Parallel to its economic development, China is facing the challenge of a rapidly aging population. This is happening at a time when urbanization and industrialization is quickly increasing in the country. It is a trend which has weakened traditional family support networks, particularly for the elderly. New policies are necessary to face this situation. In 1979, China adopted a one-child policy to limit population growth and ensure economic stability. As a result, with fewer children and better living standards, the proportion of the elderly in the population has grown substantially and will continue to do so in the coming years. According to one study, within 20 years China will have 350 million citizens over the age of 60, more than the current U.S. population. This situation will present special problems but also unique opportunities. This century’s leading countries will be those that consider their aging population not as dependent and disabled, but that will empower them to still be active participants in the country’s economic growth. This is what some people now call “active aging.” In this regard, the IMF reported last that China’s economy should surpass the U.S. economy in real terms in 2016. In spite of this, one of China’s greatest fears is that the country will grow old before it grows rich. As stated in UNFPA’s The State of World Population 2011, Professor Jiang Xiangqun, a gerontologist at Renmin University in Beijing has argued that when developed countries initially entered a period of significant population aging they had a much higher level of per capita income. The situation of older people was also affected when state-owned enterprises trimmed their ranks of tens of millions of old workers who were let go with small pensions and were replaced by younger ones. The vast majority of retired older workers now have extremely low pensions which are almost irrelevant and, in many cases, make them unable to meet some basic needs. As a result, the vast majority of older Chinese live with their families, a situation that responds not only to the Confucian tradition of respect for age and experience but also to a law that was passed in 1996 making it a legal obligation to take care of the elders in the family. According to some estimates, 98 percent of old people in China remain in their homes, or try to do so. Many remain mostly by themselves in “empty nests,” as their children migrate to cities for work or to start their own families in single-generation homes. Some researchers have called this phenomenon the 1-2-4 problem: one child taking care of two parents and four grandparents. However, as China’s population ages rapidly, the young workforce available for economic growth diminishes. This may hinder not only the development of the country but also the quality of life for its senior citizens, since the young will be less able to support their elders. This is happening while the ratio of elderly dependants to people of working age will rise sharply. It is estimated that over the next few decades this ratio will rise from 10% in 2012 to 40% by 2050. As the numbers of caregivers fail to keep pace with the growing elderly population more of them, particularly those with poor health, will seek care in specialized institutions. The proportion of elderly who develop diseases such as diabetes, heart disease, and different kinds of dementia will increase. It has been estimated that the total medical cost for treating these diseases could reach almost nine percent of China’s domestic product by 2025. The government has responded to the challenge of elders’ care by constructing more nursing homes. However, most of these homes are located mainly in big cities, and their quality varies widely. Also, they only provide basic health care and services, and mostly lack trained social workers. As things stand now, the Chinese government has to devise new strategies to deal with the demographic challenge of a rapidly aging population. It is necessary to improve a social security system to cover both rural and urban areas, improve the overseeing of welfare institutions and address old people’s special needs, not only physical but also provide them with mental health support. China’s health care system will have to address the shifting disease burden of an older population, such as the rising tide of non-communicable diseases. At the same time, it is critical to increase the training of social workers through special courses that teach them to understand and deal with the needs of older people. It is also important to increase the retirement age, which is now 60 for men and 50 for women, taking into account that today’s life expectancy is now 73. With medical advances, people now can still be productive at later ages. How the government meets this challenge will be a measure of the kind of society China intends to build in the future. Dr. Cesar Chelala is an international public health consultant and a co-winner of an Overseas Press Club of America award.