Life's Worth

Bee 1

Life’s Worth Since the dawn of humanity, people have been aging. This infamous process of slowly dying is also the development of the mind, body, and spirit. Everything people do in his or her life influences the way one ages, and therefore every routine, habit, and lifestyle choice greatly impacts when and how a person dies. But this slow rising action to the final climax of life is not only shaped by personal lifestyle choice, it is also molded by the culture to which each individual belongs. Unfortunately, becoming older has turned into a cultural economic issue. Living without income and relying on another source for financial security can be a burden in all parts of the world. The specific treatment of the subject can greatly impact the later end of one’s life, and influence a person’s final moments. The culture of aging has shifted from a sentimental time to one highly revolved around financial issues and economic burden, and has dehumanized this sensitive process.

In China, one of the world’s oldest populations, aging and dying is no new process.

However, research shows that there are many issues with an ever-growing amount of elderly citizens. The implement of the One-Child Policy has caused many of these problems that families deal with every day. After many years of limiting offspring, the 4-2-1 family structure (four grandparents, two parents, and one child) is the typical situation in China. This results in a “top-heavy pyramid in which the working population of the one-child generation will have to work harder to provide financial support and physical care” for theirs and their spouse’s parents (Zhan). In fact, it is required by the Chinese government and Confucian tradition, ​xiao, ​“which requires adult children to care for their elderly parents” (Zhan). Combining the upside-down

Bee 2

pyramid with the legal obligation of caring for elderly family members can be extremely taxing, placing huge responsibility on the working-age adults in China. They must not only work a full time job in order to support two sets of parents, provide physical care for them, and raise a child of their own.

Health care in China is improving, but creates a larger discrepancy from rural and urban life. In urbanized areas such as the Beijing Municipality, life expectancy is “now on par with many developed countries”, leaving their rural counterparts in the dust (Zimmer). As the urban areas reap benefits and become more developed and modern, rural parts remain constant, and in comparison, are falling behind on the economic growth chart. Even with a seemingly booming transformation in health care in the cities, the “reform era ushered in a decline in cooperative medicine and a subsequent increase in privatized fee-for-service practices”, something that pushes even more financial burden on the adult children of the 4-2-1 family (Zimmer). In rural areas, where it is extremely difficult to even find reliable health care, adult children following xiao ​have even more to worry about. It is estimated that the average cost of living per adult per year in China is roughly $8,000 (Fu). If the grandparents each retire at 65 and live out the average life expectancy of 76 years, The adult children are forced to care for themselves, their child, and their parents for eleven years (“Health Profile China”). The legal obligation of ​xiao​ is not economically stable, and there are too many factors that could leave the average family living in poverty, even in a more advanced, urban area. As time progresses, the 4-2-1 pyramid will grow increasingly unstable, with an ever-growing old population and a shrinking amount of younger, able citizens. Aging in China is not only a physical endeavor for the elderly, it has become de-sensitized and an exponential economic catastrophe in many Chinese households.

Bee 3

Moving westward, India’s aging situation does not fare better than China’s. The end of life care in India signals an extreme red flag, where health facilities “hardly respond to death and dying” (Sengupta). Although the Indian government does not mandate any specific care routes, the family automatically becomes responsible for the physical care of the elderly because hospitals are often inadequate. It seems as if hospitals there have no experience dealing with death at all, where there is a “lack of integrated, coordinated health structures with well-equipped workforce” (Sengupta). The underdeveloped healthcare system in India forces families to play the financial supporter, if the elderly are unable to pay for themselves, and physical caretaker by default. Lack of sufficient government funds and programs to pay for health care in India has resulted in “heavy out-of-pocket expenditure even to the extent of selling one’s assets” (Sengupta). Adult children care enough about their parents to give up anything they own to help them achieve better health, but nonetheless the effort is stressful, time consuming, and financially draining.

Life expectancy, bittersweetly, has actually improved. Although the total amount of years is not a great as China, the average person in India lives to be about 68 (“Health Profile India”).

This increasing number may look great in a statistics book, but for the average family caring for elderly and paying out-of-pocket for their health care, it doesn’t have quite the same positive effect. In India, it costs about $8,700 per year per person to live (“What is the Cost of Living”).

If a person retires at age 65, there are only three years (on average) where a family needs to support him or her. Although this is not nearly as long or as expensive as a family in China may experience, it can still be a burden nonetheless. With no government involvement, low levels of healthcare and lack of better alternatives, aging in India leaves people with nowhere to turn.

Bee 4

The “white world”, as one may call it, will clearly fare better than the eastern population of the globe. Aging in Germany makes India and China’s treatment of growing older seem inhumane. End of life healthcare in Germany is advanced and educated. More often than not, German doctors evaluate each situation with caution and thought, and “[regard] ethical factors and patients’ wishes as more important [than] hospital costs” (Richter). This shows that hospitals and their doctors are not concerned with monetary issues, but rather patient satisfaction and comfort. Their treatment of aging and dying probably makes patients more relaxed about his or her situation, and makes growing old less of a business, and more of a personal, sensitive matter.

As expected, Germans have a rather high life expectancy of 81 years (“Life Expectancy in Germany”). The length of each individual’s life will differ, but interestingly, “mortality of German early retirees is considerable higher than mortality of regular old-age pensioners” (Kühntopf). Most Germans retire at age 65, but draw government pensions. The high level of government involvement in their financial bearings puts less stress on both the aging person and his or her family. It makes the whole process of growing old manageable, and not a matter of dipping below the poverty line to compensate for heath care. The situation improves also if a person works beyond the typical age for retirement, and have the opportunity to draw a large pension, because “life expectancy is higher the later the retirement occurs and the higher the pension income is” (Kühntopf). With visible government involvement and well-developed and maintained health care facilities, aging in Germany hardly seems like an economic focus at all.

However, if the pension runs out before the end of a person’s life, the family must become responsible for the elderly subject. This possibility looms over retirees and their families, causing pre-meditated stress.

Bee 5

The United States of America, however, takes the cake when it comes to end of life care and the dying process. Mature hospital facilities and extensive options for retirement and beyond makes America fare the best when it comes to aging. Although fairly new, intensive care units are “[now] a standard part of care in any full-service hospital” (Quill). With hospitals seemingly around every corner, and almost full admittance to emergency rooms, there is no lack of facilities and trained health professionals in the United States. Religious based hospitals are also available and, their patients had “improved performance… caused by inherent institutional and theological incentives” (Quill). Like Germany, American hospitals are very patient-oriented, although can still create a financial burden on families when an outrageously high medical bill comes in the mail. An average stay in an ICU can be between $600 and $1500 per day, something an average working class person may not be able to afford, especially if their loved one remains in the hospital for several days or weeks (“Mechanical Ventilation”). Although adult children are not often the default to take care of their parents in late life, the hospital bills must be paid, potentially creating financial turmoil in the household.

Unlike Germany, old age and retirement pensions are not usually granted to average workers in America. The Baby Boomer generation are the last to receive full government pensions, leaving younger generations to pay into Social Security, without the promise of ever actually being able to draw from those funds. However, the government does offer programs such as 401Ks to help people save for their retired lives. Despite Social Security “[solidifying] retirement as a clearly defined normative phase of the life course”, many people actually go back to work after initially retiring at age 65 (Warner, David F., et al). The question is, would Americans actually retire at 65 if it hadn’t become a socially accepted norm? There has been a

Bee 6

relationship between early retirement and a return to the workforce, where “earlier ages of retirement also corresponded to increasing reentry” (Warner, David F., et al). Old people in America seem to simply get bored, and many times they return to work, whether they could use the extra income or not. However in the end, their financial skills and saving habits may make or break the final years of their lives.

Cost of living in America, however, is significantly higher than that of Germany, India, or China. At roughly $20,000 a year per person, living out the average life expectancy of 85 can make small expenses add up quickly when there is not a steady household income (“Social Security”, ​Rate Limited​). This means that there is a large possibility of the necessity of family members to absorb their financial discrepancies. Even the average American family with a disposable income may enter debt and face monetary burden set upon them by their elders. With the most expensive cost of living and the highest life expectancy, America’s aging population has turned to a business. Additionally, less return on Social Security and the decline of pension options makes growing old in the United States more of an economic factor than a personal one.

Each country deals with growing older in vastly different ways, but unfortunately the majority has turned a very sensitive topic into a business discussion. The world has become an engine that can only run on one type of fuel: money. Regrettably, the engine stops for no circumstance, including one as touchy and heart-wrenching as aging and dying. The deliberate development of one’s life all comes to a close, leaving families burdened by lack of financial resources. Although America’s posh, sophisticated hospitals and Germany’s stress-free approach to the end of life are far better than what China or India have to offer, each country is united in

Bee 7

the fact that the sentimental aspects of aging and dying have become alien. Economics and the reality of the money machine have robotized the process of the end of a person’s life.

Works Cited "Cost of Living in Germany." ​Cost of Living in Germany | InterNations​. N.p., n.d. Web. 17 Mar.

Bee 8

2017.

Fu, Furio, "Start Here!" ​Sapore Di Cina​. N.p., 11 Jan. 2017. Web. 18 Mar. 2017.

"HEALTH PROFILE CHINA." ​World Life Expectancy​. N.p., n.d. Web. 17 Mar. 2017.

"HEALTH PROFILE INDIA." ​World Life Expectancy​. N.p., n.d. Web. 17 Mar. 2017.

Kühntopf, Stephan, and Thusnelda Tivig. “Early Retirement and Mortality in Germany.”

European Journal of Epidemiology​, vol. 27, no. 2, 2012, pp. 85–89.

"Life Expectancy in Germany." ​World Life Expectancy​. N.p., n.d. Web. 17 Mar. 2017.

"Mechanical Ventilation - The American Association for the Surgery of Trauma." ​AAST​. N.p., n.d. Web. 18 Mar. 2017.

Quill, Timothy E. “In-Hospital End-of-Life Services: Is the Cup 2/3 Empty or 1/3 Full?” ​Medical Care​, vol. 40, no. 1, 2002, pp. 4–6.

Rate Limited​. N.p., n.d. Web. 17 Mar. 2017.

Richter, Jörg, et al. “Doctors' Authoritarianism in End-of-Life Treatment Decisions. A Comparison between Russia, Sweden and Germany.” ​Journal of Medical Ethics​, vol. 27, no. 3, 2001, pp. 186–191.

Sengupta, Jaydeep, and Suhita Chopra Chatterjee. “Locating End-of-Life Care in Public Health Context: Is India Prepared for the Discourse?” ​Indian Anthropologist​, vol. 43, no. 1, 2013, pp. 79–92., "Social Security." ​Calculators: Life Expectancy​. N.p., n.d. Web. 17 Mar. 2017.

Warner, David F., et al. “The Retirement Life Course in America at the Dawn of the Twenty-First Century.” ​Population Research and Policy Review​, vol. 29, no. 6, 2010, pp. 893–919.

Bee 9

"What Is The Cost Of Living In India? - 2017." ​Banker in the Sun​. N.p., 20 Jan. 2017. Web. 18 Mar. 2017.

Zhan, Heying Jenny. "Population Aging And Long-Term Care In China." ​Generations​ 37.1 (2013): 53-58. ​Psychology and Behavioral Sciences Collection​. Web. 14 Feb. 2017.

Zimmer, Zachary, et al. “Explaining Late Life Urban vs. Rural Health Discrepancies in Beijing.”

Social Forces​, vol. 88, no. 4, 2010, pp. 1885–1908.