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.
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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
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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