[Jeon Young-su's Population Prism] The Full-Scale Start of the 'Ganbyeong Society'... Crisis or Opportunity?

The novel coronavirus infection (COVID-19) has summoned Italy. This is due to the enormous number of confirmed cases and the astonishing fatality rate. There are many causes. One of them is the presence of elderly people vulnerable to the virus. In 2018, the elderly population accounted for 23% of the total population. When it exceeds 20%, it is considered a super-aged society, and Italy was the second country in the world to pass this mark in 2006. The country with the highest aging rate is Japan at 29%. It is also a longevity powerhouse. Its life expectancy (83 years) ranks fourth in the world. There are many arguments to define old age starting from 75 years, as living longer inevitably means experiencing illness. Even before the shock of COVID-19, concerns and conflicts surrounding living with chronic diseases were deep and broad issues. COVID-19 has warned that disasters can occur even in ordinary daily life.

What about Korea? It is a close call. This is why urgent preparation before the shock hits is necessary. It is the dawn of a large-scale caregiving society. The starting gun has sounded. From 2020, the leading edge of the baby boomer generation (born in 1955) will enter the age of 65, and over the next 20 years (until those born in 1975), 17 million elderly people are expected. This structure incorporates 850,000 people annually into the legal elderly category. Even if they are not sick immediately, from their 70s (by 2030), physical aging and economic difficulties will inevitably overlap. Meanwhile, the succeeding generation, which is the support base, is rapidly declining. Last year, it was barely 290,000, and if the trend continues, even 200,000 is at risk. If 290,000 people give birth at the current rate (0.92 children per woman in 2019) 30 years later, there will be only 140,000. Sustainable intergenerational support cannot be maintained.

Italy with Rapid Increase in COVID-19 Patients
23% Elderly Population as of 2018
Japan Tops World Aging Rate at 29%
Concerns Existed Even Before COVID-19 Shock

The problem lies in the unique speed and extent of aging in Korea. The pressure of premature aging beyond prediction and imagination is already felt. Looking around, signs of aging can be seen everywhere. Although caregiving issues are limited now, overshadowed by the healthy and vibrant baby boomer generation, they will inevitably intensify from 2025 when the 70s age group arrives. Middle-aged society naturally leads to a super-aged nation. Projections support this. Korea will enter a super-aged society (20.3%) in 2025. Afterwards, it is expected to set unprecedented records in human history with 25.0% in 2030, 33.9% in 2040, 39.8% in 2050, and 46.5% in 2067. This is the highest in the world. This calculation already reflects the current birth rate. If fewer children are born, the numbers will be even higher.

Professor Jeon Young-su, Graduate School of International Studies, Hanyang University

The caregiving issue will inevitably intensify. Although the sixtieth birthday celebration has become a relic, it is not common to consider seventy as youth. Even if resisted or rejected, physical and mental aging cannot be reversed. Therefore, the period after baby boomers enter their 70s (2025), when the prevalence rate will increase, is worrisome. There are only five years left. Moreover, the succeeding population, comparable in size to the baby boomers, is also approaching 70 years old. In 2017, there were 22 million people aged 40 to 70. This includes those born in 1970-1971, when over one million babies were born annually. They are middle-aged in their fifties. Ultimately, the population aged seventy will be 10.6% in 2017, 20.9% in 2035, and 30.5% in 2050 in terms of size and speed. The increased number of elderly with chronic diseases will open the door to a rapid caregiving society.

Of course, an increase in the elderly population can be positive. The proposal to consider middle age up to 70 agrees with the changed sharing of youth compared to the past and is actually the case. Nevertheless, from 70 years old, there is no way around it. The center of gravity shifts increasingly toward aging, and people face worsening conditions by age group. They change from active life agents to passive social weak groups. They fall into the category of dependents. Looking at the old-age dependency ratio (elderly population/working-age population), it rises from 18.8 in 2017 to over 50 in 2036 and reaches 102.4 in 2067, exceeding the dependent population. This is a 5.5-fold increase compared to 2017. This scenario assumes the support capacity and willingness of the succeeding generation.

From 70 years old, 'aging = caregiving' is inevitable. Another point of conflict is summarized in caregiving issues. If one is sick, they become useless. They cannot earn more, and expenses increase. When one changes from the subject of life to the object of illness, quality of life deteriorates drastically. Social costs are also considerable. The long-term care insurance, which started in 2008, turned into a deficit in less than ten years (2016). There were only 5.47 million people aged seventy in 2017, but the deficit already indicates the severity of caregiving demand. Yet, quality is unsatisfactory, procedures are complicated, and costs are expensive. The caregiving fear that will unfold from 2025 is not just a threat. Avoiding it is just luck. A disease-free old age will be extremely rare.

Korea Incorporates 850,000 'Elderly' Annually
Baby Boomer Generation Turns 70 in 2025
One in Ten Has Dementia... Conflicts Foreseeable

The absolute fear of living with chronic diseases focuses on the onset of dementia. In 2017, dementia patients accounted for 9.94% (700,000 people) of the elderly population. One in ten, with one new case every 12 minutes. It is noteworthy that this is an estimate. Many patients are hidden due to the nature of dementia. The rate jumps sharply from 21.3% in the 75-79 age group, surpassing 6.9% in the 70-74 age group. From age 80, one in three has dementia. This is the background for concern as this population increases. The progression from mild to severe disease is also a problem. Even if welfare is reformed, cost burdens are unlikely to decrease. It is similar even without dementia. The average duration of living with chronic disease (life expectancy 82.3 years - healthy life expectancy 73.2 years) is 9.1 years (2017), which is quite long. No one is free from caregiving issues.

If things continue as they are, sustainability will weaken. The rapid increase in caregiving is a burden on society as a whole. The fiscal situation is also not easy. Due to populism avoiding future pressures, national debt is skyrocketing. This is the result of a society that barely passed the 15% aging rate repeatedly engaging in indiscriminate fiscal spending without thorough analysis. The long-term fiscal outlook projects government debt at 718 trillion won in 2018, 1,241 trillion won in 2030, and 1,931 trillion won in 2040. The slope is steep. There is an unavoidable aspect. Welfare spending due to unprecedented demographic changes is inevitable. It would be fortunate if growth increased tax revenue, but as is well known, low growth is the trend. Nevertheless, tax increases are avoided as a paradoxical choice. It is a comprehensive crisis.

From 'Consumption to Production' in Elderly Systems and Perceptions
Paradigm Innovation Needed for a New Era

Crises and opportunities are two sides of the same coin. Even confirmed crises can be turned into new opportunities. What is needed is paradigm innovation suited to the new era. It is necessary to adopt a new normal that improves productivity and satisfaction by revising systems and perceptions according to demographic changes. This involves modifying and preparing related systems suitable for a mature and shrinking society. For example, the standard family has changed from 'four members to one member.' Existing systems are unfair and discriminatory in this context and need revision. Living with chronic diseases should also be transformed from 'policy demand to economic activity.' Viewing elderly issues as productive social investments can generate new added value. This is like seeing aging as 'consumption to production.' The shift from 'manufacturing to service industry' is also consistent. Adjusting the elderly age standard is necessary. Raising it from 65 to 70 years would provide relief. Extending retirement age is natural. Since circumstances have changed, changing standards is reasonable.

Advanced countries have done so as well. The Organisation for Economic Co-operation and Development (OECD) divides the elderly into 66-75 years (Younger Old) and 76 years and above (Older Old). Japan distinguishes early and late elderly at ±75 years. The United Nations (UN) has also revised age standards according to human constitution and average life expectancy: 0-17 years (minor), 18-65 years (youth), 66-79 years (middle-aged), 80-99 years (elderly), and 100 years and above (long-lived elderly). The common point is that '65 years and older ≠ elderly.' The focus is now on Korean society. Attention is on which innovation card Korea, experiencing rapid demographic changes that defy any label, will choose.