Population Ageing and Women's Health: A Cross-Country Comparative Study of Experiences from Select Asian countries.

随着平均预期寿命的增加，以及生育率的下降，保健服务的改善和医疗的进步正在导致全球人口老龄化的转变。尽管不是一成不变的，但从人口结构转型模型的各个阶段来看，这些“新的人口结构现实”意味着，解决中老年人在身心健康以及社会和经济福祉方面的需求，是学者和政策制定者日益优先考虑的问题。然而，了解女性在这一领域面临的独特健康和福祉挑战仍然是一个关键的研究差距，大多数研究都采取了性别中立的方法。例如，需要考虑包括更年期在内的生命过程事件对妇女晚年健康和福祉的影响，目前的研究大多将妇女几乎完全视为生殖存在。由于预期寿命的提高，妇女面临着与年龄和生活方式因素有关的非传染性疾病(NCDs)日益沉重的负担，同时也首当其冲地面临着卫生和社会护理服务日益增加的压力。与此同时，传统家庭和社区支助结构的转变也对老年妇女产生了不成比例的影响。亚洲国家正处于人口结构转型的不同阶段：日本和韩国等国正面临“人口悬崖”，马来西亚和印度尼西亚正向低死亡率和出生率下降过渡，印度和中国的人口增长和老龄化是同时发生的，尽管增长速度不同。这6个例子简要说明了人口老龄化和人口结构转变对妇女健康和福祉造成的各种后果。这篇论文利用生命历程的方法，考察了在人口老龄化的背景下，妇女的健康和福祉方面的转变以及关于实现创造健康老龄化的雄心的辩论的未被探索的方面。运用先进的定量研究方法和计量经济学技术，本文将使用来自选定亚洲国家的全球老龄化门户的纵向数据，提供关于人口老龄化如何影响整个亚洲社会的有力和深入的观点。它将使用来自全球人口增长和老龄化趋势前沿的6个亚洲国家的数据，包括印度(印度老龄化纵向研究，LASI)、中国(中国健康和退休纵向研究，CHARLS)、马来西亚(马来西亚老龄化和退休调查，MARS)、印度尼西亚(印度尼西亚家庭生活调查，IFLS)、韩国(韩国老龄化纵向研究，KLOSA)和日本(日本老龄化和退休研究，JStar)。它将审查以下问题：老龄化的生物标志物作为老年身心健康和福祉的预测指标的作用；更年期转变的意义和长期影响；生命过程事件的影响；获得保健和保健系统运作如何影响妇女晚年的健康和福祉。这对于了解妇女在整个生命过程中的生活经历对其老年健康经历的影响是至关重要的。因此，这一创新的论文旨在为关于人口老龄化的知情研究和政策制定提供基于证据的分析，以改善妇女的健康和福祉成果。

Improvements in health care provision and medical advancements with increasing average life expectancies, alongside declining fertility rates, is resulting in global shifts to population ageing. Though not uniform, these 'new demographic realities' seen through the stages of the demographic transitions model mean that addressing the needs of middle- and older-age adults in terms of their physical and mental health, alongside social and economic wellbeing, is a growing priority for scholars and policymakers. However, understanding women's distinctive health and wellbeing challenges in this area remains a key research gap with most research taking a gender-neutral approach. For example, there is need to consider the impacts of life course events including the menopause on women's health and wellbeing in later life, with current research mostly treating women almost exclusively as reproductive beings. As a result of higher life expectancies, women face both the rising burden of non-communicable diseases (NCDs) linked to age- and lifestyle- factors, alongside the brunt of increasing pressures on health and social care services. Meanwhile, transformations in traditional family and community support structures are also disproportionately affecting older age women. Asian countries are at different points in the demographic transition: with countries such as Japan and South Korea facing the 'demographic cliff', Malaysia and Indonesia transitioning to low mortality and falling birth rates, and India and China where population growth and ageing are happening concurrently albeit at different rates. These 6 examples provide snapshots of the varied consequences of population ageing and demographic transitions on women's health and wellbeing. This thesis on utilises a life course approach to examine under-explored dimensions of transformations in women's health and wellbeing in the context of population ageing and debates over realising ambitions of creating healthy ageing. Using advanced quantitative research methods and econometric techniques, this thesis will use longitudinal data from the Gateway to Global Ageing from select Asian countries to provide a robust and in-depth view of how population ageing is impacting women across Asian societies. It will use data from 6 Asian countries at the forefront of global population growth and ageing trends including India (the Longitudinal Ageing Study in India, LASI); China (the China Health and Retirement Longitudinal Study, CHARLS); Malaysia (the Malaysian Ageing and Retirement Survey, MARS); Indonesia (the Indonesian Family Life Survey, IFLS); South Korea (the Korean Longitudinal Study of Ageing, KLoSA); and Japan (the Japanese Study of Ageing and Retirement, JSTAR). It will examine issues such as the role of biomarkers of ageing as predictors of older age physical and mental health and wellbeing; the significance and long- term implications of menopausal transitions; the impact of life course events; and how access to health and health system functioning affects women's health and wellbeing in later life. This is essential to understand how the lived experience of women impacts across the life course impacts on their health experiences in older age. Thus, this innovative thesis aims to provide an evidence-based analysis for informed research and policy development on population ageing towards improving women's health and wellbeing outcomes.