The Still Unfinished Business From the 1994 ICPD

One of the most contentious issues at the most recent--1994--UN-sponsored World Population Conference, which is known as the International Conference on Population and Development (ICPD), was the rights of women in general, and more specifically with respect to reproduction. This week a follow-up conference was held in Istanbul, Turkey:

Lawmakers from 110 countries reaffirmed today their support to the principles and goals of the 1994 Cairo International Conference on Population and Development (ICPD), emphasizing their continued centrality to efforts to reduce poverty and safeguard people’s health and rights, including sexual and reproductive health and reproductive rights.

At the fifth global parliamentarians’ conference on population and development, held here on 24-25 May, some 400 delegates, including more than 200 parliamentarians, discussed a course of action over the coming years to implement the ICPD Programme of Action by 2014 and beyond. They also considered ways to influence any new development framework to follow the Millennium Development Goals (MDGs) in 2015

“ICPD is about human beings, respect, rights, and what we can do to ensure that every individual can make his or her own decisions,” said Dr. Babatunde Osotimehin, Executive Director of UNFPA, the United Nations Population Fund. “Only then would the world be in a better place.” 

With only two years until the Cairo agenda is expected to be complete, delegates committed themselves to its unfinished plan by unanimously adopting the Istanbul Declaration of Commitment. In it, and under the theme, Keeping Promises — Measuring Results, they determined to advocate for increased national and external funding for the entire implementation of the ICPD agenda in order to achieve access to sexual and reproductive health, including family planning.

The Istanbul conference, which concluded with an address by Turkey’s Prime Minister, Recep Tayyip Erdogan, was organized by the European Parliamentary Forum on Population and Development (EPF) and UNFPA, under the auspices of Turkey’s Grand National Assembly. It followed four similar global conferences, in Bangkok in 2006, Strasbourg in 2004, Ottawa in 2002 and Addis Ababa in 2009.

So, keeping in mind that the conference was in Istanbul and was addressed by the Turkish Prime Minister, you might be surprised then to learn that the very same Turkish Prime Minister made headlines in the New York Times this week by suggesting that abortion was murder and should be abolished.

Since 1983, abortion has been legal inTurkey for up to 10 weeks after conception, with emergency abortions allowed for medical reasons after that. Mr. Erdogan proposed outlawing all abortions that are not medically necessary, and limiting medically necessary abortions to the first eight weeks after conception, according to NTV, a private television news network.

Mr. Erdogan, who wants every married couple to have at least three children, dismissed criticism of his position, saying Friday that abortion “has no place in our values” and on Saturday that “our only goal is to elevate this country above the levels of developed civilizations, for which we need a young and dynamic population.”

This would seem to put a radically different spin on the "Istanbul Declaration of Commitment" than most of the delegates at the conference would likely agree with.

The Greek Brain Drain

One of the not-so-surprising side-effects of the budget crisis in Greece has been that younger Greeks are bailing out, creating a brain drain. We expect that those with the most salable skills are likely to be the ones to go elsewhere when the economy collapses. But what is especially surprising, according to a story today on MSNBC, is where they are heading.

Germany, Europe's economic powerhouse and a country which has been criticized by many Greeks over its harsh demands for austerity cuts in return for bailout cash, has experienced an influx of young skilled immigrants.
Der Spiegel magazine noted that while Greek newspapers "printed cartoons depicting the Germans as Nazis, concentration camp guards and eurozone imperialists who allow their debtors to bleed to death," the Greeks have kept arriving – bringing an "anything is better than Athens" attitude with them.
With more than 50 percent of young Greeks out of work, it's not surprising that official statistics show the number of Greeks who moved to Germany increased 90 percent during 2011.
Unemployment rates have consistently been shrinking in Germany in recent years and the economy is thriving despite Europe's ongoing financial crisis. Relaxed cross-border employment regulations for member states of the European Union also make Germany an attractive choice for job seekers. And while Germany is in need of specialized workers, the Greek labor market has little to offer.

This turn of events is generally good for those Greeks who can find work in Germany, although in the long term the demographic shift will clearly benefit German society at the continued expense of Greece. These younger Greeks will help to pay the pensions for aging Germans, but they will be contributing little if anything to the Greek economy. Of course, to the extent that Germany's economy is bailing out Greece, the transfer of labor power from Greece (where they wouldn't be working) to Germany (where they are more likely to be working) is probably an economically good situation.

Can the Urban Health Advantage be Maintained?

For most of human history, cities had higher death rates than rural places because crowding people together in an unsanitary environment increased the spread of disease. The public health revolution that began in the 19th century changed all that, and for the last 100 or more years, urban places have held the health advantage over rural populations. But can that hold up as more and more people crowd into cities in developing countries? That question drives much of my own current NIH-funded research and it is the topic of a Scientific American online article:

“While cities have the potential to be healthier places for their citizens, this requires active planning,”Yvonne Rydin, of the University College London’s Bartlett School of Planning, said in a prepared statement. The authors conclude that urbanization alone will not automatically help everyone lead healthier, happier lives. Already about 1 billion , and that number could double in the next 18 years. The tide of urbanization is not going to raise all proverbial ships. “Economic growth cannot be assumed to lift all urban citizens into a zone of better health,” Rydin said. “In many urban areas, rich people and poor people live in different epidemiological worlds, and the burden of ill-health is highest in the poorest groups. The double burden of communicable and non-communicable disease is borne predominantly by poor people.” To improve the health of all urban dwellers present and future concerted planning will be necessary, but global payoffs will be great.

The article unfortunately speaks to simple things like walkable neighborhoods and urban gardens. Those are the luxuries of the rich. In cities of poor countries, the health issues revolve around basic infrastructure such as clean water, sewerage, adequate housing, access to health care facilities, along with basic education about health issues, and the ability of people living on very little money to have an adequate diet that increases their chances of resisting both communicable and non-communicable disease.

Will the Arab Spring be Wasted on the Young?

Richard Cincotta is one of the foremost authorities on age structures and democracy, and the NewScientist has a story about the paper that he presented at the recent annual meeting of the Population Association of America:

A YEAR after ousting Hosni Mubarak, Egypt appears poised this week to elect his former minister of foreign affairs, Amr Moussa, as its next president. Many commentators say his presidency will differ little from Mubarak's, disappointing those who hoped to see a liberal democracy emerge from the youthful uprisings last year.

Meanwhile, Yemen elected their ousted leader's vice-president on a single-candidate ballot, violence surrounds Libya's elections and Syrian protests get bloodier by the day. Was the Arab Spring all for naught?

The recent turn of events does not surprise demographer Richard Cincotta of the Stimson Center in Washington DC. The fact that the populations of these countries are all very young, he argues, predicted not only that revolutions would occur, but also that it may be some time before they make a successful transition to liberal democracies.

Cincotta studied revolutions between 1972 and 1989, focusing on the age structure of countries. He found that oppressive autocracies with a median population age between 25 and 35 had the best chances of becoming democracies.

All of the countries that made the transition when their median age was greater than 30 are still democracies today. Nine out of 10 countries with a median age less than 25 slid back into oppressive regimes following revolution. Any older than 35 and revolutions did not occur in the first place. The only other indicator that came close to predicting transition success with the same level of accuracy was wealth per capita.

If the pattern holds, Tunisia - with a median age of 30 - is the Arab Spring country most likely to hold a democracy permanently. Egypt and Libya have median ages of 25 and 26, respectively, giving them a fighting chance of moving to democracy in the next few years, according to Cincotta. But Syria and Yemen - at 21 and 17, respectively - will be lucky to end up with even partial democracies, he says.

You can read more about Cincotta's work, along with other analyses of the youth bulge, in the recently published book that Debbie Fugate and I co-edited on "The Youth Bulge: Challenge or Opportunity."

We Are All African

A few days ago, I linked to the special issue of Nature on peopling the planet, which is based on the premise that human society began in Africa and migrated out from there over the span of tens of thousands of years. That idea draws from evolutionary theory which, unfortunately, not everyone buys into. Why unfortunate? Richard Leakey answered that question today, in a story from the Associated Press:

Sometime in the next 15 to 30 years, the Kenyan-born paleoanthropologist expects scientific discoveries will have accelerated to the point that "even the skeptics can accept it."
"If you get to the stage where you can persuade people on the evidence, that it's solid, that we are all African, that color is superficial, that stages of development of culture are all interactive," Leakey says, "then I think we have a chance of a world that will respond better to global challenges."

Thus, the point is that without this understanding of how the real really works, it will be impossible to solve the problems that we have created for ourselves by unprecedented population growth and economic development.

Now 67, Leakey is the son of the late Louis and Mary Leakey and conducts research with his wife, Meave, and daughter, Louise. The family claims to have unearthed "much of the existing fossil evidence for human evolution."
On the eve of his return to Africa earlier this week, Leakey spoke to The Associated Press in New York City about the past and the future.
"If you look back, the thing that strikes you, if you've got any sensitivity, is that extinction is the most common phenomena," Leakey says. "Extinction is always driven by environmental change. Environmental change is always driven by climate change. Man accelerated, if not created, planet change phenomena; I think we have to recognize that the future is by no means a very rosy one."
Any hope for mankind's future, he insists, rests on accepting existing scientific evidence of its past.
"If we're spreading out across the world from centers like Europe and America that evolution is nonsense and science is nonsense, how do you combat new pathogens, how do you combat new strains of disease that are evolving in the environment?" he asked.

Religion and Babies

One of my former students, Cindy Tsai, just alerted me to the fact that Hans Rosling has recently posted another video lecture (this one is 13 minutes) on TED. This one is nominally on "Religions and Babies," but the punch line is more generally on the topic of why the world's population continues to grow even though the birth rate is dropping. I love this guy's graphics, and I admit that I did not disagree with anything he said. He is not very nuanced, but he gets the point across, and it's an important one--we have to plan for a world of 10 billion people. Check it out.

Census 2010 in US was "Outstanding" According to the Census

The US House of Representatives recently voted to drastically cut the Census Bureau's budget (although that is still waiting to be debated in the Senate), so this was a good time for the Bureau to announce the findings from its post-enumeration of the 2010 Census. A random sample of households are selected in this survey and the results are then compared with the census data. Dr. Robert Groves, Director of the Census Bureau, called the census "outstanding" based on the post enumeration survey results:

The results found that the 2010 Census had a net overcount of 0.01 percent, meaning about 36,000 people were overcounted in the census. This sample-based result, however, was not statistically different from zeroThe 2000 Census had an estimated net overcount of 0.49 percent and the 1990 Census had a net undercount of 1.61 percent.
As with prior censuses, coverage varied by race and Hispanic origin. The 2010 Census overcounted the non-Hispanic white alone population by 0.8 percent, not statistically different from an overcount of 1.1 percent in 2000.

The Census Bureau attributed the overcount largely to people who own multiple homes, since the census is based initially on household addresses

The 2010 Census undercounted 2.1 percent of the black population, which was not statistically different from a 1.8 percent undercount in 2000. In 2010, 1.5 percent of the Hispanic population was undercounted. In 2000, the estimated undercount of 0.7 percent was not statistically different from zero. The difference between the two censuses was also not statistically significant.

The Census Bureau attributed these undercounts largely to the fact that higher proportions of these race/ethnic groups are renters, and renters are traditionally harder to count than home owners.

Peopling the Planet

Nature magazine has a special on-line issue this month on "Peopling the Planet," which brings together new data on the timing of humans out of Africa into the rest of the planet. As a check on up-to-dateness (if that's a word), I noted that they did indeed include the research reported in the New York Times a few days ago about the evidence that North America was likely inhabited by humans earlier than had been previously estimated.

We now know people were in the Americas earlier than 14,000 years ago. But how much earlier, and how did they get to a continent sealed off by thick sheets of ice?
Working theories vary. Some scholars hypothesize that people migrated from Asia down the west coast of North America in boats. Others suggest variations on the overland route. One theory even argues that some early Americans might have come by boat from Europe via the North Atlantic, despite the fact that the DNA of modern American Indians does not suggest European origins.

The Nature special issue isn't necessarily controversial, but it is highly informative, and I encourage you to explore it.

What's the Life Expectancy in Your County?

There are some rather remarkable disparities in life expectancy by county in the United States.

Across US counties, life expectancy in 2007 ranged from 65.9 to 81.1 years for men and 73.5 to 86.0 years for women. When compared against a time series of life expectancy in the 10 nations with the lowest mortality, US counties range from being 15 calendar years ahead to over 50 calendar years behind for men and 16 calendar years ahead to over 50 calendar years behind for women. 

Some of the disparities are sadly predictable. For example, here are the top counties in the US in terms of male life expectancy:

1. Marin, Calif.         81.6 years
2. Montgomery, Md.       81.4
3. Fairfax, Va.          81.3
4. Douglas, Colo.        81.0
5. Island, Wash.         80.9
6. Los Alamos, N.M.      80.7
7. Gunnison, Colo.       80.7
8. Pitkin, Colo.         80.7
9. Collier, Fla.         80.7
10. Santa Clara, Calif.  80.6

What do these counties tend to have in common? (hint--income).


These were among the many interesting facts that came to light in a story on the website of msnbc.com today, linking back to a paper published last year, but publicized last month by the Institute of Health Metrics and Evaluation at the University of Washington. At this latter link there is a PowerPoint presentation that you can download to look at in detail, or it will play directly on your computer. The media had especially picked up on one angle of the story--that the gap in life expectancy between men and women has been narrowing, after having widened over most of the 20th century. If you have read Chapter 5 of my text, you know that most research suggests that this narrowing of the gap has to do with smoking--women took up smoking later than men, and so the health effects of smoking, which take a long time to catch up with you--are now catching up with women, so their life expectancy is not rising as quickly as that for men. Therein lies that tale (OK, it's not quite that simple, but close to it).


More interesting from my perspective is the spatial pattern of differences in life expectancy for both men and women. Blacks have been catching up with whites over time, but predominantly black counties in the US still lag behind in life expectancy. The lack of a national health insurance scheme almost certainly accounts for a major fraction of these differences. Not all, to be sure. We know from the UK that spatial disparities can exist even when a national health insurance system has been in place for a long time. On the other hand, the UK has higher life expectancy at lower cost per person than the US.

Making Babies is Not a Totally Random Process

If you have ever thought about how many people shared your birthday (month and year), you probably came to the obvious answer--1 out of every 365 people on the planet (give or take a few, since we really should account for the leap year babies). That assumption, however, is based on the idea that the probability of conception (and the eventual live birth) is the same on every day of the year. It turns out that this is not quite the case. Demographers have known about the seasonality of births for a long time, but it is more fun when that is discovered by a lay person such as Matt Stiles, a journalist at NPR, who has a blog called thedailyviz. Recently he ran across data from the National Center for Health Statistics showing births by month in the US, which reminded us all that August has more births than any other month, suggesting that "deep in December" is when more babies are conceived than at any other time. He did a nuance to the calculation by dividing each month by its number of days, showing that September was the winner by this count, but it will refer to very early in September, so the overall conclusion about the power of winter conceptions isn't changed. In the end, though, he offers this caution:

But notice there isn’t much difference between months in the distribution of the births.

Just enough for us to notice it and comment on it... 

There May be No Such Thing as "Good" Cholesterol

The control of cardiovascular disease has been an important reason for the continued rise in life expectancy, especially in the richer countries. One of the most important risk factors for a heart attack (myocardial infarction) is high cholesterol. When we use that term generically we mean high levels of LDL (low-density lipoprotein), which causes clotting of the arteries that can then lead to a potentially fatal heart attack. LDL can be lowered by changes in diet (and exercise), often combined with drugs called statins. LDL is the "bad" cholesterol, whereas HDL (high-density lipoprotein) cholesterol has long been considered to be a "good" cholesterol, because people with high HDL are known to have a lower probability of a heart attack. As a consequence, a lot of effort (albeit largely unsuccessful) has gone into figuring out ways to raise HDL. However, a new study just published in The Lancet and reported in the New York Times suggests that the relationship between HDL and heart attack may not be causal. If this is true, then trying to raise your HDL is unlikely to save your life.

The study’s authors emphasize that they are not questioning the well-documented finding that higher HDL levels are associated with lower heart disease risk. But the relationship may not be causative. Many assumed it was because the association was so strong and consistent. Researchers also had a hypothesis to explain how HDL might work. From studies with mice and with cells grown in the laboratory, they proposed that HDL ferried cholesterol out of arteries where it did not belong.
Now it seems that instead of directly reducing heart disease risk, high HDL levels may be a sign that something else is going on that makes heart disease less likely. To investigate the relationship between HDL and cardiovascular risk, the researchers, led by Dr. Sekar Kathiresan, director of preventive cardiology at Massachusetts General Hospital and a geneticist at the Broad Institute of M.I.T. and Harvard, used a method known as Mendelian randomization. It is a study design that has recently become feasible with the advent of quick and lower-cost genetic analyses.
The study found, as expected, that gene variations that raise LDL increase risk and those that lower LDL decrease risk. The gene effects often were tiny, altering LDL levels by only a few percent. But the data, involving tens of thousands of people, clearly showed effects on risk.
“That speaks to how powerful LDL is,” Dr. Kathiresan said.
But the HDL story was very different. First the investigators looked at variations in a well-known gene, endothelial lipase, that affects only HDL. About 2.6 percent of the population has a variation in that gene that raises their HDL levels by about 6 points. The investigators looked at 116,000 people, asking if they had the variant and if those who carried the HDL-raising variant had lower risk for heart disease.
“We found absolutely no association between the HDL-boosting variant and risk for heart disease,” Dr. Kathiresan said. “That was very surprising to us.”

So, if these results are to be believed, it is still very important to lower LDL--that can save your life, as expected. But, trying to do alter your HDL may just be a waste of time.

Whites Now Account For Less Than Half of Births in the US

The top news story in the US today was the release of a set of population estimates by the Census Bureau showing that last year, for the first time in history, minority groups accounted for a majority of children under the age of one. I saw the story first in the New York Times.

Non-Hispanic whites accounted for 49.6 percent of all births in the 12-month period that ended last July, according to Census Bureau data made public on Thursday, while minorities — including Hispanics, blacks, Asians and those of mixed race — reached 50.4 percent, representing a majority for the first time in the country’s history.The trend toward greater minority births has been building for years, the result of the large wave of immigration here over the past three decades. Hispanics make up the majority of immigrants, and they tend to be younger — and to have more children — than non-Hispanic whites. (Of the total births in the year that ended last July, about 26 percent were Hispanic, about 15 percent black, and about 4 percent Asian.)
Whites still represent the single largest share of all births, at 49.6 percent, and are an overwhelming majority in the population as a whole, at 63.4 percent. But they are aging, causing a tectonic shift in American demographics. The median age for non-Hispanic whites is 42 — meaning the bulk of women are moving out of their prime childbearing years.

The problem, of course, is that older whites may not feel the same generational bonding with minority children and it is from that changing face of the youth that some of the angst stems among older Americans. On the other hand, those kids will be the ones paying the bills for the elderly.

And the fact that the country is getting a burst of births from nonwhites is a huge advantage, argues Dowell Myers, professor of policy, planning and demography at the University of Southern California. European societies with low levels of immigration now have young populations that are too small to support larger aging ones, exacerbating problems with the economy.
“If the U.S. depended on white births alone, we’d be dead,” Mr. Myers said. “Without the contributions from all these other groups, we would become too top-heavy with old people.”

Still, there are enormous challenges, especially around education, as William Frey at Brookings noted:

A college degree has become the most important building block of success in today’s economy, but blacks and Latinos lag far behind whites in getting one. According to Mr. Frey, just 13 percent of Hispanics and 18 percent of blacks have a college degree, compared with 31 percent of whites.

You can see and hear Bill Frey say these things himself on the PBS News Hour. 

Are America's "Elite" Women Ramping Up Their Fertility?

Thanks to Justin Stoler for pointing out a news item from futurity.org generated by a paper just published in the Journal of Population Economics. The authors--Qingyan Shang of The University at Buffalo and Bruce Weinberg of The Ohio State University--have found evidence that highly educated women in the United States have been having more children than in the past. The negative relationship between fertility and education is about as close to an "iron law" as you will find in demography, so this is very interesting news.

While it is still too early to be certain, research clearly shows fertility rising for older, highly educated women since the 1990s. (Fertility is defined as the number of children a woman has had.) Childlessness also declined by roughly 5 percentage points between 1998 and 2008.
“Women born in the late 1950s are the turning point,” says Qingyan Shang, assistant professor of economics at the University at Buffalo. Members of this group initially showed low fertility. But fertility increased for them when they reached their late 30s and early 40s.

The analysis pulled together data from the Census Bureau's Current Population Survey along with Vital Statistics from the National Center for Health Statistics of the US Centers for Disease Control.

The research did not directly address what factors might be contributing to the fertility increase. “We did list some possible explanations based on previous research,” says Shang, including the idea of “the learning story,” in which decisions of previous generations inform later decisions by subsequent generations.
There has also been an increased supply of personal services that have reduced childcare expenses. Other research shows men may be taking more responsibility for child care.Whether women are choosing families instead of or in addition to their careers is unclear, Shang says.“We know these women are opting for families. We don’t know if they in turn are opting out of the labor market.”The study also indicated an increase in multiple birth rates around 1990, suggesting fertility treatments may have played a role.

There is a lot of food for thought here, which should inspire follow-on research efforts. In the past, women really had to make a choice between education--especially if that was used to launch a career--and the number of children. More help around the house and more help from reproductive biology may be changing this dynamic.

Baby Boomers Are Working, Not Retiring, in Response to the Economy

Thanks to my colleague, Shoshana Grossbard, for pointing out a recent analysis of labor force data showing that the economic downturn of the past several years has had the effect of keeping baby boomers in the labor force longer than they anticipated. The story is in the Investor's Business Daily.

As the jobs crisis wears on, with payrolls still 5 million below their pre-recession peak, the share of age 55-and-older Americans working has recovered to near a 42-year high.
Workers under 55 have borne the brunt of the jobs recession, which may mean that its economic effects — due to long-term unemployment, underemployment and stretched household balance sheets — may linger.
Among those 55-and-up, the employment-to-population ratio barely dipped even in the depth of recession and is now higher than at the end of 2007. The ratio among those 25-54 remains about 4 percentage points lower than before the recession started.
For the 65-69 and 70-74 groups, the employed shares are up 1.1 percentage points and 1.6 percentage points, respectively, over the past four years.

Older workers often have the kinds of skills that keeps them valuable in the labor force, if they choose to stay. That choice is clearly driven by a person's calculation of what their standard of living will be if they leave the labor force. Social Security pensions in the United States are designed to supplement income in retirement, but not replace it. The only way to retire successfully is to have saved enough money to do so. Of course, many baby boomers thought they had done this, only to have their savings devastated by the economic crisis brought on by the banking failures. And that is why they continue in the labor force--trying to match up assets with the expected number of years for which they will need a retirement income. Keep in mind that this number of years is steadily growing, which is why younger people today will not receive full Social Security benefits until age 67 (which still may be too young).

House Votes to Lower Census Bureau's Budget--What Are They Thinking?

A few days ago, the members of the Population Association of America were alerted by email to an impending vote in the US House of Representatives aimed at cutting the budget of the Census Bureau. HR 3256 included, among other things, a provision to make the American Community Survey voluntary--a move that, if ultimately enacted--would severely limit its value. I was remiss in not blogging about this, but I did contact my Member of Congress, who nonetheless voted for this bill. Of the five Members of Congress from San Diego County, two voted for it, two voted against, and one (who is busy running for mayor of San Diego) failed to vote. That closely follows the overall vote, which was very close. The vote was a subject of an editorial in today's New York Times:

The Web site of Representative Daniel Webster, Republican of Florida, instructs visitors to click on a link for “Census data for the 8th district” to learn about the area’s economy, businesses, income, employment, homeownership and other important features. And yet, on Wednesday, Mr. Webster declared that the Census Bureau’s American Community Survey — the source for much of that data — is an unconstitutional breach of privacy.He then proposed an amendment to the bureau’s 2013 appropriation to forbid any money from being spent on the survey; the amendment was passed by most House Republicans and four Democrats.

As I pointed out to my own congressman, the cry throughout the nation is to create more jobs, but to do that businesses need information. The census, of which the American Community Survey is an integral part, is our main source of information about the United States. Without that information, we are truly walking in the dark. 

When Republicans proposed similar cuts last year, even the deficit hawks at the United States Chamber of Commerce opposed them.
The White House is opposed to the cuts and the Senate will soon have a chance to reject them when it takes up the appropriation bill. It should.

But let's not just hope that will happen. Contact your senators and push the case. 

Preventable Child Deaths Contribute to Global Mortality Levels

The health and mortality transition continues to move in the direction of people dying at older ages from degenerative diseases (albeit with some of these having roots in infectious diseases). But a new report in The Lancet by researchers at The Johns Hopkins University reminds us that children are still dying in large numbers and most of these deaths are preventable. BBC News covers the story.

The team from Johns Hopkins Bloomberg School of Public Health looked at data from a range of sources, including household surveys and registration systems for 193 countries. Mathematical modelling was used where data was incomplete.
They found child deaths had fallen by two million (26%) since 2000, and there have been significant reductions in leading causes of death including diarrhoea and measles - as well as pneumonia.
But they say there are still significant challenges.
They found two-thirds of the 7.6m children who died before their fifth birthday did so due to infectious causes - and pneumonia was found to be the leading cause of death. 
Five countries (India, Nigeria, Pakistan, Democratic Republic of Congo and China) accounted for almost half (3.75m) of deaths in children under five.

Of course, two of those five are in sub-Saharan Africa, where half of child deaths occurred, two-thirds (2.6m) of which were due to infectious causes, including malaria and AIDS. Preventing these child deaths may encourage couples to have fewer children, although that results is by means assured. Thus, we need to work to prevent these deaths at the same time that we work to provide the motivation and means for couples to limit fertility.

Infections Are an Important Source of Cancer

It is convenient to divide causes of death into communicable/infectious disease and degenerative diseases. In general, communicable disease kills younger people more than older people, whereas degenerative diseases are the kinds of things that kill older people. Researchers are increasingly discovering, however, that certain kinds of infectious diseases are actually the cause of certain kinds of cancer. If one doesn't kill you, the other might. A new study published in The Lancet Oncology by a French research team, and reported in places such HuffingtonPost, estimates that 2 million cancers each year in the world are caused by infections, especially human papillomavirus (HPV), hepatitis B and C, or Helicobacter pylori.

For men in particular, 80 percent of the infection-related cancers were liver and gastric cancers. In women, about half of the infection-related cancers were cervical cancer, according to the study.
"Application of existing public health methods for infection prevention, such as vaccination, safer injection practice, or antimicrobial treatments, could have a substantial effect on the future burden of cancer worldwide," the researchers wrote in the study.

Especially striking, though, is that infections are a much more important source of cancer in developing countries than in developed countries.

This fraction was higher in less developed countries (22·9%) than in more developed countries (7·4%), and varied from 3·3% in Australia and New Zealand to 32·7% in sub-Saharan Africa.

And equally striking is that around 30% of infection-attributable cases occur in people younger than 50 years. If you put these findings together you can see that the populations in the world that are already most susceptible to infections--younger people in developing countries--are those most susceptible to having an infection lead to cancer. 

FDA Panel Urges Approval of Drug that Prevents HIV Infection

Truvada is a medication that, if taken every day, can prevent a person from contracting HIV. This can be very important for people in high-risk situations, such as gay and bisexual men and heterosexual couples with one HIV-positive partner. The Associated Press reported today that an expert panel appointed by the US Food and Drug Administration has recommended that it be approved for sale. You might assume that this news would be widely welcomed since it would seem to offer a new opportunity to reduce HIV infections and possible death from AIDS. However, there are counter-arguments:

During the meeting's public comment period, FDA panelists heard from more than two dozen doctors, nurses and patients who said patients would not take the drug as recommended — every day, in addition to using condoms.
"Truvada needs to be taken every day, 100 percent of the time, and my experience as a registered nurse tells me that won't happen," Karen Haughey told the panel. "In my eight years, not one patient that I've cared for has been 100 percent adherent."
Other speakers worried that wide scale use of Truvada would divert limited funding from more cost-effective options. Truvada sells for about $900 a month, or just under $11,000 per year. The AIDS Healthcare Foundation, which opposes approval of Truvada, estimates that 20 HIV-positive patients could be treated for the cost of treating one patient with preventive Truvada.
"Truvada for prevention will squeeze already-constrained health care resources that can be better spent on cheaper and more effective prevention therapies," the group states in a petition to the FDA.

If the drug is approved as expected, it may simply become a boutique drug, rather than a real breakthrough. It is the latter, of course, that would be very nice, but every little bit helps. After all, 

An estimated 1.2 million Americans have HIV, which develops into AIDS unless treated with antiviral drugs. AIDS causes the body's immune system to breakdown, leading to infections which are eventually fatal. Gay and bisexual men account for the majority of cases — nearly two-thirds.
The number of new HIV infections in the U.S. has held steady for 15 years at about 50,000 per year. But with no vaccine in sight and an estimated 240,000 HIV carriers unaware of their status, doctors and patients say new methods are needed to fight the spread of the virus.

Garbage Threatens Sea Life

About 70 percent of the earth's surface is covered by ocean water, and we use it routinely as our place of refuse (not refuge, but refuse). In a relatively short span of time, this habit is coming back to bite us. Scientists at the Scripps Institute of Oceanography here in San Diego have just published results of their latest estimates of garbage in the Northwest Pacific ocean. The story was covered locally by the San Diego Union-Tribune (front page above the fold, no less) and internationally by BBC News.

The quantity of small plastic fragments floating in the north-east Pacific Ocean has increased a hundred fold over the past 40 years.
Scientists from the Scripps Institution of Oceanography documented the big rise when they trawled the waters off California.
They were able to compare their plastic "catch" with previous data for the region.
The group reports its findings in the journal Biology Letters.Researchers analyzed plastic particles reported or collected by various sources since 1972 and discovered not only a sharp growth of the “plastisphere” but also that a common insect, the sea skater, is increasingly laying eggs on the artificial flotsam. That has allowed sea skaters to boost egg densities in the North Pacific Subtropical Gyre, a phenomenon that hasn’t been documented until now among invertebrates using plastics in the open ocean.

While it is not yet entirely clear what all of this means for sea life, the consensus is that it isn't good. It is already the case that fish caught in the region have been found to have ingested plastic, and the increasing insect population is not likely to be beneficial to sea life, either. Given the worldwide reliance on fish and other sea life as a source of food (and other key products), it seems likely that our sea-borne garbage is lowering our long-term sustainability, especially in the face of continued global population growth and the demand for higher standards of living.

Can More Than 7 Billion People be Sustained?

In a nice coincidence of timing with the PERN cyberseminar on population and sustainability, I have been asked to write an essay for the ABC-CLIO/Greenwood Press World Geography database. The question posed is this: "Is a world population of over 7 billion sustainable?" If you've read my chapter on Population and the Environment, you'll know my answer to that question. My general position is that a population of more than seven billion people is only sustainable if we are willing to accept either continued gross inequality in standards of living around the globe, or if everyone is willing to accept a lower standard of living. I do not believe that the earth has enough resources for more than seven billion people to live sustainably like Americans or Europeans. 

So far, none of the people posting comments on the PERN cyberseminar have disagreed with this perspective. Keep in mind that I don't like to have this view of the world. I would very much like for every one of the 9-10 billion likely alive at mid-century to live sustainably at the current level of Americans an Europeans. However, all of the available evidence suggests that to do so will require a miracle...and in the meantime there is a continual push in the rich countries to somehow raise our standard of living even higher.

Bringing the Population-Sustainable Development Debate to a Higher Level

Today is the first day of a PERN (Population-Environment Research Network) cyberseminar on "Bringing the Population-Sustainable Development Debate to a Higher Level.” The cyberseminar will be open through Monday, 14 May, and you can participate by sending an email to: pern-m@ciesin.columbia.edu. If you are reading this after 14 May 2012 you can find the posts to the cyberseminar at the CIESIN website at Columbia University.


PERN is a is a project of The International Union for the Scientific Study of Population (IUSSP), and the International Human Dimensions Programme (IHDP) on Global Environmental Change. Bill Butz of IUSSP sent out these background notes to the cyberseminar:

The title of this seminar is meant to suggest that the pathways through which population factors affect development are higher, broader, and more complex than any one dimension.  Population size is one dimension.  So is the rate of population growth or decline.  Likewise, distribution by age and geography.  Alongside are the acquired characteristics of people: their schooling, health, and nutrition.  And their behaviors:  consumption, work, migration, and how they live together in households and networks.  Gender considerations may be important in any of these areas. In general, any of these dimensions may influence people’s ability and willingness to engage in mitigation of environmental challenges, their effectiveness in adapting to such challenges, and their success in developing and adopting new approaches and technologies across the spectrum of daily life.

Which of these dimensions are important in which geographic, environmental, and economic circumstances is a matter for research.  I hope that our discussion this week will bring to the table the research that exists and, equally important, help to prioritize the data and research still required, for policymakers and the interested public around the world to know which policy areas—education, health, family planning, consumption awareness, or others—deserve attention in particular circumstances.

As background information,  two recent international efforts have focused on bringing population considerations into prominence at the United Nations Conference on Sustainable Development to be held in Rio in June (Rio+20). In one effort, a global forum of experts met under UNFPA sponsorship in late November at IIASA in Austria to bring data and research to bear on these  higher-level population relationships. Under the broader umbrella of the Wittgenstein Centre for Demography and Global Human Capital, their summary document, the Laxenburg Declaration on Population and Sustainable Development, was announced in a 24 February 2012 letter in Science magazine. In the other, The Royal Society's expert international working group, chaired by Nobel Laureate Sir John Sulston FRS, oversaw a study which resulted in a major report, People and the Planet, which was released on 26 April 2012 (http://royalsociety.org/uploadedFiles/Royal_Society_Content/policy/projects/people-planet/2012-04-25-PeoplePlanet.pdf). They conducted a wide-ranging evidence-gathering exercise involving meetings with government, industry, academia, and intergovernmental and non-governmental organizations in the UK and overseas, as well as an open public call for evidence. Some of the experts from the IIASA and Royal Society studies will be joining our discussion.

Germany Contemplates a New Family Policy

Women in Germany currently are currently bearing an average of 1.4 children, which is more in line with Germany's eastern and southern European neighborhoods than with its western and northern European neighbors, where fertility is slightly higher, although still below replacement level. A major explanation for low fertility is the difficulty facing women in combining a career and motherhood in a society like Germany where very traditional attitudes persist regarding gender roles. The belief is that women belong at home with the children, and that doesn't square with maintaining a career. Into this situation the German government is thinking about injecting a new family policy, as reported in this week's Economist:

CRITICS call it a “hearth bonus” or “keep-your-kids-out-of-school money”. The government prefers Betreuungsgeld (“child-care benefit”). Few of its ideas are as contentious as a planned €150 ($199) monthly payment to parents who do not put their children into crèches [day care centers].

The issue is whether this really fixes any of Germany's demographic problems:

Germany’s long-term worries include a shrinking and ageing population, immigrants who are not fully integrated into the workforce and women who are both underemployed and underpaid. German women work fewer hours than women in most other OECD countries (see chart). The gap in median pay is the third-widest in the club, after South Korea’s and Japan’s. That is partly because mothers stay at home. In 2008 just 18% of children under the age of three were in formal child care, against an OECD average of 30%.

It appears that the new family policy would not really accomplish the objective of helping to raise the birth rate--if that is the objective. Subsidized day care--essentially the opposite of what this legislation proposes--is much more likely to promote among women a belief that they can work and also have a second child.

Missing Girl Babies in Canada

Asia has become famous for its distorted sex ratio at birth, caused by the desire for boy babies in an era of ultrasound procedures that allow the identification of a fetus's sex in utero. But Canada? This week's Economist reports on a study recently published in the Canadian Medical Association Journal showing that there were fewer girl babies being born in the province of Ontario than you would expect among the 767,000 babies born in the province between 2002 and 2007. Ontario takes in a lot of immigrants, and the key to the puzzle lay in the mother's country of origin.

For first-born children, the sex ratio was normal—105 baby boys to 100 baby girls (since boys are slightly more vulnerable to childhood diseases, this ratio provides for equal numbers at marriageable age). For second children, the ratio was normal for mothers born in Canada. But mothers born in South Korea bore 120 boys for each 100 girls. And for Indian, Filipina and other East Asian mothers, the ratio was 110-111 to 100. The explanation for this pattern in India is that couples welcome a first-born of either sex, but if she is a daughter, then some ensure the second child is a son. That applies even more to third children: in Ontario, mothers born in India gave birth to 1,883 sons and 1,385 daughters, a hugely distorted ratio of 136 to 100.

The only likely explanation is that some mothers from India are using information from ultrasound examinations to abort a female fetus. This sort of blatant and fatal gender bias is now illegal in both China and India, but of course even if it were illegal in Canada it would not likely stop until the parents themselves adapt to western cultural views of gender equality. However, the authors of the study note that despite the overall gender bias among immigrants from south Asia, the distorted sex ratio is much more pronounced among those from India--a secular state--than from Pakistan--an Islamic state where abortion is strictly forbidden by that religion.

What's in a Name--Redux

I have already talked about the the idea that our names provide important and useful demographic clues. Thanks to the AAG Smartbrief, I have been alerted to yet another interesting example. Researchers in China have discovered that analyses of surnames by region provide evidence of migration patterns.

A region with high surname similarity indicates that a stable population has inhabited the area long enough for drift to take place. A region of low surname similarity suggests the migration of different groups of people into the area. 
Although researchers have studied surname structure to deduce the relatedness and movement of populations in a number of other countries, China's family names possess some unique features. The country's recorded history of surnames stretches back 4000 years, and Confucian traditions dictated that surnames were consistently passed through the paternal line without hyphenation or other changes. This stability provides a rare opportunity to study the effects of drift over a long period of time. 

But one of the most interesting things about the Chinese research is the limited number of surnames:

 Furthermore, the total number of family names in China is staggeringly small. The 1.28 billion people included in the new study shared a mere 7327 surnames (compared with nearly 900,000 last names documented in a study of 18 million people in the United States). This name pool is limited partly because Chinese surnames traditionally consist of a single character. Another factor is that about 85% of the population shares the 100 most common surnames and one-fifth of Chinese people have the surnames Wang, Li, or Zhang. 

And what did they find that was relevant to our understanding of migration?

The similarity in surnames between two locations tended to decrease as the distance between the locations increased. This "isolation by distance" is a hallmark of drift happening over a long period of stable habitation. However, the researchers also found evidence of migration's influence. The counties along either side of the lower Yangtze River exhibit very low surname similarity. This diversity is perhaps due to the many large-scale migrations to this region over China's history, the authors say. In addition, the very high surname similarity between the eastern province of Shandong and a cluster of provinces in the northeast of China may reflect the migration of more than 20 million people from Shandong to the northeast in the 19th and 20th centuries. 

In the United States, there is a very high correlation between the percent of people in an area with a Spanish surname and the percent of people in that area who have roots in Latin America. Of course, some people have a Spanish surname and are not from Latin America and vice-verse. Thus, you don't want to use this information to say too much about specific individuals, but the data provide trends at the neighborhood or regional level.

Geography of Health in the US

The American Public Health Association has highlighted an updating of a very neat US health resource available on the internet--rankings of US counties by health and health predictors.

Released in April, the third annual County Health Rankings report ranks the counties within every state, using health outcomes as the primary indicators for assessing a county’s health. To assign ranking, researchers gathered data on premature death, poor physical and mental health days, smoking, physical activity rates, teen birth rates and motor vehicle deaths, among many other factors. The report also takes into account environmental factors, such as poor air quality days and access to healthy foods, and clinical indicators, such as mammography and diabetes screening rates.
“All public health is local,” said APHA member Patrick Remington, MD, MPH, co-director of the County Health Rankings project, which is sponsored by the Robert Wood Johnson Foundation. “When you focus your lens at the state level, you’re able to see even more variation…and the resolution of your view depends on what policies you’re considering. Since public health really is administered at the state and local levels, this helps people get a better look.”

This is a classic case of scale issues--relationships are often different at one geographic scale (e.g., counties) than another (e.g., states). The rankings themselves are very interesting and thought-provoking. Why, for example, is my county (San Diego) ranked 18th in the state? Since there are 52 counties in the state, that's not too bad, but the website allows you to make comparisons with other places, so that we could work out the underlying reasons for San Diego County not being closer to the top.