Abstract

PIP: This commentary by Maurice King questions the viability of current public health strategies. He advocates for an ecological approach that seeks to improve the health of the entire planet. He discusses the concept of the demographic trap. Being demographically trapped refers to a population being stuck in an "unsustainable state with a high birth rate and death rate, with an ever increasing pressure on its resources, and with a rapidly deteriorating environment". King points out that the possible outcomes are limited for a population that becomes trapped. Some of the possible outcomes include dying from starvation and disease; fleeing as ecological refugees; being destroyed by war or genocide; or being supported by food and other resources from elsewhere, first as emergency relief and then perhaps indefinitely. King believes that ecological collapse has already taken place in parts of Ethiopia and the process may have begun on a wider scale elsewhere. According to King, this ecological predicament can be found in both rural and urban areas in the developing world. This article also discusses the problem of high fertility. King believes that the widely held belief that the necessary and sufficient condition for reducing the birth rate is to reduce the child death rate is erroneous. He states that a causal relationship between the 2 rates is untenable, instead, it is more reasonable to say that both rates respond to other common factors. The author suggests that a fall in the birth rate requires the harnessing of social and economic gains to reduce poverty and promote socio-economic development. He also believes that the continued growth in the size of the world's population is due to declining efforts in family planning and declining child mortality not having its alleged effects on fertility. King also brings forth an ethical dilemma. He asks, "are there some programs which, although they are technically feasible, should not be initiated because of there long-term population-increasing consequences?" He suggests that other factors such as ecological deterioration, integrity of the ecosystem, and the welfare of future communities need to be taken into consideration. King presents a new global strategy based on the concept of "sustainability". He says that "sustainability should be the maintenance of the capacity of the ecosystem to support life in quantity and variety". Specifically, he advocates for consumption control in the industrial North with intensive energy conservation and recycling. In the South, he calls for renewed vigor in family planning efforts. Public health measures need to be understood in terms of their demographic and ecological implications. If measures are found to be desustaining, King says that complementary ecologically sustaining measures should be introduced with them. He also believes that desustaining measures, such as oral rehydration, should not be introduced on a public health scale if no adequately sustaining complementary measures are possible. He asserts that desustaining measures, without complementary interventions, can ultimately increase the man-years of human misery.