《亞洲開發銀行：2024人口老齡化現狀與老年人福祉提升舉措：亞洲發展政策報告（英文版）（162頁）.pdf》由會員分享，可在線閱讀，更多相關《亞洲開發銀行：2024人口老齡化現狀與老年人福祉提升舉措：亞洲發展政策報告（英文版）（162頁）.pdf（162頁珍藏版）》請在三個皮匠報告上搜索。

1、ASIAN DEVELOPMENT BANKASIAN DEVELOPMENT BANK6 ADB Avenue,Mandaluyong City1550 Metro Manila,Philippineswww.adb.orgAging Well in AsiaAsian Development Policy ReportThis inaugural Asian Development Policy Report examines progress in Asia and the Pacific in preparing for and achieving well-being among o

2、lder people.It explores four linked dimensions of well-being:health,productive work,economic security,and social engagement.The report provides new data and analysis to help inform policy debates in the region.It highlights the need for lifelong investment in human capital,a life-cycle approach to i

3、ntervention for age-specific needs,and population-wide outreach to people of all ages.About the Asian Development BankADB is committed to achieving a prosperous,inclusive,resilient,and sustainable Asia and the Pacific,while sustaining its efforts to eradicate extreme poverty.Established in 1966,it i

4、s owned by 68 members 49 from the region.Its main instruments for helping its developing member countries are policy dialogue,loans,equity investments,guarantees,grants,and technical assistance.MAY 2024AGING WELL IN ASIAASIAN DEVELOPMENT POLICY REPORTASIAN DEVELOPMENT BANKMAY 2024AGING WELL IN ASIAA

5、SIAN DEVELOPMENT POLICY REPORTCreative Commons Attribution 3.0 IGO license(CC BY 3.0 IGO)2024 Asian Development Bank6 ADB Avenue,Mandaluyong City,1550 Metro Manila,PhilippinesTel+63 2 8632 4444;Fax+63 2 8636 2444www.adb.orgSome rights reserved.Published in 2024.ISBN 978-92-9270-692-0(print);978-92-9

6、270-693-7(PDF);978-92-9270-694-4(e-book)Publication Stock No.SGP240253-3DOI:http:/dx.doi.org/10.22617/SGP240253-3 The views expressed in this publication are those of the authors and do not necessarily reflect the views and policies ofthe Asian Development Bank(ADB)or its Board of Governors or the g

7、overnments they represent.ADB does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any consequence of their use.The mention of specific companies or products of manufacturers does not imply that they are endorsed or recommended by ADB in preferen

8、ce to others of a similar nature that are not mentioned.By making any designation of or reference to a particular territory or geographic area inthis document,ADB does not intend to make any judgments as to the legal or other status of any territory or area.This publication is available under the Cr

9、eative Commons Attribution 3.0 IGO license(CC BY 3.0 IGO)https:/creativecommons.org/licenses/by/3.0/igo/.By using the content of this publication,you agree to be bound bytheterms of this license.For attribution,translations,adaptations,and permissions,please read the provisions andterms of use at ht

10、tps:/www.adb.org/terms-use#openaccess.This CC license does not apply to non-ADB copyright materials in this publication.If the material is attributed toanother source,please contact the copyright owner or publisher of that source for permission to reproduce it.ADB cannot be held liable for any claim

11、s that arise as a result of your use of the material.Please contact pubsmarketingadb.org if you have questions or comments with respect to content,or if you wish toobtain copyright permission for your intended use that does not fall within these terms,or for permission to use theADB logo.Corrigenda

12、to ADB publications may be found at http:/www.adb.org/publications/corrigenda.Notes:In this publication,“$”refers to United States dollars.ADB recognizes“China”as the Peoples Republic of China,“Korea”as the Republic of Korea,“United States of America”as the“United States”,and“Vietnam”as Viet Nam.Cov

13、er design by Cleone Baradas.Printed on recycled paperContentsTables,Figures,and Boxes vForeword viiiAcknowledgments ixAbbreviations xiDefinitions and Assumptions xiiiHighlights xiv1 The Well-Being of Older Asians to the Fore 1 1.1 Asias Aging Population 4 1.2 Changing Profile of Older People 8 1.3 A

14、ging and Poverty 12 1.4 Well-Being of Older People 14 1.5 Conclusion 192 Health of Older People 20 2.1 Extended Life Expectancy and Health in Older Populations 20 2.2 Health Status of Older People in Asia:Evidence from Survey Data 24 2.3 Health System Access,Universal Health Coverage,and Healthy Agi

15、ng Policies 34 2.4 Policy Directions to Promote Healthy Aging and Older Peoples Health 38 2.5 Conclusion 393 Work and Retirement of Older Persons 41 3.1 A Snapshot of the Labor Market for Older Workers 42 3.2 Well-Being and Work in Old Age 50 3.3 Policies for Productive Aging 65 3.4 Conclusion 674 E

16、conomic Security in Old Age and Pensions 69 4.1 Income and Asset Profiles of Older People and Their Families 69 4.2 Pension Systems in Developing Asia:Current State,Salient Challenges,and Some Key Issues 79 4.3 Policies for Economically Secure Aging 93 4.4 Conclusion 965 Family,Care,and Social Engag

17、ement 96 5.1 Living Arrangements and Family Relationships 96 5.2 Family and Informal Care 100 5.3 Isolation,Loneliness,and Social Engagement 110 5.4 Conclusion 1176 Living Well and Aging Well 119ivContentsBackground Papers 122References 124ANNEX Projected Impact of Population Aging on Asias Future G

18、rowth 136Tables,Figures,and BoxesTABLES 3.1 Programs and Policies Promoting Special Working Arrangements for Older Workers 62 in Selected Asian Economies 4.1 Social and Contributory Pension Design in Asia and the Pacific 80 4.2 Pension Coverage and Adequacy by Economy 82 Annex The Projected Impact o

19、f Aging on Economic Growth of 12 Asian Economies,20312040 138FIGURES 1.1 Population Shares by Age Group,Developing Asia 4 1.2 Population Share of Older People in Developing Asia 5 1.3 Old-Age Dependency Ratio,Selected Asian Economies with Younger Populations 6 1.4 Fertility Rates in Developing Asia

20、and Selected Younger Economies 6 1.5 Life Expectancy at Age 60 7 1.6 Age Distribution,by Gender in Developing Asia 8 1.7 Share of the Oldest Old in Older Populations 9 1.8 Average Schooling Years for Older People Aged 60+10 1.9 Literacy Rates for Older People Aged 65+11 1.10 Absolute Poverty Inciden

21、ce,Developing Asia versus Other Regions 13 1.11 Incidence of Absolute Extreme Poverty among Older People and in the General Population 13 in Developing Asia 1.12 Relative Poverty Rates in Some Asian Economies,Latest Available Year 14 1.13 Four Dimensions of Well-Being in Older People 16 2.1 Average

22、Life Expectancy and Healthy Life Expectancy at Age 60 in 2000 and 2019,21 by Gender and Economy 2.2 Disease and Injury Burden of Older People,by Subregion in Developing Asia and Type of Disease Burden 22 2.3 The Share of Disease and Injury Burden of Older People,by Subregion in Developing Asia 23 an

23、d Type of Disease Burden 2.4 Share of Older People with One or More NCDs by Age Group and Economy 25 2.5 Prevalence of Diagnosed Noncommunicable Disease in Older People,by Gender and Economy 26 2.6 Share of Older People Reporting at Least One ADL Limitation by Gender,Age,and Economy 27 2.7 Share of

24、Older People Reporting Three Common ADL Limitations by Gender,28 Age and Economy 2.8 Average IADL Limitations by Gender,Age,and Economy 29 2.9 Elevated Depressive Symptoms in Older People by Age Group and Economy 29viTables,Figures,and Boxes 2.10 Elevated Depressive Symptoms in Older People by Gende

25、r,Residence,Educational 30 Attainment,and Economy 2.11 Predictors of Depressive Symptoms in Older People in Developing Asia by Gender 31 2.12 Share of Older People Who Self-Assess Their Health as Excellent,Very Good,or Good,32 by Gender and Economy 2.13 Checkups and Health-Care Use by Older People,b

26、y Educational Attainment 33 2.14 Prevalence of Unmet Health-Care Needs for People Aged 6069 by Gender,Residence,34 and Economy 2.15 Distribution of Older People with No Health-Care Use,by Wealth Quintile and Economy 35 2.16 Distribution of Older People without Health Insurance,by Wealth Quintile and

27、 Economy 35 2.17 Universal Health Coverage Index,by Economy and Subregion 37 3.1 Labor Force Participation,by Age Group and by Gender,2021 43 3.2 Labor Force Participation and GDP per Capita,by Age Group,2021 45 3.3 Share of Workers Who Work Informally,2021 46 3.4 Employment Rate,by Gender,Age,and E

28、conomy 47 3.5 Labor Force Participation,by Age,Educational Attainment,and Economy 49 3.6 Average Actual Retirement Age,by Economy 50 3.7 Job Satisfaction in Selected Economies,by Age Group 51 3.8 Three Factors Governing How Work Affects Well-Being in Old Age 51 3.9 Share of Employment,by Sector and

29、Age 53 3.10 Employment Rate,by Residence and Age 54 3.11 Retirement Prospects and Plans 55 3.12 Additional Years of Work Capacity in Older Persons Aged 5569 56 3.13 Untapped Work Capacity,by Age Group,and Gender 57 3.14 Share of the Population Aged 4064 with Post-Secondary and Upper Education 60 3.1

30、5 Wage Rate and Work Hours for Older Workers by Economy and Gender 61 4.1 Distribution of Income Sources by Type of Household in Selected Economies 70 4.2 Share of Older People Reporting Income from Family Transfers,Wages,71 and Social and Contributory Pensions 4.3 Share of Transfers Between Older P

31、eople and Their Children,by Age Group 72 and Economy 4.4 Share of Older People Receiving Contributory and Social Pensions,by Wealth Quintile 73 4.5 Distribution of Older People Receiving Contributory and Social Pensions 74 4.6 Share of Older People Who Own Their Home,Land,and Financial Assets,77 by

32、Age and Economy 4.7 Total Available Household Resources for Retirement,by Economy and Source 79 4.8 Pension Coverage and Informal Employment,by Economy 84 4.9 Social Pension Coverage of Older People and Its Adequacy 86 4.10 Government Transfer or Pension Recipients Aged 15+Who Receive Transfers 89 o

33、r Pensions into an Account 4.11 The Poverty Reduction and Fiscal Costs of Boosting Social Pensions in Selected Economies 94 5.1 Change in Living Arrangements for People Aged 60+in the Past 2 Decades 97 5.2 Older Peoples Proximity to Their Children 99 5.3 Living Arrangements of Older People 100 5.4 S

34、hare of Older People Receiving Support for Activities of Daily Living,by Provider 101 5.5 Perspectives on Whether Adult Children Have a Duty to Provide Long-Term Care 105 for Their Parents 5.6 Share of Older People with Unmet Long-Term Care Needs 106viiTables,Figures,and Boxes 5.7 Willingness to Rec

35、eive and Pay for Home Care,by Age Group and Economy 107 5.8 The Share of People Who Report Feeling Lonely Frequently,by Age Group and Economy 111 5.9 Characteristics and Contexts of People Who Report Feeling Lonely Frequently 112 5.10 Older Peoples Frequency of Meetings with Children,by Economy 112

36、5.11 Share of Older People Who Report Frequent Interaction with Their Children,113 by Age Group,Type of Interaction,and Economy 5.12 Reported Frequency of Social and Religious Activity among Older People,114 by Age Group and Economy 5.13 Determinants of Social or Religious Engagement 115BOXES 1.1 Ha

37、rmonizing Aging,Health,and Retirement Surveys across Asia and the Pacific 2 1.2 Predictors of Well-Being and Life Satisfaction 17 3.1 Silver Dividend from Untapped Capacity for Work 59 3.2 Examples of Public Placement Services for Older People 63 3.3 Transition from Seniority Systems to Performance-

38、Based Compensation in Japan 65 4.1 Pensions and Work Incentives 75 4.2 Gender Dimensions of Pension Systems in Developing Asia 76 4.3 Automatic Adjustment Mechanisms in Pension Systems 85 4.4 Welfare Impacts from Pensions 88 4.5 Developing Financial Literacy Programs 91 4.6 Government Regulatory Sup

39、port Fostering Private Savings Initiatives 92 5.1 Population Aging and Living Arrangements in Sri Lanka 98 5.2 The Older Person as a Net Provider of Care 102 5.3 Caring for Caregivers 109ForewordPopulation aging is a megatrend that will reshape the economic and social landscape of Asia and the Pacif

40、ic in the decades to come.Across the diverse region,economies are experiencing demographic shifts at unprecedented speed,accompanied by increased longevity,changing epidemiological patterns,and evolving family structures.These are urgent challenges that no economy,regardless of its demographic stage

41、,can afford to ignore.Aging Well in Asia,an Asian Development Policy Report,explores how policymakers can strengthen the well-being of the regions older citizens.Despite considerable economic and social progress in reducing poverty among older people,the rapid expansion of this demographic demands p

42、roactive and tailored policies to ensure they age well.There is ample scope for governments in Asia and the Pacific to promote old-age well-being.As detailed in the report,the Asian Development Bank(ADB)stands ready to support our members,helping them to achieve universal health coverage,invest in q

43、uality infrastructure,foster age-friendly urban development,reform pensions and social security,and build robust community-based long-term care systems.Further,ADB is ready to equip policymakers with the data and analysis needed for informed decision-making.Through greater collaboration,I am confide

44、nt that we can forge a future that respects and uplifts the dignity of every aging individual in Asia and the Pacific.Masatsugu AsakawaPresident Asian Development BankAcknowledgmentsI am pleased to present the inaugural Asian Development Policy Report(ADPR).Examining regional progress toward achievi

45、ng the timely goal of aging well,the report provides new data,analysis,and insights to better inform policy debate about population aging in developing Asia.The ADPR is a new annual flagship publication launched to address major development challenges confronting Asia and the Pacific.We are confiden

46、t that it will provide high-quality data and analysis to support evidence-based policy making that contributes to a prosperous,inclusive,resilient,and sustainable developing Asia.The 2024 report,Aging Well in Asia,was prepared by staff of the Economic Research and Development Impact Department(ERDI)

47、of the Asian Development Bank(ADB).ADBs Human and Social Development Sector Group and five regional departments provided background material and suggestions toward ensuring that the report spoke to the needs of policymakers in Asia and the Pacific.This report was authored by an ADB team of ERDI econ

48、omists:Aiko Kikkawa(lead),Donghyun Park(co-lead),Gemma Estrada,Minhaj Mahmud,Silvia Garcia Mandico,Arturo Martinez Jr.,Martino Pelli,Lennart Reiners,and Paul Vandenberg.Data harmonization and visualization was provided by Filipinas Bundoc,Jade Laranjo,and Lilibeth Poot.Raymond Gaspar and Vasoontara

49、Yiengprugsawan contributed box articles.Guidance and support came from ERDI management:Deputy Director General Chia-Hsin Hu,Director Lei Lei Song,Deputy Chief Economist Joseph E.Zveglich Jr.,and me.The report was refined through reviews and comments from Jinkook Lee,Sang-Hyop Lee,Philip O Keefe,Yasu

50、yuki Sawada,and Yaohui Zhao,who served as external expert reviewers;further comments and suggestions provided by Oleksiy Ivaschenko,Meredith Wyse,and Vasoontara Yiengprugsawan,who were ADB internal reviewers;and additional inputs from Rafal Chomik and John Piggott.Comments and suggestions from parti

51、cipants in the ADPR 2024 Background Papers Workshop held on 23 October 2023 and the ADPR 2024 Review Workshop held on 6 March 2024 enhanced the first draft,as did review by Thanh Long Giang and Norma Mansor.The report benefited from technical support and comments from the ADB Office of the President

52、 and Board of Directors.Background papers written for this report were authored by Jose Ramon G.Albert,Khadija Ali,Halimah Awang,Jose Albert Nino Bulan,Zeyuan Chen,Rafal Chomik,Lakshman Dissanayake,Gretchen Donehower,Isaac Ehrlich,Raymond Gaspar,Long Thanh Giang,Muqi Guo,Thanh Hoang,Aiko Kikkawa,Hyu

53、n Kyung Kim,Chi Kin Law,Sang-Hyop Lee,Zhiqiang Liu,Paul Kowal,Norma Mansor,Arturo Martinez Jr.,Andrew Mason,Maki Nakajima,Nawi Ng,Philip OKeefe,Naohiro Ogawa,Dwi Oktarina,Takashi Oshio,Cheol-Kon Park,Donghyun Park,Martino Pelli,John Piggott,Douglas Rhein,Lennart O.Reiners,Yana van der Meulen Rodgers

54、,Yasuyuki Sawada,Iva Sebastian-Samaniego,Satoshi Shimizutani,Tetsushi Sonobe,Ni Wayan Suriastini,Mar Andriel Umali,Zhenglian Wang,Ika Yulia Wijayanti,Hanna Xue,Vasoontara Sbirakos Yiengprugsawan,Jiaying Zhao,Yi Zeng,Joseph E.Zveglich Jr.,and me.The papers were edited by Ricardo Chan and are listed a

55、t the end of the report.xAcknowledgmentsADB technical assistance under the Japan Fund for Prosperous and Resilient Asia and the Pacific funded the research behind many of the background papers that informed this report,as well as the collection of microdata on older people in selected regional econo

56、mies.Special thanks go to a team of regional scholars who joined the first regional comparative research program led by ADB,which examined the health capacity to work of older people in the region.Peter Fredenburg carefully edited the entire report.Joseph Manglicmot typeset and laid out the report,a

57、ssisted by Alvin Tubio,and Tuesday Soriano proofread it.Cleone Baradas created the cover design and header graphics with input from Anthony H.Victoria.Aileen Gatson,Ana Kristel Lapid,Editha Lavina,Elenita Pura,and Priscille Villanueva provided administrative support.A team from the Department of Com

58、munications and Knowledge Management,led by David Kruger and Terje Langeland,coordinated report dissemination,with support from Lean Alfred Santos.Kevin Nellies and Ralph Romero designed the landing webpage.Albert F.ParkChief Economist and Director General Economic Research and Development Impact De

59、partmentAsian Development BankADB technical assistance under the Japan Fund for Prosperous and Resilient Asia and the Pacific funded the research behind many of the background papers that informed this report,as well as the collection of microdata on older people in selected regional economies.Speci

60、al thanks go to a team of regional scholars who joined the first regional comparative research program led by ADB,which examined the health capacity to work of older people in the region.Peter Fredenburg carefully edited the entire report.Joseph Manglicmot typeset and laid out the report,assisted by

61、 Alvin Tubio,and Tuesday Soriano proofread it.Cleone Baradas created the cover design and header graphics with input from Anthony H.Victoria.Aileen Gatson,Ana Kristel Lapid,Editha Lavina,Elenita Pura,and Priscille Villanueva provided administrative support.A team from the Department of Communication

62、s and Knowledge Management,led by David Kruger and Terje Langeland,coordinated report dissemination,with support from Lean Alfred Santos.Kevin Nellies and Ralph Romero designed the landing webpage.Albert F.ParkChief Economist and Director General Economic Research and Development Impact DepartmentAb

63、breviationsAAM automatic adjustment mechanismsADL activity of daily livingADPR Asian Development Policy ReportCHARLS China Health and Retirement Longitudinal StudyCOFACE Confederation of Family Organisations in the European Union COVID-19 coronavirus diseaseDALY disability-adjusted life yearFSM Fede

64、rated States of MicronesiaGDP gross domestic productHART Health,Aging,and Retirement in ThailandHALE health adjusted life expectancyIADL instrumental activity of daily livingILAS Indonesia Longitudinal Aging SurveyILO International Labour OrganizationISSA International Social Security AssociationIOP

65、S International Organization of Pension SupervisorsKLoSA Korean Longitudinal Study of AgingLao PDR Lao Peoples Democratic RepublicLASI Longitudinal Ageing Study in IndiaLE life expectancyLSAHP Longitudinal Study of Ageing and Health in the PhilippinesLTC long-term careMARS Malaysia Ageing and Retire

66、ment SurveyNAP National Academies PressNCD noncommunicable diseaseOECD Organisation for Economic Co-operation and DevelopmentxiiAbbreviationsPRC Peoples Republic of ChinaROK Republic of KoreaSDR self-dependency ratioSHRC Silver Human Resources CenterUCW unpaid care workUHC universal health coverageU

67、NESCAP United Nations Economic and Social Commission for Asia and the PacificVNAS Vietnam Aging SurveyWHO World Health OrganizationDefinitions and AssumptionsThe economies discussed in Asian Development Policy Report 2024 are classified by major analytic or geographic group.For the purposes of this

68、report,the following apply:Association of Southeast Asian Nations(ASEAN)comprises Brunei Darussalam,Cambodia,Indonesia,the Lao Peoples Democratic Republic,Malaysia,Myanmar,the Philippines,Singapore,Thailand,and Viet Nam.ASEAN 4 are Indonesia,Malaysia,the Philippines,and Thailand.Developing Asia comp

69、rises 46 regional members of the Asian Development Bank listed below by geographic group.Caucasus and Central Asia comprises Armenia,Azerbaijan,Georgia,Kazakhstan,the Kyrgyz Republic,Tajikistan,Turkmenistan,and Uzbekistan.East Asia comprises Hong Kong,China;Mongolia;the Peoples Republic of China;the

70、 Republic of Korea;and Taipei,China.South Asia comprises Afghanistan,Bangladesh,Bhutan,India,Maldives,Nepal,Pakistan,and Sri Lanka.Southeast Asia comprises Brunei Darussalam,Cambodia,Indonesia,the Lao Peoples Democratic Republic,Malaysia,Myanmar,the Philippines,Singapore,Thailand,Timor-Leste,and Vie

71、t Nam.The Pacific comprises the Cook Islands,the Federated States of Micronesia,Fiji,Kiribati,the Marshall Islands,Nauru,Niue,Palau,Papua New Guinea,Samoa,Solomon Islands,Tonga,Tuvalu,and Vanuatu.Asia and the Pacific comprises the 49 regional members of the Asian Development Bank.Unless otherwise sp

72、ecified,the symbol“$”and the word“dollar”refer to US dollars.Highlights1.The Well-Being of Older Asians to the Fore Developing Asia is aging rapidly,with the pace accelerating in some economies.Greater longevity is an achievement of long-term socioeconomic development in the Asia and Pacific region,

73、but it also poses new challenges.While older people,those aged 60 and above,accounted for 13.5%of the regional population in 2022,that figure is expected to nearly double to 25.2%by 2050.While aging is more advanced in some economies,even relatively younger ones are facing rapid demographic transiti

74、on.The unprecedented speed of population aging in Asia and the Pacific stands out,with the onset happening at lower incomes than when advanced economies faced this change.The speed of change in economies like the Republic of Korea(ROK)and the Peoples Republic of China(PRC)even outpaced earlier proje

75、ctions as birth rates plunged.A concern across the region is the risk that societies will grow old before they amass sufficient resources to adequately support their aging populations.Absolute poverty for older people has declined,but relative poverty remains substantial.Available data from 22 econo

76、mies in developing Asia indicate that the incidence of extreme poverty among those aged 65+declined from 13.1%in 20102015 to 3.2%in 20162022.This improvement mirrored a reduction in poverty across all age groups in the region.However,in many regional economies,relative poverty rates for older people

77、 exceed those of the entire population.Further,conventional poverty data may not capture some complexities of poverty for older people,such as being disadvantaged in resource allocation within households.Population aging may exacerbate inequality by widening income gaps between older people and betw

78、een them and younger people.Physical and mental health challenges become more acute with age.Older persons face persistent burdens of lifestyle disease and heightened incidence of loneliness and social isolation,which is exacerbated by insufficient access to essential services such as health and lon

79、g-term care.A new harmonized dataset on older people in nine economies in developing Asia found that on average 57%of older people have at least one diagnosed noncommunicable disease(NCD),but only 40%receive regular health checks and 43%of older people with functional limitation lack long-term care.

80、Depression is widespread with 31%of older persons reporting elevated depressive symptoms,owing to illness,social isolation,and economic insecurity.Pervasive informal employment and stark gender inequality further impede well-being in old age.Up to 94%of workers aged 65+in the region are employed in

81、the informal sector.Informal workers enjoy little or no paid leave,disability allowance,or access to pensions.Many have little choice but to work as long as their health permits.Women can expect to live longer than men but are more prone to disease and therefore face insecurity in old age.Time spent

82、 on housework and family care constrains womens economic opportunity and leaves them more vulnerable in old age.xvHighlights A life-cycle and lifelong approach to policy will help to ensure the well-being of older people.The sheer speed and scale of aging,coupled with the heightened vulnerability of

83、 older persons,underscores the urgency for the region to tackle the aging challenge.Four key dimensions of older persons well-being are health,productive work,economic security,and social engagement.Among these dimensions,healthboth physical and mental is central to overall well-being as it keeps ol

84、der people productive,economically secure,and socially engaged.Yet health in old age depends on choices individuals make over a lifetime,not just in old age.Thus,for younger and older alike,governments in the region can adopt policies and programs that encourage and enable choices that promote well-

85、being in later years.2.Health of Older People Extended life years are not necessarily all healthy ones.Over the past 2 decades,life expectancy at age 60 in the region increased by more than 5 years.But the expected number of years lived in less than full health also rose in most economies.Meanwhile,

86、the share of NCD in overall burden,mainly from coronary heart disease,stroke and diabetes remains high and exceeds 80%in all subregions.Over the past two decades,the disease burden from Alzheimers and other forms of dementia increased by 7.8%in developing Asia,making dementia the seventh most preval

87、ent health condition afflicting older people.The coronavirus disease(COVID-19)pandemic made it evident that older people with NCDs are more vulnerable to infectious disease,and they also are more affected by extreme weather events which are becoming more frequent with climate change.Older people,esp

88、ecially women,face high rates of noncommunicable diseases and depression.The share of older people reporting at least one diagnosed NCD ranges from 35%to 68%across nine economies in the region.Diabetes and hypertension are universally higher in older women than men in these economies.For example,in

89、Indonesia the share of older persons with hypertension is 12 percentage points higher for women and in Bangladesh the share with diabetes is 11 points higher.Women also are more likely to report elevated depressive symptoms.In the PRC where older people have the highest prevalence of elevated depres

90、sive symptoms,the shares are 43%of older women compared to 31%of older men.Universal health coverage must meet diverse health needs of older people.While the ROK and Thailand have achieved universal health coverage,others lag behind with India having the lowest health insurance coverage among older

91、people at 21%.Unequal access to health insurance is evident in other parts of the region.The Philippines and the PRC stand out for having relatively low coverage of poor older people.Those in the poorest quintile constitute 47%of all uninsured people in the Philippines and 35%in the PRC.In Banglades

92、h,Indonesia,and India,more than half of those without access to health care are in the bottom two wealth quintiles.In addition to making progress achieving universal health coverage,it also is critical to extend essential services and interventions that optimize older peoples physical and functional

93、 capacity.Good health in old age can be ensured through promoting investments over a lifetime.Healthy aging therefore requires consistent promotion of healthy diets and investment in primary care and health-care infrastructure,and the creation of an integrated system of health-care delivery to serve

94、 the needs of people of all ages.Free annual health checkups and lifestyle evaluations should be available to people of all ages.Comprehensive health awareness campaigns should be conducted regularly to promote healthy behavior including exercise,eating habits and nutrition.To reduce the consumption

95、 of unhealthy food products,sin taxes can be levied and enforced.xviHighlights Cost-effective mental health care is urgently needed in primary health-care systems.Mental health services can be made accessible to older people by integrating them with NCD care in primary health-care systems,for exampl

96、e by facilitating use of digital mental health apps and platforms for remote consultations with specialists.Mental health also can be improved by addressing functional limitations.Simply providing eyeglasses,a hearing aid,or a walker can greatly improve their mental health,reduce their sense of isol

97、ation,and improve autonomy and self-esteem.3.Work and Retirement of Older Persons The labor force participation of people aged 65 and above was 32.0%for men and 15.2%for women on average in 2021,both of which exceeded those in advanced economies.The rate has trended down for men since 2000,while ris

98、ing for women in that period.Actual retirement age varies across the region from 51 to 63 years on average,with further variation within economies.Work and retirement patterns are notably different for workers in formal versus informal employment,and in rural versus urban areas.A large share of olde

99、r people work in agriculture,which is mostly informal work.The share of informal workers among older workers ranges from 64%to 99%in the region.Older women and people with less formal education are disproportionately employed in informal jobs.Workers who did not complete elementary school retire muc

100、h later than those with higher education.Many of these workers work without basic labor protections in physically taxing jobs that put their health and well-being at risk as they age.At the same time,older peoples capacity to work is a sizable untapped resource in the region.Formal workers typically

101、 retire as soon as they become eligible for a pension,or even before,despite a substantial increase in healthy longevity.For men aged 5569,the health-determined additional capacity to work is estimated to be between 0.3 and 2.2 years(or 426 months)in seven out of eight Asian economies studied.More t

102、han 80%of men aged 6064 are healthy enough to work,but among this potential workforce,across different economies,10%23%are not employed.The silver dividend or additional productivity that could be gained from untapped work capacity among older persons is substantial and could equal up to 1.5%of gros

103、s domestic product in the economies studied.Policy action must address the vulnerability of older workers in the informal economy.More targeted policies are needed across the region to improve the jobs available to older informal workers.In the short run,governments with large informal economies can

104、 take policy action that helps transition older informal workers,including those in agriculture,into jobs that are less physically demanding and more flexible.Such policies could promote automation or other technological solutions,upgrade workers skills,and provide access to credit.Expanded basic la

105、bor protection should include accident and illness insurance,disability allowances,pensions,and programs that facilitate saving for retirement,which smooths the transition from work.Lifelong learning and other proactive labor policies can keep older people productive and employable.Formal and inform

106、al workers alike benefit from lifelong learning that imparts employable skills and digital literacy.Governments can offer incentives for employers to hire and retain older workers.However,the low employment rates of older women are likely to continue until the gender imbalance in informal care burde

107、n is addressed.Policies that promote employment for older workers can mitigate some of the negative macroeconomic effects of population aging,notably declining workforce and rising expenditure on social security.xviiHighlights Transitions from work to retirement should be more flexible.Economies wit

108、h an outdated statutory retirement age need to move it later or introduce more flexibility,while ensuring stronger social protection for those who lose their job before being able to access a pension.Flexible work arrangements,such as the option to work part-time,help older workers transition to ret

109、irement while ensuring that tax and pension systems do not unduly penalize those who work longer.Remuneration based on seniority,as is prevalent in many Asian economies,must be reformed to make the retention and hiring of older workers more affordable.Widespread ageism in Asian labor markets calls f

110、or legislation,improved monitoring and public awareness to change attitudes and perceptions.4.Economic Security in Old Age and Pensions Family transfers are still the main income support for many older people.Despite a gradual shift toward more independent living arrangements,older people in the reg

111、ion still rely heavily on transfers and other forms of support from their families.These transfers account for at least a third of older peoples income in most Asian economies,and often more than two-thirds.Changing social norms may alter these arrangements in the future,making financial preparednes

112、s increasingly critical to keep older persons out of poverty.Financial preparedness for retirement varies across the region.An individual is considered financially prepared for old age if income,including from assets available for liquidation,meets consumption needs for the expected duration of reti

113、rement.A newly developed financial preparedness index shows the share of financially prepared near-old peoplethose within 5 years or so of retirementto be as high as 86%in Japan and 73%in India,but somewhat lower at 64%in the PRC and 58%in the ROK.There is a wide ruralurban preparedness gap in the P

114、RC with only 44%of rural residents prepared,barely half of the 82%of urban residents who are prepared.In India,the PRC,and the ROK,80%90%of financial resources for retirement come from private income and assets,not public pensions or social assistance.Contributory pensions have low coverage but soci

115、al pensions help fill the gap.Contributory pension coverage is generally low among older people at 19%on average in the region based on surveys.In many economies,coverage is substantially lower for women and rural residents,and even working-age enrollment languishes below 10%for some.Low coverage la

116、rgely reflects the prevalence of informality.Noncontributory social pensions are a widespread response to low formal pension coverage.No fewer than 28 of 35 economies surveyed in developing Asia now have noncontributory social pensions.Coverage of social pensions is significantly higher than that of

117、 contributory pensions,reaching 46%of older persons,on average.These pensions include some income redistribution as coverage is highest in the poorest wealth quintiles,exceeding 30%in economies with available survey data.At the same time,the social pension coverage in the wealthiest quintile also ex

118、ceeds 15%in almost all of these economies.Even where social pension coverage is high,low benefits mean modest impact on improving elder well-being.Governments must foster greater financial literacy,inclusion,and preparedness for retirement.Financial literacy campaigns raise awareness and understandi

119、ng of simple financial concepts such as compound interest.To help individuals make better financial decisions and become long-term savers,governments and financial institutions can leverage new behavioral insights that favor,for example,a narrow set of high-quality financial products over a bewilder

120、ing array of options.Financial literacy brings the most benefits if achieved at an early age or introduced at the point of decision.xviiiHighlights Pensions will play greater roles in economic security as Asia ages.The governments should expand contributory pension coverage to informal workers and i

121、ncrease coverage of social pensions among poorer old people.For contributory pensions,top policy priorities are to introduce schemes in which public funds are matched with the voluntary contributions of informal workers including women,expand coverage in the formal sector,and increase benefits for l

122、ower-income contributors through redistribution within programs.Reform should pay close attention to gender aspects of program design.Economies that lack social pensions should consider introducing them.Finally,pension systems can be made more efficient and effective by adopting innovative pension d

123、esign and administrative tools such as the automatic adjustment of benefits based on demographic and economic indicators,introducing digital payment and auto-enrollment,and leveraging technology and behavioral insights.5.Family,Care,and Social Engagement As more older people in the region live alone

124、,some of them will face greater vulnerability.The share of older people living alone has increased by 17%since the turn of the millennia as fertility has fallen and longevity risen.A preference for independent living is expected to strengthen as living standards improve.However,some live alone invol

125、untarily and are more vulnerable.Womens relative longevity and economic insecurity leaves more older women than men living alone,often in precarious circumstances.Older women and the poor have many unmet needs for long-term care,which are likely to increase as populations age.Families will continue

126、to play a pivotal role in old-age care,despite evolving social norms.Yet the current model of long-term care leaves large care gaps.Care needs are unmet for an average of 43%of older people with physical limitations,jeopardizing their well-being,with women and the poor being disproportionately affec

127、ted.Without policy intervention,gaps in long-term care threaten to widen further with population aging,family shrinkage,and changing cultural norms.Social isolation is an emerging issue that requires more attention.In the region,16%of older people surveyed say they feel lonely most of the time,a con

128、dition often associated with depression.People who live alone tend to feel isolated.In different Asian economies,10%30%of older individuals report not having weekly contact with even one of their children,with older women having less social engagement than men.Support for family caregivers is essent

129、ial to older peoples well-being.Long-term care systems should support aging in place.Many economies in the region have implemented low-cost community-driven interventions that provide community caregivers with information,counseling,and training.Such support should be extended to family caregivers,i

130、ncluding older caregivers who are often excluded from these programs.Further,governments should provide respite care,which has proved very effective at alleviating the burden on family caregivers and thus improving the quality of care.Integrated care systems tap families,markets,and governments to p

131、rovide seamless long-term care.The provision of long-term care requires ensuring adequate human resources,by upskilling and formalizing informal caregivers and engaging youth and volunteers.Also critical is to integrate regional labor markets and facilitate well-regulated migration of caregivers acr

132、oss borders.A smooth transition requires that integrated care systems be financially viable.Sustained public contributions are required to earn public support and trust and to ensure system sustainability.Governments should develop national and community coordinating mechanisms to facilitate collabo

133、ration by the government,community stakeholders,and families.More evidence should be collected on how various policies can improve care system design and implementation.xixHighlights Social engagement in the community can prevent isolation.Community health workers and social workers can be trained t

134、o identify vulnerable people,conduct needs assessments,and direct older people to appropriate community initiatives to promote their social engagement.Effective community-based initiatives include clubs for older people,volunteer and intergenerational activities,and cohousing solutions.Efforts shoul

135、d be made as well to remove barriers to social connectivity by developing age-friendly cities,investing in public transport,and reducing the digital divide that excludes older people.6.Living Well and Aging Well As Asia ages,it needs to step up efforts to help people age well.Economic and social pro

136、gress in the region has sharply reduced poverty,tangibly improved the quality of life,and significantly extended longevity.Yet the well-being of current and future cohorts of older people in the region remain at risk from multiple threats.Yawning inequality separates older citizens across all four d

137、imensions of well-being:health,productive work,economic security,and social engagement.A key policy agenda across the region is to ensure the well-being of older people by helping them to age well.Well-being in old age can be enhanced by individuals lifetime investment in their own health,education,

138、skills,financial preparedness for retirement,and family and social ties.Policies for aging well should promote in particular healthy lifestyles,lifelong learning to update skills and learn new ones,and long-term financial planning for retirement.The four dimensions of well-being in old age are close

139、ly interconnected.Some are inherently mutually reinforcing such as health and social engagement while others can create unintended consequences such as the work disincentives of pension benefits.Among the four dimensions of well-being,healthy aging is the overarching goal,critically influencing the

140、other three.It is thus essential for governments to design and implement well-aligned and coordinated policy actions.The private sector can play an important role by creating age-friendly jobs,offering suitable financial products for retirement,and developing the care economy.Because an extensive kn

141、owledge gap bedevils aging issues across the region,policymaking would benefit from generating microdata on older people,collating administrative data,and rigorously evaluating programs and policies to better understand the costs and benefits of various policy options and interventions.A lifelong,li

142、fe-cycle,population-wide approach is needed to meet the aging challenge.This three-pronged strategy can help the region raise the well-being of its older citizens.A lifelong approach encourages continuous investment in human capital throughout peoples lives.A life-cycle approach provides adequate in

143、terventions in accordance with age-specific needs.And population-wide outreach targets people of all ages.Comprehensive aging policies can ensure a healthy and productive older population offering a large silver dividend and other economic and social contributions.Governments can do more to empower

144、their citizens to plan and prepare for old age.They can disseminate information and raise awareness that helps workers of all ages set realistic expectations about future retirement needs,taking into account that future policies may change the retirement age and pension terms.They can also support i

145、nitiatives that help firms and workers develop career plans and retirement paths in anticipation of longer working lives.Promoting well-being in old age has fiscal costs,but countermeasures can help contain them.The expansion of health and long-term care services,and enhancement of pension coverage

146、and adequacy,will entail substantial fiscal costs.Experience in advanced economies shows that expanded fiscal space is indispensable.Fiscal space can be augmented by strengthening tax revenue mobilization and promoting xxHighlightsgrowth-oriented fiscal spending.Public and private investment in huma

147、n capitalbeginning in the cradle with preventative and curative health care,followed by lifelong educationcan generate over time bigger silver dividends as healthy and educated older people become more productive.Retirement savings can be significant new sources of capital for productive investment

148、that generates more economic growth and tax revenue.Early investment is key for Asia to harness its silver dividend.Future generations of older people will live healthier and longer lives and be more educated.To leverage their full potential to the benefit of their own well-being and the broader soc

149、iety,the time is now for Asian governments to take action to improve all four dimensions of well-being in old age.If they do this,people throughout Asia and the Pacific can aspire to live well and age well.The well-being of older Asians comes to the fore.Rapid socioeconomic progress in developing As

150、ia has enhanced the quality of life,lengthened lifespans,and lowered fertility rates,consequently aging the population.A key policy challenge facing the region now is to ensure the well-being of older Asians.1 Well-being is a state in which various human needs are met in a holistic and multidimensio

151、nal way.For older people,four interconnected dimensions of well-being are especially important:health,productive work,economic security,and social engagement.This report examines the progress made in Asia and the Pacific toward achieving the goal of aging well and the challenges ahead.It proposes po

152、licy directions to improve the four major facets of well-being of older Asians.A persons well-being in old age reflects human capital investment and the various life choices one makes over a lifetime.Policy that promotes well-being in old age therefore needs to be directed toward people of all ages

153、and throughout their lifetimes.Although the focus of this report is not the macroeconomic consequences of population aging,improving the well-being of older persons is key to maximizing their economic productivity and reducing social and economics costs of caring for older persons who have poor phys

154、ical and mental health.Absolute poverty has declined among older people,but relative poverty remains high in some economies.Data from 22 economies in developing Asia indicate that the incidence of absolute poverty among older Asians aged 65+declined from 13.1%in 20102015 to 3.2%in 20162022,mirroring

155、 a reduction in absolute poverty overall across the region.However,the data also show relative poverty rates among older people often exceeding those of the whole population in a number of regional economies.2 Further,conventional poverty data fail to capture fully the complexities of poverty affect

156、ing older people,who may be disadvantaged in,for example,accessing resources within a household.The analysis indicates that freedom from poverty is necessary for well-being,but not a guarantee.Well-being in old age is at risk in many ways,not least from a lack of preparedness in the region.On averag

157、e,57%of older people in the region are reported to have at least one diagnosed noncommunicable disease,but only 40%attend regular health checkups,according to a new harmonized dataset on older Asians in nine economies in developing Asia(Box 1.1).In different regional economies,94%of workers aged 65+

158、work in the informal sector,and 40%of older people have no access to either social or contributory pensions,while 43%of those with physical function impairments lack long-term care.Up to 31%of older people exhibit elevated symptoms of depression owing largely to illness,social isolation,and financia

159、l insecurity.Meanwhile,the region is unprepared for a rapidly unfolding demographic transition.Asian policymakers must address the aging challenge with urgency.Two major regional challenges to well-being in old age are pervasive work informality and gender inequality.Few informal workers in the regi

160、on have paid leave,insurance or other protection against illness and injury,disability allowance,or a pension or other savings option.Many have little choice but to work 1 In this report,older people are defined as those aged 60 years and over(UNESCAP 2022a),unless otherwise specified,usually as peo

161、ple aged 65 years and over,as dictated by the data source.2 The relative poverty rate is defined as the share of the group living on less than half the economys median disposable income.The Well-Being of Older Asians to the Fore12Aging Well in AsiaTo generate comparable descriptive data and analysis

162、 on the state of older peoples well-being in the region,the Asian Development Policy Report(ADPR)compiled,harmonized,and merged surveys on population aging,health,and retirement in nine economies in East,Southeast,and South Asia:Bangladesh,India,Indonesia,Malaysia,the Peoples Republic of China,the P

163、hilippines,the Republic of Korea,Thailand,and Viet Nam.Building on an existing harmonization effort by the Gateway to Global Aging Data Project(g2aging.org),a ADPR data harmonization added more economies and included variables specific to Asia and developing economies.The surveys are nationally or r

164、egionally representative,b cover the most recent data available at the time of writing this report,and include respondent characteristics specific to aging.The nine economies in the dataset comprise 84%of all older people aged 60+in Asia and the Pacific.The survey years range from 2017 to 2023 and s

165、ome are more up-to-date than others.For some economies,their data may not reflect the effect of recent policy reforms in areas such as health,labor,pension and long-term care.The variables in the harmonized data range from basic demographic characteristics to social inclusion and expenditure,further

166、 covering issues specific to older people:family and living arrangements;physical,mental,and cognitive health;access to health and old-age care;ability to perform personal activities of daily living and household instrumental activities of daily living;pensions and retirement;family relationships;an

167、d participation in social activities.Some 200 harmonized variables are thus available to analyze a diverse set of issues related to aging.They are accompanied by technical information on sample weights,household structure,and currency conversion.Box 1.1:Harmonizing Aging,Health,and Retirement Survey

168、s across Asia and the PacificOverview of Harmonized Aging DataEconomyData Source Survey YearSample SizeData Owner/CustodianBangladeshMahbub Hossain Panel Data 20235,522Ministry of Health and Family Welfare;and ADBIndiaLongitudinal Ageing Study in India(LASI)2017201972,269Ministry of Health and Famil

169、y Welfare,National Programme for Health Care of Elderly;International Institute for Population Sciences;Harvard T.H.Chan School of Public Health;and the University of Southern CaliforniaIndonesiaIndonesia Longitudinal Aging Survey(ILAS)20234,177National Development Planning Agency;SurveyMeter,Lembag

170、a Demografi;and ADBMalaysiaMalaysia Ageing and Retirement Survey(MARS)202120224,821Employees Provident Fund,the Social Security Organisation;ADB;and Social Wellbeing Research CenterPeoples Republic of ChinaChina Health and Retirement Longitudinal Study(CHARLS)201819,816National School of Development

171、,Peking UniversityPhilippinesLongitudinal Study of Ageing and Health in the Philippines(LSAHP)20185,985Demographic Research and Development Foundation,Inc.;and Economic Research Institute for ASEAN and East AsiaRepublic of KoreaKorean Longitudinal Study of Aging(KLoSA)20186,940Korea Employment Infor

172、mation Service,Ministry of Health and Welfarecontinued on next page3The Well-Being of Older Asians to the ForeTo make the analysis comparable across economies,data harmonization followed three steps.First,a set of harmonized variables was identified in a survey harmonization matrix according to the

173、broad themes of the report.Second,each individual questionnaire was reviewed and mapped to the matrix.Compatibility between questions and answer choices was examined across the nine economies and then standardized,mostly at the lowest denominators of disaggregation.Finally,the survey variables were

174、recoded according to the chosen harmonized variable definitions before being merged into a single data file.The resulting dataset thus consists of variables that are comparable across economies and includes about 130,000respondents aged 40 and over.While not every variable is available for every eco

175、nomy,most of the information is consistently coded and readily available.A harmonized micro-dataset of older people enables the well-being and characteristics of various groups of older people to be evaluated,with comparisons across economies of various indicators of well-being.The dataset does not,

176、however,allow detailed comparisons of older people against populations younger than age 40.It excludes as well older people in residential care or hospitals,as well as those constrained from expressing themselves due to impaired physical or cognitive function.EconomyData Source Survey YearSample Siz

177、eData Owner/CustodianThailandHealth,Aging,and Retirement in Thailand(HART)20202,863National Institute of Development AdministrationViet NamThe Survey on Older Persons and Social Health Insurance Vietnam Aging Survey(VNAS)201920224,3333,183Ministry of Health;ADB;and Institute of Social and Medical St

178、udiesADB=Asian Development Bank,ASEAN=Association of Southeast Asian Nations.Source:ADB.a This initiative harmonized and combined 11 datasets on aging from around the world to facilitate cross-country,longitudinal analyses.b All datasets except that of Indonesia are nationally representative.The Ind

179、onesia dataset is regionally representative covering West Sumatera,Lampung,Special Region of Yogyakarta,East Java,Bali and South Sulawesi,West Java,South Kalimantan,and Mollucas.Source:Asian Development Bank.Table continuedas long as their health permits.Workers who did not complete elementary schoo

180、l,for example,retire on average 2 years later than those with upper secondary and tertiary education.Older women can expect to live longer than men,but they are more prone to disease.Gender inequality has narrowed in some areas,but persists institutionally in pensions,which are tied to the contribut

181、ion periods of formal employees,and in cultural norms that impose informal household and care burdens on women in particular,limiting their economic opportunities and leaving them vulnerable in old age.A key challenge facing the region is how to ensure the well-being of older Asians.Income alone fal

182、ls short as a measure of well-being.The governments in the region must create an environment conducive to furthering all four aspects of well-being:physical and mental health,productive work,economic security,and social engagement.In particular,healthy aging is central to well-being in old age.Good

183、health drives productivity and economic security while promoting older peoples active social engagement and reducing their need for long-term care.Comprehensive aging policies should foster healthy and productive cohorts of older people to maximize their contribution to the economy and society.4Agin

184、g Well in Asia1.1 Asias Aging PopulationDeveloping Asia is transitioning toward a much older demographic structure.The regions share of older people in the whole population rose from 5.9%in 1960 to 8.2%in 2000 and 13.5%in 2022.The population aged 60 and above is forecast to double from 567.7 million

185、 in 2022 to 1.2 billion in 2050,when it will account for 25.2%of the regional population(Figure 1.1).Further,55.6%of the worlds older population will live in developing Asia by 2050.Asias aging will affect a wide range of economic and social indicators,including economic growth(see Annex)and fiscal

186、balances.3Some economies in developing Asia are aging rapidly,while others are undergoing a more gradual transition.In 2022,older peoples share of the population exceeded 20%in 8 of 46 regional economies:Hong Kong,China;the Republic of Korea(ROK);Taipei,China;Georgia;Niue;Singapore;Thailand;and Arme

187、nia(Figure 1.2).The speed of aging,measured by the number of years required for the share of older people to double from 10%to 20%,has been rapid in Singapore at 17 years,Thailand 18 years,and the ROK 19 years.Of the 38 economies that have not yet reached the 20%threshold,13 will do so by 2050.Among

188、 them,the transition is expected to take 13 years in Maldives;16 years in Brunei Darussalam;and 21 years in Azerbaijan,Bhutan,and Palau.By 2050,20 economies in developing Asia will have 20%shares,22 economies will have shares above 10%,and 4 economiesAfghanistan,Pakistan,Solomon Islands,and Vanuatuw

189、ill still have shares lower than 10%.4 In some areas,the speed of demographic transition is outpacing earlier projections.Differences between transition duration projections made in 2000 and actual transitions are 4 years for Hong Kong,China,with 36 years projected against 32 years actual;3 years fo

190、r the ROK and Thailand;and 2 years for the Peoples Republic of China(PRC).Figure 1.1:Population Shares by Age Group,Developing Asia061218243001234519501960197019801990200020102020203020402050%BillionYearOlder people,60+Population share of older people(right)Young,014Working age,1559Note:Projections

191、assume a medium-fertility scenario.Source:Asian Development Bank estimates using data from the United Nations,Department of Economic and Social Affairs,Population Division.2022.World Population Prospects 2022 Online Edition(accessed 2 August 2023).3 Lee,Kim,and Park(2017)forecast that demographic ch

192、ange will have a significant impact on fiscal sustainability in Asian economies.4 ADB placed on hold its regular assistance to Afghanistan effective 15 August 2021.This report was prepared based on information available for Afghanistan as of 31 July 2021 or obtained from external sources.5The Well-B

193、eing of Older Asians to the ForeFigure 1.2:Population Share of Older People in Developing Asia1950200020502100Solomon IslandsNauruVanuatuAfghanistanTuvaluSamoaPapua New GuineaPakistanKiribatiTajikistanKazakhstanTongaMarshall IslandsKyrgyz RepublicTurkmenistanFijiUzbekistanTimor-LestePhilippinesFSMLa

194、o PDRNepalMongoliaMyanmarCambodiaIndonesiaIndiaBangladeshBhutanMalaysiaMaldivesAzerbaijanBrunei DarussalamViet NamPalauSri LankaCook IslandsPRCArmeniaThailandSingaporeNiueGeorgiaTaipei,ChinaRepublic of KoreaHong Kong,China10%share of older people,aged 60+20%share of older people,aged 60+2022YearFSM=

195、Federated States of Micronesia,Lao PDR=Lao Peoples Democratic Republic,PRC=Peoples Republic of China.Note:Developing Asia reached the threshold of 10%older people aged 60+in 2013 or 2014,which coincided with it becoming an“aging society,”defined as one with 7%14%of the population aged 65+(UNESCAP 20

196、22).Source:Asian Development Bank estimates using data from United Nations,Department of Economic and Social Affairs,Population Division.2022.World Population Prospects 2022,Online Edition(accessed 2 August 2023).6Aging Well in AsiaOver the next few decades,even regional economies with younger popul

197、ations are expected to transition to much older demographic profiles.Old-age dependency ratios are projected to double in several economies by 2050,which means a huge decline in the number of working age adults to support older populations(Figure 1.3).Asian economies in the middle range will experie

198、nce dramatic shifts in population age structure as fertility rates decline and longevity lengthens.In Cambodia,the Philippines,and Uzbekistan,fertility rates are currently high at 2.32.8 live births per woman,but will fall by 2050(Figure 1.4).Across the region,projections to 2050 are for fertility r

199、ates to either decline or remain low.Figure 1.3:Old-Age Dependency Ratio,Selected Asian Economies with Younger Populations 01020304050 Philippines Uzbekistan Cambodia Mongolia Indonesia India Bangladesh Malaysia Azerbaijan Viet Nam%20222050Note:The old-age dependency ratio is the population in the o

200、ld-age group,defined as 60+,over the population aged 1559.Source:Asian Development Bank estimates using data from United Nations,Department of Economic and Social Affairs,Population Division.2022.World Population Prospects 2022,Online Edition(accessed 2 August 2023).Figure 1.4:Fertility Rates in Dev

201、eloping Asia and Selected Younger EconomiesLive births per woman Developing Asia Bangladesh Cambodia India Indonesia Philippines Uzbekistan123456719801990200020102020203020402050YearNote:Projections assume a medium-fertility scenario.Source:United Nations,Department of Economic and Social Affairs,Po

202、pulation Division.2022.World Population Prospects 2022,Online Edition(accessed 2 August 2023).7The Well-Being of Older Asians to the ForeFigure 1.5:Life Expectancy at Age 6018.2 18.6 18.7 18.9 18.9 19.2 19.3 19.3 19.7 19.8 20.2 20.5 20.8 21.0 21.0 21.2 21.3 21.5 21.6 21.8 21.9 22.1 22.2 22.4 22.4 22

203、.5 22.8 22.9 23.1 23.6 24.2 24.3 24.9 24.9 25.0 25.3 25.6 25.9 26.2 27.2 27.7 29.7 30.2 30.7 31.3 32.8 25.3 15.2 15.4 14.2 16.4 15.3 16.7 16.7 14.6 15.1 16.5 17.5 16.6 18.3 18.0 17.2 17.9 17.9 18.1 18.0 18.7 17.6 19.1 17.8 19.8 18.0 18.1 19.2 19.0 20.3 21.1 21.0 19.0 21.8 22.4 20.2 21.5 20.2 21.3 22

204、.0 24.3 26.9 26.0 25.6 27.2 25.8 27.9 22.3 40302010010203040Marshall IslandsFijiNauruAfghanistanPapua New GuineaKiribatiPakistanTuvaluPalauMyanmarSolomon IslandsTurkmenistanTimor-LesteLao PDRUzbekistanTajikistanNiueIndonesiaVanuatuPhilippinesKazakhstanNepalKyrgyz RepublicCambodiaTongaFSMAzerbaijanSa

205、moaBhutanIndiaBrunei DarussalamGeorgiaBangladeshMalaysiaMongoliaCook IslandsArmeniaViet NamSri LankaPRCMaldivesTaipei,ChinaThailandSingaporeRepublic of Korea Hong Kong,ChinaDeveloping AsiaYearMale,2022Female,2022Female,increase from 2022 to 2050Male,increase from 2022 to 2050FSM=Federated States of

206、Micronesia,Lao PDR=Lao Peoples Democratic Republic,PRC=Peoples Republic of China.Note:The data use a medium-scenario projection and the average number of years expected by a hypothetical cohort of individuals alive at age 60,who are subject during the remaining of their lives to the mortality rates

207、of a given year.The number beside each bar refers to the life expectancy at age 60 in 2050.Source:Asian Development Bank estimates using data from United Nations,Department of Economic and Social Affairs,Population Division.2022.World Population Prospects 2022,Online Edition(accessed 2 August 2023).

208、Life expectancy at age 60 in the region is expected to rise by 3.7 years for women and 4.1 years for men from 2022 to 2050.This will raise the average regional life expectancy at age 60 from 21.6 to 25.3 years for women and from 18.2 to 22.3 years for men.Older women in India will see the greatest i

209、ncrease in life expectancy at 6.4 years,followed by Kazakhstan;Georgia;and HongKong,China at 4.6 years(Figure 1.5).For older men,Armenia will have the highest increase in life expectancy at 6.1 years,followed by India at 5.7 years and Georgia at 5.2 years.In 33 of 46 regional economies,increases in

210、life expectancy to 2050 will be greater for older women than for older men.8Aging Well in Asia1.2 Changing Profile of Older PeopleThe profile of older people in the region is undergoing profound change,as older people today differ from those of the past.One clear positive development is improved hum

211、an capital among older Asians,evidenced by their improved educational attainment and literacy.Life expectancy is increasing,especially for women,and pushing up the share of the oldest old and the share of women in the cohort of old people.Meanwhile,challenges are arising for older people as living a

212、rrangements shift from extended families toward more diverse patterns,including one-person households and couples.Those who live alone are at a greater risk of poverty than those who live with family members.This study considers how these and other trends affect older Asians.1.2.1Age and Gender Comp

213、osition Skewed gender distribution in the older group will moderate somewhat toward greater representation of older men.From 1980 to 2022,life expectancy at age 60 rose by 4.7 years for women and by 3.5 years for men.Older women consequently outnumber older men,with the gap widening for the very old

214、.Going forward,however,skewed sex ratios at birth favoring boys in some areas will raise the share of males in middle age and older cohorts(Figure 1.6).Even then,older women will outnumber older men in all cohorts,but especially among the older old.A marked change in older populations is an increasi

215、ng share of the oldest old.The share of those aged 80 and above,the oldest old,in the older population reached 11.6%in 2022,or 65.7 million individuals.This share will climb further to 21.0%in 2050,reaching nearly 250 million(Figure 1.7).The region will require greater resources to provide health an

216、d long-term care for the oldest old.By subregion,East Asia will have the highest share of the oldest old in 2050.Economies in Southeast Asia and the Pacific will also see large increases in the oldest old by 2050.Ten economies in Figure 1.7 will see their share of the oldest old in the top 20%.Such

217、rapid aging is a sign of development and success,but it also creates greater challenges ahead to address the needs of older populations.Figure 1.6:Age Distribution,by Gender in Developing Asia48.548.748.848.548.549.251.455.560.565.469.751.551.351.251.551.550.848.644.539.534.630.3050100100+198047.947

218、.647.948.649.250.051.654.359.769.279.652.152.452.151.450.850.048.445.740.330.820.40501002022FemaleAgeAgeAge%Male48.748.748.548.048.048.850.553.257.566.078.951.351.351.552.052.051.249.546.842.534.021.1050100205090998089707960695059404930392029101909100+90998089707960695059404930392029101909100+909980

219、89707960695059404930392029101909Source:Asian Development Bank estimates using data from United Nations,Department of Economic and Social Affairs,Population Division.2022.World Population Prospects 2022,Online Edition(accessed 2 August 2023).9The Well-Being of Older Asians to the ForeFigure 1.7:Share

220、 of the Oldest Old in Older Populations7.68.38.58.99.49.610.110.110.210.310.710.710.911.111.111.412.312.412.713.714.014.314.514.615.415.515.915.916.016.116.116.316.416.816.919.020.421.622.626.627.530.532.533.634.336.721.0-80816243240 Afghanistan Papua New Guinea Nauru Marshall Islands Pakistan Solom

221、on Islands Lao PDR Fiji Kiribati Vanuatu Timor-Leste Tajikistan Uzbekistan Bhutan Turkmenistan Myanmar Nepal Kyrgyz Republic Philippines Indonesia Tuvalu Kazakhstan Niue Maldives Bangladesh Cambodia Samoa Mongolia FSM India Azerbaijan Brunei Darussalam Tonga Malaysia Palau Viet Nam Georgia Armenia S

222、ri Lanka PRC Cook Islands Taipei,China Singapore Thailand Republic of Korea Hong Kong,China Developing Asia%2022 Change from 2022 to 2050FSM=Federated States of Micronesia,Lao PDR=Lao Peoples Democratic Republic,PRC=Peoples Republic of China.Notes:Older populations are aged 60+,and the oldest old ag

223、ed 80+.The number at the end of each bar refers to share of the oldest old in 2050.Source:Asian Development Bank estimates using data from United Nations,Department of Economic and Social Affairs,Population Division.2022.World Population Prospects 2022,Online Edition(accessed 2 August 2023).10Aging

224、Well in AsiaFigure 1.8:Average Schooling Years for Older People Aged 60+1.41.51.72.02.73.13.23.44.44.44.54.64.76.16.16.26.57.67.77.98.48.68.78.89.09.19.29.39.39.710.010.010.010.611.011.112.05.703691215BhutanTimor-LesteAfghanistanNepalPakistanMaldivesBangladeshCambodiaIndiaLao PDRMyanmarSolomon Islan

225、dsVanuatuPRCViet NamIndonesiaKiribatiMalaysiaSri LankaPhilippinesThailandFSMFijiHong Kong,ChinaMongoliaSingaporeTaipei,ChinaTongaSamoaRepublic of KoreaAzerbaijanKazakhstanKyrgyz RepublicArmeniaTurkmenistanTajikistanGeorgiaDeveloping AsiaSchooling years1980Increase in schooling years from 1980 to 202

226、0FSM=Federated States of Micronesia,Lao PDR=Lao Peoples Democratic Republic,PRC=Peoples Republic of China.Note:The number at the end of each bar refers to the schooling year in 2020.Source:Asian Development Bank calculations based on data from Wittgenstein Centre for Demography and Global Human Capi

227、tal.Wittgenstein Centre Human Capital Data Explorer(accessed 19 November 2023).1.2.2Education and LiteracyThe current generation of older adults are more educated than same-age cohorts 4 decades ago.The average years of schooling for older Asians increased from 1.5 years in 1980 to 5.7 years in 2020

228、(Figure 1.8).5 By subregion,average schooling rose rapidly in the Caucasus and Central Asiaespecially in Armenia,Georgia,and Tajikistanto reach 1012 5 This was calculated from data on 37 economies in developing Asia from Wittgenstein Centre for Demography and Global Human Capital.Wittgenstein Centre

229、 Human Capital Data Explorer(accessed 19 November 2023).years in 2020.In East Asia,Mongolia,the ROK,and Taipei,China also experienced remarkable progress in schooling,adding 6.57.7 years to achieve an average of 910 years of schooling in 2020.In Southeast Asia,additional years of schooling varied fr

230、om a low of 0.9 years in Timor-Leste to a high of 7.7 years in Singapore.In the Pacific,the Federated States of Micronesia was a standout performer,with years of schooling rising from less than 1 year in 1980 to 8.6 years by 2020.11The Well-Being of Older Asians to the ForeFigure 1.9:Literacy Rates

231、for Older People Aged 65+16.517.626.126.330.839.044.356.063.266.477.981.184.487.188.190.593.198.398.698.799.399.399.499.6100.071.3020406080100AfghanistanTimor-LesteBhutanNepalPakistanBangladeshIndiaVanuatuCambodiaLao PDRIndonesiaSri LankaBrunei DarussalamPRCSingaporePhilippinesMaldivesSamoaAzerbaija

232、nMongoliaArmeniaTongaGeorgiaKazakhstanUzbekistanDeveloping Asia%20102014Change from 20102014 to 20192022Lao PDR=Lao Peoples Democratic Republic,PRC=Peoples Republic of China.Note:The number at the end of each bar refers to literacy rate in 20192022.Source:Asian Development Bank calculations based on

233、 data from United Nations Educational,Scientific and Cultural Organization.Sustainable Development Goal 4(accessed February 2023 and November 2023).Years of schooling for older people will further rise by 2.9 years from 2020 to 2050 to reach 8.6 years.Improved literacy among older people reflects ex

234、panded access to schooling.The average literacy rate for those aged 65 and over in the region improved from 61.3%in 20102014 to 71.3%in 20192022(Figure 1.9).More education means more economic opportunity in old age.This comes from better access to decent jobs and enhanced capacity for training and r

235、eskilling.Further,education diversifies choice and offers a greater sense of purpose in life,supports social relationships,and enhances social and economic rights.1.2.3Living Arrangements and Family TiesFamily and living arrangements for older people are becoming more diverse,with more solitary hous

236、eholds and couples.The extended family household with multiple generations has traditionally been the common living arrangement for older individuals.The share of extended-family households in the region is still high but declining.Not surprisingly,some studies find that living with ones children an

237、d grandchildren helps sustain older peoples physical and mental health and well-being(Rodgers et al.2024).Overall,findings are inconclusive,however,as 12Aging Well in Asiasignificant variation exists across the region(Ichimura et al.2017;Nakajima et al.2024).One factor that explains this variation i

238、s that richer,more educated older Asians often prefer to live with their spouse,separate from but near their children.Chapter 5 discusses in detail the changing family structures and living arrangements for older people and their effect on well-being.1.3 Aging and PovertyPoverty undermines the well-

239、being of older people in several ways.Poverty may mean eating less food and/or food of lower nutritional quality.It can mean not being able to pay for health care.As poverty and financial insecurity can trigger anxiety and depression(Ridley et al.2020),not being poor is prerequisite to aging well.In

240、equality between the old and the rest of the population,and among the old generally,grows as a consequence of population aging,and this can diminish the well-being of older Asians.Absolute poverty has declined among older people in developing Asia,mirroring poverty decline overall in the region.Data

241、 from 22 economies in developing Asia indicate that absolute(extreme)poverty among Asians aged 65 and over declined from 13.1%in 20102015 to 3.2%in 20162022(Albert et al.2024).6 Rapid economic growth in developing Asia dramatically reduced rates of extreme poverty from 58.1%in 1990 to 15.6%in 2011 a

242、nd 5.7%in 2019.Further,the percentage of people living in moderate poverty in developing Asia fell from 84.4%in 1990 to 44.1%in 2011 and 24.7%in 2019.However,the crises caused by COVID-19 and the subsequent inflation have set back poverty reduction.In 2020,the percentage of people living in extreme

243、poverty in developing Asia increased to 6.9%,and in moderate poverty to 26.2%(Figure1.10).7Absolute poverty affecting older people is in decline in most Asian economies.Figure 1.11 shows age-disaggregated rates of extreme poverty among older people and the general population across economies in deve

244、loping Asia.The decline in extreme poverty among older people reflects poverty reduction in the region as a whole,with notably steep declines in Indonesia and the Lao Peoples Democratic Republic,but rates still high in Bangladesh,the Federated States of Micronesia,Solomon Islands,and Timor-Leste.Pov

245、erty rates for older people are generally lower than for the population as a whole.Poverty statistics may fail to capture important aspects of the poverty status of older persons.While conventional poverty data can shed light on trends,they may not consider some factors that are important for older

246、people,in particular differences in intra-household resource allocation,individuals varying needs and costs,and household economies of scale(Deaton and Paxson 1995,1997).Absolute poverty has declined for older people in developing Asia,but relative poverty is high.Relative poverty rates for older pe

247、ople tend to be higher than for other demographic groups(see footnote 2).Recent data show relative poverty rates for older people higher than for children or for the population as a whole in the PRC,the ROK,Viet Nam,and Taipei,China(Figure 1.12).Relative poverty is a manifestation of income inequali

248、ty.In Asia,overall inequality has increased(Huang,Morgan,and Yoshino 2019),and rising inequality is partly driven by population aging(Deaton and Paxson 1994;Ohtake and Saito 1998).Inequality among older people could worsen as more educated and skilled people accumulate more wealth and earn higher re

249、turns than those with less education and skills.Population aging may worsen inequality by increasing the relative poverty rate of older people in the whole population and within the older group.6 Those in extreme poverty live on less than$2.15 a day(expressed in 2017 dollars at purchasing power pari

250、ty),and those in moderate poverty on less than$3.65.7 Compared with pre-pandemic numbers,or projections of what would have transpired if these crises have not occurred,at least 67.8 million more people lived in extreme poverty in developing Asia in 2022(ADB 2023a).13The Well-Being of Older Asians to

251、 the ForeFigure 1.10:Absolute Poverty Incidence,Developing Asia versus Other Regions020406080100$2.15/day$3.65/day$2.15/day$3.65/day$2.15/day$3.65/day$2.15/day$3.65/dayDeveloping AsiaLatin Americaand the CaribbeanMiddle Eastand North AfricaSub-Saharan Africa%199020182021Note:The later year is 2018 f

252、or the Middle East and North Africa,2019 for Sub-Saharan Africa,2020 for Developing Asia,and 2021 for Latin America and the Caribbean.Sources:Asian Development Bank.Key Indicators Database;and World Bank.Poverty and Inequality Platform(both accessed 13 March 2024).Figure 1.11:Incidence of Absolute E

253、xtreme Poverty among Older People and in the General Population in Developing Asia051015202530ArmeniaBangladeshBhutanFSMFijiGeorgiaIndonesiaIndiaKazakhstanKyrgyz RepublicKiribatiLao PDRMalaysiaMaldivesMarshall IslandsMongoliaMyanmarNepalPakistanPhilippinesSamoaSolomon IslandsSri LankaThailandTajikis

254、tanTimor-LesteTongaTuvaluVanuatuViet Nam%General populationOlder peopleOlder people,5 years ago or closestFSM=Federated States of Micronesia,Lao PDR=Lao Peoples Democratic Republic.Note:Reference years range from 2010 to 2022.They are 2021 for Armenia,2016 and 2010 for Bangladesh,2017 and 2012 for B

255、hutan,2013 for the FSM,2019 for Fiji,2021 and 2015 for Georgia,2022 and 2015 for Indonesia,2011 for India,2018 and 2015 for Kazakhstan,2020 and 2015 for the Kyrgyz Republic,2019 for Kiribati,2018 and 2012 for the Lao PDR,2018 and 2015 for Malaysia,2019 for Maldives,2019 for the Marshall Islands,2018

256、 and 2014 for Mongolia,2017 and 2015 for Myanmar,2010 for Nepal,2018 and 2015 for Pakistan,2018 and 2015 for the Philippines,2013 for Samoa,2012 for Solomon Islands,2019 and 2012 for Sri Lanka,2021 and 2015 for Thailand,2015 for Tajikistan,2014 for Timor-Leste,2015 for Tonga,2010 for Tuvalu,2019 for

257、 Vanuatu,and 2020 and 2014 for Viet Nam.Sources:United Nations,Department of Economic and Social Affairs.SDG Indicators Database(accessed 8 May 2023).14Aging Well in AsiaFigure 1.12:Relative Poverty Rates in Some Asian Economies,Latest Available Year01020304050Republic ofKoreaPRCAustraliaTaipei,Chin

258、aViet NamIndiaJapanGeorgia%Whole populationChildrenOlder peoplePRC=Peoples Republic of China.Notes:The relative poverty rate is the share of the group living on less than half of the median disposable income in the economy(definition adopted from the Organisation for Economic Co-operation and Develo

259、pment iLibrary).Reference years range from 2011 to 2021.They are 2011 for VietNam;2013 for India;2016 for Japan;2018 for the PRC and the Republic of Korea;2019 for Australia;and 2021 for Georgia and Taipei,China.Source:LIS Cross-National Data Center in Luxembourg.LIS Inequality and Poverty Key Figur

260、es(accessed 12 September 2023).Old-age poverty may be underestimated because research ignores intra-household resource allocation.A number of empirical studies in Asia find that intra-household resource allocation decisions tend to disfavor older household members,especially women.Using household da

261、ta from Bangladesh to quantify the extent of consumption inequality within families,Brown,Calvi,and Penglase(2021)found that older women faced a significantly higher probability of living in poverty even in households with expenditure per capita above the poverty line.Even worse,Paudel(2021)found a

262、large increase in allowances under a nationwide senior citizen program in Nepal associated with reduced food consumption by women,even though it increased the likelihood of financial assistance by 64.4%.Strikingly,eligible female beneficiaries were 8.8%more likely to eat fewer meals and 5.3%more lik

263、ely to go to bed hungry.This unforeseen consequence was partly explained by higher allowances attracting would-be beneficiaries and thus generating larger households,which reduced the resources available to older women.In neighboring India,Calvi(2020)used a natural experiment to show that a prime ca

264、use of the high and excess poverty and mortality rates among older women was their declining bargaining power within the household as they aged,and their consequently reduced share of household resources.1.4 Well-Being of Older People Well-being encompasses quality of life and its potential,which de

265、pend on factors beyond the traditional notion of poverty.Well-being is achieved when various human needs are met in a holistic and multidimensional way.It is strongly linked to happiness and life satisfaction as well as to functioning effectively and,in particular,to having the capacity to develop o

266、nes potential,gain some control over ones life,find 15The Well-Being of Older Asians to the Forepurpose in life,and experience positive relationships(Huppert 2009).8Well-being cannot be measured in terms of gross domestic product per capita alone.This basic economic measure fails to capture adequate

267、ly other dimensions that matter to individuals.The Organisation for Economic Co-operation and Development(OECD),for example,provides a comprehensive framework for understanding and measuring peoples well-being(OECD 2011,2020b).The OECD framework for well-being includes several dimensions that relate

268、 to the material conditions that affect peoples economic options,as well as quality-of-life factors that embody how healthy people are,what they know and can do,and how wholesome and safe their living environments are.The framework also considers how connected and engaged people feel,and how and wit

269、h whom they spend their time.91.4.1Defining Well-Being in Old AgeThree challenges complicate the use of a detailed framework like the OECDs to measure the well-being of older people in developing economies.The first challenge is whether the framework is able to capture the varying social and cultura

270、l values and heterogeneous institutional settings that often affect well-being.Second is whether such a framework can be directly applied to measure well-being in the subset of people at the specific life stage called old age.The third is a lack of detailed and standardized data across economies to

271、derive detailed indicators.Subjective well-being is a state of mind or cognitive assessment of life satisfaction or happiness.Researchers have suggested various subjective measures of well-beingevaluative(assessment of life satisfaction),hedonic(positive or negative feeling),eudaimonic(meaning or pu

272、rpose in life),and experiential(feeling during specific activities)but have raised numerous methodological concerns(Lee and Park 2024).Despite continuing methodological debates,the body of empirical literature on this topic continues to grow.Researchers have studied happiness around the world(Deaton

273、 2008;De Neve et al.2018;Helliwell et al.2023),in Europe or the United States(Easterlin 2006;Fonseca et al.2013,2014);and in transition economies(Guriev and Melnikov 2018;Clark,Yi,and Huang 2019;Cai,Park,and Yip 2021).Some studies focus on Asian economies,providing an overview of the active pursuit

274、of activities,wellness,and lifestyles that promote health in the region(Park et al.2021).One widely used direct measure of subjective well-being is a life-satisfaction scale based on survey questions on how satisfied the respondent is with life(Diener et al.1985).Life satisfaction measures well-bein

275、g in a positive light,while other examples of survey-based indicators of well-being measure deviation from well-being caused by physical,mental,economic and other distress,and manifested as depression,loneliness,and anxiety.It is important to consider both well-being and“ill-being,”as the causal fac

276、tors may be different.For example,social background affects ill-being more,while social networks affect well-being more(Headey,Holmstrom,and Wearing 1985).Several dimensions shape the well-being of people in general,but for older people four dimensions are critical(Figure 1.13).10 The key determinan

277、ts of well-being and ill-being in older people in Asia can be categorized into four key determinants based on the literature(Ichimura et al.2017;Teerawichitchainan,Pothisiri,and Long 2015;Nakajima et al.2024;Kwak and Lee 2024).First,well-being in older people is strongly associated with physical and

278、 mental health,especially given vulnerability to chronic illnesses.Good health goes beyond the absence of disease to include physical and mental health,as well as physical mobility 8 Well-being is distinct from wellness,which is largely about physical health.Wellness entails being actively engaged i

279、n activities,choices,and lifestyles to achieve a state of holistic health(Global Wellness Institute 2018).9 The OECD well-being framework includes over 80 well-being indicators that reflect the 11 dimensions of current well-being and four capitals of future well-being.The 11 dimensions for current w

280、ell-being are(i)income and wealth,(ii)work and job quality,(iii)housing,(iv)health,(v)knowledge and skills,(vi)environmental quality,(vii)subjective well-being,(viii)safety,(ix)worklife balance,(x)social connections,and(xi)civil engagement.The capitals of future well-being are(i)natural capital,(ii)

281、economic capital,(iii)human capital,and(iv)social capital.10 Similarly,Ichimura et al.2017 found four categories of well-being elements in old age:demographic,economic,social,and health.16Aging Well in Asiaand functions(WHO 1948).A second dimension is productivity through work for those who are able

282、 and willing to do so;finding fulfillment from work,either paid or unpaid,such as caregiving and volunteering;and contributing to society.A third dimension is economic security,which means having adequate income and wealth including a pension to finance ones consumption in old age.A fourth dimension

283、 that enhances older peoples well-being is social engagement and meaningful interaction with family.These four dimensions are interlinked and mutually reinforcing as they affect well-being in old age.As this report explores in the following chapters,health largely determines a persons physical capac

284、ity to work.Health includes mental health,which may be affected by social engagement.Ones willingness to work may also be affected by the availability of a pension to allow retirement with dignity.Therefore,a shortcoming in one area may hamper the achievement of other elements of well-being,and effe

285、ctive policy reform in one area can positively affect other areas.This argues for well-integrated aging policies and programs.Quantitative analysis confirms that health,economic security,and social engagement matter to the life satisfaction of older persons in the region.Empirical analysis shows tha

286、t,among the four dimensions of well-being in old age,self-reported health and physical functionality are by far the most influential determinants of well-being(Kikkawa et al.2024a).Social engagement in the form of living with a spouse and ones children lifts the well-being of older people as much as

287、 having income and assets.Other dimensions,including work and receiving a contributory pension,were not statistically significant,likely reflecting their more complex effects on well-being,which are either positive,negative,or neutral depending on the context(Box 1.2).Figure 1.13:Four Dimensions of

288、Well-Being in Older PeopleEconomicallySecureSociallyEngagedProductiveHealthyWELL-BEINGSource:Asian Development Bank.17The Well-Being of Older Asians to the ForeThe predictors of well-being in older Asians are examined using the satisfaction-with-life scale.a This indicator is available for five econ

289、omies included in the Asian Development Policy Report(ADPR)harmonized aging data:India,Malaysia,the Peoples Republic of China,the Republic of Korea,and Viet Nam.The box figure illustrates the results of a multivariate analysis,validating the significance and magnitude of known predictors of life sat

290、isfaction on the four areas of well-being in old age.Life satisfaction increases with age.An increase in the age of an older person has a statistically significant positive association with life satisfaction scores.The effect is small,but recurs every year.This is consistent with a recognized U-shap

291、ed relationship between life satisfaction and age(Blanchflower 2021).No significant difference is found inlife satisfaction in older men versus older women,which contrasts with other evidence showing that older women generally report higher life satisfaction than their male peers(Helliwell et al.202

292、3).Education is key to an older persons well-being.A higher educational attainment,at least at lower secondary school,is significantly associated with greater life satisfaction in old age.This finding is consistent with studies that show education to be positively correlated with self-reported quali

293、ty of life(Farzianpour et al.2015;Schwingel et al.2009).Education plays a crucial role in well-being through improved income and employment opportunities throughout life and into old age.It also increases ones ability to plan and save for old age.Box 1.2:Predictors of Well-Being and Life Satisfactio

294、nLife Satisfaction in Older People0.20.100.1Coefficient0.20.30.4Home ownershipHousehold expenditureReceives contributory pensionWorkingADL limitationsHealth insuranceDiagnosed diseasesSelf-reported good healthChild co-livingMarriedLower secondary or higherRuralMaleAgeADL=activity of daily living.Not

295、es:The dependent variable captures respondents self-reported life satisfaction on a scale of 13,ascending from not satisfied to satisfied and very satisfied(sample mean:2.35,standard deviation:0.67).The regression includes an interaction term between working and pension,which is insignificant.Househ

296、old expenditure is presented as the log of expenditure per household member.The regression is estimated using ordinary least squares.Harmonized sampling weights applied.The sample includes data on older people aged 60+in India,Malaysia,the Peoples Republic of China,the Republic of Korea,and Viet Nam

297、.N=48,565.Source:Kikkawa et al.(2024a).continued on next page18Aging Well in AsiaHealth indicators are the strongest predictors of life satisfaction.Self-assessed good health is significantly associated with a 0.3 point higher life satisfaction score,which is considerable,given that the mean is 2.35

298、,and its standard deviation is 0.67.Also,poor physical health and functional impairment in performing daily living activities are associated with a satisfaction score 0.15 points lower.Counterintuitively,a diagnosis of diabetes,hypertension,or heart disease is associated with greater life satisfacti

299、onone possible explanation being that older people with a diagnosed disease receive more care and attention(Finlay and Kobayashi 2018).In addition,disease diagnosis is consistent with better access to health-care services and a better social and economic circumstance than may be the norm for older A

300、sians.Paid work and contributory pensions are not associated with the well-being of older persons.Results show no significant association between paid work and well-being,perhaps suggesting that the effect of employment on the well-being of older people depends on the nature of the job or reasons fo

301、r working.High-quality jobs may increase satisfaction,but this effect may be canceled out by those with low-quality and undesirable jobs.Certainly,low-paying and physically demanding work can undermine the mental and physical health of older people(Henseke 2018).It may also be true that some people

302、enjoy work,while others prefer retirement.Chapter 3 of this report looks at how work affects well-being in old age.A pension is normally important for providing income in old age,but very low contributory pension coverage in the region,as discussed in Chapter 4 of this report,may explain why pension

303、s have no statistically significant effect on well-being,either positive or negative.Social engagement matters a lot for an older persons well-being.Being married and living with ones children positively affect life satisfaction.There is large variation across the region,however,in how living arrang

304、ements affect well-being in old age.Chapter 5 of this report discusses living arrangements,older peoples family and social engagement,and the impact on their well-being.Some notable differences exist across economies on how various dimensions of well-being affect life satisfaction.Notable variations

305、 are associated with gender,educational attainment,urban versus rural residence,and living with ones children,and how they affect life satisfaction.a The scale in the present analysis is ordinal:1 indicating not satisfied with life,2 somewhat satisfied,and 3 very satisfied(Diener et al.1985;Kikkawa

306、et al.2024a).References:Blanchflower,D.G.2021.Is Happiness U-Shaped Everywhere?Age and Subjective Well-Being in 145 Countries.Journal of Population Economics.34.Diener,E.D.,R.A.Emmons,R.J.Larsen,and S.Griffin.1985.The Satisfaction with Life Scale.Journal of Personality Assessment.49(1).Farzianpour F

307、.,A.R.Foroushani,A.Badakhshan,M.Gholipour,and M.Hosseini.2015.Evaluation of Quality of Life and Safety of Seniors in Golestan Province,Iran.Gerontology and Geriatric Medicine.1.Finlay,J.M.and L.C.Kobayashi.2018.Social Isolation and Loneliness in Later Life:A Parallel Convergent Mixed-Methods Case St

308、udy of Older Adults and Their Residential Contexts in the Minneapolis Metropolitan Area,USA.Social Science Medicine.208.Helliwell,J.,R.Layard,J.D.Sachs,J-E.De Neve,L.B.Aknin,and S.Wang,eds.2023.World Happiness Report.Gallup,the Oxford Wellbeing Research Centre and the United Nations Sustainable Deve

309、lopment Solutions Network.Henseke,G.2018.Good Jobs,Good Pay,Better Health?The Effects of Job Quality on Health among Older European Workers.European Journal of Health Economics.19(1).Kikkawa,A.,M.Pelli,L.Reiners,and D.Rhein.2024a.The Determinants of Well-Being of Older Persons:A Comparative Study ac

310、ross Developing Asia.Asian Development Bank.Schwingel,A.,M.M.Niti,C.Tang,and T.P.Ng.2009.Continued Work Employment and Volunteerism and Mental Well-Being of Older Adults:Singapore Longitudinal Ageing Studies.Age and Ageing.38(5).Source:Kikkawa et al.(2024a).Box 1.2 continued19The Well-Being of Older

311、 Asians to the Fore1.5 Conclusion The policymakers in Asia and the Pacific must act urgently to improve well-being in old age.Lack of preparedness risks leaving behind older Asians as the region pursues rapid economic progress.However,development that neglects such a large and growing segment of the

312、 population cannot be inclusive.Policymakers must work closely with current and future generations of older Asians to improve well-being across four dimensions:health,work and retirement,economic security,and social engagement.Even in younger economies,the time to start preparing is now because the

313、demographic landscape will change dramatically in the future.While absolute poverty among older Asians has declined,the policy objective for Asian governments should be to ensure well-being,defined using a more comprehensive measure of the quality of life.The changing profile of older people creates

314、 both challenges and opportunities.The growing prevalence of living alone,for instance,increases the risk of old-age poverty.On the other hand,improving the educational attainment of older Asians augments their productive capacity and opens up new economic opportunities.Higher productivity not only

315、improves their own well-being,but also expands the productive capacity of the entire economy.This,in turn,helps the economy cope with the economic consequences challenges associated with rising dependency ratios caused by population aging.This report is organized as follows.The next four chapters pr

316、esent the current state and effect on well-being in old age of physical and mental health(Chapter 2),work and retirement(Chapter 3),financial preparedness and pensions,(Chapter 4),and family,care,and social engagement(Chapter 5).Each chapter discusses progress in the region toward achieving the goal

317、 of aging well and identifies priority policy actions.To generate comparable descriptive data and analysis on the state of older peoples well-being in the region,this Asian Development Policy Report compiled,harmonized,and merged surveys conducted in nine regional economies on population aging,healt

318、h,and retirement.Box 1.1 provides more information on the data sources and the data harmonization process.A key facet of well-being is good health.Good health is not merely the absence of disease.Health is a multidimensional concept that encompasses physical and functional status,including the capac

319、ity to perform daily activities,mental health and cognitive functioning,and self-assessed health.The World Health Organization(WHO)defines healthy aging as developing and maintaining the functional ability that enables well-being in old age.The health status of older people varies greatly,compared w

320、ith younger people.Self-assessments of health provide information about individuals own perception of their health at a given time,which reflects their underlying medical condition and can be used as a valid indicator of objective health status.11 This chapter discusses various dimensions of old-age

321、 health to inform policy recommendations.Using available datasets,the analysis begins by looking at cross-country comparisons of the population health status of older people:life expectancy,healthy life expectancy,and the disease burden on older people from infectious disease and noncommunicable dis

322、ease(NCD),including mental and cognitive disorders.12 It then presents the physical health,health behavior,functional abilities,mental health,and self-assessed health of older people using the latest available survey data from nine Asian economies,accounting for 82%of older people living in Asia and

323、 the Pacific(Chapter 1,Box 1.1).Health-seeking behavior,access to health care,and global and regional policy initiatives on healthy aging,including the role of effective universal health coverage are also examined.Finally,specific policy recommendations are presented.2.1 Extended Life Expectancy and

324、 Health in Older Populations Life expectancy at birth has risen globally and in Asia.Since 2000,Asia and the Pacific has seen average life expectancy at birth increase by 5.6 years in low-and lower-middle-income economies,5.2 years in upper-middle-income economies,and 4.4 years in high-income econom

325、ies.In developing Asia,notable increases in longevity were recorded in Cambodia,up by 12.1 years or 20.6%;the Lao Peoples Democratic Republic(Lao PDR),by 9.7 years or 16.7%;and Timor-Leste,by 9.7 years or 16.6%.Life expectancy in the region is projected to extend further in the next 3 decades by 4.1

326、 years for men and 3.7 years for women(Chapter 1,Figure 1.5).The life years gained are not necessarily all healthy years.In the past 2 decades,low-and high-income economies alike have gained in healthy life expectancy at age 60:in Bangladesh by 2.2 years,Maldives 3.1 years,Mongolia 2.3 years,the Rep

327、ublic of Korea(ROK)3.9 years,Singapore 3.3 years,and Thailand 2.3 years.However,the difference between life expectancy and healthy life expectancy at age 60,or the number of years spent in less-than-full health,has also increased in most economies(Figure 2.1).11 Lower self-assessed health is associa

328、ted with functional decline in later age (Kim et al.2017)and higher mortality(Mossey and Shapiro 1982;Benjamins et al.2004;Reinwarth et al.2023).Physical and mental health status influences older peoples well-being and satisfaction with life(Kahneman and Krueger 2006;Sun et al.2016).12 An“older pers

329、on”is aged 60 years or above unless otherwise specified.Health of Older People221Health of Older PeopleFigure 2.1:Average Life Expectancy and Healthy Life Expectancy at Age 60 in 2000 and 2019,by Gender and EconomyMaleFemale5.14.65.04.35.24.05.14.75.04.24.94.14.23.74.64.24.74.04.54.34.84.54.03.73.83

330、.35.14.34.03.74.14.24.14.33.83.24.45.33.83.23.73.74.03.53.63.53.33.13.32.93.83.33.22.73.13.03.02.6Healthy life expectancy at 606570758085902019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 200

331、02019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 2000201920002019200020192000Age6.76.16.25.36.75.46.05.65.84.45.95.16.15.25.34.84.74.35.35.06.05.44.84.65.45.36.15.35.65.45.14.95.35.24.94.25.05.35.04.24.95.15.04.64.84.74.34.04.13.74.94.44.43.54.03.83.73.3657075808590AgeLife expect

332、ancy at 60KIR FSM MON FIJSOLVANJPNPNGCAMPHIMYATIMLAONEPINOVIEINDTONSAMSRIMALBRUBHUPRCBANMLDTHAKORSIN2019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 20002019 200020

333、19 20002019 20002019 20002019 2000201920002019200020192000KIR FSM MON FIJSOLVANJPNPNGCAMPHIMYATIMLAONEPINOVIEINDTONSAMSRIMALBRUBHUPRCBANMLDTHAKORSINBAN=Bangladesh,BHU=Bhutan,BRU=Brunei Darussalam,CAM=Cambodia,FIJ=Fiji,FSM=Federated States of Micronesia,IND=India,INO=Indonesia,JPN=Japan,KIR=Kiribati,KOR=Republic of Korea,LAO=Lao Peoples Democratic Republic,MAL=Malaysia,MLD=Maldives,MON=Mongolia,MYA