths under age 15. Among the
Hungary (1941-1994) 53 52 study countries in 2000, 5 coun-
Poland (1966-2013) 47 tries (Germany, Greece, Italy,
United Kingdom (1930-1975) 45 Bulgaria, and Japan) had more elder-
Spain (1947-1992) 45 ly than youth aged 0 to 14. By
Japan (1970-1996) 26 2030, however, all developed coun-
Developing countries
tries in Figure 2-7 have a projected
Azerbaijan (2000-2041) 41
aging index of at least 100, and
China (2000-2027) 27
several European countries and
Singapore (2001-2028) 27
Japan are in excess of 200. Today’s
Chile (2000-2025) 25
aging index typically is much lower
Jamaica (2009-2033) 24
in developing countries than in the
Sri Lanka (2004-2027) 23
Tunisia (2009-2032) 23
developed world, and the pattern of
Thailand (2003-2025) 22 future change is likely to be more
Brazil (2011-2032) 21
varied. If future fertility rates
Colombia (2017-2037) 20 remain relatively high, the absolute
change in the aging index will be
Sources: Kinsella and Gist, 1995; U.S. Census Bureau, 2000a. small. Generally, however, the pro-
portional rise in the aging index in
developing countries is expected to
EAST AND SOUTHEAST ASIA Southeast Asia (South Korea,
be greater than in developed
AGING THE FASTEST Taiwan, and Thailand), fueled by
countries.
In only one-quarter of a century — dramatic drops in fertility levels.
from 1970 to 1996 — the percent The rapidity of change in this The aging index also is useful in
of population aged 65 and over in region stands in stark contrast to examining within-country differ-
Japan increased from 7 to 14 per- some European countries, where ences in the level of population
cent (Figure 2-6). Similarly swift the comparable change occurred aging. As noted in Chapter 5, there
increases are expected in China, over a period of up to 115 years. can be significant differences in the
beginning around the turn of the Such rapidly aging societies are extent of aging between urban and
century, and elsewhere in East and soon likely to face the often- rural areas. There may also be

U.S. Census Bureau An Aging World: 2001 13


Figure 2-7. DEVELOPING COUNTRIES
Asia
Aging Index: 2000 and 2030 2000
9 2030
(People aged 65 and over per 100 people aged 0-14) Bangladesh
32
27
China
DEVELOPED COUNTRIES 91
14
Western Europe India
38
92 15
Austria Indonesia
186 52
36
96 Israel
Belgium 73
172
12
80 Malaysia
Denmark 36
143 10
Pakistan
85 25
France
155 10
Philippines
103 30
Germany 38
187 Singapore
114 96
Greece 32
206 South Korea
125
127
Italy 25
261 Sri Lanka
85
74 27
Luxembourg Thailand
117 96
76 21
Norway Turkey
131 71
94 Latin America/Caribbean
Sweden
169 39
Argentina
82 74
United Kingdom
152 18
Brazil
69
Eastern Europe 26
Chile
106 90
Bulgaria 14
244 Colombia
50
84 16
Czech Republic Costa Rica
216 64
87 9
Hungary Guatemala
179 18
64 22
Poland Jamaica
160 67
13
70 Mexico
Russia 45
141
13
78 Peru
Ukraine 43
133 53
Uruguay
73
Other Developed Countries
Africa
60
Australia 11
126 Egypt
34
66 6
Canada Kenya
148 19
115 8
Japan Liberia
231 11
51 6
New Zealand Malawi
103 10
13
59 Morocco
United States 40
102
20
Tunisia
71
9
Zimbabwe
Source: U.S. Census Bureau, 2000a. 23

14 An Aging World: 2001 U.S. Census Bureau


Figure 2-8.
Aging Index in Brazil by State: 1991
(Population aged 65 and over per 100 population aged 0-14)

Roraima

Amapa

Rio Grande
Amazonas Para do Norte
Maranhao Ceara

Paraiba
Piaui
Pernambuco
Acre
Alagoas
Tocantins
Rondonia Sergipe
Bahia
Mato Grosso

Goias

Minas Gerais
Espirito
Mato Grosso
Santo
do Sul

Sao Paulo
Rio de
Janeiro
Parana

Santa
Catarina Aging index
5.4 to 8.9
Rio Grande 9.0 to 11.9
do Sul 12.0 to 13.9
14.0 to 21.0

Source: 1991 Census of Brazil.

U.S. Census Bureau An Aging World: 2001 15


broader regional differences, espe-
cially in large nations such as Brazil Figure 2-9.
(Figure 2-8). Based on 1991 census Median Age in 12 Countries: 2000, 2015, and 2030
data, the overall aging index in (In years)
Brazil was 14. However, this meas- 2000
ure ranged from less than 6 in sev- 2015
Developed countries 2030
eral northern states of the country
to 21 in the state of Rio de Janeiro. 37
Canada 41
MEDIAN AGE TO RISE IN
44
ALL COUNTRIES
40
Population aging refers most simply Germany 45
to increasing proportions of older 47
people within an overall population 41
age structure. Another way to think Japan 45
of population aging is to consider a 50
society’s median age, the age that 40
divides a population into numerical- Italy 46
ly equal parts of younger and older 52
people. For example, the 2000 36
median age in the United States was United States 38
36 years, indicating that the num- 39
ber of people under age 36 equals
the number who have already cele-
brated their 36th birthday. Developing countries

26
The 2000 median ages of the 52
Brazil 31
study countries ranged from 17 in
37
Malawi to 41 in Japan. Developed
30
countries are all above the 32-year
China 36
level, while a majority of develop-
41
ing nations have median ages under
25. During the next three decades, 18
Liberia 18
the median age will increase in all
20
52 countries, though at very differ-
17
ent rates. By 2030, Italy is project-
Malawi 20
ed to have the highest median age,
23
with half its population aged 52 or
23
over (Figure 2-9), reflecting in large
Mexico 28
part the extremely low level of fer-
34
tility now occurring. By way of con-
19
trast, persistently high birth rates
Pakistan 24
are likely to preclude a large change
29
in median age in some developing
29
countries (e.g., Liberia and Malawi).
Thailand 35
40

Source: U.S. Census Bureau, 2000a.

16 An Aging World: 2001 U.S. Census Bureau


THE DYNAMICS OF retirees from other countries, and aged 25 to 44, and younger cohorts
POPULATION AGING return migration of former emi- were becoming successively small-
The process of population aging is, grants who are above the average er. If fertility rates continue as pro-
as noted earlier, primarily deter- population age; all three factors jected through 2030, the aggregate
mined by fertility (birth) rates and contribute to population aging. pyramid will start to invert, with
secondarily by mortality (death) Some demographers expect interna- more weight on the top than on the
rates, so that populations with high tional migration to assume a more bottom. The size of the oldest-old
fertility tend to have low propor- prominent role in the aging process, population (especially women) will
tions of older people and vice particularly in graying countries increase, and people aged 80 and
versa. Demographers use the term where persistently low fertility has over may eventually outnumber any
“demographic transition” to refer to led to stable or even declining total younger 5-year group. Although
a gradual process2 wherein a socie- population size (see Box 2-1). the effect of fertility decline usually
ty moves from a situation of high Eventual shortages of workers may has been the driving force in chang-
rates of fertility and mortality to generate demands for immigrant ing population age structures, cur-
one of low rates of fertility and labor (Peterson, 1999) and may rent and future changes in mortality
mortality. This transition is charac- force nations to choose between will assume much greater weight,
terized first by declines in infant relaxed immigration policies and particularly in relatively “aged”
and childhood mortality as infec- pronatalist strategies to raise birth countries (Caselli and Vallin, 1990),
tious and parasitic diseases are rates (Kojima, 1996). and are discussed further in the
reduced. The resulting improve- next chapter.
Figure 2-10 illustrates the historical
ment in life expectancy at birth and projected aggregate population ELDERLY POPULATIONS
occurs while fertility tends to age structure transition in develop- THEMSELVES OFTEN ARE AGING
remain high, thereby producing ing and developed countries. At
large birth cohorts and an expand- An increasingly important feature of
one time, most if not all countries
ing proportion of children relative societal aging is the progressive
had a youthful age structure similar
to adults. Other things being equal, aging of the elderly population
to that of developing countries as a
this initial decline in mortality gen- itself. Over time, a nation’s elderly
whole in 1950, with a large percent-
erates a younger population age population may grow older on aver-
age of the entire population under
structure (Lee, 1994). age as a larger proportion survives
the age of 15. Given the relatively
to 80 years and beyond. In many
Generally, populations begin to age high rates of fertility that prevailed
countries, the “oldest old” (people
when fertility declines and adult in most developing countries from
aged 80 and over) are now the
mortality rates improve. Successive 1950 through the early 1970s, the
fastest growing portion of the total
birth cohorts may eventually overall pyramid shape had not
population. In the mid-1990s, the
become smaller and smaller, changed greatly by 1990. However,
global growth rate of the oldest old
although countries may experience the effects of fertility and mortality
was somewhat lower than that of
a “baby boom echo” as women of decline can be seen in the projected
the world’s elderly, a result of low
prior large birth cohorts reach child- pyramid for 2030, which loses its
fertility that prevailed in many
bearing age. International migration strictly triangular shape as the size
countries around the time of World
usually does not play a major role of younger 5-year cohorts stabilizes
War I. In other words, people who
in the aging process, but can be and the elderly portion of the total
were reaching age 80 in 1996, for
important in smaller populations. population increases.
example, were part of a relatively
Certain Caribbean nations, for The picture in developed countries small birth cohort. The growth rate
example, have experienced a com- has been and will be quite different. of the world’s oldest-old population
bination of emigration of working- In 1950, there was relatively little from 1996 to 1997 was only
age adults, immigration of elderly variation in the size of 5-year 1.3 percent. Just a few years later,
groups between the ages of 5 and however, the fertility effects of
2
The concept of demographic transition 24. The beginnings of the post- World War I had dissipated; from
admittedly is a broad one, and some would World War II baby boom can be 1999 to 2000, the growth rate of
argue that it has many permutations or that
there is more than one form of demographic seen in the 0-4 age group. By the world’s 80-and-over population
transition; see, for example, the discussion in had jumped to 3.5 percent,
1990, the baby-boom cohorts were
Coale and Watkins (1986).

U.S. Census Bureau An Aging World: 2001 17


Box 2-1.
Population Aging in the Context of Overall Population Decline

European demographers have sounded warning bells means to affect fertility, including direct financial
for at least the last 30 years with regard to the pos- incentives for additional births; indirect pension (i.e.,
sibility of declining population size in industrialized early retirement) or in-kind benefits such as preferen-
nations. Until very recently, however, this idea had tial access for mothers with many children to subsi-
not permeated public discourse. Societies were dized housing; or measures to reduce the opportunity
aware that they were aging, but the equation of costs of additional childbearing. These policies have
aging with population decline was uncommon. In had modest impacts in authoritarian states, but only
the last 2 years, the visibility of likely population minimal impacts in liberal democracies such as France
decline has increased dramatically, in large part due and Sweden (Teitelbaum, 2000). Industrial societies
to United Nations (2000a; 2000b) reports suggesting already provide various rewards, but using them to
that populations in most of Europe and Japan will deliberately manipulate fertility is a sensitive issue,
decrease in size over the next 50 years, and to pub- potentially involving substantial economic transfers.
licity accorded to actual declines in Spain, Italy,
The United Nations (2000a) undertook an examination
Russia, and other nations.
of the likely impact of migration as a counterbalance
This trend raises several contentious issues: Is per- to aging, building on earlier work by Lesthaeghe,
sistent below-replacement fertility a threat to Page, and Surkyn (1988), the Organization for
European and other societies, and if so, can it be Economic Co-Operation and Development (1991), and
altered? To what extent, if any, should so-called others. The conclusion was that inflows of migrants
“replacement migration” be encouraged as a mecha- will not be able to prevent European population
nism to offset population aging? Are there important declines in the future, nor rejuvenate national popula-
macroeconomic (e.g., transnational capital flows; tions, unless the migration flows are of very large
changes in national savings rates) and national securi- magnitude (i.e., millions annually). On the heels of
ty issues that should be considered? this report, the United Nations convened an Expert
Group Meeting on Policy Responses to Population
There are no hard and fast answers to these ques-
Aging and Population Decline in October 2000. The
tions. One study (Bongaarts and Bulatao, 2000) exam-
consensus of the experts was that replacement migra-
ined the experience of the diverse set of countries
tion was not a viable “solution” in and of itself, but
that have made the transition to low fertility. In very
could buffer the likely impact of future aging if used
few of these countries has fertility stabilized at rates
by governments in conjunction with other policies
above two children per woman. Such an occurrence
(e.g., increased labor force participation, especially
would be dependent on substantial proportions of
among women; fertility inducements as noted above).
higher-order births, but higher-order births are largely
With regard to global financial and security issues, lit-
“anachronistic” in industrial-country settings. The ten-
tle systematic work has been done on overall
tative conclusion was that fertility is unlikely to
impacts, though researchers are beginning to explore
rebound significantly, but it has been noted that few
and model various scenarios (see, e.g., CSIS and
demographers anticipated the post-World War II baby
Watson Wyatt, 2000; Eberstadt, 2000; MacKellar and
boom that will soon have a major impact on popula-
Ermolieva, 2001; Mason et al., 2001).
tion aging. Governments have employed various

18 An Aging World: 2001 U.S. Census Bureau


Figure 2-10.
Population by Age and Sex: 1950, 1990, and 2030 Developing countries
Developed countries

Age 1950
80+ Male Female
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5- 9
0- 4
400 300 200 100 0 100 200 300 400

1990
80+
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5- 9
0- 4
400 300 200 100 0 100 200 300 400

2030
80+
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5- 9
0- 4
400 300 200 100 0 100 200 300 400
Millions
Sources: United Nations, 1999 and U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 19


considerably higher than that of the
world’s elderly as a whole (2.3 per- Figure 2-11.
cent). In the future, we expect to Percent Distribution of World Population
see sustained high growth of the Aged 80 and Over: 2000
oldest old. In the first decade of the
twenty-first century, the projected United States 13.1
average annual growth rate of the
80-and-over population is 3.9 per- China 16.3
cent (versus 2.0 percent for the India 8.7
65-and-over population), and is Japan 6.6
expected to remain above 3 percent Other Asia 8.9
during the period 2010-2020.
Russia 4.2
The oldest old constituted 17 per-
Germany 4.1
cent of the world’s elderly in 2000:
United Kingdom 3.4
22 percent in developed countries
Italy 3.3
and 13 percent in developing coun-
France 3.1
tries. More than half (53 percent) of
Spain 2.1
the world’s oldest old in 2000 lived
Other Europe 10.5
in just six countries: China, the
United States, India, Japan,
Latin America/Caribbean 6.9
Germany, and Russia (Figure 2-11).
Africa/Near East 5.8
About an additional one-fifth (22
All remaining countries 3.1
percent) lived elsewhere in Europe,
while 7 percent lived in Latin
Note: Data represent the share of the world's total oldest old in each country or region. Individual
America/Caribbean and about 6 countries with more than 2.0 percent of the total are shown separately.
Source: U.S. Census Bureau, 2000a.
percent lived in Africa/Near East
regions, and another 9 percent in
Asian countries other than China, Sweden, and 4 percent or more of countries (e.g., Barbados, Cuba,
India, and Japan. the total in several other European Puerto Rico, and Uruguay) have
countries (Denmark, Italy, Norway, higher levels than many Eastern
Among the 52 study countries, the and the United Kingdom). In gener- European nations.
percentage of oldest old in the total al, Western European nations are
population in 2000 was less than Countries vary considerably in the
above 3 percent, while other
half a percent in several developing projected age components of elder-
developed countries are between 2
countries (e.g., Egypt, Guatemala, ly populations. In the United States,
and 3 percent. In most developing
Indonesia, Kenya, and Malawi). In the oldest old were 26 percent of all
nations, less than 1 percent of the
contrast, the oldest old constituted elderly in 2000, and are expected
population is aged 80 and over,
5 percent of the total population of to continue to be 26 percent in
although some developing

20 An Aging World: 2001 U.S. Census Bureau


boom may produce a great-grand-
Figure 2-12. parent boom in many countries.
Oldest Old as a Percent of All Elderly: 2000 and 2030 The numerical growth and increas-
(People aged 80 and over as a percent of people aged 65 and over) ing heterogeneity of the oldest old
2000 compel social planners to seek fur-
2030 ther health and socioeconomic
21.7 information about this group,
Argentina
27.3 because the oldest old consume
13.2 disproportionate amounts of health
Bulgaria
27.8
and long-term care services
21.7
Japan (Suzman, Willis, and Manton, 1992).
39.3
Past population projections often
13.3
Pakistan have underestimated the improve-
14.4
ment in mortality rates among the
15.9
Russia oldest old, and as the next chapter
20.0
points out, actual numbers of
26.5
United States tomorrow’s oldest old could be
26.4
much higher than presently antici-
Source: U.S. Census Bureau, 2000a.
pated. Because of the sustained
increases in longevity in many
nations, greater age detail is needed
2030 (Figure 2-12). Some European Stability in the proportion of oldest for the oldest old. In the past, com-
nations will experience a sustained old in the elderly population should parable population projections for
rise in this ratio, while others will not deflect attention from burgeon- the world’s countries often grouped
see an increase during the next two ing absolute numbers. In the everyone aged 80 and over into a
decades and then a subsequent United States, the oldest old single, open-ended component.
decline. The most striking global increased from 374 thousand in Today, for the first time, agencies
increase is likely to occur in Japan; 1900 to more than 9 million today. (e.g., the United Nations Population
by 2030, nearly 40 percent of all The small percentage decline for Division; the U.S. Census Bureau’s
elderly Japanese are expected to be the United States in Figure 2-12 International Programs Center) are
at least 80 years old. Most masks a projected absolute increase producing sets of international pop-
developing countries should experi- of over 9 million oldest-old people. ulation projections that expand the
ence modest long-term increases in Four-generation families are becom- range of older age groups up to an
this ratio. ing increasingly common (Soldo, open-ended category of age 100
1996), and the aging of the baby and over.

U.S. Census Bureau An Aging World: 2001 21


Box 2-2.
The Growth of Centenarians

As average length of life increases, the concept of There are several problems with obtaining accurate
“oldest old” will change. While people of extreme old age data on very old people (Kestenbaum, 1992; Elo
age constitute a tiny portion of total population in et al., 1996), and estimates of centenarians from cen-
most of the world, their numbers are of growing suses and other data sources should be scrutinized
importance, especially in more-developed nations. carefully. For example, the 1990 United States census
Thanks to improvements in nutrition, health, and recorded some 37,000 centenarians, although due to
health care, we now have for the first time in history age misreporting, the actual figure is thought to be
the opportunity to consider significant numeric closer to 28,000, (Krach and Velkoff, 1999). Still, this
growth of the population aged 100 and over. represents a doubling of the population aged 100 and
According to researchers in Europe, the number of over from 1980 to 1990, similar to estimates for
centenarians has doubled each decade since 1950 in European nations. The potentially spectacular
industrialized countries. Using reliable statistics from increase in numbers of centenarians is illustrated by
ten Western European countries and Japan, Vaupel and data and projections for France. Dinh (1995) has esti-
Jeune (1995) estimated that some 8,800 centenarians mated that there were about 200 centenarians in
lived in these countries as of 1990, and that the num- France in 1950, and that by the year 2000 the num-
ber of centenarians grew at an average annual rate of ber would be 8,500. His 50-year projections suggest
approximately 7 percent between the early 1950s and 41,000 people aged 100 and over by 2025, increas-
the late 1980s. They also estimate that, over the ing to 150,000 in 2050. If these projections are real-
course of human history, the odds of living from birth ized, the number of centenarians in France will have
to age 100 may have risen from 1 in 20 million to 1 multiplied by a factor of 750 in one century.
in 50 for females in low-mortality nations such as
Japan and Sweden.

22 An Aging World: 2001 U.S. Census Bureau


CHAPTER 3.

Life Expectancy and


Changing Mortality

The spectacular increases in human European nations, the normal the world have been fairly uniform.
life expectancy that began in the lifetime in many African countries Practically all nations have shown
mid-1800s and continued during spans fewer than 45 years. On continued improvement, with some
the following century are often average, an individual born in a exceptions in Latin America and
ascribed primarily to improvements more-developed country can now more recently in Africa, the latter
in medicine. However, the major expect to outlive his/her counter- due to the impact of the HIV/AIDS
impact of improvements both in part in the less-developed world by epidemic. The most dramatic gains
medicine and sanitation did not 13 years. in the developing world have been
occur until the late nineteenth cen- in East Asia, where life expectancy
tury. Earlier and more important TWENTIETH CENTURY LIFE at birth increased from less than
EXPECTANCY HAS DOUBLED IN
factors in lowering mortality were 45 years in 1950 to more than
SOME DEVELOPED COUNTRIES
innovations in industrial and agri- 72 years today.
cultural production and distribution, Table 3-1 shows the enormous
which improved nutrition for large strides that countries have made in TREND IN RISING LIFE
extending life expectancy since EXPECTANCY MAY BE
numbers of people (Thomlinson,
CHALLENGED
1976). A growing research consen- 1900. In developed countries, the
sus attributes the gain in human average national gain in life While global gains in life expectancy
longevity since the early 1800s to a expectancy at birth was 66 percent at birth have been the norm,
complex interplay of advancements for males and 71 percent for unforeseen changes and epidemics
in medicine and sanitation coupled females during the period 1900-90. may reverse the usual historical pat-
with new modes of familial, social, In Italy, life expectancy at birth for tern. Beginning in the 1950s, the
economic, and political organization women increased from 43 years in typical sustained increase in life
(Moore, 1993). 1900 to over 82 years in 2000. In expectancy at birth in developed
some cases, life expectancy has countries began to take different
LIFE EXPECTANCY AT BIRTH more than doubled during the cen- paths. While female life expectancy
EXCEEDS 78 YEARS IN 28 tury (e.g., Spain). continued to rise virtually every-
COUNTRIES
where, male gains slowed signifi-
Increases in life expectancy were
Life expectancy at birth in Japan cantly and in some cases leveled
more rapid in the first half than in
and Singapore has reached off. From the early 1950s to the
the second half of the century.
80 years, the highest level of all the early 1970s, for example, male life
Expansion of public health services
world’s major countries, and has expectancy changed little in
and facilities and disease eradica-
reached 79 years in several other Australia, the Netherlands, Norway,
tion programs greatly reduced
developed nations (e.g., Australia, and the United States. After this
death rates, particularly among
Canada, Italy, Iceland, Sweden, and period of stagnation, male life
infants and children. From 1900 to
Switzerland). Levels for the United expectancy again began to rise.
1950, people in many Western
States and most other developed
nations were able to add 20 years In Eastern Europe and the former
countries fall in the 76-78 year
or more to their life expectancies. Soviet Union, the pace of improve-
range (Figure 3-1). Throughout the
ment in the 1950s and early 1960s
developing world, there are Reliable estimates of life expectancy
was extraordinary. Advances in
extreme variations in life expectan- for many developing countries prior
living conditions and public health
cy at birth (Figure 3-2). While the to 1950 are unavailable. Since
policies combined to produce large
levels in some developing nations World War II, changes in life
declines in mortality by reducing
match or exceed those in many expectancy in developing regions of
some major causes of death

U.S. Census Bureau An Aging World: 2001 23


(e.g., tuberculosis) to minimal lev-
els (Vishnevsky, Shkolnikov, and Figure 3-1.
Vassin, 1991). Resultant gains in Life Expectancy at Birth: 2000 Developed countries
life expectancy in excess of (In years) Developing countries
5 years per decade were common.
By the mid-1960s, however, the United States 77.1
Western Europe
rate of increase had decelerated
Sweden 79.6
sharply. In the 1970s and 1980s, Italy 79.0
changes in female life expectancy France 78.8
Norway 78.7
at birth were erratic, while male
Greece 78.4
life expectancy fell throughout the Belgium 77.8
region (Bobadilla and Costello, Austria 77.7
United Kingdom 77.7
1997). Following the demise of
Germany 77.4
the former Soviet Union, the Luxembourg 77.1
decline has continued into the Denmark 76.5
Eastern Europe
1990s in some countries. The
Czech Republic 74.5
decline has been particularly Poland 73.2
severe for Russian men; between Hungary 71.4
Bulgaria 70.9
1987 and 1994, male life
Russia 67.2
expectancy at birth plummeted Ukraine 66.0
7.3 years to a level of 57.6, before Other Developed
Japan 80.7
beginning to rise again in recent
Australia 79.8
years (Figure 3-3). The large Canada 79.4
increases in adult male mortality New Zealand 77.8
Asia
usually are attributed to a combi-
Singapore 80.1
nation of factors including Israel 78.6
increased homicide and accident South Korea 74.4
Sri Lanka 71.8
rates, excessive alcohol consump-
China 71.4
tion, poor diet, and environmen- Turkey 71.0
tal/workplace degradation Malaysia 70.8
Thailand 68.6
(Virganskaya and Dmitriev, 1992;
Indonesia 68.0
Murray and Bobadilla, 1997), Philippines 67.5
although most researchers take India 62.5
pains to point out that clear causal Pakistan 61.1
Bangladesh 60.2
mechanisms remain poorly Latin America/Caribbean
understood. Costa Rica 75.8
Chile 75.7
Uruguay 75.2
Jamaica 75.2
Argentina 75.1
Mexico 71.5
Colombia 70.3
Peru 70.0
Guatemala 66.2
Brazil 62.9
Africa
Tunisia 73.7
Morocco 69.1
Egypt 63.3
Liberia 51.0
Kenya 48.0
Zimbabwe 37.8
Malawi 37.6

Source: U.S. Census Bureau, 2000a.

24 An Aging World: 2001 U.S. Census Bureau


U.S. Census Bureau

Figure 3-2.
Life Expectancy at Birth: 2000
An Aging World: 2001 25

Under 50 years
50 to 64 years
65 to 74 years
75 years and over

Source: U.S. Census Bureau, 2000a.


Table 3-1.
Life Expectancy at Birth in 34 Countries: 1900 to 2000
(In years)

Circa 1900 Circa 1950 2000


Region/country
Male Female Male Female Male Female

DEVELOPED COUNTRIES
Western Europe
Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.8 39.9 62.0 67.0 74.5 81.0
Belgium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.4 48.9 62.1 67.4 74.5 81.3
Denmark . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.6 54.8 68.9 71.5 74.0 79.3
France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.3 48.7 63.7 69.4 74.9 82.9
Germany1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.8 46.6 64.6 68.5 74.3 80.8
Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52.3 55.8 70.3 73.8 75.7 81.8
Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52.8 55.3 69.9 72.6 77.0 82.4
United Kingdom . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.4 50.1 66.2 71.1 75.0 80.5
Southern and Eastern Europe
Czech Republic1 . . . . . . . . . . . . . . . . . . . . . . . . . . 38.9 41.7 60.9 65.5 71.0 78.2
Greece. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.1 39.7 63.4 66.7 75.9 81.2
Hungary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.6 38.2 59.3 63.4 67.0 76.1
Italy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.9 43.2 63.7 67.2 75.9 82.4
Spain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33.9 35.7 59.8 64.3 75.3 82.5
Other
Australia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.2 56.8 66.7 71.8 76.9 82.7
Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.8 44.3 59.6 63.1 77.5 84.1
United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.3 51.1 66.0 71.7 74.2 79.9

Circa 1950 2000

Male Female Male Female


DEVELOPING COUNTRIES
Africa
Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.2 43.6 61.3 65.5
Ghana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40.4 43.6 56.1 58.8
Mali. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.1 34.0 45.5 47.9
South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44.0 46.0 50.4 51.8
Uganda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.5 41.6 42.2 43.7
Congo (Brazzaville) . . . . . . . . . . . . . . . . . . . . . . . . 37.5 40.6 44.5 50.5
Asia
China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.3 42.3 69.6 73.3
India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.4 38.0 61.9 63.1
Kazakhstan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.6 61.9 57.7 68.9
South Korea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.0 49.0 70.8 78.5
Syria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44.8 47.2 67.4 69.6
Thailand. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.0 49.1 65.3 72.0
Latin America
Argentina. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60.4 65.1 71.7 78.6
Brazil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49.3 52.8 58.5 67.6
Costa Rica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56.0 58.6 73.3 78.5
Chile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57.8 61.3 72.4 79.2
Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49.2 52.4 68.5 74.7
Venezuela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.8 56.6 70.1 76.3
1
Figures for Germany and Czech Republic prior to 1999 refer to the former West Germany and Czechoslovakia, respectively.
Note: Reliable estimates for 1900 for most developing countries are not available.
Source: UNDIESA 1988; Siampos 1990; and U.S. Census Bureau, 2000a.

26 An Aging World: 2001 U.S. Census Bureau


Elsewhere, the HIV/AIDS epidemic
Figure 3-3. has had a devastating impact on life
Life Expectancy at Birth in Four expectancy, particularly in parts of
Countries: 1950 to 1998 Africa. The effect of the epidemic
on life expectancy at birth may be
Male considerable, given that AIDS
Life expectancy in years deaths often are concentrated in the
90
childhood and middle adult (30 to
80 United States 45) ages. Projections to the year
2010 suggest that AIDS may reduce
70 life expectancy at birth by more
than 30 years from otherwise-
60
South Korea expected levels in countries such as
Russia Botswana, Namibia, South Africa,
50
Zimbabwe and Zimbabwe. And while the com-
40 mon perception of AIDS mortality
usually associates AIDS deaths with
30 children and younger adults, the
epidemic may have a direct and
20
growing effect on older popula-
10 tions. In the United States in 1992,
nearly three times as many people
0 aged 60 and over died of AIDS as
1950 1960 1970 1980 1990 1998
did people under age 20. Between
1987 and 1992, the annual number
Female of U.S. children who died of AIDS
Life expectancy in years
90
remained relatively stable, whereas
United States the number of deaths to people
80 aged 60 and over nearly doubled
(Hobbs and Damon, 1996).
70
Russia
South Korea
60

50 Zimbabwe

40

30

20

10

0
1950 1960 1970 1980 1990 1998

Sources: United Nations, 1999; U.S. Census Bureau, 2000a; and country sources.

U.S. Census Bureau An Aging World: 2001 27


FEMALE ADVANTAGE IN LIFE
EXPECTANCY NEARLY Figure 3-4.
UNIVERSAL
Female Advantage in Life Expectancy at Birth: 2000
The widening of the sex differential (Difference in years between females and males)
Developed countries
in life expectancy has been a central Developing countries
feature of mortality trends in devel-
oped countries in the twentieth cen- Belarus 12.7
tury. In 1900, in Europe and North France 8.0
America, women typically outlived Japan 6.5
Hungary 9.1
men by 2 or 3 years. Today, the
Russia 10.7
average gap between the sexes is
United States 5.7
roughly 7 years, but exceeds
Spain 7.2
12 years in parts of the former Bangladesh -0.5
Soviet Union as a result of the Syria 2.3
unusually high levels of male mor- Mexico 6.2
tality discussed above (Figure 3-4). Egypt 4.2
This differential reflects the fact that China 3.7
in most nations females have lower Chile 6.8
mortality than males in every age
Source: U.S. Census Bureau, 2000a.
group and for most causes of death.
Female life expectancy now exceeds
80 years in over 30 countries and is
approaching this level in many other Figure 3-5.

nations. The gender differential


Mortality Rates at Older Ages: 2000
(Per 1,000 population in age/sex group)
usually is smaller in developing
Male
countries, commonly in the 3-6 year Female
Canada
range, and even is reversed in some
23
South Asian and Middle East soci- 65-69
12
eties where cultural factors (such as 36
70-74
low female social status and prefer- 19
57
ence for male rather than female off- 75-79
32
spring) are thought to contribute to 80+
117
higher male than female life 87

expectancy at birth. Uruguay


30
65-69
MALE MORTALITY 16
SUBSTANTIALLY HIGHER THAN 46
70-74
25
FEMALE MORTALITY AT
68
OLDER AGES 75-79
45
138
The data in Figure 3-5 illustrate the 80+
108
usual gender pattern of mortality at
Germany
older ages, wherein male rates are
26
seen to be consistently higher than 65-69
12
female rates. In Canada and 40
70-74
Germany, for instance, male mortali- 21
65
ty rates for ages 65 to 74 are 75-79
38
roughly twice as great as correspon- 147
80+
ding female rates. Among coun- 116

tries, though, age-specific mortality


Source: Estimated by the U.S. Census Bureau based on individual country sources.
rates can differ widely even where
overall mortality appears similar.

28 An Aging World: 2001 U.S. Census Bureau


nations, most demographers expect
Figure 3-6. to see a widening of the
Life Expectancy at Age 65 in Japan and the female/male difference in upcoming
United States: 1970, 1980, and 1998 decades, along the lines of the his-
(Years of life remaining for those who reach age 65) torical trend in industrialized
nations. Evidence suggests that
Japan, Male
many developing countries are
1970 12.5
experiencing increases in alcohol
1980 14.6
and tobacco consumption and
1998 17.1
vehicular as well as industrial acci-
Japan, Female
dents, all of which tend, at least ini-
1970 15.3
tially, to adversely affect men more
1980 17.7
than women. Another factor that
1998 22.0
may promote a widening gender
United States, Male
gap is education, which is positively
1970 13.1
related to survival. As women
1980 14.1
“catch up” to men in terms of edu-
1998 16.0 cational attainment, female survival
United States, Female and health status may improve (Liu,
1970 17.0 Hermalin, and Chuang, 1998).
1980 18.3
1998 19.2 OLD-AGE MORTALITY RATES
DECLINING OVER TIME
Source: U.S. Census Bureau, 2000a.
In countries where infant mortality
rates are still relatively high but
declining, most of the improvement
For example, total life expectancy cited as a source of higher male
in life expectancy at birth results
at birth in 1995 was about the mortality rates (Statistics Canada,
from helping infants survive the
same in Cuba (75.4 years) and 1997), suggesting that the gap in
high-risk initial years of life. But
Portugal (74.7 years). However, life expectancy might decrease if
when a nation’s infant and child-
World Health Organization data for women increased their use of
hood mortality reach low levels,
1995 show that the female mortali- tobacco and alcohol and their par-
longevity gains in older segments
ty rate for ages 55 to 64 was ticipation in the labor force.
of the population begin to assume
30 percent lower in Portugal than in However, data from industrialized
greater weight (Caselli and Vallin,
Cuba, and the female mortality rate countries still show no clear pattern
1990; Gjonca, Brockmann, and
at ages 65 to 74 was about 20 per- of change in the gender gap; the
Maier, 1999). Most countries are
cent lower. For older men, on the gap is widening in most of Eastern
experiencing a rise in life expectan-
other hand, rates were 15 percent Europe and the former Soviet Union
cy at age 65, as exemplified by
higher in each age group in and tends to be narrowing in other
Japanese and U.S. data in Figure 3-6.
Portugal than in Cuba. developed countries. In the United
The average Japanese woman
States, for instance, life expectancy
reaching age 65 in 1998 could
WILL THE GENDER GAP IN LIFE at birth increased 3.0 years for men
EXPECTANCY NARROW? expect to live an additional
and 1.6 years for women between
22 years, and the average man
Precise explanations of the gender 1980 and 1996. But in some
more than 17 years. Overall (i.e.,
difference in life expectancy still nations with very high overall life
both sexes combined) Japanese life
elude scientists because of the expectancy (e.g., France, Germany,
expectancy at age 65 increased
apparent complex interplay of bio- Japan), gains in female longevity
40 percent from 1970 to 1998,
logical, social, and behavioral condi- continue to outpace those of males.
compared with an overall increase
tions. Greater exposure to risk fac-
Given the small average gender gap in life expectancy at birth of 9 per-
tors such as tobacco and alcohol
in life expectancy in developing cent. Comparative figures for the
use and occupational hazards is
countries relative to developed United States are 17 and 8 percent,

U.S. Census Bureau An Aging World: 2001 29


respectively. Although greater rela-
tive improvement in life expectancy Figure 3-7.
at older ages may not yet be wide- Percent Change in Death Rates for Two Older
spread in developing regions of the Age Groups: Circa 1985 to Circa 1995
world, the proportional increase in (Based on 3-year average of mortality rates centered on 1985 and 1995)

life expectancy at older ages is 70-74 years


approaching or has surpassed the 80-84 years
Female
relative increase in life expectancy
-6
at birth in some developing coun- France -20
tries, notably in Latin America and -7
Netherlands -8
the Caribbean (Kinsella, 1994).
-27
Mauritius 9
The rise in life expectancy at age 65 -6
that is characteristic of most soci- United States -8
eties means that the chances of -24
Chile
-10
dying for particular older age -20
Israel
groups are declining. Figure 3-7 -16
-27
shows across-the-board declines in Japan -28
mortality in two older age groups -23
Austria
(with the exception of women aged -22
80 to 84 in Mauritius) during a fair- Male
ly recent 10-year period. In gener- -3
France -14
al, mortality improvements for
-13
people aged 70 to 74 have been Netherlands -3
greater than for people aged 80 to -16
Mauritius
-12
84, reflecting the growing robust-
-14
ness of younger elderly cohorts. United States
-10
-20
Chile -3
MORTALITY RATE INCREASE
APPEARS TO LESSEN AT VERY -16
Israel -13
OLD AGES -16
Japan -17
As long ago as the early 1800s,
-19
research demonstrated that the Austria -20
human death rate increases with
Source: United Nations, various issues of the annual Demographic Yearbook.
age in an exponential manner, at
least to the upper ranges of the age
distribution. Recently, researchers deceleration occurs is rising (Lynch may slow down at very old ages,
have documented that, at very old and Brown, 2001). and/or that certain genes that are
ages, the rate of increase in the detrimental to survival may be sup-
mortality rate tends to slow down. Findings such as these have gener-
pressed (see Horiuchi and Wilmoth,
In a study of 28 countries with rea- ated at least two potential explana-
1998, for a discussion and examina-
sonably-reliable data for the period tions. The “heterogeneity” hypothe-
tion of these hypotheses). The
1950-90, Kannisto (1994) noted not sis, an extension of the notion of
observed deceleration in mortality,
only a decline in mortality rates at “survival of the fittest,” posits that
combined with the fact that human
ages 80 and over, but a tendency the deceleration in old-age mortality
mortality at older ages has declined
toward greater decline in more- is a result of frailer elderly dying at
substantially, has led to the ques-
recent time periods. Other work younger ages, thus creating a very
tioning of many of the theoretical
has confirmed this tendency (e.g., old population with exceptionally
tenets of aging (Vaupel et al., 1998).
Wilmoth et al., 2000), and a recent healthy attributes resulting from
Important insights are being gar-
study in the United States suggests genetic endowment and/or lifestyle.
nered from “biodemographic”
that the age at which mortality A second, “individual-risk” hypothe-
research which attempts to
sis, suggests that the rate of aging

30 An Aging World: 2001 U.S. Census Bureau


series projection suggests that
Figure 3-8. there will be 14.3 million people
Projections of the United States Population aged 85 and over in the year 2040,
Aged 85 and Over while the low-mortality (i.e., high
(In millions) life expectancy) series implies
16.8 million. As those who will be
1960-2000 Actual
2040 Census Bureau middle mortality 85 years old and over in the year
53.9
2040 Census Bureau low mortality 2040 are already at least 40 years
2040 Guralnik et al.
old, the differences in these projec-
2040 Manton et al.
tions result almost exclusively from
assumptions about adult mortality
rates and are not affected by future
birth or infant mortality rates. In
the middle-mortality series, the
23.5 Census Bureau assumes that life
expectancy at birth will reach
16.8 84.0 years in 2050, while in the
14.3
low-mortality series life expectancy
is assumed to reach 86.1 years in
3.1 4.2 2050 (Hollmann, Mulder, and
1.5 2.2
0.9 Kallen, 2000).
1960 1970 1980 1990 2000 2040 Alternative projections (Figure 3-8),
Note: U.S. Census Bureau projections for 2040 do not reflect the results of the 2000 census. using assumptions of lower death
Sources: Guralnik, Yanagishita, and Schneider, 1988; Manton, Stallard, and Liu, 1993; and
U.S. Census Bureau, 1983, 1992, and 2000b. rates and higher life expectancies,
have produced even larger esti-
mates of the future population of
cross-fertilize the biologic and England and Wales is about the United States aged 85 and over.
demographic perspectives of aging 50 percent higher today than in Simply assuming that death rates
and senescence. While a clearer pic- 1950. Consequently, the number of will continue falling at about the
ture of the causes of mortality decel- female octogenarians is about 50 recent 2 percent rate results in a
eration at very old ages awaits fur- percent higher than it would have projection of 23.5 million aged 85
ther investigation (and will benefit been had oldest-old mortality and over in 2040 (Guralnik,
from the study of evolutionary biol- remained at 1950 levels; in absolute Yanagishita, and Schneider, 1988).
ogy and aging in nonhuman terms, this means that there are Even more optimistic forecasts of
species; see Olshansky, 1998; more than one-half million oldest-old future reductions in death rates
Wachter and Finch, 1997; Le Bourg, British women alive today who oth- have been made from mathematical
2001), its recognition at a time erwise would have been dead in the simulations of potential reductions
when numbers of the very old are absence of mortality improvement. in known risk factors for chronic
growing rapidly has important poli- disease, morbidity, and mortality.
An example from the United States
cy implications. Manton, Stallard, and Liu (1993)
illustrates the range of future uncer-
used such a method to generate an
PACE OF MORTALITY CHANGE tainty about the size of tomorrow’s
extreme “upper bound” projection
DIFFICULT TO PROJECT oldest-old population. The U.S.
for the United States of 54 million
Census Bureau estimated the num-
The pace at which death rates at people aged 85 and over in 2040.
ber of people aged 85 and over in
advanced ages decline will play a While such projections are not nec-
the United States to be about
major role in determining future essarily the most likely, they do
3.6 million in 1995 and has made
numbers of elderly and especially of illustrate the potential impact of
several projections of the future
very old population. Vaupel (1997) changes in adult mortality on the
size of this age group (Day, 1996;
has noted that the remaining life future size of the extremely old
U.S. Census Bureau, 2000b). The
expectancy of 80-year-old women in population.
Census Bureau’s middle-mortality

U.S. Census Bureau An Aging World: 2001 31


As noted earlier, researchers are
increasingly concerned with overall Box 3-1.
patterns of mortality decline in Data on Causes of Death
addition to studying the pace of
Statistics on causes of death are prone to many biases and errors in all
decline. One recent study of
countries. Underreporting of deaths, lack of precise causal informa-
mortality in the G71 countries dur-
tion, inaccurate diagnoses, and cultural differences complicate both
ing the second half of the twentieth
national and international studies of mortality. Also, by attributing
century reached a provocative con-
death to one specific cause, comorbidities and underlying conditions
clusion: mortality at each age has
such as anemia and nutritional deficiencies are often masked.
declined exponentially at a fairly
Nevertheless, World Health Organization efforts to revise and extend
constant rate in each country
coverage of the International Classification of Diseases produce ongo-
(Tuljapurkar, Li, and Boe, 2000).
ing improvements in the quality and comparability of data such as
The possibility of a “universal pat-
those referred to in this report. Although mortality data are imperfect,
tern” of mortality decline raises
they can be used to illuminate general patterns and orders of magni-
important questions about the rela-
tude, and to focus the attention of research, planning, and practice.
tionship between social expendi-
While decisionmaking should be skeptical of small differences between
tures on health and their effect on
groups, major differences are likely to indicate underlying disparities
death rates, and about the likeli-
and trends.
hood that the mortality decline will
be sustained in the future.
increase with age but in recent years cardiovascular disease is not just a
THE IMPORTANCE OF these rates have declined at older developed-country phenomenon; a
CARDIOVASCULAR DISEASE
ages in many developed countries. recent U.S. Institute of Medicine study
A major disadvantage of summary Nevertheless, cardiovascular disease (Howson et al., 1998) identifies car-
mortality indexes such as life remains the primary killer among eld- diovascular disease as the primary
expectancy is that they mask erly populations, more so than for noncommunicable health problem
changes in mortality by age and/or adults in general. For example, more throughout the developing world.
cause of death. While one can than two-thirds of all deaths to elderly
In the United States, the heart-
examine life expectancy at different people in Bulgaria and nearly half of
disease component of cardiovascular
ages, it may be more useful to con- all deaths to elderly people in
mortality is the leading cause of
sider cause-specific changes in mor- Argentina are attributed to cardiovas-
death within the elderly population.
tality, particularly if the intention is cular disease, and in most countries
Among people aged 65 to 74, heart
to devise medical or nutritional the proportion increases with age
disease and cancers were equally
interventions to affect overall (Figure 3-9). One comprehensive
likely to be reported as the major
longevity and the quality of years analysis of developed nations
cause of death in 1997, each
lived at older ages. Worldwide, (Murray and Lopez, 1996) attributes
accounting for about one-third of all
data on cause-specific mortality are nearly 60 percent of all deaths to
deaths in that age group. But as age
far from ideal for policy making in a women aged 60 and over in the early
advances, heart disease claims an
majority of countries (See Box 3-1). 1990s to cardiovascular disease; the
increasing share, about 49 percent
Many developed countries, howev- corresponding figure for older men
of deaths to people aged 75 and
er, have had reasonably good cause- was 50 percent. Cancer deaths at
over (versus 18 percent for cancers).
specific mortality data since at least older ages usually rank a distant sec-
This pattern also occurs in other (but
1950. ond, but may be more worrisome in
not all) developed countries.
the public eye; in the 1995 Canadian
Death rates due to cardiovascular dis-
Women’s Health Test, most women LUNG CANCER RAMPANT
eases — a broad category that
believed breast cancer to be the num- SINCE THE 1950s
includes heart, cerebrovascular
ber one killer of women (all ages).
(stroke) and hypertensive diseases — Although deaths from cardiovascular
Only 16 percent of those surveyed
disease are expected to remain most
correctly stated that heart disease is
1
The G7 countries include Canada, France, prominent in the future, a major
Germany, Italy, Japan, the United Kingdom, and the number one killer (Wiesenberg,
concern of health practitioners in
the United States. 1996). The prominence of

32 An Aging World: 2001 U.S. Census Bureau


responsible for 30 percent of all
Figure 3-9. cancer deaths to males in devel-
Percent of All Deaths From Cardiovascular Diseases and oped countries, and 12 percent of
Malignant Neoplasms at Older Ages in Four Countries all cancer deaths to females.
Cardiovascular diseases Proportions for the 60-and-over
Malignant neoplasms population are virtually identical.
Bulgaria, 1998
Male death rates from lung cancer
66
Male, 65 to 74 years appear to have peaked and are now
16
74 falling in some countries and stabi-
75 years and over
8 lizing in many others, perhaps por-
71
Female, 65 to 74 years tending future declines.
15
75 years and over
79 Conversely, female death rates from
6
lung cancer are rising rapidly, in
Argentina, 1996 proportion to the large increases in
Male, 65 to 74 years 43 cigarette consumption which began
24
47 several decades ago (Bonita, 1996).
75 years and over
17 Cigarette smoking has been labeled
41
Female, 65 to 74 years
27
as the single most important pre-
52 ventable cause of premature death
75 years and over
13 in women aged 35 to 69 in both
France, 1996 the United States and the United
28 Kingdom (Amos, 1996). Still, breast
Male, 65 to 74 years
42
37 cancer remains the principal neo-
75 years and over
24 plasm site among females, and
27
Female, 65 to 74 years 40 mortality rates from this source
42 have increased or remained con-
75 years and over
15 stant in most countries since the
United States, 1997 post-war period. The rise has been
40 most pronounced in Southern and
Male, 65 to 74 years
33
Eastern Europe, which is consistent
75 years and over 46
21 with the hypothesis that a diet high
36
Female, 65 to 74 years in saturated fat is a leading risk fac-
35
52 tor for breast cancer.
75 years and over
15
SUICIDE RATES MUCH HIGHER
Sources: World Health Organization, various issues of World Health Statistics Annual, and
www-nt.who.int/whosis/statistics/whsa/whsa_table4.cfm?path=statistics,whsa,whsa_table4&language=english AMONG ELDERLY MEN THAN
WOMEN

Suicide rates in 21 countries with


the industrialized world is the rise in cancer has been declining steadily
relatively reliable data (Table 3-2)
lung cancer among older women as since the 1930s, a decline clearly
are consistently higher among men
a result of increased tobacco use attributed to nutritional change, i.e.,
than women in all age groups,
since World War II. With regard to a reduction in salt content of food,
including the elderly. This is a uni-
cancers in general, overall age- especially preserved food (Lopez,
versal trend even in societies as dis-
standardized death rates for cancer 1990).
parate as Singapore, the United
rose 30-50 percent among men dur-
On the other hand, prevalence of States, Israel, and Bulgaria. Suicide
ing the period 1950-85, and fell by
lung cancer has increased since rates generally increase with age
about 10 percent among women.
World War II, initially among men among men, and are highest at
However, such broad trends often
but now increasingly among ages 75 and over. Suicide rates for
are the net result of quite different
women. Estimates for the early women also tend to rise with age,
changes in mortality for the leading
1990s (Murray and Lopez, 1996) although the peak rate for women
sites of disease. In the United
suggest that lung cancer is occurs before age 75 in about one
States and Western Europe, stomach

U.S. Census Bureau An Aging World: 2001 33


Table 3-2.
Suicide Rates for Selected Age Groups in 23 Countries: Circa 1997
(Rate per 100,000 population in each age group)

Male Female
Country
15 to 24 45 to 54 65 to 74 75 years 15 to 24 45 to 54 65 to 74 75 years
years years years and over years years years and over

Europe
Belgium, 1994. . . . . . . . . . . . . . . . . . . . . 23 37 43 98 4 17 17 20
Bulgaria, 1998. . . . . . . . . . . . . . . . . . . . . 15 27 48 116 6 9 20 50
Denmark, 1996 . . . . . . . . . . . . . . . . . . . . 13 31 35 71 2 17 16 20
Finland, 1996 . . . . . . . . . . . . . . . . . . . . . 34 55 50 48 7 18 14 7
France, 1996. . . . . . . . . . . . . . . . . . . . . . 13 38 41 87 4 16 15 20
Germany, 1997 . . . . . . . . . . . . . . . . . . . . 13 30 32 71 3 10 13 21
Hungary, 1998 . . . . . . . . . . . . . . . . . . . . 18 93 80 131 4 20 24 50
Ireland, 1996 . . . . . . . . . . . . . . . . . . . . . . 25 19 12 22 5 6 1 2
Italy, 1995 . . . . . . . . . . . . . . . . . . . . . . . . 7 14 23 43 2 5 7 8
Netherlands, 1997 . . . . . . . . . . . . . . . . . 11 16 16 34 4 8 9 12
Norway, 1995 . . . . . . . . . . . . . . . . . . . . . 23 24 32 24 6 10 10 5
Poland, 1996. . . . . . . . . . . . . . . . . . . . . . 17 42 31 31 3 8 7 6
Portugal, 1998 . . . . . . . . . . . . . . . . . . . . 4 7 20 39 1 3 7 9
Russia, 1997 . . . . . . . . . . . . . . . . . . . . . . 53 100 97 97 9 15 20 33
Switzerland, 1996. . . . . . . . . . . . . . . . . . 25 37 47 80 6 16 17 24
United Kingdom, 1997. . . . . . . . . . . . . . 10 14 9 17 2 4 4 4
North America
Canada, 1997 . . . . . . . . . . . . . . . . . . . . . 22 27 21 27 5 9 5 4
United States, 1997 . . . . . . . . . . . . . . . . 19 23 26 45 4 7 5 5
Other
Australia, 1995 . . . . . . . . . . . . . . . . . . . . 23 22 19 27 6 8 5 5
Chile, 1994 . . . . . . . . . . . . . . . . . . . . . . . 11 14 20 27 2 2 2 1
Israel, 1996 . . . . . . . . . . . . . . . . . . . . . . . 9 9 18 41 2 4 4 15
Japan, 1997 . . . . . . . . . . . . . . . . . . . . . . 11 40 35 53 6 14 19 33
Singapore, 1997 . . . . . . . . . . . . . . . . . . . 9 18 30 74 9 9 14 33

Sources: World Health Organization, various issues of World Health Statistics Annual, and
www-nt.who.int/whosis/statistics/whsa/whsa_table4.cfm?path=statistics,whsa,whsa_table4&language=english

third of the countries in Table 3-2. their elderly male populations, elderly suicide rates in the world’s
The fact that the average woman while Japan, Switzerland, and more developed countries. Few
outlives her spouse — coupled Russia have comparatively high nations have experienced the very
with studies that show that married rates among elderly women. Levels gradual rise seen in France until the
elders are happier than nonmarried for elderly men in the United States mid-1980s, or the downward ten-
elders — might lead one to predict are average when compared with dency observed in England and
that older women would have other countries, whereas the U.S. Wales (Figure 3-10). More often,
higher rates of suicide than older rate for women aged 65 and over is national rates have fluctuated with
men, but this is clearly not the case. relatively low. Although some of no perceptible pattern.
these differentials may be artificial
Among the 23 countries examined, There was a downward trend in eld-
due to differences in the reporting
Hungary and Russia had the highest erly suicide in the United States for
and/or diagnosis of suicide, their
suicide rates for elderly men, and nearly half a century prior to 1980.
sheer magnitude suggests that real
Hungary and Bulgaria had the high- From 1981 to 1988, however, the
international differences do exist
est rates for elderly women. The suicide rate of older Americans rose
and deserve closer study.
reported Hungarian rate for men about 25 percent before beginning
aged 75 and over is five to seven NO CLEAR TIME TREND IN to decline in the 1990s. Such an
times higher than similar rates in ELDERLY SUICIDE WORLDWIDE increase raised questions at a time
Ireland, the United Kingdom, and when older people were living
Data from the World Health
Norway. Belgium and France have longer and were supposedly healthi-
Organization for the past 30 years
comparatively high rates among er and more financially secure
do not show any clear trend in

34 An Aging World: 2001 U.S. Census Bureau


(Robinson 1990). Likewise in Japan,
Figure 3-10. a 30-year decline in elderly suicide
Suicide Rates by Age in England and Wales appeared to level off in the 1980s,
and in France: 1965 to 1995 though more recent data show a
significant decline in the 1990s.
England and Wales However, social scientists remain
Rate per 100,000 population in each age group
puzzled by the relatively high rates
140
of suicide among elderly Japanese
women. The unpredictability of sui-
120
cide trends is perhaps best illustrat-
ed by the case of the Netherlands.
100 Dutch society is widely recognized
as being more tolerant of voluntary
80 euthanasia than are other Western
societies, and one might think it
60
would also have higher rates of
Male 75+
recorded suicide. However, the
Male 65-74
Female 65-74 country’s rates are lower than the
40 Female 75+ industrialized-country average for
most age groups, including the eld-
20 erly, and have not changed greatly
during the past 30 years.
0
1965 1970 1975 1980 1985 1990 1995

France
Rate per 100,000 population in each age group
140

120 Male 75+

100

80

60 Male 65-74

40
Female 75+

20
Female 65-74
0
1965 1970 1975 1980 1985 1990 1995

Source: World Health Organization, various issues of World Health Statistics Annual.

U.S. Census Bureau An Aging World: 2001 35


CHAPTER 4.
Health and Disability

Many societies worldwide have expectancy at birth was approxi- DEVELOPING-COUNTRY


experienced a change from condi- mately 50 years, and the median TRANSITION APPEARS
tions of high fertility and high mor- age at death (the age to which GREATEST IN LATIN AMERICA
tality to low fertility and low mortal- 50 percent of females subject to Developing countries are in various
ity, a process commonly dubbed the the mortality risks of 1901 could stages of epidemiologic transition.
“demographic transition.” Related expect to survive) was about Change is most evident in Latin
to this trend is the “epidemiologic 60 years. By 1998, the survivorship America and the Caribbean, where
transition,” a phrase first used in curve had shifted dramatically. cardiovascular diseases were the
the early 1970s (Omran, 1971) to Female life expectancy had risen to leading cause of death in 29 of 33
refer to a long-term change in lead- 79 years, and the median age at countries examined in 1990 (PAHO,
ing causes of death, from infectious death was above 80 years. The 1994). Most deaths from chronic
and acute to chronic and degenera- proportion surviving is now quite and degenerative ailments occur at
tive. In the classic demographic high at all ages up to age 50, and relatively old ages. Comparative
transition, initial mortality declines the survival curve at older ages is data from the mid-1990s (Figure 4-2)
result primarily from the control of approaching a much more rectangu- show that half or more of all deaths
infectious and parasitic diseases at lar shape as a result of relatively in numerous nations of the Western
very young ages. As children sur- more chronic-disease mortality at Hemisphere now occur at ages 65
vive and grow, they are increasingly older ages. and over.
exposed to risk factors associated
with chronic diseases and acci-
dents. As fertility declines and pop-
ulations begin to age, the preemi-
nent causes of death shift from Figure 4-1.
those associated with childhood Survival Curve for U.S. Females: 1901 and 1998
mortality to those associated with
Percent surviving
older age (Kalache, 1996). 100
Eventually, growing numbers of
adults shift national morbidity pro- 90
1998
files toward a greater incidence of 80
chronic and degenerative diseases
(Frenk et al., 1989). 70
1901
60
EPIDEMIOLOGIC TRANSITION
SHIFTS SURVIVAL CURVE 50
Figure 4-1, which shows survival
40
curves for U.S. females in 1901 and
1998, illustrates a general pattern 30
seen in developed countries. The
20
curve for 1901 represents the early
stages of the epidemiologic transi- 10
tion in which the level of infant
0
mortality was high, there was con- 0 10 20 30 40 50 60 70 80 90 100
siderable mortality through the mid- Age
dle years, and a gradual increase at Note: Data for 1901 refer to White females.
Sources: U.S. Census Bureau, 1936; U.S. Centers for Disease Control, 2001.
the later ages. Female life

U.S. Census Bureau An Aging World: 2001 37


The pace of epidemiologic change are we spending an increasing profound impact on national health,
in East and Southeast Asian nations portion of our older years with dis- retirement, and family systems, and
is now especially rapid. In the case abilities, mental disorders, and in ill particularly on the demand for
of Singapore, where life expectancy health? In aging societies, the long-term care. In the future, health
at birth rose 30 years in little over a answer to this question will have a expectancy will come to be as
generation (from 40 years in 1948
to 70 years in the late-1970s), the
share of cardiovascular deaths rose Figure 4-2.
from 5 to 32 percent of all deaths, Proportion of All Deaths Occurring at Ages 65 and
while deaths due to infectious dis- Above in 20 Countries: Circa 1995
eases declined from 40 to 12 per- (Percent)
cent. Data from Taiwan (Table 4-1)
exemplify the typical shift in causes Barbados 75
of death; the infectious and para- Canada 75
sitic diseases that dominated United States 73
Taiwanese mortality in the mid- Cuba 67

1950s have given way to chronic Puerto Rico 62


Argentina 62
and degenerative diseases. By
Chile 61
1976, cerebrovascular disease and
Saint Lucia 59
cancers had become the leading
Trinidad & Tobago 57
causes of death. The situation in
Costa Rica 56
the 1996 was similar to that in
Paraguay 49
1976, except that the relative
Mexico 45
importance of diabetes had risen
Suriname 45
substantially while tuberculosis was Brazil 43
no longer a major killer. Although Ecuador 43
reliable data for much of the Bahamas 42
remainder of Asia and for Africa are Colombia 42
lacking, scattered evidence sug- Venezuela 41
gests the increasing importance of Guyana 37
chronic disease patterns in adult Nicaragua 34
populations.
Source: Pan American Health Organization, 1998.

DOES LONGER LIFE EQUAL


BETTER LIFE?

Chapter 3 pointed out that continu- Table 4-1.


al increases in life expectancy, espe- Rank Order of the Ten Leading Causes of Death in Taiwan:
1956, 1976, and 1996
cially at older ages, have been the
norm in most countries worldwide. Order 1956 1976 1996
As individuals live longer, the quali-
1 ....... GDEC1 Cerebrovascular disease Malignant neoplasms
ty of that longer life becomes a cen- 2 ....... Pneumonia Malignant neoplasms Cerebrovascular disease
tral issue for both personal and 3 ....... Tuberculosis Accidents Accidents
4 ....... Perinatal conditions Heart disease Heart disease
social well-being. Are we living 5 ....... Vascular lesions of CNS2 Pneumonia Diabetes mellitus
healthier1 as well as longer lives, or 6 ....... Heart disease Tuberculosis Cirrhosis/chronic liver disease
7 ....... Malignant neoplasms Cirrhosis of the liver Nephritis/nephrosis
8 ....... Nephritis/nephrosis Bronchitis3 Pneumonia
1
“Health” is a relative and continually devel- 9 ....... Bronchitis Hypertensive disease Hypertensive disease
oping concept which “reflects on the one hand 10 . . . . . . Stomach/duodenum ulcer Nephritis/nephrosis ulcer Bronchitis3
the progress made within the health sciences
and on the other hand the meanings, values 1
Includes gastritis, duodenitis, enteritis, and colitis (except diarrhoea of newborns).
and prejudices related to health in different 2
CNS refers to the central nervous system.
sociocultural contexts.” (Heikkinen 1998; see 3
Includes emphysema and asthma.
this source for a useful discussion of the differ-
ent orientations toward health that have been Source: Taiwan Department of Health, 1997.
adopted in the health sciences).

38 An Aging World: 2001 U.S. Census Bureau


An application of this model to data
Figure 4-3. from France (Robine, Mormiche, and
Survival Without Disease and Survival Without Cambois, 1996) shows that the
Disability for French Females: 1981 and 1991 increase in total survival between
1981 and 1991 was generally con-
Percent
100 sistent with the increase in disability-
free life expectancy, whereas sur-
90 vival without chronic disease
80 showed little change (Figure 4-3).
In this case, the differing trajecto-
70 ries of disability and morbidity may
be interpreted as support for the
60
theory of dynamic equilibrium,
50 which says that increases in overall
life expectancy are driven in part by
40
a reduction in the rate of progres-
Total survival in 1981
30 Total survival in 1991 sion of chronic diseases.
Survival without disability in 1981
20 Survival without disability in 1991 HEALTHY LIFE EXPECTANCY
Survival without disease in 1981
10 Survival without disease in 1991 Since the early 1970s, research has
been moving toward the develop-
0
0 10 20 30 40 50 60 70 80 90 100 ment of health indexes that take
Age into account not only mortality but
Source: Robine, Mormiche, and Cambois, 1996. also various gradations of ill health.
As of 1998, 49 nations had esti-
mates of healthy life expectancy,3
important a measure as life generated competing theories of
an indicator that attempts to inte-
expectancy is today. health change, several of which may
grate into a single index the mortal-
be characterized as: a pandemic of
Research into patterns of change in ity and morbidity conditions of a
chronic disease and disability
mortality, sickness, and disability population. Most estimates of
(Gruenberg, 1977; Kramer, 1980); a
has suggested that these three fac- healthy life expectancy are derived
compression of morbidity (Fries,
tors do not necessarily evolve in a from calculations of disability-free
1990); dynamic equilibrium
similar fashion. A four-country life expectancy using a methodolo-
(Manton, 1982); and the postpone-
study (Riley, 1990) notes that in gy pioneered by Sullivan (1971),
ment of all morbid events to older
Japan, the United States, and Britain, which employs cross-sectional
ages (Strehler, 1975). The World
mortality decreased and sickness prevalence data but may produce
Health Organization has proposed a
(morbidity) increased, while in results that underestimate temporal
general model of health transition
Hungary, mortality increased and trends in a given population.
that distinguishes between total sur-
sickness decreased.2 Discrepancies Recognizing that these earlier com-
vival, disability-free survival, and
between the trends in mortality, putational approaches could not
survival without disabling chronic
morbidity, and disability have capture the full dynamic nature of
disease. In other words, it is desir-
disability, multistate models have
able to quantitatively disaggregate
been developed to incorporate
2
The author’s broader review of historical life expectancy into different health
data concludes that the relationship between processes such as recovery and
falling sick and dying from sickness has shifted states to better understand the rela-
over time, and that the link between death and tive health of populations. Thus, a
health risks has been unstable rather than sta-
ble across time. The risk of being sick has general survival curve such as that 3
The concept of healthy life expectancy as
increased as a result of various obvious and typically used refers to expectancy without limi-
in Figure 4-1 can be partitioned into tations of function that may be the conse-
non-obvious factors — among them earlier and
better detection of sickness, declining mortality, different categories that indicate quence of one or more chronic disease condi-
and rising real income — which themselves tions. The concept is sometimes called “active
constitute valuable human achievements. The
overall survival, survival without dis- life expectancy” or “disability-free life expectan-
implication is that protracted sickness is a ability, and survival without disease. cy,” to avoid the implication that “healthy”
byproduct of such achievements. means “absence of disease.”

U.S. Census Bureau An Aging World: 2001 39


rehabilitation into the calculations
(see, e.g., Manton and Stallard, Box 4-1.
1988; Rogers, Rogers, and Belanger, Network on Health Expectancy
1990). These latter models, howev-
To facilitate and promote analyses of health expectancy, an international
er, require longitudinal data which
network (REVES, the French acronym for Network on Health Expectancy
currently are unavailable in most
and Disability Process) was formed in 1989 to bring together researchers
nations. To date, chronological
concerned with the measurement of changes and inequalities in health
series are available only for some
status, not only within but among nations. REVES has produced numer-
developed nations.
ous documents and bibliographies of relevant materials, including a sta-
In recent years, researchers have tistical yearbook that includes existing estimates of health expectancy in
been working toward developing various countries. Further information may be obtained from Jean-Marie
integrated, comparable measures Robine, Network Coordinator, INSERM Equipe Demographie et Sante,
of healthy life expectancy Centre Val d’Aurelle, 34298 Montpellier Cedex 5, France.
(Verbrugge, 1997). Presently, how-
ever, it remains impossible to
strictly compare estimates among Figure 4-4.
nations, due both to different com- Portion of Old Age Lived Without Severe
putational methods and, more Disability: Data From the Early 1990s
importantly, to differences in con- (Percent) Male
Female
cepts and definitions that define
the basic data. There are impor-
tant but not-widely-appreciated 85
Australia
distinctions between impairments, 79

disabilities, and handicaps that can 85


Canada
lead to different measures of 78
health status (Chamie, 1989).
94
Because “disability” is defined in France
90
many ways, national estimates of
disability vary enormously. For 92
Japan
example, a compilation by the 87
United Nations (1990a) showed 94
United Kingdom
national crude disability rates for 93
the total population ranging from
less than half a percent in several Note: Figures refer to the percent of a person's life, after reaching age 65, that she or he might
expect to live without needing significant help (personal care) with at least one major activity of daily living.
developing countries (Peru, Egypt, Source: Jacobzone, 1999.

Pakistan, Sri Lanka) to nearly


21 percent in Austria. Perhaps the and individuals’ ability to function FEMALE ADVANTAGE IN LIFE
most commonly-used measure- in everyday life.4 EXPECTANCY PARTIALLY
ment tools are scales which assess OFFSET BY DISABILITY
the ability of individuals to per- In spite of cross-national compara-
form activities of daily living bility problems, several general
(ADLs) such as eating, toiletting, observations seem warranted. For
and ambulation, as well as instru- 4
ADL measures vary along several dimen-
individuals reaching age 65, health
sions, including the number of activities consid-
mental activities of daily living ered and the degree of independence in per- expectancy varies more than
(IADLs) such as shopping and forming physical activities. ADLs do not cover
all aspects of disability, however, and are not
remaining life expectancy. One
using transportation. These meas- sufficient by themselves to estimate the need examination (Kinsella and Taeuber,
ures originated in industrialized for long-term care. Some older people have
cognitive impairments not measured by ADL
1993) of REVES data (See Box 4-1)
societies where debate has cen- limitations, which may or may not be captured showed that the range of life
tered on long-term care systems by IADL measures. And, of course, there are
many questions regarding the validity and expectancy at age 65 varied by
applicability of such measures in different cul- about 12 percent among developed
tural settings.

40 An Aging World: 2001 U.S. Census Bureau


(Freedman and Soldo, 1994) found
Figure 4-5. declines in less-severe disability
Number of Chronically Disabled People Aged 65 (i.e., in IADLs) during the 1980s.
and Over in the United States: 1982 to 1996 Data from Australia, on the other
hand, revealed that the increase in
Millions
10 years of disability between 1981
and 1988 was greater than the
If disability rate did not change
since 1982 overall increase in life expectancy.
8 Data for Canada and Finland sug-
gest that changes in disability-free
life expectancy have been and
Based on declines in chronic disability remain stagnant (Robine and
6 rate occurring since 1982
Romieu, 1998). Researchers posited
a number of potential factors —
4
other than actual increases in
chronic disease incidence and meas-
urement error — which might have
contributed to stagnation or
2
declines in healthy life expectancy,
including increased survival of
chronically ill individuals due to
0
1982 1989 1994 1996 improvements in medical care, earli-
er diagnosis or treatment of chronic
Source: Manton, Corder, and Stallard, 1997. diseases, greater social awareness
of disease and disability, earlier
countries for both men and women. spend a slightly greater proportion adjustment to chronic conditions
However, the percent of this time of their remaining years in a severe- due to improved pension and health
spent in “good health” (free of prob- ly disabled state relative to elderly care/delivery systems, and rising
lems with personal and instrumen- men, thus negating some of the expectations of what constitutes
tal activities of daily living) had a potential benefit of their higher life good health or normal functioning
much wider range, from 45 to more expectancy (Figure 4-4). Other (Mathers, 1991; Verbrugge, 1989).
than 80 for males, and from 37 to studies of gender differences in the More recent data and rigorous
76 for females (these figures incidence of disabling conditions at analyses, however, now strongly
exclude apparent outlier estimates older ages support this contention suggest that rates of disability in a
which would widen the ranges even (Heikkinen, Jokela, and Jylha, 1996; number of developed countries are
further). For men in developing Dunlop, Hughes, and Manheim, declining. In the United States,
countries, the estimated range of 1997; Robine and Romieu, 1998). researchers (Manton, Corder, and
remaining life expectancy at age 65 Stallard, 1997) used data from the
was 12 to 15 years. However, the DEVELOPED-COUNTRY
DISABILITY RATES AT OLDER 1982, 1984, 1989 and 1994
estimated percent of remaining rounds of the U.S. National Long
AGE SEEN TO BE DECLINING
years spent in relative health varied Term Care Survey to demonstrate
from less than 60 to 88 percent. In nations where time series esti-
that the disability rate among peo-
For elderly women, the variation in mates of health expectancy are
ple aged 65 and over declined over
life expectancy was 28 percent, available (e.g., Canada, the United
the 12-year period, such that there
while the range of healthy remain- States, Australia, England/Wales),
were 1.2 million fewer disabled
ing life was 50 to 87 percent. the general view in the 1980s was
older people in 1994 than would
one of uncertainty regarding the
Available but geographically limited have been the case if the 1982
relationship between rising life
data from the early 1990s suggest a rate had not changed (Figure 4-5).
expectancies and trends in health
further tentative statement: women Five other U.S. surveys, while vary-
expectancies. One comprehensive
reaching age 65 can expect to ing in content and nature
review of data in the United States

U.S. Census Bureau An Aging World: 2001 41


(e.g., both longitudinal and cross- obviously have substantial implica- accidents and the consequences of
sectional), have yielded findings tions for public and private health drug and alcohol abuse. As
that support a temporal decline. programs and expenditures, and economies in developing countries
Likewise, a U.S. study of changes possibly for the conceptualization expand and the demographic and
between 1982 and 1993 in self- and definition of disability itself.5 epidemiologic pictures change, we
reported ability to work found sig- might expect to see related
Many countries with aging popula-
nificant improvement among both changes in the nature and preva-
tions now recognize the need for
men and women who were in their lence of various disabilities.
longitudinal surveys as a means of
sixties (Crimmins, Reynolds, and
understanding adult health pat- Numbers of disabled people are
Saito, 1999). Another U.S. study
terns, transitions to and from differ- almost certain to increase as a cor-
(Freedman and Martin, 1998) of
ent health statuses, and how to dif- relate of sheer population growth.
the effect of changes in living envi-
ferentiate between morbidity and Figure 4-6 illustrates the applica-
ronments, device use, and survey
aging per se (Svanborg, 1996). tion of empirical gross disability
design on functional ability among
While such survey efforts involve rates to the projected population
noninstitutionalized people aged
substantial economic investment, of the Philippines. This simplistic
50 and over concludes that these
the potential cost savings in policy example assumes that disability
changes alone could not account
design and implementation would rates for men and women as meas-
completely for improved function-
seem to dwarf the initial expense. ured in 1980 will remain constant
ing, and that there has indeed
And as various national longitudinal in the future. Even with no provi-
been some improvement in under-
analyses expand, both geographi- sion for higher rates of disability
lying physiological capability.
cally and in terms of specific dis- as the population ages, the project-
Increased levels of education have
abling conditions, all health sys- ed absolute increases are alarming
been identified as a potentially
tems stand to benefit from more in terms of future service and care
powerful factor influencing disabil-
comprehensive comparisons and requirements.
ity decline in the United States.
the resultant implications for pro-
A review of trend data from nine gram priorities. ESTIMATING THE BURDEN
OF DISEASE
other developed countries plus
Taiwan concludes that, with a few DEVELOPING-COUNTRY A major ongoing effort to under-
DISABILITY BURDEN LIKELY TO
exceptions by gender, disability is stand and predict the effect of epi-
INCREASE AS POPULATIONS
declining among the elderly else- AGE demiologic change is the Global
where as well (Waidmann and Burden of Disease Project under-
Manton, 1998), as indicated by the Two decades ago, the World Health taken jointly by the World Health
French data in Figure 4-3. Organization noted a distinction in Organization, Harvard University,
Researchers increasingly have dis- prominent causes of disability and the World Bank. Using a com-
aggregated disability into more- between developed and developing putational (and controversial; see,
severe versus less-severe cate- countries. In the latter, disability e.g., Black and McLarty, 1996;
gories, and the current consensus was said to stem primarily from Cohen, 2000) concept known as
in developed countries is that the malnutrition, communicable dis- Disability-Adjusted Life Years
overall decline in disability is prima- eases, accidents, and congenital (DALYs), this study attempts to
rily the result of decreases in the conditions. In industrialized coun- measure global, regional, and
more-severe forms (Robine and tries disability resulted largely country-specific disease burdens in
Romieu, 1998). Freedman, Aykan, from the chronic diseases dis- a baseline year, and to project such
and Martin (2001), for example, cussed earlier — cardiovascular burdens into the future. Figure 4-7
have recently demonstrated a disease, arthritis, mental illness, highlights the change in the esti-
decline between 1993 and 1998 in and metabolic disorders, as well as mated (1990) and projected (2020)
severe cognitive impairment among rank order of disease burden for
the noninstitutionalized population 5
For a description of changes and paradigm the ten leading disease categories
aged 80 and over in the United shifts in disability policy in certain developed on a global basis. In addition to
countries, see Kalisch, Aman, and Buchele,
States. Such trends, if sustained, 1998. underscoring the expected shift

42 An Aging World: 2001 U.S. Census Bureau


from communicable to non-
Figure 4-6. communicable disease patterns
Projected Numbers of Disabled Males in the (largely driven by the changing sit-
Philippines by Age: 1991 and 2020 uation in developing countries;
1991 Murray and Lopez, 1997), this
2020
study raises specific warning flags
Thousands
for many countries in terms of a
700
likely increase in disease burden
due to neuro-psychiatric conditions
600
and accidents. Among the many
results, several stand out: (1) the
500
projected prominence of tobacco
use vis-a-vis mortality (as men-
400 tioned in Chapter 3) and through
various disease vectors, with the
300 expectation that tobacco will kill
more people than any single dis-
200 ease by 2020; (2) the concentra-
tion of disease burden in certain
100 developing regions. For example,
the inhabitants of India and Sub-
0 Saharan Africa were estimated to
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75+
bear more than 40 percent of the
Sources: United Nations, 1990 and U.S. Census Bureau, 2000a. world’s disease burden in 1990,
while constituting only one-fourth
of the world’s population. The
Figure 4-7. study also points out the fallacy
Change in Rank Order of Disease Burden for Top Ten that noncommunicable diseases
Leading Causes in the World: 1990 and 2020 are necessarily related to affluence;
(Disease burden measured in disability-adjusted life years) the likelihood of dying from a non-
communicable disease among
1990 2020 adults under age 70 in both India
Rank Disease or injury Disease or injury and Sub-Saharan Africa is greater
1 Lower respiratory infections Ischemic heart disease
than in Western Europe; and (3) the
2 Diarrhoeal diseases Unipolar major depression vastly underestimated importance
3 Conditions arising during Road traffic accidents of mental illnesses as major and
the perinatal period increasing sources of disease bur-
4 Unipolar major depression Cerebrovascular disease
den, which implies significant
5 Ischemic heart disease Chronic obstructive pulmonary disease
6 Cerebrovascular disease Lower respiratory infections
long-term care challenges in aging
7 Tuberculosis Tuberculosis societies (Murray and Lopez,
8 Measles War 1996).
9 Road traffic accidents Diarrhoeal diseases
10 Congenital anomalies HIV

Source: Murray and Lopez, 1996.

U.S. Census Bureau An Aging World: 2001 43


Figure 4-8.
Share of Population Versus Health Expenditure Percent of total
by Age in Nine Countries: 1993 Population
Health expenditure

Australia Sweden

88 82
<65 <65
66 62
12 18
65+ 65+
34 38
4 8
75+ 75+
20 21

Finland Switzerland

86 86
<65 <65
62 60
14 14
65+ 65+
38 40
6 6
75+ 75+
22 26

Germany United Kingdom (England)

85 84
<65 <65
68 58
15 16
65+ 65+
32 42
6 7
75+ 75+
16 27

New Zealand United States

89 87
<65 <65
67 63
11 13
65+ 65+
33 37
5 5
75+ 75+
21 21

Portugal

86
<65
64
14
65+
36
5
75+
19

Source: OECD, 1997.

44 An Aging World: 2001 U.S. Census Bureau


AGING INCREASES HEALTH is included in public health schemes among noninstitutionalized elderly,
CARE COSTS (e.g., Germany), per capita expendi- per capita health expenditure often
Population aging might be expected tures for people aged 65 and over peaks at ages 75 to 79 and declines
to increase costs of health care in may be two to three times higher thereafter. Costs per service (such
most societies because health than those for younger people; in as hospital stays and medicine pre-
expenditures by and for older age countries with more inclusive long- scriptions) for older people are less
groups tend to be proportionally term care coverage (e.g., Australia than for the population as a whole,
greater than their population share and Finland), the ratio is four times although usage rates for older peo-
(Figure 4-8). This expectation higher (OECD, 1997). ple are much higher and hence the
applies especially to nations where per capita costs are higher (OECD,
Although the picture of rising health
acute care and institutional (long- 1997). Governments and interna-
care costs with age is accurate in a
term care) services are widely avail- tional organizations are now recog-
general sense, disaggregation of
able. Cross-national comparative nizing the need for cost-of-illness
data by age shows some surprising
data on health care expenditures by studies on age-related diseases, in
facets. A large fraction of health
age are relatively uncommon, but part to anticipate the likely burden
care costs associated with advanc-
ongoing work by the Organization of increasingly-prevalent and expen-
ing age is incurred in the period
for Economic Co-Operation and sive chronic conditions (of which
just prior to death, and since an
Development has begun to docu- Alzheimer’s disease may be the
increasing proportion of people are
ment age-specific differentials. most costly), and in part to under-
living to very old age, overall health
Table 4-2 shows that per capita stand the potentially salubrious
care costs rise with age.
health expenditures for people aged effects that may accrue to future
Treatments to prolong life have
65 and over are uniformly higher generations due to higher levels of
made once-certain death much less
than for the nonelderly, and that education and access to information
certain, but there is some indication
this difference varies by country. about healthier lifestyle behaviors.
that health care costs taper off at
Much of the between-country differ- very old ages (OECD, 1998b), sug- EARLY-LIFE CONDITIONS
ence may be attributed to variations gesting that life may be prolonged AFFECT ADULT HEALTH
in program coverage. In nations up to a point but that treatment is
where relatively little long-term care The last decade has seen a rapidly
not desired indefinitely. Likewise,
growing interest in examining adult
health outcomes from a life-course
Table 4-2.
Relative Per Capita Health Expenditure by Age Group in 12 perspective. Researchers increas-
Countries: Circa 1993 ingly suggest that many negative
(0-64 = 1.0) health conditions in adulthood stem
from risks established early in life
Country 65-74 65+ 75+
(Elo and Preston, 1992). Some
Australia . . . . . . . . . . . . . . . . . . 2.8 4.0 6.0 (notably, Barker, 1995) argue that
Finland. . . . . . . . . . . . . . . . . . . . 2.8 4.0 5.5
France . . . . . . . . . . . . . . . . . . . . 1
2.2 2
3.0 3
3.7
adult health has a fetal origin,
Germany . . . . . . . . . . . . . . . . . . 2.3 2.7 3.2 wherein nourishment in utero and
4 3
Japan . . . . . . . . . . . . . . . . . . . . . 3.1 4.8 5.7 during infancy has a direct bearing
Netherlands . . . . . . . . . . . . . . . (NA) 4.4 (NA)
New Zealand . . . . . . . . . . . . . . 2.3 3.9 6.2 on the development of risk factors
Portugal . . . . . . . . . . . . . . . . . . . 1.4 1.7 2.1 for adulthood diseases (especially
Sweden . . . . . . . . . . . . . . . . . . . 2.3 2.8 3.4
Switzerland . . . . . . . . . . . . . . . . 2.6 4.0 5.7 cardiovascular diseases). Childhood
United Kingdom (England). . . 2.5 3.9 5.6 infections may have long-term
United States . . . . . . . . . . . . . . 3.1 4.2 5.2 effects on adult mortality. A World
NA Not available. Health Organization report states
1
Refers to ages 60-69. unequivocally that slow growth and
2
Refers to ages 60+. lack of emotional support in prena-
3
Refers to ages 70+.
4
Refers to ages 65-69.
tal life and early childhood reduce
Note: Data are relative to the level of per capita spending for people aged 0-64, which
physical, cognitive, and emotional
is set at 1.0. functioning in later years (Wilkinson
Source: OECD, 1997. and Marmot, 1998), as do certain

U.S. Census Bureau An Aging World: 2001 45


parental behaviors (particularly industrialized world6 has identified example, if marriage equates with
smoking and alcohol consumption) a number of socioeconomic factors better health among older
and socioeconomic circumstances that affect health and longevity: individuals, do rising rates of
(e.g., poverty). Parental divorce has people with higher education tend divorce and increased proportions
been linked to decreased longevity to live longer (Kitigawa and Hauser, of never-married individuals por-
of children (Schwartz et al., 1995). 1973); being married encourages tend poorer average health? And
healthier behaviors in U.S. adults, what of other life dimensions? A
While it seems intuitive that child-
including people in old age (relative considerable amount of current
hood conditions should affect adult
to other marital statuses), and the research is focused on not only
development and health outcomes,
effects may be greater for older social but also psychological and
separating cohort effects from peri-
men than for older women (Schone biological pathways by which
od effects (e.g., from changing liv-
and Weinick, 1998); there are clear socioeconomic status affects health
ing conditions) is empirically diffi-
gradients in the United Kingdom in (see, e.g., Adler et al., 1999).
cult. Indeed, some evidence
both mortality and health when bro-
suggests that current conditions While the weight of existing studies
ken down by social class, i.e., high-
may be more important than early- clearly supports a strong relation-
er social/occupational class is relat-
life conditions; Kannisto (1996) has ship between social and economic
ed to better health and lowered
found period effects to be much factors on the one hand and health
mortality risks (Devis, 1993;
more significant than cohort effects and mortality outcomes on the
Wilkinson and Marmot, 1998); and
on oldest-old mortality (i.e., after other, this relationship may not be
among the oldest old in Sweden,
age 80). And in a study of cohorts as strictly predictive as some have
former white-collar workers had
born just before, during, and just suggested. Research on marital sta-
better physical functioning than for-
after a severe famine in Finland in tus and health among the elderly in
mer blue-collar workers (Parker,
the mid-1860s, the researchers the United States, for instance, has
Thorslund, and Lundberg, 1994). In
found no major differences in later- shown that while widowhood is in
the United States (Crimmins,
life survival; the extreme nutritional fact associated with poorer health,
Hayward, and Saito, 1996) and in
deprivation in utero and during single women are likely to have bet-
several European countries (Robine
infancy appeared not to translate ter health outcomes than married
and Romieu, 1998), socioeconomic
into higher adult mortality risks women (Goldman, Korenman, and
conditions more strongly affect
(Kannisto, Christensen, and Vaupel, Weinstein, 1994). One Japanese
functional change than mortality,
1997). Such findings are likely to study (Sugisawa, Liang, and Liu,
which means that socioeconomic
stimulate considerable future 1994) found no significant effect of
differences in active or healthy life
research to explore the linkages marital status on the risk of dying;
expectancy are greater than those
between lingering effects of early- however, higher levels of social par-
in total life expectancy. Such find-
life and survival at advanced ages ticipation of older people were
ings might be expected to have
(Vaupel, 1997). strongly linked to lowered mortality
implications for the future health
risks. Research in Florence, Italy
SOCIOECONOMIC CORRELATES status of elderly populations. For
and Tampere, Finland uncovered no
OF MORTALITY AND HEALTH
systematic association between
If early-life factors affect future 6
Research on socioeconomic correlates of functional ability levels and educa-
mortality and health in developing countries is
health and survival, then socioeco- still sparse. Wu and Rudkin (2000) found that
tion/previous occupation
nomic differences in childhood and lower socioeconomic status was associated (Heikkinen, Jokela, and Jylha, 1996).
with poorer health among Malaysians aged 50
throughout life are likely to play an and over, and that this association held for all
In a study of nine industrialized
intrinsic role. A diverse and long- three major ethnic groups (Malay, Chinese, and nations, differences in mortality by
Indian). Liang et al. (2000) have found evi-
standing literature from the dence of a socioeconomic gradient in old-age educational level were found to be
mortality in China, but they note that there are fairly small in the Netherlands and
major differences between developed and
developing countries in terms of major health three Scandinavian nations, but
parameters, and that much more work needs to
be done in validating gradients in Third World
settings.

46 An Aging World: 2001 U.S. Census Bureau


much more substantial in larger higher mortality in Northern results point to the importance of
countries such as the United States, European countries, but no such understanding population diversity
France, and Italy. The authors sug- relationship in France, Switzerland, within countries, and suggest that
gest that between-country differ- and Mediterranean nations (Kunst et policy planners pay particular atten-
ences may be related to different al., 1999). Another multicountry tion to socioeconomic differences
social and economic policies. A study of income and mortality by gender and among subgroups
12-country study of occupational implies that the effect of income on when developing intervention
class and ischemic heart disease mortality is largely determined by strategies (see Sacker et al., 2001
mortality found the expected rela- the distribution of income within a and National Research Council,
tionship between lower class and given nation (Duleep, 1995). Such 2001 for further discussion).

U.S. Census Bureau An Aging World: 2001 47


CHAPTER 5.
Urban and Rural Dimensions

Urbanization is one of the most economic and political changes. both sending and receiving areas.
significant population trends of the Closed national economies and Definitions of urban and rural resi-
last 50 years. Though we may trading blocs have given way to dence often differ greatly from one
think of cities as synonymous with open economies that increasingly country to the next, which compli-
historical development, not until the are international in scope. In gener- cates global and regional discus-
nineteenth century did substantial al, the most rapidly-growing sions of urbanization. The view of
portions of national populations live economies since 1950 also are the United Nations has been that
and work in large cities, and only in those with the most rapid increase “differences in definition may reflect
certain parts of the world. In 1900, in their levels of urbanization. The differences in the characteristic fea-
about 14 percent of the world’s world’s largest cities tend to be con- tures of urban and rural settlements
population lived in cities (United centrated in the world’s largest considered most relevant in individ-
Nations, 1991), and this percentage economies (United Nations Centre ual countries” (United Nations,
was still below 20 by 1950. for Human Settlements, 1996). 1973). In spite of definitional incon-
However, the global population of Urbanization is linked to changes in sistencies, the basic questions con-
all ages living in urban areas (as the socioeconomic profile of a cerning aging are similar in all soci-
defined by each country) more than workforce as workers shift from eties: are the elderly increasingly
doubled between 1950 and 1975, predominantly agricultural pursuits concentrated in particular areas? If
and increased another 55 percent to industrial employment and then so, what are the implications for
from 1975 to 1990. By 1995, to services. Clark and Anker (1990) social support and delivery of serv-
about 46 percent (2.6 billion) of the have shown that urbanization is ices? For individual cities, do
earth’s people lived in urban areas related to decreased participation of changes in age structure bring
(United Nations, 1998). Soon after older people in the labor force. In about demands to reorder budget
the year 2000, the world likely will developed countries, this decrease priorities?
have more urban dwellers than accompanies a decline in manufac-
rural dwellers. About three-fourths turing employment, an increased DEVELOPED-COUNTRY
ELDERLY ABOUT THREE-
of the population in developed prevalence of early retirement
FOURTHS URBAN; ONE-THIRD
countries is urban, compared with schemes, and lower levels of educa- IN DEVELOPING COUNTRIES
slightly more than one-third in tion and job flexibility among older
developing countries as a whole. workers relative to younger work- In keeping with the worldwide pat-
However, the pace of urbanization ers. In urban areas of developing tern of increased urbanization, the
is much faster in the developing nations, the increased importance elderly population has become
world. And while the urban growth of the formal sector tends to more concentrated in urban areas
rate in most world regions has exclude older workers who find it during the past 50 years. In devel-
begun to decline, some parts of the difficult to compete with better- oped countries as a whole, an esti-
globe (notably Africa and South educated younger workers. With mated 73 percent of people aged
Asia) are now experiencing peak urbanization come changes in the 65 and over lived in urban areas in
rates of urban growth. In spite of family unit and kinship networks 1990, and this figure is projected to
declining growth rates, the world’s that have both beneficial and reach 80 percent by the year 2015.
urban population is projected to adverse consequences for the well- In developing nations, which still
virtually double between 1995 and being of elderly members. are predominantly rural, just over
2030, reaching a projected level of one-third (34 percent) of people
Urban growth affects all age groups aged 65 and over were estimated to
5.1 billion people (United Nations,
of a population. Since urbanization live in urban areas in 1990. This
1998).
often is driven by youthful migra- proportion is expected to exceed
Twentieth-century trends in urban- tion from rural areas to cities, it one-half by the year 2015 (United
ization have stemmed from broad influences the age distribution in Nations, 1991).

U.S. Census Bureau An Aging World: 2001 49


The elderly of Africa are more likely
to live in rural areas than are the Figure 5-1.
elderly of other regions, even Percent of Total and Elderly Population
Total
though the African population over- Living in Rural Areas in 39 Countries Aged 65+
all is slightly more urbanized than Africa
that of the Asia/Oceania region 54
Botswana, 1991 70
(excluding Japan). The aggregate South Africa, 1991 43
37
trend toward urbanization is Tunisia, 1994
39
42
stronger in Asia than in Africa, how- Zambia, 1990
61
85
ever. Half of the Asia/Oceania eld- Zimbabwe, 1992 69
86
erly are projected to live in cities by Asia
2015, compared with 42 percent Bangladesh, 1991
80
85
in Africa. 74
China, 1990 76
69
As a region, Latin America and the Indonesia, 1990 74
22
Caribbean is already highly urban- Japan, 1995 28
49
ized. The proportion of elderly in Malaysia, 1991 54
51
urban locales is very similar to that Philippines, 1990 54
22
of the developed-country average. South Korea, 1995 43
81
Unlike in other developing areas, Thailand, 1990 84
41
the elderly in Latin America and the Turkey, 1990 51
Caribbean have been somewhat Europe
more likely than the general popula- Austria, 1991 35
31
tion to live in cities (Heligman, France, 1990 26
31
Chen, and Babakol, 1993). Greece, 1991 41
49
28
Norway, 1990 32
ELDERLY MORE LIKELY THAN 17
Sweden, 1990
NONELDERLY TO LIVE IN 17
RURAL AREAS Former Soviet Union
32
Armenia, 1992 32
Despite the increasingly urban 46
Azerbaijan, 1989 45
nature of today’s elderly popula- 31
Belarus, 1997 53
tions, rural areas remain dispropor- 30
Estonia, 1996 31
tionately elderly in a majority of 44
Georgia, 1993
countries. In most nations, this is 51
45
Kazakhstan, 1996
primarily the result of the migration 42
66
of young adults to urban areas, and Krygyzstan, 1997 60
31
to some extent of return migration Latvia, 1996 33
32
of older adults from urban areas Lithuania, 1996 44
53
back to rural homes. Data for 39 Moldova, 1989 65
27
countries from the period 1989 to Russia, 1995 32
71
1997 show that the percent of all Tajikistan, 1993 64
32
elderly living in rural areas was Ukraine, 1995 44
59
higher than the percent of total Uzbekistan, 1989 52
population in rural areas in 27 of Latin America/Other
43
the 39 nations, with no difference Bolivia, 1992 59
in 4 nations (Figure 5-1). Five of 24
Brazil, 1991 24
the eight countries where the elder- 15
Chile, 1997 17
ly were less likely than the total 45
Ecuador, 1990 49
population to live in rural areas are New Zealand, 1991 15
10
predominantly-Muslim nations that United States, 1990
25
25
were formerly part of the Soviet
Source: U.S. Census Bureau, 2000a.
Union. Differences in the share of

50 An Aging World: 2001 U.S. Census Bureau


total versus elderly population
Figure 5-2. residing in rural areas are most
Urban Sex Ratios for Persons Aged 65 striking in Belarus, Bolivia,
and Over: 1986 or Later Botswana, Zambia, and Zimbabwe.
(Males per 100 females)

Africa
SEX RATIOS OF URBAN
Botswana, 1991 69 ELDERLY TYPICALLY LESS
Cote d'Ivoire, 1988 106 THAN 80
Egypt, 1986 123
Kenya, 1989 106 An examination of national data for
Malawi, 1987 109 54 countries from the period 1986
South Africa, 1991 79 to 1997 shows that more elderly
Tanzania, 1988 89
Tunisia, 1994 99 women than elderly men have been
Zambia, 1990 134 recorded in urban areas in all
Zimbabwe, 1992 108 except eight nations, six of which
Asia
Bangladesh, 1991 137 are in Africa. Sex ratios (number of
China, 1990 86 men per 100 women) for the urban
Indonesia, 1990 82 elderly usually are well below 100
Israel, 1994 76
Japan, 1995 70 (Figure 5-2), and are below 50 in
Malaysia, 1991 80 parts of the former Soviet Union.
Pakistan, 1990 113
Philippines, 1990 77 ELDERLY MEN MORE LIKELY
Singapore, 1990 81
THAN ELDERLY WOMEN TO
South Korea, 1995 55
Thailand, 1990 75 RESIDE IN RURAL AREAS
Turkey, 1990 77
Since women live longer than men
Europe
Austria, 1991 51 virtually everywhere, we might
Bulgaria, 1994 77 expect to see sex ratios of less than
Czech Republic, 1994 61
100 for the elderly throughout a
France, 1990 62
Greece, 1991 73 given population. Although older
Hungary, 1995 59 women outnumber older men in
Norway, 1990 66
almost every nation, the ratio of
Poland, 1994 57
Sweden, 1990 69 older men to older women general-
Former Soviet Union ly is higher in rural areas than in
Armenia, 1992 66
cities. In the rural areas of some
Belarus, 1997 49
Estonia, 1996 48 countries — e.g., New Zealand,
Georgia, 1993 54 Paraguay, and Sweden — older men
Latvia, 1996 46
52
actually outnumber older women.
Lithuania, 1996
Moldova, 1989 54 This rural male surplus is seen most
Russia, 1995 44 prominently in many countries of
Ukraine, 1995 50
Latin America/Caribbean/Other
Latin America and the Caribbean,
Argentina, 1995 67 which suggests region-specific pat-
Australia, 1986 70 terns of gender-specific migration
Bolivia, 1992 77
that have implications for health
Brazil, 1991 76
Canada, 1991 67 and social security systems in both
Chile, 1997 64 rural and urban areas.
Colombia, 1993 80
Costa Rica, 1995 77
Ecuador, 1990 82
Mexico, 1995 81
New Zealand, 1991 70
Peru, 1993 87
United States, 1990 64
Uruguay, 1990 67

Source: U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 51


Conversely, elderly women tend to
be somewhat more likely than eld- Figure 5-3.
erly men to live in urban areas Percent of All Elderly Living in Urban Areas
(Figure 5-3).1 The gender difference by Sex in Ten Countries
Male
in residential concentration proba- Female
bly is related to marital status and Developed countries
health. As discussed in Chapter 6,
68
elderly women are much more like- France, 1990
72
ly than elderly men to be widowed, 87
and also are more likely to have New Zealand, 1991
92
chronic illnesses. One study of the 54
Poland, 1994
elderly in developed countries 57
(Kinsella and Taeuber, 1993) noted 69
Russia, 1995
an inverse relationship between 67
widowhood rates and sex ratios in 73
United States, 1990
77
urban areas. Urban residence may
provide elderly women, especially Developing countries
widows, the benefits of closer prox-
24
imity to children and/or to social China, 1990
24
and health services. 67
Colombia, 1993
75
SUBNATIONAL URBAN/RURAL 55
DIFFERENCES IN AGE South Korea, 1995
59
STRUCTURE MAY BE STRIKING
56
Tunisia, 1994
The profile of aging in subnational 61
areas may be very different when 16
Zimbabwe, 1992
examined in view of urban/rural dif- 13
ferences. In Russia’s 73 oblasts Source: United Nations Demographic Yearbook, 1996.
(administrative areas), for example,
the rural population of many
oblasts is skewed in favor of older the same as the overall national population. One reason that rural
people.2 Figure 5-4 displays the age average. The majority of Kursk’s areas have such high proportions in
and sex distribution of urban ver- urban population is concentrated in older age groups is out-migration of
sus rural populations in the Kursk the working ages, which is not true younger people to urban areas in
Oblast, located in the Central in the rural areas. These pyramids search of work. Out-migration of
Chernozem Region bordering also show disparities in sex compo- young people may leave older
Ukraine. The pyramid for the rural sition. Nearly 31 percent of Kursk’s women and men without the direct
population has a particularly odd rural females are aged 65 and older, support of their family. Harsh living
shape, with people aged 65 and compared with just 15 percent of conditions and lack of amenities in
older accounting for nearly one- rural males. The sex ratio for the many rural areas pose additional
fourth of the total population. In rural elderly population is 41 men difficulties for the elderly. In 1996,
contrast, the urban population of per 100 women. for instance, official statistics indi-
Kursk is 12 percent elderly, about cate that only 23 percent of Russia’s
Kursk is not the only Russian oblast
rural population had running water
to have a large proportion of its
1
Grewe and Becker (2000), in a preliminary in their homes, and only 3 percent
examination of within-country migration rates rural population, particularly
had indoor toilet facilities.
for 65 countries with 128 observations from women, in older age groups. In
the period 1952-1996, also have noted a likely
trend toward disproportionate shares of elderly several other oblasts, more than Skewed age structures may present
women in urban areas, and of elderly men in one-fourth of the rural female popu- problems for certain localities in
rural areas.
2
Although Russia is highly urbanized (over lation is aged 65 or over. In seven terms of the provision of services
70 percent of the population lives in urban oblasts, elderly women account for and aid to older people. Skeldon
areas), its rural population remains substantial,
numbering approximately 40 million in 1996. 30 percent of the entire rural female (1999) has noted, based on the

52 An Aging World: 2001 U.S. Census Bureau


Figure 5-4.
Urban and Rural Population in Kursk Oblast: 1996

Age Urban
85+ Male Female
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
40 30 20 10 0 10 20 30 40

Rural
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
40 30 20 10 0 10 20 30 40
Thousands
Source: U.S. Census Bureau, 2000a.

experiences of Japan and Korea, the important emerging issues will residents. In countries where the
confluence of overall population revolve around the social conditions youthful influx of rural-to-urban
aging with rural depopulation and of elderly individuals in relatively migrants has slowed in recent
stagnation of small and medium- isolated rural areas. decades, many cities may now have
sized towns, and suggests that this aging populations (Chesnais, 1991).
pattern will be seen increasingly NO CLEAR TREND TOWARD Conversely, in countries where
DISPROPORTIONATE AGING OF
throughout Asia in the first half of urbanization rates remain high and
LARGE CITIES
this century. A similar situation has younger residents continue to gravi-
been noted by Golini (2000) with Although rural areas tend to be dis- tate toward cities, one would
regard to Italy. While there are few proportionately elderly compared expect the proportion of elderly in
if any negative national economic with urban areas in general, data cities to be lower than for the coun-
consequences associated with this for some large cities reveal a rela- try as a whole. Data for 13 major
development, it seems clear that tively high proportion of elderly cities (Table 5-1), however, do not

U.S. Census Bureau An Aging World: 2001 53


lend themselves to a clear interpre- Table 5-1.
tation of trends. The populations of Percent of Older Population in 13 Cities Compared With
Respective National Average
Budapest, London, and Moscow are
in fact older than their respective Age City Country
City
national averages, but this is not Year group percent percent

the case in Berlin, Paris, and Tokyo.


Bangkok and Harare are younger Bangkok,
Thailand. . . . . . . . . . . . . . . . . . . . . . . . . . 1995 65+ 4.2 5.4
than Thailand and Zimbabwe as a
Beijing,
whole, but a similar relationship
China . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1990 65+ 6.2 5.6
does not hold in the Chinese cities
Berlin,
of Beijing and Shanghai, nor in Germany . . . . . . . . . . . . . . . . . . . . . . . . . . 1993 65+ 13.7 15.1
Mexico City. In the United States in
Budapest,
general, census data from 1960 Hungary . . . . . . . . . . . . . . . . . . . . . . . . . . 1990 60+ 21.5 18.9
through 1990 indicate that the cen- Buenos Aires,
tral cities of metropolitan areas Argentina . . . . . . . . . . . . . . . . . . . . . . . . . 1991 65+ 8.2 8.9
have, on balance, consistently lost Harare,
elderly migrants to nonmetropolitan Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . 1992 65+ 1.6 3.3
areas (Fuguitt and Beale, 1993). Greater London,
United Kingdom . . . . . . . . . . . . . . . . . . . 1991 65+ 14.4 10.0
ARE RURAL ELDERLY Mexico City,
DISADVANTAGED? Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . 1995 65+ 5.2 4.4

The exodus of younger people from Moscow,


Russia . . . . . . . . . . . . . . . . . . . . . . . . . . . 1989 65+ 12.0 9.6
the countryside to cities raises the
New York,
rural proportion of elderly residents
United States . . . . . . . . . . . . . . . . . . . . . 1990 65+ 13.0 12.6
in many countries. As a result, tra-
Paris,
ditional family support systems for France . . . . . . . . . . . . . . . . . . . . . . . . . . . 1990 60+ 15.7 19.9
the frail elderly may change.
Shanghai,
Younger family members living in China . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1990 65+ 10.1 5.6
urban areas are unlikely to provide Tokyo,
direct care for distant elders remain- Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1990 65+ 9.4 12.0
ing in rural areas. At the same
Note: Data for Mexico City refer to the Federal District.
time, younger family members who
Source: Compiled by the U.S. Census Bureau from national statistical volumes.
move to cities may have improved
financial resources that can be used
Wales (Wenger, 1998) suggest that MIGRATION PATTERNS OF
to help elderly relatives still living in
rural dwellers are more likely than OLDER PEOPLE NOT WELL
the rural birthplace. DOCUMENTED
their urban counterparts to be
Quality-of-life issues for older popu- involved in community and volun- International migration of elderly
lations in rural versus urban areas tary activities. Nevertheless, the people, as noted in Chapter 2, is
are beginning to receive additional provision of health and other sup- not a significant demographic factor
attention as migration streams portive services to ill and disabled in many countries. Within-country
increase and the costs of health older people in rural areas contin- migration, however, may be sub-
care and public benefits escalate. ues to present special challenges. stantial. One common perception
Whereas graying rural communities Perhaps because of these difficul- of older people is that they tend to
were once associated with negative ties, the percentage of older dis- be much less mobile than younger
socioeconomic consequences, more abled people remaining in the people, typically “aging in place” in
recent research in developed coun- community without being institu- communities that have been home
tries has considered positive results tionalized is lower in predominantly for many years. While this may be
that may stem from increased pro- rural areas than in urban areas true in a general sense, various
portions of increasingly affluent eld- (Suzman, Kinsella, and Myers, national studies suggest that geo-
erly (Bean et al., 1994). Data from 1992). graphical mobility among older

54 An Aging World: 2001 U.S. Census Bureau


people is increasing. In the 1970s, more prevalent as levels of adults, there is mounting evidence
the mobility of the Japanese popula- education and retirement income that the movement of older people
tion declined in all age groups with increase. In the United States, the to urban areas is becoming signifi-
the exception of the elderly (Otomo oldest old have been seen to move cant (Myers and Clark, 1991).
and Itoh, 1989). Census data for more frequently than younger elder- There is much less empirical infor-
Canada show that 23 percent of all ly, suggesting that the moves of the mation on the topic of return migra-
people aged 60 and over changed oldest old are related to health tion of older people to rural places
their principal residence at least problems and the need for different of origin. One review of available
once during the 5-year period 1986 living arrangements (Hobbs and data for Africa (Becker, 1991) con-
to 1991. Thirteen of the fifty states Damon, 1996). Recent Canadian cludes that, while return migration
in the United States had net elderly survey data find that older people of older people to their ancestral
inmigration rates of more than 10 moved most often because of the homes is not uncommon, several
per 1,000 elderly population during size of their home (usually opting factors — growing land pressure,
the 1985-90 period, and one out of for a smaller residence), a desire to formalization of rural property
five residents of Florida is now aged live in a better neighborhood, or to rights, the increasing viability of
65 or older. A “retirement effect,” build/purchase a home (Che-Alford family support for elders in urban
i.e., an increase in mobility rates at and Stevenson, 1998). Among areas — will dampen the likelihood
ages 60 to 64, has been noted in older Canadians with daily activity of future return migration. Skeldon
the United States and the United limitations in 1991, the percent (1999) notes that, while return
Kingdom (Long, 1992). Refugee who moved in the previous 5 years migration may increase the size of
movements in Bosnia, Mozambique, was roughly the same as among the older rural cohorts and aggravate
and elsewhere have involved vast overall older population (22 per- social support issues, return
numbers of older people (Kalache, cent), but about one-third of these migrants also may bring with them
wealth, knowledge, and other
1995) who are often overlooked in people relocated to homes with
resources, particularly in the form
relief operations that focus on chil- special health features. A German
of pension income earned during
dren and young adults. study of motivating factors for eld-
years spent in the urban labor mar-
erly mobility in the city of
One of the few cross-national stud- ket. Migration from and within
Heidelberg (Oswald, Wahl, and
ies of elderly migration (Rogers, developing countries in general has
Gang, 1997) suggests that basic
1988) identified two basic patterns. come to be seen as a strategic fami-
needs (e.g., health) were roughly as
One is characterized by amenity- ly decision rather than as an indi-
important as “higher-order” needs
motivated, long-distance relocation, vidual decision on the part of young
such as privacy.
the other by intracommunity, leavers (Vatuk, 1995). To the extent
assistance-motivated short-distance Information on migration patterns that migration raises family
moves. Available studies in devel- of older people in developing coun- incomes and the ability to reunite
oped countries suggest that the lat- tries is fragmented at best. members, increased movement of
ter are much more common, Although rural-to-urban migration older people may be expected in
although the former may become usually is associated with younger the future.

U.S. Census Bureau An Aging World: 2001 55


CHAPTER 6.
Sex Ratios and Marital Status

One common characteristic of pop- caregiving that is readily available male mortality rates is that between
ulations throughout the world is the in case of illness or disability. age 30 and 40, women usually
preponderance of women at older begin to outnumber men. In most
ages. Women are the majority of HIGHER MALE MORTALITY countries, the relative female advan-
RESULTS IN GENDER
the elderly population in the vast tage increases with successively
IMBALANCE AT
majority of countries, and their OLDER AGES older age (Figure 6-1).
share of the population increases
with age. This gender imbalance at The primary reason for the numeri- WORLD WAR II IS STILL
cal female advantage at older ages EVIDENT IN SEX COMPOSITION
older ages has many implications
is the sex differential in mortality AT OLDER AGES
for population and individual aging,
perhaps the most important of discussed in Chapter 3. Although Historical events can play a major
which involve marital status and liv- more boys than girls are born, role in shaping the gender composi-
ing arrangements. As discussed males typically have higher mortali- tion at older ages. For instance, the
further in Chapter 8, family mem- ty rates than females. The sex dif- lingering effects of heavy war mor-
bers are the main source of emo- ferential in mortality begins at birth tality during World War II still can be
tional and economic support for the and continues throughout the life seen in the proportion female at
elderly, although in some developed course. One outcome of higher older ages in certain countries. In
countries the state has assumed a
larger share of the economic
responsibilities. Figure 6-1.
Age
Percent Female for Older
Marital status strongly affects many 65-69
Age Groups: 2000 70-74
aspects of one’s life. Studies in 75-79
developed countries show that mar- 80+
ried people, particularly married
men, are healthier and live longer 62
66
than their nonmarried counterparts Russia
75
(Goldman, 1993; Hadju, McKee, and
80
Bojan, 1995; Waite, 1995; Schone
53
and Weinick, 1998). Older married
58
couples tend to be more financially Germany
67
secure than nonmarried people. 74
Changes in marital status at older
56
ages can affect pension potential, 59
Brazil
retirement income, and an individ- 61
ual’s social support network; many 67
older widowed men, in particular, 49
may lose contact with much of their 50
India
support network after their wife 49
dies (O’Bryant and Hansson, 1996). 48

In contrast, widowed women tend 54


to maintain their support network 56
United States
58
after the death of a spouse (Scott
66
and Wenger, 1995). Marital status
also influences one’s living arrange- Source: U.S. Census Bureau, 2000a.
ments and affects the nature of

U.S. Census Bureau An Aging World: 2001 57


Russia, women account for 80 per-
cent of the oldest old (aged 80 and Figure 6-2.
older) and in Germany they repre- Sex Ratio for Population 65 Years
2000
sent nearly 74 percent. In con- and Over: 2000 and 2030 2030
trast, women account for only two- (Males per 100 females)
thirds of the oldest-old population
Developed countries
in Brazil and the United States.
78
Australia
THERE IS GREAT NATIONAL 81
DIVERSITY IN SEX RATIOS 74
Canada
AMONG ELDERLY 79
68
A sex ratio is a common measure France
74
used to portray a population’s gen-
70
der composition. A sex ratio is con- Italy
76
ventionally defined as the number
77
of men per 100 women in a given New Zealand
79
population or age category. Sex 46
ratios greater than 100 indicate Russia
58
more men than women, and sex 73
Sweden
ratios under 100 indicate the 80
reverse (i.e., more women than 49
Ukraine
men). In most countries of the 53
world, sex ratios at older ages are 71
United Kingdom
below 100, in some cases quite a 80
bit below (e.g., Russia’s sex ratio is 71
United States
46 men per 100 women aged 65 80
and older). Developed countries
Developing countries
tend to have lower sex ratios at
71
older ages than do developing Argentina
countries (Figure 6-2), although 75
119
there are many exceptions to this Bangladesh
98
generalization. The typical differ-
68
ence between developed and devel- Brazil
70
oping countries is explained by sex
88
differentials in life expectancies at Guatemala
81
birth. As shown in Chapter 3,
103
developed countries tend to have India
91
larger sex differentials in life 60
expectancy at birth than do devel- Kyrgyzstan
63
oping countries, which results in 81
Mexico
greater numbers of women than 71
men at older ages. 86
Turkey
86
PROJECTED TREND IN SEX 62
RATIO DIFFERS BY Turkmenistan
65
DEVELOPMENT STATUS
103
Zimbabwe
In the future, sex ratios at older 58
ages are projected to move in oppo-
Source: U.S. Census Bureau, 2000a.
site directions in the aggregate

58 An Aging World: 2001 U.S. Census Bureau


developed and developing worlds.
Figure 6-3. Between today and 2030, sex ratios
Aggregate Sex Ratios for Older Age Groups: for the elderly are expected to
2000 and 2030 increase in many developed coun-
2000
2030 tries because the gender gap in life
expectancy is projected to narrow
91
86 (Figure 6-3). In other words, most
81 demographers expect that male life
72
expectancies in developed countries
70
66 are likely to improve at a faster
pace than female life expectancies.
57
The opposite is anticipated in many
45
developing countries. In view of
the historical pattern in developed
nations, sex differentials in develop-
ing-country life expectancies are
projected to widen, which will in
turn lead to lower future sex ratios.

Regardless of the projected trends,


women are expected to make up
65-79 80+ 65-79 80+
the majority of the world’s elderly
Developed countries Developing countries
population (particularly at the old-
Source: U.S. Census Bureau, 2000a.
est ages) well into the next century.
Continuing or growing disparities in
sex ratios mean that many of the
Table 6-1. challenges and problems faced by
Sex Ratios for Population Aged 65 and Over for Countries
With More Elderly Men Than Women: 2000 the elderly of today and tomorrow
are, in essence, challenges and
Country Sex ratio problems faced by older women.
Qatar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
United Arab Emirates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
Sex ratios at younger ages in some
Kuwait . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 countries of the world already are
Sudan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 quite skewed in favor of women.
Bangladesh. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Saudi Arabia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 This imbalance may be due to
Iran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 excess male mortality at young
Taiwan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Afghanistan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 ages because of wars and other
Niger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 forms of violence, disease, or to
Oman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 disproportionate out-migration of
The Gambia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Eritrea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 young men seeking work in other
Yemen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 countries. If mortality is the cause
Bahrain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Bhutan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 of such severe sex ratios at younger
India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 ages, then the implications for the
Tunisia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
eventual aging of these cohorts is
Source: U.S. Census Bureau, 2000a. different than if the cause is

U.S. Census Bureau An Aging World: 2001 59


Figure 6-4.
Percent Married at Older Ages
Male
Female
DEVELOPED COUNTRIES DEVELOPING COUNTRIES

Canada, 1991 Argentina, 1991


83 79
55-64 55-64
71 61
80 76
65-74 65-74
54 42
67 63
75+ 75+
24 17

Belgium, 1998 Indonesia, 1990


82 90
55-64 55-64
74 55
80 84
65-74 65-74
56 33
65 70
75+ 75+
23 18

United States, 1995 Chile, 1992

79 74
55-64 55-64
66 57
78 69
65-74 65-74
53 42
68 59
75+ 75+
25 22

Japan, 1990 South Korea, 1995

92 94
55-64 55-64
77 66
89 88
65-74 65-74
54 34
74 72
75+ 75+
21 11

Czech Republic, 1991 Zimbabwe, 1992


84 90
55-64 55-64
65 60
80 85
65-74 65-74
42 39
60 78
75+ 75+
14 21

Source: U.S. Census Bureau, 2000a.

60 An Aging World: 2001 U.S. Census Bureau


Figure 6-5.
Percent Widowed at Older Ages
Male
Female
DEVELOPED COUNTRIES DEVELOPING COUNTRIES

Canada, 1991 Argentina, 1991


3 5
55-64 55-64
14 22
8 11
65-74 65-74
33 44
22 25
75+ 75+
64 70

Belgium, 1998 Indonesia, 1990


4 6
55-64 55-64
13 39
9 11
65-74 65-74
33 61
27 22
75+ 75+
67 76

United States, 1995 Chile, 1992


3 5
55-64 55-64
13 19
9 12
65-74 65-74
33 37
22 26
75+ 75+
65 60

Japan, 1990 South Korea, 1995

3 5
55-64 55-64
14 33
8 11
65-74 65-74
39 65
24 28
75+ 75+
75 88

Czech Republic, 1991 Zimbabwe, 1992

4 3
55-64 55-64
23 31
11 7
65-74 65-74
48 54
33 14
75+ 75+
77 73

Source: U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 61


migration and the migrants return
to their native country when they Figure 6-6.
retire (or return for other reasons). Percent Widowed in Belgium: 1998

ELDERLY MEN OUTNUMBER Percent


ELDERLY WOMEN IN SOME 100
COUNTRIES

While women outnumber men at


80
older ages in most countries, there
are 18 countries in Asia and Africa
where available data suggest that
Female
the reverse is true (Table 6-1). One 60

likely explanation involves the social


status of women versus men in cer-
tain cultures. The relatively low 40 Male

numbers of women at older ages


may reflect past levels of higher
female than male mortality, which 20
could be related to discriminatory
treatment accorded girls and women
throughout their lifetime. High sex 0
ratios at older ages also may be sta- 20-24 30-34 40-44 50-54 60-64 70-74 80-84 90-94 100+
Age
tistical artifacts. That is, women
Source: Belgium National Institute of Statistics, 1998.
(especially older women) may be
undercounted to a greater extent
than men in some national census-
aged 65 and over were married in 3 percent of men and 31 percent of
es, insofar as men are more likely to
most study countries. Elderly women aged 55 to 64 were wid-
interact with census enumerators
women are much more likely to be owed in 1992. At ages 75 and over,
and may neglect to provide informa-
widowed. In 32 of the study coun- the respective figures were
tion on all female household mem-
tries, over half of elderly women are 14 percent of men and 73 percent
bers. Furthermore, certain concen-
widowed. of women. These data are typical of
trated patterns of male labor
the pattern seen in both developed
migration may affect sex ratios to For both men and women, the pro-
and developing countries.
the extent that a significant portion portion married decreases with
of migrants remains in the host older age and the proportion wid- The gender difference in marital sta-
country after reaching age 65. owed increases. However, gender tus results from a combination of
differences in survival and other fac- factors. The first is the aforemen-
OLDER MEN ARE MARRIED; tors (see below) result in very differ- tioned sex difference in longevity;
OLDER WOMEN ARE WIDOWED
ent average ages of widowhood/ women simply live longer than
Older men are more likely to be widowerhood. In the case of men. Secondly, women tend to
married and older women are more Belgium in 1998, 82 percent of men marry men older than themselves
likely to be widowed in most coun- aged 55 to 64 were married, com- which, combined with the sex dif-
tries of the world (Figures 6-4 and pared with 74 percent of women in ference in life expectancy, increases
6-5). In all but six of the 51 study that age group. At ages 75 and the chance that a woman will find
countries with data on martial sta- over, 65 percent of men were still herself without a spouse in her
tus, over 70 percent of men aged married, compared with only older age. Furthermore, older wid-
65 and older were married. Even at 23 percent of women. The gender owed men have higher remarriage
ages 75 and older, a majority of difference in proportions widowed is rates than older widowed women in
men were married. In contrast, correspondingly pronounced (Figure many countries, often as a function
only 30 to 40 percent of women 6-6). Data for Zimbabwe show that of cultural norms (Velkoff and

62 An Aging World: 2001 U.S. Census Bureau


have never married. In some
Figure 6-7. European countries, the larger
Percent Divorced and Separated in the proportions of elderly women who
United States: 1999 have never married may be attribut-
Male able to World War II. Many of
Female today’s elderly women were of
prime marriage age soon after the
21.7 war, when there was a shortage of
20.8
potential spouses due to war
18.6 deaths. Higher-than-average pro-
17.6 18.0 17.8
portions of never-married elderly
15.8
15.1 are found in several Latin American
and Caribbean nations, which could
be a function of the prevalence of
9.3 consensual unions. While the cate-
8.8
gory “consensual union” is widely
used in census tabulations in these
countries, some people living (or
who have lived) in a consensual
union are likely to report them-
selves to be never married.
35-39 40-44 45-54 55-64 65+
Age group FUTURE ELDERS MORE LIKELY
TO BE DIVORCED
Source: U.S. Census Bureau, 2000a.
Percentages currently divorced
among elderly populations tend to
Kinsella, 1993; Cattell, 1997). The decreased. Some of the change is be low. However, this will change
fact that women are likely to lose attributable to improved joint sur- in the near future in many countries
their spouse has important econom- vival of husbands and wives (Myers, as younger cohorts with higher pro-
ic consequences for individuals and 1992). In certain countries, some portions of divorced/separated peo-
societies. A comparison of longitu- of the change can be explained by ple move into the ranks of the eld-
dinal data from Germany and the the different marital experiences of erly (Gierveld, 2001). For instance,
United States revealed that, birth cohorts. For instance, the in 1999 in the United States, around
although the level of poverty is dif- diminishing effects of World War II 9 percent of the elderly were
ferent in the two counties, most can be seen when the widowhood divorced or separated compared
women in both nations experienced rates of older women in Russia are with nearly 15 percent of men and
a decline in living standards upon compared for 1979 and 1994. In 19 percent of women aged 55 to
widowhood, and many fell into 1979, 72 percent of older women in 64. The proportion divorced/sepa-
poverty as a result of the loss of Russia were widowed while only rated is higher still for the age
public/private pension support 58 percent were widowed in 1994. group 45 to 54 (Figure 6-7). The
(Hungerford, 2001). By 1994, the cohorts that were changing marital composition of the
most affected by the war were aged elderly population as these younger
ELDERLY MORE LIKELY TO BE 75 and older. cohorts reach age 65 will affect the
MARRIED THAN IN THE PAST
nature and types of support servic-
Over the last two or three decades, SMALL PROPORTIONS OF
es that both families and govern-
ELDERLY HAVE NEVER MARRIED
the marital status of the elderly has ments may need to provide, espe-
changed. In a majority of the study Relatively few elderly in most coun- cially with regard to the growing
countries, the proportion of older tries have never married. In more number of elderly who lack direct
men and women who are married than half of the study countries, familial support (Pezzin and Schone,
has increased slightly and the pro- 5 percent or less of elderly men and 1999).
portion who are widowed has 10 percent or less of elderly women

U.S. Census Bureau An Aging World: 2001 63


CHAPTER 7.
Living Arrangements

Living arrangements are affected by those living in the community, the countries of the world, it is not
a host of factors including marital chances of institutionalization. surprising to find that the share of
status, financial well-being, health older women living alone is higher
Three major observations emerge
status, and family size and struc- than that of men. For elderly men in
from a cross-national comparison of
ture, as well as cultural traditions developed countries, the propor-
living arrangements of the elderly.
such as kinship patterns, the value tions range from a low of 5 percent
First, women in developed coun-
placed upon living independently, in Japan to a high of 25 percent in
tries are much more likely than men
the availability of social services Sweden. Proportions of elderly
to live alone as they age; older men
and social support, and the physical women residing singly are univer-
are likely to live in family settings.
features of housing stock and local sally higher, reaching half or more
Second, both elderly men and
communities. On the individual in Denmark, Germany, and Sweden.
women in developing countries
level, living arrangements are Percentages in developing countries
usually live with adult children.
dynamic, representing both a result tend to be much lower, although
Third, the use of nonfamily institu-
of prior events and an antecedent the levels for men and women in
tions for care of the frail elderly
to other outcomes (Van Solinge, some countries (e.g., Argentina,
varies widely around the world.
1994). On the societal level, pat- Cyprus) rival those of certain
terns of living arrangements among MORE THAN HALF OF ELDERLY European nations. Again, older
the elderly reflect other characteris- DANISH WOMEN LIVE ALONE women are more likely than older
tics — demographic, economic, and men to live alone; St Lucia and
Table 7-1 presents data from the
cultural — which influence the cur- Taiwan are the only exceptions in
1990s on proportions of older peo-
rent composition and robustness of Table 7-1.
ple living alone in what are usually
older citizens. In turn, living
considered to be private (i.e., nonin- The gender gap for those living
arrangements affect life satisfaction,
stitutional) households. Since alone generally increases with age
health, and most importantly for
women outlive men in virtually all (Figure 7-1). However, for countries

Table 7-1.
Percent of Elderly Population Living Alone: Data From 1990 to 1999
Developed countries Male Female Developing countries Male Female

Australia . . . . . . . . . . . . . . . . . . . . . 13.7 29.3 Argentina . . . . . . . . . . . . . . . . . . . . 11.2 21.1


Canada . . . . . . . . . . . . . . . . . . . . . . 14.1 33.7 Aruba . . . . . . . . . . . . . . . . . . . . . . . 12.5 15.4
Czech Republic . . . . . . . . . . . . . . . 19.0 47.5 Bolivia. . . . . . . . . . . . . . . . . . . . . . . 13.2 15.7
Denmark . . . . . . . . . . . . . . . . . . . . . 23.3 52.0 Cyprus . . . . . . . . . . . . . . . . . . . . . . 10.6 24.8
Finland. . . . . . . . . . . . . . . . . . . . . . . 19.5 46.5 Hong Kong . . . . . . . . . . . . . . . . . . 11.6 13.2
France . . . . . . . . . . . . . . . . . . . . . . . 15.3 40.2 Mexico . . . . . . . . . . . . . . . . . . . . . . 7.5 14.0
Germany . . . . . . . . . . . . . . . . . . . . . 16.9 50.8 Morocco (60+) . . . . . . . . . . . . . . . 11.3 44.7
Greece. . . . . . . . . . . . . . . . . . . . . . . 8.7 22.8 Philippines(60+) . . . . . . . . . . . . . . 4.4 6.4
Ireland . . . . . . . . . . . . . . . . . . . . . . . 18.9 27.7 South Korea(60+) . . . . . . . . . . . . 3.1 11.8
Japan . . . . . . . . . . . . . . . . . . . . . . . . 5.2 14.8 St. Lucia. . . . . . . . . . . . . . . . . . . . . 20.9 18.9
New Zealand . . . . . . . . . . . . . . . . . 17.8 38.0 Taiwan . . . . . . . . . . . . . . . . . . . . . . 13.0 7.4
Norway . . . . . . . . . . . . . . . . . . . . . . 21.3 44.7 Thailand(60+) . . . . . . . . . . . . . . . . 2.9 5.5
Portugal . . . . . . . . . . . . . . . . . . . . . . 9.4 23.9 Vietnam(60+) . . . . . . . . . . . . . . . . 2.5 8.1
Romania . . . . . . . . . . . . . . . . . . . . . 12.4 31.7
Sweden . . . . . . . . . . . . . . . . . . . . . . 25.1 49.9
United States . . . . . . . . . . . . . . . . . 15.1 36.8

Note: Data for Mexico are for seven cities, and refer to 1989. Data are for household populations aged 65 and over, unless otherwise
noted. Data for Morocco refer to urban areas only.
Sources: Compiled from data in United Nations Demographic Yearbooks (various dates) and national sources.

U.S. Census Bureau An Aging World: 2001 65


that disaggregate data at advanced
ages, the gender difference tends to Figure 7-1.
diminish at very old ages, presum- Percent of Elderly Living Alone in
ably as a result of health and/or Germany and the United States Male
economic factors that require insti-
by Available Age Groups Female

tutional caretaking, communal liv-


Germany, 1999 United States, 1995
ing, or sharing of housing costs.
Both numbers and proportions of 66
elderly living alone have risen 61
sharply in developed countries
since the early 1960s, although 51
recent information suggests that 45
the rise in proportions might be
leveling off in some nations. 36
Everywhere, however, the absolute 32 32

numbers are increasing. Figure 7-2 24


illustrates a trend common to most 20
developed countries, i.e., the 14 14
13
increase has been largely fueled by
women. Data from the 1996 cen-
sus of Canada show more than
700,000 elderly women living 65-69 70-74 75+ 65-74 75-84 85+
alone, a jump of more than 180,000 Age group
since 1986. The number of elderly Source: National sources.

women living alone grew at an


average annual rate of 5.4 percent
from 1961 to 1996, compared with
Figure 7-2.
a rate of 1.4 percent for the entire
Elderly Living Alone in Canada: 1961 to 1996
Canadian population. One implica-
tion of such change is that, in most Thousands
developed countries, women must 800
anticipate a period of living alone at
some point during their older years.

“ELDERLY-ONLY” HOUSEHOLDS 600


ARE INCREASINGLY COMMON
An earlier version of this report
Female
(Kinsella and Taeuber, 1993) point-
400
ed out that elderly people living
alone were a significant factor in
national household profiles in
Europe. In several nations (e.g.,
200 Male
Belgium, Denmark, France, and the
United Kingdom) in the 1980s,
more than 11 percent of all national
households consisted of a solitary 0
individual aged 65 or over. The 1961 1966 1971 1976 1981 1986 1991 1996
most common living arrangement Source: National sources.
for the elderly in Europe was with

66 An Aging World: 2001 U.S. Census Bureau


Table 7-2.
Composition of European Households With Elderly Members: Early 1990s
Percent elderly in households with:

One person 65 Another person Another person


Country
years or over 65 years or under 65 years Two Three or
(1 person over (2 person (2 person other more other
household) household) household) persons persons

Denmark . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.4 40.6 11.4 4.1 1.5


Greece . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.7 29.4 14.2 15.0 23.7
Spain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.6 31.4 11.3 17.4 23.3
France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.1 39.9 11.9 9.7 6.5
Ireland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.2 25.3 13.1 16.4 18.9
Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.9 31.3 12.7 14.7 15.4
Netherlands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.5 45.4 11.5 5.5 2.2
Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.3 29.4 12.9 10.2 12.2
Portugal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.5 33.8 11.9 14.4 21.3
Finland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.4 32.2 12.8 8.9 7.7
Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.1 44.4 10.0 3.6 0.9
United Kingdom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.7 40.5 11.9 7.9 3.9
Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34.0 41.2 12.6 8.1 4.1

Source: Eurostat, 1996.

another elderly person in a two- reimbursement payments which dis- national differences in elderly living
person household. A related calcu- courage institutional living. arrangements in Europe are charac-
lation revealed that three out of terized more by diversity than by
every ten households in a 12-nation MAJORITY OF ELDERLY IN similarity.
DEVELOPED COUNTRIES LIVE
European aggregate contained at
WITH OTHER PEOPLE TWO- OR THREE-GENERATION
least one elderly person.
Although high proportions of elder- HOUSEHOLD STILL THE
Data from the 1991 census of Great DEVELOPING-COUNTRY NORM
ly often live alone in developed
Britain (for England, Wales, and countries, a majority of those aged In all developing regions of the
Scotland) are even more striking; 65 and over still live with other world, with the possible exception
15 percent of all households in Great people. Data from 13 European of the Caribbean, the most common
Britain consisted of a single pension- nations (Table 7-2) show that the living arrangement for elderly peo-
er living alone, while another 10 per- proportion of elderly living with one ple (married or widowed) is with
cent of households had two or more other elderly person only (in most children and/or grandchildren.
pensioners with no other people cases a spouse) tends to be higher Between 72 and 79 percent of older
present. Hence, 25 percent of all than the proportion living singly. (60 and over) respondents in 1984
households in the country consisted Between 10 and 14 percent of the World Health Organization surveys
of pensioners only. Overall, one- elderly in the 13 nations live with in Malaysia, the Philippines, Fiji, and
third of Britain’s households had at one other person who is less than South Korea lived with children
least one resident pensioner. 65 years of age; many of these eld- (Andrews et al., 1986), and similar
In developed countries, the growth erly are likely to be either men liv- results have been observed in coun-
in “elderly-only” households may be ing with younger spouses, or wid- tries as diverse as India, Indonesia,
due in part to changes in social and owed or divorced individuals living Cote d’Ivoire, Singapore, and (at
economic policies. These include: with a child. Nations vary greatly in earlier times) six Latin American
increases in benefits that allow older the proportion of elderly people liv- nations (Kinsella, 1990). More
people to live independently of their ing in households of three or more recent data from four Asian nations
children; programs that more easily people, from only 5 to 6 percent in (Figure 7-3) show a persisting pat-
permit the conversion of housing Sweden and Denmark to 35 percent tern. While the levels may appear
wealth into income; programs that or more in Ireland, Greece, Portugal, similar, the broad category of “living
encourage the building of elder- and Spain. As earlier studies (Wall, with offspring” encompasses a
friendly housing; and revisions in 1989; Pampel, 1992) have noted, plethora of specific family and

U.S. Census Bureau An Aging World: 2001 67


household types, differing not only
among nations but among ethnic Figure 7-3.
groups within nations. Such diver- Percent of People Aged 60 and Over Living
sity points to the importance of cul- With Children in Four Asian Countries:
tural and ideological as well as Circa 1996 Male
demographic factors in the determi- Female
nation of living arrangements of
90.6
older people (Albert and Cattell, 86.5
1994).
76.5
71.9 72.7 71.8
A growing concern in developing 67.4 69.4
countries is the extent to which the
twin processes of modernization
and urbanization will change tradi-
tional family structures (Zhou,
2000). Data for most of the devel-
oping world generally are insuffi-
cient for documenting changes in
living arrangements of the elderly.
Although the case of Japan may not
seem especially relevant to develop-
ing nations, the extended family
Philippines Singapore Thailand Vietnam
structure common to the latter has
(Red River Delta)
historically been a feature of
Japanese society as well. Time Sources: Anh et al., 1997; Chan, 1997; Knodel and Chayovan, 1997; and Natividad and Cruz, 1997.

series data (Figure 7-4) show that


the number and proportion of
extended-family households in
Figure 7-4.
Japan have been declining, and that Living Arrangements of Japanese Elderly: 1960 to 1995
the proportions of elderly living
alone or with spouse only have
With kin Elderly Alone Institution
been increasing. couple only

These trends in Japan have led to


1960
the suggestion (Kamo, 1988) that
the impact of industrialization has
1975
undermined the indigenous culture
of Japan vis-a-vis the status of its
1985
elderly citizens, and set the stage
for the eventual predominance of 1995
the nuclear family. Related to this
is the notion of “intimacy at a dis- 0 20 40 60 80 100
Percent
tance” (see, e.g., Stehouwer, 1968;
Note: "With kin" includes very small numbers of elderly cohabitating with nonkin.
Rowland, 1991). That is, as the Source: Japan Management and Coordination Agency, cited in Atoh, 1998.
financial (and to some extent
health) status of elderly people
improves, a larger proportion are literature relates improvements in normative changes toward individ-
able to afford to live alone and social security programs and gen- ualism and personal independence
choose to do so in independent eral economic welfare to the ability (see, e.g., the discussion and refer-
dwellings, while at the same time and desire of older persons to ences in Gierveld, 2001). This con-
maintaining close familial contact choose independent living arrange- cept has found general currency in
and exchange supports. A growing ments, presumably reflecting a variety of cultural settings,

68 An Aging World: 2001 U.S. Census Bureau


internationally consistent data, and
Figure 7-5. differences between countries
Percent of Elderly in Residential Care: should be construed as orders of
Early to Mid-1990s magnitude rather then as precise
measurements. One attempt to col-
Netherlands 8.8 late reasonably-comparative data on
Sweden 8.7 residential care in the 1990s (OECD,
Denmark 7.0
1996) suggests that usage rates for
Australia 6.8
developed countries (Figure 7-5)
Canada 6.8
range from 2 percent in Portugal to
Germany 6.8
Luxembourg 6.8
9 percent in the Netherlands.1
New Zealand 6.7 There is substantial variation in the
Norway 6.6 use of custodial institutions and in
France 6.5 the mix of long-term care alterna-
Belgium 6.4 tives and services (see, e.g., Ribbe
Finland 6.4 et al., 1997; Mechanic and
Japan 6.0 McAlpine, 2000). One study (Doty,
United States 5.7 1992) suggests that Japan,
United Kingdom 5.1
Australia, and North America have
Ireland 5.0
made greater relative use of med-
Austria 4.9
ical residential care, while an
Italy 3.9
Spain 2.9
emphasis on nonmedical facilities
Portugal 2.0 has been more apparent in Belgium,
Turkey 0.2 Sweden, and Switzerland.

Notes: Canada and Finland: figures represent the midpoint of an estimated range.
In Eastern Europe and parts of the
Japan and the Netherlands: some of the residential care is provided in hospitals. former Soviet Union, the combina-
Sources: OECD, 1996; Jacobzone, 1999.
tion of low fertility and the rapid
increase in oldest-old population
although a recent analysis of data lowered fertility, increased geo- might be expected to translate into
from the Indonesian Family Life graphical mobility, and the rapid a growing use of institutional health
Survey (Cameron, 2000) finds little advance in medical technology — care and maintenance services. To
evidence that increases in the has led to a steep rise in numbers date, however, available information
income of the elderly, or that of their of institutionalized elderly. The indicates that institutionalization of
children, lead to a significant change highest rates of institutional use are older people is not common. In
in traditional family structure. found in many of the world’s oldest Russia, for instance, the capacity of
countries, and the absolute num- (number of existing places in) old
NUMBERS OF bers of users are expanding even in people’s homes and nursing homes
INSTITUTIONALIZED ELDERLY
the face of increasing efforts to throughout the former USSR in the
RISING
enhance community-based services late 1980s was estimated to be
A number of studies (e.g., Manton, and avoid or greatly reduce levels
Stallard, and Liu, 1993; Weiner and of institutionalization.
Illston, 1995; Leung, 2000) have 1
Although the percentage of elderly in insti-
In spite of the intense media scruti- tutions at any given moment may be relatively
documented the direct relationship low, on average around 5 percent in developed
between population age-sex struc- ny of and controversy surrounding countries, an estimated 25 to 30 percent of
institutional residence, the fact people who survive to age 65 can expect to
ture, age-sex-specific rates of chron- spend some time in an institutional setting
ic disease and disability, and the remains that relatively small propor- before they die (Sundstrom, 1994). Thus the
tions of elderly populations reside longitudinal risk of experiencing institutional-
need for long-term care. The con- ization is much higher than cross-sectional
fluence of several macro trends in in institutions at any given time. rates might suggest. Considerable research
interest currently is devoted to untangling the
developed countries — older popu- Cross-national comparisons of insti-
dynamics of institutional use, including transi-
lation age structures, higher inci- tutionalized populations are prob- tions to and from such facilities and the under-
lying health conditions that drive the transi-
dence of noncommunicable disease, lematic due to the absence of tions.

U.S. Census Bureau An Aging World: 2001 69


between 320,000 (Muzafarov and
Kurleutov 1994) and 380,000 Figure 7-6.
(Bezrukov, 1993); the higher esti- Percent of Elderly in Institutions in
mate represents less than 1.5 per- Austria and New Zealand: 1991 Austria
cent of the USSR population aged New Zealand
65 and over as of 1988. While the
average Russian view of institution- Male Female
37.7
alization may be extremely negative
(Powell, 1991), there does appear to
be an unmet need for institutional
services. Lengthy waiting lists for
institutional admission have been
the norm for many years, and offi- 22.2
20.8
cial time series data for Russia
show a steady rise in the number of
nursing/old people’s homes, from 14.9

around 700 in 1985 to more than


10.7
900 in 1996. At the same time, the 8.9 9.5

number of places in such institu- 5.7 5.9


5.1
tions has remained fairly constant, 4.2
3.1
2.0 2.4 2.3 2.4
suggesting a downsizing of the 1.0 1.6 0.9 1.3
average facility. Older people living
65-69 70-74 75-79 80-84 85+ 65-69 70-74 75-79 80-84 85+
alone, and especially never-married Age group
elderly men, are said to be at partic- Source: OECD, 1996.

ularly high risk of institutionaliza-


tion. In rural areas of the country,
new policies aimed at alleviating octogenarians. More than half of
district hospitals frequently serve as
current and anticipated problems. all Norwegians aged 85 and over
long-term residences for the elderly,
Long-term care provision and/or reside in institutions at a given
for social as well as health reasons
homes for the aged have become point in time, as do one-third or
(Bezrukov, 1993).
increasingly accepted and common more of this age group in Australia
Rates of institutionalization usually in countries — especially in and New Zealand. In fact, a major-
are very low or negligible in the Southeast Asia — where sustained ity of people entering institutions
developing world. In official rheto- fertility declines have led to rapid or other types of collective
ric, at least, the Western model of population aging and reduced the dwellings have reached very
institutional care for older people numbers of potential family care- advanced age. Those who enter at
often is rejected as culturally inap- givers (Phillips, 2000; Bartlett and less-advanced ages tend to be
propriate (Gibson, 1992). Outside Wu, 2000). either single or widowed and child-
of Europe and North America, social less, i.e., people who are unlikely
traditions and official decrees of fil- ELDERLY WOMEN to have young family members to
PREDOMINATE IN
ial and familial responsibility have rely upon for support (Soldo, 1987).
INSTITUTIONAL POPULATIONS
obviated, at least until recently,
Institutional use is strongly associ- Women and the oldest old, therefore,
debate about living arrangements
ated with increasing age regardless are disproportionately represented
of the elderly. Lately, however, a
of national setting (Figure 7-6). In among the institutionalized elderly
number of countries have recog-
most developed countries, fewer (Figure 7-7). In the United States in
nized that even if the family retains
than 2 percent of the young old 1997, three-fourths of all nursing
much of its support function for the
(aged 65 to 69) are in institutions. home residents were women, and
elderly, demographic and socioeco-
This level rises fairly slowly until slightly more than half of all nursing
nomic changes will inevitably pro-
age 80, but many nations experi- home residents were aged 85 or
duce strains. Consequently, many
ence a sharp increase in institu- older. People in institutions at one
developing nations have adopted
tionalization rates among point in time, however, do not

70 An Aging World: 2001 U.S. Census Bureau


discharge a high proportion of users
Figure 7-7. back into the community, while oth-
Percent of U.S. Elderly in Nursing Homes by Age: ers systems have relatively limited
1973-74, 1985, 1995, and 1997 rehabilitative services (Ribbe et al.,
1997).
Male
Percent NATURE OF INSTITUTIONAL
30 USE HAS CHANGED

Policies toward and practices of


25 institutionalization of older people
in developed countries have
changed over the past half-century.
20
In the United States and elsewhere,
85+ institutionalization in the early
15 1900s was generally associated
with poverty and/or inability to
work. The elderly often were
10 housed with younger “welfare popu-
lations” and were supported largely
5 75-84 by local agencies. By the middle of
the twentieth century, hospital-
65-74 based care for the elderly had
0 become more common, at least in
1973-74 1985 1995 1997
the United States, with financial and
operational control likely to come
Female from state governments. Beginning
Percent
30
in the 1950s, social policy encour-
85+ aged a shift away from hospital use
toward nursing-home use. The
25 United States experienced a rapid
expansion of nursing home capacity
(OECD, 1996), with emphasis on
20
providing for chronic disease and
physical disability needs. Federal
15 funding assumed greater promi-
nence, as did private sources of
funding. More recently, the private
10
long-term care insurance industry
75-84
has grown rapidly, while new forms
5 of home and community-based
65-74
services (e.g., assisted living) have
emerged. With U.S. long-term care
0
costs doubling each decade since
1973-74 1985 1995 1997
1970 (reaching an annual level of
Source: U.S. Centers for Disease Control, 1999. $106 billion in 1995; Stallard,
1998), the mix of institutional and
home-based care has been shifting
necessarily remain there and “age in multiple transitions. Some national
rapidly toward the latter, especially
place” indefinitely. Many older indi- nursing home systems (e.g., the
for the oldest old (Cutler and Meara,
viduals who enter an institution Netherlands) have well-developed
1999).
eventually leave, and many make rehabilitative programs which

U.S. Census Bureau An Aging World: 2001 71


Countries in Europe also have been attributed largely to differences in mere fact of elderly coresidence
active in changing long-term care the organization and financing of with a younger generation(s) tells
policies and practices in response long-term care as well as differing us little about the quality of intra-
to population aging. Heightened sectoral responsibilities for care. household relationships and life sat-
spending on institutional care Nations clearly are struggling with isfaction.
prompted Great Britain to revamp alternative methods of long-term
Instead of focusing on living
legislation in the 1990s, transfer- care financing and provision, and it
arrangements per se, attention
ring more fiscal control to local gov- is hoped that countries can learn
might better be directed to under-
ernments and tightening means- from one another via cross-national
standing the complex set of mecha-
tested provisions. Austria instituted research that proceeds from the
nisms and interpersonal relation-
a new federal act in 1993 aimed types of efforts now underway in
ships that determine the timing and
primarily at increasing options relat- Europe.
content of support for older per-
ed to personal care arrangements
BEYOND LIVING sons. This perspective is summed
and supporting individuals in their
ARRANGEMENTS up well by the phrase “function
own homes for as long as possible.
rather than form,” meaning that the
Germany, in 1995, unveiled a sys- Living arrangements of older per-
mechanisms and characteristics of
tem of universal long-term care sons clearly are an important com-
an individual’s support network are
insurance which features expanded ponent of life, but we should be
much more salient to well-being
benefits without major changes in careful not to infer too much from
(and to policymaking) than are mere
means-testing. Importantly, the effi- cross-sectional descriptive data on
attributes of who lives with whom
cacy of such changes will be moni- residence patterns. We need to be
(Hermalin, 1999). Survey research
tored and evaluated by research aware of how living arrangements
and methodology increasingly are
projects underway in each country change as a function of the growth
focused on the full mapping of
(Wolf, 1998). in elderly populations and their
complex kin networks, household
shifting health and kin-availability
As noted above, developed coun- and kin microsimulation techniques,
profiles (Palloni, 2000). And as
tries vary enormously in their use and new data-record linkages that
alluded to earlier, the well-being of
and view of institutional residency allow analysts and policymakers to
individuals is not necessarily reflect-
for older citizens. A study (Ribbe et better understand the underlying
ed in living arrangements. Living
al., 1997) of nursing homes in ten dynamics of intergenerational trans-
alone in old age has sometimes
nations found no apparent relation fers and well-being in old age
been interpreted as a lack of famil-
between the level of population (Hagestad, 2000; Wolf, 2000).
ial and social integration, when in
aging and the number of nursing Chapters 8 and 11 look further at
fact it may be indicative of good
home beds. The surprising lack of family and social support for older
health, economic well-being, and
cross-national consistency is persons.
social connectedness. Likewise, the

72 An Aging World: 2001 U.S. Census Bureau


CHAPTER 8.
Family and Social Support
of Older People

Shifts in population age structure and not all working-age people because the relatively large post-
generally result in new service actually work or provide direct sup- World War II birth cohorts will still
demands and economic require- port to elderly family members. be of working age through at least
ments. With an increasingly older The statistics discussed in the first 2010. In several nations (notably
age structure comes change in the part of this chapter may be seen as the United Kingdom, the United
relative numbers of people who can rough guides to when we can States, and Russia), the elderly sup-
provide support to those who need expect the particular age distribu- port ratio will not change signifi-
it. In the early 1980s, Myers and tion of a country to affect the need cantly from 2000 to 2010. Some
Nathanson (1982) identified three for distinct types of social services, developed nations, however, are
prominent issues regarding popula- housing, and consumer products. aging at a much faster pace.
tion and the family: 1) the extent to These data suggest some of the fac- Between 2000 and 2015, the elderly
which changes in social norms and tors that will shape patterns of support ratio in Denmark is likely to
responsibilities, driven by the secu- social relationships and societal increase 33 percent (from 24 to 32),
lar processes of urbanization and expenditures in the coming and the increase in the Czech
modernization, alter traditional decades, but tell us little about the Republic will likely be 36 percent
familial modes of caring for older changing nature of the health and (22 to 30). Most notably, Japan’s
people; 2) the possible social sup- economic resources of the aged in elderly support ratio is expected to
port burden resulting from reduced the future. jump 63 percent (from 27 to 44)
economic self-sufficiency of aged during the 15-year period.
people and the likelihood of height- RAPID RISE IN ELDERLY
SUPPORT RATIOS EXPECTED IN From 2015 to 2030, the elderly sup-
ened chronic disease morbidity and
DEVELOPED COUNTRIES port ratio will increase by more than
functional impairment related to AFTER 2010 40 percent in several developed
longer life expectancy; and 3) the
Broad changes in a nation’s age nations as the large working-age
ways in which countries develop
structure are reflected in changing cohorts begin to retire. In 2030,
funding priorities for public care
societal support ratios. These ratios Japan’s elderly support ratio is pro-
systems given competing demands
typically indicate the number of jected to be 52 (Figure 8-1). Italy is
for scarce resources.
youth and/or elderly people per 100 likely to have an elderly support
To gain a broad view of these people aged 20 to 64 years, primary ratio of 49 in 2030, and nearly all
dynamics, demographic assess- ages for participation in the labor European countries will have elderly
ments of intergenerational support force. A commonly used measure support ratios over 40. New
often consider various ratios of one of potential social support needs is Zealand has the lowest projected
age group to another. This chapter the elderly support ratio (sometimes ratio (30) among the developed
considers societal support ratios, called the elderly dependency ratio), nations in this study, with other rela-
parent support ratios, and changes defined here as the number of peo- tively low figures seen in the United
in kin availability. As seen through- ple aged 65 and over per 100 peo- States and Eastern Europe.
out this report, the elderly popula- ple aged 20 to 64 in a given popula-
tion is diverse in terms of its ELDERLY SUPPORT RATIOS IN
tion. In the coming decades, elderly
MOST DEVELOPING COUNTRIES
resources, needs, and abilities. The support ratios will rise in developed TO CHANGE SLOWLY
stereotype of the elderly as a pre- countries as a result of both declin-
dominately dependent group that ing fertility and increasing longevity. Elderly support ratios are much
drains a nation’s economy has erod- The rise has been and will continue lower in developing than in devel-
ed. Not all elderly require support to be modest in most countries oped countries, often with ten or

U.S. Census Bureau An Aging World: 2001 73


fewer elderly people per 100 people
aged 20 to 64. Among the 30 Figure 8-1.
developing countries in this study, Elderly Support Ratios: 1950 to 2030
Uruguay had the highest level (24)
in 2000, followed by Argentina (19)
and Israel (18). Many developing Developed countries
Number of people aged 65 and over per 100 people aged 20 to 64
countries will experience little if any
60
change in their elderly support
ratios from 2000 to 2015, because
the high-fertility cohorts of the 50 Japan
1960s and 1970s will still be under
age 65 in 2015. Thailand and
40
South Korea stand out as excep-
tions as they are expected to expe-
rience relatively large increases in 30
the ratio between 2000 and 2015. Belgium
In Bangladesh, Kenya, Malawi,
Morocco, and Uruguay, on the other 20
United States
hand, the elderly support ratio is
expected to remain stable between
10
2000 and 2015. In Jamaica and
Pakistan the elderly support ratio is
projected to decline by 2015, even 0
1950 1965 1980 1995 2010 2025
though the absolute numbers of
elderly population are increasing.
Developing countries
In countries where fertility remains Number of people aged 65 and over per 100 people aged 20 to 64
high or has just recently begun to 60

decline significantly — as in much


of Africa and South Asia — elderly
50
support ratios should change little
during the entire period 2000 to
2030. Eastern and Southeastern 40
Asia and parts of Latin America, on South Korea
the other hand, could witness signif-
30
icant change during that time. The
elderly support ratio is projected to
at least double between 2000 and 20 Argentina
2030 in 11 Asian and Latin Egypt
American study countries, and to
triple in South Korea. 10

YOUTH SUPPORT RATIOS TO


0
DECLINE 1950 1965 1980 1995 2010 2025
The working-age population also
Sources: United Nations, 1999 and U.S. Census Bureau, 2000a.
provides support for young people.

74 An Aging World: 2001 U.S. Census Bureau


bulk of support to both young and
Figure 8-2. old alike.
Youth and Elderly Components of the Total
Youth From 2000 to 2015, the total sup-
Support Ratio: 2000, 2015, and 2030
Elderly port ratio (TSR) should remain rela-
(Youth ratio: people aged 0 to 19 per 100 people aged 20 to 64;
Elderly ratio: people aged 65 and over per 100 people aged 20 to 64) tively stable in most developed
countries as declining numbers of
children more than offset growing
Australia, 2000 46 21
numbers of elderly (Figure 8-2).
2015 40 26 From 2015 to 2030, however,
2030 40 37 increasing numbers of elderly peo-
ple will boost the TSR in all devel-
France, 2000 43 27
oped nations even though the
2015 39 32 youth component may decline
2030 38 44 slightly. Among the study countries,
the proportional gain in the TSR
Uruguay, 2000 59 24
from 2015 to 2030 is projected to
2015 55 24 be greatest in Russia (30 percent).
2030 50 28 The United States is projected to
have the highest TSR (87) among
Philippines, 2000 98 7
the developed countries in the year
2015 76 9 2030, with 7 other developed coun-
2030 60 13 tries also projected to have TSRs in
excess of 80.
Source: U.S. Census Bureau, 2000a.
For the foreseeable future in devel-
oping countries, major fertility
Children outnumber working-age DIVERGENT TOTAL SUPPORT reductions are likely to outweigh
adults in many developing RATIO PATTERNS IN growing numbers of elderly people.
countries. As a result, youth sup- DEVELOPED VERSUS At the same time, the working-age
DEVELOPING COUNTRIES population is increasing. Hence,
port ratios — defined here as peo-
ple under age 20 per 100 adults The total support ratio (youth plus future TSRs for the vast majority of
aged 20 to 64 years — for 2000 elderly in relation to the working- developing countries are projected
were in excess of 100 in several age population) provides a gross to be lower than in 2000. Even
developing countries (mainly in indication of the overall support though growth rates for the youth
Africa). In the developed countries burden on working-age adults. The and elderly will be higher than in
in this study, however, youth sup- level of the total support ratio over developed countries during the
port ratios ranged from only 31 in time is pertinent to policymakers, next three decades, TSRs in devel-
Italy to 49 in New Zealand. but knowing the balance of old ver- oping countries often will be lower
sus young may be more important because of the massive numbers of
In most countries of the world, working-age adults in their popula-
because supporting the young is
youth support ratios are projected tions. Such change may portend a
probably less costly than support-
to decline between 2000 and 2030. window of economic opportunity
ing the elderly (especially as the
In countries where the present level for developing countries. As the
elderly population itself ages). With
is high, the youth support ratio may ratio of working-age to total popula-
the major exception of education,
decline by half or more. In Kenya, tion rises, economies have relatively
the costs of young people are borne
for example, the 2000 level of 133 more productive units and therefore
by families more than by govern-
is projected to plummet to 61 in more opportunity to grow (other
ment programs, although some
2030. factors being equal).
European governments provide the

U.S. Census Bureau An Aging World: 2001 75


THE USEFULNESS OF ELDERLY
SUPPORT RATIOS Figure 8-3.
Implicit in the standard definition of Standard and Alternative Elderly Support Ratios: 1998
an elderly support ratio is the
notion that all people over age 64 24 Total population
65 and over per 100
are in some sense dependent on the 31
Finland total population 20-64
population in the working ages (20 31
31 Total population 65 and over
to 64) who provide indirect support per 100 economically active
to the elderly through taxes and 26 population 20-64
contributions to social welfare pro- 33
Japan Noneconomically active
grams. We know, of course, that 25 population 65 and over per
23 100 economically active
elderly populations are extremely population 20-64
diverse in terms of resources, 27
39 Noneconomically active
needs, and abilities, and that many Spain population 65 and over per
39
elderly are not dependent in either 100 economically active
39 population 20 and over
a financial or a physical (health)
22
sense. Older people pay taxes,
United 27
often have income and wealth that States 24
fuel economic growth, and provide 23
support to younger generations. 25
Likewise, substantial portions of the 34
Germany
working-age population may not be 33
financial earners, for reasons of 32
unemployment, inability to work,
Sources: International Labour Office Yearbook of Labour Statistics, 1999 and U.S. Census Bureau, 2000a.
pursuit of education, choosing to be
out of the labor force, and so forth.

While it is empirically difficult to they are not economically depend- factors as (1) workers under age 20;
include factors such as intrafamily ent. The fourth bar builds on the (2) trends in unemployment; (3)
financial assistance and child care third bar by adding these economi- average retirement ages; and (4)
activities into an aggregate measure cally active elderly to the ratio levels of pension receipt and institu-
of social support, it is feasible to denominator of other economically tionalization among the elderly,
take account of employment charac- active individuals, on the assump- and/or the prevalence of high-cost
teristics in both the working-age tion that these working elderly con- disabilities.
and elderly populations. In Figure tinue to contribute tax revenue to
8-3, the topmost bar for each coun- national coffers. RAPIDLY CHANGING AGE
try represents the standard elderly STRUCTURE IS A CHALLENGE
support ratio as defined above. The The alternative ratios in each coun- TO SUPPORT IN SOME
try are higher than the standard eld- DEVELOPING COUNTRIES
second bar includes only the eco-
nomically active population aged 20 erly support ratio, except in Japan One of the more dramatic demo-
to 64 in the denominator, thereby where the elderly have a relatively graphic developments in the last
excluding people who choose not to high rate of labor force participation two decades has been the pace of
work, unpaid household workers, (often as part-time workers). To the fertility decline in many developing
nonworking students, and perhaps extent that policy and program countries. The common perception
those individuals whose health sta- agencies use support ratio calcula- is that below-replacement fertility
tus keeps them out of the labor tions, the effect of including versus levels are seen only in the industri-
force. The third bar represents a excluding labor force participation alized nations of the Northern
calculation similar to the second bar, rates appears considerable in most Hemisphere. As of 2000, however,
but removes economically active countries. Data permitting, other the total fertility rate was below
people aged 65 and over from the adjustments might be made to replacement level in 21 developing
numerator on the assumption that these ratios to account for such countries, mostly in Latin America

76 An Aging World: 2001 U.S. Census Bureau


Figure 8-4.
Population by Single Years of Age for China: 2000

Age Male Female

85+

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

0
15 12 9 6 3 0 3 6 9 12 15
Millions
Source: U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 77


and the Caribbean and parts of Asia
(U.S. Census Bureau, 2000a), and is Figure 8-5.
declining steeply in many other Youth and Elderly Support Ratios in
developing countries. China: 1985 to 2050

The situation in the People’s Youth ratio: people aged 0 to 19 per 100 people aged 20 to 64;
Elderly ratio: people aged 65 and over per 100 people aged 20 to 64
Republic of China illustrates the 100
potential effect that rapidly-
declining fertility may have vis-a-vis
population aging. In 1979, China 80
established an official one-child-per-
family policy aimed at curbing Youth
growth in the world’s most popu-
60
lous nation. While the policy was
relaxed somewhat in subsequent
years, China’s total fertility rate
40
declined to an estimated level of
1.8 children per woman in 2000.
As a result, China will age sooner
20
and more quickly than most devel- Elderly
oping countries.

China’s age profile in 2000 con- 0


tained a large “bulge” consisting of 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

people aged 26 to 37 (Figure 8-4). Source: U.S. Census Bureau, 2000a.


The oldest people in this age bulge
will be entering their sixties just
prior to the year 2025. This popu-
Figure 8-6.
lation momentum will produce a
Parent Support Ratios in Four World
rapid aging of the Chinese popula- 1950
Regions: 1950, 2000, and 2030 2000
tion in the third and fourth decades
(People aged 80 and over per 100 people aged 50 to 64) 2030
of the twenty-first century. Recent
analyses of 1995 sample census
data from China suggest higher old-
age mortality than had been previ-
37
ously estimated, resulting in lower
numbers of projected elderly peo-
ple. Nevertheless, the number of
Chinese aged 65 years and over is 20
17
now projected to increase from 15
88 million in 2000 to 197 million in 10 9
7 7
2025, and to 341 million in 2050. 4 4
3 3
Short of a catastrophic rise in adult
mortality or massive emigration of South America Eastern Asia Western Europe Western Africa
an unprecedented scale, we can be
reasonably certain that this growth Note: South America includes: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, French Guiana,
Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela.
will occur, because the elderly of Eastern Asia includes: China, North Korea, South Korea, Hong Kong, Japan, Macau, Mongolia, and Taiwan
Western Europe includes: Austria, Belgium, France, Germany, Liechtenstein, Luxembourg, Monaco,
the middle decades of the twenty- Netherlands, and Switzerland.
Western Africa includes: Benin, Burkina Faso, Cape Verde, Cote d' Ivoire, Gambia, Ghana, Guinea,
first century are already born. Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, St. Helena, Senegal, Sierra Leone, and Togo.
Eventually, China’s projected youth Sources: United Nations, 1997 and U.S. Census Bureau, 2000a.
and elderly support ratios are likely

78 An Aging World: 2001 U.S. Census Bureau


to converge (Figure 8-5), and we SANDWICH GENERATION A most of the oldest old were aged
may anticipate a social and eco- DEVELOPED-COUNTRY 20 to 35. Of course, people in the
nomic fabric radically different from PHENOMENON numerator (80 and over) are not
that of today. One aspect of the changing age necessarily in the same families as
structure of families that has those in the denominator (50 to 64
MORE PEOPLE WILL FACE received recent attention is the so- years). Thus, the PSR is only a
CARING FOR FRAIL RELATIVES
called “sandwich generation,” that rough indication of need for family
In the eighteenth and nineteenth is, people who find themselves car- support over time.
centuries, low levels of life ing for elderly parents while still
Relatively few people aged 50 to 64
expectancy meant that people on caring for/supporting their own
in 1950 worried about caring for
average lived a relatively short children or grandchildren and often
people aged 80 or older. In the
amount of time in a multigenera- participating in the labor force. In
developed countries in this study,
tional family (United Nations, developed countries especially,
the PSR ranged from five in Japan
1990b). While most older individu- more people will face the concern
and Hungary to eleven in Norway in
als lived with family members, and expense of caring for their very
1950. In developing countries, the
years spent in an extended-family old, frail relatives with multiple,
PSR ranged from two in Bangladesh
arrangement were limited because chronic disabilities and illnesses.
to eleven in Tunisia and Uruguay.
the average person died shortly The need for help is likely to come
Increases in the PSR since 1950
after becoming a grandparent at the very time when the adult chil-
imply that a relatively larger share
(Hareven, 1996). Declining mortali- dren of the frail elderly are near or
of middle-aged adults now may
ty and increased longevity have have reached retirement age.1 In
expect to provide care.
increased the odds of joint survival developing countries, the adult chil-
Additionally, life expectancy has
of different generations within a dren may well have children of their
increased for the disabled, the men-
family. In developed countries, own living in the household. Some
tally retarded, and the chronically
joint survival has manifested itself of the adult children may bear
ill. Today’s care for older people
in the “beanpole family,” a vertical health limitations of their own.
may be more physically and psy-
extension of family structure char- Those frail elderly without children
chologically demanding than in the
acterized by an increase in the may face institutionalization at ear-
past, especially with regard to the
number of living generations within lier ages than will people with sur-
increased numbers of people with
a lineage and a decrease in the viving adult children.
cognitive diseases. As advances in
number of members within each
One measure of the pressure the medical technology affect the ability
generation (Bengston, Rosenthal,
sandwich generation may experi- to extend life, it is at least plausible
and Burton, 1995). As mortality
ence by caring for elderly parents is to expect the duration of chronic ill-
rates continue to improve, more
the parent support ratio (PSR), ness and the consequent need for
and more people in their fifties and
defined here as the number of peo- help to increase further, even if the
sixties are likely to have surviving
ple aged 80 and over per 100 peo- average age at onset of disability
parents, aunts, and uncles. More
ple aged 50 to 64, which in a gen- rises.
children will know their grandpar-
eral sense relates the oldest old to
ents and even their great- In all countries examined except
their offspring who were born when
grandparents, especially their great- Bangladesh, Jamaica, Morocco, and
grandmothers. There is no Pakistan, the PSR is projected to be
historical precedent for a majority 1
It should be noted that the idea of a “sand- higher in 2030 than in 2000. The
of middle-aged and young-old wich generation” needs further empirical eluci- ratio has and will evolve very differ-
dation. Some researchers question the extent
adults having living parents. to which middle generations actually provide ently within and among world
Menken (1985) has estimated that care for younger and older generations. One
regions, however (Figure 8-6). In
study of 12 European Union countries (reported
one in three women 50 years old in Hagestad, 2000) reports that only 4 percent South America, Eastern Asia, and
had living mothers in the United of men and 10 percent of women aged 45-54
have overlapping responsibilities for children
Western Europe, PSRs more than
States in 1940, whereas by 1980 and for older persons who require care. The doubled between 1950 and 2000.
importance of the “sandwich” concept in a
the proportion had doubled to two PSRs will continue to rise between
given society is likely to be determined, in part,
in three. by the nature of formal institutions that provide 2015 and 2030. In Western Africa,
assistance to elderly individuals and to families
in general. most countries experienced little

U.S. Census Bureau An Aging World: 2001 79


change in the PSR from 1950 to older men who were receiving FAMILY ABILITY TO CARE FOR
2000, and the aggregate level will assistance with an instrumental ELDERLY MEMBERS MAY BE
remain low in 2030 even though activity of daily living2 had their CHANGING
absolute numbers of oldest-old peo- wife as the caregiver. However, Living with other people reduces
ple in some nations are growing only 33 percent of older women the likelihood of using formal med-
rapidly. The most pronounced relied on their husband as the care- ical care and increases the use of
changes have occurred in the indus- giver, while 58 percent were aided informal care, at least in the U.S.
trialized world. In 2000, the PSR by a daughter (Beland and context (Cafferata, 1988). Since
was 20 or higher in 12 such nations Zunzunegui, 1996). most physical, emotional, and eco-
(and also in Israel and Uruguay). nomic care to older individuals is
Whether in the role of spouse or
The difference in parent support provided by family members, the
daughter, the fact remains that
ratios between developed and demography of population aging is
women provide the bulk of informal
developing countries reflects differ- increasingly concerned with under-
and/or long-term care for elderly
ent trends in fertility. In 2030, standing and modeling kin availabil-
people worldwide. While joint sur-
those aged 50 to 64 (the potential ity. Kin availability refers to the
vival increases the number of elder-
support givers) were born between number of family members who will
ly couples, the average woman
1966 and 1980. In most develop- potentially be available to elderly
eventually outlives her husband and
ing countries, fertility was still high individuals if and when various
may have to rely on other family
during this period, or just begin- forms of care are needed. A study
members for personal care.3 Most
ning to decline. Hence, this age by Tomassini and Wolf (2000) exam-
studies (see, for example, Jenson
group will be fairly large, resulting ined the effects of persistent low
and Jacobzone, 2000, and the com-
in low parent support ratios. In fertility in Italy on shrinking kin net-
pilation of research in Blieszner and
developed countries, fertility was works for the period 1994-2050;
Bedford, 1996) have indicated that
fairly low during this period, pro- throughout the simulation period,
these other family members are
ducing small birth cohorts that will about 15-20 percent of Italian
women. Therefore, a variant of the
result in higher parent support women aged 25 to 45 are the only
parent support ratio may be useful,
ratios in 2030. living offspring of their surviving
namely, the ratio of people aged 80
mothers and thus are potentially
SPOUSE MAY BE MOST LIKELY and over to women aged 50 to 64.
fully responsible for their mothers’
TO PROVIDE CARE FOR Changes in this parent support ratio
care. While reduced fertility and
ELDERLY for females (PSRF) are similar to
smaller families obviously imply
A clear cross-national picture of those in the PSR, but the PSRF levels
fewer potential caregivers, this
caregiving for the elderly has yet to are much higher. In 2000, the PSRF
effect is offset to some extent by
emerge. In the 1980s, the stereo- was 54 in Norway and Sweden, the
increased longevity. Modeling is
typical view of caregiving was that highest level among the 52 study
further complicated by the fact that
of children caring for their aged nations. Most developed countries
while demographic forces impose
parent(s). More specifically, it gen- had PSRF levels in the 30s and 40s,
constraints on family, household,
erally was thought that adult while many developing nations had
and kin structures, these structures
daughters and daughters-in-law pro- PSRFs of 15 or less in 2000.
also are determined by social and
vided most of the personal care and Projections for the year 2030 sug-
cultural factors that are difficult to
help with household tasks, trans- gest that in Japan there will be 100
measure (Myers, 1992; Wolf, 1994;
portation, and shopping for the eld- people aged 80 and over per 100
Van Imhoff, 1999).
erly (United Nations, 1985). women aged 50 to 64, the highest
Although this may still be the case, level among the 52 nations. Research is now addressing
increases in joint survival mean whether the high rates of divorce
that, for many older people in both observed in some nations will result
developing as well as developed
2
Instrumental activities of daily living in a lack of kin support for people
include preparing meals, shopping for personal
countries, the main person who items, managing money, using the telephone,
in older age, and whether “blended”
provides care is their spouse and doing light housework. families and other forms of social
3
Although, in countries with relatively high
(Shuman, 1994). One survey in levels of income, market developments increas- arrangements will, in the future,
Spain found that 74 percent of ingly allow older individuals or their children to provide the types of care and
purchase care services directly if desired.

80 An Aging World: 2001 U.S. Census Bureau


support that are common today
Figure 8-7. (Wachter, 1998; Murphy, 2001).
Childlessness Among U.S. Women 40 to 44 Years The consensus to date foresees a
Old: 1976 to 1998 declining biological kinship support
(Percent) network for elderly people in devel-
oped and many developing coun-
19 tries. Childlessness is another trait
that will affect the nature of future
16 caregiving. Data over time for the
15 United States in Figure 8-7 show the
increasing likelihood of being child-
11 less among women aged 40 to 44;
10 10 nearly one out of five such women
in 1998 had no children. Trends in
this characteristic could be an
important determinant of eventual
care arrangements as current and
future cohorts of middle-aged
women reach older age.
1976 1980 1984 1988 1992 1998
The issue of kin availability has
Source: U.S. Census Bureau, June Current Population Surveys, 1976 to 1998. become especially important in the
context of East and Southeast Asian
countries, driven in large part by
the rapid declines in fertility that
Figure 8-8. have greatly reduced the average
Percent of Women at Age 65 in South Korea family size of young-adult cohorts.
With No Surviving Son: 1975 to 2025 The complex interplay of demo-
Married graphic and cultural factors is illus-
Widowed
trated by the case of the Republic
of Korea. There, two-thirds of the
elderly are economically dependent
on their adult children (Korea
30
29 Institute for Health and Social
26 Affairs, 1991), and cultural norms
24 dictate that sons provide economic
support for elderly women who
17 17 have lost their spouses. Lee and
15 15 Palloni (1992) have shown that
13 declining fertility means an increase
11
10 10 in the proportion of Korean women
with no surviving son (Figure 8-8).
At the same time, increased male
longevity means that the proportion
of elderly widows also will decline.
1975 1985 1995 2005 2015 2025 Thus from the elderly woman’s
Source: Lee and Palloni 1992. point of view, family status may not

U.S. Census Bureau An Aging World: 2001 81


deteriorate significantly in the
coming years. From society’s per- Figure 8-9.
spective, however, the demand for Proportion of Elderly People Receiving Home
support of elderly women is likely Help Services: Early-to-Mid 1990s
(In percent)
to increase. The momentum of
rapid population aging means that
the fraction of the overall popula- Finland 24

tion that is elderly women (especial- Denmark 17


ly sonless and childless widows) Norway 14
will increase among successive Sweden 13
cohorts. Given the strong trend United Kingdom 13
toward nuclearization of family Netherlands 8
structure in the Republic of Korea, France 7
and the traditional absence of state Australia 7
involvement in socioeconomic sup- Belgium 6
port, the future standard of living United States 4
for a growing number of elderly Austria 3
widows is tenuous. A similar 3
Ireland
prospect looms in Taiwan and Japan
Germany 2
(Hermalin, Ofstedal, and Chi, 1992;
Japan 2
Jordan, 1995). Simulations of kin
Canada 2
availability in rural China (Jiang,
Spain 2
1994) are more optimistic, suggest-
ing that, in spite of relatively low Portugal 1

fertility, improvements in mortality New Zealand 1

will ease the future burden on the Italy 1


family support system. Only a very
Note: Data for France, Australia, and Italy refer to 1985, 1988 and 1988, respectively.
small percentage of rural house- Source: OECD, 1996.
holds will have to support two or
more elderly parents, and relatively
now promote policies to maintain countries (Figure 8-9). Such
few elderly will be childless. At the
and support frail elderly people in services reached nearly one-fourth
same time, simulations using fami-
their own homes and communities of all elderly in Finland in 1990, up
ly-status life table models devel-
for as long as possible. Given the slightly from the level of 22 percent
oped by Zeng, Vaupel, and
changing nature of the family (in its in 1980. The available data sug-
Zhenglian (1997; 1998) suggest
many perturbations) and patterns of gest that countries with more
that the family household structure
kin availability, the development extensive provision of home help
and living arrangements of Chinese
and use of home help services services are those that have had a
elders may change markedly during
would appear to be a reasonable prolonged process of population
the first half of this century; by
step toward reducing the need for aging and now have relatively high-
2050, the percentage of Chinese
institutionalization. To date, how- er proportions of oldest-old resi-
elderly living alone could be 11 and
ever, the use of home help appears dents (OECD, 1996). Structural pro-
12 times larger in rural and urban
to be widespread only in grammatic factors also are
areas, respectively, than in 1990.
Scandinavian countries and the important, insofar as government
HOME HELP SERVICES ARE United Kingdom. Comparative data support or subsidization of home
MOST PREVALENT IN assembled by the Organization for help will almost certainly result in
SCANDINAVIA Economic Co-Operation and greater use. In the United States,
The previous chapter alluded to a Development from the early-to-mid- the use of home health care servic-
change in social and governmental 1990s show that the proportion of es has grown substantially since the
thinking about the desirability of elderly people receiving home help late 1980s, largely as a result of
institutionalization. Some nations exceeds 10 percent in only five changes in medicare policy that

82 An Aging World: 2001 U.S. Census Bureau


have made home health benefits production as well as paid employ- Grandparents in some developed
available to more beneficiaries for ment (Hashimoto, 1991; Apt, 1992). countries often provide day care for
longer periods of time. This in turn children so the grandchildren’s par-
An important component of many
has stimulated the home health ents can work or go to school. In
older people’s lives is their role as
care industry; the number of home the United States in 1995, 29 per-
the giver of care. Older people pro-
health agencies more than tripled cent of preschool children whose
vide care for a variety of people
between 1980 and 1994 parent(s) worked or were in school
(spouses, older parents, siblings,
(Freedman, 1999). were cared for by a grandparent
children, and grandchildren) and do
(Smith, 2000), typically the grand-
ELDERLY PROVIDE AS WELL AS so for many reasons (illness of a
mother. Because of the lack of ade-
RECEIVE SUPPORT spouse or sibling, increased number
quate day care in many Eastern
of single-parent families, increased
Many elderly receive financial help European countries and nations of
female labor force participation,
from adult children, but support is the former Soviet Union, the care
orphaned grandchildren). Often the
not a one-way street. In countries that grandmothers (babushkas) pro-
care provided by older family mem-
with well-established pension and vide for grandchildren may be inte-
bers is essential to the well-being of
social security programs, many gral to family functioning.
a family.
older adults give support (including
In many Asian countries, where
financial help, shelter, childcare, and THE IMPORTANCE OF coresidency is the norm, propor-
the wisdom of experience) to their GRANDPARENTS
tions of grandparents providing
adult children and grandchildren.
In some countries, nontrivial pro- care for grandchildren are substan-
In the North American context,
portions of older women and men tial. In the Philippines, Thailand,
studies suggest that elderly parents
are providing care to their grand- and Taiwan, approximately 40 per-
are more likely to provide financial
children. This care ranges from cent of the population aged 50 and
help than to receive it (Soldo and
occasional babysitting to being a older lived in a household with a
Hill, 1993; Rosenthal, Martin-
custodial grandparent. Survey data minor grandchild (under 18 years of
Matthews, and Matthews, 1996).
for the United States from the mid- age). In these same countries,
The elderly in developing countries
1990s (Fuller-Thomson and Minkler, approximately half or more of those
appear less likely than in developed
2001) indicate that 9 percent of all aged 50 and older who had a cores-
countries to provide financial help;
Americans with grandchildren under ident grandchild aged 10 or
data from the Malaysian Family Life
age 5 were providing extensive younger provided care for the child
Survey indicate that the main direc-
caregiving.4 In 1997, 3.9 million (Hermalin, Roan, and Perez, 1998).
tion of monetary transfers between
children (5.5 percent of all children As in the United States, grandmoth-
noncoresident parents and children
under age 18) lived in a household ers are more likely than grandfa-
is from the latter to the former
maintained by their grandparents thers in Asian countries to provide
(Lillard and Willis, 1997). Ongoing
(Casper and Bryson, 1998). Since care for their grandchildren (Chan,
research in Asia is beginning to
1990, the number of children living 1997; Uhlenberg, 1996).
reveal the complexity of familial
in households headed by grandpar-
exchange, not just among parents Many grandparents find themselves
ents has increased, especially for
and children but among wider fami- in the position of going beyond pro-
children in households with only
ly and social networks as well viding occasional care to becoming
grandparents and grandchildren.
(Agree, Biddlecom, and Valente, the sole providers of care for their
Trends in several factors (e.g.,
1999). Beyond the financial realm, grandchildren. One reason for this
divorce, HIV/AIDS, drug abuse, and
it seems clear that older persons in situation is the migration of the
child abuse) may have contributed
developing countries make substan- middle generation to urban areas to
to the increase in these types of
tial contributions to family well- work. Past research has found that
families.
being, in ways ranging from social- this is not unusual in Afro-
ization to housekeeping and child Caribbean countries (Sennott-Miller,
4
Extensive caregiving in this context meant
care. Such activities free younger 1989). These “skip-generation”
providing at least 30 hours of child care in an
adult women for employment in average week and/or caring for grandchildren families are found in all regions of
for at least 90 nights in 1 year.
unpaid family help in agricultural

U.S. Census Bureau An Aging World: 2001 83


the world and may be quite preva- of the epidemic are particularly Africa is estimated to be 12.1 mil-
lent. One study in rural Zimbabwe devastating in Sub-Saharan Africa, lion (UNAIDS/WHO 2000). For
found that 35 percent of house- where it is estimated that in 1999 many of these children, grandpar-
holds were skip-generation house- 8.6 percent of the population aged ents have become the main care-
holds (Hashimoto, 1991). 15 to 49 was infected with an HIV giver (Levine, Michaels, and Back,
virus that causes AIDS. High rates 1996). One study (Ryder et al.,
THE HIV/AIDS EPIDEMIC IS of adult infection and AIDS deaths 1994) in the city of Kinshasa found
CHANGING GRANDPARENTS’
leave many children in need of that the principal guardian for
ROLES
care. The cumulative number of 35 percent of AIDS orphans was a
The AIDS epidemic has affected the AIDS orphans5 in Sub-Saharan grandparent.
number of grandparents who are
caring for grandchildren in many 5
AIDS orphans are defined as HIV-negative
countries of the world. The effects children who lost their mother or both parents
to AIDS when the children were under age 15.

84 An Aging World: 2001 U.S. Census Bureau


CHAPTER 9.
Educational Attainment
and Literacy

Educational attainment is linked to aware of the benefits and disadvan- implications for intergenerational
many aspects of a person’s well- tages of certain types of behaviors solidarity (Choi, 1992).
being. Research has shown that associated with personal health.
Educational attainment of the eld-
higher levels of education usually Education also is related to joint
erly varies substantially among the
translate into better health status, survival of spouses, to living
countries in this report. The latest
higher incomes, and consequently arrangements, and to changing
data for the United States show
higher standards of living (Guralnik value systems which have
et al., 1993; Preston and Taubman,
1994; Smith and Kington, 1997; Liu,
Figure 9-1.
Hermalin and Chuang, 1998).
Percent of People With Completed Male, 25-44
People with higher educational lev-
Secondary Education or More Female, 25-44
els tend to have lower mortality Male, 65+
rates and better overall health than Female, 65+
their less-educated counterparts (Elo
and Preston, 1996; Zimmer et al., 86.9
89.0
1998), as well as better cognitive United States, 1998
67.6
functioning in older age (Stern and 66.6
Carstensen, 2000). Part of the rea- 21.6
son for this finding is that more- 23.9
Brazil, 1991
educated people tend to have higher 6.6
4.9
incomes throughout their lifetime,
17.2
which means they can afford better 12.8
health care than people with lower Bolivia, 1992
4.7
levels of education. Higher work- 2.3
ing-life income also translates into 20.4
13.4
higher levels of retirement savings China, 1990
2.8
and income. Hence, people with 0.5
higher educational levels may be 94.6
less dependent on their family for 92.1
Romania, 1992
45.5
financial assistance in later years.
31.9
Education significantly affects how 87.3
91.9
effectively people utilize health Russia, 1994
31.8
care. In the United States, for 21.6
example, where educational levels 64.0
of the elderly are relatively high, 61.3
Singapore, 1995
many older people, especially those 15.2
5.4
aged 85 and older, have trouble
79.6
understanding basic medical 82.5
Sweden, 1998
instructions. Even something as 44.0
simple as taking medicine correctly 38.0
may be a problem. Education fur- Note: Data for Sweden 65+ refer to ages 65-74.
ther affects health because well- Sources: U.S. Census Bureau, 2000a and national sources.

educated people may be more

U.S. Census Bureau An Aging World: 2001 85


that two-thirds of all people aged
65 and older had completed at least Figure 9-2.
secondary education.1 Comparable Percent of People With Completed Male, 35-44
completion levels in other devel- University Level of Education: 1998 Female, 35-44
oped countries are somewhat lower. Male, 55-64
Less than a third of the elderly in Developed countries Female, 55-64

Russia, for example, had finished 19


Australia 18
secondary-level education (Figure 11
9-1). Levels of education of the eld- 9
19
erly are much lower in developing Germany
14
15
countries. In Brazil, Bolivia, and 5
China, less than 5 percent of the 12
Italy 11
elderly population had a completed 7
3
secondary education.
29
Netherlands 23
FUTURE ELDERLY WILL HAVE 22
12
MORE EDUCATION 9
11
During the twentieth century, educa- Poland 11
9
tional attainment has increased
6
markedly in most countries of the Portugal 7
5
world. This improvement is clearly 4
reflected in the data on educational 14
Sweden 13
attainment by age. In some devel- 12
11
oped countries, younger cohorts are 27
more than twice as likely as the eld- United States 26
26
erly to have completed secondary 18
education. In developing countries,
the difference between younger and Developing countries
older cohorts is even more striking. 9
Women aged 25 to 44 in Bolivia were Argentina
11
5
more than five times as likely as 4
women aged 65 and older to have a 8
9
completed secondary education. Brazil 6
4
The educational attainment of the 4
2
elderly has risen during the last China 5
2
several decades in many countries, 11
and will continue to increase in the 3
India 5
future. For example, around 1
27 percent of the elderly in the 3
Indonesia 1
United States had completed at 1
0
least secondary education in 1970; 33
by 1998 the percentage had Jordan 18
15
2
1
Educational attainment in this report refers 26
in theory to completion of a particular educa- 11
South Korea 14
tional level. Data have been derived from pri-
mary national tabulations as well as from fig- 2
ures reported to international organizations. 9
While large differences in educational attain- 4
Turkey 5
ment exist, at least some of the variation is like-
ly due to different concepts, definitions, and 1
methods of data collection. We have attempted
to make the data on educational attainment in Note: Percent for females aged 55-64 in Indonesia is zero.
Source: Organization for Economic Co-Operation and Development, 2001.
this report as comparable as possible across
countries.

86 An Aging World: 2001 U.S. Census Bureau


older were literate in 1991, and just
Figure 9-3. 67 percent of the age group 75 and
Estimated Literacy Rates for Population Aged 60 and over. Proportions literate among
Over, by Sex, in Five Developing Regions: 1980 and 1995 older Greek women were even
(Percent literate)
1980
lower — approximately two-thirds
1995 of women aged 65 and older and
26
M
36 slightly over half of women aged 75
Arab States
6 and older.
F 11
40 In developing countries, literacy
M 64 may be uncommon among older
Eastern Asia/Oceania
9 populations. Many of today’s elder-
F 27
ly lived much of their lives prior to
68
M 75
the rapid increase in educational
Latin America/
58 attainment that occurred in the sec-
Caribbean
F 68 ond half of the twentieth century.
21 Consequently, many older people,
M
34
Sub-Saharan Africa and again particularly women, have
9
F low levels of literacy. While cohort
14
33 changes ensure that the future edu-
M
Southern Asia
41 cation profile of the elderly will
8 improve, it is important to remem-
F 13
ber that in many countries, a major-
Source: United Nations Educational Scientific and Cultural Organization, 1995. ity of today’s elderly are illiterate
(Hugo, 1992). This fact needs to be
explicitly recognized and consid-
jumped to 67 percent. As younger, 5 to 25 percent in the developed
ered when developing programs to
more-educated cohorts continue to countries and from 1 to 12 percent
assist older populations.
age, their attainment levels will be in developing countries. Small pro-
reflected in the educational status portions of women aged 55 to 64 Figure 9-3 presents estimated litera-
of tomorrow’s elderly. in developed countries have a uni- cy rates for the population aged 60
versity education, and proportions and over, by sex, in five developing
UNIVERSITY EDUCATION NOT in most developing countries are regions for 1980 and 1995.2 In all
YET THE NORM AT ANY AGE
smaller still. five regions, older men are more lit-
Although educational attainment erate than older women. In three of
has been improving throughout the LITERACY RATE OF MANY
the five regions, less than half of
ELDERLY POPULATIONS STILL
twentieth century, university-level older men and less than 15 percent
LOW
education still is not widespread. of older women were literate in
Relatively few people complete this In many developed countries, litera- 1995. Among developing regions,
level of education and the propor- cy data no longer are collected Latin America and the Caribbean
tion is usually lowest among the because education, at least at the has the highest aggregate literacy
elderly. In many developed coun- primary level, is so widespread that levels for older populations; three-
tries, less than a third of people literacy is considered to be univer- quarters of men and two-thirds of
aged 35 to 44 have a university sal. However, this is not always the women aged 60 and over were liter-
education (OECD, 1998a; 2001). case for the elderly, particularly for ate, similar to the levels noted
The proportion of the “near elderly” older women and the oldest old. above in Greece.
(i.e., aged 55 to 64) with this level Data from some countries that still
of education is even lower (Figure collect literacy information show 2
These estimates were produced by the
Division of Statistics of UNESCO using the most
9-2). For the set of countries that substantial proportions of the
recently available national data. For details
included in this graph, among men elderly may be unable to read and about the methodology used to produce these
estimates see UNESCO, 1995, Methodology
aged 55 to 64, the proportion with write. In Greece, for example, only Used in the 1994 Estimates and Projections of
a university education ranged from 77 percent of people aged 65 and Adult Illiteracy, Statistical Issue STE-18, Division
of Statistics, Paris.

U.S. Census Bureau An Aging World: 2001 87


Countries vary greatly in rates of lit-
eracy among the elderly. In Chile, Figure 9-4.
over 80 percent of the elderly were Percent Literate in Two Age Groups:
literate in 1992, while in Uganda Latest Available Year
Male
less than a fifth of the elderly were Female
literate (Figure 9-4). In most coun- Bolivia, 1992
tries, older men are much more 91.9
25-44
likely to be literate than older 76.6
53.8
women. In Brunei, older men were 65+
28.3
four times as likely to be literate as
Botswana, 1993
were older women. Although very
70.2
small proportions of the elderly 25-44
75.2
population are literate in many 12.9
developing countries, the rates rise 65+
11.3
rapidly for younger cohorts. For all Brunei, 1991
the countries in Figure 9-4, with the 96.0
exception of women in Uganda, 25-44 91.1
well over half of the population 45.1
65+
10.6
aged 25 to 44 were literate. And
among this younger age group, the Chile, 1992
difference in literacy by sex tends 96.6
25-44
to dissipate. 96.9
81.3
65+
80.9
GENDER DIFFERENTIAL IN
EDUCATIONAL LEVELS AMONG Iran, 1991
THE ELDERLY IS OFTEN 79.4
SUBSTANTIAL 25-44
56.1
31.3
In nearly all countries, older men 65+ 14.0
have higher average levels of educa-
Jordan, 1994
tion than do older women. Just as
96.6
overall levels of education vary wide- 25-44
86.9
ly among countries, so does the gen- 51.0
65+
der difference in education at older 16.9
ages. The gender gap3 in education- Thailand, 1990
al attainment of the elderly is larger 97.3
in many developed countries than in 25-44
95.4
developing countries, where the 76.3
65+
53.2
level of education for the elderly is
so low for both men and women Uganda, 1991

that the difference between them is 73.0


25-44
small. In many developed countries, 44.0
26.7
where overall attainment levels are 65+
7.2

3
The gender gap is defined as the absolute Zimbabwe, 1992
difference in percentage points between the 89.5
educational level of men and women. For 25-44
instance, in Romania in 1992, 45.5 percent of
74.5
men and 31.9 percent of women aged 65 and 41.0
65+
older had completed secondary or higher edu- 23.3
cation. The gender gap for the population aged
65 and older with these levels of schooling
Sources: United Nations Educational Scientific and Cultural Organization, 1995 and country sources.
would be the difference between the two levels
(13.6 points).

88 An Aging World: 2001 U.S. Census Bureau


the disadvantages that today’s
Figure 9-5. older women may face because of
Gender Gap in Literacy Rates for Selected their lower levels of education rela-
Age Groups: Latest Available Year tive to men should begin to abate
when these younger cohorts reach
Bolivia, 1992
the ranks of the elderly.
25-29 9.1
35-39 18.6 GENDER GAP IS INVERSELY
55-59 32.9 RELATED TO AGE AT OLDER
60-64 31.6 AGES
65+ 25.5 Examining the gender gap by age in
Brunei, 1991
developing countries reveals the
25-29 0.9
differential rate of improvement in
35-39 6.4
educational attainment. Figure 9-5
55-59 48.0
presents the gender gap in literacy
60-64 43.7
rates for five age groups in several
65+ 34.5
countries with data from the 1990s.
Iran, 1991
A somewhat counter-intuitive pic-
25-29 18.9
ture emerges for the three older age
35-39 26.5
groups, namely, that the gender
55-59 23.4
gap decreases as age increases. In
60-64 19.7
other words, there is a larger
65+ 17.3
absolute difference between male
Jordan, 1994
and female literacy rates at ages 55
25-29 3.9
to 59 than among people aged 65
35-39 13.9
47.3
and over. The increase in the gen-
55-59
der gap for younger-old age groups
60-64 44.8
reflects historical patterns of educa-
65+ 34.1
Uganda, 1991 tional promotion. When countries
23.9 with low overall levels of education
25-29
32.5 and limited resources began to
35-39
55-59 35.4 improve the educational attainment
60-64 27.3 of their populations, the initial
65+ 19.5 focus was more on educating males
Yemen, 1994 than females. In most developing
25-29 48.5 countries, people aged 55 and over
35-39 37.8 were of school age when formal
55-59 28.7 education was not widespread.
60-64 21.6 Although educational attainment
65+ 19.4 was improving, it was improving
more for men than for women.
Note: The gender gap is defined as the absolute difference in percentage points between the literacy rate for
men and women.
Thus, for these older age groups,
Source: United Nations Educational Scientific and Cultural Organization, 1995 and country sources. the gender gap is less among the
elderly than among people aged 55
to 64. For some countries in Figure
higher, the difference between older older cohorts. In various coun-
9-5, the gender gap at ages 25 to
men and women is larger. tries, younger women complete
29 and 35 to 39 is smaller than at
secondary education at higher
As suggested by the data on litera- the older ages, indicating a more
rates than do men, and in some
cy discussed earlier, gender differ- equal inclusion of both sexes in
nations the gender difference in
ences in educational attainment educational programs in recent
university-level attainment at
are much smaller for younger than years.
younger ages is negligible. Thus,

U.S. Census Bureau An Aging World: 2001 89


EDUCATIONAL DISADVANTAGE
IS COMMON IN RURAL AREAS Figure 9-6.

The quality and quantity of rural


Percent Literate by Age, Sex, and Urban and
Rural Residence, Yemen: 1994
educational facilities in most
nations tend to be inferior to those Percent
in urban areas. Consequently, liter- 100

acy levels and educational attain-


ment are lower in rural areas, par-
ticularly in developing countries. 80 Male urban

Data for Yemen (Figure 9-6) illus-


trate the common pattern wherein
the rural disadvantage in literacy is 60
evident for both sexes (i.e., rural Male rural
males have lower rates than urban
males and rural females have lower 40
rates than urban females). It Female rural
appears that differences by gender
are greater than differences by 20
urban/rural residence. Urban Female urban
women have lower literacy rates
than rural men, except at the very 0
youngest ages. The sexes also dif- 10 15 20 25 30 35 40 45 50 55 60 65 70 75+
fer in size of the rural/urban gap by Age
age. Rural males consistently have Source: Population and Housing Census of Yemen, 1994.

lower literacy rates than urban

Table 9-1.
Earnings Ratios of Selected Age Groups in 15 Countries by Level of Educational
Attainment: 1995
55-64 years/
45-54 years/25-29 years
45-54 years
Country
Less than upper Upper Nonuniversity
secondary secondary tertiary University Overall

Australia . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.30 1.26 1.35 2.06 0.85


Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.05 1.46 1.37 1.96 0.86
Denmark . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.21 1.23 1.29 1.60 0.92
Finland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.43 1.36 1.69 2.11 0.90
France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.18 1.47 1.45 1.95 1.07
Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.97 1.28 1.10 1.76 0.97
Ireland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.24 1.59 1.59 2.25 (NA)
Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.23 1.44 1.64 1.99 0.86
Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.13 1.61 1.33 1.65 0.84
New Zealand . . . . . . . . . . . . . . . . . . . . . . . 1.25 1.39 1.16 1.93 0.95
Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.10 1.26 1.88 1.67 (NA)
Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.38 1.26 1.67 1.70 0.90
Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . 1.06 1.25 1.52 1.80 0.97
United Kingdom . . . . . . . . . . . . . . . . . . . . . 0.93 1.09 1.41 1.50 0.81
United States . . . . . . . . . . . . . . . . . . . . . . . 1.29 1.28 1.39 1.67 0.89

NA Not available.
Note: Ratios reflect gross annual earnings before taxes. Data for Finland and Ireland refer to 1994 and 1993 respectively.
Source: Organization for Economic Co-Operation and Development (Employment Outlook 1998).

90 An Aging World: 2001 U.S. Census Bureau


males in Yemen, and the gap reading skills generally worsen with labor force entrants (25 to 29 years)
between the two areas is fairly even age; a recent study also demon- generally rises with educational
across the age spectrum. For strated that functional health attainment level, but the right-hand
women, on the other hand, the gap literacy is markedly lower at older column of Table 9-1 indicates an
between rural and urban literacy ages, even after controlling for vari- overall decline in earnings of people
levels is much wider at the younger ables such as cognitive dysfunction, 55 to 64 relative to people 45 to
than the older ages, suggesting that physical functioning and visual acu- 54. Because educational attainment
in recent years urban women have ity (Baker et al., 2000). This study may be very different by age
been afforded greater relative raises questions about the effects of cohort, this table may confound
access to education than have their life-long education, the efficacy of pure age effects with returns to
rural counterparts. tests that measure cognitive ability, education. Further analysis of avail-
and other age-related changes that able data suggests that, when aver-
EDUCATION AFFECTS OTHER may affect testing procedures. aged over all countries, the earn-
DIMENSIONS OF LIFE
ings premium of peak-earning
Table 9-1 shows ratios of average
As mentioned earlier, education is workers relative to recent entrants
earnings for workers in three age
related to health behavior and rises considerably with higher edu-
groups. The earnings ratio of per-
income accumulation throughout cational attainment (OECD, 1998
sons in the so-called peak earning
the life course. Studies in the Employment Outlook).
years (45 to 54) to those of recent
United States have shown that

U.S. Census Bureau An Aging World: 2001 91


CHAPTER 10.
Labor Force Participation
and Retirement

Rapid growth of elderly populations Figure 10-1 presents data on formal with age. On the other hand, the
may put pressure on a nation’s economic activity for older women work status of older workers differs
financial resources. This concern is and men in three countries, chosen dramatically among the countries.
based, at least partially, on the to represent different levels of eco- In Rwanda, more than three-
assumption that the elderly do not nomic development. Some of the quarters of all women aged 60 to
contribute to the economy. However, patterns mentioned above are 64 are economically active, and
many older people do work, and apparent in these data; older even at ages 70 and older, a sub-
examining the labor force participa- women have lower participation stantial number remain active in the
tion and characteristics of older rates than older men, and participa- labor force. In contrast, although a
workers gives a clearer picture of tion rates for both sexes decrease nontrivial proportion of women
their contribution. Information on
older workers also is useful in plan-
ning economic development and the Figure 10-1.
financing of retirement. Economically Active Older Population by Age for
Rwanda, Peru, and New Zealand: Late 1990s
Some characteristics of older work- (Percent)
ers seem not to vary among coun- Male
Female
tries. In all countries, the elderly Rwanda, 1996
account for a small proportion of 86.9
60-64
the overall labor force. Their share 77.8
of the total labor force in the study 81.5
65-69
73.4
countries ranges from less than
66.0
1 percent to 7 percent. A second 70-74
51.7
commonality is that labor force par- 45.6
75+
ticipation declines as people near 32.5
retirement age. A third is that par- Peru, 1999
ticipation rates are higher for older 72.5
60-64
men than for older women. 38.2
56.3
Other characteristics of older work- 65-69
23.4
ers show interesting differences 70-74
46.2
across countries. The rate of 26.2
29.0
participation of older workers varies 75+
11.1
substantially, and generally is lower
New Zealand, 1999
in developed than in developing
countries. Only 2 percent of men 57.5
60-64
32.5
aged 65 and over participate in the
20.4
labor force in some developed 65-69
10.0
countries, whereas in certain devel- 8.8
70-74
oping countries well over half of 2.9
2.8
elderly men are economically active. 75+
1.1
The occupational concentration of
older workers also varies widely Source: International Labour Office (various issues of the Yearbook of Labour Statistics).

among countries.

U.S. Census Bureau An Aging World: 2001 93


aged 60 to 64 are economically
active in New Zealand, participation Figure 10-2a.
rates decrease dramatically with Labor Force Participation Rates for Men Aged 55
age so that for women aged 70 to to 59 in Developed Countries
74, less than 3 percent are still (Percent) Early 1970s
active. Cross-national differences in Late 1990s
levels of labor force activity are
88.4
associated with societal wealth; Australia
72.5
countries with high GNP (gross
Austria 83.7
national product) tend to have 63.7
much lower labor force participa- 82.3
Belgium
tion rates of the elderly and near 52.4
elderly than do low-income coun- 86.5
Bulgaria
58.0
tries (Clark, York, and Anker, 1997).
Canada 84.9
In richer countries, the elderly or
72.2
near elderly can afford to retire 85.0
Czech Republic
because of pension schemes or 77.1
social security systems. These pro- 81.8
France
grams are often lacking in poorer 70.4
countries. Germany 86.8
76.5
84.4
Hungary
45.9
75.0
Italy
54.1
94.2
Japan
94.7
79.3
Luxembourg
53.4
92.1
New Zealand
81.2

Poland 90.9
55.2
88.4
Sweden
84.4

United States 86.8


78.4

Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

94 An Aging World: 2001 U.S. Census Bureau


TIME TREND IN LABOR FORCE
PARTICIPATION DIFFERS BY
Figure 10-2b.
GENDER
Labor Force Participation Rates for Men Aged
60 to 64 in Developed Countries The trend in most developed coun-
(Percent) Early 1970s tries has been for labor force
Late 1990s participation rates for older men to
decline in recent decades. Figure
Australia 75.6
46.7 10-2 shows male labor force partici-
44.9
pation rates for three older age
Austria
16.7 groups in 16 developed countries;
Belgium 79.3 in all of these countries, participa-
18.6 tion rates declined between the
Bulgaria 33.6 early 1970s and the late 1990s.
11.1
These declines are particularly pro-
74.1
Canada nounced for men aged 60 to 64.
46.6
33.3
In ten of the sixteen countries in
Czech Republic
27.5 the early 1970s, well over half of
54.6 men aged 60 to 64 were still active.
France
16.4
Germany 68.8
30.3
43.7
Hungary
10.6
40.6
Italy
31.7
85.8
Japan
74.1

Luxembourg 45.5
15.5

New Zealand 69.2


57.4

Poland 83.0
33.4
75.7
Sweden
55.5

United States 73.0


54.8

Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

U.S. Census Bureau An Aging World: 2001 95


In the remaining six countries activ-
ity rates ranged from 33 percent to Figure 10-2c.
46 percent. By the late 1990s, only Labor Force Participation Rates for Men
Japan, New Zealand, Sweden, and Aged 65+ in Developed Countries
the United States had male partici- (Percent) Early 1970s
pation rates over 50 percent. Rates Late 1990s
also have fallen for the 65-and-over
Australia 22.2
age group.1 In the early 1970s,
9.6
only two countries in Figure 10-2 8.0
Austria
had participation rates lower than 4.6
10 percent for elderly men; by the 6.8
Belgium
late 1990s, most of the countries 2.8
had rates less than 10 percent. But 10.3
Bulgaria
4.5
as discussed later in this chapter,
Canada 23.6
the trend in declining participation
9.9
rates for older men has stopped or
14.6
Czech Republic
even reversed in a number of devel- 7.2
oped countries. 10.7
France
2.3

Germany 16.0
1
In the United States, much of the decline in 4.5
labor force participation rates for elderly men
16.7
occurred earlier in the twentieth century. Hungary
According to Costa (1998), 70 percent of the 3.8
decline in participation rates between 1880 and 13.4
1990 for men aged 65 and older occurred Italy
6.3
before 1960.
Japan 54.5
35.5

Luxembourg 10.1
1.9
New Zealand 21.3
10.4

Poland 56.4
15.3

Sweden 15.2

United States 24.8


16.9

Note: Later data for Belgium 65+ refer to ages 65-69 and for Hungary to ages 65-74; data for Sweden
65+ are not reported by the ILO.
Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

96 An Aging World: 2001 U.S. Census Bureau


The trend for older women in these
Figure 10-3a.
developed countries differs from
Labor Force Participation Rates for Women the male pattern. In many coun-
Aged 55 to 59 in Developed Countries tries, female participation rates
(Percent) Early 1970s have increased for almost all adult
Late 1990s age groups up to age 60, whereas
rates for elderly women have
28.3
Australia declined (Figure 10-3). In some
44.6
35.8
cases, the increase among women
Austria
25.4 aged 55 to 59 has been quite
20.0 marked. In New Zealand, for exam-
Belgium
27.6 ple, 60 percent of women aged 55
Bulgaria 26.1 to 59 were economically active in
10.7
1998, up from 28 percent in 1971.
38.7
Canada
50.6
36.5
Czech Republic
33.2
42.1
France
51.7
34.5
Germany
55.3
29.2
Hungary
16.6
16.9
Italy
22.7
53.8
Japan
58.7
18.6
Luxembourg
24.6
27.5
New Zealand
60.1

Poland 68.1
35.0
41.1
Sweden
79.0
47.4
United States
61.8

Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

U.S. Census Bureau An Aging World: 2001 97


While female participation was
increasing at younger ages, nearly Figure 10-3b.
all developed countries experienced Labor Force Participation Rates for Women
a decrease in elderly female labor Aged 60 to 64 in Developed Countries
force participation between the (Percent) Early 1970s
early 1970s and the late 1990s. Late 1990s
Very small proportions of elderly
16.0
women currently are economically Australia
18.3
active in developed nations; among 13.2
Austria
the 22 developed countries in 8.7
Appendix A, Table 10, only Japan, Belgium
7.6
Poland, and the United States have 6.7
elderly female participation rates 8.2
Bulgaria
4.7
above 4 percent.2
29.1
Canada
26.0
2
Rates for Norway and Ukraine in Appendix 18.2
Czech Republic
Table 10 are about 9 percent, but these refer to 12.9
only a portion of their elderly female popula- 27.9
tions, i.e., women aged 65 to 74. France
15.2

Germany 17.7
12.7

Hungary 17.1
5.5

Italy 9.9
8.1
Japan 43.3
39.8
Luxembourg 12.0
11.7
15.5
New Zealand
32.5

Poland 51.1
19.2
25.7
Sweden
46.5
36.1
United States
38.8

Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

98 An Aging World: 2001 U.S. Census Bureau


WHY THE BIG DECREASE FOR
OLDER MEN?
Figure 10-3c.
Labor Force Participation Rates for Women Several reasons may account for the
Aged 65+ in Developed Countries sharp decline in activity rates of
(Percent) Early 1970s older men in developed countries.
Late 1990s An increase in societal wealth is
4.2 most likely the main reason for the
Australia
3.1 drop in participation rates. A sec-
3.2 ondary reason may be that new
Austria
2.0 technologies have changed the
2.2 industrial and occupational organi-
Belgium
0.8
zation of many economies, and
1.7
Bulgaria generated the need for a recently
2.1
8.3
trained labor force. New technolo-
Canada
3.4 gies can make the skills of older
5.2 workers obsolete and these workers
Czech Republic
2.7 may choose to retire rather than
5.0 learn new skills (Ahituv and Zeira,
France
2.0 2000; Bartel and Sicherman, 1993).
5.7
Germany In countries with persistently high
1.6
levels of unemployment, there may
5.8
Hungary be formal and informal pressures
1.6
3.2 on older workers to leave the labor
Italy
1.7 force to make room for younger
Japan
19.7 workers. Perhaps most importantly,
14.9 the growth and proliferation of
Luxembourg 4.0 financial incentives for early retire-
0.6
ment have enabled many older
3.5
New Zealand workers to afford to stop working.
3.9
33.0 In much of Eastern Europe and the
Poland
8.5 former Soviet Union, older workers
3.2 are choosing early retirement over
Sweden
unemployment as new market
10.0 mechanisms prompt firms to fire
United States
8.9
redundant workers (Commander
Note: Later data for Belgium 65+ refer to ages 65-69 and for Hungary to ages 65-74; data for Sweden and Yemtsov, 1997).
65+ are not reported by the ILO.
Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

U.S. Census Bureau An Aging World: 2001 99


ELDERLY IN DEVELOPING
COUNTRIES HAVE HIGH Figure 10-4a.
PARTICIPATION RATES
Labor Force Participation Rates for Men Aged 55
The proportion of economically to 59 in Developing Countries
(Percent) Early 1970s
active elderly men is high in devel-
Late 1990s
oping countries compared with
more-industrialized nations. Not 80.4
Argentina
surprisingly, many elderly people in 82.8
predominantly rural agrarian soci- Chile 82.6
83.4
eties work of necessity, while
Ethiopia
“retirement” may be a luxury 93.3
reserved for urban elites. In nations Mexico 86.2
as diverse as Bangladesh, 86.8
Indonesia, Jamaica, Mexico, Peru 92.8
85.6
Pakistan, and Zimbabwe, more than
Singapore 73.9
50 percent of all elderly men are 77.9
considered to be economically South Korea 85.4
active. Economic activity rates of 81.0
older and elderly women also are Tunisia 86.0
78.4
higher in developing than in devel-
Turkey 88.0
oped countries. Some national data 60.3
may understate the true economic Uruguay
81.2
activity of women, particularly in 89.3

developing countries where much Note: Data for Ethiopia in the early 1970s are not available.
Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
of the work that women engage in Yearbook of Labour Statistics).
is not counted or captured in cen-
suses and labor force surveys, or is
not considered to be “economic.” Figure 10-4b.
Many of the activities that older Labor Force Participation Rates for Men Aged 60
women are involved in, such as to 64 in Developing Countries
(Percent) Early 1970s
subsistence agriculture or house- Late 1990s
hold industries, often are not well
57.2
documented by conventional data Argentina
63.2
collection methods (Hedman, 72.1
Chile
Perucci, and Sundström, 1996). 69.2
Ethiopia
89.4
Mexico 81.5
77.3
Peru 83.9
72.5
Singapore 55.6
48.6
67.9
South Korea
65.5
Tunisia 66.5
54.1
Turkey 83.0
54.0
Uruguay 58.9
59.3

Note: Data for Ethiopia in the early 1970s are not available.
Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

100 An Aging World: 2001 U.S. Census Bureau


Data on economic activity rates
Figure 10-4c.
over time for developing countries
Labor Force Participation Rates for Men do not show as clear a trend for
Aged 65+ in Developing Countries older workers as seen in developed
(Percent) Early 1970s countries. Although many devel-
Late 1990s oping countries have experienced
a decrease in economic activity of
Argentina 29.1
27.6 older male workers, in most such
Chile 42.4 countries the decrease is much
27.4 smaller than in developed coun-
Ethiopia tries (Figure 10-4). Akin to the pat-
65.7
tern in developed countries, many
Mexico 67.1
52.4 developing countries have wit-
Peru 61.5 nessed an increase in labor force
41.1 participation rates for women aged
Singapore 31.9 55 to 64 (Figure 10-5). Unlike the
21.7
pattern in developed nations, sev-
South Korea 35.1
40.2 eral developing countries also have
Tunisia 38.0 experienced increases in participa-
34.0 tion for women aged 65 and older.
Turkey 67.8 Because of the problems with sta-
33.6
tistics on female economic activity
Uruguay 20.9
19.4 mentioned above, these changes
could reflect “real” increases in
Note: Data for Ethiopia in the early 1970s are not available.
Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the activity rates as well as improve-
Yearbook of Labour Statistics).
ments in data collection.

Figure 10-5a.
Labor Force Participation Rates for Women Aged 55
to 59 in Developing Countries
(Percent) Early 1970s
Late 1990s

Argentina 16.2
35.4
Chile 15.5
32.4
Ethiopia
58.6
Mexico 15.4
32.4
Peru 16.1
47.5
Singapore 16.2
28.4
South Korea 39.1
51.2
Tunisia 11.3
12.2
Turkey 50.0
30.4
Uruguay 21.7
41.0
Note: Data for Ethiopia in the early 1970s are not available.
Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

U.S. Census Bureau An Aging World: 2001 101


AGRICULTURE STILL
IMPORTANT SOURCE OF Figure 10-5b.
EMPLOYMENT FOR ELDERLY
Labor Force Participation Rates for Women
Just as labor force participation Aged 60 to 64 in Developing Countries
rates of older workers vary among (Percent) Early 1970s
countries, so do levels of concentra- Late 1990s

tion in various occupations. Argentina 10.3


Economies in developed countries 22.6
have shifted from agriculture and Chile 11.1
21.0
heavy industries toward services
Ethiopia
and light industries, which is a shift 50.0
from physically demanding and Mexico
14.4
sometimes hazardous jobs to work 25.9

Peru 13.4
which requires less brawn and dif-
38.2
ferent technical skills. This shift 13.4
Singapore
may benefit older workers insofar 14.9
as jobs requiring mental ability 26.9
South Korea
rather than physical strength may 46.3
Tunisia 8.6
enable them to remain active
7.7
longer. Conversely, the shift could 47.6
Turkey
be detrimental to older workers if 23.4
the new jobs require skills or train- Uruguay 12.2
ing which older workers may not 23.9

have or easily acquire. Note: Data for Ethiopia in the early 1970s are not available.
Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

Figure 10-5c.
Labor Force Participation Rates for Women
Aged 65+ in Developing Countries
(Percent) Early 1970s
Late 1990s

Argentina 4.7
8.9

Chile 6.5
6.5
Ethiopia
27.5
Mexico 11.8
14.6
Peru 8.5
19.2
Singapore 6.5
5.2
South Korea 10.6
21.4
Tunisia 4.8
3.5
Turkey 35.1
13.3
Uruguay 3.6
6.7
Note: Data for Ethiopia in the early 1970s are not available.
Sources: U.S. Census Bureau, 2000a and International Labour Office (various issues of the
Yearbook of Labour Statistics).

102 An Aging World: 2001 U.S. Census Bureau


Not surprisingly, agriculture is by
Figure 10-6. far the most common occupation
Percent of Elderly Workers in Agriculture for older and elderly workers in
Male most developing countries (Figure
Female
10-6). And despite the worldwide
88.3 trend away from employment in
China, 1990
93.2 agriculture, this sector was still an
Ecuador, 1990 57.0 important source of employment in
30.0
many developed countries during
30.7
Japan, 1995 the 1970s and 1980s. Even in the
34.7
21.2 1990s, a nontrivial proportion of
New Zealand, 1991
15.3 economically active elderly in some
Philippines, 1990 76.4 developed countries worked in the
32.2
agricultural sector. In 1995 in
75.7
Turkey, 1990 Japan, 31 percent of elderly men
95.6
11.4 and 35 percent of elderly women
United States, 1998
3.2 were involved in agriculture.
Aggregate data from the early
Note: Data for New Zealand refer to ages 60 and over.
Source: National sources. 1990s for 12 European Union
nations showed that agriculture

Table 10-1.
Older Workers (55 and Over) per 100 Younger Workers (Under 55) in Selected Job
Sectors: 1998
Goods-producing sector Service sector

Agriculture,
hunting and Manu- Personal Social
Total forestry facturing Total services services

OECD average 15 39 10 12 11 12
Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 28 6 7 7 7
Belgium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 21 5 7 8 7
Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 27 10 10 9 10
Czech Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 12 9 10 9 13
Denmark . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 34 11 12 15 13
Finland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 24 9 9 8 10
France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 20 6 8 10 8
Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 30 14 15 16 16
Greece. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 68 11 11 12 9
Ireland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 45 7 10 10 13
Italy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 33 8 13 12 13
Korea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 131 8 13 (NA) (NA)
Luxembourg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 19 6 7 5 10
Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 28 8 11 13 7
Netherlands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 21 8 7 6 8
New Zealand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 26 7 7 - 8
Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 36 16 15 9 18
Portugal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 112 10 15 18 12
Spain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 36 11 12 14 13
Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 50 17 19 15 21
Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 39 18 17 20 18
United Kingdom . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 32 14 13 14 14
United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 25 13 15 11 16

- Represents zero. NA Not available.


Source: Excerpted from Organization for Economic Co-Operation and Development (Employment Outlook 2000).

U.S. Census Bureau An Aging World: 2001 103


continued to employ a dispropor-
tionate share of older relative to Figure 10-7.
younger workers (Eurostat, 1993a). Percent Distribution of Elderly Workers by
More than 20 percent of economi- Occupation in the United States: 1998 Male
Female
cally active men and women aged
60 and older in these countries Managerial/ 33.8
worked in agriculture compared Professional/ 24.7
Technical
with about 5 percent of people 14.8
Sales
aged 14 to 59. More recent infor- 16.7
mation for 23 OECD countries 16.9
Clerical/Service
shows that the ratio of older (55+) 47.8
to nonolder (54 and under) workers Production
23.2
is generally much higher in agricul- 7.6
ture, hunting, and forestry than in 11.4
Agriculture
any other goods-producing or serv- 3.2

ice sector (Table 10-1). Source: Bureau of Labor Statistics, unpublished tabulations from the Current Population Survey,
average annual data, 1998.
NEARLY TWO-THIRDS OF
ELDERLY FEMALE U.S.
WORKERS IN SERVICE AND of retirement itself. During periods OLDER WOMEN MORE LIKELY
SALES of economic contraction in highly THAN OLDER MEN TO WORK
industrialized nations, governments PART TIME
Figure 10-7, which presents the
occupational distribution of elderly may actively encourage older work- Some older workers use part-time
male and female workers in the ers to cease active employment at work as a gradual transition to
United States, shows distinct differ- relatively young ages. On the other retirement (Walker, 1999). Part-time
ences by gender. In 1998, almost hand, when the labor market is work is an option that may appeal
half of elderly working women were tight, governments may look for to older workers by enabling them
employed in clerical or service jobs methods to entice older workers to to remain active in the labor force
compared with only 17 percent of remain in the labor force or re-enter while also pursuing leisure activities
elderly men. A majority of working the labor force. (Quinn and Kozy, 1996). Data for
elderly men held either manageri- working men aged 60-64 in nine
In developed countries, retirement
al/professional/technical positions developed countries show large dif-
from the workforce was an event
(34 percent) or production jobs ferences in the prevalence of part-
that occurred almost exclusively at
(23 percent). Corresponding figures time employment, ranging from
a regulated age until the 1950s,
for elderly women were 25 percent less than 8 percent in Italy and
with little possibility of receiving a
and 8 percent. Unlike the situation Germany to more than 35 percent
pension prior to that age (Tracy,
in some developed countries, only in Sweden and the Netherlands
1979). Since then, countries have
11 and 3 percent of active elderly (OECD, 2000). Available data from
adopted a wide range of approach-
U.S. men and women, respectively, developed countries suggest that
es to providing old-age security,
worked in agriculture. older working women are much
and different potential routes have
more likely than older men to be
emerged for people making the
BRIDGES TO RETIREMENT involved in part-time work (Figure
transition from labor force participa-
Just as the propensity to work at 10-8). In Australia, three-fourths of
tion to retirement. Some of these
older ages varies considerably from elderly women who were economi-
different routes are working part
country to country, so too do pat- cally active in 1999 worked part
time, leaving career jobs for transi-
terns of retirement and the concept time, compared to fewer than half
tion jobs, or leaving the labor force
of economically active elderly men.
because of a disability.

104 An Aging World: 2001 U.S. Census Bureau


data availability, the effects of the
Figure 10-8. business cycle, and differences in
Percent of Economically Active Elderly Population definitions across countries.3 In
Working Part Time in Australia, countries with available data,
Canada, and France Male unemployment rates for all age
Female groups commonly were higher in
74.2 1999 than in 1980. Gender differ-
ences in unemployment rates at
older ages are not consistent; in
some countries, men have higher
53.2 rates and in others the reverse is
true. When unemployment rates
44.1
for ages 55 to 64 are disaggregat-
38.6 ed, rates for the age group 55 to
33.2 59 tend to be somewhat higher
than for the age group 60 to 64,
20.7 perhaps because people in the
older age group may opt to retire if
possible rather than be unemployed.

Although the unemployment rate


may be lower for older than for
Australia 1999 Canada 1991 France 1995
younger workers, older people who
Note: Data for France refer to ages 60 and over. are unemployed tend to remain
Source: National sources.
unemployed longer than their
younger counterparts. In several
In the 15 European Union countries gradual retirement is still relatively OECD countries, well over half of
as a whole, 41 percent of working uncommon in industrialized nations. unemployed people aged 55 and
women aged 55-64 were in part- The strongest tendency toward part- over had been unemployed continu-
time positions in 1998, compared time work was seen in Japan, ously for more than 1 year. In most
with just 8 percent of working men Sweden, and the United States. OECD countries, the proportion of
in that age group (Eurostat, 2000). long-term unemployed people aged
UNEMPLOYMENT LOW AMONG
55 and older is much higher than
The rate of part-time work for peo- THE ELDERLY
among younger age groups. A simi-
ple nearing retirement generally was
The elderly typically have low lev- lar pattern is seen in some Eastern
increasing with time in the late
els of unemployment compared to European nations. In Bulgaria in
1980s/early 1990s (Eurostat,
younger workers. In developed 1995, 74 percent of unemployed
1993b). Even though percentages
countries, unemployment rates for men aged 50 to 59 and 78 percent
of older workers who work part
the elderly frequently are less than of unemployed women aged 50 to
time may be substantial, a recent
5 percent (OECD Labour Force 54 had been without work for more
OECD (2000) analysis notes that
Statistics, 2000). However, people than 1 year (European Commission,
these percentages often represent
aged 55 to 64 often have unem- 1995).
only a small fraction of the total
ployment rates higher than or simi-
older population, since many people
lar to rates for people aged 25 to
have retired by age 60. Looking at 3
And, in many developing countries, the
54 (Figure 10-9). Establishing a
older male cohorts as they aged in lack of programs to provide monetary support
time trend in unemployment rates during unemployment means that most people
the 1990s, the study concludes that cannot “afford” to be unemployed.
for older people is hindered by

U.S. Census Bureau An Aging World: 2001 105


Figure 10-9.
1980
Unemployment for Three Age Groups: 1980, 1990, and 1999
1990
(Percent)
1999
Canada Germany
Male Female Male Female
15.5

12.8

8.7
8.1
7.6
7.2 7.2 7.0 7.3
6.8 6.9 6.7
6.2 6.5
5.7 5.8 5.9
5.1 5.1 4.9
4.4
3.6 3.8
2.7 2.9
1.8 1.5 2.0 2.2

0.8 0.6
0.4

25-54 55-64 65+ 25-54 55-64 65+ 25-54 55-64 65+ 25-54 55-64 65+
United States Sweden
Male Female Male Female

7.3
6.5
6.0 5.9 5.9
5.1
4.6 4.6
3.8
3.4 3.1 3.0 3.0 3.4 3.3 3.1 3.1 3.2
3.0 2.7 2.8 2.6
1.6 1.3 1.7 1.7 1.6
1.2 1.3 1.0 1.2 1.3

25-54 55-64 65+ 25-54 55-64 65+ 25-54 55-64 65+ 25-54 55-64 65+

Japan France
Male Female Male Female

12.6

10.7

9.0 8.7 8.7


7.6
6.7
6.3 6.2
5.9 6.0
4.8
4.4
3.7 3.7 3.4
3.3
2.9 2.8
2.2 2.0 2.1 1.9
1.5 1.4 1.4 1.5
1.2 1.4
0.5 0.5 0.5 0.6 0.8

25-54 55-64 65+ 25-54 55-64 65+ 25-54 55-64 65+ 25-54 55-64 65+
Age group Age group
Notes: Unemployment rates for people aged 65+ in Canada, Germany, Japan, and Sweden were reported to be zero in certain years.
Latest data for Canada refer to 1998. 1980 data for Germany refer to West Germany.
Source: Organization for Economic Co-Operation and Development, 2000 (Labor Force Statistics 1979-1999).

106 An Aging World: 2001 U.S. Census Bureau


DISCOURAGEMENT REDUCES there is no work available or discouragement of older workers is
NUMBER OF OLDER WORKERS because they do not know where to thought to be related to changes in
The definition of discouraged work- look. Workers who become dis- occupational structure and the sub-
er differs somewhat from country to couraged from actively seeking sequent need for a more-educated
country, but the basic concept work are no longer considered part workforce which favor younger
refers to people who are no longer of the economically active popula- over older workers.
looking for work because they think tion. In some countries,
Cross-national data on discouraged
workers are fairly sparse. One com-
parison of 13 countries for 1993
Figure 10-10. indicates that older workers make
Older Share of Economically Active Population and up a disproportionate share of all
Discouraged Worker Population: 1993
discouraged workers, except in
(In percent)
Economically Sweden. Illustrative data for six of
Australia active people these countries (Figure 10-10) show
11 aged 55-64 as
Male that while people aged 55 to 64
55 a percent of
7 all economically account for a small proportion of all
Female active people economically active people, they
29
aged 25-64
Canada
account for a much larger propor-
Discouraged tion of all discouraged workers,
11
Male workers aged
50 especially in the United Kingdom
55-64 as a percent
9 where more than two-thirds of all
Female of all discouraged
42 workers aged discouraged male workers were
Denmark 25-64
aged 55 to 64. In countries with
13 data over time, discouraged older
Male
44
11 workers were more numerous in
Female
53 the early 1990s than in the early
Mexico 1980s. Discouragement seems to
12 be more permanent among older
Male
36 workers, as they are less likely to
8
Female re-enter the labor force than their
26
younger counterparts. Survey data
United Kingdom
for 1990 for Belgium and France
14
Male
69
show that more than half of men
12 aged 55 to 59 who had lost their
Female
53 jobs in the 3 years preceding the
United States surveys were no longer in the labor
12 force (OECD, 1995). The correspon-
Males
26 ding figure for all workers was clos-
11
Females 24 er to one-quarter. Because of the
difficulties older people face in
Note: Data for Norway include persons aged 64-74; data for the United States include people
aged 65 and over. obtaining a new job, discourage-
Sources: Organization for Economic Co-Operation and Development, Employment Outlook 1995 and
International Labour Office Yearbook of Labour Statistics, 1994.
ment often becomes a transition
from unemployment to retirement.

U.S. Census Bureau An Aging World: 2001 107


INVALIDITY AND DISABILITY
PROGRAMS MAY BE AVENUES Figure 10-11.
TO RETIREMENT Percent of Retired Men Aged 55 to 64 Who Left Last
Another path to retirement for older Job Due to Own Illness or Disability: 1995-96
workers has been disability pro-
grams. In Europe during the last Switzerland 28.9
three decades, economic recessions Finland 25.0
and high unemployment led some Germany 22.9
governments (e.g., Germany, the
United Kingdom 22.8
Netherlands, Sweden) to encourage
Spain 18.3
retirement by means of public
measures such as disability Luxembourg 16.6
schemes and long-term sickness Netherlands 15.6
benefits. In many countries in the Ireland 15.1
late 1980s and early 1990s, disabil-
Denmark 9.5
ity pensioners made up the largest
Belgium 7.7
proportion of all early pensioners
(OECD, 1992). Data for 1990 France 7.3
showed that the proportion of older Sweden 7.0
people receiving an invalidity bene- Italy 5.2
fit could be very large, e.g., nearly
Greece 4.1
one-third of all people aged 60 to
Austria 2.6
64 in Finland and Sweden, and
nearly half of the same age group Portugal 2.1
in Norway (OECD, 1995). While
Source: Excerpted from Organization for Economic Co-Operation and Development
numerous nations have modified or (Employment Outlook, 2000).
revamped their disability/invalidity
programs during the last decade, it
appears likely that the varying fully entitled to public pension awarded. In spite of the lowering
national provisions of such pro- benefits. These reductions were of statutory retirement ages, the
grams have an impact on retirement propelled by a combination of fac- actual average age of retirement is
patterns. Comparative data for 16 tors including general economic lower than the statutory age in a
European countries in the mid- conditions, changes in welfare phi- large majority of industrialized
1990s (Figure 10-11) show that the losophy, and private pension countries. Of the 24 countries in
percentage of older retired men trends. The proliferation of early Table 10-2, the actual age exceeds
who retired due to their own illness retirement schemes has increased the standard age only in Greece,
or disability ranged from 2 percent the number and usually the propor- Japan, and Turkey, and also in
in Portugal to 29 percent in tion of older workers who avail Iceland for men and in Italy for
Switzerland. themselves of such programs (Tracy women. In several countries (e.g.,
and Adams, 1989). Austria, Belgium, and Finland), the
ACTUAL RETIREMENT AGE average man retires 6 years or more
OFTEN LOWER THAN One important issue for policymak-
before the standard retirement age.
STATUTORY AGE ers and pension funds is the rela-
Differences are often greater for
tionship between the standard
Over several decades, many indus- women, approaching 10 years in
(statutory) retirement age and “actu-
trialized nations lowered the stan- Luxembourg and the Netherlands.
al” retirement age, the average age
dard age at which people become
at which retirement benefits are

108 An Aging World: 2001 U.S. Census Bureau


Table 10-2. income than did earlier cohorts of
Standard and Actual Retirement Age in 24 Countries: elderly.
1995
Some nations have raised (or are
Male Female
Country considering an increase in) statutory
Standard Actual Standard Actual retirement age as one means of off-
Australia . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 61.8 60 57.2 setting the fiscal pressures of popu-
Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 58.6 60 56.5 lation aging,4 in addition to foster-
Belgium . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 57.6 60 54.1
Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 62.3 65 58.8 ing policies that encourage labor
Denmark . . . . . . . . . . . . . . . . . . . . . . . . . . 67 62.7 67 59.4 force participation at older ages.
Finland . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 59.0 65 58.9
The effect of such actions is not yet
France . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 59.2 60 58.3
Germany . . . . . . . . . . . . . . . . . . . . . . . . . . 65 60.5 65 58.4 certain. Data for nine OECD coun-
Greece . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 62.3 57 60.3 tries from 1975 to 1990 reveal a
Iceland . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 69.5 67 66.0
Ireland . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 63.4 66 60.1 general downward trend in actual
Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 60.6 57 57.2 retirement age during the period
Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 66.5 58 63.7
1975-1990, with an apparent level-
Luxembourg . . . . . . . . . . . . . . . . . . . . . . . 65 58.4 65 55.4
Netherlands. . . . . . . . . . . . . . . . . . . . . . . . 65 58.8 65 55.3 ing off in the latter part of the peri-
New Zealand. . . . . . . . . . . . . . . . . . . . . . . 62 62.0 62 58.6 od. Gendell’s (1998) analysis of
Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 63.8 67 62.0
Portugal . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 63.6 62.5 60.8 Germany, Japan, Sweden, and the
Spain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 61.4 65 58.9 United States generally supports
Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 63.3 65 62.1
Switzerland . . . . . . . . . . . . . . . . . . . . . . . . 65 64.6 62 60.6
this picture (Figure 10-12).
Turkey . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 63.6 55 66.6 However, several studies have
United Kingdom . . . . . . . . . . . . . . . . . . . . 65 62.7 60 59.7 argued that the early retirement
United States . . . . . . . . . . . . . . . . . . . . . . 65 63.6 65 61.6
trend in the United States has
Note: The standard age of retirement (also called the statutory age) refers to the age stopped (Smeeding and Quinn,
of eligibility for full public pension benefits. The actual age reflects the estimated average
age of transition to inactivity among older workers. 1997; Burkhauser and Quinn, 1997;
Source: Organization for Economic Co-Operation and Development, 1998 (Ageing Quinn, 1997). Furthermore, a recent
Working Paper 1.4). OECD (2000) analysis of employ-
ment rates notes that the rates for
men aged 55 to 59 and 60 to 64
TREND IN EARLY RETIREMENT health of older workers were two
have increased slightly in the late
MAY BE CHANGING other factors said to have increased
1990s in both the United States and
The downward shift in the statutory early retirement. More recent
the Netherlands, and have stopped
age at retirement during the 1970s research, however, discounts the
declining in Canada, Germany,
and 1980s in developed countries importance of these factors (Levine
Finland, Japan, Sweden and the
was accompanied by an increase in and Mitchell, 1993; Blondal and
United Kingdom. The OECD study
the number of public early retire- Scarpetta, 1998; Fronstin, 1999)
suggests that this change is related
ment programs and a correspon- and points instead to changes in
to the secular economic upturn in
ding increase in the number of social security/private pension pro-
the latter 1990s.
retirees leaving the labor force prior visions as well as to improved eco-
to the statutory age. Some coun- nomic status of older workers and
4
In the United States, for example, the
tries promoted early retirement as a increases in wealth overall. As Social Security system was revised in 1983 to
means of offsetting persistently Ruggles (1992) has noted in the establish higher statutory retirement ages for
people born after 1937 (i.e., who reach age 65
high levels of unemployment. In context of the United States, com- after the year 2002). An individual’s retirement
Denmark, for example, a voluntary parisons of today’s elderly with the age is linked to year of birth; beginning in the
year 2003, the “normal” retirement age of 65
early retirement scheme was con- elderly in previous decades suggest will edge higher in small increments until reach-
great increases in economic status. ing 67 years in the year 2025 (Robertson,
structed to encourage older work- 1992). Germany’s 1992 Pension Act also pro-
ers to leave the labor market People entering the ranks of the vides for a progressive increase in pensionable
elderly have higher educational age beginning at the turn of the century.
(Petersen, 1991). Mandatory retire-
ment practices and worsening attainment, higher-paid employment
histories, and higher average

U.S. Census Bureau An Aging World: 2001 109


Figure 10-12.
Average Age at Labor Force Exit in Four Countries: Late 1960s to Early 1990s

Germany Sweden
Age Age
70 70

65 Male 65 Male

Female Female

60 60

55 55

0 0
1965 1970 1975 1980 1985 1990 1995 1965 1970 1975 1980 1985 1990 1995

Japan United States


Age Age
70 70

Male

Female
65 65

Male
Female

60 60

55 55

0 0
1965 1970 1975 1980 1985 1990 1995 1965 1970 1975 1980 1985 1990 1995

Source: Gendell, 1998.

110 An Aging World: 2001 U.S. Census Bureau


ADULTS SPENDING GREATER years before entry into the labor number of years in retirement had
PORTION OF LIFE IN market (primarily spent in school); jumped to 12. Unlike the trend for
RETIREMENT years not in work due to unemploy- men, the average number of years
Gains in life expectancy during the ment and/or economic inactivity; in employment for women has been
twentieth century have intersected years in the labor force; and years increasing, reflecting the temporal
with declining retirement ages to in retirement. Figure 10-13 shows changes in female labor force par-
produce an increase in the propor- that in 1960, men on average could ticipation described earlier. At the
tion of an individual’s life spent in expect to spend 46 years in the same time, the amount of time
retirement. The OECD, using an labor force and a little more than women live after reaching retire-
average of unweighted data for 15 1 year in retirement. By 1995, the ment age increased greatly, from
member countries, has decomposed number of years in the labor force 9 years in 1960 to more than
the life course into four states: had decreased to 37 while the 21 years in 1995.

Figure 10-13.
Decomposition of the Life Course, OECD Average: 1960 to 1995

Male Female
Age Age
90 90

Life
80 80 expectancy
Life
expectancy Years in retirement
70 70
Years in retirement
Age of
60 retirement 60 Age of
retirement

50 50
Years in employment

Years in employment
40 40

30 30
Years not in work

20 Years not in work 20 Age of


Age of
entry in entry in
the labor the labor
10 Years before the labor market market 10 Years before the labor market market

0 0
1960 1970 1980 1990 1995 1960 1970 1980 1990 1995

Note: Based on an unweighted average of data for 15 member countries, using average life expectancies and labor force patterns as they existed for the
years shown. These graphs are illustrative of overall trends, and should not be construed as representing the experience of any particular age cohort.
Source: Organization for Economic Co-Operation and Development, 1998b.

U.S. Census Bureau An Aging World: 2001 111


PUBLIC PENSION SYSTEM eventual benefit payment rate for benefits may be initially obtained at
PROVISIONS SOMETIMES people who retire after age 60. In age 62, but the benefit payment
INDUCE EARLY RETIREMENT the United States, social security rate is less than if a worker retires
Research has begun to consider
national differences among labor
force participation at older ages as Figure 10-14.
a consequence (intended or unin- Implicit Tax Rate on Work in France and
tended) of retirement provisions the United States: Circa 1995
and/or tax policy. In some coun- Percent
tries, retirement benefit payments 90
are increased for people who post-
pone their retirement beyond the
France
allowable early retirement age. In 60
other countries, there is no future
benefit to be gained by postponing
retirement. One synthesis of vari- 30
ous studies in industrialized nations
(Gruber and Wise, 1999) looked at
the “implicit tax on work,” a con- 0
cept which contrasts the longer
United States
stream of future benefit payments
that a worker would receive by -30
retiring at an early age versus the
shorter stream of future payments
that a worker might receive by
-60
delaying his/her retirement. In 56 58 60 62 64 66 68 70
Age
France, for example, social security
Source: Gruber and Wise, 1999. Reproduced with permission from graphs in "Social Security and
benefits are first available at age Retirement Around the World," Research Highlights in the Demography and Economics of Aging,
60, and there is no increase in the Issue No. 2, June 1998.

112 An Aging World: 2001 U.S. Census Bureau


later, e.g., at age 65. Figure 10-14 States. The age-specific retirement surprisingly corresponds to the
compares the implicit tax rates on age in France shows a steep jump large implicit tax rise at that age.
work in France and the United in retirement at age 60, which not
The same study also considered a
“tax force to retire,” defined as the
total of the annual tax rates on
Figure 10-15.
work between the ages of 55 and
Tax Rates and Unused Capacity in 11 Developed
Countries: Circa 1995 69. Plotting this variable against a
measure of unused productive
Unused productive capacity (55-65), in percent capacity (simply, the percentage of
80
people aged 55 to 65 who were not
70
Belgium working) reveals a strong cross-
Italy
national relationship between the
France
60 Netherlands two (Figure 10-15). This finding
United Kingdom suggests that the financial structure
Germany of national social security systems
50 Spain
Canada
may reward early retirement, and
40 United States that attempts to encourage
Sweden increased labor force participation
30 at older ages may be largely contin-
Japan gent upon policy changes in these
20 systems. This study also highlights
the potential power of focusing on
10 system design features, and stands
as a powerful example of the
0 importance of cross-national
0 1 2 3 4 5 6 7 8 9 10
research on aging-related issues.
Tax force to retire (55-69)
Source: Gruber and Wise, 1999. Reproduced with permission from graphs in "Social Security and
Retirement Around the World," Research Highlights in the Demography and Economics of Aging,
Issue No. 2, June 1998.

U.S. Census Bureau An Aging World: 2001 113


CHAPTER 11.
Pensions and Income Security

Public pensions have become the retirement age. This example is tional transfers to provide adequate
financial lifeline of the elderly in based on average ages of retire- retirement income for older citi-
many societies. While some ment for employees in 1995 esti- zens. The number of countries
European public pension systems mated by the Organization for with an old age/disability/survivors
date back to the end of the nine- Economic Co-Operation and program increased from 33 in 1940
teenth century, current systems are Development (OECD) and popula- to 167 in 1999 (Figure 11-2). The
the result of changes instituted tion age/sex structures for 2000 World Bank (1994) has estimated
largely after World War II. The most and 2030 estimated and projected that formal public programs provide
obvious and, to governments, most by the U.S. Census Bureau. The coverage for approximately 30 per-
worrisome consequence of project- numerator of the ratio comprises all cent of the world’s older (aged 60
ed population aging will be an people at or over the average age and over) population, with some 40
increase in budgetary outlays in the of retirement in each country, and percent of the world’s working-age
form of old-age pension payments, the denominator all people between population making contributions
especially in those countries in the age of 20 and the average toward that support.
which public pensions are predomi- retirement age, assuming no
nately financed on a pay-as-you-go change in the average age of retire- LABOR FORCE PENSION
COVERAGE VARIES FROM
basis. Increases in migration also ment between 2000 and 2030. The
UNIVERSAL TO NIL
are prompting governmental con- ratio increases notably over time in
cern about the “exporting” of cash all cases, and more than doubles Mandatory old-age pension plans
benefits to retirees in other coun- for men in the Netherlands. now cover more than 90 percent of
tries (Bolderson and Gains, 1994). the labor force in most developed
Many nations, both developed and PUBLIC OLD-AGE SECURITY countries. Governments are respon-
SYSTEMS PROLIFERATING sible for mandating, financing, man-
developing, are now reconsidering
their existing old-age security sys- Since the Second World War, public aging, and insuring public pensions.
tems, often with an eye toward pension plans have played an Public pension plans usually offer
introducing or strengthening private increasingly important role in pro- defined benefits that are not tied to
pension schemes. viding retirement income to older individual contributions, but rather,
people. Old-age pension schemes are financed by payroll taxes. This
DEMOGRAPHIC CHANGE have become social institutions in arrangement is commonly referred
ALONE MAY DOUBLE to as a “pay-as-you-go” system inso-
many if not most countries through-
RETIREE/WORKER RATIO
out the world. The goal of most far as current revenues (taxes on
The potential effect of demographic public old-age pension schemes is working adults) are used to finance
change on future retired popula- to provide all qualifying individuals the pension payments of people
tion/worker ratios, holding other with an income stream during their who are retired from the labor force
factors constant, may be approxi- later years, income which is: 1) (Mortensen, 1992).
mated in various ways. The most continuous; 2) adequate; 3) con-
Most pay-as-you-go systems in
commonly used indicator, as dis- stant, in terms of purchasing
industrialized countries initially
cussed in Chapter 8, is an elderly power; and 4) capable of maintain-
promised generous benefits.
support ratio which contrasts one ing the socioeconomic position of
These pension programs, at their
population segment (people aged the retired in relation to that of the
inception, were based on a small
65 and over) to another (people active population (Nektarios, 1982).
number of pensioners relative to a
aged 20 to 64). One variation on
The major impetus for development large number of contributors
this theme, shown in Figure 11-1
of public pension systems, particu- (workers). As systems matured,
for 10 developed countries, allows
larly in industrialized countries, was ratios of pensioners to contributors
for national differences in average
the inability of private intergenera- grew and in some countries

U.S. Census Bureau An Aging World: 2001 115


became unsustainable, particularly
during periods of economic stag- Figure 11-1.

nation. One result of such


Ratio of Retirement-Age to Working-Age
Population in Ten Countries: 2000 and 2030
changes was the development of
(Average retirement age shown in parentheses)
private pension systems to com-
2000
plement public pension systems Male 2030
(Fox, 1994). Other measures taken 23
or considered have included Australia (61.8)
43
increasing worker contribution 24
rates, restructuring or reducing Denmark (62.7)
44
benefits, and raising the standard 40
age of retirement (ISSA, 1993; Finland (59.0)
75
Holtzmann and Stiglitz, 2001). 34
France (59.2)
57
In developing countries, public pen-
sion systems typically cover a much 35
Italy (60.6)
63
smaller fraction of workers than in
21
industrialized nations (Figure 11-3). Japan (66.5)
41
Even economically vibrant societies
such as Hong Kong and Thailand 30
Netherlands (58.8)
63
offer no publicly supported, compre-
hensive retirement pension scheme 30
Spain (61.4)
54
(Bartlett and Phillips, 1995;
Domingo, 1995). In many cases, 26
United Kingdom (62.7)
45
coverage in developing countries is
restricted to certain categories of 20
United States (63.6)
37
workers such as civil servants, mili-
tary personnel, and employees in
Female
the formal economic sector. Rural,
40
predominantly agricultural workers Australia (57.2)
72
have little or no pension coverage in
42
much of the developing world, Denmark (59.4)
69
although some governments have
46
taken steps to address this situa- Finland (58.9)
81
tion. Each state in India, for exam-
48
ple, has implemented an old age France (58.3)
80
pension scheme for destitute people
58
with no source of income and no Italy (57.2)
105
family support (Kumar, 1998). While
35
pension amounts are minimal and Japan (63.7)
65
coverage far from universal, the for-
50
mal institution of such a system Netherlands (55.3)
96
affords a nation a foundation upon
46
which to expand future coverage. Spain (58.9)
85
44
United Kingdom (59.7)
71
31
United States (61.6)
52

Note: Ratios represent the number of persons at or above average retirement age per 100 persons between age
20 and the average retirement age in 1995. Each national average is shown in parentheses.
Sources: OECD, 1998 (Aging Working Paper 1.4) and U.S. Census Bureau, 2000a.

116 An Aging World: 2001 U.S. Census Bureau


Informal (usually family) systems
Figure 11-2. provide the bulk of social support
Number of Countries With Public Old-Age/Disability/ for older individuals in many coun-
Survivors Program: 1940 to 1999 tries, particularly in Africa and
South Asia. As economies expand
and nations urbanize, informal sup-
167 port systems such as extended fam-
ily care and mutual aid societies
have tended to weaken. A major
135
challenge for governments in devel-
123
oping nations is to effect the expan-
sion of formal-system coverage
97 (especially in rural areas) while
maintaining support for extant
informal mechanisms.
58
HOW GENEROUS ARE PUBLIC
44 PENSIONS?
33
The “value” of pensions can be con-
strued and measured in different
ways, depending on how many and
1940 1949 1958 1969 1979 1989 1999 which people in a given household
rely on pension income, the taxable
Source: U.S. Social Security Administration, 1999. status of such income, the type of
job a retiree was engaged in, the
level of pension income in a given
Figure 11-3. society vis-a-vis other benefits such
Percent of Labor Force Covered by Public Old-Age as universal health care, and so
Pension Program: Circa 1995 forth. The concept of “replacement
rate” is often used as a measure of
Nigeria 1 how much of a person’s pre-
Zambia 10 retirement income is supplied by
her/his pension. MacKellar and
Morocco 21
McGreevey (1999) note that, in
South Korea 30
industrialized countries, the aver-
Jordan 40 age pension rose from 14 percent
Brazil 50 of the average wage in 1930 to 55
Poland 66 percent in 1980. A comparison of
Russia 72 gross income replacement of social
Germany 94
security and other compulsory
retirement pension programs in
Italy 96
12 European nations circa 1990
Source: World Bank, 1998.
(International Benefits Information

U.S. Census Bureau An Aging World: 2001 117


Service, 1993) revealed that replace-
ment rates ranged from 46 percent
Figure 11-4.
to 102 percent, based on average Expected Old-Age Public Pension Replacement
annual pay for a manufacturing Rate in 26 Countries: 1995
worker with dependent spouse. (Percent)

For reasons mentioned above, there


is no single replacement rate in any Australia 41
national retirement program, and Austria 80
cross-national comparisons there- Belgium 68
fore are difficult. For comparative Canada 52
purposes, however, the OECD has Czech Republic 53
constructed, for 1995, a synthetic Denmark 56
indicator of the expected gross Finland 60
replacement rate (as a percent of France 65

earnings) for a 55-year-old individ- Germany 55


Greece 120
ual who retires at the standard age
Hungary 55
of entitlement to a public pension.
Iceland 93
This indicator takes account of two
Ireland 40
earnings levels (average and two-
Italy 80
thirds of average) and two types of Japan 52
households (single earner and Luxembourg 93
worker with a dependent spouse). Netherlands 46
Pensions in some countries can be New Zealand 61
expected to replace a large percent- Norway 60
age of earnings, and even to match Poland 54
or exceed the latter in Greece and Portugal 83
Spain. At the other end of the spec- Spain 100

trum are Australia and Ireland, Sweden 74


Switzerland 49
where the public-pension replace-
United Kingdom 50
ment rates are on the order of
United States 56
40 percent. For the majority of
countries examined, the expected
replacement rates are about one- Note: Synthetic indicator based on different earning levels and household types; see text and
source for more detail.
half to two-thirds of pre-retirement Source: OECD, 1998 (Aging Working Paper 1.4).

income (Figure 11-4).

118 An Aging World: 2001 U.S. Census Bureau


PUBLIC PENSIONS ABSORB
Figure 11-5. ONE-SEVENTH OF GDP IN SOME
Public Pension Expenditure as a Percent of Gross COUNTRIES
Domestic Product in 25 Countries: Circa 1996 The cost of public pensions general-
ly is greatest among industrial
Italy, 1995 15.0
nations, most of which have pay-as-
Uruguay, 1996 15.0
France, 1995 13.3 you-go systems. Pension expendi-
Germany, 1995 12.0 ture had, on average, come to
Croatia, 1997 11.6 exceed 9 percent of gross domestic
United Kingdom, 1995 10.2
product (GDP) in OECD nations in
Hungary, 1996 9.7
United States, 1995 7.2 the early 1990s, and represented 8
Japan, 1995 6.6 percent of GDP in Eastern Europe.
Cyprus, 1996 6.4 Between 1960 and 1990, one-
Israel, 1996 5.9 quarter of the increase in total pub-
Russia, 1996 5.7
Kazakhstan, 1997 5.0 lic expenditure in OECD countries
Brazil, 1996 4.7 was growth in pension expenditure;
Australia, 1995 4.6 on average, the latter grew twice as
Turkey, 1995 3.7 fast as did GDP. By 1996, public
China, 1996 2.7
Sri Lanka, 1996
pension spending in Italy and
2.4
Algeria, 1997 2.1 Uruguay had reached 15 percent of
Vietnam, 1998 1.6 GDP (Palacios and Pallares-Miralles,
Ecuador, 1997 1.0 2000). Expenditure levels typically
Uganda, 1997 0.8
Togo, 1997
are much lower in most developing
0.6
Mexico, 1996 0.4 countries (Figure 11-5), where rela-
Cote d'Ivoire, 1997 0.3 tively younger populations and
Source: Palacios and Pallares-Miralles, 2000.
smaller pension programs do not
yet place large demands on GDP.

ADMINISTRATIVE COSTS OF
PUBLIC PENSION SYSTEMS
Figure 11-6. HIGH IN SOME DEVELOPING
Net Administrative Fees as a Percent of COUNTRIES
Total Contributions in Eight Latin American
The cost of administering a public
Individual-Account Systems: 1999
pension scheme is an important fac-
tor in the scheme’s overall efficacy.
Argentina 23.0 In many developing countries,
Mexico 22.1 administrative costs as a percent of
Peru 19.0 total old-age benefits have been
El Salvador 17.6 high (e.g., 10-15 percent in Brazil
Chile
and Turkey) relative to the devel-
15.6
oped world — administrative costs
Uruguay 14.3
as a percent of old-age benefits are
Colombia 14.1 less than 2 percent in most OECD
Bolivia 5.5 countries. In many developed
countries, the cost/benefit ratio
Source: James, Smalhout and Vittas, 2001. declined in the 1970s and early

U.S. Census Bureau An Aging World: 2001 119


1980s (Estrin, 1988) as a result of:
1) government austerity programs Figure 11-7.
that helped contain administrative Percent of Pensioners With Income From
costs; 2) increases in total benefit Employer-Provided Pensions: Late 1990s
expenditures, reflecting not only Male
the maturation and/or expansion of Female
20
Australia
programs but also the impact of 7
inflation; and 3) greater use of com- 54
Canada
puters for the processing of bene- 31
fits, with corresponding gains in 21
Germany
efficiency. 9

The World Bank (1994) compiled 76


Netherlands
23
information on administrative costs
66
per participant in publicly managed United Kingdom
32
pension plans as a percent of per
48
capita income in the early 1990s, United States
26
demonstrating that such costs were
considerably higher in lower-income Source: Whitehouse, 2000.
countries. For example, costs per
participant as a percent of national
per capita income were 8 percent in
Tanzania, 7 percent in Burundi, and
high income workers in developed employers to provide pension bene-
2.3 percent in Chile, compared with
countries. About one-third of the fits for employees above a certain
one-tenth of 1 percent or less in
labor force in OECD countries was income level. OECD estimates for
Switzerland and the United States.
enrolled in occupational pension the early 1990s, compiled from var-
These data illustrate the importance
plans circa 1990, but a much ious sources, show occupational
of an educated labor force, commu-
smaller proportion is covered in scheme coverage in 19 industrial-
nications infrastructure, and other
most developing countries and tran- ized countries ranging from 5 per-
advanced technological input to the
sitional economies, where employ- cent in Italy and Greece to 90 per-
pension production function. More
er-sponsored schemes tend to cover cent in Sweden and the Netherlands
recently, James, Smalhout, and
only public-sector workers (World (OECD, 1998, Ageing Working Paper
Vittas (2001) estimated the net
Bank, 1994). 2.2).
administrative fee in individual
account systems as a percent of a Cross-national estimates of occupa- Of course, not all workers who are
person’s total contribution in eight tional-scheme coverage among all covered by occupational plans are
Latin American countries (Figure 11- workers vary widely in the pub- in fact enrolled in them. Further,
6). These fees were in double dig- lished literature, due in part to dif- the percent of older people actually
its in seven of the eight nations as ferent temporal references as well receiving benefits from employer-
of 1999, and exceeded 20 percent as different definitions of what an provided plans is likely to be lower
in Argentina and Mexico. occupational scheme is.1 Most still, because many retirees either
occupational plans are employer- did not have access to such plans
ROUGHLY ONE-THIRD OF specific, but in some nations (e.g., during their working years, or did
OECD WORKERS COVERED BY
Denmark and the Netherlands) not participate for enough years to
OCCUPATIONAL PENSION PLANS
plans are organized on an industry- become vested. Whitehouse (2000)
While public pension systems are wide basis, with compulsory partici- has compiled data on the percent-
more widespread than occupational pation a result of collective bargain- age of pensioners with income from
pension plans, the latter are grow- ing. Switzerland requires all employer-provided pensions in
ing in coverage. Occupational eight developed countries in the
pension plans tend to be a more 1
For a useful discussion of occupational
late 1990s (Figure 11-7). In coun-
pension schemes within the context of broader
important source of retirement retirement system reforms, see OECD, 1998, tries where a gender breakdown is
income than public pensions for Ageing Working Paper 3.4.

120 An Aging World: 2001 U.S. Census Bureau


Box 11-1.
Chile is the Developing-Country Model for Pension Privatization

Chile first enacted a public pension scheme in 1911, administered retirement fund (additional payroll
and expanded its program following the European deductions are made for life insurance and fund
social insurance model financed on a pay-as-you-go expenses). Workers themselves select from many
basis. Between 1960 and 1980, the ratio of pension- competing investment companies, are free to switch
ers to contributing workers increased from 9 per 100 their accounts, and have several options for with-
to 45 per 100, due to rapidly changing demographics drawal and annuities upon retirement. To reduce mis-
and increasing tax evasion on the part of employees management risks, the government assumes a major
and employers (Williamson, 1992). These changes, supervisory and regulatory role (Schulz, 1993).
occurring in the context of a stagnant economy,
By most accounts, the Chilean experiment during its
resulted in a situation where the pension system was
initial decade was a success, with real annual returns
no longer able to meet current obligations. Faced
on contributions averaging in excess of 12 percent
with an increasingly bleak future scenario, the Chilean
during the 1980s. From 1995 to 1998, however,
government in 1980 abandoned its public system in
annual rates of return were much lower and in
favor of a compulsory savings plan administered by
2 years were negative, before rebounding in 1999
private-sector companies.
(Figure 11-8). Overall, the long-term (19-year) aver-
Since 1981, all wage and salary earners are required to age real return exceeds 11 percent. Observers have
contribute 10 percent of their earnings to a privately pointed out several drawbacks to the system, such as
high administrative costs,
workers’ loss of freedom vis-
Figure 11-8. a-vis one-tenth of their earn-
Real Rate of Return of Chile's Private ings, and the fact that even-
Pension System: 1981 to 1999 tual income replacement
rates are not guaranteed, i.e.,
Percent
30 are reliant on investment
earnings that may suffer in
Average, 1981-1999:
times of economic stagnation
25
11.2% (Gillion and Bonilla, 1992).
Nevertheless, many countries
20
in Latin America, Eastern
Europe, and Asia have adopt-
15 ed or are seriously consider-
ing aspects of the Chilean
10 system, or are experimenting
with variations on the theme
5 (Kritzer, 2000; Fox and
Palmer, 2001). Consideration
of increased privatization of
0
social security systems is
now commonplace in much
-5 of the developed world as
1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
well, and has become a hotly
Source: Reported in Palacios and Pallares-Miralles, 2000.
debated political topic.

U.S. Census Bureau An Aging World: 2001 121


available, the data show that men
are much more likely to receive Figure 11-9.
such benefits, as would be expect- Private Pension Fund Assets as a Percent
ed from past gender patterns of of GDP: 1970 and 1998
labor force participation. 1970
1998
Company-based pension programs 14
Canada
48
in the developing world are found
19
most frequently in former British Denmark
22
colonies and in countries with large
29
multinational subsidiaries. Most Netherlands
86
such programs are subject to less
38
regulation and lower funding Switzerland
75
requirements than their counter-
21
parts in industrialized countries, United Kingdom
84
although both Indonesia and South
29
Africa have developed comprehen- United States
86
sive and well-regulated private pen-
sion systems. Coverage of private- Note: Later Swiss figure refers to 1996.
Sources: World Bank, 1994 and OECD, 2000.
sector workers is increasing in a
number of other large developing
nations such as Brazil, India, and
Table 11-1.
Mexico (World Bank, 1994). Payroll Tax Rates for Provident Fund Schemes:
Early-to-Mid-1990s
PRIVATE PENSION FUND (Percentage of wages)
ASSETS A MAJOR SOURCE OF
LONG-TERM CAPITAL Country Employees Employer

Private pension fund assets are Africa


The Gambia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 10
sizeable in many developed coun-
Ghana. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 12.5
tries. In 1998, such assets were Kenya . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5
equivalent to more than 80 percent Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6
Swaziland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5
of GDP in the Netherlands, the Tanzania. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10
United Kingdom, and the United Uganda. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 10
Zambia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5
States (Figure 11-9). Most occupa-
tional-plan funds have been invest- Asia
Fiji . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 7
ed in private-sector assets, are India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10
internationally diversified, and have Indonesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2
Kiribati . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5
earned higher returns than publicly
Malaysia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 11
managed funds (Davis, 1993; Nepal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10
1998). Singapore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-30 10
Solomon Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 8
Sri Lanka . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 12
These funds have grown consider-
Western Samoa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5
ably over the last three decades.
Latin America
The average annual growth rate of Argentina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 0
pension funds for OECD countries Chile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 0
Colombia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9
as a whole between 1990 and 1996
Peru . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 0
was 11 percent (OECD, 1998b).
Source: World Bank, 1994.

122 An Aging World: 2001 U.S. Census Bureau


This increase is expected to contin- Where provident-fund coverage is nonmonetary indicators of welfare,
ue for at least the short term, extensive, such funds may in effect and concluded that in all 12
because many aging nations with be the public pension system. nations, the nonelderly were better
relatively underdeveloped pre- off than the elderly (Tsakloglou,
The performance of provident funds
funded systems have considerable 1996). Data for France, however,
globally has been erratic. In some
room for growth. The looming poli- suggest that extreme poverty
East Asian countries (notably
cy question is whether population (below the level of guaranteed mini-
Singapore, which has the world’s
aging will depress rates of return mum income) is much less common
largest provident fund), funds typi-
on private pension funds. As the among the elderly than among
cally have earned positive annual
large post-World War II cohorts younger households (David and
investment returns. In other
move into retirement, they are Starzec, 1993).
nations, inflation and poor econom-
expected to divest some of their
ic growth have lessened the value The OECD (2000) has concluded
financial assets accumulated during
of fund contributions; in Sri Lanka, that there has been a stable or
their working years. This prospect
for example, the real annual rate of improving economic picture for
highlights the importance of the
return for the Employee Provident older people, both in absolute
nature of pension fund manage-
Fund in the 1980s and early 1990s terms and relative to the nonelderly
ment, changes in government regu-
often was negative (International population. Poverty rates for older
lations, and the varying sociocultu-
Labour Office, 1993). Such perform- people have declined in most
ral impetuses for retirement savings
ance has led several countries to nations, as has the share of older
(OECD, 2000; National Research
abandon provident schemes in people among the poor. In the
Council, 2001).
favor of defined-benefit pension United States, the overall situation
PROVIDENT FUNDS plans (Palacios and Pallares-Miralles, of elderly people improved dramati-
PARAMOUNT IN SOME 2000). cally during the last third of the
DEVELOPING COUNTRIES twentieth century. Studies of real
ARE LIVING STANDARDS OF median household income (adjusted
A provident fund is a form of com- THE ELDERLY CHANGING IN
pulsory defined-contribution pro- for household size) have demon-
DEVELOPED COUNTRIES?
gram wherein regular contributions strated much larger gains for elder-
Given the maturation of public pen- ly people relative to the general
are withheld from employee wages
sions systems, increases in the level population (Radner, 1995; McNeil,
and invested for later repayment.
of female labor force participation, 1998). And, poverty among the
Payouts typically are in the form of
and the development of private elderly has declined. One-third of
a lump sum upon retirement, but
pension schemes, one might expect all U.S. elderly were below the
may also be made earlier in times
that older citizens in industrialized poverty line in 1960; by the mid-
of special need. Except in some
nations are better off, economically, 1990s, the level had declined to
Latin American countries, employ-
than previous generations of elderly 10 percent, lower than among chil-
ers match or exceed the employee
people. And, there is a growing dren under the age of 18 (Friedland
contribution. Although provident
perception in some countries that and Summer, 1999).
funds can cover private-sector
the elderly as a whole are faring
workers, they are managed publicly. Data from the Luxembourg Income
better than other population sub-
Malaysia, in 1951, was the first groups. However, the complexity of Study reveal considerable inter-
nation to establish a wide scale measuring economic well-being country variation in poverty rates
provident fund, and other Asian often precludes a definitive assess- among elderly citizens. An analysis
nations (e.g., India, Singapore, and ment of these issues, and there is of standardized information from
Sri Lanka) have had provident funds considerable concern about the will- nine nations (Smeeding and
for more than 40 years. By the ingness and ability of households to Saunders, 1998) suggests that
mid-1990s more than 20 nations adequately save for retirement Canada, Germany, and Hungary pro-
had developed such schemes (Table needs (see, e.g., MacKellar, 2000). vide their elderly the best overall
11-1). None of these countries had One study of 12 European Union protection from poverty relative to
a public pay-as-you-go system at countries in the late 1980s com- the other six countries (Figure
the time its provident fund was pared survey data on consumption 11-10). This analysis also highlights
established (World Bank, 1994). expenditure, income, and the fact that overall figures may

U.S. Census Bureau An Aging World: 2001 123


mask large differences among (Jiminez-Martin, Labeaga, and the Health and Retirement Survey in
population subgroups, as seen in Granado, 1999). In order to capture the United States (see Burkhauser
the data for elderly women living the complexity of such transitions and Gertler, 1995 for a comprehen-
alone. The economic vulnerability and understand their significance sive overview of this study, and
of single elderly women also has for policy planning, several nations National Research Council, 2001 for
been noted in a 14-country study of have mounted (or are planning to future recommendations).
data from the European Community initiate) longitudinal studies akin to
Household Panel (Heinrich, 2000).

One obviously important compo-


nent of elderly living standards is Figure 11-10.
health care and its costs. As the Percent of Elderly Living in Households With Less
latter have escalated in the 1990s, a Than 50 Percent of Adjusted National
Median Disposable Income All elderly
growing body of research has
Elderly women
focused on identifying the costs of living alone
specific illnesses and on projecting 29
Australia, 1990
health expenditures (see, e.g., 62
Cutler and Meara, 1999; Mayhew, 7
Canada, 1991
1999; and OECD, 2000). Other 16
major thrusts of current research in 16
Finland, 1991
the economics of aging seek: to 35
8
more fully and accurately measure Germany, 1989
13
levels of household wealth and
9
assets; to better assess differences Hungary, 1995
14
in these variables within popula-
18
tions; and to understand transitions Japan, 1992
N/A
in income and poverty status, 11
Poland, 1992
particularly as they relate to chang- 19
ing health status at older ages. 25
Taiwan, 1991
Data from the European Community 74
Household Panel Survey is begin- 23
United States, 1994
43
ning to shed light on the interplay
of health status and retirement deci- Note: Percent for elderly women living alone in Japan is not reported.
Source: Smeeding and Saunders, 1998.
sions of older European couples

124 An Aging World: 2001 U.S. Census Bureau


APPENDIX A.
Detailed Tables

U.S. Census Bureau An Aging World: 2001 125


Table 1.
Total Population, Percent Elderly, and Percent Oldest Old: 1975, 2000, 2015, and 2030
(In thousands)

1975 2000

Country Percent of Percent of 80+ as a Percent of Percent of 80+ as a


Total population population percent of Total population population percent of
population 65+ 80+ 65+ population 65+ 80+ 65+

United States . . . . . . . . . . . . . . . 220,165 10.5 2.1 20.4 275,563 12.6 3.3 26.5
Western Europe
Austria . . . . . . . . . . . . . . . . . . . . . . . 7,579 14.9 2.3 15.5 8,131 15.4 3.4 22.2
Belgium . . . . . . . . . . . . . . . . . . . . . . 9,796 13.9 2.3 16.4 10,242 16.8 3.5 20.8
Denmark . . . . . . . . . . . . . . . . . . . . . 5,060 13.4 2.4 18.0 5,336 14.9 4.0 26.7
France . . . . . . . . . . . . . . . . . . . . . . . 52,699 13.5 2.5 18.3 59,330 16.0 3.7 23.3
Germany . . . . . . . . . . . . . . . . . . . . . 78,679 14.8 2.2 14.6 82,797 16.2 3.5 21.6
Greece. . . . . . . . . . . . . . . . . . . . . . . 9,047 12.2 2.1 17.1 10,602 17.3 3.5 20.2
Italy. . . . . . . . . . . . . . . . . . . . . . . . . . 55,441 12.0 1.9 16.0 57,634 18.1 4.0 22.2
Luxembourg . . . . . . . . . . . . . . . . . . 362 13.0 2.2 17.0 437 14.0 3.0 21.2
Norway . . . . . . . . . . . . . . . . . . . . . . 4,007 13.7 2.5 18.2 4,481 15.2 4.4 28.6
Sweden . . . . . . . . . . . . . . . . . . . . . . 8,193 15.1 2.7 17.8 8,873 17.3 5.0 29.2
United Kingdom . . . . . . . . . . . . . . . 56,226 14.0 2.4 17.0 59,508 15.7 4.0 25.5
Eastern Europe
Bulgaria . . . . . . . . . . . . . . . . . . . . . . 8,722 10.9 1.4 12.8 7,797 16.5 2.2 13.2
Czech Republic . . . . . . . . . . . . . . . 9,997 12.9 1.7 13.5 10,272 13.9 2.4 17.1
Hungary. . . . . . . . . . . . . . . . . . . . . . 10,532 12.6 1.7 13.3 10,139 14.6 2.5 17.4
Poland . . . . . . . . . . . . . . . . . . . . . . . 34,022 9.5 1.2 12.4 38,646 12.3 2.1 16.8
Russia . . . . . . . . . . . . . . . . . . . . . . . 134,233 8.9 1.2 14.0 146,001 12.6 2.0 15.9
Ukraine . . . . . . . . . . . . . . . . . . . . . . 49,016 10.5 1.6 15.0 49,153 13.9 2.2 16.0
North America/Oceania
Australia . . . . . . . . . . . . . . . . . . . . . 13,900 8.7 1.5 17.4 19,165 12.4 3.0 24.0
Canada . . . . . . . . . . . . . . . . . . . . . . 23,209 8.4 1.6 19.3 31,278 12.7 3.1 24.8
New Zealand . . . . . . . . . . . . . . . . . 3,083 8.7 1.4 16.4 3,820 11.5 2.9 25.0
Asia
Bangladesh. . . . . . . . . . . . . . . . . . . 76,582 3.6 0.3 8.4 129,194 3.3 0.5 15.0
China . . . . . . . . . . . . . . . . . . . . . . . . 927,808 4.4 0.6 12.5 1,261,832 7.0 0.9 13.1
India . . . . . . . . . . . . . . . . . . . . . . . . . 620,701 3.8 0.3 8.1 1,014,004 4.6 0.6 13.1
Indonesia. . . . . . . . . . . . . . . . . . . . . 135,666 3.2 0.3 8.6 224,784 4.5 0.4 10.0
Israel . . . . . . . . . . . . . . . . . . . . . . . . 3,455 7.8 1.0 12.3 5,842 9.9 2.4 23.9
Japan . . . . . . . . . . . . . . . . . . . . . . . . 111,524 7.9 1.1 13.5 126,550 17.0 3.7 21.7
Malaysia . . . . . . . . . . . . . . . . . . . . . 12,258 3.7 0.5 13.3 21,793 4.1 0.5 13.5
Pakistan. . . . . . . . . . . . . . . . . . . . . . 74,734 3.0 0.3 10.9 141,554 4.1 0.5 13.3
Philippines. . . . . . . . . . . . . . . . . . . . 43,010 2.7 0.4 13.4 81,160 3.6 0.5 13.6
Singapore . . . . . . . . . . . . . . . . . . . . 2,263 4.1 0.4 9.7 4,152 6.8 1.5 21.3
South Korea . . . . . . . . . . . . . . . . . . 35,281 3.6 0.4 10.1 47,471 7.0 1.0 13.9
Sri Lanka. . . . . . . . . . . . . . . . . . . . . 13,603 4.1 0.5 13.2 19,239 6.5 1.0 15.6
Thailand. . . . . . . . . . . . . . . . . . . . . . 41,359 3.0 0.3 10.9 61,231 6.4 0.9 13.9
Turkey . . . . . . . . . . . . . . . . . . . . . . . 40,025 4.5 0.4 7.9 65,667 6.0 0.9 15.2
Latin America/Caribbean
Argentina. . . . . . . . . . . . . . . . . . . . . 26,049 7.6 0.9 12.1 36,955 10.4 2.2 21.7
Brazil . . . . . . . . . . . . . . . . . . . . . . . . 108,167 3.9 0.5 12.5 172,860 5.3 0.8 15.3
Chile. . . . . . . . . . . . . . . . . . . . . . . . . 10,337 5.3 0.8 14.5 15,154 7.2 1.2 16.8
Colombia . . . . . . . . . . . . . . . . . . . . . 25,381 3.6 0.4 11.8 39,686 4.7 0.6 12.2
Costa Rica . . . . . . . . . . . . . . . . . . . 1,968 3.4 0.5 13.6 3,711 5.2 0.9 17.9
Guatemala . . . . . . . . . . . . . . . . . . . 6,018 2.8 0.4 13.1 12,640 3.6 0.5 13.5
Jamaica . . . . . . . . . . . . . . . . . . . . . . 2,013 5.8 0.8 14.5 2,653 6.8 1.5 21.6
Mexico . . . . . . . . . . . . . . . . . . . . . . . 59,099 4.0 0.7 17.9 100,350 4.3 0.6 14.9
Peru . . . . . . . . . . . . . . . . . . . . . . . . . 15,161 3.5 0.3 9.1 27,013 4.7 0.7 15.0
Uruguay. . . . . . . . . . . . . . . . . . . . . . 2,829 9.6 1.6 16.9 3,334 12.9 2.7 21.2
Africa
Egypt . . . . . . . . . . . . . . . . . . . . . . . . 38,841 4.2 0.4 9.7 68,360 3.8 0.4 10.2
Kenya. . . . . . . . . . . . . . . . . . . . . . . . 13,741 3.7 0.5 12.8 30,340 2.7 0.4 13.0
Liberia . . . . . . . . . . . . . . . . . . . . . . . 1,609 3.7 0.9 23.3 3,164 3.4 0.6 16.8
Malawi . . . . . . . . . . . . . . . . . . . . . . . 5,244 2.2 0.2 8.0 10,386 2.8 0.3 9.9
Morocco. . . . . . . . . . . . . . . . . . . . . . 17,305 3.7 0.5 14.2 30,122 4.6 0.7 14.2
Tunisia . . . . . . . . . . . . . . . . . . . . . . . 5,668 3.5 0.5 13.1 9,593 6.0 0.8 13.3
Zimbabwe . . . . . . . . . . . . . . . . . . . . 6,143 2.6 0.3 9.9 11,343 3.5 0.5 14.7

126 An Aging World: 2001 U.S. Census Bureau


Table 1.
Total Population, Percent Elderly, and Percent Oldest Old: 1975, 2000, 2015, and
2030—Con.
(In thousands)

2015 2030

Country Percent of Percent of 80+ as a Percent of Percent of 80+ as a


Total population population percent of Total population population percent of
population 65+ 80+ 65+ population 65+ 80+ 65+

United States . . . . . . . . . . . . . . . . . . . 312,524 14.7 3.8 25.8 351,326 20.0 5.3 26.4
Western Europe
Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,316 18.8 4.9 26.2 8,278 25.2 7.0 27.9
Belgium . . . . . . . . . . . . . . . . . . . . . . . . . . 10,336 19.4 5.7 29.3 10,175 25.4 7.3 28.8
Denmark . . . . . . . . . . . . . . . . . . . . . . . . . 5,521 18.9 4.4 23.6 5,649 23.0 7.1 30.8
France . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,545 18.8 5.8 30.9 61,926 24.0 7.5 31.2
Germany . . . . . . . . . . . . . . . . . . . . . . . . . 85,192 20.2 5.4 26.6 84,939 25.8 7.2 28.1
Greece . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,735 20.6 6.3 30.5 10,316 25.4 7.8 30.8
Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56,631 22.2 6.8 30.5 52,868 28.1 9.0 32.1
Luxembourg . . . . . . . . . . . . . . . . . . . . . . 519 15.3 4.1 27.1 580 19.8 5.2 26.2
Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,767 17.4 4.6 26.3 5,018 22.0 6.6 30.0
Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . 8,900 21.4 5.7 26.8 8,868 25.1 8.6 34.3
United Kingdom . . . . . . . . . . . . . . . . . . . 61,047 18.4 4.9 26.8 61,481 23.5 7.0 29.7
Eastern Europe
Bulgaria . . . . . . . . . . . . . . . . . . . . . . . . . . 6,663 20.2 4.6 23.0 5,668 25.9 7.2 27.8
Czech Republic . . . . . . . . . . . . . . . . . . . 10,048 18.8 4.2 22.3 9,409 24.7 7.4 30.0
Hungary . . . . . . . . . . . . . . . . . . . . . . . . . . 9,666 17.6 4.3 24.2 9,034 22.5 6.3 27.9
Poland . . . . . . . . . . . . . . . . . . . . . . . . . . . 38,668 15.0 3.8 25.1 37,377 22.2 5.5 24.8
Russia . . . . . . . . . . . . . . . . . . . . . . . . . . . 141,073 13.8 3.1 22.7 132,859 20.5 4.1 20.0
Ukraine. . . . . . . . . . . . . . . . . . . . . . . . . . . 45,294 15.0 3.2 21.1 42,273 19.7 4.2 21.5
North America/Oceania
Australia . . . . . . . . . . . . . . . . . . . . . . . . . . 21,697 15.8 4.1 25.9 23,497 21.1 6.0 28.5
Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . 35,653 16.1 4.3 26.8 39,128 22.9 6.2 26.9
New Zealand. . . . . . . . . . . . . . . . . . . . . . 4,396 13.7 3.5 25.7 4,768 17.8 5.0 28.2
Asia
Bangladesh . . . . . . . . . . . . . . . . . . . . . . . 160,486 4.4 0.6 12.5 184,478 7.2 1.0 13.5
China . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,397,414 9.5 1.7 18.0 1,483,121 16.0 2.9 18.3
India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,241,572 5.9 0.9 14.5 1,437,103 9.0 1.4 15.7
Indonesia . . . . . . . . . . . . . . . . . . . . . . . . . 275,152 6.2 1.1 16.9 312,592 10.9 1.7 15.6
Israel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,992 11.1 3.0 26.6 7,873 14.9 3.9 26.5
Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125,843 24.9 7.0 28.2 116,740 28.3 11.1 39.3
Malaysia. . . . . . . . . . . . . . . . . . . . . . . . . . 28,414 5.9 0.8 14.3 35,306 9.4 1.6 16.9
Pakistan . . . . . . . . . . . . . . . . . . . . . . . . . . 185,715 4.5 0.7 15.0 226,251 6.5 0.9 14.4
Philippines . . . . . . . . . . . . . . . . . . . . . . . . 106,098 4.9 0.7 14.6 129,448 7.7 1.2 15.9
Singapore . . . . . . . . . . . . . . . . . . . . . . . . 6,646 8.7 2.1 24.1 9,047 14.8 3.0 20.4
South Korea . . . . . . . . . . . . . . . . . . . . . . 52,239 11.3 2.2 19.3 53,763 19.5 4.2 21.3
Sri Lanka . . . . . . . . . . . . . . . . . . . . . . . . . 21,527 9.5 1.7 17.7 22,937 15.2 3.1 20.2
Thailand . . . . . . . . . . . . . . . . . . . . . . . . . . 68,139 9.8 1.8 18.0 71,311 16.4 3.1 19.3
Turkey. . . . . . . . . . . . . . . . . . . . . . . . . . . . 76,685 7.9 1.6 19.9 84,195 12.9 2.4 18.7
Latin America/Caribbean
Argentina . . . . . . . . . . . . . . . . . . . . . . . . . 42,916 11.8 3.1 26.0 47,229 14.7 4.0 27.3
Brazil. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192,313 8.1 1.5 18.7 203,489 13.2 2.7 20.6
Chile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,405 10.7 2.1 19.3 18,915 16.4 3.7 22.3
Colombia . . . . . . . . . . . . . . . . . . . . . . . . . 49,189 6.5 1.0 15.6 57,666 11.5 1.8 15.9
Costa Rica. . . . . . . . . . . . . . . . . . . . . . . . 4,583 7.3 1.4 19.2 5,272 12.8 2.4 18.9
Guatemala . . . . . . . . . . . . . . . . . . . . . . . . 18,105 4.1 0.7 17.8 24,038 5.6 1.0 17.6
Jamaica . . . . . . . . . . . . . . . . . . . . . . . . . . 2,992 7.4 1.8 24.1 3,353 12.5 2.3 18.7
Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . 121,712 6.3 1.0 16.6 139,125 10.2 1.9 18.7
Peru . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33,551 6.4 1.2 18.3 39,253 9.9 1.9 19.0
Uruguay . . . . . . . . . . . . . . . . . . . . . . . . . . 3,730 13.5 3.8 28.2 4,109 15.5 4.4 28.1
Africa
Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85,219 5.1 0.6 11.9 99,583 8.0 1.1 14.2
Kenya . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33,612 3.8 0.6 16.6 34,836 5.2 1.1 20.7
Liberia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,655 4.0 0.8 21.1 6,745 4.2 1.0 24.9
Malawi . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,017 3.1 0.4 12.7 12,817 3.2 0.6 17.5
Morocco . . . . . . . . . . . . . . . . . . . . . . . . . . 37,832 5.5 1.0 17.4 44,664 9.1 1.4 15.2
Tunisia . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,174 7.6 1.5 19.8 12,322 12.7 2.3 17.7
Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . 10,548 5.0 1.0 20.2 9,086 6.4 1.8 27.7

Source: United Nations, 1999 and U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 127


Table 2.
Population by Age: 2000 and 2030
(In thousands)

2000
Country
0 to 24 25 to 54 55 to 64 65 to 69 70 to 74 75 to 79 80 years
All ages years years years years years years and over

United States . . . . . . . . . . . . . . . 275,563 97,064 119,662 24,001 9,436 8,753 7,422 9,225
Western Europe
Austria . . . . . . . . . . . . . . . . . . . . . . . 8,131 2,325 3,629 926 347 332 294 278
Belgium . . . . . . . . . . . . . . . . . . . . . . 10,242 3,033 4,432 1,052 521 462 383 358
Denmark . . . . . . . . . . . . . . . . . . . . . 5,336 1,594 2,340 610 219 194 167 212
France . . . . . . . . . . . . . . . . . . . . . . . 59,330 18,852 25,513 5,471 2,711 2,466 2,100 2,216
Germany . . . . . . . . . . . . . . . . . . . . . 82,797 22,309 36,224 10,813 4,104 3,592 2,846 2,911
Greece. . . . . . . . . . . . . . . . . . . . . . . 10,602 3,088 4,480 1,195 605 521 341 371
Italy. . . . . . . . . . . . . . . . . . . . . . . . . . 57,634 14,873 25,640 6,696 3,093 2,766 2,253 2,313
Luxembourg . . . . . . . . . . . . . . . . . . 437 133 199 44 19 17 12 13
Norway . . . . . . . . . . . . . . . . . . . . . . 4,481 1,435 1,937 426 167 164 156 196
Sweden . . . . . . . . . . . . . . . . . . . . . . 8,873 2,655 3,674 1,010 380 363 343 447
United Kingdom . . . . . . . . . . . . . . . 59,508 18,549 25,496 6,138 2,585 2,347 2,018 2,373
Eastern Europe
Bulgaria . . . . . . . . . . . . . . . . . . . . . . 7,797 2,354 3,255 902 453 382 282 169
Czech Republic . . . . . . . . . . . . . . . 10,272 3,250 4,505 1,093 448 409 323 244
Hungary. . . . . . . . . . . . . . . . . . . . . . 10,139 3,207 4,336 1,113 479 420 326 257
Poland . . . . . . . . . . . . . . . . . . . . . . . 38,646 13,915 16,676 3,319 1,616 1,372 953 794
Russia . . . . . . . . . . . . . . . . . . . . . . . 146,001 49,232 64,197 14,160 5,996 6,182 3,299 2,936
Ukraine . . . . . . . . . . . . . . . . . . . . . . 49,153 16,052 20,607 5,647 2,080 2,294 1,377 1,096
North America/Oceania
Australia . . . . . . . . . . . . . . . . . . . . . 19,165 6,629 8,427 1,727 668 633 509 573
Canada . . . . . . . . . . . . . . . . . . . . . . 31,278 10,154 14,322 2,838 1,147 1,012 822 984
New Zealand . . . . . . . . . . . . . . . . . 3,820 1,417 1,637 324 124 116 91 110
Asia
Bangladesh. . . . . . . . . . . . . . . . . . . 129,194 76,298 42,947 5,645 1,744 1,206 710 643
China . . . . . . . . . . . . . . . . . . . . . . . . 1,261,832 515,155 572,082 86,822 34,926 25,426 15,908 11,513
India . . . . . . . . . . . . . . . . . . . . . . . . . 1,014,004 536,947 373,956 56,037 18,477 13,785 8,627 6,175
Indonesia. . . . . . . . . . . . . . . . . . . . . 224,784 113,419 88,231 13,080 4,616 2,872 1,559 1,006
Israel . . . . . . . . . . . . . . . . . . . . . . . . 5,842 2,617 2,257 391 168 152 120 138
Japan . . . . . . . . . . . . . . . . . . . . . . . . 126,550 34,782 53,858 16,385 7,031 5,812 4,012 4,670
Malaysia . . . . . . . . . . . . . . . . . . . . . 21,793 11,583 8,175 1,152 353 260 151 119
Pakistan. . . . . . . . . . . . . . . . . . . . . . 141,554 86,109 43,165 6,485 2,317 1,637 1,071 770
Philippines. . . . . . . . . . . . . . . . . . . . 81,160 46,410 28,087 3,717 1,220 820 504 401
Singapore . . . . . . . . . . . . . . . . . . . . 4,152 1,333 2,281 253 98 76 49 61
South Korea . . . . . . . . . . . . . . . . . . 47,471 18,091 22,191 3,875 1,365 895 594 460
Sri Lanka. . . . . . . . . . . . . . . . . . . . . 19,239 8,759 7,933 1,295 455 358 244 195
Thailand. . . . . . . . . . . . . . . . . . . . . . 61,231 25,879 27,045 4,386 1,591 1,086 699 545
Turkey . . . . . . . . . . . . . . . . . . . . . . . 65,667 32,182 25,619 3,935 1,514 1,099 721 597
Latin America/Caribbean
Argentina. . . . . . . . . . . . . . . . . . . . . 36,955 16,326 13,856 2,946 1,209 1,026 761 831
Brazil . . . . . . . . . . . . . . . . . . . . . . . . 172,860 84,691 68,842 10,136 3,501 2,594 1,693 1,403
Chile. . . . . . . . . . . . . . . . . . . . . . . . . 15,154 6,733 6,194 1,133 391 310 210 184
Colombia . . . . . . . . . . . . . . . . . . . . . 39,686 19,897 15,867 2,071 742 546 338 225
Costa Rica . . . . . . . . . . . . . . . . . . . 3,711 1,888 1,438 193 70 53 35 34
Guatemala . . . . . . . . . . . . . . . . . . . 12,640 7,922 3,765 496 184 132 79 62
Jamaica . . . . . . . . . . . . . . . . . . . . . . 2,653 1,312 1,027 135 56 48 36 39
Mexico . . . . . . . . . . . . . . . . . . . . . . . 100,350 54,699 36,241 5,092 1,722 1,197 757 642
Peru . . . . . . . . . . . . . . . . . . . . . . . . . 27,013 14,735 9,606 1,409 500 351 223 189
Uruguay. . . . . . . . . . . . . . . . . . . . . . 3,334 1,348 1,257 298 138 118 84 91
Africa
Egypt . . . . . . . . . . . . . . . . . . . . . . . . 68,360 37,706 24,572 3,509 1,162 748 401 261
Kenya. . . . . . . . . . . . . . . . . . . . . . . . 30,340 20,064 8,423 1,021 340 237 146 108
Liberia . . . . . . . . . . . . . . . . . . . . . . . 3,164 1,985 929 141 43 29 19 18
Malawi . . . . . . . . . . . . . . . . . . . . . . . 10,386 6,955 2,757 385 126 85 49 28
Morocco. . . . . . . . . . . . . . . . . . . . . . 30,122 16,826 10,472 1,434 538 393 262 197
Tunisia . . . . . . . . . . . . . . . . . . . . . . . 9,593 4,834 3,638 542 223 173 106 77
Zimbabwe . . . . . . . . . . . . . . . . . . . . 11,343 7,281 3,238 422 156 112 74 59

128 An Aging World: 2001 U.S. Census Bureau


Table 2.
Population by Age: 2000 and 2030—Con.
(In thousands)

2030
Country
0 to 24 25 to 54 55 to 64 65 to 69 70 to 74 75 to 79 80 years
All ages years years years years years years and over

United States . . . . . . . . . . . . . . . 351,326 115,218 128,484 37,305 19,844 17,878 14,029 18,569
Western Europe
Austria . . . . . . . . . . . . . . . . . . . . . . . 8,278 1,916 3,034 1,244 636 500 367 582
Belgium . . . . . . . . . . . . . . . . . . . . . . 10,175 2,553 3,683 1,357 709 628 501 744
Denmark . . . . . . . . . . . . . . . . . . . . . 5,649 1,515 2,076 760 357 295 246 400
France . . . . . . . . . . . . . . . . . . . . . . . 61,926 16,405 22,599 8,073 3,775 3,435 3,005 4,635
Germany . . . . . . . . . . . . . . . . . . . . . 84,939 20,074 31,104 11,886 6,502 5,192 4,036 6,145
Greece. . . . . . . . . . . . . . . . . . . . . . . 10,316 2,287 3,814 1,594 692 620 503 807
Italy. . . . . . . . . . . . . . . . . . . . . . . . . . 52,868 10,165 18,788 9,033 4,115 3,307 2,685 4,775
Luxembourg . . . . . . . . . . . . . . . . . . 580 164 229 72 35 29 22 30
Norway . . . . . . . . . . . . . . . . . . . . . . 5,018 1,405 1,856 653 295 261 217 331
Sweden . . . . . . . . . . . . . . . . . . . . . . 8,868 2,210 3,267 1,167 555 482 424 763
United Kingdom . . . . . . . . . . . . . . . 61,481 16,077 22,663 8,296 4,215 3,336 2,598 4,296
Eastern Europe
Bulgaria . . . . . . . . . . . . . . . . . . . . . . 5,668 1,096 2,240 866 381 362 315 408
Czech Republic . . . . . . . . . . . . . . . 9,409 1,933 3,718 1,436 583 532 512 696
Hungary. . . . . . . . . . . . . . . . . . . . . . 9,034 2,012 3,662 1,330 485 506 472 566
Poland . . . . . . . . . . . . . . . . . . . . . . . 37,377 9,260 15,184 4,642 2,087 2,267 1,882 2,056
Russia . . . . . . . . . . . . . . . . . . . . . . . 132,859 35,650 53,589 16,428 8,288 7,776 5,681 5,446
Ukraine . . . . . . . . . . . . . . . . . . . . . . 42,273 11,383 17,099 5,479 2,553 2,292 1,683 1,783
North America/Oceania
Australia . . . . . . . . . . . . . . . . . . . . . 23,497 6,643 8,941 2,960 1,356 1,212 975 1,410
Canada . . . . . . . . . . . . . . . . . . . . . . 39,128 10,368 14,987 4,800 2,581 2,249 1,728 2,414
New Zealand . . . . . . . . . . . . . . . . . 4,768 1,400 1,914 607 233 209 166 238
Asia
Bangladesh. . . . . . . . . . . . . . . . . . . 184,478 71,167 84,043 16,060 5,248 3,821 2,356 1,783
China . . . . . . . . . . . . . . . . . . . . . . . . 1,483,121 437,787 588,812 219,501 84,958 59,230 49,367 43,466
India . . . . . . . . . . . . . . . . . . . . . . . . . 1,437,103 558,161 614,683 135,423 49,013 35,886 23,744 20,194
Indonesia. . . . . . . . . . . . . . . . . . . . . 312,592 112,472 132,916 33,067 12,612 9,740 6,450 5,335
Israel . . . . . . . . . . . . . . . . . . . . . . . . 7,873 2,724 3,154 825 327 288 246 310
Japan . . . . . . . . . . . . . . . . . . . . . . . . 116,740 25,589 40,441 17,661 7,094 6,391 6,562 13,002
Malaysia . . . . . . . . . . . . . . . . . . . . . 35,306 15,017 13,891 3,063 1,236 919 617 563
Pakistan. . . . . . . . . . . . . . . . . . . . . . 226,251 95,929 98,625 17,008 5,826 4,186 2,568 2,109
Philippines. . . . . . . . . . . . . . . . . . . . 129,448 55,474 53,369 10,581 3,738 2,814 1,877 1,596
Singapore . . . . . . . . . . . . . . . . . . . . 9,047 2,345 4,158 1,204 468 360 239 274
South Korea . . . . . . . . . . . . . . . . . . 53,763 14,515 20,967 7,819 3,470 2,959 1,803 2,231
Sri Lanka. . . . . . . . . . . . . . . . . . . . . 22,937 7,102 9,580 2,771 1,142 945 694 703
Thailand. . . . . . . . . . . . . . . . . . . . . . 71,311 21,219 28,987 9,441 3,927 3,189 2,303 2,245
Turkey . . . . . . . . . . . . . . . . . . . . . . . 84,195 26,295 36,793 10,231 3,940 2,899 2,002 2,036
Latin America/Caribbean
Argentina. . . . . . . . . . . . . . . . . . . . . 47,229 16,082 19,374 4,834 1,963 1,705 1,376 1,895
Brazil . . . . . . . . . . . . . . . . . . . . . . . . 203,489 66,334 87,458 22,898 9,091 7,080 5,099 5,530
Chile. . . . . . . . . . . . . . . . . . . . . . . . . 18,915 5,863 7,817 2,133 1,006 823 582 691
Colombia . . . . . . . . . . . . . . . . . . . . . 57,666 21,940 23,069 6,034 2,481 1,872 1,217 1,053
Costa Rica . . . . . . . . . . . . . . . . . . . 5,272 1,796 2,248 554 235 188 124 127
Guatemala . . . . . . . . . . . . . . . . . . . 24,038 12,128 9,105 1,455 493 368 252 238
Jamaica . . . . . . . . . . . . . . . . . . . . . . 3,353 1,062 1,447 425 158 110 73 78
Mexico . . . . . . . . . . . . . . . . . . . . . . . 139,125 52,128 58,225 14,646 5,165 3,700 2,621 2,639
Peru . . . . . . . . . . . . . . . . . . . . . . . . . 39,253 14,952 16,694 3,735 1,394 1,031 711 736
Uruguay. . . . . . . . . . . . . . . . . . . . . . 4,109 1,444 1,593 434 183 156 119 179
Africa
Egypt . . . . . . . . . . . . . . . . . . . . . . . . 99,583 38,878 43,516 9,212 3,144 2,261 1,437 1,136
Kenya. . . . . . . . . . . . . . . . . . . . . . . . 34,836 15,729 15,402 1,902 610 472 349 373
Liberia . . . . . . . . . . . . . . . . . . . . . . . 6,745 3,958 2,213 292 92 69 50 70
Malawi . . . . . . . . . . . . . . . . . . . . . . . 12,817 6,856 5,087 466 144 111 81 71
Morocco. . . . . . . . . . . . . . . . . . . . . . 44,664 17,220 19,141 4,225 1,546 1,180 735 618
Tunisia . . . . . . . . . . . . . . . . . . . . . . . 12,322 3,806 5,428 1,517 581 442 270 278
Zimbabwe . . . . . . . . . . . . . . . . . . . . 9,086 4,622 3,566 317 146 147 127 161

Source: U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 129


Table 3.
Average Annual Growth Rate and Percent Change Over Time for Older Age Groups:
2000 to 2015 and 2015 to 2030
(In percent)

Average annual growth rate

2000 to 2015 2015 to 2030


Country
55 to 64 65 to 79 80 years 65 years 55 to 64 65 to 79 80 years 65 years
years years and over and over years years and over and over

United States . . . . . . . . . . . . . . . . . . . 2.5 1.4 1.3 1.4 –0.5 2.8 3.0 2.8
Western Europe
Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 0.9 1.9 1.1 0.9 1.7 2.3 1.9
Belgium . . . . . . . . . . . . . . . . . . . . . . . . . . 1.5 0.2 2.5 0.8 –0.3 1.7 1.6 1.7
Denmark . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 1.6 0.7 1.4 0.6 0.8 3.3 1.5
France . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.9 0.5 2.4 1.0 0.1 1.7 1.7 1.7
Germany . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.9 2.3 1.2 0.2 1.5 2.0 1.6
Greece . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 0.2 3.0 0.9 0.9 1.1 1.2 1.1
Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.4 2.5 0.9 1.3 1.0 1.5 1.1
Luxembourg . . . . . . . . . . . . . . . . . . . . . . 1.8 0.9 2.5 1.3 0.9 2.6 2.2 2.5
Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7 1.1 0.5 1.0 0.6 1.6 2.8 1.9
Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 1.2 0.6 1.1 0.3 0.3 2.7 1.0
United Kingdom . . . . . . . . . . . . . . . . . . . 1.0 0.9 1.2 0.9 0.7 1.4 2.4 1.7
Eastern Europe
Bulgaria . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 –0.4 3.0 0.2 –0.6 0.1 1.8 0.6
Czech Republic . . . . . . . . . . . . . . . . . . . 1.2 1.1 2.8 1.4 0.2 0.7 3.3 1.4
Hungary . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0 0.3 2.3 0.7 –0.1 0.8 2.1 1.2
Poland . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 0.5 3.0 1.0 –1.3 2.4 2.3 2.4
Russia . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.8 –0.2 2.0 0.3 –1.4 2.5 1.4 2.2
Ukraine. . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 –0.4 1.3 –0.1 –0.6 1.3 1.5 1.4
North America/Oceania
Australia . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 1.7 2.2 1.8 0.7 2.2 3.1 2.5
Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 1.7 2.2 1.9 –0.1 3.0 3.0 3.0
New Zealand. . . . . . . . . . . . . . . . . . . . . . 1.9 1.5 1.7 1.6 1.6 2.1 2.9 2.3
Asia
Bangladesh . . . . . . . . . . . . . . . . . . . . . . . 2.8 2.6 1.6 2.5 3.2 4.1 4.7 4.2
China . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.8 1.8 3.6 2.1 2.5 3.8 4.0 3.9
India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 2.2 2.7 2.2 2.6 3.6 4.3 3.7
Indonesia . . . . . . . . . . . . . . . . . . . . . . . . . 2.9 2.3 5.3 2.7 2.3 4.7 4.1 4.6
Israel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 1.3 2.0 1.5 1.3 2.7 2.7 2.7
Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . –0.2 1.5 3.2 1.9 0.7 –0.8 2.6 0.3
Malaysia. . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 3.2 3.5 3.2 2.4 4.3 5.7 4.5
Pakistan . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 1.8 2.5 1.9 3.5 3.8 3.4 3.7
Philippines . . . . . . . . . . . . . . . . . . . . . . . . 3.0 2.7 3.1 2.8 3.0 4.3 5.0 4.4
Singapore . . . . . . . . . . . . . . . . . . . . . . . . 5.2 3.4 4.2 3.6 3.5 5.9 4.5 5.6
South Korea . . . . . . . . . . . . . . . . . . . . . . 2.5 2.5 4.5 2.9 1.4 3.7 4.5 3.8
Sri Lanka . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 2.3 3.1 2.5 1.7 3.3 4.4 3.5
Thailand . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 2.4 3.9 2.6 1.7 3.6 4.2 3.7
Turkey. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 1.9 3.5 2.2 3.0 4.0 3.4 3.9
Latin America/Caribbean
Argentina . . . . . . . . . . . . . . . . . . . . . . . . . 1.6 1.1 2.3 1.4 1.2 2.0 2.4 2.1
Brazil. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 2.4 3.6 2.6 2.1 3.5 4.3 3.6
Chile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 2.5 3.3 2.6 1.1 3.2 4.4 3.4
Colombia . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 2.5 4.0 2.7 2.6 4.8 4.9 4.8
Costa Rica. . . . . . . . . . . . . . . . . . . . . . . . 3.6 2.7 3.1 2.8 2.3 4.7 4.6 4.7
Guatemala . . . . . . . . . . . . . . . . . . . . . . . . 2.9 2.1 3.8 2.4 3.4 4.0 4.0 4.0
Jamaica . . . . . . . . . . . . . . . . . . . . . . . . . . 2.8 0.9 1.6 1.1 4.0 4.7 2.5 4.2
Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 2.8 3.4 2.9 3.6 3.9 4.8 4.1
Peru . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 2.5 3.7 2.7 3.1 3.8 4.2 3.9
Uruguay . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 0.3 2.2 0.8 1.3 1.6 1.6 1.6
Africa
Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 2.5 3.4 2.6 2.9 3.9 5.2 4.0
Kenya . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 1.9 3.4 2.1 2.6 2.0 3.8 2.3
Liberia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.5 2.4 3.8 2.7 2.9 2.5 3.9 2.8
Malawi . . . . . . . . . . . . . . . . . . . . . . . . . . . – 1.1 2.5 1.3 1.3 0.3 2.8 0.6
Morocco . . . . . . . . . . . . . . . . . . . . . . . . . . 3.0 1.8 3.0 2.0 3.3 4.7 3.6 4.5
Tunisia . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 1.5 3.9 1.9 3.4 4.3 3.3 4.1
Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . –0.2 1.1 3.0 1.4 –1.6 – 2.7 0.6

130 An Aging World: 2001 U.S. Census Bureau


Table 3.
Average Annual Growth Rate and Percent Change Over Time for Older Age Groups:
2000 to 2015 and 2015 to 2030—Con.
(In percent)

Percent change

2000 to 2015 2015 to 2030


Country
55 to 64 65 to 79 80 years 65 years 55 to 64 65 to 79 80 years 65 years
years years and over and over years years and over and over

United States . . . . . . . . . . . . . . . . . . . 66 33 29 32 –7 52 56 53
Western Europe
Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 19 48 25 15 30 42 33
Belgium . . . . . . . . . . . . . . . . . . . . . . . . . . 34 4 64 16 –4 30 27 29
Denmark . . . . . . . . . . . . . . . . . . . . . . . . . 14 37 16 32 9 13 63 24
France . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 10 61 22 1 28 30 29
Germany . . . . . . . . . . . . . . . . . . . . . . . . . 6 20 57 28 3 25 34 27
Greece . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 5 81 20 15 18 20 19
Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 8 65 20 22 16 25 18
Luxembourg . . . . . . . . . . . . . . . . . . . . . . 45 19 65 29 14 47 40 45
Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 26 11 22 10 26 52 33
Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . 10 28 14 24 5 5 50 17
United Kingdom . . . . . . . . . . . . . . . . . . . 22 19 27 21 11 23 42 28
Eastern Europe
Bulgaria . . . . . . . . . . . . . . . . . . . . . . . . . . 5 –7 83 5 –8 2 32 9
Czech Republic . . . . . . . . . . . . . . . . . . . 27 25 73 33 4 11 65 23
Hungary . . . . . . . . . . . . . . . . . . . . . . . . . . 22 5 60 15 –2 14 38 19
Poland . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 10 83 22 –17 44 42 43
Russia . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 –3 50 5 –19 45 23 40
Ukraine. . . . . . . . . . . . . . . . . . . . . . . . . . . 6 –7 30 –1 –8 22 25 23
North America/Oceania
Australia . . . . . . . . . . . . . . . . . . . . . . . . . . 55 40 55 44 11 40 59 45
Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . 71 41 56 45 –1 56 57 56
New Zealand. . . . . . . . . . . . . . . . . . . . . . 47 35 40 36 27 36 54 41
Asia
Bangladesh . . . . . . . . . . . . . . . . . . . . . . . 76 69 37 64 62 85 102 87
China . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 43 107 51 45 78 82 78
India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 54 73 57 47 72 89 75
Indonesia . . . . . . . . . . . . . . . . . . . . . . . . . 79 58 188 71 41 102 84 99
Israel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 29 49 34 22 51 50 51
Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . –3 34 89 46 11 –11 47 5
Malaysia. . . . . . . . . . . . . . . . . . . . . . . . . . 84 89 102 91 44 92 134 98
Pakistan . . . . . . . . . . . . . . . . . . . . . . . . . . 55 42 64 45 70 76 67 75
Philippines . . . . . . . . . . . . . . . . . . . . . . . . 82 73 87 75 57 92 112 95
Singapore . . . . . . . . . . . . . . . . . . . . . . . . 182 97 130 104 68 143 96 131
South Korea . . . . . . . . . . . . . . . . . . . . . . 64 66 148 78 23 73 96 78
Sri Lanka . . . . . . . . . . . . . . . . . . . . . . . . . 67 59 86 64 29 65 94 70
Thailand . . . . . . . . . . . . . . . . . . . . . . . . . . 67 62 120 70 29 73 87 75
Turkey. . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 46 103 55 57 81 68 79
Latin America/Caribbean
Argentina . . . . . . . . . . . . . . . . . . . . . . . . . 36 25 59 32 20 35 44 37
Brazil. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 62 107 69 38 68 90 72
Chile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 64 95 70 19 61 93 67
Colombia . . . . . . . . . . . . . . . . . . . . . . . . . 99 66 123 73 47 106 110 107
Costa Rica. . . . . . . . . . . . . . . . . . . . . . . . 105 71 87 74 40 103 98 102
Guatemala . . . . . . . . . . . . . . . . . . . . . . . . 77 54 113 62 65 83 81 83
Jamaica . . . . . . . . . . . . . . . . . . . . . . . . . . 74 20 39 24 81 102 46 88
Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 74 99 78 72 80 107 84
Peru . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 64 108 71 58 78 87 80
Uruguay . . . . . . . . . . . . . . . . . . . . . . . . . . 20 6 55 16 21 27 26 27
Africa
Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 66 99 69 55 78 118 83
Kenya . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 47 96 53 47 35 76 42
Liberia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 62 116 71 54 45 79 52
Malawi . . . . . . . . . . . . . . . . . . . . . . . . . . . –1 25 65 29 22 4 51 10
Morocco . . . . . . . . . . . . . . . . . . . . . . . . . . 80 43 83 49 63 103 72 97
Tunisia . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 36 120 47 66 90 65 85
Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . –4 24 81 32 –22 –1 50 10

Source: U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 131


Table 4.
Median Population Age: 2000, 2015, and 2030
Country 2000 2015 2030

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 38 39
Western Europe
Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 44 47
Belgium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 43 46
Denmark . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 42 43
France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 42 44
Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 45 47
Greece. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 44 49
Italy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 46 52
Luxembourg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 40 41
Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 41 42
Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 43 45
United Kingdom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 42 44
Eastern Europe
Bulgaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 44 50
Czech Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 43 49
Hungary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 42 47
Poland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 39 46
Russia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 39 44
Ukraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 39 44
North America/Oceania
Australia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 39 42
Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 41 44
New Zealand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 37 40
Asia
Bangladesh. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 27 33
China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 36 41
India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 28 32
Indonesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 30 34
Israel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 32 36
Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 45 50
Malaysia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 26 30
Pakistan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 24 29
Philippines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 25 29
Singapore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 38 41
South Korea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 38 43
Sri Lanka. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 33 39
Thailand. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 35 40
Turkey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 32 38
Latin America/Caribbean
Argentina. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 32 36
Brazil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 31 37
Chile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 33 39
Colombia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 29 33
Costa Rica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 30 36
Guatemala . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 21 25
Jamaica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 31 38
Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 28 34
Peru . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 27 33
Uruguay. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 34 36
Africa
Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 27 32
Kenya. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 23 28
Liberia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 18 20
Malawi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 20 23
Morocco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 27 33
Tunisia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 32 39
Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 22 25

Source: U.S. Census Bureau, 2000a.

132 An Aging World: 2001 U.S. Census Bureau


Table 5.
Total and Elderly Urban Population by Sex: Available Data From 1970 to the Present
Males Females
Country
Percent Percent Elderly
Year All ages Elderly elderly All ages Elderly elderly sex ratio

United States . . . . . . . . . . . . 1970 71,958,564 5,859,472 8.1 77,366,366 8,771,643 11.3 67


1980 80,287,243 7,327,774 9.1 86,767,395 11,672,992 13.5 63
1990 90,386,114 9,179,593 10.2 96,667,373 14,388,961 14.9 64
Western Europe
Austria . . . . . . . . . . . . . . . . . . . . 1971 1,762,775 223,701 12.7 2,103,790 403,229 19.2 55
1981 1,919,638 244,735 12.7 2,241,407 463,164 20.7 53
1991 2,386,002 272,021 11.4 2,646,187 533,663 20.2 51
Denmark . . . . . . . . . . . . . . . . . . 1970 1,922,558 206,818 10.8 2,023,599 290,237 14.3 71
1981 2,089,529 251,479 12.0 2,207,563 376,266 17.0 67
France . . . . . . . . . . . . . . . . . . . . 1975 18,658,540 1,858,540 10.0 19,728,800 3,054,920 15.5 61
1982 19,239,340 1,912,080 9.9 20,560,480 3,204,660 15.6 60
1990 20,194,431 2,236,685 11.1 21,728,802 3,625,554 16.7 62
Greece. . . . . . . . . . . . . . . . . . . . 1971 2,781,700 239,820 8.6 2,904,040 317,300 10.9 76
1981 3,311,565 316,153 9.5 3,478,383 413,686 11.9 76
1991 2,914,404 301,833 10.4 3,124,577 412,831 13.2 73
Norway . . . . . . . . . . . . . . . . . . . 1970 1,241,873 122,137 9.8 1,313,040 182,976 13.9 67
1980 1,409,663 133,166 9.4 1,483,530 211,705 14.3 63
1990 1,488,678 188,455 12.7 1,567,516 287,279 18.3 66
Sweden . . . . . . . . . . . . . . . . . . . 1970 3,232,096 342,732 10.6 3,342,837 474,392 14.2 72
1975 3,327,513 403,825 12.1 3,461,919 564,329 16.3 72
1980 3,378,530 452,876 13.4 3,534,963 642,174 18.2 71
1990 3,494,512 517,841 14.8 3,670,257 753,536 20.5 69
Eastern Europe
Bulgaria . . . . . . . . . . . . . . . . . . . 1975 2,517,816 174,000 6.9 2,543,653 218,000 8.6 80
1987 2,923,029 221,049 7.6 2,998,215 281,896 9.4 78
1994 2,789,501 277,493 9.9 2,926,403 360,531 12.3 77
1996 2,741,483 272,800 10.0 2,893,119 364,313 12.6 75
Czech Republic . . . . . . . . . . . . 1994 3,731,186 365,443 9.8 3,989,275 602,153 15.1 61
1996 3,719,889 378,763 10.2 3,974,872 618,011 15.5 61
Hungary. . . . . . . . . . . . . . . . . . . 1970 2,217,658 205,423 9.3 2,449,193 326,340 13.3 63
1980 2,733,600 283,600 10.4 2,968,000 447,900 15.1 63
1988 3,000,826 289,051 9.6 3,284,713 486,970 14.8 59
1995 3,038,844 328,028 10.8 3,401,226 551,982 16.2 59
1996 3,037,842 331,902 10.9 3,405,105 559,268 16.4 59
Poland . . . . . . . . . . . . . . . . . . . . 1970 8,167,184 464,200 5.7 8,887,220 847,900 9.5 55
1978 9,667,100 660,000 6.8 10,472,600 1,171,000 11.2 56
1988 11,120,389 716,691 6.4 12,054,337 1,286,368 10.7 56
1994 11,422,337 847,910 7.4 12,435,702 1,476,495 11.9 57
1996 11,429,857 916,922 8.0 12,466,966 1,560,339 12.5 59
Russia . . . . . . . . . . . . . . . . . . . . 1970 36,930,897 1,432,200 3.9 43,700,474 3,909,327 8.9 37
1979 43,754,734 2,300,003 5.3 51,187,562 5,966,210 11.7 39
1989 50,332,668 2,566,076 5.1 57,626,334 6,960,412 12.1 37
1995 50,405,185 3,684,024 7.3 57,373,948 8,329,645 14.5 44
Ukraine . . . . . . . . . . . . . . . . . . . 1970 11,823,177 586,310 5.0 13,722,473 1,248,423 9.1 47
1979 13,953,878 887,799 6.4 16,215,059 1,897,668 11.7 47
1989 15,981,442 972,137 6.1 18,315,789 2,222,828 12.1 44
1995 16,298,622 1,292,193 7.9 18,529,728 2,602,852 14.0 50
North America/Oceania
Australia . . . . . . . . . . . . . . . . . . 1971 5,424,345 379,844 7.0 5,489,106 557,526 10.2 68
1976 5,768,584 436,202 7.6 5,881,892 636,732 10.8 69
1986 6,567,861 605,540 9.2 6,749,084 867,372 12.9 70
Canada . . . . . . . . . . . . . . . . . . . 1971 8,104,535 557,750 6.9 8,306,250 762,300 9.2 73
1976 8,528,975 635,970 7.5 8,838,000 905,065 10.2 70
1981 9,013,665 746,085 8.3 9,422,265 1,096,860 11.6 68
1991 10,175,040 1,002,465 9.9 10,731,835 1,500,100 14.0 67

U.S. Census Bureau An Aging World: 2001 133


Table 5.
Total and Elderly Urban Population by Sex: Available Data From 1970 to the Present—Con.
Males Females
Country
Percent Percent Elderly
Year All ages Elderly elderly All ages Elderly elderly sex ratio

New Zealand . . . . . . . . . . . . . . 1981 1,299,006 115,065 8.9 1,351,878 165,414 12.2 70


1991 1,395,495 140,316 10.1 1,471,236 200,823 13.6 70
Africa
Egypt . . . . . . . . . . . . . . . . . . . . . 1976 8,539,623 265,355 3.1 8,018,049 247,043 3.1 107
1986 10,908,850 444,257 4.1 10,306,654 358,645 3.5 124
Kenya. . . . . . . . . . . . . . . . . . . . . 1979 1,307,158 21,142 1.6 1,075,045 18,128 1.7 117
1989 1,933,437 23,090 1.2 1,606,451 21,877 1.4 106
Malawi . . . . . . . . . . . . . . . . . . . . 1977 253,545 3,842 1.5 217,113 3,203 1.5 120
1987 445,863 7,085 1.6 407,527 6,479 1.6 109
Morocco. . . . . . . . . . . . . . . . . . . 1971 2,627,918 94,678 3.6 2,740,046 103,436 3.8 92
1982 4,378,706 138,248 3.2 4,354,801 140,753 3.2 98
Tunisia . . . . . . . . . . . . . . . . . . . . 1975 1,401,510 50,650 3.6 1,377,670 46,990 3.4 108
1984 1,869,010 83,920 4.5 1,816,460 75,490 4.2 111
1994 2,717,168 137,874 5.1 2,644,759 138,586 5.2 99
Zimbabwe . . . . . . . . . . . . . . . . . 1982 940,620 28,540 3.0 825,130 16,290 2.0 175
1992 1,636,352 32,614 2.0 1,551,368 28,651 1.8 114
Asia
Bangladesh. . . . . . . . . . . . . . . . 1974 3,538,531 84,854 2.4 2,734,781 63,247 2.3 134
1981 7,370,000 226,000 3.1 5,858,000 157,000 2.7 144
1988 8,163,604 212,600 2.6 6,918,309 131,859 1.9 161
1991 11,301,085 305,677 2.7 9,571,119 222,943 2.3 137
China . . . . . . . . . . . . . . . . . . . . . 1982 107,915,090 4,183,470 3.9 98,332,070 5,186,590 5.3 81
1990 157,491,587 7,081,751 4.5 142,665,833 8,260,440 5.8 86
India . . . . . . . . . . . . . . . . . . . . . . 1971 58,718,371 1,526,269 2.6 50,378,274 1,494,668 3.0 102
1981 83,876,401 2,486,231 3.0 73,803,766 2,545,642 3.4 98
Indonesia. . . . . . . . . . . . . . . . . . 1971 10,194,359 196,839 1.9 10,255,961 245,422 2.4 80
1980 16,439,900 374,916 2.3 16,401,825 489,857 3.0 77
1990 27,683,319 800,720 2.9 27,750,471 981,431 3.5 82
Israel . . . . . . . . . . . . . . . . . . . . . 1972 1,343,341 100,705 7.5 1,341,228 104,050 7.8 97
1983 1,793,397 156,353 8.7 1,822,632 177,579 9.7 88
1994 2,390,900 205,500 8.6 2,453,000 271,200 11.1 76
1995 2,452,000 211,000 8.6 2,518,500 281,200 11.2 75
Japan . . . . . . . . . . . . . . . . . . . . . 1970 36,889,500 2,044,900 5.5 37,799,200 2,612,500 6.9 78
1975 41,988,960 2,579,504 6.1 42,933,417 3,387,121 7.9 76
1980 43,979,403 3,094,757 7.0 45,138,389 4,218,737 9.3 73
1985 45,766,358 3,559,634 7.8 47,082,519 5,138,386 10.9 69
1990 47,124,420 4,224,745 9.0 48,519,101 6,279,911 12.9 67
1995 48,210,196 5,385,903 11.2 49,798,911 7,693,917 15.4 70
Malaysia . . . . . . . . . . . . . . . . . . 1970 1,402,000 40,628 2.9 1,378,254 45,916 3.3 88
1980 2,044,873 69,340 3.4 2,028,232 79,699 3.9 87
1991 4,472,970 133,071 3.0 4,425,611 167,315 3.8 80
Pakistan. . . . . . . . . . . . . . . . . . . 1972 9,019,171 289,765 3.2 7,561,180 213,461 2.8 136
1981 12,767,061 446,804 3.5 11,074,410 327,383 3.0 136
1990 14,514,629 433,128 3.0 13,542,746 383,029 2.8 113
Philippines. . . . . . . . . . . . . . . . . 1970 5,670,816 149,101 2.6 5,999,388 170,339 2.8 88
1975 6,553,324 182,848 2.8 6,752,757 198,287 2.9 92
1980 8,765,413 244,103 2.8 9,178,240 341,658 3.7 71
1990 14,546,463 415,222 2.9 14,893,690 537,747 3.6 77
Singapore . . . . . . . . . . . . . . . . . 1970 1,062,127 30,589 2.9 1,012,380 38,775 3.8 79
1980 1,231,760 51,202 4.2 1,182,185 62,722 5.3 82
1990 1,517,776 75,403 5.0 1,498,603 93,266 6.2 81
South Korea . . . . . . . . . . . . . . . 1975 8,369,909 128,569 1.5 8,400,037 253,528 3.0 51
1980 10,697,843 183,694 1.7 10,711,606 365,207 3.4 50
1985 13,154,130 271,087 2.1 13,263,842 521,815 3.9 52
1995 17,595,723 536,398 3.0 17,396,241 978,119 5.6 55

134 An Aging World: 2001 U.S. Census Bureau


Table 5.
Total and Elderly Urban Population by Sex: Available Data From 1970 to the Present—Con.
Males Females
Country
Percent Percent Elderly
Year All ages Elderly elderly All ages Elderly elderly sex ratio

Sri Lanka. . . . . . . . . . . . . . . . . . 1971 1,513,102 58,346 3.9 1,335,014 56,084 4.2 104
1981 1,665,539 68,979 4.1 1,528,940 72,270 4.7 95
Thailand. . . . . . . . . . . . . . . . . . . 1970 2,257,068 55,778 2.5 2,296,032 79,328 3.5 70
1980 3,744,425 109,059 2.9 3,888,491 147,891 3.8 74
1990 4,941,000 173,200 3.5 5,265,900 230,700 4.4 75
Turkey . . . . . . . . . . . . . . . . . . . . 1980 10,272,130 345,047 3.4 9,372,877 457,407 4.9 75
1985 14,010,670 399,207 2.8 12,855,087 532,949 4.1 75
1990 17,247,553 518,630 3.0 16,078,798 675,302 4.2 77
Latin America/Caribbean
Argentina. . . . . . . . . . . . . . . . . . 1980 11,213,938 820,687 7.3 11,978,954 1,159,370 9.7 71
1995 14,820,662 1,185,585 8.0 15,736,243 1,761,004 11.2 67
Brazil . . . . . . . . . . . . . . . . . . . . . 1970 25,173,439 803,470 3.2 26,801,506 1,010,184 3.8 80
1980 39,192,230 1,447,919 3.7 41,172,542 1,864,900 4.5 78
1991 53,854,256 2,333,327 4.3 57,136,734 3,082,663 5.4 76
Chile. . . . . . . . . . . . . . . . . . . . . . 1970 3,173,323 139,527 4.4 3,501,814 193,934 5.5 72
1982 4,464,374 219,108 4.9 4,851,754 313,023 6.5 70
1992 5,364,760 288,375 5.4 5,775,645 427,059 7.4 68
1997 6,052,039 324,862 5.4 6,368,467 503,897 7.9 64
Colombia . . . . . . . . . . . . . . . . . . 1973 5,904,613 172,482 2.9 6,703,236 232,676 3.5 74
1985 8,927,542 321,963 3.6 9,786,011 407,186 4.2 79
1993 11,211,708 472,784 4.2 12,302,362 593,057 4.8 80
Costa Rica . . . . . . . . . . . . . . . . 1973 360,701 14,033 3.9 399,378 18,497 4.6 76
1984 514,426 24,261 4.7 560,828 32,416 5.8 75
1995 674,634 53,926 8.0 694,787 69,823 10.0 77
Guatemala . . . . . . . . . . . . . . . . 1973 905,685 29,216 3.2 972,506 36,717 3.8 80
1981 949,676 35,220 3.7 1,030,857 42,529 4.1 83
Jamaica . . . . . . . . . . . . . . . . . . . 1982 494,155 23,230 4.7 551,886 33,216 6.0 70
1991 543,108 27,635 5.1 605,083 39,724 6.6 70
Mexico . . . . . . . . . . . . . . . . . . . . 1970 13,882,914 463,048 3.3 14,425,642 580,730 4.0 80
1995 32,720,158 1,277,431 3.9 34,283,357 1,570,619 4.6 81
Peru . . . . . . . . . . . . . . . . . . . . . . 1972 4,028,169 125,390 3.1 4,030,326 154,174 3.8 81
1981 5,517,769 193,224 3.5 5,574,154 225,243 4.0 86
1993 7,606,489 324,827 4.3 7,852,110 372,285 4.7 87
Uruguay. . . . . . . . . . . . . . . . . . . 1975 1,099,634 99,670 9.1 1,214,722 138,060 11.4 72
1985 1,222,260 119,891 9.8 1,358,827 177,647 13.1 67
1990 1,306,601 130,547 10.0 1,441,721 194,640 13.5 67
1996 1,366,092 148,110 10.8 1,505,985 225,783 15.0 66

Notes: ‘‘Urban’’ refers to localities defined as such by each country. Individual national definitions are available in the annotations to
respective International Data Base tables.
‘‘Elderly Sex Ratio’’ is defined as the number of men aged 65 years and over per 100 women aged 65 years and over.
Source: U.S. Census Bureau, 2000a.

U.S. Census Bureau An Aging World: 2001 135


Table 6.
Sex Ratio for Population 25 Years and Over by Age: 2000 and 2030
(Men per 100 women)

2000 2030

Country 25 to 55 to 65 to 70 to 75 to 25 to 55 to 65 to 70 to 75 to
54 64 69 74 79 80 years 54 64 69 74 79 80 years
years years years years years and over years years years years years and over

United States. . . . . . . . . . . 98 91 85 79 72 52 98 92 89 86 81 64
Western Europe
Austria . . . . . . . . . . . . . . . . . . 103 95 85 72 50 38 104 99 96 89 79 58
Belgium . . . . . . . . . . . . . . . . . 102 96 87 78 66 41 102 98 93 87 80 57
Denmark. . . . . . . . . . . . . . . . . 103 99 90 82 70 49 102 98 96 90 82 62
France . . . . . . . . . . . . . . . . . . 100 96 85 77 66 46 103 96 88 82 76 57
Germany . . . . . . . . . . . . . . . . 105 98 89 73 49 35 102 98 94 87 77 56
Greece . . . . . . . . . . . . . . . . . . 100 94 89 83 75 67 105 98 91 87 82 65
Italy . . . . . . . . . . . . . . . . . . . . . 100 92 85 77 66 50 102 96 91 86 77 58
Luxembourg. . . . . . . . . . . . . . 102 99 88 78 53 42 98 94 92 86 79 59
Norway . . . . . . . . . . . . . . . . . . 104 99 91 83 70 50 100 97 95 90 82 62
Sweden . . . . . . . . . . . . . . . . . 104 101 91 83 75 54 104 99 96 91 83 64
United Kingdom . . . . . . . . . . 102 97 91 82 70 45 105 101 96 90 81 60
Eastern Europe
Bulgaria . . . . . . . . . . . . . . . . . 97 87 82 75 67 62 102 89 79 72 63 48
Czech Republic. . . . . . . . . . . 101 90 78 67 55 42 103 97 89 81 71 53
Hungary . . . . . . . . . . . . . . . . . 98 80 70 62 53 43 102 92 80 70 61 42
Poland . . . . . . . . . . . . . . . . . . 100 85 75 65 54 44 102 94 84 76 66 49
Russia. . . . . . . . . . . . . . . . . . . 96 73 62 51 33 26 97 84 72 62 52 39
Ukraine . . . . . . . . . . . . . . . . . . 93 73 66 54 37 29 97 80 67 58 49 34
North America/Oceania
Australia . . . . . . . . . . . . . . . . . 102 101 94 88 75 55 102 98 93 87 80 66
Canada. . . . . . . . . . . . . . . . . . 101 97 92 83 71 52 102 97 93 87 79 61
New Zealand . . . . . . . . . . . . . 101 97 95 89 74 53 103 101 92 86 79 62
Asia
Bangladesh . . . . . . . . . . . . . . 104 116 115 118 126 128 104 101 97 96 100 105
China . . . . . . . . . . . . . . . . . . . 106 108 101 93 80 59 107 100 95 90 80 63
India . . . . . . . . . . . . . . . . . . . . 106 108 103 100 106 106 107 99 90 92 92 89
Indonesia . . . . . . . . . . . . . . . . 100 89 83 79 74 64 101 95 90 85 78 59
Israel . . . . . . . . . . . . . . . . . . . . 101 91 84 74 72 70 104 101 96 87 80 66
Japan . . . . . . . . . . . . . . . . . . . 102 95 89 83 64 48 104 100 94 88 81 61
Malaysia . . . . . . . . . . . . . . . . . 99 96 84 80 71 64 104 97 86 76 71 61
Pakistan . . . . . . . . . . . . . . . . . 104 98 98 97 95 96 105 102 95 87 78 70
Philippines . . . . . . . . . . . . . . . 96 91 85 79 76 77 102 92 83 74 67 61
Singapore. . . . . . . . . . . . . . . . 94 100 88 83 76 59 85 84 86 86 81 64
South Korea . . . . . . . . . . . . . 103 94 76 62 55 40 108 97 88 82 75 56
Sri Lanka . . . . . . . . . . . . . . . . 93 90 92 93 93 94 96 86 78 72 68 63
Thailand . . . . . . . . . . . . . . . . . 96 91 85 82 75 59 102 90 82 77 71 56
Turkey. . . . . . . . . . . . . . . . . . . 105 96 93 91 84 62 102 101 98 91 83 63
Latin America/Caribbean
Argentina . . . . . . . . . . . . . . . . 100 92 82 74 66 56 102 95 89 83 75 58
Brazil. . . . . . . . . . . . . . . . . . . . 96 85 78 70 63 50 98 88 80 74 67 52
Chile . . . . . . . . . . . . . . . . . . . . 99 91 83 76 68 46 102 96 90 85 76 55
Colombia . . . . . . . . . . . . . . . . 94 82 85 83 80 72 97 89 84 79 70 53
Costa Rica . . . . . . . . . . . . . . . 101 100 95 91 84 71 104 99 91 86 81 67
Guatemala . . . . . . . . . . . . . . . 98 94 93 91 83 75 101 94 89 84 76 67
Jamaica . . . . . . . . . . . . . . . . . 98 93 89 85 78 68 104 99 90 79 75 65
Mexico . . . . . . . . . . . . . . . . . . 92 89 87 84 77 65 98 89 79 73 68 57
Peru . . . . . . . . . . . . . . . . . . . . 101 97 93 87 80 68 101 97 93 89 82 68
Uruguay . . . . . . . . . . . . . . . . . 97 87 82 75 68 53 103 96 86 78 72 52
Africa
Egypt. . . . . . . . . . . . . . . . . . . . 102 91 85 79 70 64 102 100 85 78 69 53
Kenya . . . . . . . . . . . . . . . . . . . 101 85 78 80 80 77 108 88 73 66 61 56
Liberia. . . . . . . . . . . . . . . . . . . 90 109 109 103 92 87 98 85 77 76 79 87
Malawi . . . . . . . . . . . . . . . . . . 96 73 70 69 69 68 111 81 57 47 41 37
Morocco . . . . . . . . . . . . . . . . . 98 84 83 86 84 81 101 94 88 84 75 58
Tunisia . . . . . . . . . . . . . . . . . . 99 89 95 99 105 117 104 98 92 87 79 69
Zimbabwe . . . . . . . . . . . . . . . 101 97 105 108 104 90 130 105 70 55 52 56

Source: U.S. Census Bureau, 2000a.

136 An Aging World: 2001 U.S. Census Bureau


Table 7.
Marital Status of Older Persons by Sex: Selected Years 1970 to 1995
Males Females
Country, year, and age
Separated/ Percent Separated/ Percent
Total Single Married Widowed divorced widowed Total Single Married Widowed divorced widowed

U.S. Census Bureau


United States
1977
55 to 64 . . . . . . . . . . . . . . . . . 9,476,000 549,000 8,109,000 323,000 495,000 3.4 10,601,000 492,000 7,434,000 2,023,000 652,000 19.1
65 and over . . . . . . . . . . . . . . 9,132,000 539,000 7,007,000 1,298,000 288,000 14.2 12,968,000 831,000 5,029,000 6,750,000 358,000 52.1
75 and over . . . . . . . . . . . . . . 2,991,000 139,000 2,070,000 727,000 55,000 24.3 4,968,000 327,000 1,070,000 3,463,000 108,000 69.7
1987
55 to 64 . . . . . . . . . . . . . . . . . 10,277,000 591,000 8,439,000 293,000 954,000 2.9 11,606,000 485,000 7,903,000 1,935,000 1,283,000 16.7
65 and over . . . . . . . . . . . . . . 11,576,000 526,000 8,806,000 1,622,000 622,000 14.0 16,396,000 898,000 6,565,000 8,070,000 863,000 49.2
75 and over . . . . . . . . . . . . . . 3,969,000 172,000 2,692,000 937,000 168,000 23.6 6,773,000 435,000 1,577,000 4,541,000 220,000 67.0
1990
55 to 64 . . . . . . . . . . . . . . . . . 9,981,417 556,412 8,004,491 347,468 1,073,046 3.5 11,166,506 508,048 7,398,225 1,776,893 1,483,340 15.9
65 and over . . . . . . . . . . . . . . 12,565,173 618,893 9,398,672 1,781,502 766,106 14.2 18,676,658 1,025,944 7,218,018 9,225,990 1,206,706 49.4
75 and over . . . . . . . . . . . . . . 4,623,560 226,579 3,111,154 1,079,851 205,976 23.4 8,511,713 535,978 1,964,130 5,638,182 373,423 66.2
1995
55 to 64 . . . . . . . . . . . . . . . . . 9,878,000 494,000 7,821,000 275,000 1,288,000 2.8 10,878,000 467,000 7,152,000 1,405,000 1,854,000 12.9
65 and over . . . . . . . . . . . . . . 13,002,000 543,000 9,693,000 1,755,000 1,011,000 13.5 18,262,000 768,000 7,421,000 8,636,000 1,437,000 47.3
75 and over . . . . . . . . . . . . . . 4,905,000 201,000 3,353,000 1,062,000 289,000 21.7 8,145,000 360,000 2,057,000 5,284,000 444,000 64.9
Western Europe
Austria
1975
55 to 64 . . . . . . . . . . . . . . . . . 292,514 18,067 251,872 11,958 10,617 4.1 418,214 45,134 234,142 115,307 23,631 27.6
65 and over . . . . . . . . . . . . . . 419,222 27,803 303,413 76,226 11,780 18.2 712,408 89,807 198,134 398,481 25,986 55.9
75 and over . . . . . . . . . . . . . . 128,104 8,290 75,050 42,124 2,640 32.9 270,703 36,463 37,532 189,810 6,898 70.1
1982
55 to 64 . . . . . . . . . . . . . . . . . 325,102 18,770 282,401 11,910 12,021 3.7 464,436 48,055 287,062 100,012 29,307 21.5
65 and over . . . . . . . . . . . . . . 398,381 25,044 288,932 72,426 11,979 18.2 717,382 83,309 189,290 414,188 30,595 57.7
75 and over . . . . . . . . . . . . . . 151,921 9,974 92,455 45,729 3,763 30.1 318,738 39,736 45,590 223,728 9,684 70.2
1991
55 to 64 . . . . . . . . . . . . . . . . . 368,200 24,300 309,800 14,600 19,500 4.0 406,700 33,400 269,400 76,300 27,600 18.8
65 and over . . . . . . . . . . . . . . 404,400 21,500 303,400 66,100 13,400 16.3 762,500 78,900 229,900 414,900 38,800 54.4
80 and over . . . . . . . . . . . . . . 81,000 4,900 45,500 28,700 1,900 35.4 201,800 22,600 19,900 152,200 7,100 75.4
Belgium
1970
55 to 64 . . . . . . . . . . . . . . . . . 510,104 41,674 432,431 27,202 8,797 5.3 568,179 47,653 397,082 112,424 11,020 19.8

An Aging World: 2001


65 and over . . . . . . . . . . . . . . 531,595 36,822 367,496 121,407 5,870 22.8 764,113 76,475 289,108 388,803 9,727 50.9
75 and over . . . . . . . . . . . . . . 165,281 10,634 87,673 65,842 1,132 39.8 278,504 31,894 57,762 185,981 2,867 66.8

137
Table 7.