In 1965 I entered the faculty of medicine. The world’s population was just over 3 billion; that of Brazil, 83 million. Birth rates were high, and the big concern was overpopulation. The neo-Malthusian theory prevailed, encouraging the use of contraceptive methods and controlling population growth with the influence of the State. Otherwise, the world would not be able to produce food for so many people.
Rivers of money from American foundations were pouring in to stop the “rampant population growth.” No one was talking about population aging. The proportion of 60+ in the world was 4.2. In Brazil, the elderly were only 2.8% of the population, while 21.4% were children under 15 years of age.
Over the decades that I have been a doctor, a very different world has emerged. If high birth rates had prevailed, the world milestone of 8 billion would have long since been reached, and Brazil would have a much larger population than today’s 215 million.
It is estimated that Brazil will reach its population peak in 2046, with 231.1 million. The proportion of elderly people, currently around 15.5%, will double by 2050. According to the IBGE, in 2022 the proportion of people over 50 years of age exceeded that of under 30 years of age. The only segment of the population that will continue to grow throughout the century is the elderly.
This scenario of rapid aging envisioned for Brazil is shared with other developing countries, such as China. The difference is that in the Asian giant it was the result of a strict policy of one child per family, while in Brazil the drop in birth rates was as vertiginous as it was unscheduled.
Before 2000, the average number of children at the end of a woman’s reproductive life was below the level needed for replacement: two —couples need to have an average of more than two children for population growth, except in countries that receive many immigrants . Before long, women born in the 1980s and 1990s, when birth rates were still relatively high, will reach menopause. We will then have reached our population peak.
The health implications are transcendental. Focusing only on Brazil, it is necessary to formulate health policies for a much older population. This presupposes a life course perspective as no one ages “suddenly”. We are, at the end of life, a reflection of our habits and behaviors – which, in turn, depend on opportunities for them to be healthier.
Health is created in everyday life, where people live, work, move, have fun, love each other, as the WHO’s 1986 Ottawa Health Promotion Charter said. It is therefore crucial to make healthier choices easier, simpler and cheaper. Stark inequalities distinguish those who reach old age well and millions who age prematurely and poorly.
Given the impossibility of completely preventing chronic diseases associated with aging, it is imperative to postpone them as much as possible. If we gain ten, 15 years without cardiovascular diseases, hypertension, diabetes, cancer, neurodegenerative diseases, including various types of dementia, it is not only the quality of life that increases. The costs for health systems, public or private, drop significantly.
Population aging presupposes developing a culture of care. It is a civilizational landmark. It is neither feasible nor fair that the onus should fall exclusively on the family. It is the duty of the State to develop policies and interventions that share this responsibility.
It is even less fair to expect that such “care for the family” is a euphemism, that the responsibility falls to the women of the family. They take care of their children, parents, in-laws and even the husband, who is usually older, and when they need care themselves, there is no one to take care of them. Although they live longer, women suffer more from disabling diseases, such as musculoskeletal diseases. This gender issue is fundamental for a country that is aging so quickly. Men will need to stop being above all recipients of care in order to participate actively in it.
Globally, we will see challenging transformations in the coming decades. India is expected to overtake China as the world’s most populous country in 2023. They are followed by the United States, Indonesia and Pakistan, with Brazil in sixth place. In 2050, India and China will follow in the first positions, followed by Nigeria and, in the ranking of the ten most populous countries in the world, there will also be Ethiopia, Congo and Bangladesh.
The UN projects that in 2064 we will have 10 billion and in the 2080s we will reach a peak of 10.4 billion
The influential Institute for Health Metrics and Evaluation, linked to the University of Washington, projects that the world population will be 9.7 billion in 2064 and will soon begin to decline, with the exception of sub-Saharan countries. The geopolitical implications are obvious: the rest of the world is much older, huge young populations from poor countries looking for opportunities. It’s time to take demography much more seriously than we do in Brazil.
With a wealth of experience honed over 4+ years in journalism, I bring a seasoned voice to the world of news. Currently, I work as a freelance writer and editor, always seeking new opportunities to tell compelling stories in the field of world news.
