In view of the almost universal desire among the people in all countries to improve their health services and thus reduce their death rates as fast as possible, it will be in order to note briefly the more important implications involved in the establishment of health services aimed at reducing these rates to new and still lower levels in the underdeveloped countries which now contain about two-thirds of the world’s population.
The first fruits of even modest health services are already clearly evident Health programmes meet with comparatively little resistance from even the most tradition minded peoples even the ones, who generally oppose all change. Scotching an epidemic of smallpox by vaccination, saving a pneumonia victim or a victim of a dozen other diseases from death by the use of penicillin, teaching mother how to protect her baby from diarrhea arid enteritis are such obvious benefits that almost all people are glad to avail themselves of these services almost as soon as they know about them.
The immediate effect of the services is so much to be desired by individuals that the more distant social and economic effects of reducing the death rates rapidly, in perhaps two-thirds of mankind, are quite generally overlooked.
These health services should be established and made effective whenever possible, but we do urge that the more distant social and economic effects of these health services should be anticipated and deliberately controlled as far as this is possible.
Indeed, under certain circumstance, we should be prepared to defend the thesis that an efficient public health service in the underdeveloped areas of the world is an essential prerequisite if rapid headway is to be made in the establishment of a world-population policy, the purpose of which would be to bring about a better adjustment of the rate of population growth to the rate of increase of the goods and services man needs to assure himself of a decent level of living.
Stated briefly, the circumstances under which we should justify in urging better and better health services are
- the health services staff from the top to the bottom, are made fully cognizant of the effects of their work on the growth of the population. Including the fact that the more efficient the health services become the more rapid
- The growth of the population will be that the health services of a country and its physicians where private practice prevails, are ready and willing to inform the mothers, who bring young children to them for advice regarding their care, that they can control the size of their families and are also willing to show them how this can be done if the mothers are interested and want to know. At present, in underdeveloped countries, few mothers know that the voluntary control of the size of the family is possible and even fewer know how to exercise such control.
Perhaps the greatest obstacle to the establishment of a world-population policy is the fact that very few nation are ready to adopt national policies and in the underdeveloped countries whose governments have openly espoused population policies they can not implement them quickly. Until the mass in any country are able to control the size of their families and are willing to do so, no government can guarantee co-operation with other nations in a world-population policy aimed at adjusting man’s numbers to his ability to support them well. But there are also other serious obstacles to the formulation and implementation of a world-population policy — nationalism, racism, ideologies and perhaps most of all, the sheer inertia of traditionalism in most underdeveloped countries.
The importance of these several obstacles will vary from country to country and it will be impossible here to discuss all these obstacles as they operate in different countries and among different peoples. Nationalism as an obstacle to the effectuating of a world-population policy perhaps needs little discussion as it is quite widely realized today that the citizens of every country are generally much more concerned with the welfare of their fellow countrymen than with that of the people in the other countries.
Racism is of importance because now for the first time the colored peoples of the World see a chance to attain equality of living conditions with the whites. Indeed, by reason of their present numbers and their more rapid growth, some of their leaders are hoping not only to become equal with the whites economically but also to become dominant politically. It is not surprising that some of the leaders of these people are reluctant to adopt a population policy that would equate the growth of the colored peoples with that of the white peoples.
As regards the conflicting ideologies of different people, it must be recognized that orthodox communism denies that the growth of population poses any threat to the welfare of man and this doctrine appeals to many of the leaders in underdeveloped countries(2). Moreover, these leaders are often conditioned by past experience to accept the view of the Communists that imperialism, colonialism, and capitalism are the real causes of their poverty and its accompanying hardships. The point here is that several very potent forces make a world-population policy very unlikely to become an effective agency in reducing the rate of population growth in the foreseeable future.
Furthermore, it should be realized that the control of population growth is much less urgent in some regions and countries than in other; i.e. in some countries, the population is not growing so fast and/or the natural resources are so abundant that there is little danger of a significant deterioration in the living conditions of the people during the lifetime of the present leaders if their resources are exploited intelligently.
In others, the need for slower growth is already urgent. Can any government in any country set up “a most desirable size of the family” for its people and enforce the adoption of this standard within a few years? The answer must be No for those countries which still have good, unused land and large natural resources. This being the case, can these countries be expected to cooperate in encouraging slower population growth even though it might hasten considerably the attainment of a higher level of living for their people through more rapid economic development?
Most of the people in any country, even when they know how to control the size of their families, may be expected to confirm more or less closely to some standard size of family only if they are convinced that their community approves of such control and that it is to the advantage of their own family to do so.
There can be no doubt that the governments of most countries, through education and propaganda, can in the course of time influence the Judgement of their people in die determination of what family size is best can also hasten the adoption of the small-family pattern if that seems desirable. But the range of family size within which governmental efforts of this character can operate even in the more developed countries appears to be quite small at the present time.
As a matter of fact, when the leaders of the authoritarian governments tried to influence their people to have more children, they did not succeed because the people as a whole did not agree with the policies of their governments for increasing the size of their families.
The simple fact is that at the present time only a few countries have birth rates and death rates which appear sufficiently low to give some assurance of a decent living for all citizens. The leaders of these few countries might feel sufficiently confident of the direction and the amount of their population growth for several years in the future to feel justified in subscribing in good faith to a world-population policy for the control of population growth.
The leaders of most of the nations of the world, however, could not do so even with a small degree of confident in the ability or the willingness of their people to conform to some world standard, chiefly because they do not know how long it will take their people to adopt effective control over the birth rate and how fast the death rate will decline in the next few decades. (This assumes that any world-population policy must have as its first and primary objective for the next few decades the reduction of the rate of population increase in those countries which now have high birth rates and in which death rates are falling rapidly).
Moreover, as we have already noted, there is no unanimity of opinion among leaders of the high-birth-rate people as to the desirability of a policy to reduce the rate of population growth.
In spite of the fact that no effective world policy calculated to reduce the rate of population growth can be achieved In the future, it is highly desirable to get a statement of world policy regarding population growth from as many nations as possible and even from private organizations in nations unready to declare any official attitude toward population growth.
Such declarations of the desirability of population control or even in opposition to a policy of population control would-help to get for a while the matter before the people and would almost certainly hasten the thoughtful decision of an increasing proportion of couples regarding the desirable size of their own families.
In the long run this decision must be personal, but any expression of opinion, official or private, which stimulates the consideration of voluntary population control is preferable to ignoring the problem which faces the world when a large majority of the more than 3,000 million people in the world suddenly begin to increase at a rapid rate 3 percent or more per year before these people have ht know-how and the physical means to increase their goods and services fast enough to say nothing of providing themselves with goods and services increasing faster than their numbers.