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Background From 2020 to 2050, China’s population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer’s disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country. Methods Using official and population-level statistics, we summarise China’s demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China’s improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: ‘what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?’. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China’s second long-term care insurance pilot phase in 2020. Results Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home. Conclusions China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.

Purpose Before the turn of the century, taking overseas students was more about a diplomatic issue dominated by the state in China, for which reason this section is relatively independent within the higher education system. However, evidence from a series of new policy documents and their impacts suggests that international student mobility (ISM) has been intensively shaped by the central government in the desire to promote its national strategy, namely the belt and road initiative. ISM policy, although with a significant proportion marketized, was introduced for a clear purpose of cultural diplomacy. The paper aims to discuss these issues. Design/methodology/approach Looking beyond the debate of market-driven vs state-dominated, this paper attempts to provide a thorough understanding of this changing pattern based on examination of key changes of policy statements along with official data analysis. Findings This paper argues that the new pattern must be understood against a context of a hierarchy of higher education institutes in contemporary China: a sector led by a small number of prestigious universities generously funded by the central government with a large number of ordinary universities underfunded and eager to generate income. Prestigious institutes enroll international students to satisfy performance indicators listed by policies like “Double First-rate”; other universities, benefiting from the reputation and momentum generated by the top ones, take self-funded students for profit. Originality/value By making good use of both performance indicators and market motives, the country managed to move a state-dominated ISM policy in the twentieth century into the existing state-steering marketization model and made China a major destination for overseas study.