HEATHER FRANCESE AND KEVIN KINSELLA
AGING TRENDS: THAILAND
As is true in most other Asian countries, the elderly population o f Thailand is growing much faster than the population as a whole. Between 1991 and 2020 Thailand's total population will increase by about one-third, but the population aged 55 and over is projected to more than triple, adding 11 million older men and women, almost half o f w h o m will be 65 and older. Currently, 9.7 percent o f the population in Thailand is aged 55 and over (Table I). Thailand now has higher proportions o f people in older age groups relative to other countries in the region; with the exception o f Singapore (where more than 12 percent o f the population is aged 55 and over), Thailand is the "oldest" country in Eastern South Asia. Projections to the year 2020 imply that 22 percent o f the population will be aged 55 and over, making the Thai elderly one o f the fastest growing older populations in Asia. With respect to median age (the age that divides a population into numerically equal parts o f younger and older persons), Thailand again is second only to Singapore in its rapid "maturing". Between 1990 and 2020, Thailand's median age is projected to rise from 23 to more than 36 years (Figure I). In other words, the number o f persons under the age o f 23 now equals the number over that age, whereas in 2020 this dividing age will be 13 years higher. By way o f contrast, the median age in the Philippines will rise about 9 years - from 20 to 29 - in the next 30 years, while Singapore's median age will j u m p from 30 to 41 in the same period o f time. TABLE I Percentage of population in older age groups: 1991 to 2020 Region or country
Year
55 and over
Eastern South Asia
1991 2005 2020
8.8 10.6 16.4
3.7 5.1 7.3
1.0 1.6 2.4
Thailand
1991 2005 2020
9.7 13.2 21.7
4.1 6.4 10.3
1.3 2.1 3.7
Philippines
1991 2005 2020
8.0 9.8 14.3
3.3 4.4 6.6
1.1 1.4 2.1
Singapore
1991 2005 2020
12.7 18.8 31.8
5.8 8.8 15.9
2.0 3.0 4.9
Journal of Cross-Cultural Gerontology 7: 89-96, 1992. © 1992 Kluwer Academic Publishers. Printed in the Netherlands.
65 and over
75 and over
90
HEATHERFRANCESEAND KEVINKINSELLA Years
45
...........................................................................................................................................................................................................................
40
35
30
25
........................... i n ° ° n e s l a ...
20
1 1960
I
I
I
I
I
I
1970
1980
1990
2000
2010
2020
Fig. 1. Median age: 1960-2020. The rapid increase in median age in Thailand is due, in large part, to a marked decline in fertility since 1965. The total fertility rate in Thailand dropped precipitously from 6.1 in 1970 to 3.7 in 1980, and has continued its downward trajectory toward replacement level. Current estimates indicate that each Thai woman of childbearing age will have, on average, just over two children (2.1), and this figure is projected to decline even further in the future. In Singapore and several European nations, such low levels of fertility have prompted governments to consider or introduce pronatalist policies aimed at increasing fertility through monetary incentives and other measures (Martin 1991). Another indicator of population aging is the change in support ratios - the number of "dependent" persons (children under age 20 and/or adults 65 years and over) per 100 persons in the "productive" ages (20 to 64 years). In 1991 the total support ratio, or total age-dependency ratio, for Thailand is 86; this means that for every 100 persons in the productive age range there are 86 persons in the dependent age ranges. Although the total support ratio in Thailand will decrease over the next three decades (to 59 in 2020), the elderly support ratio (the number of persons aged 65 and over divided by the number aged 20-64 years) will rise from less than 8 in 1991 to more than 16 in 2020 (Figure 2). Increasing elderly support ratios imply increasing economic dependency of and financial responsibility for the elderly population.
AGINGTRENDS:THAILAND
91
Thailand
16.3
Philippines
1991
11.2
2005 Indonesia
[--I
9.0
2020
I 12.7
Singapore
] 263 Fig. 2. Elderly support ratios: 1991, 2005, and 2020.
LIFE EXPECTANCY Life expectancy at birth in Thailand is not unlike that in other Eastern South Asian countries. A Thai born today can expect to live at least 68 years, similar to levels in the Philippines, Vietnam, and Malaysia (65, 65, and 68 years, respectively). The average Thai woman outlives her male counterpart by nearly 5 years (71 versus 66 years). Shortly after the turn of the century, average female life expectancy at birth is projected to exceed 75 years, while males will have reached 70 years. While much of the gain in average life expectancy at birth comes from improvements in infant and childhood mortality, life expectancy for older persons also is increasing. In 1980, Thai women 55 years of age could expect to live another 22.8 years. By 2000, women who reach their 55th birthday will be likely to see another 24.8 years. AGING AND DEVELOPMENT An aging society shares certain characteristics with a developing economy. Both show improved life expectancy and reduced fertility, which are related to effective family planning policies, improvements in public health, urbanization, and a higher standard of living. On the other hand, a shift in age structure from younger to older can place stress on those same indicators of development. For example, as life expectancy rises and as health care systems improve, Thailand will have increasing numbers of people in the "oldest old" age range (75 years and over). By 2020, 2.8 million
92
HEATHERFRANCESEAND KEVINKINSELLA
13.8 Reported III
mm 60 and over
22.8 III for 4 weeks+
All ages
52.8 Hospitalized/injured ~9.4
Fig. 3. Health indicators for the elderly and total population: 1981. living people in Thailand will have celebrated their 75th birthday, nearly quadruple the present number. Many of these people may be living with disabilities and illnesses from which they might have died a generation earlier. This can be taxing on society in terms of increased hospitalization and public health expenditures, as well as on individual families, as more full-time care is needed from children and grandchildren who might otherwise be in the work force. HEALTH AND MORBIDITY Thailand's Health and Welfare Survey of 1981 found that the morbidity level for the elderly (age 60 and older) was substantially higher than for the nation as a whole. The proportion of older persons reported ill for more than four weeks was 23 percent, versus 8 percent of the entire population (Chayovan, in C U P S , 1985). Nevertheless, the level of hospitalization for those ill and injured was similar (around 50 percent) among the two aggregates (Figure 3). Looking to the near future, this suggests not only greater absolute numbers of people needing health care because of growing numbers of elderly, but also a change in the types of predominant illnesses. Aging populations increasingly experience chronic and noncommunicable conditions such as cardiovascular disease, chronic rheumatism, and cognitive function difficulties. Thailand Ministry of Public Health statistics for the early 1980s (National Epidemiology Board of Thailand 1987) show that cardiovascular disease is the leading cause of death for those aged 65 and over. This highlights the increased need for longterm, full-time care which may necessitate a change in focus for the health care industry in Thailand.
93
AGING TRENDS: THAILAND
2400
........................................................................................................................................................................................
2100
1800 Males
,-'"
1500 1200
ooo
............................................................................
--:..
...............................................................
j600
................................................................... .. Y ~ : .....................................................................................
............................. .-" 300 35-39
, 40-49
, 50-59
, 60*
Age
Dis=bled persons per 100,000 popul=tion
Fig. 4. Prevalence of disability by age group: 1981.
The 1981 survey also shows a rapid increase in the prevalence of disabilities for both men and women after age 49, with the rate for men being consistently higher than that for women (Figure 4). Another study done in 1982 (Siriphanich et al., in CUIPS, 1985) shows that about 7 percent of the elderly were disabled, compared to only 1 percent of the total population. Put another way, more than one quarter of all disabled persons in Thailand were elderly (60 and older), and about one half of those who were blind, hard of hearing or paralyzed were also elderly. Nearly one third of the reported disabilities among the elderly in 1982 involved loss of hearing (Figure 5). URBAN/RURAL DIMENSIONS Between 1970 and 1980 the proportion of elderly living in urban areas remained essentially the same (5.2 percent), while the elderly share of the rural population increased slightly from 4.8 to 5.5 percent (CUIPS 1985). This trend is beginning to reverse itself. Over the next three decades the elderly population in Bangkok will most likely grow more rapidly than the elderly population as a whole, in part because of Bangkok's lower mortality rates as well as the aging of its sizable young adult population. The portion of the metropolitan area's residents aged 60 and older is projected to increase from 5 percent in 1980 to 8 percent in 2000 and 14-18 percent (depending on demographic assumptions) in 2020 (Wames and Horsey 1988).
94
HEATHER FRANCESEAND KEVIN KINSELLA
Paralyzed 23,5%
Blindness ~,,, ,u,, 16.2% Loss of limbs 7.9%
Loss of speech 7.3% Other 13.3%
Deaf/hearing loss 31.7% Fig. 5. Disabled elderly (60+) by type of disability: 1982.
More older women than older men live in urban areas, and in proportions higher than found in rural areas. For every elderly man (65 and older) there were 1.4 elderly women living in Thailand's cities in 1980. In rural areas, by contrast, there were 1.24 elderly women for each elderly man. The effects that urbanization has on the well-being of the elderly are open to debate. Evidence suggests that older people in Thailand are - at least at first negatively affected during the transition from a predominantly rural to urban society. Changes in familial values and the migration of young people to cities have often loosened extended family ties, possibly leading older people (less than a third of whom still support themselves with their own salaries) to rely on non-family forms of support such as the government or community. In 1985 only 54 percent of elderly women and 38 percent of elderly men in Thailand said that their main source of support was their children or grandchildren (Hugo 1988). In addition, many elderly are not eligible for government pensions. Thailand's pension system currently covers only civil servants and some private sector employees, about 3 percent of the working population in 1985. In that same year, 5 percent of males and 1 percent of females said that their main source of support was some form of pension (Table II). Several studies have suggested that a majority of the elderly in Thailand have some economic difficulties, regardless of where they live. Data from various sample populations in the early 1980s reveal large proportions of elderly with incomes below the poverty level (less than 1,000 baht per month), reaching as high as 77 percent in one study (Kumnuansilpa et al., in CUIPS, 1985).
95
AGING TRENDS: THAILAND
Reported work participation rates among the urban elderly are consistently lower than in rural areas. In 1986, 39 percent o f rural Thai aged 60 and over were in the labor force versus 23 percent o f older persons in municipal areas. Some o f this differential is related to the varying demands o f agrarian work, which m a y require one to work later in life. In addition, older people living in cities m a y have more difficulty supporting themselves due to the standards and regulations o f the formal sector such as prescribed retirement ages and required levels o f education. O f those men 60 and older living in cities who were in the labor force in 1981, 30 percent were reported as being "inadequately utilized." This means that they were unemployed, wanted to work more hours than they did, or said that their education and training did not match their present occupation. F o r urban women aged 60 and over in the labor force, 43 percent were reported as inadequately utilized. TABLE II Primary source of economic support for persons aged 60 and over: 1985 (in percent)
Country Thailand
Indonesia Malaysia Singapore
Pension
Children or grandchildren
Own business or salary
Other
Male Female
Male Female
Male Female
Male Female
5
1
38
54
40
21
17
24
13 16 9
4 6 1
22 38 53
47 67 80
56 36 25
30 12 7
9 10 13
19 15 12
Source: Hugo 1988, Tables 4, 5 and 11.
ACKNOWLEDGEMENTS This report was prepared with the support o f the Directorate for Health, Bureau for Science and Technology, U.S. Agency for International Development. Unless otherwise indicated, data in the text, tables, and figures come from the U.S. Bureau o f the Census, Center for International Research, International Data Base on Aging. REFERENCES CITED Chulalongkorn University Institute of Population Studies (CUIPS) and Thailand Population and Manpower Planning Division, Office of the National Economic and Social Development Board, 1985 The Thai Elderly Population: A Review of Literature and Existing Data. Bangkok. Hugo, G. 1988 The Changing Urban Situation in Southeast Asia and Australia, Some Implications for the Elderly. Paper presented at the U.N. Conference on Aging Populations in the context of Urbanization. Sendai, Japan.
96
HEATHER FRANCESE AND KEVIN KINSELLA
Martin, L. 1991 Population Aging Policies in East Asia and the United States. Science 251:527-531. National Epidemiology Board of Thailand 1987 Review of the Health Situation in Thailand. Priority Ranking of Diseases. Bangkok. Thailand National Statistics Office 1982-88 Report of the Labor Force Survey. Whole Kingdom (various rounds). Bangkok. Wames, T. and A. Horsey 1988 The Elderly Population of Third World Cities: Projections for Selected Metropolitan Areas. Preliminary Report of a King's College Study Supported by the Simon Population Trust. London.
Center for International Research U.S. Bureau of the Census Washington, D.C., 20233, U.S.A.
AGING TRENDS: THAILAND
As is true in most other Asian countries, the elderly population o f Thailand is growing much faster than the population as a whole. Between 1991 and 2020 Thailand's total population will increase by about one-third, but the population aged 55 and over is projected to more than triple, adding 11 million older men and women, almost half o f w h o m will be 65 and older. Currently, 9.7 percent o f the population in Thailand is aged 55 and over (Table I). Thailand now has higher proportions o f people in older age groups relative to other countries in the region; with the exception o f Singapore (where more than 12 percent o f the population is aged 55 and over), Thailand is the "oldest" country in Eastern South Asia. Projections to the year 2020 imply that 22 percent o f the population will be aged 55 and over, making the Thai elderly one o f the fastest growing older populations in Asia. With respect to median age (the age that divides a population into numerically equal parts o f younger and older persons), Thailand again is second only to Singapore in its rapid "maturing". Between 1990 and 2020, Thailand's median age is projected to rise from 23 to more than 36 years (Figure I). In other words, the number o f persons under the age o f 23 now equals the number over that age, whereas in 2020 this dividing age will be 13 years higher. By way o f contrast, the median age in the Philippines will rise about 9 years - from 20 to 29 - in the next 30 years, while Singapore's median age will j u m p from 30 to 41 in the same period o f time. TABLE I Percentage of population in older age groups: 1991 to 2020 Region or country
Year
55 and over
Eastern South Asia
1991 2005 2020
8.8 10.6 16.4
3.7 5.1 7.3
1.0 1.6 2.4
Thailand
1991 2005 2020
9.7 13.2 21.7
4.1 6.4 10.3
1.3 2.1 3.7
Philippines
1991 2005 2020
8.0 9.8 14.3
3.3 4.4 6.6
1.1 1.4 2.1
Singapore
1991 2005 2020
12.7 18.8 31.8
5.8 8.8 15.9
2.0 3.0 4.9
Journal of Cross-Cultural Gerontology 7: 89-96, 1992. © 1992 Kluwer Academic Publishers. Printed in the Netherlands.
65 and over
75 and over
90
HEATHERFRANCESEAND KEVINKINSELLA Years
45
...........................................................................................................................................................................................................................
40
35
30
25
........................... i n ° ° n e s l a ...
20
1 1960
I
I
I
I
I
I
1970
1980
1990
2000
2010
2020
Fig. 1. Median age: 1960-2020. The rapid increase in median age in Thailand is due, in large part, to a marked decline in fertility since 1965. The total fertility rate in Thailand dropped precipitously from 6.1 in 1970 to 3.7 in 1980, and has continued its downward trajectory toward replacement level. Current estimates indicate that each Thai woman of childbearing age will have, on average, just over two children (2.1), and this figure is projected to decline even further in the future. In Singapore and several European nations, such low levels of fertility have prompted governments to consider or introduce pronatalist policies aimed at increasing fertility through monetary incentives and other measures (Martin 1991). Another indicator of population aging is the change in support ratios - the number of "dependent" persons (children under age 20 and/or adults 65 years and over) per 100 persons in the "productive" ages (20 to 64 years). In 1991 the total support ratio, or total age-dependency ratio, for Thailand is 86; this means that for every 100 persons in the productive age range there are 86 persons in the dependent age ranges. Although the total support ratio in Thailand will decrease over the next three decades (to 59 in 2020), the elderly support ratio (the number of persons aged 65 and over divided by the number aged 20-64 years) will rise from less than 8 in 1991 to more than 16 in 2020 (Figure 2). Increasing elderly support ratios imply increasing economic dependency of and financial responsibility for the elderly population.
AGINGTRENDS:THAILAND
91
Thailand
16.3
Philippines
1991
11.2
2005 Indonesia
[--I
9.0
2020
I 12.7
Singapore
] 263 Fig. 2. Elderly support ratios: 1991, 2005, and 2020.
LIFE EXPECTANCY Life expectancy at birth in Thailand is not unlike that in other Eastern South Asian countries. A Thai born today can expect to live at least 68 years, similar to levels in the Philippines, Vietnam, and Malaysia (65, 65, and 68 years, respectively). The average Thai woman outlives her male counterpart by nearly 5 years (71 versus 66 years). Shortly after the turn of the century, average female life expectancy at birth is projected to exceed 75 years, while males will have reached 70 years. While much of the gain in average life expectancy at birth comes from improvements in infant and childhood mortality, life expectancy for older persons also is increasing. In 1980, Thai women 55 years of age could expect to live another 22.8 years. By 2000, women who reach their 55th birthday will be likely to see another 24.8 years. AGING AND DEVELOPMENT An aging society shares certain characteristics with a developing economy. Both show improved life expectancy and reduced fertility, which are related to effective family planning policies, improvements in public health, urbanization, and a higher standard of living. On the other hand, a shift in age structure from younger to older can place stress on those same indicators of development. For example, as life expectancy rises and as health care systems improve, Thailand will have increasing numbers of people in the "oldest old" age range (75 years and over). By 2020, 2.8 million
92
HEATHERFRANCESEAND KEVINKINSELLA
13.8 Reported III
mm 60 and over
22.8 III for 4 weeks+
All ages
52.8 Hospitalized/injured ~9.4
Fig. 3. Health indicators for the elderly and total population: 1981. living people in Thailand will have celebrated their 75th birthday, nearly quadruple the present number. Many of these people may be living with disabilities and illnesses from which they might have died a generation earlier. This can be taxing on society in terms of increased hospitalization and public health expenditures, as well as on individual families, as more full-time care is needed from children and grandchildren who might otherwise be in the work force. HEALTH AND MORBIDITY Thailand's Health and Welfare Survey of 1981 found that the morbidity level for the elderly (age 60 and older) was substantially higher than for the nation as a whole. The proportion of older persons reported ill for more than four weeks was 23 percent, versus 8 percent of the entire population (Chayovan, in C U P S , 1985). Nevertheless, the level of hospitalization for those ill and injured was similar (around 50 percent) among the two aggregates (Figure 3). Looking to the near future, this suggests not only greater absolute numbers of people needing health care because of growing numbers of elderly, but also a change in the types of predominant illnesses. Aging populations increasingly experience chronic and noncommunicable conditions such as cardiovascular disease, chronic rheumatism, and cognitive function difficulties. Thailand Ministry of Public Health statistics for the early 1980s (National Epidemiology Board of Thailand 1987) show that cardiovascular disease is the leading cause of death for those aged 65 and over. This highlights the increased need for longterm, full-time care which may necessitate a change in focus for the health care industry in Thailand.
93
AGING TRENDS: THAILAND
2400
........................................................................................................................................................................................
2100
1800 Males
,-'"
1500 1200
ooo
............................................................................
--:..
...............................................................
j600
................................................................... .. Y ~ : .....................................................................................
............................. .-" 300 35-39
, 40-49
, 50-59
, 60*
Age
Dis=bled persons per 100,000 popul=tion
Fig. 4. Prevalence of disability by age group: 1981.
The 1981 survey also shows a rapid increase in the prevalence of disabilities for both men and women after age 49, with the rate for men being consistently higher than that for women (Figure 4). Another study done in 1982 (Siriphanich et al., in CUIPS, 1985) shows that about 7 percent of the elderly were disabled, compared to only 1 percent of the total population. Put another way, more than one quarter of all disabled persons in Thailand were elderly (60 and older), and about one half of those who were blind, hard of hearing or paralyzed were also elderly. Nearly one third of the reported disabilities among the elderly in 1982 involved loss of hearing (Figure 5). URBAN/RURAL DIMENSIONS Between 1970 and 1980 the proportion of elderly living in urban areas remained essentially the same (5.2 percent), while the elderly share of the rural population increased slightly from 4.8 to 5.5 percent (CUIPS 1985). This trend is beginning to reverse itself. Over the next three decades the elderly population in Bangkok will most likely grow more rapidly than the elderly population as a whole, in part because of Bangkok's lower mortality rates as well as the aging of its sizable young adult population. The portion of the metropolitan area's residents aged 60 and older is projected to increase from 5 percent in 1980 to 8 percent in 2000 and 14-18 percent (depending on demographic assumptions) in 2020 (Wames and Horsey 1988).
94
HEATHER FRANCESEAND KEVIN KINSELLA
Paralyzed 23,5%
Blindness ~,,, ,u,, 16.2% Loss of limbs 7.9%
Loss of speech 7.3% Other 13.3%
Deaf/hearing loss 31.7% Fig. 5. Disabled elderly (60+) by type of disability: 1982.
More older women than older men live in urban areas, and in proportions higher than found in rural areas. For every elderly man (65 and older) there were 1.4 elderly women living in Thailand's cities in 1980. In rural areas, by contrast, there were 1.24 elderly women for each elderly man. The effects that urbanization has on the well-being of the elderly are open to debate. Evidence suggests that older people in Thailand are - at least at first negatively affected during the transition from a predominantly rural to urban society. Changes in familial values and the migration of young people to cities have often loosened extended family ties, possibly leading older people (less than a third of whom still support themselves with their own salaries) to rely on non-family forms of support such as the government or community. In 1985 only 54 percent of elderly women and 38 percent of elderly men in Thailand said that their main source of support was their children or grandchildren (Hugo 1988). In addition, many elderly are not eligible for government pensions. Thailand's pension system currently covers only civil servants and some private sector employees, about 3 percent of the working population in 1985. In that same year, 5 percent of males and 1 percent of females said that their main source of support was some form of pension (Table II). Several studies have suggested that a majority of the elderly in Thailand have some economic difficulties, regardless of where they live. Data from various sample populations in the early 1980s reveal large proportions of elderly with incomes below the poverty level (less than 1,000 baht per month), reaching as high as 77 percent in one study (Kumnuansilpa et al., in CUIPS, 1985).
95
AGING TRENDS: THAILAND
Reported work participation rates among the urban elderly are consistently lower than in rural areas. In 1986, 39 percent o f rural Thai aged 60 and over were in the labor force versus 23 percent o f older persons in municipal areas. Some o f this differential is related to the varying demands o f agrarian work, which m a y require one to work later in life. In addition, older people living in cities m a y have more difficulty supporting themselves due to the standards and regulations o f the formal sector such as prescribed retirement ages and required levels o f education. O f those men 60 and older living in cities who were in the labor force in 1981, 30 percent were reported as being "inadequately utilized." This means that they were unemployed, wanted to work more hours than they did, or said that their education and training did not match their present occupation. F o r urban women aged 60 and over in the labor force, 43 percent were reported as inadequately utilized. TABLE II Primary source of economic support for persons aged 60 and over: 1985 (in percent)
Country Thailand
Indonesia Malaysia Singapore
Pension
Children or grandchildren
Own business or salary
Other
Male Female
Male Female
Male Female
Male Female
5
1
38
54
40
21
17
24
13 16 9
4 6 1
22 38 53
47 67 80
56 36 25
30 12 7
9 10 13
19 15 12
Source: Hugo 1988, Tables 4, 5 and 11.
ACKNOWLEDGEMENTS This report was prepared with the support o f the Directorate for Health, Bureau for Science and Technology, U.S. Agency for International Development. Unless otherwise indicated, data in the text, tables, and figures come from the U.S. Bureau o f the Census, Center for International Research, International Data Base on Aging. REFERENCES CITED Chulalongkorn University Institute of Population Studies (CUIPS) and Thailand Population and Manpower Planning Division, Office of the National Economic and Social Development Board, 1985 The Thai Elderly Population: A Review of Literature and Existing Data. Bangkok. Hugo, G. 1988 The Changing Urban Situation in Southeast Asia and Australia, Some Implications for the Elderly. Paper presented at the U.N. Conference on Aging Populations in the context of Urbanization. Sendai, Japan.
96
HEATHER FRANCESE AND KEVIN KINSELLA
Martin, L. 1991 Population Aging Policies in East Asia and the United States. Science 251:527-531. National Epidemiology Board of Thailand 1987 Review of the Health Situation in Thailand. Priority Ranking of Diseases. Bangkok. Thailand National Statistics Office 1982-88 Report of the Labor Force Survey. Whole Kingdom (various rounds). Bangkok. Wames, T. and A. Horsey 1988 The Elderly Population of Third World Cities: Projections for Selected Metropolitan Areas. Preliminary Report of a King's College Study Supported by the Simon Population Trust. London.
Center for International Research U.S. Bureau of the Census Washington, D.C., 20233, U.S.A.
