The Doom and Gloom

In 1971, population biologist Paul Ehrlich estimated that if human numbers kept increasing at the high rates of the time, by around 2900 the planet would be teeming with sixty million billion people (that’s 60,000,000,000,000,000). But the rate of population rise actually peaked in the 1960s and demographers expect a leveling-off of human numbers this century.

No kidding. If the current growth rate continued, in 130 years Pakistan’s population will be equal to the population of world today.

The population of Pakistan in mid-2004 was 159.2 million, births per 1000 are 34 and deaths per 1000 are 10. Pakistan’s rate of natural increase in population growth is 2.4 percent, and projected population in the year 2025 and 2050 would be 228.8 and 295.0 million, respectively. The projected population change in 2004-2050 would be 85 percent.

In 1950 Pakistan had a population of about 40 million people. Since then it has grown many times. But the real population explosion in Pakistan will only come over the next few decades, because the country not only has a very young population, but also still an extremely high fertility - much higher. These large numbers of children and young adults will soon come into reproductive age and will produce a large number of offsprings.

The latest facts and figures state that future population prospects are shaped in large part by the age profile of its citizens. More than half of Pakistan's population is below the age of fifteen; nearly a third is below the age of nine. Pakistan is one of the few countries in the world with an inverse sex ratio: official sources claim there are 111 men for every 100 women. The discrepancy is particularly obvious among people over fifty: men account for 7.1 percent of the country's total population and women for less than 5 percent. This figure reflects the secondary status of females in Pakistani society, especially their lack of access to quality medical care.

In population Pakistan ranks sixth in the world and its land area stands at thirty-second position among nations. Thus Pakistan has about 2 percent of the world's population living on less than 0.7 percent of the world's land. In the year 2050, Pakistan would continue to gracefully stand elevated among top 5 population giants. Pakistan cannot be pulled out of the poverty trap with 3 million additional births every year.

Pakistan is poised to more than double its size by 2050 even as supplies of water, forests, and food crops are already showing signs of strain and other species are being squeezed into smaller and smaller ranges.

A huge consumption gap exists between industrialized and developing countries and Pakistan. The world's richest countries, with 20 per cent of global population, account for 86 per cent of total private consumption, whereas the poorest 20 per cent of the world's people account for just 1.3 per cent.

A newborn in the USA or Europe will put greater pressure on the Earth’s carrying capacity than a whole family of newborns in Pakistan. Numbers and the Earth’s ability to provide are increasingly framed by the realities of gender relations. It is now generally agreed that while enabling larger numbers of women and men to use modern methods of family planning is essential, it is not sufficient. By expanding the choices and capacities of women, a central thread can be formed in the population story. Consumption—what we need and what we want—is, too.

Pakistan's people are not evenly distributed throughout the country. There is an average of 146 persons per square kilometer, but the density varies dramatically, ranging from scarcely populated arid areas, especially in Balochistan, to some of the highest urban densities in the world, such as Karachi and Lahore.

Municipal governments in Pakistan are least able to muster the human and financial resources to contend with these problems, especially when the poorest, non-taxable segment of the urban population continues to grow rapidly.

The risks of instability among youth may increase when skilled members of elite classes are marginalized by a lack of opportunity. It isn’t difficult to find contemporary parallels. The collapse of the Communist regime in the Soviet Union in the early 1990s was partly due to the mobilization of large numbers of discontented young men who were unable to put their technical education to use due to party restrictions on entering the elite.

The greatest challenge before government hence is the need to tackle the underlying factors contributing to discontent among young people, including poverty and the lack of economic opportunity. It can address part of the risk associated with youth unemployment by investing in job creation and training, boosting access to credit, and promoting entrepreneurship.

Eventually, however, the only way to achieve the necessary long-term changes in age structure will be through declines in fertility. Government can facilitate fertility decline by supporting policies and programs that provide access to reproductive health services and by promoting policies that increase girls’ educational attainment and boost women’s opportunities for employment outside the home.

The stewardship of the planet and the well-being of its people are a collective responsibility. Everywhere we face critical decisions. Some are about how to protect and promote fundamental values such as the right to health and human dignity. Others reflect trade-offs between available options, or the desire to broaden the range of choice. We need to think carefully but urgently about what the choices are, and to take every action that will broaden choices and extend the time in which to understand their implications. We need a decision today not just to bring down the birth rate but also to attain a balance between resources and population. For a secure future this goal must be pursued vigorously through sound population management. Asif J. Mir, Organizational Transformation

Living Longer

Human aging is being controlled and researchers have proven that human cells can be created and in this century people will begin to live 100, 200 or even 300 years. Mice are already living 50% longer with the help of genetic inventions. Thanks to the human genome project, scientists are closer to identifying ways to decelerate human aging. Contrarily, with incompetent, insufficient, and laughable healthcare system in place, Pakistan seems to continue grappling with policy lapses. Due to factors related to high fertility rates, high illiteracy, high mortality, and above all uncreative methods of policy planning, Pakistan stands as a stranger to such a milieu. Its policymakers don’t even sense the world passing through a profound transformation. They lack their understanding for making decisions to understand forthcoming breakthroughs and strategically plan for new environs.

The rapid pace of technology and medicine are quickly posing the prospect of banishing aging and disease, and yes even most causes of death. Some of the most extreme but very possible aspects of technologies such as molecular manufacturing and nanomedicine promise continual cellular maintenance that will alleviate aging altogether and make it impossible for disease or toxins to injure one's body or take one's life. Present anti-aging treatments do not slow aging and do not extend life span more than quitting smoking, exercising, eating vegetables, or heeding ordinary medical advice does. While all over the world we have seen improvements in health and life spans, Pakistan has large gaps and much effort needs to be spent in narrowing that gap.

Although vainly wrestling with high female mortality at younger ages and during the reproductive years, Pakistan claims a life span of 65. This predominantly seems farce when almost one-half of women receive no antenatal care during their pregnancy and 72 percent receive no postnatal care at all.

The advancements in longevity can be generally attributed to improvements in sanitation, the discovery of antibiotics, and medical care. Despite tall claims, Pakistan’s record on these areas is hopeless. Now, as scientists make headway against chronic diseases like cancer and heart disease to extend anti-aging even further, such diseases in Pakistan are greater than ever and basic healthcare service is inaccessible to a vast majority.

There are theories on aging. The programmed theories hold that aging follows a biological timetable, perhaps a continuation of the one that regulates childhood growth and development. The damage or error theories emphasize environmental assaults to our systems that gradually cause things to go wrong.

Lengthening life expectancies in the industrialized nations are bringing about substantial changes including large increases in the number of elderly and in their proportion in the population. Such changes have occurred, for example, in the type of economic activity, housing, social services, and population make-up of the communities. With growth in the health care system and changes in the service mix provided, the elderly continue to consume more health care per capita and need different services.

Health care institutions, including hospitals, which are widely expected to experience increasing demand as the elderly population grows; organizations will provide home-based medical care and other types of assistance, allowing the individual to remain in their own residence; and a variety of assisted living facilities, ranging from adult day care to residential care to nursing homes.

Of greater concern, the already awful health care industry of Pakistan finds itself ill prepared to handle significant increases in the number of the very elderly. Today, there are almost 9.7 million senior citizens. When it has no policy in place for this population today, it has no concern for tomorrow. Neither public nor private sectors are equipped financially to deal with the problems caused by aging population. When a society starts aging, its economic vitality becomes inferior to that of young societies and sluggish economic growth reduces its opportunities to become well heeled. Thus, in Pakistan an aging population will become a heavy public burden, forcing its people to bring down the cost by establishing large institutions so that, by virtue of economies of scale, they could manage to provide the elderly with the most basic care and medical needs.

The health sector of Pakistan offers an inadequate remedy for the serious problems of an outdated and basically unsound system and hence needs an offensive. People must be offered a vision of a revitalized health care system that provides incentives for increased quality and technological innovation, while at the same time, reducing costs. Pakistanis need a system that gives them control over healthcare decisions, while encouraging them to set aside the resources they need to purchase this care.

The policy makers of Pakistan should keep themselves abreast of technological advances and management strategies by constantly scanning the literature and media, interviewing authorities, and drawing on other sources to identify emerging trends. These trends then need to be analyzed to select those that are most significant.

It needs to begin to prepare now for what will be a very different future. The key questions it needs to think about include: What is it that we should be asking? What is it that its policymakers need but do not get in their human development courses? People should be asking about connections -- connections between existing mindsets and human development. These connections simply are not made in most textbooks available for use in human development courses. In fact, effective change requires more than knowledge of human development. Effective change also requires the ability to devise strategies that take advantage of that knowledge … strategies for connecting research and practice. Asif J. Mir, Organizational Transformation