Community-based health and aged care in China

The population of China is currently 1.34 billion, which represents almost one-fifth of the world’s population. Over the period 2010 to 2065, it is estimated the proportion of people aged 65 years and over will increase from nine percent to 30 percent. In order to improve equity and financial sustainability, China is undergoing rapid health and aged care system reforms in response to its ageing population and rapid increases in the number of people with chronic diseases.


Innovative programme

Health system reforms include establishing a stronger primary healthcare system that incorporates patient-centred care and chronic disease self-management principles. A recent innovative programme has been introduced in Beijing, China, to help older people with diabetes to manage their illness. Called the “Happy Life Club”, it utilises health coaches trained in behavioural change and counselling principles to address the management of diabetes in older people in primary care settings in China. These coaches support participants to improve modifiable risk factors and adhere to effective self-management treatments associated with diabetes. This type of approach is popular with both health practitioners and older people.

Below is a typical comment from one of the health coaches:

“I have an older patient with diabetes who is a heavy drinker. I told him to quit many times but this did not work. He knew alcohol was a bad thing but he continued to drink. After my coach training, I understood that I needed to work with him to find a solution. He had tensions with his wife and used alcohol to free himself. He said to me ‘Can I bring my wife to see you. She trusts you’. After these family consultations and counselling, the old couple was happy to work together. Now he has a very happy family life, and, surprisingly he has stopped drinking!”

China is committed to improving the skills of its primary healthcare workforce. To meet the needs of an ageing population, more health professionals will be needed with improved skills in patient-centred and behavioural change approaches. Programmes such as the Happy Life Club are leading the way in the training of doctors and nurses. However, a challenge is the sheer scale of the training programme required to meet the needs. In addition, a significant issue for older people in China today is that many are not covered by adequate health insurance to allow them to take full advantage of the reforms. Many rely on their families for financial and health and aged-care support.


Growth in private-care homes

In the aged-care sector, family-based care is the traditional and most common form of care for older people. However, the one-child policy and extensive internal migration by younger people from rural areas to major cities has reduced the opportunities for families to care for their older members. As a consequence, China is witnessing explosive growth in private-care homes for older people.

In 2010, there were 366 aged-care facilities in Beijing and around one-third were run by the private sector. Of the 55,809 beds available, 24,525 were provided by the private sector. Community care, providing services for older people to remain in their own homes, is limited in China. A survey by the China Research Centre on Ageing showed that the percentage of older people who were willing to move to an aged-care facility dropped from 18.6 percent in 2000 to 11.3 percent in 2010.

We conducted a study in Beijing where we interviewed people about their experiences of ageing. Our findings found that older Chinese prefer to “age at home” with support from their families and their community. However, many of our participants described how family support for them was low and how they actually provided support to their family by caring for their grandchildren. A typical comment is:

“Others can’t take care of me. I wish for my children to come very much, but my children don’t have time. My son is very tired from work. And, he also has no strength to take care of me. I have to take care of myself. But I need to help with the grandchildren, get up at 5 o’clock to take them to school. We not only have to help ourselves’ but also to help our grandson, granddaughter ….”

In conclusion, to meet the needs of an ageing population, China needs to invest in patient-centred health and aged-care services that support older people to live in and to contribute to their communities.


– Professor Colette Browning, professor of healthy ageing, deputy head, School of Primary Health Care, Monash University of Melbourne, Australia; Dr Hui Yang, senior research fellow of School of Primary Health Care Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia and Professor Shane Thomas, professor and director of primary care research in the School of Primary Health Care Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia. Professor Browning is a speaker at the World Health Summit Regional Meeting – Asia in Singapore (April 8 to 10) where she is speaking on community-based healthcare for the elderly in Asia.

(* PHOTO CREDIT: China shots2, mfb1982, stock.xchng)



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2 Responses to “Community-based health and aged care in China”

  1. Jack May 2, 2013 at 2:38 PM #

    From the reading I’ve done, continuing to live at home in old age seems to be the preferred option everywhere in the world. The “Happy Life Club” sounds like a positive initiative. Australia has developed similar programs to address social problems for the elderly. One of the most successful has been ‘Men’s Sheds’, a place for men of all ages to meet and socialise, which has been a step forward for alleviating depression among older men.

    • agelessadmin
      agelessadmin May 13, 2013 at 1:08 AM #

      Yes, I have heard of the Men’s Shed. Could I have a contact to find out more about them?

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