The Devil’s in the Demographics

This is a story of great success. It should also perhaps come with a warning; it contains a lot of number – something that may turn a few people off. Yet the aim here is not to confuse, more to paint a vivid picture of the world we live in – or perhaps more specifically – who lives in that world.

A growing world 

The global population is growing at an exceptional rate. The United Nations population division estimates that in 1950 the world population stood at 2.53 billion people – today it currently stands at around 7.16 billion - and is expected to reach 9.55 billion in the year 2050.  Far from simply stopping at 2050 the world will continue to grow onwards and upwards, just at a slightly slower pace. 

These figures alone do not tell the full story though. It is important to delve into the global figures and look at what is happening in different regions around the globe. Estimates suggest that nearly all population growth over the next decades will occur in developing countries. In fact the European population is expected to decrease by 31 million by 2050 – something that some European countries are concerned about. In contrast, Sub-Saharan Africa grew from 179 million in 1950, to 831 million in 2010, and will reach 2.1 billion by 2050.  That means that currently the population of Sub-Saharan Africa grows by more then 31 million people every year.

While these projections could be subject to large changes from even small shifts in the number of births and deaths - such as an unexpected epidemic or faster than predicted falls in fertility - on the whole they paint a pretty vivid picture.

Growing older by the day

 As staggering as the increasing world population is, this tells but part of the story. The world is also getting older – much older. The percentage of populations over the age of 60 is currently increasing at 1% annually in the most developed countries and by 2.9% in the less developed regions. Put in another way, every 24 years the population over 60 years of age in less developed regions is doubling, and by 2050 79% of people over the age of 60 years will live in less developed countries.

Indeed the rate of growth at much older ages is also staggering, with increases in the number of people over the age of 80 and 90 also on the rise. It has been suggested that if increases in life expectancy seen over the past two centuries continued at the same pace, many children born after the millennium – in certain countries including the UK, Germany, USA and Japan –will reach their 100th birthday.

Living in an urban world

So now we know that the number of people living in the world is set to increase. We also know that many of these people will live to much older ages. So the question now is where are all these people going to live?

It was around 2010 that for the first time that more than half of the world population lived in urban setting. Globalisation, economic growth and technology perhaps all driving people to seek an urban residence. In 2050, 6.28 billion of the 9.55 billion people globally will live in an urban setting. It does not take much to imagine the increasing pressure this will add to city infrastructure and services.

What does it all mean to you?

To some all of the above numbers may seem striking. To other they may simply be large numbers that bear no real meaning on our everyday lives. When thinking of the increasing world population many people – quite rightly – will think predominantly of the potential for food and water shortages, the struggle for power generation and the impact of climate change. All of these are certainly major challenges that must be addressed in the coming years.

‘Demography is not destiny’

Undoubtedly an increasing world population, who live longer and reside in urban areas, will present certain challenges.  These are challenges we must stand up and tackle head on. If we do not, the consequences for human development will be severe. However, at the same time we should have optimism for the future, with the view that it is not impossible to triumph over these challenges.

Looking through a health lens, in less developed countries communicable disease, under nutrition and maternal health still represent a major issue, while the incidences of non-communicable and chronic disease are increasing at a frightening pace. Perhaps one of the major synergies these very different diseases share is their propensity to affect the poorest and most vulnerable, perpetuating and entrenching a vicious cycle.

In my opinion an essential component to addressing these challenges is to expand the process horizontal thinking. Vertical programmes focusing on specific diseases have succeeded to a certain extend, but we must look to more horizontal integrated approaches to address both current and future challenges in a sustainable manner. Already strained health systems will be an essential element to preventing and treating all diseases in the expanding, aging population.  It is also important to ensure that these health systems reach all of the population, vast health inequities already exists. Therefore it is essential that we embrace new and innovative ways to close these inequity gaps, such as using mobile health (Mhealth) technology.

We must also look beyond the traditional ideas of a ‘western lifestyle’ and realise that in emerging economies people living in urban areas are not simply exposed to the same factors as their ‘western’ counter parts, but that far more nuanced understandings of such life style factor are needed. Through such understanding we can ensure that the current evidence we have for preventing and treating all types of disease and disability are integrated sufficiently into national policies.

This is not an easy task. It will take a long and sustained commitment that spans political, donor and health sector boundaries. It is inevitable that we must make some difficult decisions in the coming years. We must all hold our hands up and be accountable for those decisions, both now and in the coming decades.

Demography is not destiny!

Thanks for reading

Henry.