Challenges and Responses of Left-Behind Elderly and Children in Rural China Amid the New Population Development Stage.

The disparate economic growth in China has compelled numerous adults from rural areas to migrate to cities in search of more lucrative employment prospects (1). In the 7th National Census, it was reported that the floating population totaled 375,816,759, accounting for approximately 26.00% of the overall population. Such migratory patterns often result in leaving behind vulnerable groups, particularly children and older adults, in rural regions. Given the inadequately established care systems, these groups are particularly susceptible and have consistently been at the forefront of social security concerns in China (2). The inadequate public pension benefits and health insurance systems result in older adults relying heavily on their offspring, generally their sons, for their overall well-being (3). Migration has led to the rise of a vulnerable group known as the “rural left-behind older adults”, where older family members lack necessary support as their caretaker children move to urban areas. Simultaneously, the growth and well-being of children hinge on parental care, but employment constraints, limited financial resources, and rural residency restrictions often make it unfeasible for migrant workers to bring their children to the cities where they work (4). Consequently, these children are regularly left behind in their rural homes, becoming the “left-behind children in rural areas”. During the first meeting of the Financial and Economic Affairs Commission under the 20th Communist Party of China (CPC), Xi Jinping, General Secretary of the CPC Central Committee, accentuated that the country is entering a new stage of population development. This phase is characterized by declining birthrates, an aging population, and uneven population growth among regions. Additionally, the rural population characterized by an unbalanced age population structure, has been pronouncedly affected by the inconsistent economic development and these factors. Status of Imbalanced Age Structure and Increasing Burdens The 2020 Population Census reported that in China, the child-age dependency ratio was 26.24 per 100 working-age individuals, while the old-age dependency ratio was 19.74. Notably, rural areas displayed significantly higher dependency ratios in comparison to urban areas. In rural areas, the child-age dependency ratio was at 30.58 and the old-age dependency ratio was 28.13. Contrastingly, in urban areas, these ratios were 24.07 and 15.56, respectively. The heavily skewed age structure in rural areas has imposed a greater burden on the adult population due to these pronounced dependency ratios. Moreover, notable societal aging has been recorded in China, predicting a future transition from an aging society to an aged society, which may exacerbate the existing burdens. Concerns over declining fertility rates and rising populations of older adults are not unique to China. According to the World Population Ageing 2020 report and the United Nations Population Division, over the last fifty years, the total fertility rate (TFR) has halved. As of 2021, the global TFR stands at 2.32. Furthermore, projections suggest that the global population of individuals aged 65 years or older will increase from 9.3% in 2020 to 16.0% by 2050. Population pyramids effectively illustrate the age and sex composition of both rural and urban populations in 2010 and 2020 (Figure 1A). Compared to urban populations, the rural population pyramids display a more marked decline. This is characterized by a significantly smaller children’s population, an expanded older-adult population, and the outflow of working-age adults. It’s notable that from 2010 to 2020, the middle section of the rural regions’ pyramid has narrowed, paired with an evident bulge at the top. This indicates a substantial decrease in the adult population and a growing proportion of elderly people, placing increased strain on the diminishing labor-age population. In light of declining fertility rates and China CDC Weekly