Demographic Megatrends in Asia and Eastern Europe – Challenges and Opportunities for Health and Social Protection

November 13 – 14, 2013, Hanoi, Viet Nam

Conference Discussants - copyright GIZ

Rachel Welcome to the 13th Sector Network Conference being held this year in Hanoi, Vietnam. I'm Rachel Harvey and I'll be bringing you updates here each day. The topic we have been asked to grapple with is Demographic Megatrends in Asia and Eastern Europe – Challenges and Opportunities for Health and Social Protection. It’s a broad subject, incorporating everything from population growth to urbanization, global aging to the so-called youth bulge. But these issues are increasingly a focus for policy makers around the World. International experts will share their knowledge with those who have first hand experience from countries around the world about the impact of population dynamics on the provision of health care social protection. We’ll be bringing you news of each day’s discussion and conclusions and, shortly after the conference, a full report on the event. For instant updates throughout the conference, follow us on Twitter @HealthyDEvs using the hashtag #GIZDemTrends


13 November 2013 

Conference Opening 

Demographic Dynamics - Challenges and Opportunities by Thomas Buettner
(large file - 39 MB!)

The Demographic Challenge for Health and Social Protection by Karen Eggleston 

Interactive parallel Sessions 

1. Population Dynamics: Opportunities to realise the demographic dividend 

Population Dynamics in German development cooperation by Thierry Kuehn

Realizing the Demographic Dividend in Pakistan by Jasmin Dirinpur

Population Dynamics in Pakistan by Durre Nayab 

2. Population Dynamics: How to meet the needs in pluralistic health systems 

Population Dynamics and Pluralistic Health Systems by Dominic Montagu

Peer Educator Networks for Diabetes and chronic NCD in Cambodia by Maurits van Pelt

Mapping the Healthcare Delivery in Bangladeshi Cities by Tanvir Ahmed

Private Sector SRHR services in Kyrgyzstan by Tatjana Popovitskaya

Poster: Providing Adolescent-Friendly Services in the Public Sector by Kathrin Schmitz 

3. The political economy of old age protection in Asia 

Demographic Changes, Pension Reform Needs in Asia by Giang Thanh Long

Comprehensive Social Security for the Unorganized Worker in India by Sandra Kissling

Old Age Social Protection in the Philippines by Alexander Tabbada

Social Protection Program in Indonesia by Frank Schneider 

4. Tackling exclusion 

Tackling Exclusion by Marianne Schulze

Poster: Nepal‘s out-bound low-income migrants by Ramesh Baral and Richa Shivakoti

Poster: Old Age in India by Rajeshwar Devarakonda

Poster: Inclusion of Persons with Disabilities by Vũ Thị Bình Minh 

Global Fund Session

Introduction to the new Funding Model by Gail Steckley

14 November 2013 

Innovative Approaches 

WHO-ITU joint Program on mHealth for NCDs by Sameer Pujari

Reducing Child Malnutrition through Social Protection by Michelle N. Domingo-Palacpac

Intergenerational Self-help Clubs by Quyen Tran

IT-Tool DeCiDe by Thomas Ott 

Conference report

There is ample evidence of the demographic changes taking place in the world. But there is no simple answer to the complex questions posed by those shifts; the challenges and opportunities vary from one country to another. The 13th conference of this GIZ Sector Network asked to consider the particular impact of demographic megatrends on health and social protection in Asia and Eastern Europe.

To help focus what is a broad topic, the conference was organised around five key demographic trends:

  • Continuing Population Growth
  • Youth Bulge
  • Global Aging
  • Urbanisation
  • Migration

Countries in Asia and Eastern Europe are facing these trends to different degrees and in different combinations. In Eastern Europe and Eastern Asia fertility rates are generally decreasing while life expectancy is increasing. Since 2010, much of Asia has been experiencing a youth bulge, but by 2040 that will be over. In Eastern Europe and Central Asia the total population is shrinking, while Asia is undergoing a rapid period of urbanisation and migration.

Where the proportion of young people in a population is high, health and social protection systems will need increasingly to reflect their particular needs, such as in sexual and reproductive health. For example young people account for an estimated 40% of all new HIV infections among adults worldwide. The youth bulge also contributes to urbanisation and migration, further complicating the overall demographic picture.

Aging populations are causing a shift in the global disease burden, from infectious, nutritional and maternal related illnesses to chronic and degenerative conditions. This implies greater demands for preventative health services and social protection systems to mitigate the specific risks of old age.

Urbanisation tends to be characterised by inequalities, with poorer sectors of the population exposed to increased health hazards due to inadequate housing, sanitation and working conditions.

Meanwhile migration patterns vary greatly from one region to another with an outflow of skilled health workers clearly placing a burden on the delivery of services in some countries, while an inflow of remittances contributes a significant proportion of GDP in others.

The aim of the conference was to seek innovative solutions to address these challenges. By bringing together academic experts, field experience, and case studies, the Sector Network conference in Hanoi sought to motivate and inspire participants to incorporate demographic trends in their current and future work. Read the full report online below or download it from the 'Related documents' section on the right.

Summary - Day two

“More people have access to a mobile phone than access to clean water.” 

It is a shocking fact, perhaps, but Sameer Pujari of the World Health Organisation (WHO), says this new global reality can be harnessed as a force for good.  Mr Pujari’s presentation to the second day of this GIZ Sector Network, Health and Social Protection, Asia and Eastern Europe, Conference peaked the interest of a number of participants.  The theme of the day was “Innovative Approaches” and the examples on offer ranged from the highly technical to the surprisingly simple. 

For the first time we have a communication mechanism to reach out to every person on the planet, Mr Pujari said.  All countries in the world, regardless of GDP, are concerned with saving money in the health sector. MHealth  (mobile health) could be part of the answer. 

The WHO has teamed up with the International Telecommunication Union (ITU) - the United Nations specialized agency for information and communication technologies - to launch a generic mobile health platform that is now being piloted. It can be programmed to focus on any non-communicable disease (NCD) or risk factor.  The model is direct, targeted, and, Mr Pujari said, it could be very cost effective.  There are challenges, such as how to encourage government ownership, but the early results are encouraging.

Technology was also on offer as a support tool for those who are not experts to be able to incorporate demographics into their work.  DeCiDe was developed by the Office for Applied Geographic Information Systems as an open source platform for development workers. It suggests a number of potential demographic challenges and matches them with weighted potential options to help users make informed decisions. 

The conference also heard the details of an Asian Development Bank case study aimed at reducing child nutrition in the mountainous Karnali region of Nepal. In 2010, the Government introduced the Child Protection Grant that allocates 200 Nepalese Rupees (about USD 2) per month for children under 5 years old. 

The project provides training and information at the village level, including advice about food preparation and hygiene, with the ultimate aim of improving child nutrition through social protection. 

Quyen Tran, of HelpAge Vietnam, described an equally locally focussed project but with a rapidly expanding reach.  The Intergenerational Self-help Clubs are, he insisted, “not just about old people.”  They arose from a desire to move away from vertical models towards something that was more inclusive and beneficiary led. 

HelpAge supports the clubs in getting started, but the idea is that they should then be self-managed and self-sustaining.  The clubs tackle any issues of interest to members, from healthy exercise to homecare.  The model has clearly captured attention, with other agencies now seeking to replicate it. 

As two days of debate, discussion, networking and knowledge sharing came to an end one participant remarked how welcome it had been to exchange ideas over coffee and cake.  But another highlighted the potential danger of that approach, saying their key take-away would likely be 3 kilos of added weight.   

That’s a health challenge the conference organisers perhaps hadn’t anticipated!

Summary - Day one

“Demography is a friend if treated with respect, knowledge and evidence.” 

That was the encouraging message from Dr. Thomas Buettner to the 13th conference of the GIZ Sector Network Health and Social Protection Asia and Eastern Europe. 

The theme of the conference in Hanoi, Vietnam, is Demographic Megatrends in Asia and Eastern Europe: Challenges and Opportunities for Health and Social Protection. 

Dr. Buettner, a demographics expert with decades of experience working for the UN, was tasked with providing some context against which we can better understand some of the key “megatrends” facing the World today – overall population growth with a youth bulge in some countries, an aging society in others and a general pattern of urbanization and migration.  

The good news is that there is growing acknowledgement that these trends are important, and Germany believes it is taking a strong lead in trying to force the issue onto global political agendas.  “If you want to create strong health and social protection systems and if we want to create sustainable development through our programmes,” said Theirry Kuehn of the BMZ Sector Department of Health “we have to pay greater attention to demographic megatrends.”  

But Dr. Buettner warned that population dynamics need long perspectives to be properly understood. What happened 40-60 years in the past still determines what is happening now. “We need to get that message through to policy makers,” he urged the conference. 

The long-term view was echoed by Dr. Karen Eggleston of Standford University, California, particularly when considering population aging.  The “New Demographic Transition”, she said, meant that most gains in life expectancy were now realized late in life. 

A comment from the room highlighted the fact that demographic changes are happening much faster in Asia than in older industrialized countries, which meant there was increased pressure to act speedily. 

Dr Eggleston suggested Asian and Eastern European countries could leverage new technologies and learn from the mistakes of countries with a slower rate of aging to seek more effective systems for health and social protection. She also cautioned that any demographic dividend was a one-time boost in GDP per capita, only realized when the working-age population is high and productively employed. 

An expert panel, on which Dr. Buettner and Dr. Eggleston were joined by Prof. Giang Thanh Long, of the National Economics University, Hanoi, and John Hyde, representing the Asian Forum of Parliamentarians on Population and Development, were in solid agreement that an aging population should not be considered a burden, but rather should be embraced as a treasured asset.  

Prof. Long put forward as an example the indirect economic contribution made by grandparents who allow a younger generation to go out to work by providing childcare. Dr Buettner, suggested we look to Disneyland, Florida where, he said, much of the workforce appears to be over 70 years old, healthy and happy.   

There was repeated mention of the challenge of aging populations, but the younger generation was not forgotten in the discussion. There was a general consensus that targeted youth health provision and social protection was a crucial investment in the future.  

So the challenges of shifting demographics are increasingly understood, and the potential opportunities they offer are beginning to be appreciated. 

The question then is how best to shape policies and programmes to reflect that knowledge.  Only then perhaps will demography really have become our friend.

The conference

Organised by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) this conference will bring together health and social protection experts working for programmes supported by the German government, their counterparts, representatives from BMZ, KfW and GIZ head offices as well as representatives from international organisations, NGOs, the private sector and the government in Hanoi, Viet Nam.

The aim of the meeting is to analyse the challenges and opportunities that demographic mega trends pose for health and social protection systems.It will bring together scientific evidence, country experience and good practice examples from international cooperation. Taking a multi-sector approach the conference aims to identify effective and comprehensive responses as well as innovative solutions to current challenges in the fields of health and social protection.

The background

Low- and middle-income countries in Asia and Eastern Europe are facing demographic changes that significantly affect their health and social protection systems and their links to other sectors. The most challenging demographic trends have an impact on all countries in the region, however, to a different extent and in various combinations. Further information…

The Experts

Buettner Thomas Buettner is an economist and demographics expert with more than two decades of experience working on population related issues with the United Nations Secretariat in New York.  He is currently employed as a consultant having previously held the position of Assistant Director of the Population Division, Chief of Population Studies, within the Department for Economic and Social Affairs.  Dr Buettner travels extensively to conduct specialist training and presentations.  Widely published he has also been involved with the development and implementation of demographics related software and databases. He has sat on numerous influential panels, including more than ten years as a member of the German Fund for World Population (Deutsche Stiftung Weltbevölkerung DSW), and currently as a member of the Board of Trustees, Berlin Institutes for Population and Development.


Hyde John Hyde is the Senior Advocacy coordinator for the Asian Forum of Parliamentarians on Population and Development.  He also coordinates regional parliamentarian groups in East, South-East Asia and the Pacific and was a key driver in the adoption of progressive positions on population and development at the recent United Nations Asia Pacific Population Conference.  He was the Member for Perth in the West Australian Parliament for 12 years, until 2013. He also served as Parliamentary Secretary to the Attorney-General and Minister for Health, implementing a range of human rights, population and development initiatives.  In 2012 he was named as the Population Champion for Australia by the AFPPD for his work in advocating for progress on population and development issues. 


Long Giang Thanh Long is Deputy Director of the Institute of Public Policy and Management (IPPM) at the National Economics University of Hanoi, and a Vice Director of the Institute of Social and Medical Studies (ISMS).  He is also an Affiliate Research Fellow of the Oxford Institute of Population Ageing, University of Oxford.  Professor Long’s research interests include the economics of aging and micro-simulation of anti-poverty programs for the elderly, particularly in Vietnam, Indonesia and Myanmar.  He was a member of the drafting team for Vietnam’s Social Protection Strategy 2011-2020 and his research has been published widely, including in the Asian Economic Journal, Asia Pacific Migration Journal, Asia Pacific Population Journal, Asia Pacific Development Journal, Development and Change, International Social Science Journal, and Journal of Population Ageing

Eggleston Karen N. Eggleston is Fellow and Asia Health Policy Program Director: Walter H. Shorenstein Asia-Pacific Research Center, and Fellow: Center for Health Policy/Primary Care and Outcomes Research at the Freeman Spogli Institute for International Studies, Stanford University.  She is also a Faculty Research Fellow at the National Bureau of Economic Research and an Advisory Board Member of the Aging and Health Research Center, Institute for Population and Development Studies, School of Public Policy and Administration, Xi'an Jiaotong University, China. In addition, Dr Eggleston serves on the Editorial Board of the Journal of the Economics of Aging, Elsevier, and the Research Advisory Group:  Asia Pacific Observatory on Health Systems and Policies. She has written, edited or contributed chapters to several books, including Aging Asia: Economic and Social Implications of Rapid Demographic Change in China, Japan, and South Korea, co-edited with Shripad Tuljapurkar, (Stanford University Walter H. Shorenstein Asia-Pacific Research Center series with Brookings Institution Press: 2011). Her work is featured regularly in peer-reviewed journals and other publications.

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