Characteristics of Population Ageing Process in Vietnam and Issue of Caring for the Elderly

52 Characteristics of Population Ageing Process in Vietnam and Issue of Caring for the Elderly Nguyen Huu Minh 1 1 Institute for Family and Gender Studies, Vietnam Academy of Social Sciences. Email: minhngaanh@yahoo.com Received on 1 April 2019. Revised on 19 July 2019. Accepted on 20 August 2019. Abstract: The paper analyses some demographic and socio-economic characteristics associated with the current population ageing process in Vietnam and the needs for care for the elderly. Improved education and living standards allow families to take better care of the elderly. However, for many elderly people, accumulated assets are still not enough to take care of their lives. The proportion of elderly people increases coupled with a decreased rate of fertility, smaller household sizes, and limited level of financial accumulation, etc., has increased the demand for care for the elderly, while social services on this issue are limited with the family continuing to be the main institution of providing care for the elderly. From the analysis results, the article proposes several policy aspects that need to be considered regarding the care for the elderly, from the perspective of the role of the state, the community, the family, relatives, and the market. Keywords: Ageing population, care for the elderly, family and social policies. Subject classification: Sociology 1. Introduction Population ageing or the "ageing population" period is calculated to happen when the proportion of people aged 60 or older accounts for 10% or more of the total population. It is the result of demographic transition when both mortality and fertility levels decline, reducing the proportion of children under 15 and increasing the proportion of elderly people. For the past few decades, along with great socio-economic changes, Vietnam has been undergoing a strong population ageing process. On the one hand, this process reflects the improved quality of life of the people, but on the other hand, it raises new issues of taking care of the elderly that need due attention as this portion of people occupies a growing part of the population. With statistical data and sociological surveys, this paper focuses on analysing the socio-demographic aspects of population ageing process as well as the operational status of the four basic Nguyen Huu Minh 53 institutions: the state, the community, the family and the relatives for the care for the elderly in Vietnam. On that basis, the paper suggests some policy issues that need attention for the elderly in the current period. 2. Population ageing in Vietnam Over the years, the average life expectancy of Vietnamese people has increased considerably. The average life expectancy of Vietnamese people from 63 years for men and 67.5 years for women in 1989 increased gradually to 70.8 for men and 76.1 for women in 2016 [28], [31], [36]. In association with the increase in average life expectancy, the proportion of elderly people also increases. According to the 2009 Population and Housing Census, the proportion of elderly people (60 years of age or older) in Vietnam increased from 7.1% in 1979 to 7.2% in 1989, and 8% in 1999 to nearly 9% in 2009. By 2012, this percentage reached 10.2% and in 2016 it was 11.9% [3], [31], [36]. As such, Vietnam's population has reached the threshold of an ageing population since 2012. Another important indicator of population ageing is the ageing index, which is calculated as the ratio of the number of people aged 60 and older to 100 people under the age of 15. The population ageing index in Vietnam increased from about 18.2 in 1989 to 24.3 in 1999, 35.5 in 2009, and 50.1 in 2016, higher than the average for Southeast Asia [11]. This shows that the population ageing in Vietnam was very rapid in the last three decades [3], [28], [36]. According to calculations, the time for the portion of the Vietnamese population aged 65 and older to increase from 7% to 14% of the total population is much shorter than that of many countries: for France it is 115 years, for the US it is 69 years, for Japan and China it is 26 years, while for Vietnam it is only 20 years. This is a serious challenge for the care for the elderly in Vietnam, while the level of socio-economic development is not high yet [40]. The difference between average life expectancy and healthy life expectancy, i.e. the average number of years living with illnesses, is a very important indicator when considering the issue of ageing. The goals of countries are not only to increase average life expectancy, but more importantly to increase a healthy life expectancy, meaning a long life but a healthy life. However, according to the WHO’s data, the average number of years living with illnesses in Vietnam is relatively high compared to that of other countries. In Vietnam, women's average number of years living with illnesses is 11 years and for men it is about eight years [11]. The population ageing trend in Vietnam places new care needs on the elderly that are to be met. The elderly people's care needs vary by region of residence and population group. According to data from the 2006 Vietnam Family Survey, the National Survey of the Elderly and the recent censuses show that the dependency ratio in urban areas is lower than that in rural areas, and that the dependency ratio in areas with average living standards or higher is lower than that in poor regions. Similarly, the dependency ratio for households with better living standards is lower than that for poor households [8], [33], [36]. Vietnam Social Sciences, No. 6 (194) - 2019 54 3. Some socio-demographic characteristics associated with caring for elderly in Vietnam Along with the ageing population, a number of other demographic characteristics also changed over the past decades and have potential effects on the care of the elderly. The total fertility rate in Vietnam keeps declining. It was 2.25 in 2001 and close to the replacement fertility rate with 2.03 children in 2009. In 2012, the figure was 2.05, and in 2016, it was 2.09. There are significant differences between fertility rates in urban and rural areas. In 2009, the total fertility rate in urban areas was 1.81 children and in rural areas it was 2.14 children. The corresponding figures for 2012 were 1.80 and 2.17; for 2014 - 1.85 and 2.21; and for 2016 they were 1.86 and 2.21 [33], [36]. The smaller number of children implies that the ability to care for the elderly of family members will be more inhibited in the current period and the coming years. The results of the population censuses and national sample surveys (such as the annual Population Change Survey, the Household Living Standard Survey) in the past few decades also show that the family size is smaller and the structure of the family is also becoming more and more simplified towards a nucleus family, meaning that the family consists of only the spouses and their immature children. The average number of people in the household was 3.6 in 2016; 3.7 in 2012; 3.8 in 2009; 4.6 in 1999, 4.8 in 1989 and 5.2 in 1979. The family size in urban areas is smaller than in rural areas (3.6 members in urban areas and 3.7 members in rural areas in 2016) [3], [28], [31], [33], [36]. Results of the 2014 Living Standards Survey also indicate that the average household size of poor households is often bigger than that of rich households, and the average household size of mountainous households is bigger than that of plain households [34]. A decreasing family size affects the ability of family members to take care of the elderly due to having fewer people at home. The reduction in household sizes has a positive impact on daily life in general, including the increased ability to provide material support and the improved mental health. In terms of material support, average income and average expenditure per person increase as family size decreases. On the contrary, some negative consequences are also evident, for example, the increased livelihoods of the elderly living alone. Marital status is important for the lives of the elderly because for them, living with a spouse is highly meaningful as a Vietnamese proverb goes "Children take care of their father not as well as their mother take care of him". The common feature today is that the majority of the elderly live with their spouses, but there is a fundamental difference between men and women in this regard. Data from the 2009 Population and Housing Census shows that 84.9% of men aged 60 and older live with their wives, but only 44.1% of women aged 60 and older live with their husbands at the time of the survey [3]. The corresponding proportions in 2014 were Nguyen Huu Minh 55 85.8% and 47%, while in 2016 they were 86.2% and 48% [33], [36]. Among elderly people who did not live with their spouses at the time of the survey, the majorities were widowed and the proportion of widowed women was significantly higher than that of men. According to the 2009 Population and Housing Census data, the proportion of men aged 60 and older who were widowed at the time of the survey was 13.8% (the proportion of men aged 60-64 was 4.47%; for those aged 65-69 it was 7.64%; for those aged 70-74 it was 12.64%, and for those aged 75 and older it was 27.36%), and the proportion of women aged 60 and older who were widowed at the time of the survey was 52.6% (the proportions corresponding to the age groups were 30.55%; 42.04%; 52.43% and 73.22%) [3], [29]. The results of the mid-term census in 2014 showed that the proportion of men aged 60 and older who were widowed was 12.6%, while for women, 47.6% of women aged 60 and older were widowed. The corresponding figures for the 2016 Mid- term Census showed that the proportion of men aged 60 and older who were widowed was 11.9% and that of women aged 60 and older who were widowed was 45.0% [31], [33], [36]. In Vietnam, divorce is not common. However, in recent years the rate of divorces has increased. The census data shows that the proportions of the population aged 15 and older who divorced (at the time of the survey) were 0.5% in 1989, 0.8% in 1999, 1.0% in 2009, 1.5% in 2014 and 1.8% in 2016. The trend of the growing divorce rate is reflected in both urban and rural areas, as well as for men and women, but higher for women and in urban areas. For the elderly, the divorce rate also tends to increase. As of 1 April 2014, the divorce rates for men and women aged 60 and older were 0.6% and 1.2%, while in 2016 they were 0.6% and 1.8% respectively [33], [36]. The above figures show that, in general, the elderly men often live with their wives while a significant proportion of the elderly women do not live with their husbands. That creates the risk of possible injuries in life due to the lack of one of the two, especially for women because women are often more vulnerable to socio-economic shocks [26 with reference to 40]. This requires policies to provide care for the elderly and to pay attention to this trend. The next issue to consider is whether the elderly live with their children or not. Data from the population living standard surveys shows that the percentage of elderly people living with children was still very high but tends to decrease (from nearly 80% in 1992/1993 to 62% in 2008) [40]. The proportion of elderly people living alone increased from 3.47% in 1992/1993 to 6.14% in 2008. The majorities of elderly people living alone were in rural areas and were women. In addition, the proportion of households with only married elderly people increased, more than doubled, in the period of 1992/1993 - 2008. According to the results of the 2017 Awareness and Attitude of Family Survey in Can Tho city with 1,205 households [45], out of 189 Vietnam Social Sciences, No. 6 (194) - 2019 56 elderly respondents, 16.9% said only married elderly couples lived together. Similarly, out of 268 respondents whose elderly parents were still alive, 15.3% of the elderly parents lived alone or together as married couples. In the context of limited social security, such a living arrangement is a great difficulty for care for the elderly [40]. For those elderly people who do not live with their children, the living distance between parents and children is a matter of great concern for the care for the elderly, both physically and mentally. There is a difference between urban and rural areas in this regard. In rural areas, children who do not live with their parents after getting married are easily able to contact their parents due to their proximity. However, this is more difficult in the urban environment due to the lack of land, especially before the 1986 đổi mới. Since đổi mới, there have been more and more opportunities for urban residents to find suitable homes close to their parents' houses. So, parents and children can easily help each other. However, the proportion of children living separately but close to their parents' residence in urban areas is still lower than those living in rural areas. The 2010 Perception and Attitude towards Family Survey in Hanoi found that 196 elderly people (aged 60 and older) with 549 married children were not living under the same roof, 41.9% of these children were living within 15 minutes' walk from their elderly parents' houses and 26% within a 15-30 minute's drive. The corresponding proportions in urban areas were 27.9% and 36.1%, and in rural areas they were 48.9% and 21% [43]. Survey data in Can Tho city in 2017 showed that among 168 elderly people with 507 married children who currently were not living under the same roof, 32.1% of their children were living within 15 minutes' walk and 18.9% within a 15-30 minutes' ride from their elderly parents' residence. The corresponding proportions in urban areas were 31.4% and 18.8%, while in rural areas they were 32.9% and 19.0% respectively [45]. The desire to have a son is closely related to the care of the elderly because the son is expected to live with and care for his parents later on, ensuring that the elderly have a well-being in old age (“Young children rely on their father, the elderly rely on their children”, as a Vietnamese saying goes). The fact that the desire to have a son is strongly expressed in Vietnamese society through the sex ratio at birth indicator 2 has increased beyond normal levels since 2006 to present. According to the results of the 2006 Population Change Survey, the sex ratio at birth in Vietnam was 109.8 boys for every 100 girls born. In 2007 and 2008, the ratios were 111.6 and 112.1 respectively. That trend continued with 112.3 in 2012, 112.2 in 2016 and 114.8 in 2018 [38, p.47]. The Red River Delta was the region with the highest sex ratio at birth in the country, with 115.3 in 2009, 120.9 in 2012 and 118 in 2014 [31], [33], [36]. In addition to the reason for the desire to have a son, the policy of each married couple having just one to two children, the development of Nguyen Huu Minh 57 new technologies that allow for sex selection of the fetuses (by means of ultrasound and abortion) at the parents' desire, coupled with inadequate management of medical advances, were a number of important causes of this situation [44]. An excessive increase in the sex ratio at birth will affect people's ability to get married and the care of the elderly in the future. According to the 2006 Vietnam Family Survey, the proportion of households having the elderly aged 60 and older was 32.6%, corresponding to 35.7% in urban areas and 31.4% in rural areas [8]. The 2017 Household Survey, with a sample of 2,000 households, showed that overall 27.1% of households having elderly aged 60 and older, 32.8% in urban areas and 25.4% in rural areas [27]. Based on the data from the Ministry of Labour, War Invalids, and Social Affairs in 2006, one-third of the elderly were poor or near poor and were facing difficulties in their material life, especially those living in rural and mountainous areas. More than 100,000 elderly people were living in makeshift houses and many did not have enough warm clothes to wear in the winter. The situation of parents and grandparents were ill treated or cared for by their children and grandchildren still existed [4]. The 2017 Family Survey showed that 12.5% of the total number of households having elderly people was poor households, and at the same time 11.8% of the total number of elderly people was living in poor households [27]. A 2006 report of the Ministry of Health confirmed that about 95% of the elderly people were suffering from diseases and illnesses and that the average elderly person was infected with 2.69 diseases, mostly chronic and not communicable and infectious diseases. The proportion of the elderly with good health was only about 5 - 7%, those having poor health accounting for 23%, and the rest were living with an average health level [41]. The 2011 Vietnam Elderly Survey, with a nationally representative sample size, showed that 65.4% of the elderly self- assessed their health as weak and very weak; 29.8% rated it as normal and only 4.8% rated it as good and very good [40]. This shows a very high demand for healthcare for the elderly in Vietnam today. The majority of the elderly people in Vietnam were born and raised in the context of war and got matured in the period of the subsidised economy. When the country shifted to a market-driven economy, those people had to face numerous economic difficulties because they either did not have accumulated wealth or their wealth was inadequate for them to lead a decent life and to support their health in old age. 4. Socio-economic change associated with taking care of the elderly Thanks to the implementation of đổi mới, or renovation, policies (started in 1986), the Vietnamese economy has experienced strong growth. The average annual GDP growth rate was about 7.26% in the 2001- 2010 period, 5.9% in 2011 and it was estimated that for the whole year 2017 it would reach 6.8% [15], [12], [35]. GDP per capita was USD 1,168 in 2010, a three-fold Vietnam Social Sciences, No. 6 (194) - 2019 58 increase compared to that of 2000. In 2017, GDP per capita was estimated at 2,385 USD, an increase of USD 170 compared to that of 2016. With these new developments, Vietnam has graduated from a poor country to a lower middle-income country. As a result of economic growth, investment in social sectors, including healthcare, has increased. According to data from the Ministry of Health and the Health Partnership Group [9, p.49], the share of state budget spending on health in 2014 was estimated at 8.2%, an increase compared to 7.7% in 2010. State budget spending on health in the period of 2011-2015 increased over the years with a higher rate than the increase in state budget spending (except for 2011, there was a negative growth rate after deducting the GDP deflator). However, social and economic development processes in Vietnam still face many difficulties. Total investment for the social development sector in 2013 was only 30.4%, the lowest since 2000. This shows that Vietnam will conti