China Confronts an Aging Crisis as Palliative Care System Struggles to Meet Demand

A Personal Story of Desperation and Discovery

When Zhou Jiayi’s father received a diagnosis of adrenocortical carcinoma, a rare and aggressive cancer affecting the adrenal glands, the 67-year-old retired man faced not only a medical battle but a care crisis that would test his family’s limits. Zhou had served as her father’s primary caregiver, but as his condition deteriorated, she found herself overwhelmed by demands that exceeded her capabilities. Her search for help led to Sereniturn Palliative Care, a specialized service that provided round-the-clock medical supervision and psychological support at a facility in Hebei province. Through early conversations with social workers who understood her father’s background and family needs, Zhou found support she could not have provided alone. “They helped with processes like ways to communicate,” she recalled. “Without the social workers’ support, I do not think I could have done it.”

Zhou’s experience reflects a growing reality for millions of Chinese families navigating the complexities of aging and terminal illness in a country where the healthcare infrastructure is racing to catch up with demographic transformation. Her father’s case illustrates both the urgent need for professional palliative care and the scarcity of such services in the world’s second most populous nation.

The Scale of the Demographic Transformation

China is aging at a speed few nations have experienced. According to official statistics, people aged 60 and above now constitute approximately 23 percent of the population. By 2035, this proportion is projected to reach 30 percent, representing more than 400 million individuals. The demographic shift accelerates as life expectancy increases while birth rates decline sharply. In 2024, China’s population contracted for the third consecutive year, falling by 1.39 million to 1.408 billion, with deaths continuing to outpace births despite a modest uptick in newborns.

The implications extend beyond raw numbers. The old-age dependency ratio, which measures elderly populations against working-age adults, stood at just over 21 percent in 2024. Economists at the International Monetary Fund project this figure will double by the early 2040s, creating fiscal pressures that touch every aspect of social welfare. By 2050, the working-age population is expected to shrink by more than 200 million people, while the number of individuals aged 65 and above could reach 220 million, representing 15.6 percent of the total population according to National Bureau of Statistics data.

This aging wave coincides with rising chronic disease burdens. Cancer has emerged as a leading cause of mortality alongside cardiovascular conditions, with 4.8 million new cancer cases reported in 2022, the highest number globally. Among late-stage cancer patients, 60 to 80 percent experience significant pain, creating complex care needs that China’s current medical infrastructure struggles to address.

Critical Shortages in Palliative Care Access

Despite the clear and growing need, China’s palliative care system remains underdeveloped. Industry reports suggest that fewer than 3 percent of patients who require palliative care actually receive it. This gap stems from multiple systemic deficiencies that have accumulated over decades of medical development focused primarily on curative rather than comfort-oriented care.

Palliative care is not yet recognized as a fully established medical specialty in mainland China, resulting in the absence of systematic domestic training pathways. Qin Yuan, director of the palliative care department at Beijing Haidian Hospital, has observed this evolution firsthand. “Over time, we have deeply felt the need to become more professional and more capable of truly helping patients,” she explained. However, she noted that advancing the discipline remains challenging without formal specialty status.

The training deficit runs deep through the medical education system. A 2015 survey of 201 doctors revealed that 66 percent did not fully understand morphine dosage protocols, contributing to extremely low consumption of opioid analgesics despite their status as the most widely used palliative painkillers worldwide. Communication skills regarding end-of-life care are similarly underdeveloped, as medical education historically centered on curative treatment of physical illnesses rather than holistic management of terminal conditions.

Facilities equipped to provide specialized care remain scarce. Of China’s 1 million registered medical institutions, only approximately 36,000 are authorized to prescribe painkillers, and fewer than 18,000 stock intravenous pain medications. Fewer than 5,000 institutions nationwide maintain dedicated palliative care departments. At Beijing Tsinghua Changgung Hospital, a leading facility, the palliative care ward contains just eight beds, reflecting severe capacity constraints across the system.

Cultural Barriers and the Silence Around Death

Beyond infrastructure gaps, deep cultural traditions complicate the expansion of palliative care services. In Chinese society, discussing death remains largely taboo, creating emotional resistance to hospice services that many families associate with giving up hope. Traditional beliefs emphasize family obligations to pursue every possible treatment, reflected in the saying that it is “better to live a wretched existence than to experience a good death.” This mindset often leads to aggressive medical interventions for terminally ill patients, including transfers to intensive care units where bodies remain connected to tubes and machines in attempts to prolong life.

Lu Guijun, director of pain management at Beijing Tsinghua Changgung Hospital, has worked to change these perceptions through his 27 years of experience in palliative care. “We cannot control when life begins, but we can choose how we think about death,” he stated. His ward has cared for over 300 patients since 2019, helping individuals fulfill final wishes that range from personal photography exhibitions to farewell parties and last sips of preferred beverages. “People at the end of life need more than just medication,” Lu emphasized. “They need a life that is calm, authentic and filled with love.”

Efforts to normalize conversations about mortality are emerging through unconventional channels. Art exhibitions like “Bringing Death Back to Life” at Beijing’s MACA Art Center have drawn thousands of visitors to contemplate end-of-life issues through installations, paintings, and interactive displays. One exhibit featured “Memorial Bears” crafted from clothing of deceased loved ones, while another simulated ICU ventilator sounds to illustrate how modern medicine often isolates dying patients from human connection. These cultural interventions represent a societal awakening to what sociology professor Jing Jun of Tsinghua University identifies as a necessary transformation: “When every family faces the dilemma of elderly care and end-of-life arrangements, a dignified departure becomes a luxury, and that is not a good sign. It reflects our lack of death education.”

Policy Evolution and Pilot Programs

The Chinese government has recognized the urgency of developing hospice infrastructure, initiating systematic reforms over the past eight years. In 2017, the National Health Commission issued foundational documents establishing basic standards, management norms, and practice guidelines for hospice care centers. That same year, five cities including Beijing’s Haidian District and Shanghai’s Putuo District were designated as national pilot centers to develop service models for nationwide replication.

These pilot programs have expanded dramatically. By 2023, the initiative covered 185 cities and districts across multiple provinces, promoting diverse service models including hospital-based, community-based, and home-based care. The Beijing municipal government has established quantitative goals requiring each district to maintain at least one hospice care center with no fewer than 50 beds by 2025, targeting a citywide total of 1,800 beds.

Legal frameworks are evolving to support patient autonomy. In 2022, Shenzhen became the first Chinese city to pass legislation allowing terminally ill patients to decline excessive lifesaving treatments, explicitly recognizing the right to a dignified death. The regulations require medical agencies to respect patients’ living wills regarding resuscitation, life-support equipment, and primary disease treatments at end of life. This legislative milestone represents a significant shift from traditional family-centered decision-making toward individual patient rights.

Specialized programs for vulnerable populations have also emerged. The “Daisy Home” children’s hospice initiative, launched in 2017 at Beijing Children’s Hospital, established the country’s first family-style pediatric hospice ward. Operating in cooperation with facilities across multiple provinces, the program has accompanied 900 children through their final moments, providing multidisciplinary support from healthcare professionals, social workers, psychologists, music therapists, and volunteers.

International Collaboration and Knowledge Transfer

As domestic capacity struggles to meet demand, China has increasingly turned to international partnerships to accelerate professional development. A significant collaboration launched earlier this month connects Beijing Haidian Hospital with Singapore’s Tan Tock Seng Hospital (TTSH) and the philanthropic Lien Foundation. Under the Lien Collaborative for Palliative Care initiative, more than 1,000 Chinese healthcare professionals from at least 18 medical institutions will receive training over three years.

The curriculum covers symptom management, therapeutics, and communication skills through on-site exchanges and online workshops. Neo Han Yee, head of palliative medicine at TTSH, explained the collaborative approach: “They are looking at our sharing as a platform whereby they can learn what regional standards are, and how we practise palliative care in Singapore. They will then adopt what they can, aligning with their cultural context, laws, ethics and financing structure.”

Other international knowledge transfer programs have taken root across the country. The Beijing Advance Care Planning Association introduced the Quality End of Life Care for All program, developed by St. Christopher’s Hospice from the United Kingdom, which has been conducted ten times nationwide. Project HOPE, in collaboration with the Hubei Provincial Nursing Quality Control Center, has trained 181 trainers using the Training of Trainers approach since 2017, who subsequently reached over 18,000 healthcare professionals through peer education programs.

Educational resources are also evolving domestically. Hospice care has been incorporated into national nursing textbooks for undergraduate programs, and three universities currently enroll master’s students specializing in hospice and palliative care. The Chinese Nursing Association has certified 1,443 nurses through specialized training programs consisting of four weeks of coursework and four weeks of clinical practice.

Economic Implications and Foreign Investment

The demographic transformation carries profound economic consequences that extend beyond healthcare into fiscal sustainability. According to International Monetary Fund projections, if current pension rules remain unchanged, public pension spending could rise from approximately 5 percent of GDP in 2024 to more than 15 percent by 2050. Economic growth could slow by roughly 2 percentage points annually as the workforce contracts, while national savings rates may decline as retirees draw down assets.

China’s 2024 retirement age reform, which will gradually raise men’s retirement age to 63 and adjust women’s retirement ages upward, offers partial relief. The IMF estimates this reform will increase GDP growth by 0.2 percentage points annually and reduce pension spending to 11.9 percent of GDP by 2050, compared to 15.3 percent without reform. However, officials recognize that additional measures, including further retirement age increases and updates to benefit formulas reflecting increased life expectancy, will be necessary to ensure long-term stability.

Despite these fiscal pressures, the expanding silver economy presents substantial investment opportunities. China’s per capita healthcare spending reached approximately 2,500 yuan (US$365) in 2024, compared to nearly US$6,000 across OECD countries. This gap indicates significant headroom for growth in medical services, eldercare facilities, and specialized care sectors. Chinese officials have signaled openness to foreign investment in healthcare, particularly in eldercare, rehabilitation, and specialized medical services, as policymakers acknowledge the “explosive growth” of demographic demand.

Liu Baocheng, director of the Center for International Business Ethics at Beijing’s University of International Business and Economics, captured the scale of opportunity: “From senior homes to the tomb, there is a large potential that needs to be further tapped.” As delegates gather for the annual Two Sessions political meetings, healthcare sector development sits prominently among policy priorities alongside telecommunications and education reforms.

Looking Toward a Dignified Future

The convergence of rapid aging, rising chronic disease burdens, and cultural transformation is forcing China to reimagine its approach to death and dying. Healthcare professionals, policymakers, and cultural advocates are working to shift perceptions from viewing palliative care as abandonment to understanding it as a compassionate bridge to dignity. “Palliative care is not about giving up on patients,” explained Chen Yan, a physician at Fuzhou First Hospital’s Palliative Care Department. “It is about balancing the length and quality of life. It is about focusing on the patient, considering their wishes and addressing their needs.”

With over 10 million deaths occurring annually in China, and approximately two-thirds of those individuals potentially requiring palliative care services, the gap between need and availability remains vast. Yet the trajectory is shifting. From legislative innovations in Shenzhen to art exhibitions in Beijing, from Singaporean training partnerships to community-based pilot programs, the foundations for a comprehensive palliative care system are being established. Whether these efforts can scale sufficiently to serve hundreds of millions of aging citizens within the next decade will determine not only healthcare outcomes but the quality of life’s final chapter for a significant portion of humanity.

Key Points

• China’s population aged 60 and above now represents 23 percent of the total, projected to reach 30 percent (over 400 million people) by 2035
• Fewer than 3 percent of patients requiring palliative care currently receive such services in China, with fewer than 5,000 medical institutions maintaining dedicated palliative care departments
• Palliative care is not yet recognized as a fully established medical specialty in China, creating gaps in systematic training and professional certification pathways
• Shenzhen became the first Chinese city to pass legislation in 2022 allowing terminally ill patients to decline excessive lifesaving treatments
• International collaborations, including a three-year partnership with Singapore’s Tan Tock Seng Hospital, aim to train over 1,000 Chinese healthcare professionals in palliative care practices
• Without reforms, pension spending could rise from 5 percent to over 15 percent of GDP by 2050, while economic growth may slow by approximately 2 percentage points annually
• Art exhibitions and death education initiatives are emerging to challenge cultural taboos surrounding discussions of mortality and end-of-life care