Transcript Population Density

Population and Global Health
Stephen Gloyd, MD, MPH
GH 101
March 1, 2016
“One stinking hot night in Delhi”
(description of the population problem)
“As we crawled through the city [in a taxi], we
entered a crowded slum area. The temperature
was well over 100, and the air was a haze of dust
and smoke. The streets seemed alive with people.
People eating, people washing, people sleeping.
People visiting, arguing, and screaming. People
thrusting their hands through the taxi window,
begging. People defecating and urinating. People
clinging to buses. People herding animals. People,
people, people, people. As we moved slowly
through the mob, hand horn squawking, the dust,
noise, heat, and cooking fires gave the scene a
hellish aspect. Would we ever get to our hotel?”
Paul Ehrlich, ‘The Population Bomb’ 1960
Response: Mahmood Mamdani
“The fact is that a hot summer night on Broadway
in New York or Picadilly Circus in London would put
Ehrlich in the midst of a far larger crowd. …..
…what disturbed him about the crowd in Delhil was
not its numbers, but its ‘quality’ – that is, its
poverty.
…to talk, as Ehrlich does, of ‘overpopulation’ is to
say to people: you are poor because you are too
many.’
Mamdani, The Myth of Population Control, 1972
World Bank Perspective - 1968
“I want to discuss with you….a problem that arose
out of the recent past: that already plagues man in
the present, and that will diminish, if not destroy,
much of his future – should he fail to face up to it,
and solve it.
It is the tangled problem of excessive population
growth…If anything is certain about the population
explosion, it is that if it is not dealt with reasonably,
it will in fact explode: explode in suffering, explode
in violence, explode in inhumanity.”

Robert McNamara, World Bank President, 1968 Speech
to World Bank Board of Governors
Population thinking –
“conventional wisdom”
Overpopulation has been posed as a
major determinant of
 Global poverty and health
 Environmental degradation
(pollution, deforestation)
 Climate change
We will explore all of these notions
Population Terms
Crude Birth Rate
# births/1000pop
Crude Mortality Rate
# deaths/1000pop
(General) Fertility Rate # births/15-44 women
Total Fertility Rate
her lifetime
Population Growth Rate
avg # children/woman in
CBR-CMR
Dependency Rate = Pop <20 + Pop >65/pop 20-64
Pop growth vs. growth in
pop-control funding since 1960
World population growth from 1960 - 1977
5
International assistance for population activities
1960-1977
4.23
400
4
3.71
350
350
3.35
4
3
Millions of US$ spent
Billions of people
3.04
3
2
2
300
250
200
150
125
100
1
50
1
2
18
0
0
1960
1965
1970
1977
1960
1965
1970
1977
History of Approaches to Population

Encouragement of population growth
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Malthus 1798 –
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Eugenics movement (USA – 1900-30)

Population crisis (1960-1980)
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Debates about population-healthpoverty-environment
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anti-public assistance for poor
Mexico City Conference 1984 (“global gag rule”)
Cairo Conference 1994 (focus on women’s rights)
Clinton-Gore policies (pop & urbanization)
Bush policies (“Global Gag Rule”)
Projections of late 2002 reducing concerns
Obama’s policies
Basics: Empirical evidence exists that:
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Population is growing rapidly (esp. in developing
LICs)
Migration to urban areas has increased everywhere
Poor countries have higher population growth rates
Poor families have more children
Global environment is compromised by pollution &
warming
Questions for policy:
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Are population growth, large family size, high
population density root causes of poverty, hunger,
pollution?
Is urbanization a root cause of poverty hunger,
pollution?
Does family planning reduce population growth?
Does family planning improve health and
development?
Is population a root cause of…

Poverty?
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Hunger?
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Poor families have more children
Poor countries have high growth rates
Famines in India, Bangladesh, Ethiopia
World production of food vs. population
Environmental degradation?
Contributors:
 Rich areas (fossil fuels, consumption,
waste)
 Poor areas (wood (fuel) – erosion)
Population, poverty & hunger
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India has 2x more cropped land/person than China
Bangladesh has 2x more farmland/person than Sri
Lanka
Honduras has more farmland than Costa Rica
Population and Pollution
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Average American consumes 30x more than
average African
African growth rate would have to be 10x higher to
be a problem for world’s non-renewable resources
Brazil: 2% own 60% of arable land. Logging and
cattle ranching patterns reflect land ownership
patterns
Classic Stages of Demographic
Transition
Note: Natural increase is produced from the excess of births over deaths.
Less Developed Countries Have More
Young People Relative to Elderly
Source: United Nations Population Division, World Population Prospects: The 2006 Revision,
and Population Reference Bureau (2010)
Relationships between Population,
Health and Poverty
Are there causal relationships between:
1.
2.
3.
Rapid population growth
High population density
Large family size
and health and poverty indices?
Overall answer:
 Variable associations (positive and negative)
 Usually small quantitative relationships, if any
 Not a dominant effect
Population Density
Is population density a causal
factor in poverty or malnutrition?
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High population density might potentially lead to poverty,
malnutrition, or poor health by decreasing the amount of
arable land for farming, thus reducing available food.
Also, increased density might increase pollution and
reduce fuel biomass

No analysis has demonstrated a causal link.
Note: Many of the densest populations are well off rich countries in
Europe or Asia. Pollution is not consistently associated with high
population density (e.g., USA)
Population Density (pp/km)
(among countries over 20m pop)
Poorest
Ethiopia
Bangladesh
DRC
Uganda
Myanmar
1997
34
688
13
86
62
Other countries
Vietnam
Netherlands
India
China
Haiti
Kenya
Nigeria
Kerala (30m)
2010
75
1033
28
139
71
Richest
USA
Japan
Germany
France
UK
1997
223
351
227
107
192
33
104
819
1997
25
322
225
110
230
2010
265
400
373
140
360
70
171
Source: United Nations World Population Prospects (2004 revision). Data is for 2005.
2010
32
335
231
114
255
Global Population Density
Source: http://sedac.ciesin.columbia.edu/wdc/map_gallery.jsp
Family Size
Is large family size
a causal factor in poverty?
Theoretical arguments, pro and con:
Large family size can lead to poverty by
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increasing intra-household inequality, by decreasing the
ability of women to work for pay
decreasing opportunities for education and health of
children
by reducing the family's ability to save and invest to
protect itself from unexpected decreases in income.
Large family size can operate to reduce poverty by
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providing resources to a resource-poor household (from
family chores to income generation)
providing security for old age
enlarging the pool of potential generators of wealth for
families who have income insecurity.
Why do poor families
have many children?
1.
Children as resources: labor,
income, insecurity
2.
Powerlessness of women, men
3.
Son preference
4.
Religion, social class, culture
5.
Lack of health services
Is large family size
a causal factor in poverty?
Evidence:
 Studies
from developed countries generally find
evidence of a negative impact of family size on
child well-being
 Empirical
studies from developing countries is
mixed – both positive and negative impacts
(Ahlburg, Pop Growth & Poverty1994)
 Extra
birth (twins) reduces schooling of siblings
17-34% (Rosensweig, JPolEcon 1990)
 Large
families (older children and relatives)
provide additional resources and level out
fluctuations of income in poor families
 Small
impact of family size compared to
education, assets, family income (most authors)
Population Growth
Developing Regions Make Up an
Increasing Share of World Population
World Population (in Billions): 1950-2050
Source: United Nations Population Division, World Population Prospects: The 2006 Revision, and
Population Reference Bureau (2008).
Projected Population Change
Percent Population Change, 2005-2050
Source: Population Reference Bureau, 2005 World Population Data Sheet.
Less Developed Countries Have More
Young People Relative to Elderly
Population by Age and Sex, Less Developed Countries: 2008
Source: United Nations Population Division, World Population Prospects: The 2006 Revision,
and Population Reference Bureau (2008)
Population Growth - some studies
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Regression analysis of 22 countries from 19601985: Pop growth was not associated with
changes in poverty, using different measures of
poverty, models, and time periods (Squire,
AmEcRev 1993)
No evidence of wage decrease during 60-80
population growth (accommodations –land
reform, land inputs, increased non-agricultural
employment, development of human capital of
poor)
Past population growth = higher GNP/capita
growth; recent pop growth = lower GNP/capita
growth difficult to assess cause and effect
(Johnson,Lee, Pop Growth&Devt 1987)
Other studies/observations
regarding Population Growth
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Common property decrease from 1950-80
(firewood, free ranging for animals, water,
building materials) – but result of government
policy as much as growth (Jodha 1990)
Decrease educational expense per child in
countries with larger population growth – but
mostly related to economic adjustment and
social policies (Cox, Jiminez)
Population GROWTH explained 1/3 of the GDP
per capita growth in E Asia 1960-1990
Thus, Causal effect of rapid
population growth and poverty is
basically unclear
“It is likely that …these studies are too unreliable
for significant inferences to be made, except
perhaps for two: 1) that population is not a
dominant effect—….and 2) that no analyses have
yet been conducted that fully meet contemporary
econometric standards.”
Robert Cassen, 1994, ODC
Policy Implication: “…If family planning programs
are driven by demographic goals (as they
frequently have been), they will often fail to
address women's reproductive health problems
and actually diminish the prospects of the
demographic goals being met.”
Summary
Are there causal relationships between:

High population growth
Large family size
High population density

and health and poverty indices?


Overall answer:
 Variable associations (positive and
negative)


Usually small quantitative relationships,
if any
Not a dominant effect
Bad Population Policies*
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Disinvestment in social services, i.e. SAPs
Favoring imports over production of local
goods
Taxing farmers for outputs and low
investments into agriculture
Favoring urban populations which
encourages in-migration
*From UW Demographer Bill Lavely
Does birth spacing improve health?
Birth spacing (>2 yrs) (estimates from
PRB, studies not documented)

Reduces mortality of second child by 2x
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Can prevent 25% of infant deaths
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Can prevent 25% of maternal deaths (20% if
meeting just existing demand) BUT, no change
in risk of death
Doubling birth intervals increases birth weight
3-6%; postponing birth one year increases BW
1.4-3.2%
Does family planning (in general) work?
Family Planning = Conscious effort of couples to
regulate the number and spacing of births
through artificial and natural methods of
contraception.
Among users compared to non-users
 Reduction in child mortality (~25%)
 Reduction in maternal deaths (~25%)
How?
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Reduces maternal depletion and teen childbearing
Reduces abortions (20 m/yr resulting in ~75,000 deaths)
Condom use prevents HIV/AIDS
Gives women (and men) power to choose when to be
pregnant
Source: White Ribbon Alliance for Safe Motherhood
Use of contraception
Population control programs:
“But they were so nice, you know. And they
came from distant lands to be with us. Couldn’t
we even do this much for them? Just take a few
tablets? Ah! Even the gods would have been
angry with us. They wanted no money for the
tablets. All they wanted was that we accept the
tablets. I lost nothing and probably received
their prayers. And they, they must have gotten
some promotion.”
Khanna Study, Mamdani, “The Myth of Population Control”
1972
Different Patterns
of Contraceptive Use
Percent of Married Women Using Contraception, Selected Countries
N.A. – Data not available.
Sources: Demographic and Health Surveys and United Nations Population Division, Population Reference
Bureau
100
Percentage of Women Giving Birth
by Age 20, by Level of Education
None
75
Primary Grade
Secondary Grade
50
25
Africa
Latin America,
Caribbean
Asia
(U.N. Population Fund. State of the World Population 2003. http://www.unfpa.org/swp/2003swpmain.htm )
Application of Family Planning Programs
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Large unmet need (Mozambique – 80%
want to “rest” between pregnancies)
Current demand 150 million women –
worldwide
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Low cost (~$2/cap/yr)
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Works within health care system
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Donors like it
Source: White Ribbon Alliance for Safe Motherhood
Different Patterns of Fertility Decline
Fertility Patterns for Selected Countries: 1950-2010
Sources: United Nations Population Division, World Population Prospects: The 2006 Revision;
Population Reference Bureau; and Korea National Statistics Office.
Underlying
conditions
Intermediate outcomes &
symptomatic issues
Desired
outcomes
Lower pop- density
Lower fertility
Reduced teen pregnancy
Family
planning
Birth spacing
Smaller family
size
Reduced
Maternal Mort
Education
Poverty
Reduction
Family income
National Income
(GNP/cap)
Access to
PHC, prenatal,
birth, child care
Family Nutrition
Water, San,
Hygiene
Reduced
perinatal & child
mortality
Reduced disease
(HIV, malaria,
etc)
Food and Hunger
Global Distribution of Land Cover
Per capita food production is growing
Source: suyts.wordpress.com
FAO statistics database http://faostat.fao.org
Tasteofsustainability.org
Per capita food losses and waste
by world region www.fao.org
Just 10 Multinationals Control The Global
Processed Food Industry pencecooper.blogspot.com
Developed Countries Consume
More
Climate Change &
the Environment
History - climate change awareness
1959 – Carbon warming the earth
1965 – President Johnson – “climate changes ..by
increased CO2…deleterious
1988 – IPCC formed
 NASA 99% confidence in warming trend linked
to human activity.
World conference on climate in
Toronto. Time Magazine : “Planet of
the year: Endangered Earth”
1989 – Berlin Wall collapsed “End of History” “New World Order”
History continued - Climate change
and neoliberal globalization
1992 – NAFTAs signed, Rio Earth Summit (Rio)
(“measures taken to combat climate change…should not constitute
….a disguised restriction on international trade”
1992 –1994 – WTO formed (corporations able sue
governments for climate policies)
1997 – Kyoto Protocol on emission targets
2001 – China gets full WTO membership
2005 – Trans-Pacific Partnership (TPP)

(US negotiators proposed to remove climate change provisions)
Trade agreements:
 Climate change commitment – honor system
 Trade commitments – legal framework w teeth
Health Impacts of climate change
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Malnutrition
(local food productivity)
Deaths, injuries, illness from storms,
heatwaves, fires, drought
Vectors – change in intensity and
distribution (e.g., malaria, Dengue, Zika,
cholera)
Other impacts of climate change
and pollution
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Extreme weather kills animals
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Pollution (e.g., oil) kills sea life
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Reproduction vulnerability (polar
bears, sea turtles, larvae of shrimp, clams,
oysters, humans [refineries in Louisiana,
fracking in Colorado]
Third World population growth and the environment –
a bum rap?
Is population control a reasonable
response to climate change?
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Poor populations living on the margin
of society are not the big contributors
to climate change
Policy changes regarding
sustainable economic
growth are key
Neoliberalism has hugely
worsened climate change
Neoliberal global trade
characteristics
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Huge increase in transport of goods over very
long distances (container ships, jumbo jets, diesel trucks)
Aggressive protection of patents (vs free transfer of
green technologies)
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Industrial agriculture
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Increase in extractive industries
(rich subsidies to expand energy
intensive, higher emissions model – global food system now
accounts for 19-29% of greenhouse gas emissions)
Carbon taxes or
Carbon “Cap & Trade”
Carbon credits: Sequester land, plant trees, upgrade dirty
factories, producing low-carbon energy
Gaming, “Law of the jungle” “Carbon cowboys”
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handing over land in LICs to conservation groups for money
- “carbon offset projects”
stopping bad practices to get carbon credits (e.g., stopping
flaring in Nigeria, curbing coolant venting)
For every ton of CO2 “protected,” corporations can
pump another ton of CO2 into the air
When price of carbon falls, pollution goes up
Alternative: Reducing emissions by fixed amounts
In 2013 – 130 NGOs called to end carbon trading
Emissions accounting systems
Transportation across borders not attributed to
any nation state
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Countries only responsible for pollution created inside
their borders – not goods shipped to shores
Distorts picture of global emissions – wealthy states can
say their emissions have stabilized or gone down - when
emissions embedded in their consumption have soared
during the free trade era
48% of China’s total
emissions related to
producing goods for export
What to do?
Many small solutions
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Choose the right policy battles Examples
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Examples of big change (?analogous)
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carbon tax vs guaranteed minimum income
Integrated plant management – can regenerate
soil, reduce fertilizer, pesticide, and water use
Ecuadorian constitution:
Pittsburgh law:
Abolition movement (huge economic impact for elites)
Anti-colonial independence movements
Arab spring
Social vs economic change
Alternative policies
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More efficient cars vs discouraging cardependent settlements and cheap public transit
Consume green vs incentivizing farmers for
low-energy farming
Manufacturer responsibility for waste and
pollution
Reduce built-in redundancies & obsolescence
Martin Luther King, Jr. - 1967
“We as a nation must undergo a radical revolution
of values.
“We must rapidly begin the shift from a ‘thingoriented’ society to a ‘person-oriented’ society.
“When machines and computers, profit motives
and property rights are considered more
important than people, then the giant triplets of
extreme materialism, racism, and materialism are
incapable of being conquered.”
What can we do?
Values debate
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Extraction vs regeneration
Delegitimize the current worldview of
unregulated free-market ideology
Collectivity vs economic growth and
corporate profit
Class exercise
In class, you will develop answers, with 2-4
people sitting next to you, the following
question:
 What are the three most important actions
that we, in high income countries, can do to
address global environmental change?
We will ask you to present some ideas in class.
For your write up, please list five actions
citizens can take (you are free to use ideas from
other students presented in class).
Thank you!