Population aging, health care, and growth

This paper constructs a small open two-sector (health care and non-health care) overlapping generations model and investigates how changes in the demand for health care induced by population aging influence the economy’s employment structure and per capita income growth rate. We show that population aging induces a shift in labor from the non-health care sector to the health care sector and lowers the per capita income growth rate. This paper also investigates public policy for child care and demonstrates the existence of an intergenerational conflict between current and future generations concerning public policy on child care.     

How a trend towards a stationary population affects consumer demand

Abstract During the great depression of the 1930seconomists in both the United States and Europe tried to analyse the economic consequences of declining rates of population growth. Not only were birth rates in many industrial countries at the lowest levels ever, but they coincided with high rates of unemployment. Of the many economists who held that demographic trends were partly responsible for the adverse economic conditions, a prominent example was John Maynard Keynes. According to his so-called stagnation thesis, population growth stimulates investment demand in two ways: more people need more goods and services and, hence, more investment in factories and machinery; and with population growing, businessmen are more likely to regard their investment misallocations as less serious than when the growth is slow or nil.(1)A minority of writers were more optimistic about the economic consequences of slower rates of population growth. For example, Thompson argued that with a lower ratio of consumers to producers the population would enjoy a higher standard of living and the education of children should improve.(2).     

We must pay attention to the difference between the original intention and the current status of family planning]

Due to imperfections in the current family planning (FP) policy, and the differences un program implementation in urban and rural areas, the fertility of the urban population with higher IQ scores is under control but this is not the case for the rural population. Among rural couples, one child is rare and two or three are commonplace, while in cities over 70% of couples are having one child. In the metropolitan cities, this figure is about 90%. In the rural areas, provision of education is a serious problem because of insufficient resources, a lack of qualified teachers and inadequate facilities. At the present, at least 3 million school age children in rural areas can not go to primary school. Besides there is a big contrast in FP practice between Han nationality and minorities. Population growth is basically under control among the more advanced Han nationally but not among the less advances minority nationalities. This growth rate among the minority population was about 50.27/1000 in the past five years, which is alarming. Furthermore, the couples given opportunity to have a second child are often those whose first child had birth defects or is mentally retarded, whereas couples with a normal child can have only one child. This has become a vicious circle, since subsequent children are more likely to have the same birth defects. It was discovered from a 1983-85 survey that the prevalence of birth defects was 12.8/1000. The current situation is that the fertility of urban, educated, and healthy people is restricted while the less educated, those living in less developed areas, and those with health defects are having more children. The outcome of this situation is the decline of national population quality, which greatly deviates from the original intention of the FP.     

Some problems about the policy of controlling population growth in China]

This discussion of some problems regarding the policy of controlling population growth in China focuses on the formation and the development of the policies of planned population growth control, how demands of modernization require a policy of only 1 child for each couple, and the need for ideological education as well as essential economical and administrative measures. The process of forming and developing the population control policies of China can be divided into 3 phases: the mid-50s to the early 1970s; the early 1970s to March 5, 1978 -- the date the new constitution became effective; and March 5, 1978 to the present. The 1st formal policy on planned popultion control emerged in 1956 at the 8th national meeting of the Communist party. The necessity for propagating planned birth control and advocating planned birth was recognized at this time. During the 2nd phase, the planned birth program was almost stopped by interference from an anti-revolutionary group. The maladjustment between population development and economic development were getting worse during the 1966-1971 period. Health services in both rural and urban areas were developed, and maternal and child health care services were reinforced in order to lower the death rate and to increase the practice of birth planning. The objective was to adjust the birth rate by improving production development and the living coinditions of the people. The new constitution indicated that the country should advocate and practice planned birth. The special committee on planned birth of the State Council, meeting in June 1978, established guidelines for the national planned birth program. The population policy of only 1 child for each couple was proposed for the longterm benefit of China and its people and because of the urgent demand of the 4 modernizations. The indication of the achievement of the 4 modernizations by the end of the 20th century is a per capita income of 1000 United States dollars. To reach the $1000 figure, the per capita income needs to be increased 3-fold. This is a difficult task, and to realize it effort must be placed on both material production and population control. Problems that may result from the advocation of only 1 child for each couple are reviewed. The way to promote the exeuction of the policy of planned control of population growth is to apply ideological education as the major method and to integrate it with economical and administrative measures.     

The family planning law should be issued as soon as possible]

China is facing a baby boom in the next ten years. Now is a perfect time to formulate legislature on family planning (FP) to strengthen the current policy and regulations in order to slow the momentum of excessive population growth. As a result of current economic reform and implementation of the rural household responsibility system, the migrant population has increased tremendously. The fact that millions of rural farmers are shifting to non-agricultural areas created new challenges to the effectiveness of traditional measures of the FP program. Promulgating laws and legislature will facilitate the job of FP. The law should stress the restriction of population growth and encouraging one child per couple. In the rural area it is not feasible to implement the one child policy indiscriminately. Under the policy of one child for a majority of the couples, no third birth is permitted. Local governments should be given the authorization to grant permission for second births for special cases within the birth planning quota. Allowing people living in poor and less developed areas to have more children and granting mothers of handicapped children permission to have an additional child were in fact facilitating the deterioration of the quality of the population. Some current policy in rural income distribution and social welfare was beneficial to large-sized family. Such policies should be changed to give incentives to small-sized families.     

Is it necessary to control the population growth of national minorities]

In the process of Socialist construction and modernization, the development of the population of national minorities deserves our attention because it is directly related to the economic and cultural development in the areas inhabited by such national minorities, and it has a great impact on the welfare and future of those people. Moreover, the population growth of the minorities is a key factor in the national population control strategy. A rapid population growth among the minorities has caused serious problems in distribution of farm land and food supply, low personal income, a rise in the unemployment rate, and a rise in the illiteracy rate. This has prevented a rise in the living standard among the minority population. In order to prevent and solve population problems among the minorities, we must take appropriate measures according to local conditions to control population increases. Through popularization of education, population growth may be put under control. For those people who volunteer to practice family planning, the government should provide all kinds of assistance. At the same time, an effort is needed to introduce the necessity of improving birth quality, to popularize new methods of child birth, and to develop health and medical care for the general public, so that the quality of the minority population may be gradually improved.     

Conceptual and ethical problems underpinning calls to abandon vaginal breech birth

The view that vaginal breech birth is unjustifiable due to neonatal safety concerns has resulted in continued calls for breech pregnancies to be managed via a policy of planned caesarean birth. Vaginal breech birth has of course always occurred, but women with term breech pregnancies who seek to have a vaginal birth often face coercive pressures to have a caesarean birth instead. In this paper I argue that even if there is population level evidence that vaginal birth is relatively riskier for the breech presenting fetus, implementing a policy of planned caesarean birth would essentially be an unjustified attempt at forced medical intervention upon women. Advocates of a policy of planned caesarean birth often conflate the acceptability of allocating participants to a treatment group (policy) within the context of a randomized controlled trial with the justifiability of doing that as part of individual health care. Calls for obstetricians to “abandon vaginal breech birth” mistakenly position vaginal breech birth itself as a form of medical intervention that can simply be removed as an option for women by obstetricians. In reality, abandoning vaginal breech birth would entail abandoning women by denying them access to healthcare options that are otherwise available to any woman having a vaginal birth.     

A survey on the sex ratio at birth in Beijing]

A survey was conducted on the sex ratio at birth in Beijing for the period between 1964 and 1982. In the 1960s, birth control ideas and plans were first introduced. In the 1970s, birth control measures were gradually taken to curb the population growth. In the 1980s, the policy of 1 child for each married couple was adopted and put into practice. Although the birthrate is being maintained at a low level, the number of childbearing age women has increased, and the birthrate has shown some increase. Statistics show almost equality in the sex at birth, but the number of newborn boys is slightly higher than that of newborn girls. Under the influence of Chinese tradition, a great many people in the countryside still prefer to have boys rather than girls, and they might have reported fewer newborn girls than the actual number. The average sex ratio for the past 3 years has still been close to a balance. With the practice of 1 child for each family, the sex ratio has been maintained close to a balance. This overall situation is made possible because of the development in the quality of birth and eugenics and the improvement in health care.     

我国独生子女规模估计及其生育政策调整对未来人口控制的影响

本文对目前人们关心的有关独生子女的生育政策是否应该调整、调整生育政策会对我国人口发展产生那些影响等问题进行探讨.为了实现这一目的,本文首先给出我国城镇人口中独生子女的规模和年龄分布估计的方法和模型,然后,利用得到的估计值对不同的独生子女生育政策进行队列模拟,通过比较得出结论.     

Continue to encourage one couple to have one child]

The Chinese State Council exhorted the masses in 1984 and 1986 to improve upon its adherence to the birth policy. The policy of 1 child per couple is the proper policy reflecting specific historical conditions. China's goal to modernize cannot be realized if the population grows unchecked. With the exception of minorities and certain rural families, all couples are affected by this policy. The 1 child rate jumped from 20.73% in 1970 to 58.3% in 1984, while the 3 child rate dropped to 19.8% from 60.21% during those years. In order to solve one of China's major future population problems, it is necessary to continue advocating 1 child per couple. With the 1986 population at 1,060,080,000, China's average per capita income is among the lowest in the world. It is not enough simply to improve the economy. Population growth must be contained at 1,200,000,000 by 2000. If every couple were permitted 2 children, and allowing for unplanned births, the population would be 1,300,000,000 in 2000. Therefore, it is essential to encourage more couples to limit families to 1 child through example by officials, propaganda, material incentives and priorities in jobs and housing.     

The impact of child care on fertility in urban Thailand

Women’s labor force participation in Thailand, particularly in the modem sector, recently has increased in conjunction with rapid declines in fertility. This paper examines whether a relationship exists between child care considerations and fertility decision making among Bangkok women. Although the two-child family has become the norm in recent years, and although most respondents said that ideally they would like to have two children, a high proportion of women surveyed said they planned to only have one child. Women’s work status and type of employment is found to strongly affect the likelihood of having a second birth: those who work at jobs that not only are low-paying but are located in a formal setting are least likely to have a second child. The type of child care for the first child also has an impact: those whose first child is in a less preferred situation are less likely to have a second. Variables measuring the need for and type of child care are found to have greater consequences for fertility than do usual measures of socioeconomic status.     

Paperbark and pinard: A historical account of maternity care in one remote Australian Aboriginal town

Background and aimMaternity care in remote areas of the Australian Northern Territory is restricted to antenatal and postnatal care only, with women routinely evacuated to give birth in hospital. Using one remote Aboriginal community as a case study, our aim with this research was to document and explore the major changes to the provision of remote maternity care over the period spanning pre-European colonisation to 1996.MethodsOur research methods included historical ethnographic fieldwork (2007–2013); interviews with Aboriginal women, Aboriginal health workers, religious and non-religious non-Aboriginal health workers and past residents; and archival review of historical documents.FindingsWe identified four distinct eras of maternity care. Maternity care staffed by nuns who were trained in nursing and midwifery serviced childbirth in the local community. Support for community childbirth was incrementally withdrawn over a period, until the government eventually assumed responsibility for all health care.ConclusionsThe introduction of Western maternity care colonised Aboriginal birth practices and midwifery practice. Historical population statistics suggest that access to local Western maternity care may have contributed to a significant population increase. Despite population growth and higher demand for maternity services, local maternity services declined significantly. The rationale for removing childbirth services from the community was never explicitly addressed in any known written policy directive. Declining maternity services led to the de-skilling of many Aboriginal health workers and the significant community loss of future career pathways for Aboriginal midwives. This has contributed to the current status quo, with very few female Aboriginal health workers actively providing remote maternity care.     

Projected consumption patterns for a stationary population

Abstract Recently economists have demonstrated a renewed interest in the population problems of a mature society. This revival of interest has been sparked by the general recognition of the relationship between population growth and environmental problems and has led to general acceptance of the proposition that ' ... a zero rate of population growth is the only equilibrium rate that can be sustained'.(1) Consequently the literature produced during the discipline's last period of similar concern, a period running from the late 1920's through the 1940's, needs re-examination. At that time economists were primarily occupied with the implications of a declining rate of population growth and most anticipated the arrival of a stationary population within the foreseeable future. For most of the economists of this earlier period the onset of a stationary or declining population was fraught with dangers for mature capitalism.     

On the situation and tasks of current birth planning work]

This is the text of the closing speech delivered by the author at the 2nd Chinese National Symposium on Population Theories held on December 13, 1979. The meeting had been successful for several reasons, including the concern, support, and leadership of the State Council, provincial, and revolutionary committees. Under the leadership of the State Council, targets of natural population growth rates were established for 1980 and 1981. Financial rewards for couples producing only 1 child had been planned. Contraception, adequate child care, and eugenics were stressed. Attendants were urged to learn from Sichuan's successful experience. During 1979, a policy was established that advocates 1 child/couple and penalizes couples producing 3 children. Agreements were signed with the UN whereby China would receive US $50 million during 1980-1983 for equipment upgrading, education, and other related purposes. The goal for a 1% growth rate could not be achieved in 1979; the actual rate was probably about 1.2%. The major reasons for this failure could be attributed to traditional feudal concepts still prevalent among many Chinese as well as to organizational problems among birth planning units and technical problems in birth control. With goals of population growth set for 1980, and 1985 and zero growth at 2000, China would encounter tremendous difficulties in its efforts to achieve them. However, under the determination and leadership of the central government coupled with valuable experience over the past 30 years, these goals would be attainable.     

中国普遍二孩生育的政策环境与政策目标

普遍二孩生育政策的实施效果,不仅涉及人口长期均衡发展目标的实现,也决定着生育政策下一步改革的方向和速度。文章围绕“谁来生”（生育主体）、“如何养”（社会经济条件）、“生多少”（生育文化）三个问题,着重分析了中国普遍二孩生育的人口环境、社会经济环境和政治文化环境。结果显示普遍二孩生育政策并不会起到立竿见影提升生育率水平的效果,其对劳动力短缺、人口老龄化等结构性问题的解决也不会是即时的。文章对这一政策的可能效果与实现政策目标的关系进行了理论上的探讨,认为政府工作的重点须顺应政策环境的变化,努力创造生育友好型社会,而不是急于求成再次贸然改变生育政策。     

Theory and methods in China's population policy]

Before 1949, China's population development was noted for its high birth rate, high death rate, and low natural growth rate. After 1949, the death rate showed a large-scale decline, the birth rate was maintained at a high level, and natural growth rate also remained high. Between 1949 and 1973, the natural growth rate was kept above a 2% annual rate. Since then, the need for population control has become increasingly obvious. The theory and methods of China's population policy can be summarized in the following points: (1) material production has to keep up with the pace of population growth, and that means the quantity and quality of the population have to match athe production of materials needed for life and consumption; (2) in a Socialist society, material production and population growth have to develop with well-designed plans; (3) the population question has a direct impact on social and economic development; (4) through enforcement of a national policy, cooperation from different individuals, and ideological education, family planning will gradually be accepted by the general public for the well-being of the country.     

Advocating "one couple with one child" being an optimal choice]

Zero population growth within the next 5 years in China would be reached only if many couples were not allowed to have their own child. On the other hand, if every couple were allowed to have 2 children China's population would reach 1500 million within the next 50 years. It seems advisable to advocate the "1 couple 1 child" idea; couples will have to keep in mind both the national interest and the communist ideology; social welfare to assure good living conditions for the old people will relieve the worries of parents with 1 child only. Most people are willing to follow this decision made by the Communist Party; many people declare their willingness to stick by this rule during their wedding ceremony; many couples send back their permit to have a second child, and many women choose abortion when pregnant with a second permitted pregnancy. By the end of 1979 the proportion of "1 couple 1 child" couples was 90% in many large cities; people realize that the practice of "1 couple 1 child" is the best assurance for the future of the country and of their children. This policy will not result in aging of the population, lack of manpower and shortage of soldiers; even if birth rate were 1% in 1985 the proportion of older people for the next 25 years will still be lower than that in European countries. The problem of aging of the population will not occur in this century, and population policies can always be adjusted when needed. Today's problem is to control population through the "1 couple 1 child" policy, even if it may result in many lonely old people, which is a lesser problem than too many people. Even if China has reduced its population growth by 10 million births each year from 1970 to 1979, the necessity to control population growth is still present, in the interest of the country and economic development.     

Control of population by economic means]

Education alone cannot effectively control population growth. Benefit to the individual must be coordinated with the benefit to the community and the country. It is absolutely necessary and possible to control population by economic means. The economic policy in Tienjing includes: 1) give preference to single child families in child care, health benefits, education, and employment, and financially punish families with more than two children; 2) establish a better rationing policy, one not based on a per capita ration, and give preference to single child families; 3) establish retirement benefits and guarantee higher living standards for retirees who have either no children or only 1 or 2 children, and give paid sick leave to people experiencing complications following sterilization operations; 4) establish equal inheritance rights for both male and female offspring; and 5) give bonuses to units with excellent family planning results and to medical personnel with fewer complications during sterilization operations, and financially punish groups with poor family planning results. In order to effectively implement the economic means, coordinate bonuses with punishment, and coordinate local policies with those of the entire society. The key is strong leadership, but the voluntary and active involvement of the public insures success.     

The evolution in China's fertility and an analysis of population development]

There have been numerous projections on China's population at the end of century. Their differences are due to different estimations on the effects of fertility determinants. 2 simulation models have been developed, both from micro and macro levels, to estimate the population at the end of the century on the basis of 6 different fertility patterns. 3 possible options for fertility patterns are discussed. 1.) The 1 child per family option means that every couple has 1 child by the year 1989, the population of China will be 1.2 billion in the year 2000. Even if this is a ideal situation, it would not be a feasible policy, as the pressure from the rural population to have more than 1 child has been increasing in recent years. Nevertheless, it is still possible for urban couples to accept having only 1 child. Therefore, encouraging more people to have 1 child should be held as a basic policy. 2.) Under the option of 2 children per family with 2 or 3 years of spacing, the total population in the year 2000 would be 1.2 - 1.4 billion, which is unacceptable in terms of the development situation. 3.) Following a differential fertility policy towards urban, rural, and minority populations would mean that urban couples would have 1 child, rural couples whose first child is a girl or those who are in special circumstance would have 2 children. Minorities would have 2 or 3 children. AMong the above options, number 3 is more likely to be achieved in view of current socioeconomic, cultural, and demographic factors.