Category: Population

Related directly to population issues.

Categories
Contraception Family Planning Population Reproductive Health

Reject these Old Memes—2-2014

Recently a friend introduced me to the word “meme”. Now I run across this concept frequently.
The word “meme” is analogous to “gene”, but it is information in our culture rather than in our DNA. A meme is a building block upon which our way of life is built. One definition is: “an idea, belief or belief system, or pattern of behavior that spreads throughout a culture”.
An old example is the Pythagorean theorem—the square of the hypotenuse of a right triangle is equal to the sum of the squares of the other two sides. This meme is ancient.
One accidental meme is changing lives in Brazil. The average family size has dropped rapidly. In 1954, when I visited as a child, women had an average of over 6 children. Now the average is 1.8—less than replacement. This big change is largely because of TV telenovelas, where middle class families are all small.
Some memes are harmful. An example is a tradition in Nigeria that leads to the death of many children. For eons Traditional Birth Attendants used mud or other unclean substances to dress newborn babies’ umbilical cord stumps. If tetanus spores are present, the baby can die a horrible death from tetanus. This improved when TBAs were taught the advantages of cleanliness and sterile instruments. Now pregnant women getting prenatal care are immunized against tetanus and there are many fewer deaths.
Galileo, who was born 450 years ago this month, suffered because of a religious meme. This meme slowed the development of knowledge for centuries.
Ancient Egyptians thought that the sun rotated around them—the geocentric model of the solar system. A Greek may have first proposed that Earth revolved around the sun 2500 years ago—the heliocentric model. For centuries people believed that the earth was the center of the universe, supported by theology that interpreted the Bible thusly. One verse that supports this meme is found in Psalms 104:5: “(God) built the earth on its foundations, so it can never be moved”. There are still people who hold that the sun goes around the earth—including 26% of US citizens, according to a recent National Science Foundation survey!
In the early 17th century Galileo defended the heliocentric theory, for which he was accused of heresy and placed under house arrest for the rest of his life. The Inquisition’s ban on reprinting his works was only lifted a century later. It was not until the 19th century that the Roman Catholic Church removed books advocating heliocentrism from its Index of Prohibited Books. Pius XII was the first Pope to acknowledge the many important contributions of Galileo—in 1939. Yet there are people who believe that heliocentrism is a conspiracy (http://www.johnthebaptist.us/jbw_english/default.htm). It is amazing how long this meme has persisted!
Years ago I sold “green umbrellas” at a public health meeting. From a campaign in Bangladesh (where it rains a lot), these umbrellas carry slogans such as “stay well” and “take health services” in Bengali. A doctor from Bangladesh bought one, then a few minutes later returned and wanted his money back. I asked him what was wrong. He replied that one of the sayings is “small families”, and we should have as many children as Allah gives us. This is another case of a religious meme that has outlived its usefulness, since Bangladesh is very crowded.
I find it amazing that some religions have not yet recognized the benefits of contraception to individuals, to families and to the world. The official doctrine of the Roman Catholic Church is that only periodic abstinence (the “rhythm” method) is acceptable. This policy is ignored by many of the 1.2 billion Roman Catholics worldwide—and many women I have talked with have left the Church because of this policy.
In many Catholic countries, such as Brazil and in Western Europe, couples use modern contraception resulting in average family size less than two. There are places, including some of the poorest countries in the world where this prohibition against effective contraception is followed. They will continue to be stuck in poverty so long as people are prohibited from using modern family planning. Rwanda is an example; its rapid population growth was one factor leading to its genocide 20 years ago.
Memes can outlive their usefulness to society. It is time for women to have the same status and rights as men, and for all people to have the access to the means to manage their fertility.

© Richard Grossman MD, 2014

Categories
Population Public Health

Age Gracefully—1-2014

Last July, when I turned 70, I wrote about my own aging. What happens as a large group of people age?

Let’s look at the start of the process of demographic change, when birthrates fall. This causes a decrease in the number of young people so there are fewer dependents. With more people in the working age range and not many old people yet, the group can prosper; this is the “demographic dividend”. Many regions have experienced this, notably in Africa and Asia. A European example will serve us better, however, since the information is more complete.

The Republic of Ireland is strongly Roman Catholic. In 1935 the government made contraception illegal, except for fertility awareness methods.  Their Total Fertility Rate (TFR—the average number of children a woman will bear during her lifetime) climbed to 4.  Despite its strong religious heritage, the country legalized contraception in 1979. Then TFR gradually dropped to about 2—below replacement and in the current range of other European countries. During the 1990s Ireland enjoyed a period of economic growth.

What is going to happen to countries as their populations age? Will it be as much of an detriment to economies as the demographic dividend was a benefit?

Never before have whole countries had their populations shrink voluntarily so markedly as is happening now. Perhaps the closest western civilization encountered was in Europe during the mid-14th century—the Black Death. This pandemic is estimated to have killed half of all Europeans. Indeed, the popular press has drawn the analogy of population shrinkage to a plague.

Half of the world’s countries have a TFR less than replacement—less than 2.1—which means they will decrease in population. This shrinkage has been slow at first, but birthrates seem to continue dropping. What some people fear is the change in the age structure. There will be an advantage because there will be fewer dependent young people. At the same time, people are living significantly longer than previously, so the number of older people will increase, increasing the number of dependents for each working person.

How can countries deal with this change in demographics? Will this transformation in age structure spell economic disaster? Some writers think so.

Perhaps the best glimpse into the future is the example of Japan, where one quarter of its population is 65 years old or older. It has the very low TFR of 1.4, little immigration and its population is shrinking at about 0.2 % annually. Furthermore, because of good diet and fine medical care, the life expectancy for a child born now is 83 years—about the best in the world.

How has the graying of its population affected the Japanese people? One trivia is the sale of diapers. They are unique in the world because sales of baby diapers will soon be by equaled by sales of adult diapers.

Birth control pills were not available in Japan until 1999. For many years people relied on just condoms and abortion to plan their families. Nevertheless, the TFR dropped below 2.0 in 1975. The sociological changes that have catalyzed this low reproductive rate include the changing role of women. Instead of staying home, now many women are well educated, work outside the home and postpone marriage until they are older.

Japan has avoided economic disaster despite the aging of its people, although they did suffer from the 2008 recession. The average retirement age is close to 70—since people are healthier, they can work longer. Because of the smaller number of children, there are still plenty of workers to support each dependent person.

Many European countries also have aging populations, but they use a different method to deal with the decreasing number of native young, low-skilled workers. They have “guest worker” programs, which allow people to immigrate from poorer countries to do work that the locals don’t want to perform.

Demographics are changing in many countries. In cultures that are aging, some occupations and businesses will have decreased demand, including obstetricians, childcare and teachers. Other occupations and businesses will increase—geriatricians, retirement communities and physical therapists.

The “population explosion” is not over. We are still growing by almost 80 million people yearly—mainly in poor, southern countries. Many people have enjoyed the demographic dividend, but the time has come to adjust to a new reality. Since growth cannot go on forever, it is absolutely necessary to reach a stable population, which means a period of population aging.

© Richard Grossman MD, 2014