This November the BBC reported a dramatic study, published by The Lancet, which told us that falls in the fertility rate of nearly half of all countries have resulted in insufficient births per fertile woman to maintain their population. The information was described as a “huge surprise”. Not to Catholic Herald readers of course since this column described the situation, its gravity and the likely consequences back in February 2015. And perhaps the headline over-egged the drama because in fact the fertility rates of well to do countries are very low; while the rates of poor to do countries are very high.
The fertility of the poorer countries is easy to understand. The lack of education, the unavailability of contraception, child mortality and the dependence on other family members inevitably result in high fertility rates. The prosperous countries have the opposite reasons for reducing family size. The UK, for instance has a fertility rate of 1.91 – similar to the US, and higher than many European countries. The rate required to maintain the population is about 2.1.
Our first reaction might be to congratulate ourselves on our contribution to reducing the population. But, before we do so, we might consider the situation of Japan. It is seen as a model of what can happen to a modern country which reduces its population. After the War, when Japan was, in effect, under the control of the US, artificial contraception was introduced – and widely taken up. Stanislas de Lestapis, the Jesuit demographer, writing at that time about the long term consequences of reducing the birth rate, was uncannily accurate in his description of the future. So much so, that the circumstances of modern Japan are now taken as a model for our own potential futures.
The first problem is simply mathematical. If a society drops its birth rate significantly the first effect is the growing discrepancy between generations. The younger, working, generation becomes relatively smaller than the retiring generations. The Congo, for instance, has a fertility rate of about 7. Imagine the effect of that rate dropping to 2. Even allowing for substantial improvement in infant mortality, the disproportion is going to cause big problems, and will continue to do so for several generations. Lestapis focussed on this discrepancy of generations, but he was not in a position to chart future increases in longevity.
Life expectancy in Japan is already four years ahead of the UK, and in the next forty years Japanese women can expect to live, on average, into their 90s. Over a quarter of its population is older than 64 years and appears to be creating a new level of society with its own social, economic, and medical needs. One characteristic is impaired cognitive function through forms of dementia. In Japan about five million people have some form of this disorder, and this is expected to rise to seven million by 2025. By that time the cost of care, medical and other services, will be around $160 billion. Interestingly The Lancet, in a major study of increasing longevity, attributes the poor performance of the USA in this regard at least partly to “to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care.”
This alarming situation is not just a matter of concern for the Japanese, it will eventually occur in many countries including our own. Even more dramatically it may one day directly affect anyone reading this column. I can only imagine what it would feel like to have dementia. There are of course many levels and types of mental disorder but I suppose that a gradual loss of competence must be increasingly distressing. It may well be shaming too since dementia carries a social stigma. It will be easier to write us off than to offer the sympathetic care and company which we really need. As one commentator said, “Having even advanced dementia doesn’t mean people know nothing, that they don’t have feelings. All they have is deep insecurity about their memories.”
Ironically we are fortunate in just one respect: the Japanese are facing this enormous problem already. They are establishing models for the care of the aged, which we in turn will be able to adapt and use. Those among us who have relations or friends with mental disorders or other incapacities will be well aware of the coming problems. Already some will have shortened their working hours or even abandoned paid work to care for relatives. The rest of us must understand the need for a systematic approach to care for this new level of society. It will be expensive but unavoidable.