Hungary is Hungry for People

As the Historian of the Population Association of America, I automatically keep my eye on stories that relate to Past Presidents of the PAA. I don't know how he does it, but Todd Gardner has his eye on everything and just posted a tweet link to a story about Hungarian demographics featuring Past PAA President Paul Demeny. Paul is Hungarian by birth, but received his PhD at Princeton and was President of the Population Council and Editor of the prestigious journal Population and Development Review until his retirement just a few years ago, which I commented on at the time. My wife and I had dinner with him at the PAA meetings in San Francisco just a few months before he retired, but I haven't seen him since, so it was very nice to "be in touch" again.

Hungary Today recently published an interesting interview with Pál Demény, a demographer who is researching population trends. The 85-year-old Demény left Hungary in 1956, lived in the US and now has decided to retire to Budapest. (Read here.) [And, yes, I definitely recommend that you click on that link]

He was born in Nyíregyháza, went to university in Budapest and in 1961 received a PhD in Economics from Princeton. Demény has analyzed the links between demography, economics and policies and claims that Hungary will face a dramatic population decline soon. He agrees that by 2100 Hungary’s population will be halved; it will drop to 5.4 million. According UN estimates Hungary’s population will drop to 8.3 million by 2050. Can this trend be stopped, or only slowed down?

Mr. Orbán [Hungary's Prime Minister] thinks that by spending 4.6 percent of the GDP on family support programs sooner or later fertility rates will dramatically increase. I think he is mistaken and Demény also disagrees with him. He says that Hungary’s population decrease is irreversible!

Many demographers have warned that the Hungarian government is already late to start an immigration program. Demény thinks that the population problems of poorer countries will not be solved by emigration, “because only a small fraction of the population might conceivably leave.” He is probably right, but the “small fraction” can run in the millions.

In the lengthy interview with Paul Demeny in January, referred to above, Paul discusses the immigrant issue in more detail. He also offers a very interesting stimulus to the birth rate, which I had never heard of before: give children a vote! Of course, you don't actually let them vote until they are adults, but their parents could have a weighted vote. So, if you are a mother with 2 children you would have 3 votes in an election instead of just 1. The rationale is that your vote doesn't just affect you, but also the future of your children. That adds nuance to the idea that demography is destiny.

We're No Longer Making Much Progress on Life Expectancy Gains

Yesterday I discussed the claims by Hong Kong that it has the highest life expectancy at birth in the world. Every country would undoubtedly like to be in the running for that honor as long as it means that we are all on an upward trajectory. Back in December, I noted that U.S. life expectancy had gone down for the second year in a year, after reaching a record high in 2009. Of course, even at the time of that record high, the U.S. lagged behind every other rich country in the world with respect to life expectancy, despite having the highest per person health care costs of any nation in the world.

The slowdown in the U.S. life expectancy trajectory is, unfortunately, not too far different from the global pattern. Thanks once again to Todd Gardner for pointing to a story on WebMD summarizing a recent paper published by Carolina Cardona and David Bishai, both of whom are in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. Bishai is well qualified on these topics, having a PhD in Health Economics, along with an MD and MPH, and Cardona is a PhD student of his. They provide a concise summary of their analysis:

New technological breakthroughs in biomedicine should have made it easier for countries to improve life expectancy at birth (LEB). This paper measures the pace of improvement in the decadal gains of LEB, for the last 60-years adjusting for each country’s starting point of LEB.

LEB increases over the next 10-years for 139 countries between 1950 and 2009 were regressed on LEB, GDP, total fertility rate, population density, CO2 emissions, and HIV prevalence using country-specific fixed effects and time-dummies. 

Contrary to the expectation that advances in health technology and spending would hasten improvements in LEB, we found that the pace-of-growth of LEB has slowed around the world.

The WebMD article adds a bit of background to this:

They [Cardona and Bishai] said the slowdown in life expectancy gains does not mean that humans have simply reached their maximum biological life span. Rather, the researchers argue that their findings could mean that recent medical advances have not sustained historic increases in average life expectancy.

"This is not about us hitting the ceiling," researcher David Bishai said in a Hopkins news release. "The slowdown has been sharpest in countries that have the most life expectancy to gain."

"It's a rebuke to the idea that you can fix global health just by inventing more stuff," he said. "New health technology has been essential to making strides in life expectancy, of course, but our predecessors in the 1950s were making faster progress with the basics of soap, sanitation and public health."

This latter point is one I have tried to make emphatically in my book. The big gains in life expectancy in the world have come from a combination of public health science and medical science. Both are important and countries have to invest in both in order to keep people alive longer.

Can Hong Kong Really Claim to Have the Highest Life Expectancy?

A story on CNN yesterday saw the boast from Hong Kong that it has edged past Japan in terms of life expectancy at birth. 

Narrowly beating residents of Japan and other "blue zones" such as Italy, men in Hong Kong are living, on average, up to 81.3 years and women even longer, 87.3 years, as of 2016. "Over the last few decades, (Hong Kong) has caught up in a big way," said Dr. Timothy Kwok, professor of geriatric medicine at the Chinese University of Hong Kong.

Dr. Gabriel Leung, dean of the faculty of medicine at Hong Kong University, noted that "we inched past Japan about five years ago. It's not a position that we've found ourselves in for decades."

The latest PRB World Population Data Sheet shows Hong Kong and Japan neck-and-neck in terms of life expectancy at birth for males and females, while the UN Population Division still gives Japan a slight edge. Still, Hong Kong has accomplished a lot in terms of keeping people alive from birth into old age. And of genuine interest is the fact that researchers there have been trying to figure out why this is true. Here are their hypotheses about long life in Hong Kong:

1. Easy access to everything
2. 'Greener than most'
3. Good hospitals -- for everyone
4. A determined population
5. Good weather
6. A take on the Mediterranean diet
7. The value of family

To the extent that these factors make a difference in Hong Kong, then we might expect them also to show up as causal factors in the other countries with the highest life expectancy, including Japan, Italy, Spain, Australia, Sweden, and Norway. Someone needs to volunteer to do that research...

Economic Uncertainty Keeps Fertility Low in Italy

The rich country angst about low fertility is widespread, and often overshadows the concern about fertility levels that are higher than wanted in many less-rich nations. At the same time, if we believe that every person and every population of people should aim for replacement-level fertility, both concerns are equally important. I thought about this demographic divide as I was reading the latest publication in Demographic Research--a paper by Francesca Fiori, Elspeth Graham, and Francesca Rinesi titled "Economic reasons for not wanting a second child: Changes before and after the onset of the economic recession in Italy".

This is a very nice descriptive analysis of data drawn from ISTAT (the Italian National Institute of Statistics) surveys conducted in 2002 and 2012. The authors focus on women who have already had one child and look at which ones in each of the two surveys (before and after the Great Recession) are thinking about having a second child.

Between 2002 and 2012, the proportion of primiparous mothers in Italy intending not to have a second child increased. The economic recession appears to have played a role in shaping their negative intentions, as the proportion of mothers who reported economic constraints as their main reason increased significantly.

This raises the interesting question of whether the increase in negative fertility intentions simply reflects the higher proportion of women experiencing economic hardship. Our findings suggest that it does not, but rather that it is also the consequence of a more pervasive feeling of insecurity which has affected the wider population, including those who have not been as severely hit by the crisis. Our results show a narrowing of socioeconomic differences, which indicates a greater increase in the propensity to avert risks associated with having another child among mothers with medium or high educational levels, and even among mothers with permanent employment contracts. At the same time, age differences have become more pronounced, mainly in response to the particularly adverse effect of the economic recession on younger individuals, suggesting that personal experience of economic difficulties may be more influential among younger women.

Keep in mind that economic insecurity has been rampant among humans forever, but very low fertility is a relatively new phenomenon. Obviously, it is the relative level--the gap between expectations and reality--that is important. The authors do not get into issues for which there were no data collected in the ISTAT surveys, such as the role of patriarchy and paternalism in pushing fertility to below-replacement levels in rich countries, but they leave the door open for these kinds of discussions. 

Racism in China

Racism has been an issue in the United States since the founding of the country. For that sad reason, we are familiar with the topic and race/ethnicity is routinely analyzed as an important demographic characteristic. At the same time, we generally lump all persons of Asian-origin into a single race/ethnic category, even though there is tremendous cultural variability within the Asian-American community. And, of course, we have to remind ourselves that the cultural differences are the only things that really separate people. Ethnicity as a cultural variable is real in a way that race as a biological variable is not. This latter point is important to keep in mind when reading an article in The Economist about racism in China.

Chinese officials often try to portray racism as primarily a Western problem. Yet there is a widespread tendency in China to look down on other races, especially black people. Two years ago a television ad for a laundry detergent showed a young Chinese woman luring a black man closer, triumphantly popping a detergent capsule into his mouth and stuffing him into a washing machine. At the end of the cycle, out came a fresh-faced Chinese man, over whom the woman swooned. Among the tens of thousands of Africans living in a neighbourhood of Guangzhou known as “Chocolate City”, many report racist slights.

The outraged response of many netizens in China to the African skit suggests a growing awareness at home that bigotry is a Chinese problem, too. It may be one that time will help alleviate. After all, America went from bans on inter-racial marriage to electing a black president in a mere four decades. And even those Chinese who acknowledge that China has a problem rightly observe that it is far from the worst offender. Myanmar burns Rohingya villages, Islamic State tried to wipe out the Yazidis, and Sudan until recently enslaved black Africans. Racism in China, by contrast, is seldom expressed violently.

But a problem it is, and one that is aggravated by the authorities’ efforts to suppress discussion of it (censors raced online to delete criticism of the TV sketch). The Communist Party fears that such debate may undermine its efforts to portray Chinese people as victims of Western racism during the 19th and early 20th centuries—a narrative of humiliation which the party regards as a crucial explanation of why it has the right to rule.

This is an under-appreciated demographic reality in modern China, and one that Westerners may confront in person as the Chinese government seeks increasingly greater influence in the global economy and global politics. No one can profitably ignore the country that for several centuries has had the world's largest population.