Population Issue for Doctors

– and for all others concerned!

Part A     Given that population is, surely, the “upstream” driver of all environmental threats: why is addressing this issue, humanely and appropriately, important for climate-activist doctors, above all other professions?

Because it was our profession that, starting around 1850, dramatically reduced death-rates while birth-rates remained high, so that we sadly bear some responsibility – completely unintendedly – for the ongoing population “explosion” from a base of c 1,250 million then to almost 8,000 million now, in just 170 years. 

Therefore, given the words of Maurice Strong, Secretary General of the UN’s Rio Earth Summit in 1992:

either we reduce our numbers voluntarily or Nature will do it for us, brutally”

       …as doctors we must, surely, be uniquely motivated to:

1 Campaign for better environmental education for all, including affluent high greenhouse gas emitters – who need to learn, however well “educated” they may be otherwise, that having one less child is hugely beneficial [since that child will be responsible in its lifetime for at least 30 times more greenhouse gas emissions than one from a least-developed country].  But also:

2 Advocate for wise, compassionate and proven effective policies that make  voluntary family planning services fully accessible to ALL couples worldwide: removing well-known tangible (economic) and intangible (cultural, religious and mis-informational)  barriers to their access;  while also strengthening human rights and achieving full gender equity, including secondary education as a global norm for girls.

3 Promote the long acting contraceptives, which of course require a provider with the relevant medical-training; and …

4 Choose if relevant for self to have a small family, meaning  a maximum of two children (ie replacement fertility), on principle and as an example.

Part B     There is a common accusation that those who maintain that “population matters” are by implication “victim blaming” couples who have above-replacement families in the least-developed countries.  In truth these are the very people whosuffer most from rich-country-induced climate change, yet are mostly very low greenhouse gas emitters.         

Some thoughts in response: –

1 We do not blame – and we simultaneously promote replacement fertility through two child only families as a planetary ideal maximumfor affluent couples, with ‘buy-in’ by them, the more so in fact due to the huge green house gas emission benefit of every rich child not born.  See: www.theguardian.com/environment/2017/jul/12/want-to-fight-climate-change-have-fewer-children –  based on the evidence-based article by  Wynes and Nicholas https://doi.org/10.1088/1748-9326/aa7541

2 We agree with and fully endorse George Monbiot, Greta Thunberg and others, that in addressing the climate crisis maximum attention should be paid to lower consumption by all who are affluent (including rich elites in the least developed countries). 

3 Since ending poverty cannot realistically happen in the foreseeable short term without increased green house gas emissions, fewer future people needing to escape poverty can only help.  After all, accepting the well-known ‘green’ slogan that “the greenest energy is the energy you don’t use”, only a human not present – never born – has a zero carbon footprint. Addressing world population growth – wisely, compassionately and democratically, by policies that do NOT tell people what to do, instead meeting women’s choice and unmet need  must be simultaneous with the point made above:  ie with no let-up of emphasis on massively reducing corporate and individual consumption and excessive energy use.

4 Fearsome famines are imminent. Fewer mouths to feed can only help the escalating humanitarian crisis of world hunger, especially among the climate victims.  Moreover, ever more humans annually, as now, certainly means more deforestation, including in the least developed countries. Carbon dioxide and other toxins are released as forests are felled or burnt to create land for agriculture – which worldwide causes 30% of greenhouse gas emissions.

5 Having an evidence-based concern about total human numbers on our finite planet is not, intrinsically and of itself, coercive.   Advocating for and properly resourcing rights-based voluntary family planning services as defined above does work ; in the past 50 years average family size has fallen from high levels to replacement (TFR of 2) in many countries.  This cannot be coercive if directed to removing the barriers (tangible & intangible) to women’s choice to use it.

Part C     Given worldwide failure to address population (the ‘P’ factor in the Ehrlich-Holdren equation) isn’t it too late now for fewer births to be of benefit, whether in high or low resource settings?   Are there not too many planet-trashing and green house gas-emitting humans here already? Almost all of them unprepared to change behaviour fast enough to prevent the irreversible, self-perpetuating chain-reaction, phase of the climate disaster?

Though we aren’t about to give up, sadly that may prove to be true.  However, if despite all efforts the pending “perfect storm” of dystopian scenarios is not averted, still arguing now for birth reduction by better-resourced, benignly delivered, contraceptive care remains crucial.  As a last resort, this might at least reduce the number of humans to suffer, if and when later this century billions of humans have to face:

The five ‘Fs’ that will cause climate-related premature deaths: 

  • Fires – wild, remorseless; along with ever more equally lethal heat waves
  • Floods – whether of salt or fresh water + ferocious winds
  • Famines – droughts and food shortages
  • Fevers – ie infections: new viruses plus tropical diseases outside the tropics
  • Fighting – between and within nations. 

Even then therefore, belatedly and with much regret that it was not fully appreciated far sooner, James Grant’s quote from UNICEF Annual Report (1992) would apply:

“Family planning could bring more benefits to more people at less cost, than any other single technology now available to the human race”

John Guillebaud November 2019