While the Western World has reeled from its rapidly ageing population, spiraling health care costs and falling pension benefits, the countries of South-East Asia have quietly grown a massive industry based on the provision of care to the elderly. Hospitals, nursing homes, taxi companies, catering companies, emergency medical alert support and drug companies – all have benefited from the continuing influx of elderly Europeans and Ameri-cans.

In the 1980s, it was the manufacturing industry that looked to the cheaper pro-duction costs of the Far East. Then, early in the millennium, European businesses began to move call centres to India to benefit from its lower labor costs. It was only a matter of time before Japan began to ship some of its elderly population to The Philippines for care, beginning a trend that has spawned one of South-East Asia’s most successful industries.

ANALYSIS >> SYNTHESIS: How this scenario came to be

2000: The young-old balance shifted

The world population is 6 billion. The proportion of people aged 60+ years in the more developed regions (19%) is slightly higher than the proportion of children below 15 years (18%).

The population of the European Union is 375 million people. However, due to low fertility and increased longevity, this is expected to fall to 300 million in 2050, despite immigration. The birthrate in Italy is the lowest in the EU – and one of the lowest in the world – at 1.2 children per women. A birthrate of 2.1 children is needed in Italy to keep the population stable.

By contrast, the population of the USA is increasing. Currently just under 280 million, it is projected to rise to almost 350 million in 2050.

The young-old balance has shifted throughout the world, as the proportion of children declines further. This number rose from 2.8 million in 2000, and is expected to rise to 5.2 million in 2025.

2002: Population growing

Globally the population has grown by 0.1 billion in the last year. The United Nations’ report, State of the World Population 2002, predicts that it will increase from 6.2 billion in 2002, to 9.2 billion by 2050. In the least developed countries, where fertility and population growth is highest, the figure is expected to triple by 2050.

2003: Massive ageing of world population predicted

The UN demographers cut 400 million people from their best estimate of the world’s population in 2050. It is now expected to be 8.9 billion. The report warns that fertility rates will be well below replacement levels in three-quarter of the world by 2050.

The report also warns that the next five decades will see a massive ageing of the world population. The number of people aged 80+ will rise fivefold by 2050.

In 2003, one in every ten people is 60 years or above. The older population is itself ageing. The oldest old (80+ years) are the fastest growing segment of the older population. These people make up 11% of the 60+ years age group, which will increase to 19% in 2050.

There are striking regional differences. One out of every five European is 60+ years, compared with one in twenty Africans. Japan has the most rapidly ageing population in the world. It also has one of the lowest proportion of foreigners – barely 1%. 5,000 immigrants are needed for every one million Japanese inhabitants each year, just to maintain the worker-pension ratio.

Over four million elderly Japanese people need nursing care. The Japanese Finance Minister, Masajuro Shiokawa, proposes to send his country’s elderly to nursing homes in the Philippines, where care is much cheaper in and there is a greater proportion of younger people to look after them.

In Europe there is a collapse in pensions. 12 million workers do not have an occupational pension. Millions of Britons will have to rely solely on state help when they retire.

2005: ‘Baby Boomers’ retire

The ‘Baby Boomers’, the largest generation born in the 1950s and 1960s, start to retire. They have very different expectations and life expectancy from their parents and grandparents.

300,000 elderly Japanese are cared for in Philippine nursing homes. Japan eases its immigration policy, allowing more people from South-East Asia into the country to fill the labor market.

2008: Elderly sent to care homes in South-East Asia

The West begins to debate the viability and ethics of sending its elderly population to care homes in South-East Asia. Public feeling is very mixed on the issue. Governments argue the financial benefit, as public spending spirals and the effects of the ageing population begin to bite.

2010: One in nine people now aged 60+ years

One in nine people is now aged 60+ years in the West. After considerable debate in the European Courts, the UK, Germany and Italy each send 100,000 elderly people to care homes in the Philippines. Six months later, after lengthy debate in Congress, the USA also sends 300,000 people.

2012: Care for elderly in South-East Asia established

Care for the elderly in South-East Asia is established as a viable proposition. While the moral debate continues, the Philippines reap the reward.