Last December I visited China as part of the administration's new Strategic Economic Dialog. While there, I had a chance to meet with a little girl who had survived avian influenza. She lived in a little village in Szechuan Province. I visited the village and met her parents and grandparents.

I learned there that many villages in China are mostly just grandparents and children. The children's parents are often away working in a nearby city. They depend on their own parents to look after their children. It is not a bad arrangement - having grandparents look after the kids. Many American families do the same. My wife Jackie and I just became grandparents last year, so I can attest to what a joy it is to be one.

The problem for China and for many other countries, including the United States, is how to care for the grandparents when they can no longer care for themselves. It is a growing problem because, thanks to modern medicine, grandparents are living longer and longer these days. As a result, societies on average are getting older.

By 2030, nearly 20 percent of Americans will be 65 or older. Older societies mean fewer family members to care for elderly parents. They also mean fewer workers to pay for the pensions and health care than many elderly have come to expect. Older societies also mean a shift in the kinds of care that societies will need to provide -- less child care and more elder care, more concern for the diseases and disabilities that come with age. Unfortunately, the focus of many health officials is still only on the young.

That is slowly changing. We all need to recognize the changing needs of the world's older population.

In 2002, my Assistant Secretary for Aging, Josefina Carbonell, attended the Second World Assembly on Aging in Madrid. The Madrid assembly produced an International Plan of Action on Aging. Josefina's office has been reviewing our progress on the issue. In November I will be sending her back to Spain for another meeting.

The action plan for the United States stresses a "bottom up" approach, starting with the elderly themselves. Our aim is to give people more choices and greater control over their own health. The "bottom up" approach to aging is consistent with the New Freedom Initiative the President ordered soon after taking office. The initiative was designed to provide more choices to people of all ages with disabilities. That means dismantling the bias toward institutional care, encouraging competition, and seeking local solutions, not simply federal mandates. In the United States today, families provide long-term care for 80 percent of the nation's elderly. One in five American households provides some form of long-term care. They are not doing this because they have no other alternative. They are doing it because the elderly would rather live in their own homes and communities and be cared for by their own loved ones.

My department estimates that the dollar value of family care is around $306 billion a year. But that doesn't tell the whole story. You can't really put a value on keeping several generations within the same family together.