Population and Health Geography.pdf

This chapter focuses on the fundamentals of human population distribution and change through time, at both global and regional scales. We begin by outlining the past, present, and possible future of global population distribution, and then explore the nature of population change. The two factors on which all changes in population size depend are fertility and mortality. In this chapter, we introduce the various measures used to track fertility and mortality rates, some of the factors that influence those rates, and the temporal and spatial variations that occur in both cases. We look at recent evidence indicating that fertility is declining not only in the more developed parts of the world, but in the less developed parts as well. We also review how governments actively seek to influence fertility through policy. In this chapter, we also look at the history of population growth and several explanations that have been proposed both to explain the history of population growth and to predict possible scenarios for the future. In addition, we discuss the redistribution of global population through an examination of migration. This chapter concludes with an exploration of the geographical dimensions of health, including aging, health inequalities, and differential access to health care services. Where do we live today, why do we live there, and why does this matter? Is it appropriate for national governments to implement policies designed to either decrease or increase fertility, or should people be left to determine for themselves how many children they have? In the early nineteenth century, Malthus argued that our human future would be characterized by famine, vice, and misery. Was he correct? Why or why not? The “Yick Cheong Building” in the Quarry Bay area of Hong Kong, China. Hong Kong is one of the most densely populated cities on Earth. Photo credit: Vincent Isore/IP3/Getty Images n 2017, the total world population was estimated to be 7.6 billion. By the time you read these words, that figure will be even higher. The UN estimates the world population will reach 8.6 billion by 2030, 9.6 billion by 2050, and possibly a stable population of just over 10 billion by 2100. Of key interest within these statistics is the fact that much of the population increase is occurring in less developed parts of the world that are arguably the least capable of supporting them. In contrast, population in the more developed world is expected to remain essentially unchanged through to at least 2050. One recurring theme in this chapter is the uncertainty associated with what this increasing population means for human well-being. Human geographers, among others, have suggested links between population growth and such problems as migration, famine, disease, and environmental deterioration. Others, however, are more optimistic about our ability to cope with increasing population, arguing that past increases have been offset by improvements in human well-being through technological advances. less developed world A large group of countries (effectively the whole world excluding those that are more developed) characterized by low standards of living and social well-being; often used interchangeably with the developing world; historically, referred to as the Third World. more developed world A group of countries, including Canada, the United States, most of Europe, Australia, New Zealand, and Japan, that are characterized by a high standard of living and social well-being; often used interchangeably with the developed world; historically, referred to as the First World. Much of this chapter draws on measures and procedures developed in demography, the science that studies the size and makeup of populations (according to such variables as age and sex), the processes that influence the composition of populations (notably fertility and mortality), and the links between populations and the larger human environments of which they are a part. Population geographers and health geographers are concerned with the spatial dimensions of population and health respectively, and thus work closely with demographers. demography The study of human populations. As outlined in Chapter 1, distribution has three key dimensions: concentration and dispersion, density, and pattern. When examining the spatial distribution of population, we typically look at how populations are concentrated (are they clustered or dispersed?) as well as population density (why do more people live in some places rather than others?). Pattern is less of a focus because, while populations are certainly not distributed randomly across the earth’s surface, it is often hard to infer any specific order in the spatial distribution. Population distribution refers to where people are located and in what numbers, and it is one of the key concerns of human geography. Key to knowing how many people live in particular locations is data collected through a census. Unfortunately, counting people is not as simple as it sounds. There is a great deal of diversity in the collection of this data, and some countries do not collect this data as regularly or reliably as others. census The periodic enumeration of all individuals and collection of demographic and other data in a given country at a particular point in time (commonly every 5 or 10 years). BOX 2.1 | Levels of Development When we talk about development, we are generally referring to notions and measures of economic size and growth, social well-being, and modernization. Typically, it is understood to refer to a process of becoming larger, more mature, and better organized, and is most commonly measured using economic criteria. It is possible to define, for any given area at any given time, the level of development. Following this logic, certain areas are qualified as more developed and others as less developed. This distinction is discussed further in Chapters 3 (Uneven Development and Global Inequalities) and 11 (Geographies of Globalization). Distinguishing between the more developed and less developed parts of the world can have analytical value. It allows us to highlight spatial disparities in economic and social well-being. Importantly, however, we need to use caution in applying these relative terms because they require cultural and social considerations. For example, if we use income levels as a measure of development, we need to recognize that income levels may reflect economic success, as well as opportunity, exploitation, and cultural values, which are discussed further in Chapters 4 and 5. The general framework used to identify the levels of development originated from the United Nations. Under this framework, the more developed world includes Canada, the United States, most of Europe, Australia, New Zealand, and Japan. These countries are characterized by a high standard of living, as measured by income, and also high levels of social well-being as measured by health outcomes and educational attainment, among other factors. The less developed world includes all other countries, and is characterized by lower standards of living and social well-being. This binary characterization has obvious limitations. Not all less developed countries are the same, nor are all the more developed countries. Due to these limitations, the UN sometimes subdivides the less developed world into two groups: less developed and least developed. There are other systems of classifying countries based on levels of development. The World Bank, for example, categorizes countries into high-income, middle-income (upper-middle and lower-middle), and low- income groupings. The influential Swedish author and researcher Hans Rosling (1948–2017) has long argued that we should move away from the “us” and “them” mentality that terms such as developed and developing create. Instead, Rosling (2018) argues we should use a more inclusive and meaningful system of levels based on daily average earnings per person (Figure 2.1). While not a perfect way of characterizing the world, it is a more reflective one because it relates more directly to the lived experience of individual people. Unfortunately, until more agencies such as the UN adopt more reflective data, most discussions about development will continue to characterize parts of the world as more and less developed. We use mostly these terms throughout this book. However, in some cases, where the data allows, we use more nuanced categories. FIGURE 2.1 | World income and lifespan, 2017 Using four levels of income, Rosling shows the relationship between income and life expectancy. Source: Based on Rosling, H. 2018. Factfulness. New York: Flatiron Books. The UN celebrates the world’s population reaching seven billion. In 1989 it designated 11 July as World Population Day, a day to focus on population issues. The world population is not evenly distributed (Figure 2.2); there are three main areas where the population is highly concentrated: East Asia (including China and Japan), South-Central Asia (including India, Pakistan, and Bangladesh), and, to a lesser extent, Europe. There are also many areas of the earth’s surface that are sparsely populated, including the northern areas of the North American and Eurasian continents, as well as northern Africa, Australia, and the Antarctic. To some extent, the population distribution is related to environmental circumstances, and the suitability of some parts of the world for human habitation and in particular food production. However, human (cultural) factors related to a history of settlement also influence where people live. People prefer living in certain places more than others, and these preferences are linked to both human and physical geographic factors. At the global scale, there are variables that influence where we live. Some of these are physical geographic characteristics related to agriculture. Growing food is easier in areas where temperatures permit a long growing season, fresh water is abundant, the topology is relatively flat, and the soil is rich with nutrients. The importance of food to human survival has led to high concentrations of people in parts of the earth that exhibit these characteristics and more dispersed populations in places where they are not present. FIGURE 2.2 | World population distribution, 2017 Source: Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC. In addition to physical geographic variables, global population distribution is also influenced by broad human and cultural experiences. For example, many of the areas of population concentration shown in Figure 2.2 correlate with centres of long-established civilizations, such as China (East Asia) and India (South-Central Asia). However, not all areas of concentrated population today were once centres of early civilization. Europe and northeastern North America, for example, have high concentrations of population that developed much more recently in the era of the Industrial Revolution due to the tremendous urbanization associated with it. The distribution of the world population reveals areas of both concentrated population and dispersed population (or largely devoid of human settlement). The three most prominent areas of population concentration are South-Central Asia, East Asia, and Europe, and each is discussed briefly below. South-Central Asia South-Central Asia is the most populous region in the world, home to nearly two billion people, who live on, or adjacent to, the Indian subcontinent. The most populated and largest country by area in the region is India, which contains more than a billion people. The adjacent countries of Bangladesh and Pakistan also have more than 100 million inhabitants each, placing them among the select group of the 10 most populous countries in the world. To some degree this concentration of human settlement is a result of a very long history of human occupation of the area. Some of the oldest known human settlements, outside of East Africa, are centred around the Indus River in modern-day Pakistan. The population of South-Central Asia is predominantly clustered along the coastline of the Indian Ocean and in the region’s major river valleys such as the Ganges and Indus. While South-Central Asia contains some of the world’s largest cities such as Delhi, Mumbai, Dhaka, and Karachi, the bulk of its population lives outside of urban areas, in rural areas on farms and small settlements. The Ganges delta, for example, where the Ganges River meets the Indian Ocean, is one of the most densely settled rural areas of the world, where many people live on small plots of land suitable for food production. Villagers return home after a day on the rice fields near Sundarbans, India, which is located in the Ganges River delta in South- Central Asia. East Asia More than 1.6 billion people live in East Asia, with the majority (1.4 billion) residing in China. China is currently the most populous country in the world, and the fourth-largest country by land area. Despite China’s large land area, much of China’s population lives in a relatively concentrated fashion in the eastern half of the country. Two other countries in East Asia, Japan and South Korea, have relatively large populations (a combined population of 175 million people), but, in contrast to China, are comparatively small in area. Eastern China includes some of the world’s biggest cities such as Shanghai, Beijing, and Guangzhou, which are located near the Pacific coast. However, as in South-Central Asia, much of the population in eastern China resides outside of urban centres on the agriculturally productive coastal plains. The population of China gradually shifts toward a more dispersed distribution in western China, including Tibet. When compared with population density in eastern China, the density of western China is remarkably sparse. The concentration of people in eastern China, along with the nearby clusters in Japan and South Korea, makes this region one of the most populous areas in the world. And as in South-Central Asia, a long period of human settlement in eastern China is a main reason for this concentrated population; humans have been living in the Yangtze River valley for over 4,000 years. Europe No other region in the world has a population concentration comparable to that seen in South-Central or East Asia; however, Europe’s population is notable with approximately 750 million people. The most populous country in the region is Russia, followed by Germany, the United Kingdom, France, and Italy. While South-Central and East Asia have some of the world’s largest cities, they are both comparatively rural places; 65 and 38 per cent of South-Central Asia and East Asia’s populations, respectively, live in rural areas. In contrast, more than 80 per cent of the European population live in urban areas, particularly in Northern and Western Europe. As the birthplace of the Industrial Revolution, and the resultant urbanization that followed, Europe’s urban character is not surprising. At the same time, however, careful inspection of the distribution of population in Europe reveals that physical geographic factors, including those that contribute to food production, are important influences on where people live in large numbers. TABLE 2.1 | World population distribution by major area (percentage): Current and projected Region 2017 2050 Asia 59.6 53.3 Africa 16.6 26.1 Europe 9.9 7.5 Latin America & the Caribbean (incl. 8.5 8.0 Mexico) North America (Canada and US only) 4.8 4.5 Oceania 0.6 0.6 Source: Calculated from Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC. TABLE 2.2 | The 10 most populous countries: Current and projected 2017 2050 Country Population Country Population (millions) (millions) China 1,387 India 1,676 India 1,353 China 1,343 United States 325 Nigeria 411 Indonesia 264 United States 397 Brazil 208 Indonesia 322 Pakistan 199 Pakistan 311 Nigeria 191 Brazil 231 Bangladesh 165 DR of Congo 216 Russia 147 Bangladesh 202 Mexico 129 Ethiopia 191 Source: Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC. In addition to the spatial distribution of population discussed above, we can consider distributions in other ways: from both regional and national perspectives. Table 2.1 highlights the dominance of Asia, which is home to nearly 60 per cent of the world’s population today. Africa is the only other region currently home to more than 10 per cent of the world’s population. While the figures in the 2017 column tell us something about the current pattern of population distribution, perhaps more interesting is how the relative proportions are expected to change over the next 30 years. Asia is expected to continue to be the most populous region in 2050 with more than 50 per cent of the global population, but Africa’s share is expected to rise from 16.6 to 26.1 per cent. Africa’s increasing relative share of the population between 2017 and 2050 represents an increase of about 1.3 billion people in only 33 years. As the global population is expected to increase by a total of 2.3 billion people over this same time period, more than half of that increase is projected to come from Africa; Europe, North America, and Latin America will account for only about 10 per cent of this increase. At a national level, Table 2.2 identifies the 10 countries with the largest total populations in 2017 and includes projections to the middle of this century. Although China and India are projected to remain the most populous countries, India is projected to overtake China as the world’s most populous country, perhaps as early as 2020. As we might expect given the regional population discussion above, African countries will become more prominent by 2050, with Nigeria moving up from seventh to third place and Democratic Republic of Congo and Ethiopia occupying eighth and tenth places, respectively, by mid- century. The two countries slipping off the list by 2050 are Russia and Mexico, both of which are expected to either lose population or perhaps grow more slowly between 2017 and 2050 than some of the other more populous countries of the world. As you recall from Chapter 1, one of the key considerations in thinking about a spatial distribution is density: a measure of the number of a geographic phenomenon within an area. Table 2.3 shows the number of people per square kilometre in each of the top 10 most populous countries. Of these countries, the three in South-Central Asia (India, Pakistan, and Bangladesh) are ranked as the most densely populated, with Bangladesh at the top. We should note that this list of countries comprises those with the largest populations, not necessarily those with the highest population densities. In general, the world’s most densely populated countries tend to be small island nations of quite modest populations, such as those in the Caribbean or the South Pacific. Although the world map of population density (Figure 2.3) is valuable, it presents a static picture of a dynamic situation and provides no indication of how the spatial pattern developed or how it might change in the future. It shows three areas of high-density settlement: East Asia, South-Central Asia, and Europe. Both of the Asian areas are long-established population centres, locations of early civilizations, and areas of early participation in the Agricultural Revolution. Both also include areas of comparatively high rural population density (especially in the coastal, lowland, and river valley locations) and many very large urban centres. Population density is also high in Europe, but certainly lower than in the two high- density areas of Asia. In all three areas, population densities are clearly related to the productivity of land for agriculture. Additional scattered areas of high-density settlement are found in northeastern North America, Latin America, the Nile Valley of northern Africa, and parts of West Africa. TABLE 2.3 | Population densities of the 10 most populous countries, 2017 Country Population Density per km2 (millions) Bangladesh 1,101 India 394 Pakistan 244 Nigeria 192 China 143 Indonesia 132 Mexico 61 United States 33 Brazil 24 Russia 8 Source: Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC. FIGURE 2.3 | World population density BOX 2.2 | World Population Density Conventionally, population density is measured as arithmetic density, the total number of people in a unit area. Maps of population distribution often portray density; Figure 2.3, showing population density for the world, is a good example. Many data sources use a single statistic to identify the population density of a country, but that practice can be misleading. Canada is a prime example, because its population is not evenly distributed. In some areas the density is very high and in others very low, and so a single density statistic for the entire country is rather meaningless. The 2017 arithmetic population density for Canada was 3.5 people per km2, but this single statistic is merely an average, produced by combining large areas that are virtually unpopulated and relatively small areas that are densely populated. In most cases, the local scale is the only one where density measures are appropriate; the smaller the area, the less likely it is to include significant spatial variations. More refined density measures relate population to some other measure, such as land suitable for agricultural activity. For example, physiological density is the relation between population and that portion of the land area deemed suitable for agriculture. By this measure, Canada’s population density is 80 people per km2 of arable land, still one of the least densely settled countries. By way of comparison, the rate for the United States is 211; for China, 1,312; and for the United Kingdom, 1,062. The countries ranked the most densely settled, by this measure, are either small island nations, such as those in the Caribbean or South Pacific, or those countries with very limited arable land due to physical environmental factors such as deserts: Egypt (3,498), Qatar (20,611), United Arab Emirates (25,067), and Kuwait (43,158). physiological density Population per unit of cultivable (arable) land. All global changes in population size can be understood by reference to two factors: fertility (births) and mortality (deaths). Fertility and mortality rates vary over time and differ from one location to the next. We can measure how population changes over time using the following expression: where Pi = population at the beginning of time period 1 Po = population at the beginning of time period o (before time period 1) B = number of births between time periods o and 1 D = number of deaths between time periods o and 1 At a subglobal (i.e. region or country) level, a third factor becomes relevant: migration. The movement of people into and out of that particular part of the world also affects its overall population. Thus, where Pi = population at the beginning of time period 1 Po = population at the beginning of time period o (before time period 1) B = number of births between time periods o and 1 D = number of deaths between time periods o and 1 I = number of migrants into the area (immigrants) between times o and 1 E = number of migrants out of the area (emigrants) between times o and 1 According to these simple dynamics, the population of any country or region of the world is determined by the relative numbers of births, deaths, and migrants into and out of its territory. As you might expect, these numbers vary spatially and temporally; birth and death rates, and rates of migration ebb and flow with changing political and economic circumstances. The simplest and most common measure of fertility is the crude birth rate (CBR), the total number of live births in a given period (usually one year) for every 1,000 people already living. Thus, fertility A population’s natural capability of having children; also used to refer to the actual number of live births produced by a woman. In 2017 the world CBR was 20; this means there were 20 births for every 1,000 people alive that year. Historically, measures of CBR have typically ranged from a minimum of about 8 (the theoretical minimum is 0) to a maximum of 55, which is a rough estimate of the biological maximum. Clearly, the CBR is a very useful statistic and is relatively easy to calculate, but it can be somewhat misleading because births are measured relative to the total population and not to the subset that is actually able to conceive. (It includes both the very young and the infertile.) To more accurately reflect underlying fertility patterns, demographers measure female fecundity—the ability of a woman to conceive and have children. fecundity A biological term for the potential capability of having children; refers to potential rather than actual number of live births. The total fertility rate (TFR) is the average number of children a woman will have, assuming she has children at the prevailing age-specific rates, as she passes through her child-bearing years. This age- specific measure of fertility is useful because the rates of having children vary considerably with age. It reflects that teenagers and those in their forties have fewer children than those in their twenties or thirties. The world TFR for 2017 was 2.5, meaning that the average woman has 2.5 children during her child-bearing (or fecund) years. Although there are various other measures of fertility, with different measures used in different circumstances and with different aims in mind, we will focus on the CBR and the TFR. The former is a factual measure reflecting what actually happened in a given time period—X number of children per 1,000 members of the population were born. The latter, on the other hand, predicts that a woman will have the same number of children as other women her age. The impact of a particular CBR or TFR on population totals is related to mortality. Generally, a TFR of between 2.1 and 2.5 is considered replacement-level fertility; that is, it maintains a stable population. Of course, if there were no early deaths, the replacement level would be 2.0—two parents replaced by their two children. But in reality, the replacement level has to allow for the fact that some women may die before giving birth or may die before they have completely moved through their child-bearing years. The lower figure in this replacement-level range (2.1) applies to areas with relatively low levels of mortality (few females dying before having children), such as in much of the more developed world, and the higher figure (2.5) applies to areas with relatively high levels of mortality (more females dying before having children). replacement-level fertility The level of fertility at which a population exactly replaces itself from one generation to the next; each couple has just enough children to replace themselves. The reproductive behaviour of a population is affected by biological, economic, and cultural factors. It is not difficult to identify many of these aspects; it is challenging, however, to assess their relative effects. But perhaps the most surprising fact to emerge as the discussion of population unfolds throughout this chapter is that human beings might be the only species whose members reproduce less when they are well fed. Biological Factors Age is the key biological factor in fecundity. For females, fecundity begins at about age 15, reaches a maximum in the late twenties, and terminates in the late forties. The pattern for males is less clear, with fecundity commencing at about age 15, peaking at about age 20, and then declining but without a clear termination age. Regardless of age, some females and males are sterile and some couples are infertile. Sterility means that it is impossible for a couple to conceive a child, which can result from any number of biological complications. Infertility, on the other hand, means that a couple can (biologically) conceive a child, but has been unable to. Reproductive behaviour is also affected by nutritional well-being; populations in ill health are very likely to have impaired fertility. Thus, periods of famine reduce population growth by lessening fertility (as well as increasing mortality). Another diet-related biological factor is that women with low levels of body fat tend to be less fecund than others. Nomadic pastoral societies, whose members are particularly likely to have low levels of body fat because they eat a low-starch diet, are characterized by low fertility. Economic Factors Until recently, fertility changes in more developed countries were essentially part of an economic development process. With increasing industrialization and urbanization, fertility declines. This economic argument suggests that traditional societies, in which the family is a total production and consumption unit, are strongly pro-natalist; that is, they favour large families. By contrast, modern societies emphasize small families and individual independence. In economic terms, children once were valued for their contributions to the household economy but today represent an expense. The economic argument is that the decision to have children is essentially a cost-benefit decision. In the traditional (often, extended- family) setting, children are valuable as they can contribute to the family economy and care for their parents in their old age. Both of these aspects have historically led to, and in some respects continue to lead to, the creation of large families. Neither of these factors is important in most more developed societies. This economic claim implies that any reductions in fertility are essentially caused by economic changes. The idea is central to the demographic transition theory—one of several explanations of population growth to be discussed later in this chapter. Couples walk during a mass wedding ceremony in Jakarta, Indonesia. In Indonesia, where the legal marrying age is 16 for females and 18 for males, the government has created many policies and initiatives that encourage marriage. This ceremony, which was held for thousands of couples, was sponsored by the Indonesian Armed Forces. Cultural Factors A host of complex and interrelated cultural factors also affect fertility; it is frequently suggested that the reasons behind current reductions in fertility are primarily cultural rather than economic. This suggestion is central to the fertility transition theory (Box 2.3). Most cultural groups recognize marriage as the most appropriate setting for family reproduction. In such cultural contexts, the age at which women marry is important because it may reduce the number of effective fecund years. A female marrying at age 25, for example, has “lost” 10 fecund years. Until recently, perhaps the most obvious instance of such loss was Ireland. In the 1940s, the average age at marriage for Irish women was 28 and for Irish men 33; moreover, high proportions of the population—as many as 32 per cent of women and 34 per cent of men—lost all their fecund years as a result of not marrying. Late marriage and non-marriage are usually explained by reference to social organization and economic aspirations. Interestingly, since about 1971 the Irish people have tended to marry earlier and more universally. Most countries in the world have adopted a standard age of 18 for legal marriage, although some allow for younger people to marry with parental permission. However, some countries actively encourage early marriage, by lowering the legal marriage age to 16. On the other hand, some of the recent success in reducing fertility in China can be explained by the government requirement that marriage be delayed until age 20 for females and 22 for males. Of course, changing cultural norms about marriage and reproduction in many countries complicate this issue. In Canada, for example, marriage is still more common than common-law unions, where couples live together without being married, but the rate of common-law unions has been steadily increasing over the last half century. Today, nearly one in five couples are in a common-law union. Further, nearly 30 per cent of babies in Canada are born to mothers who are not married, a figure which was less than 10 per cent a generation ago. This shift reflects a greater social acceptance toward having children outside marriage, and the increasing independence and empowerment of women in Canadian society. As discussed in Box 2.3, fertility is also greatly affected by contraceptive use. Attempts to reduce fertility within marriage have a long history. The civilizations of Egypt, Greece, and Rome all used contraceptive techniques. Today, contraceptives are used around the world but especially in more developed countries. Less developed countries typically have lower rates of contraceptive use, although most evidence shows that the rates are increasing (Table 2.4). The practice of contraception is closely related to government attitudes and to religion. Most of the worlds people live in countries where governments actively encourage limits to fertility, but at the same time many people practise religions that actively discourage contraceptive use. The complex issue of government policies designed to impact fertility is discussed later in this chapter. BOX 2.3 | Declining Fertility in the Less Developed World The less developed world Is experiencing a decline In fertility that began in the 1970s. The reasons behind this decline have little to do with economic factors and everything to do with cultural change. The magnitude of this decline is evident in countries such as Thailand, which had a 1975 TFR of 4.6 and a 2014 TFR of 1.8; similar reductions have occurred in many other countries in Asia, Latin America, and North Africa. The fact that several sub-Saharan African countries—including Kenya, Botswana, Zimbabwe, and Nigeria—also are experiencing reduced fertility is especially significant, as this area has long appeared to be resistant to any such trend. These fertility declines are in addition to the case of China, where (often compulsory) government policies have contributed to a below-replacement fertility level of 1.4 only about 30 years after the introduction of the regulations. The importance of fertility declines in the less developed world is difficult to overstate, both practically and in terms of our understanding of fertility change. The conventional wisdom in the 1970s was well expressed by Demeny (1974, 105): countries in the less developed world “will continue their rapid growth for the rest of the century. Control will eventually come through development or catastrophe.” It now appears that rapid population growth is slowing down but not for either of these two reasons. As a result, many earlier accounts of anticipated population growth are being revised. The most powerful influence on fertility in the less developed world has been improvement in the education and lives of women and the related extent to which modern contraceptive methods are employed. This logic is labelled the fertility transition model. Education leads to family planning; hence, fertility drops. In the less developed world (not including China), about 46 per cent of married females practise modern methods of family planning. Information about family planning is widespread because of the influence of public education campaigns in schools and media. According to the fertility transition model, large families have fallen out of favour because of the obvious problems associated with rapid and substantial population increases, such as pressure on agricultural land and poor quality of urban life. The evidence is clear: females—who are generally experiencing a rise in social status—favour later marriage, smaller families, and more time between births. Thus, the principal reason fertility is declining so rapidly in the less developed world is that women are better educated and more empowered. Also, effective contraception is available to meet the demand as soon as the necessary cultural impetus is in place; this was not the case when the more developed world was first culturally predisposed to smaller families, a time when abstinence, withdrawal, and abortion were the only birth control techniques available. The current fertility decline may be best described as a “reproductive revolution” because it is rapid and substantial. Economic development helps to create a climate conducive to reductions in fertility, but the key point of the fertility transition argument is that these reductions are caused by a new cultural attitude related to educational advances, a desire for smaller families, and the willingness to employ modern contraceptive methods, as well as the accessibility of these methods. TABLE 2.4 | Contraceptive use by region, 2017 % Married Women 15–49 Using Contraception All Methods Modern Methods1 World 62 55 More developed world 70 60 Less developed world 61 55 Less developed world (excl. China) 54 46 Least developed 37 32 1 Modern methods include the pill, IUD, condom, and sterilization. Source: Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC. A woman sits by her stall in the Jorkpan market in Monrovia, Liberia. The Liberian government has made family-planning services, such as contraceptives and counselling, available in the markets throughout the country, an initiative that is aimed at tackling the high adolescent pregnancy rate. Another important cultural factor affecting fertility is abortion, the deliberate termination of an unwanted pregnancy. In many countries, governments actively try either to promote abortion (as a measure to control population growth) or to discourage it for their own pragmatic reasons. China’s liberal abortion law reflects the need for population control; abortion is obligatory for women whose pregnancies violate government population policies. Sweden has a liberal abortion law on the grounds that abortion is a human right. In other countries, particularly those where the dominant faith is either Catholicism or Islam, access to abortion is either denied or limited to instances in which the woman’s life is threatened. Generally, in countries where abortion becomes legal two things happen: abortion rates decline, likely as a result of changing cultural attitudes about contraception, and maternal mortality rates decline as a greater share of pregnancies are terminated safely. Abortion is an even more complex moral question than contraception. Although it is a long-standing practice, it is subject to condemnation, usually on religious and moral grounds. In countries such as Canada, Australia, the United Kingdom, and (especially) the United States, abortion is one of the most hotly debated biological, ethical, social, and political issues. Notably, UN documents do not refer to abortion as a right because of the opposition of some member countries. Spatial variations in fertility correspond closely to levels of economic development. But this does not necessarily mean that economic factors are the key cause of variations in fertility. Modernization and economic development have been related to lower levels of fertility, mainly since the onset of the Industrial Revolution. At the broad regional level, the more developed world had a CBR of 11 and a TFR of 1.6 in 2017, while the less developed world had a CBR of 21 and a TFR of 2.6. More specifically, in the more developed world, Portugal was among the group of countries with very low fertility, with a CBR of 8 and a TFR of 1.4, while in the less developed world, Niger had a CBR of 48 and a TFR of 7.3. Figure 2.4 maps CBR by country. In general, variations of this type reflect economic conditions. As noted in Box 2.3, fertility rates in the less developed world are decreasing, and the reasons are more cultural than economic. Rather more surprisingly, there is evidence of declining fertility in several countries in the more developed world that may be prompted by cultural factors (Box 2.4). Of course, fertility also varies significantly within any given country. There is, for example, usually a clear distinction between urban areas (relatively low fertility) and rural areas (relatively high fertility). This distinction can be found in all countries, regardless of development levels. Similarly, fertility within a country is generally higher for those with low incomes and for those with more limited education. Like fertility, mortality may be measured in a variety of ways. The simplest, which is equivalent to the CBR, is the crude death rate (CDR), the total number of deaths in a given period (usually one year) for every 1,000 people living. Thus, mortality Deaths as a component of population change. The CDR for the world in 2017 was 8. Measures of CDR today typically range from a minimum of 5 to a maximum of 20, but a half-century ago several countries had CDRs of nearly 50. The CDR does not take into account the fact that the probability of dying is closely related to age. Usually, death rates are highest for the very young and the very old, producing a characteristic J-shaped curve (Figure 2.5). FIGURE 2.4 | World distribution of crude birth rates, 2017 Source: Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC. BOX 2.4 | Declining Fertility in the More Developed World The lowest fertility rates in the world are found primarily in Europe: for the region as a whole, the TFR is 1.6, but it is as low as 1.2 in Romania; 1.3 in Italy, Spain, and Greece; and 1.4 in Croatia, Slovakia, Poland, and Portugal. The extraordinarily low figures for much of the continent reflect both a culture to postpone starting families and a desire for smaller families. For many Europeans, their ideal family now includes only one child. In response, many European countries have placed fertility high on the political agenda. Sweden and Norway in particular—where the TFR is, respectively, 1.88 and 1.72—have a range of policies intended to encourage couples to have more children, notably generous maternity and paternity leave arrangements, heavily subsidized daycare, and flexible work schedules. France, where the TFR is just under the replacement level, has the most extensive state-funded child care system in Europe. Europe is not alone in having low fertility rates, as much of the rest of the more developed world does too. Canada and the United States, along with Australia, New Zealand, Japan, and South Korea all have below-replacement fertility rates. Some of these countries are also concerned by their low fertility: South Korea’s government, for example, actively promotes higher fertility by offering financial incentives to couples who have more than three children. A young mother enjoys a walk by the Oslo Opera House in Oslo, Norway. Norway is among a number of European nations with a TFR well below replacement- level fertility. TABLE 2.5 | Population data, Canada, 2017 Total population 36.7 million CBR (crude birth rate) 11 CDR (crude death rate) 8 RNI (rate of natural increase; %) 1.0 IMR (infant mortality rate) 4.3 TFR (total fertility rate) 1.6 Sources: Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC.; United Nations, Department of Economic and Social Affairs, Population Division. 2017. World population prospects 2017—Data booklet. UN, New York, NY. Although Canada’s fertility rates are not among the lowest in the world, both CBR and TFR statistics have been declining or stable in recent years. Most European countries have slightly lower birth and fertility rates than Canada, but the United States has slightly higher levels (CBR is 12 and TFR is 1.8). Table 2.5 summarizes the demographic situation in Canada. Other measures of mortality consider the age structure of the population; these are called age- adjusted mortality rates. The most useful of these for our purposes is the infant mortality rate (IMR), the number of deaths of infants under one year old per 1,000 live births in a given year. The world IMR for 2017 was 32, although figures for individual countries ranged from less than 5 for countries such as Finland, Japan, and Canada to nearly 100 for Sierra Leone and the Central African Republic. The IMR is sensitive to cultural and economic conditions, declining with improved medical and health services and better nutrition. Infant mortality, and child mortality more generally, are declining, largely because of vaccinations, mosquito nets, and increased rates of breastfeeding. FIGURE 2.5 | Death rates and age Although not a mortality measure per se, another useful statistic that reflects mortality is life expectancy (LE), which estimates the average number of years one is expected to live. World life expectancy in 2017 was 71. For individual countries, the LE ranged from the low eighties in Canada, Japan, South Korea, and many European countries and in the low fifties for the Central African Republic, Chad, Nigeria, and Sierra Leone. Humans are mortal. Whereas it is theoretically possible for the human population to attain a CBR of zero for an extended period, the same cannot be said for the CDR. Unlike fertility, which is affected by many biological, cultural, and economic variables, mortality is relatively easy to explain. As the CDR and LE figures cited above suggest, mortality generally reflects socio-economic status: high LE statistics are associated with high-quality living and working conditions, good nutrition, good sanitation, and widely available medical services—and vice versa for low LE levels. When disease is prevalent, mortality increases: several dramatic examples are illustrated later in this chapter with respect to Ebola and LHIV/AIDS. Mortality is also higher when countries experience conflict, as we have seen in recent years with illustrative examples such as Afghanistan, DR of Congo, Iraq, Sudan, and Syria. The study of death statistics tells a great deal about how people lived their lives because many die not as a result of aging but rather as a result of environmental conditions, lifestyle, or both. The world pattern for CDR (Figure 2.6) shows much less variation than does that for CBR. This is a reflection of the general availability of at least minimal health care facilities throughout the world. Most countries have a CDR of 10 or less, with the striking exception of several sub-Saharan African countries. Generally speaking, rates lower than 10 are acceptable. It is notable that, in some countries, rates are increasing because of the increasing percentage of elderly people in a national population; the greater the proportion of elderly people, the higher the death rate. For example, both Sweden and the United Kingdom have a CDR of 9, whereas Bangladesh and Iran have rates of 5. These different statistics reflect not differences in health and the quality of life but rather different age structures—all four countries have “low” death rates. Figure 2.7 illustrates LE by country. As already noted, LE figures are more sensitive to availability of food and health care facilities than are death rates. The map of LE is a fairly good approximation of the health status of populations. Low LE statistics are found in tropical countries in Africa and in South- Central and Southeast Asia. High LE statistics are particularly common in Europe and North America. For an illustration of the connections between levels of development and life expectancy, see Figure 2.1. Mortality measures also vary markedly within countries. In countries such as the United Kingdom, Canada, the United States, and Australia, certain groups and certain regions have higher CRDs and IMRs and lower LEs than the population or country as a whole. These differences reflect what we might call the spatial or social inequality of death. In the United States as a whole, for example, the IMR in 2017 was 5.8, but at the state level it varied from 3.7 to 9.1. All the highest IMR states are in the southeast, including Alabama, Louisiana, Mississippi, and Arkansas; each of these states has higher than average levels of rural poverty. As we will discuss later in this chapter, the health of specific subpopulations also varies by social characteristics. Age, ethnicity, race, income level, and immigrant status, among others, are important determinants of health and well-being and these vary both socially and spatially. FIGURE 2.6 | World distribution of crude death rates, 2017 As this map shows, the world pattern of death rates varies relatively little. Most countries have rates of 15 or less, with the striking exception of several sub-Saharan African countries. Generally speaking, rates lower than 15 are acceptable. It is notable that, in some countries, rates are increasing because of the increasing percentage of elderly people in a national population; the greater the proportion of elderly people, the higher the death rate. For example, both Finland and the United Kingdom have a rate of 9, whereas Malaysia and the Philippines have rates of 5 and 6, respectively. These different statistics reflect not differences in health and the quality of life but rather different age structures—all four countries have “low” death rates. Source: Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC. FIGURE 2.7 | World distribution of life expectancy, 2017 Source: Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC. The rate of natural increase (RNI) measures the rate (usually annual) of population growth by subtracting the CDR from the CBR. In 2017 the world CBR was 20 and the CDR was 8, producing an RNI of 12 per 1,000; this figure is typically expressed as a percentage of total population (hence 1.2 per cent). Between 2016 and 2017 the world’s population increased by about 83 million people, as a result of 143 million births and 60 million deaths. The size of the annual increase has been relatively constant in recent years, meaning that world population is still increasing but at a slowly decreasing rate. The reduction in the RNI began about 1990 because, as discussed earlier, world fertility is declining. This decrease in the rate of annual increase is very significant. Note that because RNI data take into account only mortality and fertility, not migration, they generally do not reflect the true population change of any area smaller than the earth. Although, as outlined in Boxes 2.3 and 2.4, fertility is declining in parts of both the less and the more developed worlds, the number of females of reproductive age continues to rise. Thus, the total world population continues to grow rapidly because of population momentum. population momentum The tendency for population growth to continue beyond the time that replacement-level fertility has been reached because of the relatively high number of people in the child-bearing years. To use world numbers in this way is to ignore important regional differences. The RNI data included in Tables 2.6 and 2.7 and mapped in Figure 2.8 provide a useful commentary on these variations. Low rates prevail in Japan and in many European countries, while high rates are concentrated in sub- Saharan and North African countries, as well as Southwest Asia. In addition to considering RNI data, it is important to recognize that large populations grow faster than small ones—even when they have lower fertility rates—simply because the base population is so much larger. At present, China and India combined are home to more than a third (36.5 per cent) of the world’s population; hence, even a small increase in fertility in one of these countries will mean a significant increase in the total world population. TABLE 2.6 | Countries with the highest rates of natural increase, 2017 Country Rate of Natural Increase (%) Population (millions) Qatar 6.6 2.6 Oman 6.5 4.6 Lebanon 6.0 6.1 Kuwait 5.4 4.1 Jordan 4.9 9.7 Equatorial Guinea 4.2 1.3 Niger 3.8 21.5 Angola 3.5 29.8 Uganda 3.4 42.9 Gabon 3.3 2.0 DR of Congo 3.3 81.3 Chad 3.3 14.9 South Sudan 3.3 12.6 Iraq 3.2 38.3 Afghanistan 3.2 35.5 Source: United Nations, Department of Economic and Social Affairs, Population Division. 2017. World population prospects 2017—Data booklet. UN, New York, NY. TABLE 2.7 | Countries with the lowest rates of natural increase, 2017 Country Rate of Natural Increase (%) Population (millions) Syria −2.3 18.3 Georgia −1.4 3.9 Lithuania −1.3 2.9 Latvia −1.2 2.0 Romania −0.6 19.7 Bulgaria −0.6 7.1 Ukraine −0.5 44.2 Serbia −0.4 8.8 Portugal −0.4 10.3 Greece −0.4 11.2 Croatia −0.4 4.2 Estonia −0.3 1.3 Hungary −0.3 9.7 Spain −0.2 46.4 Italy −0.1 59.4 Albania −0.1 2.9 Japan −0.01 127.5 Source: United Nations, Department of Economic and Social Affairs, Population Division. 2017. World population prospects 2017—Data booklet. UN, New York, NY. Table 2.8, showing projected data for selected world regions/countries, highlights the fact that much of the growth predicted between 2017 and 2050 will occur in sub-Saharan Africa and South-Central Asia, including India. Of the anticipated world growth of 2.3 billion, sub-Saharan Africa will contribute 1.2 billion and South-Central Asia another 521 million (323 million in India), together accounting for 74 per cent of the total growth. These regional projections also have implications for the larger arena of political power and economic growth. For example, the population of Africa as a whole is projected to more than double by 2050, whereas that of Europe and East Asia (including China, Japan, and South Korea) is expected to decline. Related to the RNI is the useful concept of doubling time. In the unlikely event that the current 1.2 per cent annual growth rate continues, rather than declining as expected, the world population would double in approximately 58 years. Relatively minor variations in RNI can significantly affect the doubling time. An RNI of zero (where CDR and CBR are equal) results in a stable population with an infinite doubling time; on the other hand, an RNI of 3.5 per cent produces a doubling time of a mere 20 years. doubling time The number of years required for the population of an area to double its present size, given the current rate of population growth. Governments often try, directly or indirectly, to control deaths, births, and migrations. All policies to control deaths have the same objective: to reduce mortality. Such policies, usually adopted for both economic and humanitarian reasons, include measures to provide medical care and safe working conditions. Despite the near universality of such policies, many governments actively raise mortality levels at specific times, for instance, in times of war. Further, many governments do not ensure that all members of their population have equal access to the same quality of health care. This is true throughout the world, regardless of levels of economic development. FIGURE 2.8 | World distribution of rates of natural increase, 2017 Source: United Nations, Department of Economic and Social Affairs, Population Division. 2017. World population prospects 2017—Data booklet. UN, New York, NY. As previously discussed, many governments have actively sought to influence fertility, and the policies in place may be a factor affecting fertility at the national scale. However, unlike policies to reduce mortality, those related to fertility have varying objectives. While many governments choose not to establish any formal policies, either because of indifference to the issue or because public opinion is divided, others are either actively pro-natalist or actively anti-natalist. TABLE 2.8 | Projected population growth, 2017–2050 Region or Country Population, 2017 Projected Projected Population (millions) Population, 2050 Growth, 2050(%) (millions) World 7,536 9,846 30.7 South Asia (incl. India) 1,885 2,406 27.6 East Asia (incl. China) 1,625 1,557 −4.2 Sub-Saharan Africa 1,021 2,193 114.8 Europe 745 736 −1.2 Latin America & the Caribbean 643 783 21.8 US and Canada 362 444 22.7 Western Asia 269 390 45.0 Northern Africa 230 381 65.7 Oceania 42 63 50.0 Source: Calculated from Population Reference Bureau. 2017. 2017 world population data sheet. Population Reference Bureau, Washington, DC. Pro-natalist policies typically exist in countries dominated by a Catholic or Islamic theology (e.g. Italy, Iran), in countries where the politically dominant ethnic group is in danger of being numerically overtaken by an ethnic minority (e.g. Israel), and in countries where a larger population is perceived as necessary for economic or strategic reasons. Singapore and Malaysia, both of which belong to the Asian group of newly industrialized countries (see Chapter 10), began to actively encourage fertility increases in the 1980s (Dwyer 1987). The two countries had succeeded in lowering their TFRs by following an anti-natalist line but, in 1984, decided that new policies were required to reverse the trend and increase fertility again. In Singapore, this reversal was related to the economic difficulties perceived to be the result of reducing the TFR to 1.6; there was a perceived need to provide a larger market for domestic industrial production and a larger workforce. The Malaysian case was similar in that the motivation was economic, although the TFR remained at 3.9, well above replacement level. The extent to which such pro-natalist policies are successful is debatable; the 2017 TFR for Singapore was 1.2 (tied for the lowest in the world) and for Malaysia it was only 2.0. Other countries are also greatly concerned about low fertility. In 2006 President Vladimir Putin stated that the situation in Russia was critical—in recent years, medals have been handed out to very large families, including in 2010 to a family with 17 children. In 2008 the president of Turkmenistan announced financial incentives for women who have more than eight children. Japan also has introduced financial incentives with the aim of encouraging a baby boom. The concern in this country is explicitly economic, as it is feared that an aging population supported by fewer working people would keep the country in a state of permanent recession. In addition, daycare facilities in Japan are being expanded and employers are making their companies more family friendly. Yet, although these policies have been in place for about 30 years, they do not appear to have prompted increased fertility. Canada has similar policies and practices in place, with subsidized daycare and with many employers offering generous maternity and paternity leaves. One effective tactic, at least in the short term, was employed in Georgia by the head of the Georgian Orthodox Church. Government concern about low fertility prompted Patriarch Ilia II to promise in 2007 that he would personally baptize any baby born to parents who already had two children. In a country where about 80 per cent of the population are adherents of this faith and the patriarch is held in great esteem, the immediate result was a 20 per cent increase in births in 2008. It seems likely that more and more countries will adopt pro-natalist policies if their fertility declines to the point where not only the economic, but also the political and cultural consequences, are seen as unacceptable. For instance, such policies could be implemented if it is feared that immigrants entering a country to take up the slack in the labour force will lead to a smaller native-born population and a loss of national identity. Despite the pro-natalist policies of some countries, the most common current policies relating to births are anti-natalist. Since about 1960, many of the less developed countries have initiated policies designed to reduce fertility. The argument behind such policies is that overpopulation is a real danger and that carrying capacity has been (or will soon be) exceeded. A fundamental problem with this argument is that it ignores the fact that carrying capacity is not static. Consider, for example, that without the early twentieth-century invention of a chemical process to produce nitrogen fertilizers, the carrying capacity of the earth would be about half the present population. carrying capacity The maximum population that can be supported by a given set of resources and a given level of technology. Children raise their hands at a daycare centre in Montreal. Quebec’s child care system, which is heavily subsidized by the provincial government, has the lowest fees in Canada, up to 80 per cent lower than fees in other provinces. These subsidies are an example of a pro-natalist government policy. India was the first country to intervene actively to reduce fertility. Beginning in 1952, the government introduced a series of programs designed to encourage contraceptive use and sterilization. The first program offered financial incentives; others have been coercive or educational. Fertility rates have declined, but with a 2017 RNI of1.2 per cent (meaning a doubling time of 58 years and on par with the global average), it is clear that the various programs have only partially achieved the desired result. China, on the other hand, has made great strides toward reducing fertility. The 2017 RNI was 0.5 per cent and the doubling time 140 years. However, the causes of this fertility decline are debated. Much of this success might be attributed to the programs introduced, mostly in the late 1970s, by the communist government. Families were restricted to having one child, and marriage was prohibited until the age of 28 for men and 25 for women. Contraception, abortion, and medical sterilization were free. There were financial incentives for families with only one child and penalties for those with more than one. However, some Chinese academics contend that fertility was declining prior to the introduction of the one-child policy, making it a largely irrelevant factor. They say that fertility was declining because of the education of women, better health care, and social and economic development in general. As noted in Box 2.5, the policy was formally abandoned in 2015 with the government announcing that all couples could have two children. Is it possible that the best government population policy is neither pro-natal nor anti-natal, but no policy at all? The logic behind having no policy is simply that people should be allowed to have as many children as they wish. Anti-natal policies in particular have destroyed lives (for example, through forced sterilization) and are derived from imperialist ideas of supremacy and the presumed ignorance of others. Perhaps the most compelling reason not to have an anti-natal policy is that such policies may not be needed. The last few decades have made it clear that, with education and improved lifestyles, women choose to have fewer children and do not need to be told to or, worse, be coerced into doing so. Even in the case of China, as noted in Box 2.5, it can be argued that fertility was already declining prior to the introduction of the one-child policy and that improved educational opportunities for women, combined with the ongoing process of urbanization and industrialization, would have been sufficient to lead to the desired low fertility. Viewed retrospectively, many anti-natal policies were put in place by government officials, or by presumed experts from more developed countries, on the arrogant grounds that people do not know what is best for themselves. There is perhaps a fine line between arrogance, and assuming what is best for others, and inhumanity, requiring that people behave in ways deemed appropriate by others. Fertility and mortality vary significantly with age, and the growth of a population is affected by the population’s age composition, which is dynamic. As we have seen in Box 2.5, it is usual to represent age and sex compositions with a population pyramid. Keep in mind that population pyramids measure biological sex at birth, not gender identity. As well, a shortcoming of population pyramids is that they do not account for intersex individuals (those with both male and female sex organs or other sexual characteristics), largely because this data has not been available and is not consistent. Some estimates (Fausto-Sterling 2000) place the intersex portion of the population as high as 1.7 per cent and although these higher estimates have been debated (Sax 2002) this proportion would have some meaningful effects on the pyramid, especially at the younger ages. Nonetheless, three general patterns appear in population pyramids (Figure 2.10). First, if a population is rapidly expanding, a high proportion of the total population will be in the younger age groups. Because fertility is high, each successive age group is larger than the one before it. Second, if a population is relatively stable, each age group, barring the older groups that are losing numbers, is similarly sized. Third, if a population is declining, the younger groups will be smaller than the older groups. population pyramid A diagrammatic representation of the age and sex composition of a population. BOX 2.5 | Population in China As of 2017, China continued to have a declining CBR that is low by Asian standards (13), a CDR that is among the lowest in the world (7), an RNI of 0.5, a TFR of 1.6, and an LE that is approaching the average for the more developed world (76). A useful way to depict the late-twentieth-century history of Chinese population growth is with a population pyramid (Figure 2.9). The pyramid for 1970 shows a classic “expanding” shape, which is characteristic of a population with high fertility. The pyramid for 2010, however, shows not only that the Chinese population is no longer growing, but that it is showing signs of decline. The indentations in the 2010 pyramid show several changes in fertility and mortality during the late twentieth and early twenty-first centuries. The 1960s were a period of generally high fertility and low mortality, reflected by the bulge for the 10- year cohort aged 38 to 47 in 2010; these were people born in the high-fertility period occurring between 1963 and 1972. In 1964, more than 40 per cent of the population was under age 15. The high fertility of 1972 was followed then by dramatic decreases in fertility beginning 1973 that resulted in a narrowing of the pyramid, that continues today. The narrowing of the pyramid since the early 1970s has continued steadily for fifty years with the exception of a population “echo” in the decade between 1985 and 1995. The 2010 Chinese census highlights three key population developments. First, it seems that, if existing fertility trends continue, China’s population will begin to actually decline about 2042. For many commentators inside China, this prediction means the fertility rate is too low. This astounding prospect prompted authorities to informally relax the one-child policy, and it became common for rural couples to have two children, especially if the first was a girl. But the policy continued to be applied in some parts of the country by local officials. In 2015 the government formally announced that all couples could have two children. Even though the one-child policy has been abandoned, most observers think it likely that the TFR will increase only slightly. The second significant development is a marked disparity in the sex ratio of children born in recent years. Recent data show a ratio of 118 males to 100 females. This suggests that increasing numbers of female fetuses have been aborted. Female infanticide is practised, but is likely much less evident than selective abortion. There is also evidence of a higher IMR for girls than for boys because of neglect or maltreatment. Much of the reason for this disparity in the sex ratio is cultural. Many Chinese parents prefer sons over daughters because, according to traditional Chinese norms, a daughter is responsible for her birth family only until she marries (at which point she becomes responsible for her husband’s family). In contrast, a son remains responsible for his birth family after marriage. The other country with a similar pattern of female abortion is India, where many parents still have to offer dowries to find husbands for their daughters. The third significant development is the rapid aging of the population. It is estimated that the Chinese population’s rate of aging will be the fastest in the world. Assuming current trends continue, the ratio of people of working age to retirees will fall from about 6:1 in the early twenty-first century to about 2:1 by 2040. Given China’s rising global economic power, we might describe this aging trend by saying that China will get old before it gets rich. Certainly, the huge elderly non-working population is expected to place great stress on the national economy. China is approaching what can be described as a “4−2−1” scenario, that is, four grandparents, two parents, and one child. FIGURE 2.9 | Age and sex structure in China in 1970 and 2010 Source: Data from PopulationPyramid.net. n.d. China 1970, 2010. https://www.populationpyramid.net/china/1970/; https://www.populationpyramid.net/china/2010/ FIGURE 2.10 | Age structure of populations Expanding populations have a high percentage in the pre-reproductive age group. Stable populations have relatively equal pre- reproductive and reproductive age groups. Diminishing populations have a low percentage in the pre-reproductive age group. A Chinese couple and their children on their way back home for the 2018 Chinese Lunar New Year at the railway station in Ji’nan city in China. China’s central government changed its long-standing one-child policy in 2016 when it gave all married couples the right to have two children. Despite these steps, the birth rate in China continues to decline, with a main reason being the continuous decrease in the number of women at a suitable age for child- bearing—15 to 49 in China. The three generalizations in Figure 2.10 are insightful, but specific age and sex composition pyramids are more revealing. Usually, population pyramids distinguish males and females and divide them into five-year categories. Each bar in the pyramid indicates the percentage of the total population that a particular group (such as 30–34-year-old females) makes up. Figure 2.11 presents the population of Brazil for the period 1975 to 2050 in a series of three pyramids. These three age-sex pyramids show the changes and predicted changes in Brazil’s population over a 75-year period. The wide base and gently sloping sides in the 1975 pyramid indicate high rates of births and deaths. Much of the population was under 20 years old, ensuring that births would continue to be high in the future. The 2000 pyramid shows a slight reduction in the number of births and a decrease in deaths. Throughout this period, the population increases rapidly because birth rates are high and death rates are dropping. This pyramid indicates that Brazil’s population growth has not yet reached its maximum acceleration, a fact that does not bode well for a nation experiencing difficulties supporting its current population. The predicted 2050 pyramid shows a different situation, with the narrowing base reflecting a reduction in births and signs of an aging population. Discussions of the number of males and females in a population refer to the sex ratio (technically, a masculinity ratio as it relates the number of males to the number of females). Sex ratio data for individual countries frequently are estimated, but it is generally accepted that there are about 101 males for each 100 females. Under normal circumstances and in most parts of the world, about 104 to 108 boys are born for each 100 girls. The major exceptions are those countries, especially India, Taiwan, South Korea, and China, where there is a preference for sons and the number of girls is reduced through abortion and female infanticide, as discussed in Box 2.5. sex ratio The number of males per 100 females in a population. The surplus of males at birth is reduced through time as male mortality rates are generally higher and male life expectancy generally lower than that of females. In most countries the number of males in the population will be overtaken by the number of females by middle age, and the elderly population usually is predominantly female. In short, sex ratios vary with age. The year 2000 was the first year that people under 14 were outnumbered by people over 60. The process by which older individuals come to make up a proportionally larger share of the total population, known as population aging, is occurring in most countries around the world, albeit at different rates. population aging A process in which the proportion of elderly people in a population increases and the proportion of younger people decreases, resulting in increased median age of the population. In 1900, about 1 per cent of the world’s population was over age 60; by 2017 this figure had increased to about 13 per cent, and an estimate for 2050 is 21 per cent (Figure 2.12). Furthermore, global aging is occurring at an increasing rate: the older population is growing faster than the total population in most parts of the world, and the difference between the two growth rates is increasing. Table 2.9 provides data on the global aging trend; the median age of the world’s population is expected to increase from 30 years in 2015 to about 36 years in 2050. FIGURE 2.11 | Age and sex structure in Brazil: 1975, 2000, 2050 Source: US Census Bureau. International data base. www.census.gov/ipc/www/idbpyr.html; United Nations, Department of Economic and Social Affairs, Population Division. 2017. World population prospects: The 2017 revision, online demographic profiles. UN, New York, NY. Figure 2.13 depicts five population pyramids that provide information about the composition of Canada’s population. In 1861, immigration and high fertility combined to produce a pyramid that shows cohorts steadily decreasing in size with age. The 1921 pyramid shows the effects of reduced fertility in a narrowing of the base, but the effects of immigration still are apparent. In 1981 the Canadian population was characterized by extremely low birth and death rates; the age-sex structure exhibits a beehive shape. The pyramid bulge between the ages of 15 and 35 represents the postwar baby boom, which accelerated population growth. The birth rate has long since returned to its normal low; without the baby boom, the pyramid would have had almost vertical sides. A continuing low birth rate and an aging population are reflected in the projection for 2050. This age-sex structure may well represent the future for most countries in the more developed world. Although population aging is indeed a global phenomenon, there are significant regional differences, most obviously related to differences between the more and less developed parts of the world in their patterns of fertility decline and increasing life expectancy. In the case of fertility, the decline started later in the less developed world but is proceeding more rapidly. In the case of life expectancy, the increases are lower throughout the less developed world and have fallen in some places because of HIV/AIDS. Among specific countries, Japan, Italy, and Germany have the highest median age (approximately 46 years), but it is estimated that by 2050 at least 10 countries will have a median age above 50, the majority of which are in Europe and East Asia. The two principal causes and some likely consequences of population aging are discussed in Box 2.6. Jean Seddon, who is in her seventies, is factory supervisor at Cooper & Stollbrand in Manchester, UK. Like Seddon, many retirees continue to work because they enjoy it; however, many others do so because the recent recession has made them unable to retire. FIGURE 2.12 | Proportion of the population aged 60 years or over: World and development regions, 1950–2050 Source: United Nations, Department of Economic and Social Affairs, Population Division. 2017. World population ageing 2017. UN, New York, NY. TABLE 2.9 | Global aging, 1950–2050 Median Age (years) Aged 60 or Older (%) Region 1950 2015 2050 1950 2017 2050 World 23.5 29.6 36.1 8.1 12.7 21.3 More 28.6 41.1 45.4 11.7 24.6 32.9 developed world Less 21.3 27.8 34.8 6.4 10.4 19.5 developed world Source: United Nations, Department of Economic and Social Affairs, Population Division. 2017. World population ageing 2017. UN, New York, NY. Human populations have increased in some periods and declined in others. The principal constraints on population growth historically were climate and the (related) availability of food. Unlike other animals, humans gradually increased their freedom from such constraints through the development of culture and associated technology. Cultural adaptation has enabled humans to increase in numbers and, so far, avert extinction. For most of our time on earth, however, our numbers have increased very slowly. Among the cultural changes that permitted human numbers to increase before about 12,000 years ago were the evolution of speech, which facilitated co-operation in the search for food; the introduction of monogamy, which increased the chances that children would survive; and the use of fire and of clothing, which together made it possible to move into cooler areas. Nevertheless, the cumulative effect of these advances was not great; 12,000 years ago, the human population was estimated to total approximately four million. The rapid growth in the world’s population since that time has not been regular. Rather, there have been several relatively brief growth periods and longer intervals of slow growth. Each growth period can be explained by a major cultural advance. The Rise of Agriculture The first such advance, beginning about 12,000 years ago, was the Agricultural Revolution (see Chapter 9). The Agricultural Revolution involved a gradual cultural transition of subsistence in which people shifted from primarily hunting and gathering to producing their own food through the domestication of plants and animals. As this idea, known as agriculture, spread, the first human economic activities of hunting and gathering became marginal. This took place in various centres, beginning in the Tigris and Euphrates Valleys of present-day Iraq. Some 9,000 years ago, the first region of high population density appeared, stretching from Greece to Iran and including Egypt. By 6,000 years ago agriculture and related population centres had developed on the Mediterranean coast and in several European locations, as well as in Mexico, Peru, China, and India. Around 2,000 years ago, new centres arose throughout Europe and Japan, and the total world population reached an estimated 250 million—a dramatic increase in the 10,000 years since the beginnings of agriculture. Before the cultural innovation of agriculture, population numbers had changed little, increasing or decreasing depending on cultural advances and physical constraints. Birth and death rates were high, about 35 to 55 per 1,000, and life expectancy was short, about 35 years. Following the introduction of agriculture, birth rates remained high but death rates fluctuated as regular but periodic epidemics had devastating consequences on the population. This state of affairs continued until the seventeenth century. The world population approximately 2,000 years ago of 250 million had reached 500 million by 1650, but the pace of growth remained slow in the absence of any major cultural advance. The Rise of Industry From about 1650 onward, however, the world population increased rapidly in response to improved agricultural production and the beginning of a demographic shift to cities, especially after the onset of the second major cultural advance, the Industrial Revolution (see Chapter 10). This development initiated a rapid growth and diffusion of technologies, and industry replaced agriculture as the dominant productive sector. The Agricultural Revolution had involved more effective use of solar energy in plant growth. This second revolution involved the large-scale exploitation of new sources of energy—coal, oil, and electricity. The result was a rapid reduction in death rates, with a delayed but equally significant drop in birth rates. World population increased to 680 million in 1700, 954 million in 1800, and 1.6 billion in 1900. FIGURE 2.13 | Age and sex structure in Canada: 1861, 1921, 1981, 2017, 2050 Sources: Dumas, J., with Y. Lavoie. 1992. Report on the demographic situation in Canada, 1992. Catalogue no. 91–209E. Minister of Industry, Ottawa, 132–3; United Nations, Department of Economic and Social Affairs, Population Division. 2017. World population prospects: The 2017 revision, online demographic profiles. UN, New York, NY. https://population.un.org/wpp/Graphs/DemographicProfiles/ (accessed 28 December 2018). BOX 2.6 Causes and Consequences of Population Aging Causes Population aging is the result of ongoing changes in fertility and mortality. 1. Fertility is declining in both more developed and less developed countries, and this is the primary reason for population aging. The fewer young people there are in a population, the larger the proportion of elderly people. Globally, the TFR has declined by about half in the past 50 years. As fewer babies are born, the base of the population pyramid narrows, producing a relative increase in the older population. 2. At the same time that mortality is declining, life expectancy is increasing (particularly for women) everywhere as well. Globally, life expectancy has increased by about 50 per cent since 1950, with females now expected to live 73 years and males 69 years. Canada, Japan, South Korea, and several European countries had the highest life expectancies in 2017, with females and males expected to live to 84 and 80 years, respectively. Life expectancy is increasing due to ongoing improvements in health care and living conditions. Consequences The aging of the population in the less developed world may do more to reshape our collective future than even the proliferation of chemical and other weapons, terrorism, global warming, and ethnic tribalism (Peterson 1999, 42). The reasoning behind this prediction has to do with changes in the ratio between the dependent elderly population and those of working age. Some suggest this ratio will double in much of the more developed world and triple in much of the less developed world. Most notably, an aging population will place increasing stress on retirement, pension, and related social benefits, necessitating radical changes in social security programs. Further, global aging will lead to different patterns of disease and disability; for example, degenerative diseases associated with aging, such as cancer, heart problems, and arthritis, will become increasingly common. The need for adjustments to national health care programs is apparent. At the same time, national economies will face enormous strain as the numbers of workers available to support the growing population of non-working elderly gradually decline. It is possible that a decrease in the number of dependent young will free up some resources for the dependent elderly; however, the amount of public spending required to support an elderly person is two to three times that required to support a young person. Countries with a strong tradition of children supporting elderly parents, such as China, will face particular stress as increasing life expectancy makes this more and more difficult (Box 2.5). Inevitably, the problems of aging will be exacerbated in parts of the world that already lack financial and other resources. Babies born in less developed countries can expect to live into their seventies. In China and India, both with very large populations, the number of people aged over 80 is expected to increase about five times by 2050. The fact that the more developed world became rich before aging, whereas the less developed world is aging before it has a chance to get rich, is a very significant difference between more developed and less developed countries. It might be argued that aging is threatening national security in more developed countries because of a declining workforce and related loss of entrepreneurial initiative. Aged societies may favour consumption over investment and the elderly over the youthful. One very interesting argument is that population aging in more developed countries facilitates the economic globalization discussed in Chapter 11. Because people in these countries are living longer and having fewer children, they necessarily rely on the more affordable labour of people in other countries. The growth initially spurred by industrialization has ceased in the more developed world, but rapid growth continues in the less developed world. As a result, the total world population continues to increase substantially. Table 2.10 places the recent and expected growth in context by noting the number of years taken to add each additional billion people, and Figure 2.14 displays these data graphically. To summarize the current situation, the world population growth rate, the rate of natural increase, has fallen from a late 1960s high of 2.0 per cent per year to 1.2 per cent per year. Because of this decline, the world population will grow less rapidly in this century than it did in the twentieth, although it will continue to increase substantially because of population momentum. This brief account explains the basis of population growth. Numbers have increased in response to cultural, specifically technological, advances. The dramatic increases since about 1650 reflect the fact that the death rate began to fall before the birth rate did. In what is now the more developed world, populations grew rapidly after about 1650; elsewhere, numbers increased rapidly in the last century, particularly since the 1940s. An interesting question about world population is raised in Box 2.7. Predicting population growth is fraught with difficulty. For example, in the early 1920s, Raymond Pearl, a biologist and statistician, predicted a stable human population of 2.6 billion by 2100. In 1945 Frank Rotestein, an American demographer, predicted a global population of 3 billion by 2000. But despite some unimpressive precedents, there is good reason to suggest that we are in a position to make better forecasts. The principal reason is that both fertility and mortality rates now lie within narrower ranges than was previously the case. Current UN projections suggest a world population of 9.8 billion for 2050 (Table 2.8). This projection assumes that the mortality transition will be complete at that time, such that the CDR is approximately equal throughout the world. As we have stated, a look further ahead might see the fertility transition in the less developed world completed by the year 2050, with a relatively stable world population of 10 to 12 billion by 2100. This estimate has remained essentially unchanged for about 20 years, reflecting a broad consensus about our future population forecast. Nevertheless, it is still a projection and may be incorrect. There are two complicating issues regarding this prediction. First, the assumption of a continually declining TFR may be questioned. Some evidence suggests that the fertility decline has stalled in parts of the less developed world because contraceptive needs are not being met and because large families are still preferred; as an example, the UN projects that Nigeria’s population will increase from 190 million today to nearly 800 million by 2100. Among the current large countries (greater than 100 million people) this is by far the largest projected population growth. TABLE 2.10 | Adding the billions: Actual and projected Billions Year Reached Years Taken 1 1800 2 1930 130 3 1960 30 4 1974 14 5 1987 13 6 1999 12 7 2011 12 8 2026 15 9 2042 16 Source: Calculated from United Nations, Department of Economic and Social Affairs, Population Division. 2017. World population prospects—2017 revision. UN, New York, NY. Second, it is possible that population numbers will collapse because of limits to growth. This phrase became popular after it was used as the title of an influential report published by the Club of Rome (an independent group of scholars, politicians, and business leaders concerned about the future of our planet). Many environmentalists and ecologists argue that there are definite limits to the growth both of populations and of economies. The earth is finite, and many resources are not renewable. The classic argument in this genre is that of Malthus (see below), but the Club of Rome report broade

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