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Research Article

Improving wellbeing and reducing future world population

Roles Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Department of Ecology, Evolution and Marine Biology, University of California Santa Barbara, Santa Barbara, CA, United States of America

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Roles Conceptualization, Data curation, Formal analysis, Methodology, Visualization, Writing – review & editing

Affiliation Department of Statistics and Applied Probability, University of California Santa Barbara, Santa Barbara, CA, United States of America

Roles Conceptualization, Formal analysis, Methodology, Visualization, Writing – review & editing

Roles Conceptualization, Formal analysis, Project administration, Visualization, Writing – review & editing

  • William W. Murdoch, 
  • Fang-I Chu, 
  • Allan Stewart-Oaten, 
  • Mark Q. Wilber

PLOS

  • Published: September 12, 2018
  • https://doi.org/10.1371/journal.pone.0202851
  • Reader Comments

Fig 1

Almost 80% of the 4 billion projected increase in world population by 2100 comes from 37 Mid-African Countries (MACs), caused mostly by slow declines in Total Fertility Rate (TFR). Historically, TFR has declined in response to increases in wellbeing associated with economic development. We show that, when Infant Survival Rate (ISR, a proxy for wellbeing) has increased, MAC fertility has declined at the same rate, in relation to ISR, as it did in 61 comparable Other Developing Countries (ODCs) whose average fertility is close to replacement level. If MAC ISR were to increase at the historic rate of these ODCs, and TFR declined correspondingly, then the projected world population in 2100 would be decreasing and 1.1 billion lower than currently projected. Such rates of ISR increase, and TFR decrease, are quite feasible and have occurred in comparable ODCs. Increased efforts to improve the wellbeing of poor MAC populations are key.

Citation: Murdoch WW, Chu F-I, Stewart-Oaten A, Wilber MQ (2018) Improving wellbeing and reducing future world population. PLoS ONE 13(9): e0202851. https://doi.org/10.1371/journal.pone.0202851

Editor: Heidi H. EWEN, University of Indianapolis, UNITED STATES

Received: May 3, 2018; Accepted: August 9, 2018; Published: September 12, 2018

Copyright: © 2018 Murdoch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data used in this article are publicly available. The data are third party data and the authors had no special privileges when accessing these data. The data can be found in at the following locations: United Nations population estimates and projections (available at https://esa.un.org/unpd/wpp/ ), Human Development Index (available at http://hdr.undp.org/en/content/human-development-index-hdi ), country classifications by income (available at http://blogs.worldbank.org/opendata/new-country-classifications-2016 ), per capita GNI data (available at http://data.worldbank.org/indicator/NY.GNP.PCAP.PP.CD .), and measures of corruption (available at https://www.transparency.org/news/feature/corruption_perceptions_index_2016 ).

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The UN’s median projected world population in the year 2100 is more than 11 billion and still increasing [ 1 – 3 ]. Just over 3 billion people, or 78.5% of the 3.86 billion projected world population increase from 2015 to 2100, come from the world’s poorest region: a band of 37 high-fertility Mid-African Countries (MACs), which include all African countries with at least 1 million people in 2000, except for the five northern and five southern low-fertility nations. All but Sudan are sub-Saharan. The median UN-projected 2100 MAC population is over 3.97 billion.

The great majority of sub-Saharan (and hence MAC) projected population increase comes from high and slowly declining fertility [ 4 ]. Sub-Saharan fertility decline started about 20 years later than that of other developing nations [ 5 ] and, once begun, is estimated to have been one-fourth as fast as in Asia and Latin America at the equivalent demographic stage [ 6 ].

Historically, fertility has declined in response to increases in wellbeing associated with economic development. We show that, when Infant Survival Rate (ISR, a proxy for wellbeing) has increased, MAC fertility has declined at the same rate, in relation to ISR, as it did in 61 comparable Other Developing Countries (ODCs) whose average fertility is now close to replacement level. We show that if MAC ISR were to increase at the historic rate of these ODCs, and fertility declined correspondingly, then the projected world population in 2100 would be decreasing and 1.1 billion lower than currently projected. Such rates of ISR increase, and fertility decrease, are quite feasible and have occurred in ODCs in conditions comparable to MACs in the present day. Increased efforts to improve the wellbeing of poor MAC populations are key.

Approach and results

Middle-african (macs) and other developing countries (odcs).

We compare MACs with the demographic history of 61 Other Developing Countries (ODCs) which had high fertility (Total Fertility Rate, TFR = 6 or greater in almost all cases) in 1950-55 (the first period for which UN world data are available), and which experienced all or almost all of their fertility decline thereafter ( S1 Text ). We excluded China from the ODCs because of its unique 1-child policy. As in the MACs, all ODCs had more than 1 million people in 2000. The ODCs represent all major geographical regions ( Fig 1 ).

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Mid-African Countries (MACs) : Eastern Africa: Burundi, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Rwanda, Somalia, S. Sudan, Uganda, U.R. Tanzania, Zambia, Zimbabwe; Middle Africa: Angola, Cameroon, Central African Republic, Chad, Congo, D.R. Congo, Gabon; North Africa: Sudan; Western Africa: Benin, Burkina Faso, Cote d’Ivoire, Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo. Other Developing Countries (ODCs) : Northern Africa: Algeria, Egypt, Libya, Morocco, Tunisia; Southern Africa: Botswana, Lesotho, Namibia, South Africa, Swaziland; Eastern Asia: R. Korea, Mongolia; Central Asia: Tajikistan, Turkmenistan, Uzbekistan; Southern Asia: Afghanistan, Bangladesh, India, Iran, Nepal, Pakistan, Sri Lanka; S.E. Asia: Cambodia, Indonesia, Lao P.D.R., Malaysia, Myanmar, Philippines, Singapore, Thailand, Viet Nam; Western Asia: Azerbaijan, Iraq, Jordan, Kuwait, Oman, Saudi Arabia, State of Palestine, Syria, Turkey, U.A. Emirates, Yemen; Southern Europe: Albania; Caribbean: Dominican Republic, Haiti, Jamaica; Central America: Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama; South America: Bolivia, Brazil, Colombia, Ecuador, Paraguay, Peru, Venezuela; Melanesia: Papua New Guinea. The base map is from Natural Earth and is in the public domain under a Creative Commons license.

https://doi.org/10.1371/journal.pone.0202851.g001

The average TFR for MACs in 2015 was 5.19, more than twice both the ultimate replacement rate and the overall world average (2.51) [ 3 ], and almost twice the ODC average (2.66). As seen in the sub-Saharan comparisons discussed above [ 6 ], MAC fertility decline has been later and slower than in the ODCs ( Fig 2A ).

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A . Mean Total Fertility Rate (TFR) and B . mean Infant Survival Rate (ISR) with 95% confidence limits for Mid-African Countries (MAC) and Other Developing Countries (ODC), over time since 1950-55. Data from [ 3 ].

https://doi.org/10.1371/journal.pone.0202851.g002

The different MAC and ODC fertility trajectories suggest there may be some major causal differences [ 6 ]. [ 7 ] shows that fertility decline in sub-Saharan Africa began at an unusually low level of economic and social development. He also shows that the higher sub-Saharan African fertility since 1960 is correlated with a higher desired family size (though [ 8 ] note that, recently, desired family size has been declining in the region). However, we suggest that the main drivers of fertility decline operate in the same way in ODCs and MACs: that decrease in fertility is a response to the level and rate of change of the population’s general wellbeing.

Wellbeing and fertility

A vast body of evidence shows that desired family size is determined rationally and, beginning in Europe in the late nineteenth century, has declined largely in response to increased parental socio-economic wellbeing, including associated changes in the costs and benefits of children [ 7 – 11 ]. A diffusion effect, in which fertility decline spreads within a culture may also have operated in some situations [ 7 ]. Note that at the lowest levels of development, fertility often first increases with improved wellbeing (e.g. MACs in Fig 2A ), but thereafter has typically declined steadily.

We next illustrate briefly the relationship between fertility and wellbeing. First, about half (54%) of the variation in TFR among developing countries at one point in time is explained by variation in log(per capita income) ( Fig 3A ). But per capita income misses a major aspect of general wellbeing, namely how widely income and the benefits of development, such as improved health and education, are spread across the population. The UN Human Development Index [ 12 ], HDI, which combines per capita income with scores representing levels of health and education explains about 75% of the variation in TFR ( Fig 3B ).

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A . Linear regressions (and 95% confidence bands) of TFR vs log(GNI per capita) (referred to as “per capita income” in the main text) for all developing countries in 2010 as defined by the World Bank [ 13 ]. Income data from World Bank [ 14 ] and TFR data from United Nations [ 3 ]. B . Linear regression (and 95% confidence bands) of TFR on Human Development Index (HDI) in 2010, for all countries in Fig 3 for which an HDI value is available [ 12 ]. C . Linear regression (and 95% confidence bands) of TFR on ISR in 2010. TFR and ISR data from United Nations [ 3 ].

https://doi.org/10.1371/journal.pone.0202851.g003

Second, [ 7 ] conducted a wide-ranging analysis of development and fertility patterns in sub-Saharan Africa. He suggests that fertility has broadly responded to development in sub-Saharan Africa as in 52 other developing countries, with the provisos noted above that sub-Saharan African’s fertility began to decline at a lower level of development, but usually remained higher at each particular level.

Finally, in 25 sub-Saharan countries with DHS (Demographic and Health Surveys) data from multiple time periods, fertility fell significantly faster between consecutive surveys in countries that experienced a greater increase in female education and in those that experienced a greater reduction in infant and child mortality [ 5 ].

Infant survival rate and general wellbeing

We use Infant Survival Rate, ISR = the percent of infants who survive to their first birthday, as our proxy for wellbeing (see S2 Text for other possible measures). It is equivalent to the Infant Mortality Rate (ISR = 100—IMR/10) used by the UN (see [ 3 ]). ISR is likely to indicate not only the health of infants, but also other components of wellbeing such as general health, access to medical care, other services, information, and other goods or opportunities. There is more historical data for ISR than for HDI (described above) and it explains statistically about 70% of the variance in TFR ( Fig 3C ). It is a particularly good indicator of improvement in general population wellbeing, as we explain next.

Data collected during the Demographic and Health Surveys (DHS) illustrate the relationship between national ISR values and general wellbeing in the population. The surveys measure ISR in families that are also classified into five equal-sized relative “wealth” classes. Wealth, a proxy for income, is measured by an index of household conditions and goods [ 15 ].

In developing countries, ISR is of course higher in richer segments of the population: averaged over all available data, ISR increases as we move from the poorest to the richest segments of developing-country populations ( Fig 4A ). ISR has also increased over time in all wealth classes ( Fig 4B ). However, it has increased faster in the poorer than in the richer fractions of the population. The estimated rates of increase per year for the poorest 20%, and the poorest 40% were, respectively, greater than the rates in the richest 20% and the richest 40% (the respective differences between rates being 0.10 (± 0.02 SE) and 0.07 (±0.02 SE)). These differences are statistically different (both p<0.0001 obtained by a linear mixed effects model including random intercepts for 985 observations of 72 countries).

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A . The boxplot summarizes the relation between ISR and relative wealth. For each of 72 developing countries, we obtained ISR values from 1990 to 2014 for the 5 wealth classes. For each wealth class, we combined the values across countries for the box plots (the sequence of medians from Lowest to Highest is: 92.3, 93.1, 93.4, 94.3 and 95.6). Using the medians for each country’s wealth classes, a Friedman test that accounts for the within country correlation showed a significant difference among wealth classes ( χ 2 = 161.85 on 4 degrees of freedom, p < 0.0001). Similar results were obtained when using mean ISR instead of median ISR. The outlier had no effect on these results. B . Trends in ISR values between 1990 and 2014 in the five wealth classes. Each thin line is a single country; the thick lines were fitted by local regression.

https://doi.org/10.1371/journal.pone.0202851.g004

Initial (1950-55) ISRs were on average lower in MACs (median, 82%) than in ODCs (median, 85%) and remained so through 2010-15: the highest observed ISR in a MAC is 96.3% (median, 94%) and in ODCs 99.8% (median, 98%) ( Fig 2B ).

Fertility decline vs improvement in wellbeing in MACs and ODCs

UN data show that general wellbeing (as measured by ISR) improved later and more slowly in MACs than in ODCs. Our claim that this caused the later and slower fertility decline in MACs implies that improvements in wellbeing should be associated with similar declines in fertility in the two groups. We use two approaches to examine this.

Between-group analyses : We first compare TFR vs ISR in MACs and ODCs, as a whole, between 1950-55 and 2010-15.

Fertility declined approximately linearly, and at virtually identical speeds, in the shared range 90% ≤ ISR ≤ 96.3%. Linear regressions (black lines) fitted to the two groups over this range have statistically indistinguishable slopes ( Fig 5 ). Reinforcing a conclusion of [ 7 ], MAC TFR was approximately half-a-child higher than ODC TFR at the start of the decline (see also Fig 2 ); because the two fertilities declined at the same speed, the half-child difference persisted. The speed of fertility decline in ODCs increased as ISR approached 100% ( Fig 5 ).

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Curves are local regression (LOESS) fits, using span = 1/3 [ 16 ]. Black regression lines are fitted in the approximately linear decline phase using all points with 90.0%≤ISR≤96.3%, indicated by vertical dotted lines. These have slopes -0.365 (ODC, 328 points, SE = 0.041) and -0.351 (MAC, 166 points, SE = 0.036), which are not statistically different. (In the linear model TFR = Mean + Region + ISR + Interaction, with independent, homoscedastic, Normal errors, the test for “no Interaction” gives t = 0.21, p = 0.84. When ODC and MAC error variances are not assumed equal, the slope estimates can be compared by a Welch t-test, which gives t = 0.26 and p = 0.79 on 380 degrees of freedom.) The extreme UN regions in the flat region (ISR ≤ 90%) are indicated by the olive and brown LOESS fits to West Asia and S.E. Asia, respectively. MAC and ODC slopes for 71.5%≤ISR≤87.5% are nearly flat (MAC slope = 0.04; ODC slope = -0.036) but differ statistically (the test for “no Interaction” gives t = 3.63, p = 0.0003). Markers A at 87.5% and B at 93.9% indicate the lower and upper limits for the range of slope overlap used in the single-country slope analyses (see S3 Text for further details).

https://doi.org/10.1371/journal.pone.0202851.g005

Fertility decline began at approximately the same ISR values in MACs and ODCs ( Fig 5 ). Median ISR in the year in which onset occurred (at a TFR 10% lower than the preceding highest value) was 91.18% in MACs and 92.05% in ODCs (MACs range of observations: 84.59%-95.29%; OCD range of observations: 83.46%-97.14%).

MAC and ODC trajectories are significantly different in the pre-decline phase (ISR ≤ 87.5%, point A in Fig 5 ), but the MAC trajectory was well within the large regional variation in ODCs seen in this phase. The slight decrease in ODC overall-group fertility in this phase was caused by differences among ODCs in initial (1950-1955) TFR values, not by fertility declines in individual countries: in the 34 ODCs that had initial ISR ≤ 85%, mean TFR change in this phase was -0.01 (± 0.71 SE).

Single-country analyses : Second, we measure change in fertility in individual countries over an ISR range that most countries in the two groups have experienced, and which also includes the ISR values where most fertility declines began. The range of overlap is 87.5% to 93.9% ISR (points A and B in Fig 5 ). Thirty-six MACs and 46 ODCs, have experienced ISR as low as 87.5% since 1950-55, and 90 of the 98 countries began their fertility declines at or above this threshold. The upper limit, 93.9%, is the median of the highest ISRs observed in MACs by 2010-15 and has been experienced by all but three ODCs.

The speeds of decline of TFR vs ISR over this ISR range are statistically indistinguishable in the two groups (p>0.42 with two sample t-test for unequal variance, sample size for ODC = 60 and MAC = 37), though on average are slightly faster in MACs ( Fig 6 ). The ODC group, which is geographically and culturally more diverse, shows a wider range of slopes.

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The black bars in the boxplots give the median slopes. The steepest regression slope for a MAC was -0.62, and for an ODC was -0.91. Mean slopes (± SE), MACs = -0.30 (± 0.15) and ODCs = -0.27 (± 0.28), are not significantly different (two sample t-test with unequal variance: t = −0.76 on 93.93 degrees of freedom, p = 0.45, sample size for ODC = 60 and MAC = 37). The outlier slope for ODC countries is Jamaica. Data from [ 3 ].

https://doi.org/10.1371/journal.pone.0202851.g006

Population projections

We forecast population growth in the MACs by replacing what might be called the current “business as usual” scenario, which gives us the 11 billion projection for 2100, with scenarios where MACs achieve the faster improvements in wellbeing (indicated by ISR) that have been seen and projected in the ODCs, and hence faster declines in fertility. By contrasting these two scenarios we estimate the potential reduction in world population that can be achieved by actively investing in such accelerated improvement in wellbeing in the MACs.

The modeling machinery was that developed by Raftery and colleagues and now used by the UN [ 1 , 17 – 19 ]. Population projections for each future 5-year interval for each country are based on many sequences of age-specific birth and age- and sex-specific death rates generated from probability distributions of these vital rate parameters, following procedures in BayesPopURL [ 20 ]. We used 1000 such sequences. Before replacing MAC rates by ODC rates in these calculations (as described below), we confirmed that using the MAC rates allowed us to replicate UN results: our median projected 2100 total MAC population (3.94 billion) was within 1% of the UN projection (3.97 billion). (See S4 Text for details.)

We then projected MAC populations based on historic and projected rates for 56 of the ODCs. (Following [ 1 ] we excluded from the ODCs the five nations affected by AIDS epidemics.) We first aligned the current (2010-2015) ISR of a given MAC with the matching ISR of each of the 56 ODCs (37 MACs x 56 ODCs = 2,072 MAC-ODC combinations). For example, Angola’s current ISR equals that of Laos in 1990-95. We then kept the first (2015-2020) set of UN-projected MAC rates but replaced the rest by the historic and projected ODC rates, beginning with the matching period. This delay assumes conservatively that even if wellbeing improves immediately, there is a lag of about 5 years before vital rates are affected. For example, we kept Angola’s 1000 sets of 2015-2020 rates (which affect its 2020-2025 population), replaced each set of its projected rates for 2020-2025 to 2040-2045 by Laos’s historic rates for 1990-1995 to 2010-2015, and replaced Angola’s sets of projected rates for 2045-2050 to 2095-2100 by Laos’s sets of projected rates for 2015-2020 to 2065-2070. This pattern—MAC rates for 2015-2020, then historic ODC rates, then projected ODC rates—holds in most cases.

In general, the initially-matched ODC and MAC ISR values will not be equal, so we find the two consecutive ODC periods that straddle the current MAC value, and choose the earlier (lower ISR value) period.

In 2% of 2,072 MAC-ODC combinations even the 1950-55 ODC ISRs are higher than the 2010-15 MAC ISR, and in another 2% the current ODC ISRs are lower than the current MAC ISR. We expand the matching criterion to treat these conservatively (see S4 Text ).

Our projected ODC-based median total MAC population in 2100 is 2.86 billion (2.86B), which is 1.1B (28%) lower than the UN projection ( Fig 7 ). Under these circumstances, world population in 2100 would be 10.1B, and stabilized by 2085. Improving wellbeing quickly is crucial: if MACs were to move earlier to ODC-based trajectories, in 2015-20, the 2100 projected median MAC total would be about 1.5 billion lower than the UN projection.

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The intervals show quantiles of the distribution of our MAC population projections. More than 90% of their spread is due to variation in the historic and projected demography among the ODCs. The rest is due to the UN’s probabilistic trajectories. The calculations are described in S4 Text (Method B, median-adjusted). For a given MAC population projection, a value for the world population can be obtained by adding the total of the median UN projections for all other countries (7.24 billion).

https://doi.org/10.1371/journal.pone.0202851.g007

Improving wellbeing in MACs

The results suggest that MAC fertility would fall as fast as it has done in the ODCs if wellbeing, exemplified by infant survival rate, were to increase at the speed it has done in the ODCs in similar demographic circumstances. This seems quite feasible. MACs are mostly poor, inequitable, corrupt and undemocratic; but most ODCs experienced similar conditions during their demographic transition.

Unusually rapid increases in ISR have been achieved at very low incomes and high levels of corruption. For the ODC countries in Fig 5 , we recorded real per capita incomes [ 21 ] in the 5-year period when each first reached ISR ∼ 90%; the median income was $2387 (see S5 Text for details). We then calculated how rapidly (number of percentage points gained per 5-year period) ISR increased to 96% [ 3 ]. Eleven ODCs had increase rates ≥ 1.65%; three of them (Bangladesh, South Korea and Nepal) had among the lowest recorded incomes ($997-$1300) and S. Korea ($1300) had the highest recorded increase rate (2.6%). A fourth, Egypt, had the lowest income and the highest increase rate ($1740, 2.33%) among the five Muslim North African countries. (The other seven ODCs with rapidly increasing ISRs, mainly oil producers and all Muslim, were among the richest; they achieved 90% ISR very late, i.e. at high incomes.)

A focus on the poor has facilitated rapid increases in ISR at low per capita incomes. S. Korea ( c .1960) was one of Asia’s poorest countries but had a famously equitable income distribution and land reform [ 22 , 23 ]. The Bangladesh government explicitly expanded benefits (e.g. micro-credit to women, health care, increased free female schooling, access to contraception services) to poor and, especially, rural portions of the country, also using help from NGOs [ 24 , 25 ]. It has achieved key 2015 UN Millennium Development Goals (MDGs), such as reducing maternal and childhood mortality and the fraction of the population in poverty, at extremely low average income levels. Controlled trials in Matlab, Bangladesh, showed reductions in childhood and maternal mortality and fertility in villages receiving outreach health and family planning services [ 25 ]. Nepal’s government likewise has committed to, and largely achieved, MDG targets. Among MACs, Rwanda, with ISR increase rate 2.0% and income only $1025 at ISR = 90%, exemplifies the effect of explicit government focus on achieving 2015 MDGs in a poor MAC [ 23 ].

Most encouragingly, MACs in general have achieved ISR ∼ 90% at much lower incomes (median = $1,283) than did the ODCs (median = $2,387). Furthermore, the nine MACs with ISR increase rates > 1.5% (1.57% to 2.25%) all had incomes ($344-$1171) below the MAC median.

With regard to corruption, in 2015 22 MACs ranked below (i.e. were worse than) 100 out of 167 countries, but 26 ODCs were also in this range [ 26 ]. Indeed, the rest of these 100 low-ranked countries all have ISR ≥ 98% except for three nations with population < 1M [ 26 ]. Bangladesh and Nepal have dismal histories of corruption. Bangladesh ranked last or second-to-last in the first four years of data (2002-2005), and by 2016 these two nations had escaped the bottom third in only two years [ 26 ].

Perhaps most surprising, in MACs since 1990 there is no correlation between the speed at which ISR has increased and the standard measures of civil conflict: frequency, intensity, and total deaths ( Fig 8 ). Nepal again, is illustrative of this general point. Nepal achieved its relatively rapid increase in ISR even though its Maoist rebellion ended only in 2006, and it experienced almost 10,000 battle deaths between 1996 and 2006, close to the average number in MACs (10,127 deaths).

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A . Speed of increase in ISR, between 1990-95 and 2010-15, versus overall intensity of civil conflict between 1990 and 2014 in 36 MACs (no data for S. Sudan). Each dot is a MAC. The slope of the relationship is not significantly different from 0 (slope = 0.008, t = 1.02 on 34 degrees of freedom, p = 0.32). B . Speed of increase in ISR vs log(cumulative number of battle deaths+1) in these countries. The slope of this relationship is not significantly different from 0 (slope = 0.03, t = 1.35 on 34 degrees of freedom, p = 0.19). Change in Rwanda, the point with coordinates (9.1, 2.2), is between 1995-2015 because the 1994 genocide temporarily and severely suppressed ISR to 71.9% in 1990-95. Shown are 95% confidence bands. Data from [ 27 ]. See S6 Text for more details on this figure.

https://doi.org/10.1371/journal.pone.0202851.g008

The UN’s median estimated world population for 2015 is 7.35 billion with 934 million people in the MAC countries. For 2100, its median projected populations are 11.2 billion and 3.97 billion respectively. Our ODC-based median projection for the MACs is 2.86 billion. Using the UN projections for all other countries, our median projected world population is 10.1 billion. Other sets of assumptions also lead to projections lower than the UN’s.

[ 28 ] made alternative population projections for sub-Saharan countries to determine the expected effect on future population size if the observed initial slow fertility decline were to be followed by an accelerated decline (then steady tapering) as seen in some other developing countries. For the projected sub-Saharan fertility patterns, [ 28 ] substituted observed fertility patterns seen in 21 other developing countries covering a range of social and economic contexts (e.g. Bangladesh, China, Peru). The resulting median projected 2100 sub-Saharan population was 770 million below the UN median projection, again emphasizing that significant slowing of growth is consistent with some historical experiences. Using the UN projections for all other countries, the projected world population is 10.4 billion.

[ 29 ] assumed universal implementation of several key UN (2015) Sustainable Development Goals by the target date of 2030: education through secondary school, specific reductions in maternal and infant mortality, and improved reproductive health and family planning. In their highly detailed model, education is the main driver of fertility and also increases survival rates and access to and use of family planning. Achieving these goals results in a boost to development and the demographic transition between 2015 and 2030; thereafter development and demographic changes occur at a more regular speed. Their model applies to all regions of the world, not just MACs or sub-Saharan Africa, and projects a total world population in 2100 of 8.19—8.65 billion.

Our projection is more empirical than that of [ 29 ]: we project on the basis of past experience, that of the ODCs. This experience varied widely, so our ODC-based projections do too: our 5% and 95% quantiles for the 2100 MAC population are 1.75 and 6.23 billion. If the MACs experienced fertility and mortality rate changes following those of S. Korea (the ODC with the fastest rate of increase in infant survival) or of Thailand, the median projected MAC population in 2100 would be only 1.75 billion. Using the UN projections for all other countries, our median projected world population would then be 8.99 billion. Basing future MAC rates on those of Bangladesh, Azerbaijan, Brazil or Myanmar would also lead to world projections which are at least 2 billion below the UN’s median of 11.2 billion.

These special cases are realistic. There is reason to hope that MAC infant survival could increase faster, and hence fertility decrease faster, than predicted by the overall ODC experience. As noted above, ISR reached 90% at a median income of $2,387 in ODCs, but of only $1,283 in MACs. Thus, while the projections of [ 29 ] are optimistic, the necessary demographic changes have been achieved in the past.

Our results and these others suggest that improving widespread wellbeing in MACs, at rates previously achieved by many other developing countries, is likely to lead to future populations much smaller than currently projected. A key step is to intensify current efforts to improve conditions in poor and rural areas, by governments (of MACs and more developed countries), international agencies and NGOs [ 22 , 23 ].

Supporting information

S1 text. details relating to fig 1 : country groups..

https://doi.org/10.1371/journal.pone.0202851.s001

S2 Text. Fertility decline vs improvement in wellbeing in MACs and ODCs: other possible measures.

https://doi.org/10.1371/journal.pone.0202851.s002

S3 Text. Fertility decline vs Infant Mortality Rate.

https://doi.org/10.1371/journal.pone.0202851.s003

S4 Text. Population projection methods.

https://doi.org/10.1371/journal.pone.0202851.s004

S5 Text. Data on per-capita income.

https://doi.org/10.1371/journal.pone.0202851.s005

S6 Text. Data on armed conflicts.

https://doi.org/10.1371/journal.pone.0202851.s006

Acknowledgments

We thank Hana Ševčíková for responsive guidance in our use of BayesPopURL, David Lopez-Carr for helpful comments on the manuscript, and Javier Birchenall for advice on real incomes.

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  • 26. Transparency International. Transparency International: The Global Coalition Against Corruption; 2017. Available from: https://www.transparency.org/news/feature/corruption_perceptions_index_2016 .

Can We Talk About Overpopulation?

As numbers soar, scholars revisit a thorny debate.

Twenty years ago, farmers looked out at the tropical woodlands and savannahs of Uganda and saw endless virgin territory. A young man, upon starting a family, would clear a patch of wilderness near where he was raised and plant his own fields of sorghum, millet, groundnut, plantains, or cassava.

Now, after decades of unprecedented population growth, the land is running out. In southern Uganda, as in many parts of sub-Saharan Africa, farm communities are bumping up against one another and against dry lands, mountains, and rain forests. Pockets of arable land can still be found, but only in malaria-ridden hinterlands where nobody wants to live. Many farmers, rather than relocating long distances, are clearing rain forests near their homes, despite the fact that a tropical forest’s acidic soil is poorly suited to growing grains, fruits, and vegetables. Other farmers are subdividing their parents’ land, reducing the typical-sized farm plot in some parts of Africa to half an acre.

“That’s too small to feed a family,” says economist Jeffrey D. Sachs, who directs Columbia’s Earth Institute.

Africans will never be able to grow enough food for themselves, Sachs argues in his latest book, Common Wealth: Economics for a Crowded Planet , unless they start having fewer babies. Subsistence farmers in sub-Saharan Africa today raise an average of six children, which is causing the populations of some nations to double every 20 years. Few of these farmers are able to feed their children properly, let alone afford their education. Children thus grow up desperately poor and have huge families of their own. Shrinking farm plots add yet another burden: Food production on a per-capita basis is declining and malnutrition is worsening, which means that children are likely to grow up even less healthy and less productive.

“The poorest places in the world right now are stuck in a demographic trap,” says Sachs. “A family of subsistence farmers with six or seven kids doesn’t stand a chance.”

The only way to break this cycle of overpopulation and misery, Sachs writes in Common Wealth , is for wealthy nations to provide birth control to the world’s poor. Sachs recommends that rich countries quadruple foreign assistance for reproductive health programs to roughly $25 billion annually. That’s enough money, he estimates, to provide birth control, as well as maternal health care and STD treatment, to some 200 million women who lack it; most of them live in rural Africa.

The prospect of giving poor people contraceptives so they can lift themselves out of poverty might not seem particularly controversial, aside from the opposition that might be expected from some religious conservatives. Yet Sachs is the first mainstream economist in decades to formally propose this idea. Since the 1980s, family planning programs have been promoted strictly as a human right, not as a way to kick-start economic development. That’s because Western family planners in the 1960s and 1970s, in their zeal to slow population growth and to spur development in Asia, supported forced sterilizations, slum demolitions, and other abuses. Women’s rights advocates subsequently wrested control of international family-planning programs and made sure they never again aimed explicitly to lower birthrates.

The days of promoting birth control purely as a way to empower women, however, may be ending. There is a growing sense among scholars that the topic of overpopulation — which has faded from public consciousness as the world’s population growth rate has declined from its mid-1960s peak of 2 percent annually down to about 1.2 percent — is going to reemerge as a hot topic. Recently, the Sierra Club, the Worldwatch Institute, and other environmental groups have offered recommendations similar to those in Common Wealth , in which Sachs urges that we halt world population at 8 billion by 2050, rather than allowing it to grow to 9 billion from today’s 6.7 billion, as the UN projects.

Still, many population experts wonder: Is the marriage bed really the place to address economic and environmental problems? Is it even possible to manage people as numbers while respecting them as human beings?

Don’t blame the victim

Joel E. Cohen, a Columbia demographer, is an expert on population growth and environmental sustainability. He cringes at the term overpopulation .

“I have no idea what that word means, and you’ll never hear me use it,” he says. “It suggests that the size of a population can become so big that it starts causing problems in itself. That’s not the way it works. I’d put the situation this way: Rapid population growth makes it trickier for a poor country to deal with every problem that it faces, from distributing food and water during a drought to providing education and health care in rural areas. But it doesn’t cause these problems.”

There’s wide agreement among economists and demographers today that rapid population growth is troublesome. A report published in April by the UN Population Division concludes that high birthrates are hampering economic development across sub-Saharan Africa, mainly by limiting per-capita investments in education and health care. (Columbia economist Xavier Sala-i-Martin has shown that high birthrates typically stunt economic development.) The UN report also states that population pressure is worsening food and water shortages in the region. Environmental concerns also are real: rain forests in sub-Saharan Africa and in South America are being destroyed primarily by subsistence farming, according to NASA data, and deforestation is reducing local rainfall and exacerbating global climate change.

Cohen’s concern is that people often imagine a direct causal link between population growth and problems like hunger, poverty, and environmental degradation. It’s easy to think this way when visceral images of teeming third-world slums and starving masses invite human-scale explanations: Why do these people have so many babies? Cohen says we then may ignore political factors that contribute to these problems. For instance, agriculture subsidies in rich nations contribute to hunger by driving down farm incomes in the developing world; and African governments are famous for mismanaging food and water supplies. “During the Ethiopian famines of the 1980s, cash croppers in that country were allowed to export alfalfa to Japan as cattle feed,” he says. “Is that a population problem? I don’t think so.”

Cohen agrees with Sachs that international family-planning programs are underfunded. But he says that family planning should continue to be promoted — both to Western donors and to government officials in developing countries — strictly as a human right. To advance birth control as a means to slow population growth, Cohen says, implies that poor people need to solve their societies’ problems through private choices of childbearing. Might this cause the West to back away from other aid obligations, or inspire poor countries to implement coercive methods of population control?

Cohen hesitates. “It’s not as if a developing country’s problems are going to vanish if it manages to lower birthrates,” he says. “I would say that until the West has done its utmost to give poor people access to education, health care, job training, and family planning for the purpose of giving them more control over their lives, it’s premature to talk about trying to convince them to have fewer babies.”

Dirt to dust

Sachs insists that we speak clearly about population pressures. The problem of dwindling farmland in sub-Saharan Africa, he says, is insurmountable without a major effort to slow population growth.

As arable land in Africa has vanished, Sachs explains in Common Wealth , farmers have abandoned land-management techniques they used previously to sustain the long-term fertility of their fields, such as allowing one of the fields to lie fallow each season. Three-quarters of all arable land in sub-Saharan Africa today is severely depleted of nutrients because it has been overused, according to a recent study by the International Center for Soil Fertility and Agricultural Development.

A doubling of the region’s population since the early 1980s helps explain why almost all of sub-Saharan African countries now depend on foreign food aid. Until a few years ago, most were food exporters . “There’s a tyranny of the present at work,” Sachs writes, “and the poor, in their desperation to survive, are often contributing to massive local environmental degradation.”

Population control isn’t the only way to address food shortages, of course. Sachs points out that farmers in sub-Saharan Africa can’t afford chemical fertilizers, high-yield seed varieties, or modern irrigation. He and colleagues at the Earth Institute, as part of the United Nations Millennium Villages project, which Sachs initiated, are helping the governments of a dozen nations in Africa introduce modern farm technologies. They’ve had some remarkable success: The tiny, famine-prone nation of Malawi has tripled its grain yields in the past two years by subsidizing chemical fertilizer for all farmers.

“The problem is that these kinds of agricultural improvements never will produce gains to keep pace with a doubling of population every generation,” Sachs says.

Other types of foreign aid, such as for education or health care, also will bring diminishing returns if population growth rates don’t decline, says Sachs, who is academia’s most influential proponent of aid to Africa. He says that countries in sub-Saharan Africa now must spend huge portions of their budgets providing basic services, which leaves little money for the type of agricultural investment that Malawi is making in its fertilizer program. Economists thus say that countries experiencing explosive population growth must expend their budgets on “service widening,” to deliver basic services to more and more people, rather than on “service deepening,” to improve average services per person.

“If people continue having huge numbers of kids, and if farm sizes continue to shrink,” Sachs says, “I can’t imagine how the next generation is going to make it.”

Sordid history

Back in the 1960s, the populations of many poor countries in Asia, Latin America, and North Africa were growing as rapidly as the populations in sub-Saharan African countries are today. International health programs had gone into former colonies in these areas following World War II with antibiotic drugs, vaccines, and pesticides, which lowered mortality rates dramatically. Farmers in poor countries had always had lots of babies: They needed to, in order to ensure that at least one son grew up to work their fields and to take care of them in their old age. The problem was that while more of their children were surviving, rural people retained a cultural proclivity for huge families. Furthermore, they had little or no access to modern birth control, so they ended up with even more kids than they would have otherwise chosen.

Population growth soon was outpacing food production, especially in Asia, causing Western officials to fear that widespread famine would destabilize the continent, Columbia history professor Matthew Connelly explains in his latest book, Fatal Misconception: The Struggle to Control World Population . President Lyndon B. Johnson and his advisers viewed the situation through a lens of Cold War–inspired paranoia: Johnson, speaking to U.S. troops stationed in South Korea in 1966, warned that hordes of starving Asians might one day “sweep over the United States and take what we have.” His fear didn’t seem so irrational: 19 Nobel laureate scientists in 1960 had issued a public letter decrying how overpopulation could push the world into “a Dark Age of human misery, famine, and under-education, which could generate growing panic, exploding into wars.”

So in the late 1960s, the U.S. government began pouring tens of millions of dollars annually into international family-planning programs. The programs were administered primarily by Planned Parenthood, under the auspices of the newly formed United Nations Population Fund (UNFPA), which was financed largely by U.S. dollars and which claimed that its programs provided contraceptives, sterilization procedures, and abortions on a voluntary basis. In reality, American and British economists and demographers had designed these programs to slow population growth by nearly any means necessary, according to Connelly.

South Asian countries with caste systems were willing to push family planning most aggressively, Connelly writes, because many ruling-class Hindus feared social unrest among the hungry lower castes. So Indian officials, under the guidance of Western family planners, agreed to pay famished people small sums of money to be sterilized; they also agreed to fire doctors who didn’t meet sterilization quotas. India, Pakistan, Bangladesh, and Sri Lanka implanted in women a type of intrauterine contraceptive device that was proven to cause infections and the rupturing of the uterine wall. Couples in all of these countries lost medical, housing, and education benefits for having more than a designated number of children. When local health officials balked at implementing aggressive programs, the U.S. Agency for International Development and the UN threatened to shut off Western food aid.

The endgame for this chapter of family planning started to unfold in 1975, when Indira Gandhi’s government bulldozed entire blocks of Delhi slums where large numbers of residents refused to be sterilized. Around the same time, police rounded up at gunpoint all of the men in the Indian village of Uttawar and forced them to get vasectomies. These atrocities drew international outrage and led to Gandhi’s being voted out of power the following year. They also prompted a backlash from feminists and women’s rights advocates who were assuming leadership roles within the NGO community in the 1970s.

International family-planning programs, which by this time had spread throughout Latin America and North Africa, gradually abandoned coercive methods over the next few years. The population control movement would have one last gasp, though, when UNFPA and Planned Parenthood helped China launch its draconian one-child policy in 1979.

Women’s choice

By the late 1980s, the UNFPA and Planned Parenthood had cleaned up their programs so that medical workers on the ground no longer were expected to lower birthrates. Clinicians now concentrated on helping women make informed choices about their sex lives and childbearing. If family planning executives discussed the prospect of slowing population growth in public, Connelly says, it was only as an ancillary benefit of giving women more control over their bodies.

“The term population control has since had a negative connotation, as well it should,” Connelly tells Columbia .

The economic benefits of slowing population growth, though, were apparent: as birthrates plummeted in most of the developing world, prosperity and modernization typically arrived. The governments of many countries in Asia and Latin America, now that they had proportionately fewer poor people to care for, could afford to invest in industry and modern agricultural methods, which boosted grain production 300 percent in some nations between the 1960s and the 1980s. (Connelly, in Fatal Misconception , makes the controversial argument that family planning programs have received too much credit for declining birthrates, and hence for development; see sidebar to the left.)

The good news for women’s rights advocates was that voluntary family-planning programs seemed to have lowered birthrates just as much as had coercive programs. For instance, a UN-sponsored program that had offered birth control pills to all poor women in Thailand in the 1960s, on the advice of a young field-worker named Allan Rosenfield, who later became dean of Columbia’s public health school, helped to halve the number of children born per woman in that country, from six to three, in less than 20 years. Across the developing world, birthrates declined where family planners provided a range of safe contraceptives and taught people the benefits of limiting their family size — not only where they bribed people to be sterilized or threatened tax penalties.

Yet, just as family planning programs were beginning to define a new humanitarian mission, funding stagnated. The trouble started during Ronald Reagan’s first term as president, Connelly writes, when the emerging pro-life movement in the U.S. launched a major lobbying effort against international family-planning programs. Abortion opponents called attention to the fact that Planned Parenthood and UNFPA were providing technical assistance to China for its country’s one-child policy, which in the mid-1980s was in its most coercive phase, allegedly requiring some women to have abortions and to be implanted with intrauterine devices. “It was not much,” writes Connelly, “but it was enough of a perch to permit pro-lifers to pile calumny upon calumny on China’s program and all who could be associated with it.” Since then, every Republican president has refused to contribute to UNFPA, which is the primary source of funding for international family-planning services. Partly as a result, financial support for international family planning has remained flat, which means that the funding hasn’t kept pace with increasing demand as populations in poor countries continue to climb.

Sub-Saharan Africa is home to most women who lack access to birth control today in part because family planning programs arrived to the region late, in the 1980s, when the money had already begun to dry up, say family planning executives. Family planning came to Africa late, they say, because international health programs, with their ensuing population boom, had arrived late, too.

A lack of money isn’t the only thing that has kept family planning from many Africans, though: “There is mistrust in some nations about family planning programs because of their checkered past,” Connelly says. “In African countries where there are ethnic tensions, for instance, it can be politically difficult for leaders to implement family planning programs because many people fear that they’ll be used to reduce the populations of some groups, and not others.”

Counting backward

Today, UN-backed family-planning programs operate in nearly all developing countries. If the UNFPA were better funded, say its proponents, birth control would be more available in rural Africa as well as in many Muslim and Catholic countries, where Western family planners must work hard to educate local leaders about the benefits of reproductive health services.

How to raise the money? Advocates for family planning are doing a lot of soul-searching these days. Many leaders in the NGO community believe that family planning organizations would be better financed if they once again promoted their work as a way to slow population growth, says Suzanne Petroni, a researcher who monitors funding for reproductive health programs at the Summit Foundation, a Washington, D.C.–based nonprofit that promotes environmental sustainability.

“The sense among many family planners is that they’re getting less money than they used to from Western donors, in part because their programs are no longer connected to a practical purpose,” says Petroni. “They believe that the human rights pitch hasn’t worked.”

Particularly tempting to some family planners, Petroni says, is the prospect of exploiting public concerns about global warming. The sales pitch would go something like this: if we limit the number of people on earth, we limit the number of carbon footprints. (Sachs validates this logic in Common Wealth , warning that decades from now, when the crowded nations of sub-Saharan Africa modernize — and Sachs is optimistic that they will modernize eventually — energy consumption on the continent will skyrocket.)

Many women’s rights advocates fear that if family planning programs are positioned once again as a means to combat overpopulation, the door will open for more human rights abuses, Petroni says. This debate within the aid community is contentious because there remains distrust between feminists and some older environmentalists who backed the original population-control movement.

Matthew Connelly sides with the women’s rights advocates. He was convinced in writing Fatal Misconception , he says, that family planning programs that aim to lower birthrates are bound to commit abuses. He found, for instance, that crimes occurred in the 1960s and 1970s even when Western family planners tried to operate their programs ethically: medical workers in several South Asian countries strong-armed patients into accepting sterilizations because they thought that lowering birthrates was good for their own careers, and family planning programs inevitably devoted more resources to sterilization procedures and to abortions than to follow-up care.

Connelly worries that Western nations, if their aid programs once again were promoted as a means to slow population growth, would be tempted to withhold other forms of development aid from countries if they don’t lower birthrates to specified levels.

Lynn Freedman, a Columbia public health professor and an attorney who is an expert on population issues, concurs. “The idea that foreign aid could be linked to a country’s success at lowering birthrates is not wildly unlikely,” she says. “Aid agencies today are in the habit of designing all sorts of performance targets in order to account for the efficiency of their programs, and these targets can easily be misused in a way that violates people’s rights. The ’60s weren’t that long ago.”

Sachs doesn’t see that happening. “The worst I could imagine is that an agency might attempt to link a country’s family- planning money to birthrate reductions,” he says, “but I don’t think that other kinds of foreign aid would be linked in this way.” He also dismisses as unrealistic the possibility that international family-planning programs could once again employ coercive methods. Family planning programs must, and will, remain voluntary, he believes.

The greater moral danger today, Sachs argues, is that large numbers of women will continue to want for birth control, and populations will continue to grow rapidly in sub-Saharan Africa and in places like Haiti, Bolivia, Venezuela, Yemen, Afghanistan, Iraq, and Myanmar, in part because Western scholars and aid workers insist on tiptoeing around the subject of overpopulation for fear of being seen as insensitive to the abuses of the past. In Common Wealth , Sachs even advances the term population control, which has long been considered impolitic among scholars, because he says he wants to break the taboo.

“For years people have been telling me, ‘Don’t talk about population, talk instead about access to reproductive health services,’” Sachs says. “And I’ve said, ‘No, I want to talk about population, because it’s a serious problem.’ I think it’s time we take this subject out of the whispers.”

Birth control, under audit

Columbia professor Matthew Connelly’s Fatal Misconception, a history of the population-control movement of the 1960s and 1970s, is shocking for its parade of morally compromised scholars and diplomats who spread birth control around the world. There’s Planned Parenthood head and ecologist William Vogt, who thought that starving people in the developing world should be left to die and therefore opposed food aid; there’s Robert McNamara, who, as head of the World Bank, resisted funding healthcare programs in poor countries because they saved lives and contributed to overpopulation; there are the Planned Parenthood doctors who at a 1963 UN conference decided that a female contraceptive’s tendency to pierce the uterus, causing sterilization, was to be considered a side benefit.

Fatal Misconception was among the most controversial scholarly monographs of 2008, not just because Connelly calls out early family planners as xenophobic and racist, however. His most startling critique is that these programs didn’t even lower birthrates as designed: he says that between 1950 and 2000, the dozen or so developing nations that employed the most aggressive family- planning tactics reduced birthrates little more than did other countries. Relying on UN data, Connelly notes that China, for instance, reduced the number of children per woman from 6.2 to 1.7 during that 50-year period. In Brazil, where little effort was made to encourage family planning, the numbers fell from 6.2 to 2.3 children during the same period. Connelly lists half a dozen such examples to make his point. He then argues that girls’ education, women’s employment, and other social factors affected birthrates more so than did family planning programs.

“In many poor countries where birthrates declined dramatically,” Connelly tells Columbia, “the declines actually started before family planning programs even showed up.”

How could people have managed to have fewer babies without contraception? The same way they did in early-19th-century Europe, where birthrates plummeted a full century before modern birth control became available, Connelly says: They used traditional forms of birth control like the rhythm method.

Connelly charges that UN and Planned Parenthood officials who administered most family-planning programs in the 1960s and 1970s knew that data on the ground weren’t validating their efforts. They soldiered on, he says, because of institutional inertia. “These programs gave jobs to millions of people, and administrators weren’t interested in scrutinizing the numbers,” he says. “They were interested in making payroll.”

Many contemporary family planners are apoplectic over Connelly’s assertion that birth control programs don’t lower birthrates. Steven Sinding, a professor at Columbia’s Mailman School of Public Health and past director-general of Planned Parenthood International, has blasted Connelly over his book’s conclusions. Sinding claims that about 50 percent of birthrate declines in poor countries are attributable to family planning programs.

Columbia called T. Paul Schultz, a Yale economics professor who has spent his career studying birthrate dynamics. This subject invites confusion, he says, because no long-term controlled studies have ever been conducted. That’s partly because there are a multitude of factors that influence birthrates, so aid agencies whose programs target any one of these areas are reluctant to fund expensive, long-term studies to showcase the relatively small impact that their work likely has on fertility. The dearth of data, Schultz says, allows both advocates and opponents of family planning to cherry-pick statistics.

But the most sophisticated data available, collected over two decades in Bangladesh, Schultz says, suggest that the availability of free contraception accounted for about 20 percent of the region’s birthrate decline. That’s a strong relationship, considering how many variables were tested, he says. “The intuition of development experts has always been that family planning must slow population growth,” Schultz says, “and I’ve never seen any good data that suggest otherwise.”

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Global Population Increasing and Control Research Paper

Why population policy makers should avoid population control, positive effects of increasing global population, main problems of immense population, potential problems of global population, solutions to avoid the problems without reducing the global population.

Population control is a very controversial subject. This paper will give a stringent analysis of the subject by addressing four main issues:

  • why population policy makers should avoid population control,
  • positive effects of the increasing global population,
  • main and potential problems of the increasing global population,
  • solutions to avoid the problems without reducing the global population.
  • Saving human species: Reproduction is the only way to save the life of some desirable human species. Nations that restrict families to deliver one child endangers the existence of the families in future (Sen, Germain, & Chen, 2004). If the only child dies before reproducing, families with intellectual brains are wiped out, and the world losses greatly.
  • Survival for the fittest hypothesis: If the population is not controlled, the natural selection aspect will work efficiently to ensure that the best species of the human race survive. The healthiest, the most intelligent people, and most aggressive people will survive while the sickly, lazy, and dim-witted people will die. Therefore, the world will select the best human species to reproduce and evolve the world.
  • Violation of human rights: Enforcing laws to limit the number of children that a family should bear is violating human rights (Caldwell, Phillips, & Barkat, 2002). A family ought to have the freedom to bear the number of children that they want. The issue of governments controlling population suppresses the human fraternity, as there are people who would wish to have many children but it is against the law.
  • Women health: Most population control measures emphasize that the woman ought to use contraceptives. The vast side effects that the contraceptives have to the women’s health are ignored (Robinson & Ross, 2007). Women are obligated to prevent further births at the expense of their health, which is unreasonable.
  • Religious considerations: Most religions support their followers to bear as many children as possible. Essentially, the Creator commanded people to multiply and fill the earth. Therefore, restricting the number of births is against the will of God (Knudsen, 2006).
  • Ethical considerations: It is noteworthy that some nations are too strict with the population control measures. Some women have to abort their fetuses out of the fear of the adverse consequences that they might face because of bearing more children than required. The merciless killing of innocent children is unethical, as mothers will always undergo psychological torture (Gordon, 2003).
  • Biodiversity concerns: The increasing population triggers innovators to come up with ideas to solve problems and generate more resources than before. Controlling or reducing population will discourage new inventions, and the development processes may come to a halt.
  • Remedy for good governance: An increasing population will prompt governments to find ways of distributing its resources equally. Governments will struggle to bring accountability and transparency to meet the demands of the increasing population (Louhiala, 2004).
  • Globalization concerns: The increasing population triggers the desire of companies to target customers across the globe. Controlling population will adversely affect globalization, as international companies would cut on their international trade because of the decreased number of customers.
  • Migration concerns: Some industrialized nations are in desperate need of human resources. Such national will save overpopulated nations in times of war, famine, diseases, and during tough economic conditions. Controlled migration would play a great role in vacating people from densily-populated regions instead of denying someone a chance to live.
  • Enhanced global economy: One of the main factors that businesses consider is the end user of their products and services. An increasing global population is a clear indication of the growth and development of a flourishing business (Campbell, Merrick, & Yazbeck, 2006).
  • Fulfilling human rights: Human beings will be happiest if they have the freedom to bear their desired number of children. Their religious concerns and the fulfillment of God’s desires will happiness and contentedness in the human fraternity.
  • Remedy for innovations and inventions: Human being will work hard to ensure that they feed, educate, and provide for their children. The survival for the fittest proposition will take full effect, whereby, in the process of working hard, human beings will innovate and invent new ideas that are very essential in global development.
  • Human resources: An increase in population indicates that there are plenty of human resources, which are necessary for the evolution of the world economy. Indeed, some nations with inadequacy of human resources can have the opportunity to outsource human resources.
  • Dismissal of false allegations: Many people associate increasing population with poverty and hunger. The allegation is somewhat false as some nations are highly populated yet they are able to come up with upgraded ideas to handle their issues in a simplified manner (Zhu, 2005). Many hands make work easier, and an increasing population would work towards simplifying problems.
  • Poverty: It is evident that an increasing population strains the government. The little revenue that the government collects is used to import foodstuff instead of investing in development. The cycle continues and such nations will always remain poor with the increasing population (Birdsall, Kelley, & Sinding, 2001).
  • Health issues: In the third world nations, health care facilities are limited. Therefore, women who bear children uncontrollably do not access medical attention whenever needed. Such women are prone to health complications, and infant mortality is considerably high. The children who are lucky to survive would be malnourished, unhealthy, and unproductive (Glasier & Gülmezoglu, 2006).
  • Unemployment is a major issue in developing nations that have more human resources than needed. The learned youths are frustrated because of the lack of employment opportunities within their country.
  • Internal conflicts and wars: Conflicts are likely to arise in an overtly populated region with idlers. The idlers will argue of some negligible stuff and create endless problems that lead to recurrent wars.
  • Most third world nations with high populations have a great gap between the rich and the poor. The poor will always do menial jobs for the wealthy individuals and earn their little pay because they have no otherwise. The wealthy individuals will mistreat the poor workers, pay them poorly, and continue earning massive profits from their hard labor.
  • World hunger: With the increasing population, there is a possibility of reaching a point where the available food will be inadequate to feed the entire population (Gwatkin, Rutstein, Johnson, Suliman, & Wagstaff, 2003).
  • Increased crime rates: An increasing population will mean that at some point, there will be inadequate resources to cater for the needs of every person. Therefore, the people who lack a share of the national cake would opt to join crime troops to steal from the wealthy individuals to earn a living.
  • Environmental deprivation: An increasing population will lead to overuse and overexploitation of the available resources (Alexandratos, 2005). Therefore, the increasing demands of the increasing population may strain the natural resources without adding value, which is a great threat for future generations.
  • Political instability: Most leaders in developing nations encourage people to bear many children so that they can have many votes. The ethnically based political aspect would lead to political uproars if one of the ethnic groups decides to control births. Therefore, such nations are susceptible to political instability issues in future.
  • Collapse of the ecosystem: The increasing population increases consumption rates, where, people may have to clear the natural environment to grow crops (Paige, 2004). The increasing population will endanger the lives of rare animal species and indigenous vegetation cover.
  • The potential issue of world hunger is solvable if nations agree to work together. Wealthy nations should make it their obligation to educate developing nations of the methods of increasing agricultural productivity using new technologies.
  • Nations can reduce crime rates if they improvise ways to ensure there is equal distribution of the scarce resources. Governments should employ social safety measures to prevent crime incidences instead of fighting with criminals.
  • It is evident that some parts of the world have inadequate human resources. The population policy makers can find ways of transferring some people from overcrowded nations to regions that have deficits of human resources (Schultz, 2003).
  • Poverty is an issue in most developing nations. However, population is not to blame because most developing nations have not fully exploited their natural resources. Developed nations should help the poor nations to exploit their resources and employ the latest technologies to reap maximally and sustain the growing population.
  • Political instability based on ethnicity and population is solvable through enlightenment of the entire population. Political education, modernization, and civilization of citizens of nations that are susceptible to political uproars would be a great way to address political instability issues.
  • Governments should make it their obligation to add value to the existing natural resources, and exploiting of new resources to prevent the problem of overexploitation.
  • Governments should make it their obligation to ensure that their citizens access medical attention. In fact, high infant mortality rates are a threat to the global population, and governments should seek for help from global health organizations to address the issue.
  • If people adopted the modern agricultural techniques that do not require much land, they could save the ecosystem. Greenhouse farming, hybrid farming, and all forms of urban farming techniques would need less space than the traditional farming techniques that require large pieces of land.
  • The internal conflicts and wars resulting from idleness are solvable if governments of such nations improvised ways of occupying the minds of the idlers. Devolution and creation of industries would offer the idlers with some manual job opportunities and they would have little time for conflicts and wars.
  • The governments should improvise strict laws that protect the workers. Employers who mistreat or underpay their workers should face criminal charges and have their companies closed if they cannot adhere to the employment laws (Bongaarts, 2004). Whistleblower policies will also play a great role in protecting the employees.

Alexandratos, N. (2005). Countries with rapid population growth and resource constraints: Issues of food, agriculture, and development. Population Development Review , 31 (3), 237-258. Web.

Birdsall, N., Kelley, A.C., & Sinding, S.W. (2001). Population matters: Demographic change, economic growth, and poverty in the developing world . South Melbourne, Vic: Oxford University Press. Web.

Bongaarts J. (2004). Population policy options in the developing world. Science , 263 (1), 771-776. Web.

Caldwell, J.C., Phillips, J.F., & Barkat, K. (2002). The future of family planning programs. Family Planning Studies Journal, 33 (3), 1-10. Web.

Campbell, W. A., Merrick, R.W., &Yazbeck, A.S. (2006). Reproductive health: The missing millennium development goal . Washington, DC: The World Bank. Web.

Glasier, A., & Gülmezoglu, M. (2006). Putting sexual and reproductive health on the agenda. Lancet , 10 (16), 140-185. Web.

Gordon, L. (2003). Woman’s Body, Woman’s Right. New York: Penguin Press. Web.

Gwatkin, D.R., Rutstein, S., Johnson, K., Suliman, E.A., & Wagstaff, A. (2003). Initial country level information about socio-economic differences in health, nutrition, and population. Washington, DC: The World Bank. Web.

Knudsen, L. (2006). Reproductive Rights in a Global Context . Nashville, TN: Vanderbilt University Press. Web.

Louhiala, P. (2004). Preventing intellectual disability: Ethical and clinical issues . Cambridge: Cambridge University Press. Web.

Paige, W. E. (2004). Global Population Policy . Aldershot, England: Ashgate Publishing. Web.

Robinson, W. C., & Ross, J.A. (2007). The global family planning revolution: Three decades of population policies and programs . Washington, DC: World Bank Publications. Web.

Schultz, T.P. (2003). Investments in the schooling and health of women and men: Quantities and returns. Journal of Human Resource, 28 (2), 694-734. Web.

Sen, G., Germain, A., & Chen, L.C. (2004). Population Policies Reconsidered: Health, Empowerment and Rights . Boston: Harvard University Press. Web.

Zhu, B.P. (2005). Effect of inter-pregnancy interval on birth outcomes: Findings from three recent US studies. International Journal of Gynecology Obstetessi, 89 (5), 25–33. Web.

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283 Population Essay Topics

🏆 best essay topics on population, 👍 good population research topics & essay examples, 🌶️ hot population ideas to write about, 🎓 most interesting population research titles, 📌 easy population essay topics, ✍️ population essay topics for college, 💡 simple population essay ideas, ❓ research questions about population.

  • Recycling in Dubai and Its Impact on the Population and Environment
  • The Issues of Aging Population
  • Business Analysis: Population and Sampling Techniques
  • Natural Resources and Population Growth
  • Population Growth and Technology
  • Critique of Population Health Intervention
  • Evidence-Based Population Health Improvement Plan
  • Impact of a Growing Elderly Population The growing elderly population has a number of impacts on the society, the economy, and families. Governments should develop policies that will address this challenge.
  • Dubai Spatial Planning. Population and Urban Growth The spatial planning of Dubai involves the public sector function that influences the distribution of activities in the city.
  • Social Impact of Population Growth The case study concentrates on South Africa as an example to show the impact of population rate growth and climate change on social and economic spheres in developing countries.
  • Egypt’s Population, Languages, Religion & Culture Egypt is a transcontinental nation that extends to the southwest corner of Asia and the northeast corner of Africa. Egypt is considered third of the largest economies in Africa.
  • Human Population Growth and Environment The article argues, as a result, with an increasing trend in the human population, there are negative impacts on the environment.
  • Population Parameters in Statistics Population parameters refer to the statistical measures that are fixed and when used as variables, they make the population distribution descriptive hence descriptive statistics.
  • Aging Population in Canada and Public Policies The measures listed in this paper have to be proposed as the basis for the future policy aimed at maintaining the economic well-being of Canadians and Canada, in general.
  • Population Growth and Agriculture in the Future The current industrial agriculture needs to be advanced and developed in combination with sustainable agricultural practices.
  • Promoting Better Health for the American Population The official statistic shows that the United States life expectancy rate is significantly lower than in the majority of developed countries of the world.
  • The Decline in the Honeybee Population and Its Effects in the U.S. This essay outlines three adverse outcomes of the decrease in the honeybee population for farmers in the United States.
  • Coconut Grove: Vulnerable Population Assessment Coconut Grove is a neighborhood in the southern part of Miami Florida roughly constituted of twenty thousand people. This paper will discuss the prevalent health problem in this area.
  • Communication Strategies with a Vulnerable Population Communication during a crisis is essential for both victims and the emergency services. Often, conventional forms of communication are unavailable due to the circumstances of the crisis.
  • Vulnerable Population in Modern Society The following paper is to cover different reasons that make populations vulnerable under the variety of circumstances, to examine some events that may cause it.
  • Female Population of India Introduction It is hard to disagree that it is essential for humans to be aware of cultural differences and know how females are treated in various areas. Such a knowledge allows persons to learn how their own counties can be improved. The area selected for this assignment is India, and…
  • Health Promotion Among Hispanic-Latino Population This paper aims to review the health status of the Hispanic/Latino population and discuss the best health promotion methods for this segment.
  • Population, Urbanization, and Environment The boom of urbanization came during the second half of the 20th century, when the world’s urban population almost doubled, from 29 to about 61%.
  • Distraction from Injections in a Pediatric Population This paper examines various distraction interventions and their impact on pain, anxiety, and fear reduction in children and adolescents during injections.
  • The Health Status of a Population Understanding the health status of a population is very important in public health. Mortality and morbidity are used as common indicators of measures of health.
  • Preventing Infection and Transmission of COVID-19 in the Population To address the problem of rapid transmission of COVID, the US government created public health and safety measures, which have been implemented in many states across the country.
  • Challenges Faced by Hispanic Immigrant Population The purpose of this article is to briefly describe the problems faced by Hispanic immigrants and suggest ways in which you can help them.
  • Social Workers’ Advocacy for Queer Population At the international level, local social workers are not able to introduce significant changes and help LGBTQ people.
  • “China’s Population Destiny: The Looming Crisis” by Wang Feng The article “China’s Population Destiny: The Looming Crisis” by Wang Feng explores the untouched element of the Chinese population, which remains a monumental topic.
  • Guatemala’s Population, Territory, and Traditions This research paper examines Guatemala in terms of its population, territorial distribution, traditions and beliefs.
  • Prison Population by Ethnic Group and Sex Labeling theory, which says that women being in “inferior” positions will get harsher sentences, and the “evil women hypothesis” are not justified.
  • The Vulnerable Population: Homeless The Vulnerable Population: Homeless do not have permanent home. Some homeless people sleep in a shelter or hotel. An individual is considered homeless if they sleep in their car.
  • Statistics Application: Population and Sample Descriptive statistics presents some sample properties, while an inferential approach analyzes the sample to make conclusions about the broader population.
  • Population, Consumerism and Capitalism The author analyzes examines the joint impact of population, consumerism and capitalism on the economy and on the environment.
  • Population, Life Expectancy Rate of Different Countries Life expectancy, literacy rate and per capita GDP are very good indicators of quality of life in a country and therefore, these variables should be studied in detail and understood well.
  • Vulnerable Population Assessment in Miami, Florida In Miami, Florida, the priority community health problem is the obesity of middle-aged adults. It is related to a Healthy People 2020 topic of nutrition and weight status.
  • Population Changes and Its Impact on Economic Activity This paper attempts to achieve a better understanding between changes in the population and its subsequent impact on economic activity within specific regions and how this influences the construction industry.
  • Hispanic Ethnocultural Population: Immersion Project This project explores the “Hispanics” group that consists of the US citizens affiliated with the Hispanic ethnocultural background, who share some of the same behavioral traits.
  • Human Population Growth and Its Effects The rapid human population growth is a significant challenge from both a socio-economic and environmental perspective.
  • Social Work With Native American Population The Native American or Indigenous population has historically been challenged by severe oppression ever since the European population’s first arrival in the Americas.
  • Patient Engagement and Population Management Patient participation is an essential part of healthcare and is increasingly recognized as an important part of delivering safe and people-centered services.
  • The Portrayal of the LGBTQ+ Population in the Media Many scholars have investigated the portrayal of the LGBTQ+ population in the media, noting that it does not always reflect reality.
  • Population Health: Social Determinants and Risk Factors Population health is linked to psychosocial, cognitive, and behavioral factors. There are social activities that affect individuals’ biological performances.
  • Aging Population: Contemporary Issue Population aging is becoming increasingly common in the industrialized nation beginning from the 21st century and is now continuing to cause harm to the population.
  • Environmental Degradation as a Result of Growing Population It’s not always large populations that are ultimately the main cause of environmental stress. There’re a number of factors involved including larger populations, global warming.
  • Communicable Diseases: Measles and Its Impact on the Population Among the variety of communicable diseases, there are those that are typical for certain population groups. One of the problems of modern medicine is measles, mostly a child’s ailment.
  • Disabled as the Vulnerable Population of Miami There are many categories of people in the world that can be categorized as medically and socially vulnerable. Such people tend to be less fortunate than others.
  • National and Cultural Identity of Canadian Population The principles of the national and cultural identity of the Canadian population are contradictory for a variety of cultural, political, social, and other reasons.
  • Miami Gardens’ Vulnerable Population Health The paper overviews, assesses, and discusses the vulnerable population of Miami Gardens in order to identify the related community health problem typical for the selected area.
  • Vulnerable Population: Disaster Management’ Improvement This paper helps understand that addressing an array of needs and demands of the vulnerable population remains one of the major issues in the sphere of disaster and emergency management.
  • Health of North Miami Beach Vulnerable Population The purpose of this paper is to assess the vulnerable population in North Miami Beach by describing its specific characteristics, exploring strengths, risk factors, and barriers.
  • Horse Population, Evolution, and Physiology The evolution of horses occurred over a period of 55 million years. By analyzing bones and DNA of the ancient horses, we are able to get an idea about their origins.
  • The Population of the Alternative Currencies Alternative currencies’ popularity has risen because of their well-known benefits, such as ease of storage, minimal transaction fees, and speed.
  • Health Disparities of Transgender Population The problem is centered around the healthcare inequality experienced by members of the transgender community, where the barriers include financial factors and discrimination.
  • Population Health Data in California The role of nursing staff in improving population health indicators is high, particularly given the fact that various levels of academic training are offered to nurses.
  • Epidemiology of Population Health The development of a public health policy provides information, recommendations, evidence, and the presentation of a position to the authorities.
  • Telehealth and Population Health Speciality In the past, most patients, especially those from rural areas, have encountered many challenges that prevent them from accessing hospital facilities.
  • DNP Admission Essay: Polypharmacy in an Elderly Population A nurse leader is expected to be a capable team leader and organizer, skilled in care delivery and administrative roles.
  • Health Problems Facing the Vulnerable Population Despite aspirations and efforts in the U. S. to eliminate or minimize inequalities in healthcare by 2010, disadvantaged societies endure facing large differences in morbidity.
  • The Ugly History of Environmental Fears and Population Controls Rapid population growth and its strain on global resources are one of the most significant discussion points of the twenty-first century.
  • The US Economy’s Effects of the Aging Population This paper aims to evaluate and address the effects of an aging population on the United States economy with the support of real-life examples.
  • Health Risks of Homeless Population The issue of the homeless population is diverse and encompasses many underlying challenges to individuals who are homeless and social infrastructure at the same time.
  • Puerto Rico: Declining Human Population Lack of land resources and continuous population growth in Puerto Rico exacerbate the housing problem, as the question arises that there is virtually nowhere to build housing.
  • Impact of Different Population Group on Children Development The active involvement of different population groups allows other children to understand and perceive the world differently.
  • Political Leaning and Population Changes in Texas It is likely that the political leaning of the entire state of Texas as a whole will slowly change with the changes in its population.
  • Substance Abuse in Population and How to Address It Substance abuse is one of the issues in the population that affect not only the people who conduct the abuse but those around them as well.
  • Future Fuel Price Rise and Its Impact on Population Fuel prices significantly impact people’s daily lives, and the current price increase may seriously harm them.
  • Population Aging: Benefits and Challenges While longer life expectancy and excellent health in later life are among the century’s shining successes in many parts of the world, these changes also pose several challenges.
  • Descriptive Statistics for the Infected Population A survey was performed to determine the demographic characteristics of the infected population. This survey involved 969 participants with a mean age of 29.06 years.
  • St. Louis Hopes Afghan Refugees Boost Its Population This article discusses the decline in St. Louis’s population and the city’s efforts to attract Afghan refugees to reinvigorate its urban areas.
  • Population Aging and Healthcare Concerns Population aging is a critical issue, and its solution requires effective and constant coordination between health care and aging systems.
  • Analysis of Group Setting Population Social concerns associated with a decline in educational and cultural level, the blurring of life reference values, and the inability to interact constructively and resolve conflicts.
  • The Great Pacific Gyre and Indigenous Population The paper examines the problem of the Great Pacific Gyre, its effects on the indigenous population, and approaches to fix it.
  • Causes of the Changing Population of the World The rapid population growth rates have been caused by development in critical areas such as science, technology, medicine, and education.
  • Judaism and Christianity: History and Population A dedicated analysis is needed to determine why Christianity currently has billions of adherents while Judaism remains the religion of just one nation.
  • Cold War: History and Impact on Population This work aims to describe the causes and stages of the Cold War, as well as to assess its impact on the population through the use of qualitative research techniques.
  • Health Systems and Population Health: Memorandum This memo aims to explain how the market and public policy changes, including reimbursement mechanisms, are driving changes in how the hospital engages in population health.
  • Cannabis Legalization in the U.S.: Population Health Impacts This paper aims to provide the reflection of the counselor after reading the “Cannabis legalization in the US: Population health impacts” article.
  • Esophageal Cancer: Description, Population Affected, and Prognosis In esophageal cancer, malignant cells develop in the esophagus tissues, leading to tumor formation; it accounts for 1% of all malignancies diagnosed in the USA each year.
  • Indigenous Population of Brazil and the Struggle for Brazilian Rainforest The policy of aggressive agricultural expansion based on non-sustainable practices taken by the Brazilian government threatens the Amazon rainforest with with grave consequences.
  • Population Science Meets Real Life The benefits of science in real life outweigh the disadvantages, and it is important to embrace science as a part of life.
  • Telehealth for Vulnerable Population: Pros and Cons Certain advantages and disadvantages characterize any healthcare or medical achievement, and the promotion of telehealth for the vulnerable population is no exception.
  • Access to Preventive Care as Population Health Issue The identified challenge concerned is the limited access to preventive care services, factors that contribute to it include lack of health insurance, transportation issues, etc.
  • Depression in the Older Population The paper discusses depression is an actual clinical disorder for older people with specific reasons related to their age.
  • Challenges of Treating Substance Abuse in Homeless Population Substance abuse remains among the major problems the health care industry is facing, also in developed countries.
  • Population-Based Health Information Health data are information generated by healthcare centers relating to the condition, diagnosis, the type of treatment administered, and other patients’ definitions.
  • Limited African Population Growth and Its Reasons There are two main factors behind the limited population growth in Africa in the past: unfavorable environment and the spread of deadly diseases.
  • Population, Social Movements, and Social Change In various ways, the worldwide spread of social media is already influencing how individuals pursue and define social change.
  • Vulnerable Population Assessment: First Nations Vulnerable populations are those individuals faced with adverse conditions such as a lack of financial resources, being homeless, and being among ethnic minorities.
  • Population Analysis: The U.S. Versus Nigeria By comparing the differences in the population of the U.S. and Nigeria, one will infer crucial aspects of effective economic performance.
  • The Responsibility of the Marketing Manager to the Population In the case under review, the dilemma lies in attracting the target population to the energy drink without discouraging them from consuming more expensive but healthier food.
  • The Population-Health Oriented Policies The purpose of this work is to consider strategies for medical institutions that will be based on the provision of health services.
  • Vulnerable Population: Safety Concerns Vulnerable population refers to the disadvantaged subsegments in society. In the healthcare industry, safety concerns for vulnerable people result in better healthcare services.
  • COVID-19 Impact on New York State Population African Americans have been more affected by COVID-19 than other communities in the U.S. Social identities determine people’s vulnerability to epidemics.
  • Population Control Discussion The paper describes forced birth control and disproves the assertion made in the video “Does Population Growth Lead to Hunger and Famine?”
  • Issues Related to Freedom and Population Surveillance in China The paper emphasized several vital issues related to freedom and population surveillance in China, the adverse use of technology, and the importance of AI supremacy.
  • Supporting the Population’s Health: The Role of Nurses Promoting healthy lifestyles is one of the main tasks of nurses in supporting the health of patients of different cultures.
  • COVID-19 Among the African American Population in the United States Two years since it was first reported, the COVID-19 pandemic continues to rake havoc in many parts of the world.
  • Average Lifespan: Human Population Data Analysis This lab aims to gather and analyze human population data using statistical methods to analyze data, that was gathered from the “Find a Grave” website.
  • Personal Responsibility and World Population In the face of today’s conditions, when each decade, humanity grows more than in the last, it is of crucial importance for every person to understand their personal responsibility.
  • United States of America: Population Control Programs The overpopulation of the planet and the subsequent struggle for survival are among the main fears of civilization over the past centuries.
  • Suicide Prevention for the Elderly Population Disturbing trends call for increased attention to the identification of underlying causes, recognition of warning signs, and prevention of suicide among the elderly.
  • Global Warming in Relation to Human Population Size The density of the world population in the future is a crucial component of climate policy to safeguard the vulnerable future generation.
  • Foodborne Illness as Population Health Concern in the US Foodborne illness affects at least one in every six Americans. Food safety issues claim over 3,000 deaths per year in the US.
  • Issue of Aging Population: The Healthcare Challenge The US population is swiftly aging which poses challenges to healthcare system. It is estimated that approximately 20% of American people will reach the age of 65 within a decade.
  • Fertility Rate as Population Dynamics Measurement The Natality index, or fertility rate, shows the number of children born theoretically by one woman until she reaches a specific age.
  • Health of Population in Philadelphia Community Based on the Healthy People classification, the main public health determinants are Social Determinants of Health, Nutrition and Weight Status, and Access to Health Services.
  • The Rise in Population in Europe in the Eighteenth Century The 18th century saw millions migrate from Europe to America and counter people from the country and other nations into European cities.
  • Maintaining Population Nutrition General rations, supplementary feeding programs, and therapeutic feeding programs take the leading role in maintaining population nutrition.
  • Immunization in Refugee and Immigrant Population The partners are chosen due to their roles in such processes as communication, care provision, and resource allocation, helping the nurse develop immunization programs.
  • Enlightenment and Its Impact on the French Population and the Industrial Revolution The work examines the connections between the Enlightenment and the French people’s academic achievements, and its relation to the Industrial Revolution.
  • COTA and Occupational Therapy within Adolescent Population with Cerebral Palsy This paper discusses the role of the Certified Occupational Therapy Assistant (COTA) in physical and developmental disabilities, and models of practice.
  • An Investigation of HIV/ AIDS Prevention Program Targeted to Unique Population Group in Bangkok The prevention strategy for unique populations, like in the project initiated in Thailand, is aggravated by the necessity to study these populations.
  • Aspects of Counseling African-American Population Due to various social factors, African Americans often suffer from depression, post-traumatic stress disorder, anxiety, and so on, and are in need of treatment.
  • Affordable Care Act for North Carolina Uninsured Population The Act has provisions that set the new guidelines for the health insurance industry, ensure the expansion of the health insurance market, and create subsidies for the premiums.
  • Improving the Overall Health of Vulnerable Population: Hope House Residents This paper aims to propose a project for improving the overall health of vulnerable population, specifically homeless people, at Hope House Residents, Middletown, Ohio.
  • Covid-19 Pandemic and Mental Health of American Population After the Covid-19 outbreak, the depression rates in the US have increased threefold. The pandemic cost many people their employment, cut off social ties, and separated families.
  • Population Health in the United States and Canada To begin with, it is obvious that the health outcomes of the U.S. and Canada are rather similar, as both are among high-income countries.
  • African American Population’s Health-Related Problems This paper provides a critical analysis of the factors that put African Americans at greater health risks and steps that can be taken by the governments to address this problem.
  • Vulnerable Population: Dependence on Field of Interest The concept of population vulnerability depends on the field of interest. In health, vulnerable populations are those susceptible to different diseases.
  • Photovoice of Homeless Population Homelessness impacts our lives in a number of ways including matters to do with public health, public safety, and security issues.
  • Advocacy Campaign for Hypertension in African American Population The paper argues health risks can be eliminated with the help of thoroughly designed and successfully implemented health advocacy campaigns.
  • Suicidal Ideation & Depression in Elderly Living in Nursing Home vs. With Family This paper attempts to compare the incidence of suicidal ideation and depression among elderly individuals living in nursing homes and those living with family in the community.
  • Biological Processes and Population Health The integration of biological and medical results to the population health has led to amassed linking factors to demographic measures.
  • Moving Upstream to Improve Population Health Down Road This paper looks into the connections between the developmental origins of life and health and the rates of chronic diseases and life expectancy in the adult life.
  • Reducing the Incidence of Diabetes Mellitus and Diabetic Foot in the Veteran Population The research proposes to use a comprehensive education program to reduce the incidence of diabetes mellitus and diabetic foot in the Veteran population.
  • HIV Among Adolescents: Nurse Practitioners Intervention The increased prevalence of HIV among the representatives of the adolescent population can partly be attributed to drug abuse.
  • Population-Based Care Method Overview Population-based care can be simply defined as a method that perceives patients as those seeking healthcare services, not as isolated entities, but as members of certain groups.
  • Environmental Health Status of Population Environment plays a central role in the health status of a population because it comprises determinants of health that interacts in a complex manner.
  • Health Care Reform and Its Effects on Population This paper analyzes health plans influence in Colorado based on the article “In Colorado, disparity in health plan prices underscores ambitions, and limits, of Affordable Care Act”.
  • HIV in Adolescent Population: Healthy Promotion Intervention Plan The intervention program is about the distribution of leaflets for adolescents with HIV as well as other representatives of society.
  • Autistic Children as Vulnerable Population in Maryland This paper looks at the evidence that proves that the problem of autism is a reality and that it exists in Maryland.
  • Needs of a Growing Population This paper presents that individuals should be able to access services and acquire care in all areas, regardless of their geographic locations or economic status.
  • Cholera: Overview of the Affected Population and Description of the Disease The paper describes one of the latest cholera epidemics to date that began in Haiti in 2010. Only in the past 12 months, no new cases have been reported.
  • Aging Population: A Relevant Problem of the Future Increasing the retirement age or removing pension funding entirely comes with an adverse reaction from the population, and many countries cannot afford such measures.
  • The Ethnicity Mixes and Growth of Houston’s Population The ethnicity mixes and growth of Houston’s population have brought about significant changes and improvements for the past three decades.
  • Translational Science Model, the Organizational Setting and the Population The project will take place at a prevention and primary care medical office that employs ten people and provides services to roughly 25-30 adult patients a day.
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Non-communicable diseases, digital education and considerations for the Indian context – a scoping review

  • Anup Karan 1 ,
  • Suhaib Hussain 1 ,
  • Lasse X Jensen 2 ,
  • Alexandra Buhl 2 ,
  • Margaret Bearman 3 &
  • Sanjay Zodpey 1  

BMC Public Health volume  24 , Article number:  1280 ( 2024 ) Cite this article

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Introduction

The increasing ageing of the population with growth in NCD burden in India has put unprecedented pressure on India’s health care systems. Shortage of skilled human resources in health, particularly of specialists equipped to treat NCDs, is one of the major challenges faced in India. Keeping in view the shortage of healthcare professionals and the guidelines in NEP 2020, there is an urgent need for more health professionals who have received training in the diagnosis, prevention, and treatment of NCDs. This paper conducts a scoping review and aims to collate the existing evidence on the use of digital education of health professionals within NCD topics.

We searched four databases (Web of Science, PubMed, EBSCO Education Research Complete, and PsycINFO) using a three-element search string with terms related to digital education, health professions, and terms related to NCD. The inclusion criteria covered the studies to be empirical and NCD-related with the target population as health professionals rather than patients. Data was extracted from 28 included studies that reported on empirical research into digital education related to non-communicable diseases in health professionals in India. Data were analysed thematically.

The target groups were mostly in-service health professionals, but a considerable number of studies also included pre-service students of medicine ( n  = 6) and nursing ( n  = 6). The majority of the studies included imparted online learning as self-study, while some imparted blended learning and online learning with the instructor. While a majority of the studies included were experimental or observational, randomized control trials and evaluations were also part of our study.

Digital HPE related to NCDs has proven to be beneficial for learners, and simultaneously, offers an effective way to bypass geographical barriers. Despite these positive attributes, digital HPE faces many challenges for its successful implementation in the Indian context. Owing to the multi-lingual and diverse health professional ecosystem in India, there is a need for strong evidence and guidelines based on prior research in the Indian context.

Peer Review reports

Non-communicable diseases (NCDs) kill 41 million people each year. Of these deaths, more than 15 million happen to people between the ages of 30 and 69 years, and the vast majority of these “premature” deaths occur in low- and middle-income countries (LMICs) [ 1 ]. It is estimated that by 2030 the share of NCDs in global total mortality will be 69% – a dramatic rise from 59% in 2002 [ 2 ]. Although the burden of NCDs continues to increase across all regions of the world, it disproportionately affects poorer regions [ 3 ], with almost 80% of NCD-related deaths occurring in LMICs [ 4 ].

This shift is largely driven by demographical and epidemiological transitions, coupled with rapid urbanization and nutritional transitions in LMICs [ 5 ].

With approximately six million annual deaths from NCDs, India presents an important case study with respect to these challenges [ 6 ]. Similar to many other LMICs, India is experiencing a rapid health transition with a rising burden of NCDs now surpassing the burden of communicable diseases [ 7 ]. In India, NCDs such as cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes are estimated to account for around 63% of all deaths, thus making them the leading causes of death [ 6 ]. This NCD burden has severe implications for the healthcare system. In particular, the shortage of skilled health professionals, i.e. medical specialists, nurses, and other professionals equipped to treat NCDs, presents a serious challenge [ 8 ]. The inadequacy of educational institutions to impart quality medical and nursing education has been one of the main reasons for the health workforce shortage [ 8 ]. In a recent study, the number of Indian doctors and nurses/midwives was estimated at 0.80 million and 1.40 million, with a density of 6.1 and 10.6, respectively, per 10,000 population. The numbers further drop to 5.0 and 6.0 per 10,000 population, respectively, after accounting for the adequate qualifications [ 9 , 10 ]. All these estimates are well below the WHO threshold of 44.5 doctors, nurses and midwives per 10,000 population [ 11 ]. The study also highlights the highly skewed distribution of the health workforce across states, rural–urban and public–private sectors. The skewed distribution of the health workforce across India means that this shortage is even more grave in rural and remote areas [ 9 , 10 ]. The revised guidelines of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), are a welcome strategy in the prevention and control of NCDs [ 12 ]. The focus of the guidelines on health promotion, early diagnosis and screening, and capacity building of healthcare professionals will definitely push for increased attention to the management of NCDs and how this relates to the pre- and in-service training needs of health professionals. In addition, the recent establishment of Health and Wellness Centres (HWC) in managing NCDs and achieving UHC is an excellent response to the changing demographic and epidemiological profile in India. However, this initiative is not without challenges, with a major challenge being the need to build human resource capacity with a continued need for training [ 13 , 14 ]. Although some states have conducted specific training programs to improve the capacity and address the issue, the lack of training modules for NCD management remains an important challenge to be addressed [ 14 ]. The need to strengthen the HWCs through adequate financing, human resources, and logistics for medicines and technology, especially in hard geographical areas, is an area to be focussed upon [ 13 ].

The National Education Policy (NEP) 2020 by the government of India has highlighted the role of digital education in training and continuing education [ 15 ]. Digital education is defined as an act of teaching and learning by means of digital technologies involving a multitude of educational approaches, concepts, methods, and technologies [ 16 ]. The NEP 2020 focuses attention on implementing and strengthening multidisciplinary, inclusive and technology-based learning that is accessible to all. With a large geographical and cultural diversity in India, meeting this need has proven to be a challenge to India’s existing systems of health professions education (HPE). Hence, the use of technology in education is proposed as a way to access remote areas and bypass geographical barriers [ 15 ].

Although the NEP 2020 has some aspirational objectives, there is a lack of specific knowledge regarding the digital education of health professionals in India. A recent review of Indian research in digital health professions education found that the body of literature is very limited and that the studies that do exist tend to take the form of evaluations of local educational interventions rather than more systematic contributions to research-based knowledge [ 17 ].

Considering the scarcity of empirical evidence related to digital education and training of health professionals regarding NCDs, it is relevant to look outside of India and explore what research may have been done in other contexts.

Digitalization of education may help us address the urgent need for more health professionals who have received training in the diagnosis, prevention, and treatment of NCDs. However, it is still unclear what constitutes best practice in NCD-related digital education, and how experiences from across the world are relevant to the Indian context.

The objective of the present paper is to conduct a scoping review of the published research examining the digital education of health professionals within NCD topics. More specifically the paper aims to: (i) assess the strengths and weaknesses of the digital teaching-learning practices described in the literature; and (ii) discuss the findings in relation to the Indian context.

The scoping review methodology is appropriate for exploring the extent of research activity within a topic where the literature is limited and disorganized. With a more flexible approach than what is known from systematic reviews, the scoping methodology can provide an overview of what kinds of evidence exist and help inform future research [ 18 ].

To identify relevant publications, we searched four research databases (Web of Science, PubMed, EBSCO Education Research Complete, and PsycInfo). This was done with a search string consisting of three elements, namely terms related to digital education ( n  = 174), terms related to health professions ( n  = 30), and terms related to NCD ( n  = 36). The search string with all terms is included in the online supplementary material .

The search produced 1032 hits combined from all the databases (Web of Science: 443; PubMed: 259; EBSCO Education Research Complete: 118; PsycInfo: 212). When searching, we did not limit the search to any specific time frame, but subsequently, we opted to exclude papers published before 2017. This was decided to ensure that the included papers reported on interventions that represent current digital technologies. After removing duplicates and papers published before 2017, we had 463 documents. These documents were imported into the online review tool Covidence, which was used to manage the screening and data extraction processes.

Figure  1 . PRISMA flow chart showing the screening process.

figure 1

PRISMA flow chart showing the screening process

In Covidence, the first step was to screen the title and abstract of these 463 documents to determine whether they were suitable for inclusion in the review. This screening process excluded studies that were.

Not empirical (e.g., reviews and commentaries).

About training patients to manage their own chronic disease.

About digital health solutions (e-health, m-health, apps, etc.)

Not related to NCD prevention, treatment, or care.

This process led to the exclusion of 385 documents, leaving a pool of 78 for full-text screening. The full-text screening followed the same exclusion criteria. This led to the exclusion of a further 50 documents, leaving a pool of 28 documents for inclusion in the review. The PRISMA flow chart in Fig.  1 illustrates this process, and Table  1 presents an overview of the 28 included studies. We note quality assessments are not typically recommended or conducted with scoping reviews [ 19 ] Moreover, as we were primarily focused on understanding what kinds of evidence exist, we did not undertake a quality assessment of the included documents.

From each of these 28 papers, we extracted data about the study’s objectives, location, target population, research design and methodology, findings, health focus, and modality of the digital educational intervention. This extraction process was undertaken by one author (SH). A few unclear cases were discussed with a further two authors (AB, LXJ). In the results section below, we present a synthesis of the extracted data, with an emphasis on the benefits and challenges identified in the various digital educational interventions.

Description of studies

The final list of the 28 studies included in our review consisted of 22 studies from high-income countries with the majority of them from United States of America (USA). Only six studies were from LMICs, more specifically from Brazil, Pakistan, Türkiye, and Uganda, as well as two studies that spanned several LMICs.

The target groups were mostly in-service health professionals but a considerable number of studies also included pre-service students of medicine ( n  = 6) and nursing ( n  = 6). Among the targeted in-service health professionals, most were nurses ( n  = 12), followed by doctors ( n  = 8) and other health professionals ( n  = 8) including emergency technicians, primary care providers, medical assistants, etc.

The majority of the studies in the overall pool used either experimental or observational study designs and gathered data using online questionnaires, interviews, and/or analysis of individual or online interactions between learners. The details about target groups and study designs are shown in Table  2 . We use the term experimental for studies that have no specific information on the randomization of the participants or where randomization has not been done. These studies typically included two groups of the study population, where one group served as an experimental one provided with the intervention and the other with no or some traditional type of intervention. Other than the observational and experimental studies, randomized control trials (RCTs) and evaluation studies were part of our review.

The studies in our review comprised mainly of educational interventions related to diabetes, stroke, hypertension and cardiac disorders.

Assessment of digital educational intervention

Based on the digital education modality that was described, we grouped the studies into three categories: blended learning, online learning with instructor, and online learning as self-study. In the sub-sections below we present the interventions, study findings, effectiveness and identified challenges of each modality.

Blended learning

Our review includes seven studies providing blended learning to health professionals and students. For this purpose, we identify blended learning as any intervention that combines online learning with some form of onsite training or teaching. All the studies report the advantages of blended learning over traditional learning and the increase in overall knowledge.

Blended learning was incorporated in various formats in the studies. Some of the studies include the online learning proponent prior to the onsite training [ 33 , 40 ]. In these, the online learning was provided in modules that could be taken at the participants’ own pace before the onsite programme which was characterised by hands-on workshops and lectures. Other studies began with on-site training followed by an online learning proponent [ 23 , 36 , 39 ]. In these studies, the online proponent consisted of further self-study of the content learned in the prior onsite training. The remaining two studies did not have a set order but rather had the online proponent as a learning resource that the participants could draw upon among other resources such as tele-education sessions, a local support coach [ 46 ] or interactive classroom lectures with group discussions and role play [ 43 ].

The studies consisted of both RCTs and observations. The RCT studies mostly highlighted the strengthening capacity of nursing professionals. For instance, in one RCT study in Thailand, the findings showed the effectiveness of blended learning in strengthening competency in diabetes care among nurses, wherein the levels of perceived self-efficacy, outcome expectancy, knowledge and skills in diabetes management care were statistically and significantly higher at Weeks 4 and 8 compared to the control group [ 39 ]. In another RCT conducted in Australia, the addition of access to online learning, as well as face-to-face education, significantly increased the uptake of diabetes education among hospital non-specialist nursing staff [ 40 ]. A study based in Pakistan gathered information about perceptions about social media as a tool for online training and reported that Facebook, with tutor support, enabled participants to study the material when their schedule permitted. The online teaching component and facilitation were ideal for their full-time working nurses, as reflected by their improved post-course test results [ 43 ]. The detailed findings for studies examining blended learning are provided in Table  3 .

Generally, among health professionals, the perception of blended learning was positive. Blended learning was perceived to be beneficial and impactful in increasing knowledge. This type of learning makes the learning interactive. However, certain challenges were identified that hampered online learning, e.g., limited internet connection and computer skills for the participants enrolled in the learning [ 43 ]. As many of the participants are health professionals active in the workforce, the long duration of the working hours makes it difficult to spare time for online learning [ 36 , 40 ].

Online learning with instructor

There were six studies in our review, wherein online learning with instructors was explored. Such online learning includes following a simultaneous schedule allowing for contact between learners and teachers/trainers during the course. Two of the six studies had no control group. All the studies assessed the effects of their online teaching through survey-based questionnaires. A majority of the studies reported that these types of courses are cost-effective and can help bypass the geographical barrier. The findings of these studies are given in Table  4 .

Regarding instructor involvement, five of the studies used learning platforms such as Moodle or Zuvia for the instructor to organise courses, materials and activities [ 22 , 27 , 38 , 42 , 45 ]. Four of these also had an online forum or messaging app for peer discussions about the content, two of these also included interactions with faculty and tutor support [ 27 , 38 , 42 , 45 ]. For instance, a study by Paul et al. [ 38 ] had an online request form for specialist advice regarding diabetes. The last study by Hicks and Murano [ 30 ] had an instructor-led webinar followed by self-study.

The studies showed a positive effect on practice. A Spanish study on cerebrovascular medical emergency management from reported that interprofessional online stroke training in the Catalonian Emergency Medical Service (EMS) was effective in increasing the study participants’ knowledge of cerebrovascular medical emergencies. The results encouraged the Catalonian EMS to maintain this training intervention in their continuous education program [ 27 ].

Online learning as self-study

Of the included papers, 15 were about online learning as self-study. In such an intervention, the learner undertakes an online course/training as flexible self-study. This means the course can be done at any time and does not require any set schedule or contact with teaching staff. Table  5 presents an overview of the study findings.

Largely the studies using online learning as self-study reported improvements in learning following the training. For instance, A study across Latin American countries studied the effects of online training on medical knowledge regarding acute kidney injury (AKI) on nephrologists and primary care physicians. The study reported gains in knowledge equivalent to 36%. It is important to note that the study concluded that the interactive, asynchronous, online courses were valuable and successful tools for continuing medical education in Latin America, reducing heterogeneity in access to training across countries. The application of distance education techniques has proved to be effective, not only in terms of primary learning objectives but also as a potential tool for the development of a sustainable structure for communication, exchange, and integration of physicians and allied professionals involved in the care of patients with AKI [ 34 ]. However, one study explored the use of online simulations [ 25 ]. This randomized control trial reported no significant change in the experimental group following an online educational course regarding oral anticoagulants in case of atrial fibrillation. Also, the reading material in certain modules being too dense and lengthy poses a challenge for the participants in one study to complete the learning [ 45 ]. Another study by Lombardi et al. [ 34 ]., also questioned whether the knowledge effect is retained on a long-term basis.

Some of the studies emphasise the possibilities that online learning provides. One study indicated that a 6-week internet-based course in diabetes and obesity treatment may serve as an important resource in postgraduate education for medical doctors as well as other health professionals. From a wider perspective, education based on Massive Open Online Courses (MOOC) may assist the professional community by providing the latest evidence-based guidelines in an easily accessible and globally available way [ 47 ]. An evaluation study in the United States reported that online learning modules can be developed and maintained with minimal costs and basic technological requirements and present a unique opportunity to provide essential information in a short timeframe. In addition, these modules can be specifically tailored to address identified knowledge gaps among various groups and can be easily disseminated and can be an effective method for educating nurses in a time- and cost-sensitive manner [ 41 ].

The major challenges faced by health professionals or students when participating in online learning by self-study include time constraints and out-of-date or inappropriate hardware and software [ 20 , 34 ]. Some barriers that online learning can help organisations overcome include logistical difficulties and expenses associated with maintaining an adequate pool of educators, coordinating training sessions, and standardizing training across sites [ 21 ].

This section discusses the strengths, weaknesses, and advantages of digital education related to NCDs in the reviewed literature in the context of India.

Value of online and blended NCD education

The limited literature available on the topic paints a positive picture regarding the increase in learning/knowledge of health professionals on NCDs due to online learning. A majority of the studies reported an increase in knowledge after the interventions. A study from Latin America provides an example of how online courses can be a valuable and successful tool for continuing medical education and reducing heterogeneity in access to training across countries. The diverse findings suggest that modality alone is not the sole issue; for example, a recent study comparing traditional vs. online learning [ 44 ] suggests interactivity may matter.

The studies reported a number of challenges related to the online format in general. One highlighted that training of healthcare providers can be more difficult in time constrained and low-resource settings due to limited accessible equipment, inadequate environment and competing interests [ 28 ]. Another found that augmented reality smartphone apps may not provide the extensive information needed for complex content [ 29 ]. The senior doctors were not as pleased as their less-experienced colleagues with the web-based format of the learning [ 35 ]. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake as they require more commitment, activity, and dedication [ 38 ]. Although there are challenges with online learning, the included studies also emphasized the opportunities it provides, e.g. making knowledge more accessible to a wider population and making it more flexible for health professionals with heavy workloads to learn at their own pace [ 36 , 39 , 47 ].

Although we categorize and present the interventions in the three modalities, it is important to note that many of the challenges and opportunities we found are shared by all modalities. Because of this, it is not possible to highlight a single modality that is best in all situations – rather, they each have different affordances in relation to important considerations such as learner flexibility or programme scalability. Online learning as self-study offers almost complete learner flexibility and programme scalability – but it lacks important elements of individualized feedback, collaborative learning, and the motivation that learners and teachers can experience when they are together in the same room at the same time. Blended learning tries to balance the advantages of being together with the flexibility of learning online. This blend can take many forms, and rather than a single pedagogical approach, it should probably be considered a spectrum of approaches inhabiting the space between campus learning and online self-study.

Relevance to Indian context

The review showed that most of the literature is from high-income countries like the United States, United Kingdom, Australia, and Spain. Only very few studies describe educational interventions set in LMICs, and none of them were from India. It is, however, important to point out that the category LMIC is very broad, including both countries in sub-Saharan Africa, as well as countries like Türkiye and Thailand. This entire spectrum is also present within India. Despite the great diversity within India, the high-income setting of most of the described interventions limits their direct applicability in many of the most underserved Indian contexts, where the health professions, education systems, and health care systems in general already have significantly fewer resources. We hope, however, that the experiences from other countries can serve as inspiration for educational interventions and research which is tailored to the needs, challenges, and opportunities that are relevant to India.

In an Indian context, the main advantage of online learning is the flexibility to reach people in rural areas, especially for in-service training of health professionals who are no longer residing close to a medical or nursing college. This flexibility is even more pronounced with online self-study training. The advantages of online learning are beginning to be recognised in India. During the last decade, the digital education platform has seen a perceptible growth in India. Several public and private organizations and entities have started providing digital training for capacity building of healthcare professionals especially in terms of NCDs. Different types of courses are offered in the form of online or blended learning. However, it is important to note, that the use of digital education and training in rural areas comes with its own set of challenges in relation to lacking connectivity and insufficient technical infrastructure. Furthermore, the significant linguistic and cultural diversity of India, also influences how well digital education interventions can scale. Nonetheless, with the NEP 2020 focusing on digital and equitable education among health care professionals and the post-pandemic time period, the courses offered digitally have increased severalfold. Introducing such courses in The National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) could help India address shortages and skewed distributions of its health workforce. Also, with the introduction of MOOCs and EdTech investments in the last decade, many leading universities and schools of public health are hosting NCD courses, which are available for learners in the Indian subcontinent and worldwide. These are primarily aimed at medical doctors, with just very few targeting nurses. Many of the courses that are open to nursing are open to almost all sections of health care workers.

Examples of digital training in India mainly focus on diabetes education and are provided by the government through public institutions as well as private organizations. Some examples of online training on diabetes through government institutions include through National Institute of Public Health Training and Research (NIPHTR) and Christian Medical College (CMC) Vellore [ 48 , 49 ]. In addition to these, various organizations have partnered to provide quality training courses on diabetes. One such example is an online certification course in diabetes by British Medical Journal & Fortis C-DOC, endorsed by The Royal College of Physicians (RCP), London [ 50 ]. Another example is an online training on diabetes targeted at primary care physicians offered by Public Health Foundation of India (PHFI). PHFI has developed the capacity of more than 15,000 primary care physicians with its various diabetes-related capacity-building programs since 2010 in collaboration with academic partners like Dr. Mohan’s Diabetes Education Academy (DMDEA) [ 51 ]. There are numerous examples of online courses on diabetes education that have been started in recent times [ 52 , 53 ]. However, these trainings through online learning have rarely been evaluated and there is a lack of literature examining the effectiveness of such programs.

However, India faces some challenges to online learning as well. The adherence to course curriculum and retention rates will vary according to different health professionals of different geographical regions. Technological issues like internet connectivity, limited computer skills, and out-of-date software or hardware can have direct effects on the participation of health professionals. Also, there might be reluctance in the case of senior professionals to learn from their junior colleagues in instructor-based online learning [ 35 ].

Strengths and limitations

This review is a diverse contribution from a team of Indian and non-Indian authors.

Our review includes a wide range of study designs and methodologies.

The review synthesizes evidence on an emerging topic in Lower Income Countries and provides evidence for further research.

We did not systematically employ dual independent screening and data extraction.

We did not conduct a formal assessment of the quality of the included literature. However, this is typical of scoping reviews [ 19 ], and also, the value of the insights we gained from the included studies was not necessarily bound to the quality of their findings.

To focus on current forms of digital teaching and learning we chose to limit our search to research published since 2017. Including older publications, or those in the grey literature, may have yielded further evidence that could have had relevance to our objectives.

Digital education related to NCDs has proven to be beneficial for both in- and pre-service health professionals. Digital education may also offer an effective way to bypass geographical barriers that can be utilized for capacity building of the existing health workforce especially in relation to NCDs. Despite these positive attributes, and an increased openness to learning and collaborating online, digital education faces many challenges for its successful implementation in the Indian context. Owing to the multi-lingual and diverse health professional ecosystem in India, there is a need for strong evidence and guidelines based on prior research in the Indian context. Rigorous research in the form of evaluation, quasi-experimental studies or RCTs needs to be done in order to address the challenges and uncover potentials for online learning in India.

Declarations.

Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

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This work was supported by the Novo Nordisk Foundation (NNF22SH0078207).

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Karan, A., Hussain, S., Jensen, L.X. et al. Non-communicable diseases, digital education and considerations for the Indian context – a scoping review. BMC Public Health 24 , 1280 (2024). https://doi.org/10.1186/s12889-024-18765-7

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The Costs and Benefits of Clan Culture: Elite Control versus Cooperation in China

Kinship ties are a common institution that may facilitate in-group coordination and cooperation. Yet their benefits – or lack thereof – depend crucially on the broader institutional environment. We study how the prevalence of clan ties affect how communities confronted two well-studied historical episodes from the early years of the People's Republic of China, utilizing four distinct proxies for county clan strength: the presence of recognized ancestral halls; genealogical records; rice suitability; and geographic latitude. We show that the loss of livestock associated with 1955-56 collectivization (which mandated that farmers surrender livestock for little compensation) documented by Chen and Lan (2017) was much less pronounced in strong-clan areas. By contrast, we show that the 1959-61 Great Famine was associated with higher mortality in areas with stronger clan ties. We argue that reconciling these two conflicting patterns requires that we take a broader view of how kinship groups interact with other governance institutions, in particular the role of kinship as a means of elite control.

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