India in an ageing world: Many shades of grey

China’s leaders stuck with an emergency population plan far more severe than anything in India’s Emergency in the 1970s. As a result, it will fall off a demographic cliff. By 2100, one estimate suggests that China’s population will have fallen from 1.4 billion to 732 million.

Had China pursued a more humane policy, it could have had a gentler population slope, but that slope is a consequence of women, and their partners, having choices. When families know their children are likely to survive, they have fewer children, if they can get access to contraception. When women are educated and have opportunities, they balance having children with other aspirations, as Bangladesh shows.

A very fast rise in prosperity can do what the one-child policy did in China: South Korea is on an almost identical population trajectory. Hong Kongers are having about a third the number of children they need to sustain total numbers.

Nineteen of the 20 countries with the highest birth rates are in Africa — the exception is Afghanistan. Most of the countries with high population growth are very troubled: Chad, Niger and Somalia, for example.

No one should see Somalia as a model and no country should think about copying Iran or some of the US states in trying to force women to have children. Reproductive rights are a fundamental part of human rights, but also because we need fewer people. People are the biggest contributors to the climate crisis and virtually the sole reason for the exhaustion of the planet’s resources. Besides, it doesn’t work: It is almost impossible to persuade women who have got used to families with one or two children at most that they should have five.

The inevitable transition means that the world will get steadily and rapidly older. Difficult as it may be to imagine today, human resources will become scarce, even in India. There are three obvious ways to cope.

Artificial Intelligence (AI) might take over a higher proportion of all work as the labour force shrinks and as lots of old people need more and more services. That is not, though, what has happened in any previous technological revolution – the displaced find new jobs. Who ever imagined we would need app developers, baristas and personal trainers? AI may, though, make health more affordable as doctors give up most of the tasks they perform today and as discovery of new vaccines and medicines is turbocharged by its analytic capacity.

We might start luring in immigrants. Nigeria’s population is set to quadruple by 2100; Afghanistan won’t lag behind that growth by much. Nigeria cannot support 800 million people. The young from those areas may need to move to places where many couples are having one child or none. It will require a radical shift in thinking about culture.

Neither AI nor migration will solve most of our problems, so we need now to be focussed on the third coping mechanism: Making every person as healthy and productive as she can be.

Health is heavily determined early in life. Over the past 20 years, we have made remarkable progress in preventing diseases of childhood that can impair for life the children who survive them. Some of that progress is now being lost to anti-vaxxers whose malign influence is reaching around the world. As societies, we must also find effective ways to marginalise them.

Every human life has inherent value, but every child now has unprecedented economic value. We should be spending much more on their health.

We also need to think about how to keep the disenchanted elderly at work: They are mostly able to work for longer but, in Europe and North America, they tend to enjoy an unsustainably long retirement. In 1950, Americans received social security at age 65; by 2020, it was by 66. The world is not doing well at preparing for it silver future. American life expectancy in 1950 was just over 68; by 2020, it was over 79 years.

Some 70-year-olds will want to work like 20-year-olds; most will not. If we keep a one-job-description-fits-all approach to being an accountant or a driver or a nurse, they will retire. Fortunately, AI will make it easy for us to customise working schedules and task allocations so that a person looks forward to her 15 hours a week of work in the hospital.

To work, older people need to be kept healthy. Prevention is vital and access to care is an investment in the prosperity of our societies.

Healthy older people do not just work, they spend. Across the G20, which contains many emerging economies with young populations, 56% of total spending in 2015 came from families over 50. The International Longevity Centre UK has shown that spending just 0.1 percentage points more on preventative health can unlock an additional 9% in spending by older consumers. When you’re old, you’re not saving up for a house or your children’s schooling.

The ageing world will dominate policy as the century progresses. Those who think about it now will be best able to respond to the panic when it comes.

This article is authored by Mark Chataway, international health expert and managing partner, Finn Partners, New York.