Saturday, August 10, 2013

Health, Environment, Population

Invited lecture to Department of Public Health and Environment, 
World Health Organization

My slides are now accessible here.

August 26, 2013
Dr Margaret Chan (W.H.O. Director General) recently criticized “Big Soda” (and other “Bigs”) as driving forces which generate non-communicable diseases. This criticism could be extended not just to Big Carbon, but big Capitalism too, and for many additional adverse health outcomes. But when it comes to the nexus between population, environment, development and health, it is not just capitalists and the Right who have a narrow vision; so too does the Left, which for at least two centuries has argued that redistribution is not only necessary but sufficient to solve poverty and resource scarcity.

This lecture will attempt to review and explain the decline of understanding and interest in Limits to Growth and population growth; the nascent but fragile revival of interest in these issues, and why these issues are central to global development, security and health: past, present and future.

This is a preliminary meeting which might lead to the establishment of a WHO- led working group to re-examine these issues; hopefully to re-consider the orthodox view which has dominated the Right since about 1980, the Left since at least 1800 and academia since about 1985.

For example: "The Population Association of America, representing US demographers and population specialists .. questioned the basis of the White House policy (at the 1984 Population Conference in Mexico City): ("the PAA prepared a statement commenting that the authors of the draft report was "either unaware of 50 years of demographic research, or deliberately ignored it" .. "Dr Sheldon Segal, the co-recipient of the 1984 UN population prize also questioned the US position.")

Finkle, J. L. & Crane, B. 1985. Ideology and politics at Mexico City: The United States at the 1984 International Conference on Population. Population and Development Review, 11, 1-28. (footnote 61).

Prof Colin Butler is funded by the Australian Research Council, as a “Future Fellow”, a four year research grant. His topic is called “Health and Sustainability: Australia in a Global Context”. He has published many articles on topics relevant to these themes, against the mainstream current, including “Overpopulation, overconsumption and economics" (Lancet, 1994) and "Human carrying capacity and human health" in PLoS Medicine (open access).

In 2009 he was named one of 100 doctors for the planet. He was lead author for the Millennium Ecosystem Assessment chapter on future human well-being in the scenarios working group, where he collaborated closely with Carlos Corvalan. He is trying to make "Limits to Growth and Health" a legitimate and central issue for global public health. He is also a contributing author to the IPCC health chapter.

Tuesday, August 6, 2013

The Future of Global Health. Reasons for Alarm and a Call for Action

Just published (open access) in the World Medical Journal (Vol 59, issue 3)

Co-written with Prof Phil Weinstein

The abstract is below. Mainly this paper warns that "business as usual" will lead to a deterioration in global population size and life expectancy. "Peak health" may already be in the past. We might be able to change course but it's getting very late.

This paper was requested after the editor read our editorial in EcoHealth, in 2011. It is to be translated to Latvian.

Here is the abstract:

"The future of global health depends far more on fundamental ecological and social determinants than on progress for health technologies, whether surgical, pharmacological or immunological. There is a growing gap between the optimism in official forecasts of development and global health and the trend of the most important health determinants. Without fundamental change to these, in turn requiring a global shift in culture and measurements of progress, the prospects for global health look bleak. “Peak health” in the past has generally referred to humans in their prime of fitness; in the future it may be seen to refer to the time when global life expectancy reached its maximum. That time may be within a decade – but, if we can change sufficient practices, then we might still improve global health through this century."

“The prospect for the human race is sombre beyond all precedent. Mankind is faced with a clear-cut alternative: either we shall all perish, or we shall have to acquire some slight degree of common sense. A great deal of new political thinking will be necessary if utter disaster is to be averted.” Bertrand Russell, 1945.

Saturday, August 3, 2013

The Right to be Human - healing the rift between population and human right activists

The following is adapted from an essay I wrote for a competition on population policy and human rights. Selected essayists were invited to a workshop in Berlin in February 2007, organised by the Irmgard Coninx Stiftung Foundation. My fellow finalists were human rights activists and junior academics from all inhabited continents, though not Russia, a country then experiencing a serious decline in population, health and human rights. I remember how one of the moderators of this meeting, a prominent US social scientist, was cold, rude and indifferent to my arguments; I will not name her. Some of my colleagues were also blind (but not rude), but some were very sympathetic.

A version of this essay was published in BODHI Times in June 2007 (number 32). 

A queue in heaven
Imagine you are in a heavenly queue, await your turn to occupy the next available womb. What womb would you hope for? Few readers of this essay would choose, as their new mother, a woman who is illiterate, impoverished, diseased, or so vulnerable that disease and poverty are ever imminent. But the souls in our imaginary queue have no choice. We know, today, that a vast number of human conceptions occur in women who meet one or more of these criteria. In turn, almost from the moment of conception, foetuses who develop in such women are likely to suffer progressive disadvantage. Usually, the uterine environment in such women is doubly burdened by an under-supply of nutrients, especially of the vitamins and other trace elements needed for optimal development (including long chained fatty acids), but with an over-supply of development-harming contaminants, such as lead, mercury, and a cocktail of persistent organic pollutants.
By the time of birth – often underweight, to an underweight mother – most infants who have gestated in such an environment are likely to suffer at least subtle cognitive and often physical impairment. Very often, further disadvantage then accrues, as the child learns (or fails to learn) in conditions of scarcity, limited intellectual stimulation, and ongoing and chronic nutritional adversity and environmental pollution.
A few children will escape from severe poverty but they are likely to be exceptional. Far more pass lives burdened by chronic scarcity, insecurity, and servitude. In many places, such as Rwanda, Darfur in the Sudan, Sri Lanka’s Jaffna Peninsula, or the Chittagong Hills of Bangladesh, human lives are too frequently characterised by intermittent or even constant fear of violence, the perpetration of violence, or both.

Two communities and two propositions

This essay pleads for greater co-operation and dialogue between two mutually suspicious communities. On one side are human rights advocates, anti-globalisation activists and feminists. On the other are a small number of academics, activists and development workers who argue that fertility and population growth rates are crucial determinants of progress towards greater prosperity, freedom and human rights.

My argument rests on two main propositions. First, the social, economic and developmental benefits of slower population growth rates have been substantially underestimated in recent decades. Because of the sustained effort of a handful of activists, the importance of this principle is be being belatedly rediscovered. For example, an enquiry into this question by the UK Parliament (released 2007) emphatically agreed with this. Summarising this evidence, Dr Martha Campbell, Professor John Cleland and two co-authors published a paper in the prestigious journal Science, called ‘Return of the Population Growth Factor,’ in March, 2007.

Soon after WWII there was widespread economic and political understanding of this principle. The Green Revolution, which started in the late 1960s, won a temporary reprieve in the ancient race between the stork and the plough. Within fifteen years of Norman Borlaug’s 1970 Nobel prize speech, warning that the Green Revolution should be regarded as a precious opportunity to slow population growth, the view that high population growth is harmful for human development came under vigorous attack from a coalition of forces led by the government of US President Ronald Reagan.

Borlaug said (in part):

"the tide of the battle against hunger has changed for the better during the past three years. But tides have a way of flowing and then ebbing again. We may be at high tide now, but ebb tide could soon set in if we become complacent and relax our efforts. For we are dealing with two opposing forces, the scientific power of food production and the biologic power of human reproduction. Man has made amazing progress recently in his potential mastery of these two contending powers. Science, invention, and technology have given him materials and methods for increasing his food supplies substantially and sometimes spectacularly, as I hope to prove tomorrow in my first address as a newly decorated and dedicated Nobel Laureate. Man also has acquired the means to reduce the rate of human reproduction effectively and humanely. He is using his powers for increasing the rate and amount of food production. But he is not yet using adequately his potential for decreasing the rate of human reproduction. The result is that the rate of population increase exceeds the rate of increase in food production in some areas.

There can be no permanent progress in the battle against hunger until the agencies that fight for increased food production and those that fight for population control unite in a common effort. Fighting alone, they may win temporary skirmishes, but united they can win a decisive and lasting victory to provide food and other amenities of a progressive civilization for the benefit of all mankind."

Representing vested interests such as the oil industry, and intensely threatened by the implications of the ‘Limits to Growth’ arguments the Reagan administration called for "free", deregulated markets, including to determine for population size.

In 1985 two leading demographers published "Ideology and politics at Mexico City: The United States at the 1984 International Conference on Population". Footnote 75 of this article states:
"President Reagan's personal views are contained in a pamphlet made available by the US delegation at its first press conference, Ronald Reagan, Abortion and the Conscience of the Nation (Washington, D.C.: The White House, n. d.). In a televised debate during the Presidential campaign, President Reagan responded to a question about the "population explosion" by stating that it has been "vastly exaggerated----over-exaggerated," New York Times, 22 October 1984, p. 85.

(Unfortunately I have been unable to retrieve the original NYT article.)

Gullible supporters of free market ideology claimed (especially in the 1990s) that since no limits to growth actually exist, and since the "invisible hand" of the market would maximise public goods, any attempt to regulate population growth would not only be pointless but also would harm human rights.
There were probably thousands of such essays written in the 1990s, but they are not easy to find on the web. Here is one. I recently tried to find a link to "Apocalypse soon" published in The Economist (332, 25-26) in 1994, but it's no longer easy. The Economist published a slew of such papers, in support of hyper-optimists such as Julian Simon and Bjorn Lomborg; in the days before the 2008 Financial Collapse, and the rise in the price of energy and food.

My second major proposition is that it is more likely that inclusive economic growth will generate improved human rights than the converse. (Leave aside, for the time being, the vexed definition of what economic growth measures and constitutes.) That is, while the relationship between economic growth and freedom is far from straightforward, in the main, freedom is more likely to flourish in a rich society than in a poor society. This is likely even if existing wealth is distributed fairly evenly in both societies. (Consider for example, the lack of freedom in egalitarian Czechoslovakia during the Cold War).

(The following argument also ignores the fact that much wealth in rich societies is stolen, appropriated or otherwise kept from the poor so that their comparatively high freedom is likely to have a narrow scope.)

For a start, people in rich societies are more likely to be educated and have the tools to develop their human potential than are people in poor societies. Though people in Singapore are neither democratic nor free, I would much rather be born there than in a terribly poor country like Burundi. Poverty is no guarantor of human rights, as the current situation in Zimbabwe clearly shows.

Contesting Freedoms and Rights

Obviously, choosing one’s family size is a human freedom. In calling for a lower population growth rate in order to accelerate development (in countries such as Pakistan, Uganda or East Timor where the total fertility rate is much greater than replacement levels), I am not arguing for an enforced reduction in family size, nor even for explicit economic or social penalties (such as restricted promotion) tied to family size. Instead, I am calling for a greater recognition of the role of high population growth in undermining development, including by academic and political leadership. I am also calling for the implementation of social policies which will accelerate the demographic transition.

The most important of these factors are well known. They include universal primary school education, the lifting of taboos concerning discussion of this topic, and the availability of cheap contraceptives, especially condoms. Feminists, human rights activists and the many development workers who remain ignorant about or silent on this issue need to engage in this debate. One response from this community is to argue that the open discussion of this topic will inevitably lead to abuses, such as the compulsory sterilisation of minorities. In fact, denying the role of smaller families in economic take-off helps to perversely maintain poverty and inequality.

Of course, slowing human population growth is not enough to solve our human predicament (illustrated, for example, by the increasingly dire predictions concerning climate change). The tension between the right to reproduce and the struggle to develop is hardly unique. All acts of co-operation necessarily entail a trade-off between competing freedoms and responsibilities. As a society, we choose to restrict the freedom to drive on both sides of the road (except in Delhi on the way to the airport!)

Nor are human restrictions on fertility a recent invention. While a few demographers might still claim otherwise, there is increasing recognition that contraception is ancient, by methods including prolonged lactation, herbs, taboos and possibly other means.

Skewed age distributions 

One reason to lower fertility is to reduce ‘youth bulges’. These refer to concentrations of young men who are poorly educated, under-employed, (rationally) resentful, comparatively easy to manipulate and potentially violent. Such men are vulnerable to recruitment into activities which can damage society, such as gangs, rebel groups and terrorists. A youth bulge was pivotal in the 1994 Rwandan genocide, when land scarcity forced many young unmarried men to unsuccessfully seek work in the city.


I am not arguing that curtailing the liberty to choose to have as many children as one might like is without cost to human freedom. Rather, I am arguing that that right needs to be balanced against other rights and freedoms, including for other people and future generations.

Although denied by most of the mainstream economic, political and demographic literature, localised and global overpopulation are realities. The former is manifest through means such as poverty traps, violence, poor governance and epidemics. The latter is evident through the twin threats of the loss of ecological wealth and climate change. Although both consequences are mediated by technological and social factors, future human well-being is at serious risk. Climate change is increasingly understood as having agricultural consequences, including of increased inequality of highly productive agricultural land. Combined with climate change, the existence of weapons of mass destruction and high population growth in developing countries is a toxic brew. There is an urgent need for fairer global governance. This will slow population growth, and contribute to a virtuous cycle. Development with human rights is the best contraceptive. Lobbyists for human rights need to re-examine the economic arguments for slowing population growth; campaigners for slowing fertility need to seek allies from within the human rights community.