The People’s Republic of China has the largest population of older persons of any country in the world. It is a nation that has experienced enormous economic, social, and demographic changes over the past three and a half decades. Traditionally, the family was the main social support for older persons; this changed somewhat under early socialism, but in recent years, the importance of family support has been reasserted. However, over this time, the family’s ability to support its older members has been considerably altered and arguably weakened. This article reviews four key issues (population change, the hukou system, economic reform, general features surrounding modernization) that have gradually changed families’ capacity to provide support for older members. Research foci and public policy directions are considered under which the state might take some responsibilities from the family, support capacity to care, and improve the quality and quantity of support for older citizens.

Since the prevalence of many chronic health conditions increases with age, we might anticipate that as the population ages the proportion with one or more such conditions, and the cost of treatment, would rise. How much would the overall prevalence of chronic conditions increase in a quarter century if age-specific rates of prevalence did not change? How much would the requirements for health care resources increase? How much difference would it make to those requirements if people had fewer chronic conditions? The overall prevalence rates for almost all conditions associated mostly with old age would rise by more than 25 per cent, and health care requirements would grow more rapidly than the population – more than twice as rapidly in the case of hospital stays – if the rates for each age group remained constant. Even modest reductions in the average number of conditions at each age could result in substantial savings.