We must learn from how the Japanese are facing this problem. We'll have to face it too someday
This November the BBC reported on 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 – “‘Remarkable’ decline in fertility rates” – over-egged the drama because in fact the fertility rates of well-to-do countries are very low, while the rates of poor countries are very high.
The fertility of the poorer countries is easy to understand. The lack of education, low rates of contraceptive use, high child mortality and dependence on other family members inevitably result in soaring fertility rates. The prosperous countries have the opposite reasons for reducing family size. Britain, for instance has a fertility rate of 1.91 – similar to that of the United States, and higher than those of 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’s birth rate drops significantly, the first effect is the growing discrepancy between generations. The younger working generation becomes relatively smaller than the retiring generations. The Democratic Republic of the Congo, for instance, has a fertility rate of 6.1. 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 focused 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 that in Britain, and in the next 40 years Japanese women can expect to live, on average, into their 90s. More than a quarter of Japan’s population is older than 64 and this 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 and 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 United States in this regard at least partly 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.
Visit secondsightblog.net and join the discussion.