The world’s population is 8 billion today. It is a moment to celebrate the advancement of human health and longevity.
We have come a long way since the dire predictions of Malthus, a philosopher who had envisioned doom in the 1798 foretelling, that the world would lack the capacity to feed growing numbers of human beings and animals.
Malthus has been proved wrong. The global population is growing at its slowest rate since 1950.
Fertility has fallen markedly in most countries and future growth will be concentrated, hereafter, in only eight countries – five of which are in Africa, the remaining three being India, Pakistan and the Philippines.
The two largest causes of death, maternal and infant mortality, have seen huge reductions across the world.
Next year, as India becomes the most-populated country in the world overtaking China, it is time to reflect on our opportunities as well as challenges.
All Indian states except five -- Bihar, Uttar Pradesh, Meghalaya, Manipur and Jharkhand -- have achieved replacement levels of fertility despite being considered unattainable quite recently.
Although UP and Bihar constitute the largest percentage of India’s population taken together, and where the problem of high fertility continues, it is fortunately confined to specific districts.
With greater focus and better availability of contraceptives, the challenge can be overcome.
The average Indian woman now will be giving birth to only two children - to replace herself and her husband.
India’s workforce will remain buoyant until 2055 which bodes well for productivity.
The dependency ratio will also be very favourable with enough young people to look after the old.
Window closing in the South
Although all this makes India the envy of the world, there is a catch.
Japan and Europe have reached irreversible levels of low fertility. China is not far behind as it faces the double brunt of low fertility and the aftermath of its 'one child' policy.
Chinese couples are unwilling to have more than one child despite extraordinary state support to produce more babies.
India will no doubt have an abundant supply of young people, but not for long or universally.
We must become aware that the window of demographic opportunity has already begun closing in the southern states which are fast ageing.
Kerala and Tamil Nadu which had pursued the goal of nurturing a small and educated population right from the 70s and 80s now face the prospect of growing cohorts of the elderly in need of support services and care.
It will need farsightedness and careful planning to equip young men and women from the prolific north to fill these gaps.
The signs have, however, not been welcoming even as insular mindsets are exploited by political forces to shun outsiders.
Unless a spirit of multiculturalism is imbued right from a young age, it can become a case of a lost opportunity.
Farsightedness and careful planning
Skilling continues to be wedded to present-day needs. Unless there is a clear vision about how Indians can fill the gaps in support and caregiving in Japan and Europe, not now but 10 to 15 years down the line, the school education curriculum will not adjust to foresee those opportunities.
Vocational education and skilling have an opportunity to cater to the needs of countries where life expectancy is already very high and will remain that way for the foreseeable future.
One of the biggest challenges in India will be to cope with increased urbanisation.
As parents will have just two children or even fewer, they will do whatever is in their means to make their progeny “succeed in life”.
The natural tendency would be to give education as their income permits to encourage their children to find a middle-class foothold in the cities.
While the general perception of planners is that urbanisation is a good thing, unplanned urbanisation can prove to be disastrous as we are already witnessing in major cities in India.
Investment in satellite townships, with proper drainage, sewerage and connectivity will be needed to avoid the spectre of unauthorised colonies that have sprung up in India’s major cities making many unliveable.
The healthcare sector has begun reinventing itself. Gone are the days of family practitioners, neighbourhood clinics and nursing homes that could take care of day-to-day problems.
Most hospitals have moved into multi-specialty, super specialty and quaternary care that will prolong life but not necessarily enhance its quality.
The challenge will be to prevent large swathes of the younger population, including children, from falling prey to unhealthy eating and lifestyles.
Preventive health - will become hugely important. Today of all healthcare functions, only 7 percent is spent on preventive health while more than 80 percent is spent on treatment and cure.
As the population grows and ages the challenge will be how to prevent illnesses caused by unhealthy lifestyles – even as new infectious diseases, epidemics and outbreaks become increasingly transmissible in a globalised world.
The world’s population is a good news story thanks to medical advances and technological prowess.
But now its real success will be the capacity to live in harmony with one another and with nature.
(The writer is the former secretary in the Health Ministry and first executive director of the Jansankhya Sthirata Kosh-National Population Stabilisation Fund)
