Building a Diverse, Tiered, and Regionally Differentiated Policy Framework for Rural Elder Care (AI Translation)

构建多元分级分区域的农村养老政策框架

China is among the countries with the highest degree of population aging globally. According to the "2024 National Bulletin on the Development of Aging Undertakings," by the end of 2024, the nation had 310.31 million people aged 60 and above, accounting for 22.0% of the total population. The challenge of addressing an aging population is formidable. Data from the seventh national census show that in rural areas, 20.06% of the population is aged 60 or older—seven percentage points higher than in urban regions—while those 65 and over comprise 13.84%, nearly double the urban proportion. Given the stark and complex realities of aging in the countryside—and in line with this year’s No. 1 central policy document, which calls for enhancing a three-tiered county-township-village elderly care service network, piloting innovative county-level elderly care systems, and encouraging mutual-aid elderly care services at the village level—ensuring that elderly people in rural areas can enjoy a healthy, purposeful, and dignified later life is of utmost importance.

To truly understand the challenges of elderly care in rural China, we must examine the core contradictions, which I summarize as “one root cause, two intensifying factors.” The “one root cause” is the historical legacy of a dual-structure system separating urban and rural China. China’s elderly care system evolved from traditional family care into a state-led social security system, a transition first seen in late-19th century Germany. In 1889, the Bismarck government implemented the Disability and Old Age Insurance Law, and the U.S. enacted the Social Security Act during Franklin D. Roosevelt’s presidency. These established the modern framework for public pensions, and while they were shaped by their respective times, neither country imposed significant distinctions between urban and rural areas. By contrast, early in the history of the People’s Republic of China, the country adopted the Soviet-inspired “state insurance” model, which, under the influence of the household registration (hukou) system, entrenched a strict divide between urban and rural residents. In the planned economy era, urban residents enjoyed cradle-to-grave protections through workplace affiliations, with the employee medical reimbursement rate exceeding 70% in 1978, while rural residents were excluded from social security, setting a foundation of systemic inequality. This gap widened in the reform era. From the inception of employee pension insurance in 1991 to the integration of rural and urban pension schemes in 2014, farmers experienced a 23-year void without coverage. For years, “urban and rural resident pension insurance” provided substantially lower benefits compared to employee pensions. The “two intensifying factors” are the concurrent forces of urbanization and family planning. Family planning was enshrined as a basic state policy in September 1982 and incorporated into the constitution that December. Its implementation accelerated the breakdown of traditional rural family structures, exponentially increasing the burden on only-child households to care for aging parents. China’s early transition into an aging society is directly related to this policy. With little opportunity to accumulate retirement assets and lagging coverage for social pensions, many rural families found themselves “growing old before getting rich.” The siphoning effect of urbanization has drawn a massive workforce of young and able-bodied laborers from the countryside to the cities, leaving behind a population increasingly dominated by the elderly—a shift from the old pattern of “three left behinds” (the elderly, women, and children remaining in the village) to one where the elderly are the overwhelming majority. In recent years, the migrant worker population has continued to rise, reaching nearly 300 million nationwide in 2024, with 180 million working away from home; in many villages, those aged parents who remain now account for over 60% of the local population. The growing prevalence of “empty-nest” households has eroded the traditional belief in “raising children to provide for old age” rooted in filial piety. The family’s role in elderly care is deteriorating, the network of mutual support fostered by close-knit rural communities and clan culture has crumbled amid population outflows, and effective village-based support organizations are sorely lacking. According to research from the China Research Center on Aging, the rural elderly suicide rate is two to three times higher than in cities, with more than 60% of these deaths attributed to loneliness, illness, and economic pressure—a vicious cycle of material and emotional deprivation. This represents a grave and tragic societal risk requiring a coordinated response from policy makers, families, and communities.

The challenges of rural elderly care in China are influenced both by traditional values and by current realities. There are evident tendencies to favor cities over rural areas, the young over the elderly, and development over elder care. Recently, the General Office of the CPC Central Committee and the State Council issued the “Implementation Plan for the Child Rearing Subsidy System,” which provides an annual subsidy of 3,600 yuan for children under the age of three. Additionally, the State Council General Office released the “Opinions on the Gradual Implementation of Free Preschool Education,” specifically stating that beginning with the autumn semester of 2025, public kindergartens will waive the childcare and education fees for the final year of preschool. I believe these policies are excellent; they are crucial measures for supporting high-quality population growth as a foundation for Chinese-style modernization. At the same time, I am convinced that, if the same resolve and determination were applied to resolving rural elderly care issues, many obstacles could also be overcome. The way we treat adolescents and infants determines the ceiling of our future development, while our approach to caring for the elderly sets the floor for our society’s development during that process. We should attach the same importance to rural elderly care as we do to cities, education, and future development. This baseline is one we must firmly uphold.