Medical Observer oped: Doctors should lead on population

By Dr David King

THE Reverend Thomas Malthus argued in 1798 that population growth was generally restricted by available resources. At this time one billion people lived on Earth.

Since then mechanised agriculture has produced dramatic growth in crop yields, and the world population exceeded seven billion in 2011.

Paul Ehrlich also warned about population pressure in his controversial 1968 book The Population Bomb. Both authors were viewed as alarmist, as their predictions have not played out as predicted.

By the 1980s, concern for population growth was even perceived as racist, particularly as developing countries experienced the largest growth rates. Since then the issue has been described as “the elephant in the room”.

Many health and development NGOs dropped contraception programs due to threats to overall funding. The focus instead shifted to poverty reduction and education of women, with the expectation that this was the most effective means to encourage smaller family sizes.

Yet a Royal Society analysis indicates countries that have incorporated population policies achieved higher economic growth and reductions in poverty, with lower population growth rates allowing more per capita investment in education and health.1

In 2014, a UN report2 revised population projections upwards. It estimated there would be 9.6 billion earthlings in 2050 and 10.9 billion by 2100. Most of this increase is predicted for Africa, though India will soon surpass China as the most populous country.

Over the last decade population pressure started to attract attention, mostly through the focus on food security. Feeding an extra three billion will be challenging, particularly in association with climate change and rising sea levels.

Doctors for the Environment Australia produced a population poster titled “The more of us; the less for all”. This reflects that population growth leads to habitat loss, the leading cause of species extinction. Robust biodiversity is vital for a healthy environment, and as a source for new pharmaceutical products. Fighting over scarce resources has been implicated in conflicts such as Rwanda and Sudan, resulting in massive movement of refugees.

The WWF calculates that annual consumption of ecosystem services, like topsoil, fresh water, forest and fish stocks, are currently under depletion 1.5 times faster than they are regenerated.

By “maxing out” our ecological credit card, we are reducing our life-sustaining environmental capital. Population growth can be considered a wicked problem with no easy solutions.

We live in a finite world but our economic system needs continuing growth, achieved by growing populations of consumers and workers. Critics of population policies are concerned about women’s right to their own fertility choices.

Finally, population levels alone provide little evidence about ecological footprint. Wealthy countries have commensurately higher impacts than more populous but poorer countries. The 2012 Royal Society People and Planetreport3 made several recommendations, including more effort towards ending extreme poverty and reducing inequality, stabilisation and then reduction in consumption levels in developed and emerging economies, and urgent investment in reproductive health and voluntary family planning programs.

It also recommended urbanisation as a mechanism to reduce consumption, but this will contribute to other health problems.

Doctors have the potential to lead on this complex issue. We have the authority to bring this issue to mainstream attention and encourage broad scientific inquiry. We can deliver the practicalities of contraception programs and assist economic development through improved public health.

We also understand both biological systems and social determinants of health. This is because we understand there are limits to growth, and that sometimes “less is more”, for both human health and the health of the planet.


Dr David King is a GP, Senior Lecturer at the University of Queensland, and a DEA Member.


1. J Bongaarts. Human population growth and the demographic transition Philos Trans R Soc Lond B Biol Sci. 2009 Oct 27; 364(1532): 2985–2990.

2. World population stabilization unlikely this century. P Gerland, A Raftery, H Šev?íková, et al. Science 10 Oct 2014,Vol 346;6206;234-237

3. Royal Society: People and Planet report. April 2012


This article first appeared in the Medical Observer on 16 June 2015.

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