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Aleksandrova S., A. Velkova. Population ageing in the Balkan countries, Folia Medica, 2003, 4, 5-10.

POPULATION AGEING IN BALKAN COUNTRIES

S. Aleksandrova, A. Velkova

Department of Social Medicine and Public Health

Higher Institute of Medicine, Pleven, Bulgaria

INTRODUCTION

As we enter the third millennium an unprecedented rapid increase of total and relative

numbers of older persons in both the developed and the developing world is being observed (7). At

the global level the number of people aged 60 years or over is expected to double by the year 2025

– from 606 million in 2000 to 1.2 billion, and to reach almost two billion in 2050. The increase in

the number of oldest old (80 years or over) is expected to be even more marked, passing from 69

million in 2000 to 379 million in 2050 - more than five-fold increase (11).

The process of population ageing will have considerable social and economic consequences

as have already been documented in many developed countries (2, 3, 9, 10, 12). We need to

consider these issues when planning for social provisions, medical services, economic needs, etc. In

most industrialized nations more than 10% of the population is over 65 years of age. In Japan, for

example, this figure will reach 22% by the year 2020 (3). Similar trends are predicted for Germany,

Sweden and other countries. Simultaneously to the tendency of decrease in the number of young

generations entering the working age, there has been observed a dramatic decrease in the ratio of

people working to those retired (2, 5, 6). In many developed countries the older population (persons

over 65 years or over 60 years) has already surpassed the child population (persons aged 0-14) and

by 2050 г. there will be 2 older persons over 60 years for every child (11).

Balkan countries are not isolated from the world demographic trends even though each

region has its own demographic features. The rapid development of world and regional information

databases allows regional analyses and comparisons to be made more easily and effectively.

The aim of this survey is to analyze the basic characteristics of population ageing in

Bulgaria and Balkan countries, and to reveal the main similarities and differences between these

countries and countries of the European Union (EU) and Central and Eastern Europe (CCEE).

MATERIAL AND METHODS

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The primary information was obtained from WHO European Region Database “Health for

all” (June 2001 update) and European Public Health Information Network for Eastern Europe

(EUPHIN-EAST) (4,8). In addition, the World Health Reports 1999 and 2000, as well as the United

Nations Population Fund Prospects on World Population were used (9, 10, 11).

To describe the process of ageing we analyzed the proportions of people aged 65 years or

over and 0-14 years and calculated the following specific indicators of ageing:

Old dependency ratio – the proportion of people 65 years or over to the working age

population (15-64 years);

Youth dependency ratio – the proportion of people 0-14 years to the working age

population (15-64 years);

Ratio of people 65 years or over to 0-14 years.

Ten Balkan countries were included in this analysis – Albania, Bosnia-Herzegovina, Bulgaria,

Croatia, Greece, FYR Macedonia, Moldova, Romania, Slovenia and Turkey. Unlike some

researchers (1), we assign also Moldova to Balkan countries.

For six Balkan countries the period under study included 30 years (1970-1999). For the rest four

countries the data available covered shorter periods:

Moldova – 1981-1999 (19 years);

Slovenia – 1985-1999 (15 years);

FYR Macedonia – 1991-1999 (9 years);

Bosnia-Herzegovina - 1985-1991 (7 years);

Each of the above-mentioned indicators was compared with the average value for the 15 EU

countries and 12 countries of Central and Eastern Europe (except the Newly Independent States of

the former Soviet Union).

To evaluate the rate of changes in different indicators we calculated the percentage of increase

(expressed by positive or negative value) taking the first year available as a base (100%) of

comparison.

RESULTS AND DISCUSSION

As it is shown in Table 1, the greatest proportion of people aged 65 years or over at the

beginning of the period under study was observed in Greece, Croatia, Bulgaria and Slovenia. In

Bosnia-Herzegovina, Albania and Turkey it was about 2-2,5 times lower. Over the last three

decades in all Balkan countries (except Turkey) there was a significant increase in the proportion of

older people with the highest rate of change in Bulgaria (67% as compared to 1970), followed by

Greece and Romania.

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Table 1. Proportion of people 65 years or over in Balkan countries, EU and CCEE

over the period 1970-1999

Countries First available

1970 Rank

Last available

1997-1999 Rank

% of

increase

Greece 11,06 1 16,73 1 51,3

Bulgaria 9,59 4 16,02 2 67,05

Slovenia 10,04(1985) 3 13,79 3 37,4

Romania 8,59 5 13,04 4 51,8

Croatia 10,2 2 12,36 5 21,2

Moldova 7,67(1981) 7 9,34 6 21,8

FYR Macedonia 7,97(1991) 6 9,24 7 15,9

Bosnia-Herzegovina 5,76(1985)

8 6,29(1991)

8 9,2

Albania 4,44 9 6,15 9 38,5

Turkey 4,39 10 4,21(1986) 10 - 4,1

EU 12,2 15,9 30,3

CCEE 10,61 12,44 17,2

It is worth underlying that in 1999 the proportion of people aged 65 years or over in Bulgaria

even exceeded the average value for the 15 developed countries of the European Union that have

quite higher life expectancy. Bulgaria has greater proportion of older people than France, Norway,

United Kingdom, Austria, Switzerland, etc.

It is well understood that population ageing is due to two factors: increased life expectancy and

decreasing fertility rate. But in Bulgaria over the last 2-3 decades we do not observe an increased

life expectancy. Just the opposite – the life expectancy in men has decreased very significantly and

is about 7-8 years lower than in the developed countries and it has remained almost the same in

women. Thus, the leading factor of ageing for Bulgarian population is the unfavorable trend of

fertility rates over the last decades. As a result of this trend the proportion of people aged 0-14 years

in Bulgaria is one of the lowest as compared to other Balkan and European countries (Table 2). In

1999 only Greece, Italy and Spain had lower proportion of young people than Bulgaria.

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Table 2. Proportion of people 0-14 years in Balkan countries, EU and CCEE

over the period 1970-1999

Countries First available

1970 Rank

Last available

1997-1999 Rank

% of

increase

Turkey 41,14 2 37,14(1986) 1 -9,7

Albania 42,38 1 32,55 2 -23,2

Bosnia-Herzegovina 25,7(1985) 6 24,26(1991) 3 -5,6

Moldova 26,59(1981) 3 24,23 4 -8,9

FYR Macedonia 25,94(1991) 4 23,8 5 -8,2

Croatia 22,6 9 19,77 6 -12,5

Romania 25,93 5 18,77 7 -27,6

Slovenia 21,94(1985) 10 16,29 8 -25,7

Bulgaria 22,83 8 16,09 9 -29,5

Greece 24,64 7 15,59 10 -36,7

EU 24,51 17,08 -30,3

CCEE 24,63 19,45 -21,1

When analyzing the process of ageing it is very useful to look at the ratios of people aged 65

years or over and 0-14 years to people in working age. These ratios bring important information on

the burden for the working population to support dependent populations (children and retired

persons).

It is evident from the data in Table 3 that by the ratio of people 65+/15-64 years (old

dependency ratio) Bulgaria takes the second rank among all Balkan countries and is commensurate

with EU (23,6% in Bulgaria and 23,72% in EU). The rate of increase of old dependency ratio in

Bulgaria is among the highest – 66,3% (from 14,19% in 1970 to 23,6% in 1999), while in the most

Balkan countries it is below 50%, and in Croatia, Moldova, Albania – only about 20%.

When the increase of old dependency ratio is combined with a high rate of unemployment as

in Bulgaria and in other Balkan countries, the burden for the society and its working population

becomes even greater and the situation is more critical.

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Table 3. Old dependency ratio (65 +/15-64) in Balkan countries, EU and CCEE

over the period 1970-1999

Countries First available

1970 Rank

Last available

1997-1999 Rank

% of

increase

Greece 16,68 1 24,72 1 48,2

Bulgaria 14,19 4 23,6 2 66,3

Slovenia 14,76(1985) 3 19,72 3 33,6

Romania 13,12 5 19,12 4 45,7

Croatia 15,18 2 18,27 5 20,4

Moldova 11,67(1981) 7 14,06 6 20,5

FYR Macedonia 11,68(1991) 6 13,8 7 18,2

Albania 8,35 8 10,03 8 20,1

Bosnia-Herzegovina 8,34(1985) 9 9,06(1991) 9 8,6

Turkey 8,06 10 7,18(1986) 10 -10,9

ЕU 19,28 23,72

CCEE 16,38 18,26

Youth dependency ratio (Table 4) is extremely low in Greece, Slovenia and Bulgaria (about

23-24 children for 100 persons in working age) and it is below the average value for EU and CCEE

(25,48% and 28,56% respectively). It has decreased significantly over the last three decades and

will have very serious impact on the labor force in the years to come. At the same time, in Turkey

and Albania the youth dependency ratio is 2,5-3-fold higher.

Table 4. Youth dependency ratio (0-14/15-64) in Balkan countries, EU and CCEE

over the period 1970-1999

Countries First available

1970 Rank

Last available

1997-1999 Rank

% of

increase

Turkey 75,5 2 63,3(1986) 1 -16,2

Albania 79,69 1 53,1 2 -33,4

Moldova 40,45(1981) 3 36,47 3 -9,8

FYR Macedonia 38,02(1991) 5 35,5 4 -6,6

Bosnia-Hercegovina 37,5(1985) 6 34,9(1991) 5 -6,9

Croatia 33,6 8 29,12 6 -13,3

Romania 39,6 4 27,53 7 -30,5

Bulgaria 33,78 9 23,7 8 -29,8

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Slovenia 32,26(1985) 10 23,3 9 -27,8

Greece 37,16 7 23,03 10 -38,1

ЕU 38,73 25,48

CCEЕ 38,03 28,56

The future development of each nation is best characterized by the ratio of older population

to the coming generations (65+/0-14). The critical point is when this ratio will reach and surpass

100%, e.g. when there will be more than 100 people aged 65 years or over for every 100 children.

This means that fewer and fewer people will enter the working age. Such situation may occur when

there is relatively high life expectancy and continuously low fertility rate.

Table 5. Ratio of people 65 + to 0-14 years in Balkan countries, EU and CCEE

over the period 1970-1999

Countries First available

1970 Rank

Last available

1997-1999 Rank

% of

increase

Greece 44,89 3 107,3 1 139,0

Bulgaria 42,01 4 99,56 2 137,0

Slovenia 45,76(1985) 1 84,65 3 85,0

Romania 33,13 5 69,47 4 109,7

Croatia 45,13 2 62,52 5 45,2

FYR Macedonia 30,72(1991) 6 38,82 6 26,4

Moldova 28,85(1981) 7 38,55 7 33,6

Bosnia-Hercegovina 22,41(1985) 8 25,93(1991) 8 15,7

Albania 10,48 19 18,89 9 80,2

Turkey 10,67 9 11,34(1986) 10 6,3

ЕU 49,78 93,09 87,0

CCEЕ 43,08 63,96 48,5

The data in Table 5 show that in 1970 several Balkan countries (Croatia, Bulgaria, Greece)

had similar values of the ratio 65+/0-14 (42-45%) but in 1999 it has reached almost 100% in

Bulgaria and over 100% in Greece. In both countries the ratio is higher than in EU and far different

from that in CCEE (93,09% and 63,96% respectively).

The comparison of the ratio 65+/0-14 years in Bulgaria with some selected European

countries (Table 6) points out that from 42% in 1970 (rank 7) it has increased to almost 100% in

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1999 and Bulgaria takes the third position preceded only by Italy and Spain with 117,98% and

105,17% respectively.

Table 6. Ratio of people 65+ to 0-14 years in Bulgaria and selected European countries

over the period 1970-1999

COUNTRIES

First available

1970 Rank

Last available

1997-1999 Rank

Italy 43,68 6 117,98 1

Spain 34,74 10 105,17 2

Bulgaria 42,01 7 99,56 3

Sweden 65,6 1 92,82 4

Austria 57,92 2 91,92 5

Portugal 33,97 11 89,43 6

Belgium 56,56 3 88,43 7

France 55,78 5 84,86 8

Switzerland 56,44 4 84,86 9

Finland 37,16 9 78,99 10

The Netherlands 37,2 8 72,9 11

To explain this tendency we should take into account that the population ageing in

developed European countries is mainly due to increased life expectancy. For example, in most

Western European countries over the last three decades life expectancy has increased by 5-6 years,

while at the same time in Bulgaria it has only increased by half a year for the total population, and

for male population it has decreased by almost 2 years. In most European countries fertility rates are

quite low but they haven’t undergone such dramatic decrease as in Bulgaria where birth rate and

total fertility rate have decreased about 2-fold which has never been observed in other Balkan or

European country.

CONCLUSION

Balkans give shelter to five basic ethnic groups: Albanians, Bulgarians, Greeks, South Slavs

(Croatians, Montenegrins, Serbs and Slovenians) and Turks. Balkan countries face the same

challenges of population ageing as the rest of the world.

In most Balkan countries the trends in population ageing are similar to those in developed

countries even though their socio-economic development (except Greece) is far below.

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Bulgaria is among the countries that face the most serious challenges related to the process

of population ageing and this problem should be among the priorities of public policy.

In some Balkan countries (Albania and Turkey) the trends in population ageing are similar

to those in developing countries – they still have younger age structure, lower rate of increase of the

proportion of people aged 65 years or over, lower life expectancy and significantly higher fertility

rates.

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