End of Mission Statement by the United Nations Independent Expert on the enjoyment of all human rights by older persons, Ms. Rosa KORNFELD-MATTE, on her visit to the People’s Republic of China

Chinese | French

Delivered at the press conference, held at 14:30h local time on Tuesday 3 December 2019 at UN House, No. 2 Liangmahe Nanlu, 100600 Beijing, China, at the end of her official country visit to share her preliminary findings with the media.

Unofficial English translation - the Original French version is authoritative

Beijing, 3 December 2019

Members of the Press and Media Representatives,
Ladies and Gentlemen,

In my capacity as United Nations Independent Expert on the enjoyment of all human rights by older persons, I conclude today my first official visit to the People’s Republic of China, which officially took place from 25 November to 3 December 2019. I am an independent expert who reports to the United Nations Human Rights Council and the General Assembly, and advises on progress, opportunities and challenges encountered in the realization of the human rights of older persons worldwide.
We, independent experts are part of the mechanisms of Special Procedures of the United Nations Human Rights Council, appointed by the Human Rights Council to assess, to the extent possible, and report back to the UN Human Rights Council. This position is honorary and I am not staff of the UN nor paid for my work.

I would like to begin by expressing my gratitude to the Government of the People’s Republic of China for accepting my request to visit its country to assess, in a spirit of dialogue and cooperation, the level of enjoyment of rights of older persons, the opportunities and existing necessities and challenges; and for the cooperation extended to me prior to and throughout the visit.

Please allow me to seize this opportunity to sincerely thank the UN Resident Coordinator, the UN agencies and the UNDP Resident Representative and his Office for their considerable efforts to coordinate this visit as well as for all the support, which I benefited in order to ensure the success of my mission.

During my visit, I met numerous central, regional and local government authorities, including representatives of the National Ageing Office and the National Committee on Ageing, non-governmental social welfare organisations, representatives of the academia and universities, private companies/businesses, social workers and volunteers working with older persons and I also met with older persons themselves and the organisations representing them in Beijing, Shanghai, Changzhou and Shenzhen. Moreover, I met with tech-companies and researchers working on emerging assistive technologies and digitalization of health and care services for older persons using integrated big data computing, artificial intelligence and facial recognition technologies. It was a privilege; and a profoundly enlightening and instructive experience altogether.

I have also visited a good number of old age homes, care centers and related institutions, as well as 3rd age universities and met with the community and representatives of the local authority.

Please allow me to convey my deep appreciation to all who took the time to meet with me.

I am here to share with you today some preliminary and I must say very provisional remarks on some of the issues that, along with others, will be explored in more detail in my comprehensive country visit report to the United Nations Human Rights Council, which will be submitted in September 2020.

These preliminary observations neither reflect all the issues presented to me, nor all the initiatives undertaken by the Government of the People’s Republic of China.

Ladies and Gentlemen,

Let me start with the demographic data and figures:

By the end of 2018, China had 249 million persons aged 60 years or above, that is approximately 17.9% of the total roughly 1.4 billion population. Out of 249 million, some 166 million people are aged 65 years or above, accounting for 11.9 percent of the total population. [Government submission]

Projections suggest that by 2050, China will be reaching 483 or 487 million older persons aged 60 years and above – i.e. around 34.9% - more than 1/3 of the population.

The numbers speak for themselves.

At the same time, due to slowing population growth, low birth rates, ad extended life expectancies, the percentage of the working age population is projected to decline. This in turn is expected to cause the old age dependency ratio to rise more than three-fold by 2050, hitting 44% according to United Nations projections.

The impact of age-structural change of this magnitude poses naturally the question how to address this challenge. The question is also how to sustain and enhance the well-being in all regions, while at the same time reducing the inequalities and ensuring an equitable reallocation of resources within and between generations. As countries develop, so their citizens are able to access the benefits of social, economic, and scientific progress. In all societies, however, some people are better able to access these resources than others. How these resources are distributed accounts for the inequalities within societies.

Demographically speaking – there are two main types of inequality: that within a generation, the intra-generational inequality that is mainly mediated by socio-economic, ethnic, and gender factors; and that between generations, termed as inter-generational inequality as it pertains to inequalities between different birth cohorts.

In a nutshell, reallocation of resources to ensure intergenerational equity is key in fostering societal and intergenerational solidarity and tackling old age poverty.

Ladies and Gentlemen,

It is commendable that the Government has various dedicated policies on older persons and a dedicated comprehensive law on the “Protection of the Rights and Interests of Older Persons”, adopted on 29 August 1996 and revised for the third time on 29 December 2018. This law regulates various aspects of old age life, such as care, caregiving and support, social security and protection as well as social services. This law transposes and concretizes the fundamental rights protection specifically formulated for older persons in the Constitution of the People’s Republic of China, especially in article 45 stipulating the right to social assistance and protection and article 85 on the right to care.

Furthermore, I learned that the “Social Insurance Law” regulates the basic old-age and medical insurance. There of course numerous other laws, regulations and regulatory instruments relevant to older persons human rights protection and realization. The existing complex legal framework at the central and local level exhibit the importance attached to the rights of older persons given by the government.

This commitment is also demonstrated by the efforts and achieved goals formulated in the national “12th five-year plan” as well as in the “13th five-year plan”. In light of the ongoing consultations of the “14th five year-plan” ahead, however, a dedicated policy on older persons is crucial to ensuring improved protection of their rights, and I call on the Government to consider elaborating a systematic policy that draws from good practices and experiences on implementing older person’s policies and laws. I would see an added value in elaborating a comprehensive policy that addresses systematically older person’s rights in different situations and addresses rural and urban settings in a differentiated approach. This would enhance the efficiency of existing instruments, laws and policies, so as to meet the needs of the most ostracized and the vulnerable of the vulnerable – like older women in rural areas, older persons with disabilities, those with dementia and other medical conditions. A differentiated approach targeting vulnerable people would also be useful in conjunction with a recognition of the heterogeneity of the old age group. In this context, I think that also the collection of disaggregated date can be further improved.

I feel my visit and the dialogue with the Government is very timely in this regard, as this is an opportunity for me to emphasize that any normative or policy action on older persons has to adopt a human rights-based approach. A human rights-based approach places the individual and his/her rights at the centre. The existing international human rights framework, notably the United Nations principles on the right of older persons alongside the core human rights instruments should guide the Government’s efforts in this regard.

I welcome the dedicated institutional structures and mechanisms, the China National Committee on Ageing and the National Ageing Office. This is important to ensure that older persons centered approach is mainstreamed into all activities. From my own experience in the Latin American context, I know how crucial it is to have of an independent inter-ministerial coordination mechanism which could also greatly facilitate the implementation of a national policy or action plan. By ensuring a multidisciplinary approach to ageing, this contributes usually to improving the enjoyment of all human rights by older persons in the country.

Another prerequisite for efficient policy design is the availability of data and analysis. I am not sure whether China has a recent baseline study on the human rights of older persons, it would however allow to measure the impact of the steps taken. While I note that statistics are disaggregated by age, I would encourage to further strengthen the specific focus on older persons and –as mentioned above- further disaggregate the data in order to reflect the extreme heterogeneity of the particular age group of those 60 years and older.

In the same vein, strategic comprehensive policies on Alzheimer diseases, but also other mental conditions such as depression, Parkinson etc. are good practices of counter measures. The prevalence of these conditions is also important to assess, analyse and the collection of disaggregated data essential. It will contribute to an improved strategic planning and preparation of the care system, in particular long-term care needs of older persons, who will be living with chronic diseases and disability.

The Chinese social security system and protection floor has achieved remarkable progress over a historically short period of time. In terms of extension of personal protection, the decade between 2005 and 2015 has seen medical coverage in both urban and rural areas become almost universal, with pension coverage increasing from less than 200 million persons to some 850 million persons, due particularly to the introduction in 2009 of a new scheme for rural residents not otherwise protected.

Regarding pensions, the number of beneficiaries – i.e. benefits in payment – in the urban old-age insurance scheme grew from 32 million in 2000 to 92 million in 2015, that is from 1 out of 3 to 2 out of 3 persons of the population aged 65 years and older. Amounts paid in benefits are also non negligible, since public pensions represented in 2015 some 50% of the average wage, with an economic replacement rate of 44% [meaning economic replacement rate of pension benefits: ratio between amount of benefit and GDP per working capita], which fares reasonably well compared to most advanced economies.

Family structures have changed radically over recent decades, especially in urban areas, as a result of the one-child family policy.

Today, the resulting configuration of 4 grandparents, two parents and one child has become standard reality. The extended family is weakening further through migration to urban areas etc. Another reality is that older persons are at the service of their children economically or through support – taking care of their grandchildren. Both -by the way- applies to me personally as Grandmother in Chile. However, in the end older person’s savings are regularly insufficient for any care and health support in old age.

Moreover, I would like to recommend to reconsider the current governing “hukou” system, which restricts household registration to specific birth localities and ties social benefits thereto. However, it seems that in practice many rural residents move to urban areas unofficially, while retraining their rural “hukou” status and associated social benefits. Older persons returning to their place of origin often cannot claim entitlements.

While I realize that the current contributory and social pension system is in transition, I do recommend an unqualified universal non-contributory pension for the most vulnerable. Those who worked to support families and household, raise children and continue to give care to older parents, those who are usually women in rural areas but also men, tend to face income inadequacy and insecurity. The current social pension is an individual savings account system, which has by nature a number requirements to be fulfilled from the residency issue (“hukou” system) but also the 15 years of contributions that ultimately even if rectifiable are ultimately impediments. I encourage the government to further consolidate the progress achieved so far and to address issues of adequacy, equality, portability and sustainability in a more systemic manner.

Moreover, I take this opportunity to advocate for the translation of the word “ageism” along with its conception. It is –to my mind- important to have a specific term. “Ageism” which refers to stereotyping and/or discrimination against individuals or groups on the basis of their age. This may be casual or systematic. This term was coined in 1969 by Robert Neil Butler to describe discrimination against older persons. While, various anti-discrimination means exists, which generally prohibits discrimination, I noticed awareness and appreciation of the problem and would recommend considering adopting policies and a law specifically targeting “ageism”.

The WHO notes that Chinese culture lays a particular emphasis on harmony and respect within society. It follows that neglecting the care of an older person is considered an act of abuse. If family members fail to fulfil their kinship obligations to provide food and housing, this also constitutes neglect. Article 49 of the People’s Republic of China’s Constitution states that “maltreatment of old people, women, and children is prohibited”. The law on the “Protection of the Rights and Interests of Older Persons” is of particular relevance, along with a number of other related measures to address violence, abuse, maltreatment and neglect of older persons. I commend the government for the measures taken. I encourage the government to do more, to raise awareness, and sensitize the population. This can take the form of training of judges, lawyers and prosecutors, which is essential to ensure that investigation of cases of domestic violence proceeds to signal to the community that violence and abuse against older persons are serious crimes and will be treated as such.

The continued prevalence of older persons’ abuse indicates that normative action is not enough and that further measures and mechanisms are required to detect, report and prevent all forms of abuse of older persons in institutional care and in family settings. Protocols and processes are usually needed to assist individuals, families, carers in institutional settings and community groups to understand the issues surrounding abuse of older persons, to recognize individuals who are at risk and to respond when appropriate. Caregivers in domestic and institutional settings need to be further sensitized and trained on how to prevent and detect violence, abuse, maltreatment and neglect against older persons.

Further, the government has established special preferential policies for older persons focusing on health care, transportation, business services, museum, cultural activities etc. These measures are important and of benefits to older persons. They foster the social inclusion and participation in life.

Although the law defines older persons as aged 60 or older, I have found that the specific benefits designed for older persons in China depend also on local regulations and different programs and that 60 years were not uniformly recognized as the age of these people. There are significant disparities not only between cities, but also depending on the objective of a regulation and further harmonization is needed.

I was privileged to visit the various old age residencies, community-based care centers and old age homes. Some of them impressive in terms of size and standard like the Taikang Community Center, which is of high standard and requires considerable individual resources. But I also saw various social welfare institutions, with integrated health, steady institutional and day care facilities, like the Jinsong Old Age Center or the Beijing No. 1 Institute with an integrated day care rehabilitation service for older persons. I understand that the housing and living arrangements for older persons are in transition, moving away from the classical household configuration with more and more, older persons living alone or with a partner.

As to health care, it is organized through two main streams: hospitals and primary health care institutions. The ratio of medical doctors to patients in urban and rural areas is 3.2 and 1.4 per 1000 people, respectively. In the last few years there has been a steady increase in the number of specialized health-care facilities for older persons.

A gigantic number of older persons with disabilities or conditions will be requiring care. This means that there is a growing demand for specific medical and nursing and long term-care as well as rehabilitation services. Family and home caregiving will need to be supplemented on a large scale by more formal long-term care. I welcome the long-term care insurance scheme, a measure that I myself recommend regularly as a key element in coping with increasing care demands. I note, that the State Council’s Twelfth Five-Year Plan of China on Ageing Undertaking Development (2011–2015) prioritized long-term care and rehabilitation services for bedridden older persons. I would like to add here, that consequentially, I really urge and encourage the Government to further invest in infrastructure and –also- in academia to train, educate medical doctors and medical support staff in geriatrics and develop training and scientific expertise in geriatrics and gerontological studies. I sincerely, think that this field has to be prioritized.

I would need to add that China has very good practices with regard to “3rd Age Universities” for older persons. I – myself visited China in 2004 at the occasion of a World Congress on “3rd Age” Universities and education, training and lifelong learning for older persons. I have myself been involved in established these institutions across Latin America and I know very well that these institutions are particularly exceptional in China. Since 1983, when China’s first University of the “3rd Age” opened, some 70,000 more institutions were established across the country. It seems that last year some over 3% of China’s of 60 years and above enrolled. While some of the schools are reserved for retired civil servants, others are open to all. Most are government-funded and the average cost of fees is 200 Yuan (31 USD) per term. I had the privilege to visit in Shenzhen a modern and well-equipped “3rd Age” University that left a lasting impression on me.

Finally, I would like to express my appreciation for the efforts deployed in making it possible for me to meet with tech-companies and researchers working on emerging assistive technologies and digitalization of health and care services for older persons.

The exchange with business and researchers working in this field is crucial and constructive. I have learned that the digitalization of services for older persons is a priority focus, perceived as potential thriving market. The so-called “90-7-3 older persons care pattern” figures in the “12th Five-Year Plan for the Development of Old Age Care Services” and means that 90% of the older persons should receive home-based care, 7% community-based care, and 3% institutional care.

While this general objective requires a variety of measures, artificial intelligence-based applications and facial recognition technologies are meant to play a key role in both health and care service. The guiding principle is connectivity and linkages of personal and physiological data, behavioural patterns that would enable all-round analysis and tailored & monitored services, including more precise predictability of health conditions and care needs. I am certainly interested in solutions to challenges of data protection, informational self-determination and informed consent, in particular for older persons.
In this context, I would like to refer you to my 2017 thematic report, which examines the impact of assisting technologies, robotics, artificial intelligence and automation on the fundamental rights of older persons and contains a number of useful recommendations in this area (A/HRC/36/48).

I would like to acknowledge the increasing awareness on the human rights of older persons and the tremendous efforts of United Nations agencies and international cooperation organizations in this area. I strongly encourage the United Nations system, and especially the UN Country Team, the diplomatic community in the People’s Republic of China and international cooperation actors to make all of their projects inclusive of older persons and age-sensitive to mainstream in all of their cooperation strategies and programmes in the country. Moreover, UN efforts to support the implementation of the SDGs should consider the realization of the rights of older persons in a cross-cutting and systemic manner, so as to truly ensure that no one is left behind.

Before closing, I would like to reiterate that I am very grateful to the Government of the People’s Republic of China for accepting my invitation to visit the country, enabling me to learn about the efforts they are making to improve the situation of older persons and the opportunities for improvement. I would also like to thank in particular the Permanent Mission of China in Geneva and the Ministry of Foreign Affairs, the Special Representative for Human Rights and the Directorate for International Organizations and Multilateralism for its cooperation and constructive dialogue throughout. I further hope that my visit contributes to multiply and further deepen existing avenue for cooperation with the UN Human Rights mechanisms and the UN-OHCHR. I also hope that my visit will contribute supporting governmental efforts to address the challenges of an ageing society and in particular in the fight of old age poverty and in advancing the promotion and protection of the human rights of older persons, in accordance with the UN’s leitmotiv of the SDGs – sustainable development goals to “leave no one behind”.

As I have observed at the beginning, my remarks today are of a preliminary nature and do certainly not cover all issues in a comprehensive manner. I will further analyse the information received in connection with my visit and elaborate on my findings in my report to the UN Human Rights Council to be submitted in September 2020.

I would like to reaffirm my commitment to continue the dialogue with the Government of China and that I look forward to working with the Government in a spirit of cooperation on ensuring that older persons in China can fully enjoy their human rights.

END