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It’s Your Problem—and My Solution

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Burden Lundgren
May 4th, 2021

During my never-ending quest to file all the papers in my home, I found, “The Demographic Future,” a 2010 article by Nicholas Eberstadt in Foreign Affairs. On rereading it, I appreciated why I had saved it. Eberstadt provides a thoroughgoing exploration of the relationship between demographics and the world economy.

Despite the population growth of the 20th century from 1.6 to 6.1 billion people, a trend toward dropping fertility had already established itself just after World War II. The population bulge was due mainly to increasing numbers of people living well into old age. Eberstadt sees that as a problem. In public health, we call that success.

Half the world’s countries now have below-replacement fertility rates. This is already leading to a decrease in workforces in almost every area except for sub-Saharan Africa. The drop-off in numbers presents serious economic challenges.  

Among the most challenged countries is China. But China is only a somewhat exaggerated version of India, Russia, Japan and Western Europe. The United States is affected too, but has a “secret weapon” to escape the worst consequences of low fertility: immigration.

So, according to Eberstadt, the world faces an eventual depopulation problem which will bring inadequate workforces and high dependency ratios. But what else will it bring? For women, it brings an almost unimaginable degree of freedom from pregnancies and child-rearing. It opens at least the possibility of education. It also means that more women will be in the workforce, a possibility not considered by Eberstadt. And fewer births mean fewer mothers dying from pregnancy—now an estimated 330,000 every year. In public health, we call that success.

Fewer births also align with lower rates of childhood deaths. In sub-Saharan Africa, 1 in 13 children dies before his/her 5th birthday compared to 1 in 189 in high income countries—those with plummeting fertility. Fewer births also mean more resources ranging from adequate nutrition to better education can be invested in each child, producing a healthier and more productive workforce. In public health, we call that success.

But the biggest beneficiary of depopulation is the planet we call home. The resources of this planet are not inexhaustible. Just to point to one problem, life is not sustainable or even possible without water—and we are running out. Only 3% of the water on Earth’s surface is freshwater, and less than 0.5% of that is available for drinking. Cape Town recently came a whisker short of running out of water altogether. Beijing, Tokyo and London are headed that way.

Climate change is accelerating the problem, bringing widescale droughts. Two thirds of the world’s population will find it difficult to find fresh water just four years from now. And the global population is expected to grow to 11 billion by century’s end before it drops. A bulging population trying to access vanishing and ever more costly resources, be they water, food, shelter or other life necessities, is likely to bring wars and massive population displacements, both of which are public health disasters.

As to reduced production, we could ask production of what? So much of what is produced ends up in our basements and garages and landfills that we now have an entire industry to tell us how to declutter and another one to figure out what to do with all the stuff polluting both our lands and waters. And recycling uses its own energy and causes its own pollution. The planet does not offer free lunches.

As to energy, clearly using more fossil fuels will increase pollution and accelerate damage to the Earth. Both effects threaten population health. Other forms of energy production are not harmless when it comes to planetary effects, but a smaller population could be expected to use less energy no matter what its source.

The pandemic has served as a classic example of the perilous consequences of population pressure. As humans break into more and more wild areas, contact with animals increases and the viruses they host jump to us. This happens too when more and more people consume more and more meat. And it can happen with both wild and farmed animals. A sparser population may allow us to maintain our distance and stay healthy.

Eberstadt’s vision of success is a growing economy producing more and more goods. The public health vision of success is a long-lived, healthy global population. A large part of that is taking care of the planet that takes care of us. A smaller, stable economy seems much more likely to meet public health goals. So, while traditional economists are wringing their hands at the prospect of declining growth rates, we in public health are clapping ours.

But some economists are coming around to a point of view more consistent with public health goals. Promoters of so-called “doughnut economics” envision a future where social goals (including population health) can be met within the Earth’s carrying capacity. So, we have the “doughnut” people, public health practitioners and environmentalists largely agreeing on where we need to go—but it could be a very rocky century until we get there.

Author: Burden S Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care. After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA. She has served as a consultant to a number of non-profit groups. Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected].

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