The total population of the world crossed 8 billion a couple of months ago.
Although a clear milestone has been passed, there remain additional challenges about where the population is concentrated. The population of the world is an important determinant for resources and needs of humanity and how these are met. The population map of the world is interesting to look at.
People like to have children for a number of reasons; biological, social, emotional, material, or seeking support in their old age. People need food, freedom, finances, friends and shelter. With the increasing pressures on very many limited resources, what are the responses? How should humanity look at this milestone and respond?
There are undoubtedly challenges in short, medium, and long-term. The increase in population is a result of people living longer and better infant survival. However, the recent pandemic has illustrated that longevity of population if anything has stalled. Indeed, the growth is not uniform, as was demonstrated a few days ago, when it was reported that China’s population has fallen for the first time since 1961. The Japanese Prime Minister, also, expressed concerns about Japan being on the brink because of its falling birth rate and with an increase in longevity and ageing.
At the same time, more than half of the world population lives in seven countries: China, India, USA, Indonesia, Pakistan, Nigeria, and Brazil. All the countries bar the USA are low or middle income groups, although their national economies are large enough, with China as the second largest economy and India now the fifth largest. Differential birth and survival rates may be contributing factors to these variations. Arguably, even though census data from many countries may be old, partial, or even exaggerated, these numbers in themselves are very impressive.
Pew Research reported that only 8 years ago, in 2015, half the world’s population was living in just six countries. Nigeria moved from 7th to 6th place, overtaking Brazil in these last 7 years.
As Pew Research reports, the United Nations estimate that the population will be closer to 10 billion by 2050 and pass that figure in the next 5 decades, going from 9.7 billion to 10.4. Not surprisingly, the bulk of this population growth is set to occur, and be concentrated, in sub-Saharan Africa.
This inequality of population distribution raises further challenges for the survival of humanity
We know that geopolitical determinants affect social determinants which affect health, including mental health, although there are challenges in making sense of data from population surveys in many countries.
Health inequalities occur on a gradient influenced by wealth. The impact of climate change due to deforestation, population increase, industrialisation, and urbanisation is only now being understood. The unequal distribution of populations brings with it challenges regarding access to basic resources and needs: migration, selective depopulation, unemployment, poor housing, and overcrowding.
Around the world, medical services are largely based in urban areas, making access to them by rural populations difficult.
People are living longer, but they are also likely to have multiple, often complex co-morbid conditions. This makes their healthcare needs more complex as well as diverse, for which a younger and physically able workforce may be required. This basically means that countries like Japan and China may require economic migrants, the simple idea of which is anathema to many nationalistic politicians.
With negative population growth in many countries, there appears to be an urgent need for young migrants who can help with economic growth.
There have been recent calls in the UK for retired people to return to work. In many low-income countries, where cultures are in transition, younger physically able people are moving away to towns and cities and across national borders in search of employment, while older individuals are often left to live by themselves and often consequently left feeling alone with increasing frailty.
In many countries, the notion of filial piety is beginning to change, adding to a sense of abandonment by older adults. In India, where the majority of the population is aged between 24–35, rapid urbanisation has added stress to people living in both rural and urban places. For example, in my recent visits to India, I noticed a massive demand and expansion of old people’s care homes.
In the past, the world has adapted successfully to what was called euphemistically ‘population explosion’, but at the present time, it is impossible to predict the curve of change at various levels.
India appears to be on track to most likely overtake China as the most populous nation in the world. Birth rates in Nigeria are 20 times that of China. Food security, poverty, overcrowding, and a lack of familial support are all likely to increase rates of psychiatric disorders.
How can healthcare systems cope with it?
Healthcare services around the globe need to take these population changes into account and develop services that meet the needs of these changing populations.
Services need younger healthier trainees and workers, but also more experienced individuals who can train and mentor others.
Firstly, we need culturally appropriate services. The explanatory models of mental illnesses vary tremendously according to educational, economic and social status, but are also culturally influenced. Hence, we must take full account of these. Undoubtedly these models will continue to change as cultures become less traditional.
We need to build on cultural capital and, even more importantly, as the population increases, we must use human capital properly. Use of AI is likely to increase in clinical services but will also remain supplementary in many settings. Developing community-based support systems with volunteers, community leaders, and non-governmental organisations (NGOs) will be some of the ways forward and reflect how social cohesion can work. Creating community social hubs where people can find information and seek help without facing stigma must be encouraged.
Increasing population might be a milestone, but can also be a millstone as far as resources are concerned.
In order to avoid that eventuality, we must use this opportunity to be innovative in delivering healthcare which is appropriate and helps improve the assessment and management of mental illnesses away from the institutions and close to where people live work and play.