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In: Health and disease in developing countries, edited by Kari S. Lankinen, Staffan Bergstrom, P. Helena Makela, Miikka Peltomaa. London, England, Macmillan Press, 1994. 25-36.The magnitude of the population problem is indicated by the annual addition of about 100 million people and the acceleration of growth. There were around 5.3 billion inhabitants in the world in 1990, but by the year 2020 there will be about 8 billion people, although the total fertility rate decreased from around 6 children per woman in 1960 to 4 in 1985. The unprecedented growth of population, particularly in poor countries, together with overconsumption and lack of global justice in the distribution of goods has put a severe stress on the environment. The overconsumption problem is illustrated by the case of the United States, with 6% of the world's population but with the consumption of 40% of its resources. The energy consumption of 1 American equals that of 2 Frenchmen, 6 Mexicans, 39 Indians, and 456 Nepalese. The poverty trap and the demographic trap has recently been analyzed in 4 parts: 1) the lack of productive assets. The poor are poor because they do not own assets (in several Latin American countries 1% of landlords own more than 40% of arable land); 2) physical weakness and illness means constant malnourishment and low productive capacity; 3) population pressure forces salaries down to survival levels while having large families often becomes necessary for economic security; and 4) powerlessness means that most poor people are often coerced into signing away their rights and legal systems offer little protection. The structural readjustment programs have had adverse repercussions for the poor, because maternal and child health expenditures were slashed. The HIV infection rate reached 40-50% of pregnant women in some parts of Zimbabwe. Freedom and coercion issues in population control pertain to the compulsory sterilizations in the mid-1970s and female contraceptive surgery consisting only of abortion and sterilization.
Lancet. 1990 Oct 13; 336(8720):937.This commentary is a rebuttal to Dr. King's proportion in the Lancet that without guaranteed reductions in birth rates (in developing countries) the world population will increase to a size beyond the planet's ability to sustain it. The author uses a parallel argument of the present-day "oil war" to argue that while the western world is prepared to go to war to protect its interests in oil, it is not willing to ration it. The real problem of poverty in developing countries is determined more by the consumption patterns of the 20% rich population in the world. Rather than looking at developing countries and criticizing their inability to allocate budgets to improve the health status of the poor, western countries should consider "rationing its use of the world's resources so that the proportion that it consumes more equitably reflects its share of the world's population."