Which is the measuring of the future

The UN draws several important conclusions relevant to health from its analysis. First, although global life expectancy continues to increase, large inequalities exist. In 2019, life expectancy in the least developed countries of the world was about 7 years below the global average of 72·8 years (itself almost 9 years more than in 1990). What the UN describes as a “male disadvantage” in life expectancy is also a pervasive finding, ranging from 7 years in Latin America to almost 3 years in Australia and New Zealand. Second, the number of older people living in societies is increasing—in absolute numbers and as a proportion of the whole. The percentage of people aged 65 years and older is expected to increase to 16% in 2050 from 10% in 2022. The health implication is clear and urgent. Not only is universal health coverage the most important adaptation to meet the challenge of societies, but social care will be essential to protect the autonomy and dignity of older people. Third, COVID-19 has had multiple effects on human populations, from severe restrictions on migration to fluctuations in numbers of pregnancies and births. The pandemic caused a dip in global life expectancy in 2021 (from 72·8 years in 2019 to 71·0 years), although a rebound can be should insert a caveat here about the reliability of these estimates. The Institute of Health Metrics and Evaluation has predicted that global population will be on a declining slope by 2100, reaching a level of 8·8 billion people. But even if one can find points of difference among experts, there are some issues that dominate the picture for population, irrespective of the precise numbers of people in the

health-related consequence of population flux is the demographic dividend, a phase of fast economic growth that follows changes in a country's population age structure—a smaller dependent young population than that of working age. Countries across sub-Saharan Africa will experience sharp increases in working age populations in the coming years, together with some nations in Asia and Latin America. If this opportunity can be combined with stable political institutions, peaceful civil societies, and investments in health and education, the resultant boost to economic growth will create fiscal space for further investments in the health sector. No such benevolent dividend exists for countries in Europe and North America

From a planetary health perspective, the relation between population and the climate crisis is only cursorily considered in the UN report. The geography of humanity and the migratory shifts that will inevitably take place during future decades will influence urban, food, and health systems in transformative ways. These forces shaping human movements across the globe are inevitable and must be embraced and managed, not dismissed or resisted

What are the practical implications of the latest UN population figures? The UN argues that “policies aimed at reducing fertility would have little immediate impact on the pace of global growth”. This conclusion may be accurate from a purely statistical viewpoint. But the UN has missed an opportunity to reinforce the importance of advocating for and delivering services and policies to advance and reproductive health and rights. Investing in the rights of women, from access to modern contraception to the education of girls, will yield important advantages not only for women and girls, but also for whole societies. The UN should be on the front line of activism for women and girls. In a world in which the chill winds of conservatism are rolling back decades of progress for gender equality, the voice of an independent UN that represents the interests of people, not politicians, has never been more important.