Category: Health Care

How China Realized a Demographic Dividend

SAMI J. KARAM

This article was first published at Exante Data’s Money Inside and Out.

China was ready for its historic opportunity.

Although a widely used aphorism, “demographics is destiny” is not strictly true in the modern era. Long gone are the days when troop size could on its own determine the outcome of a war, or when deploying manpower on a massive scale could result in a decisive economic advantage. Brute force just isn’t what it used to be. Today, thanks to advanced technology, small groups can inflict enormous damage in war, and a handful of software programmers can create billions in new wealth.

That said, demographics remains an important part of destiny in combination with other non-demographic factors.

Some of these factors can mitigate, or even completely counteract, a deteriorating demographic picture. Others can multiply the positive effects of demographics. This distinction—between demographics as a leading determinant of national stature vs. demographics as merely one of several components —can be illustrated by the following two opinions.

The first is a view promoted among others by Fareed Zakaria in his book The Post-American World (2008). Here is Zakaria in a 2008 Newsweek column The Rise of the Restrepeating the theme of his book:

It is an accident of history that for the last several centuries, the richest countries in the world have all been very small in terms of population. Denmark has 5.5 million people, the Netherlands has 16.6 million. The United States is the biggest of the bunch and has dominated the advanced industrial world. But the real giants—China, India, Brazil—have been sleeping, unable or unwilling to join the world of functioning economies. Now they are on the move and naturally, given their size, they will have a large footprint on the map of the future.

The second is from Winston Churchill’s speech Fifty Years Hence. It is from 1931 but remains as pertinent as ever:

When we look back beyond a hundred years over the long trails of history, we see immediately why the age we live in differs from all other ages in human annals. Mankind has sometimes traveled forwards and sometimes backwards, or has stood still even for hundreds of years. It remained stationary in India and in China for thousands of years. What is it that has produced this new prodigious speed of man? Science is the cause. Her once feeble vanguards, often trampled down, often perishing in isolation, have now become a vast organized united class-conscious army marching forward upon all the fronts towards objectives none may measure or define. It is a proud, ambitious army which cares nothing for all the laws that men have made; nothing for their most time-honoured customs, or most dearly cherished beliefs, or deepest instincts. It is this power called Science which has laid hold of us, conscripted us into its regiments and batteries, set us to work upon its highways and in its arsenals; rewarded us for our services, healed us when we were wounded, trained us when we were young, pensioned us when we were worn out. None of the generations of men before the last two or three were ever gripped for good or ill and handled like this.

Zakaria was not wrong about the growth of China, India, Brazil and others (he was after all writing in 2008 when that growth was already evident) but he gave demographics more weight than it deserves. Zakaria saw the overwhelming success of the less populous West as an “accident of history” while “the real giants – China, India, Brazil – have been sleeping, unable or unwilling to join the world of functioning economies.”

By contrast, Churchill saw the West’s advance as no accident and as the logical result of scientific progress. Note in the excerpt Churchill’s mention of India and China, to emphasize that demographics had been overtaken by science.

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Demographic Dividend: Which Countries Are Next?

SAMI J. KARAM

Sub-Saharan Africa is nearing a historic opportunity, but most of its nations are not ready.

Published on Africa Day 2023.

The population of India will have surpassed that of China by the end of this year, with each country counting 1.43 to 1.45 billion people. This milestone has led several observers to wonder whether the Indian economy can achieve a demographic dividend in the same way that China did after 1990. There is however widespread misunderstanding around the question of what constitutes a demographic dividend. This recent statement from a leading Indian daily is typical but inaccurate:

“A high population, especially in a younger age cohort, is generally seen as an asset rather than a liability for the economic fortunes of a country. The simple reason for this is that more people also means more working hands.”

The Financial Times similarly published “Can India Unlock the Potential of its Youth?” in which it discussed India’s prospects of deriving a demographic dividend from its youth bulge.

“More people” or a “youth bulge” could in theory mean “more working hands” but only if there is a sufficient number of jobs being created. The fact that tens of millions of new young cohorts will come of age every year and will need to take jobs to make a living does not automatically mean that those jobs will be there for the taking. A benign economic outcome cannot be taken for granted merely because of a shift in demographics. If for example investment is weak or if literacy is low, having more people may result instead in greater poverty and other deteriorating conditions. In addition if there is a too-large “younger age cohort”, there may be new headwinds slowing the economy in cases where the number of dependents (the young and elderly) overwhelms the number of workers. All of this is to say that while the sheer total number of citizens is important, it is less important than the age distribution of the population and other non-demographic factors.

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You Are What You Risk, With Michele Wucker, 19 April 2021

Editors

“For some people, risk is scary and dangerous, and means peril and loss. For others, it means risk assets and they have to pile on because they just see the upside. But risk is actually value-neutral. It is important to be aware of the bias that you bring to things. Do you see both sides and do you weigh them? Or are you likely to overweigh the downside or overweigh the upside?” ________ Michele Wucker

We all have an ambivalent attitude towards risk. In 1850, a young Emily Dickinson wrote to her friend Abiah Root “the shore is safer, Abiah, but I love to buffet the sea. I can count the bitter wrecks here in these pleasant waters, and hear the murmuring winds, but oh, I love the danger!”

In her new book You Are What You Risk, author and strategist Michele Wucker codifies this ambivalence to risk. In this podcast with Sami, Michele explains the concepts of “risk fingerprint” and “personal risk portfolio”, among others.

Topics include:

  • 0:00 Introduction of Michele Wucker
  • 2:13 Thesis of ‘You Are What You Risk’
  • 5:20 Attitude towards risk: innate vs. acquired through experience
  • 10:40 Taking a risk vs. following a path; Risk and entrepreneurship
  • 14:10 About each person’s risk fingerprint
  • 19:45 Taking risk as the only woman in the room
  • 24:40 “Risk is value-neutral”
  • 33:00 Matching risk fingerprints in interactions; Measuring risk
  • 38:20 The personal risk portfolio
  • 42:25 Remembering the onset of the pandemic as a gray rhino

TO HEAR THE PODCAST, CLICK HERE OR ON THE TIMELINE BELOW:

(photo of Michele Wucker by Hal Shipman)

On the Seasonality of the Virus

Editors

What are the odds that the coronavirus will recede on its own during the spring because of warmer temperatures or a higher ultraviolet (UV) index? This has been a question from the beginning.

There has been some research in support of the idea that the warmer season would force the virus to retreat. And there has been other research that concluded that the virus would retreat but not disappear, that it would survive in the southern hemisphere and that it could then stage a comeback in the northern hemisphere in the fall when cooler temperatures return.

Single Variables

Looking at the United States state by state, we find little correlation between the number of deaths per capita and the UV index. For example, Wisconsin with a UV index of 4 in March has so far suffered 25 deaths per million inhabitants, but Rhode Island also with a UV index of 4 saw as many as 60 deaths per million. At one extreme, New York, New Jersey, Michigan, Connecticut and Massachusetts, all with a March UV index of 4, had over 100 deaths per million. At the other extreme, South Dakota also with a March UV index of 4 had only 7 deaths per million. (All deaths figures are as of 12th April 2020 per Worldometer). Read more →

A Few Certainties About Covid-19

Editors

There is plenty that we do not know about the coronavirus. But let us take stock of the things that we do know for sure, and of some other things that we will soon know.Screen Shot 2020-01-27 at 2.29.15 PM

Real-world Exponentiality

By now, a child understands exponential growth. If you start with one apple on March 1st and double every three days, you will have a thousand apples on March 31st and a million on April 30th.

But in the real world, not the abstract world of math, there are constraints on that growth. Doubling your apples every three days is feasible for a month or so because you can probably find a thousand apples and also find a place to store them. But it would be more difficult to find, transport and store a million apples, unless you are willing to pack a six car garage with apples from floor to ceiling (accurate math). If you did, most of them would rot and your neighbors would call for psychiatric help, two other constraints on unbridled exponentiality. Read more →

The Pandemic as a ‘Gray Rhino’ Event, with Michele Wucker

Editors

“The paradox of the Gray Rhinos is that the further they are down the road, the less likely you are to do something about them. But that is the time when it will cost the least and you are most likely to be successful.” ____ Michele Wucker

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Sami J. Karam speaks to best-selling author Michele Wucker about her 2016 book The Gray Rhino and how its method and lessons apply to the coronavirus pandemic. Gray Rhino threats are highly probable, highly impactful but often neglected until it is too late or until the cost of dealing with them becomes very high.

Topics include:

  • 0:00 Introduction of Michele Wucker
  • 1:05 When will we be able to travel to Asia or Europe again?
  • 3:10 Explaining the concept and examples of Gray Rhino events
  • 9:00 Various reactions to the spread of the pandemic
  • 15:50 Was the virus predictable?
  • 19:20 Why should we have been readier for the virus when it is so rare?
  • 22:00 Why we ignore what is “over there”. Did it start “over there” or over here?
  • 25:35 How could we have prepared for the pandemic?
  • 31:00 The current catch-22: deaths by virus vs. deaths of despair
  • 44:10 Stages of a Gray Rhino event applied to the pandemic
  • 50:10 What other Gray Rhino events do you worry about? A triad of Gray Rhinos
  • 55:45 How alarmists help avert deep crises
  • 59:40 Conclusion

TO HEAR THE PODCAST, CLICK HERE OR ON THE TIMELINE BELOW:

(photo of Michele Wucker by Hal Shipman)

The Relationship Between Fertility and National Income

SAMI J. KARAM

We all heard that “demography is destiny”. But how many of us truly believe it? If demography was destiny, the world would look very different today. The two demographic giants China and India would be uncontested economic and military powers. The United States would be a regional power struggling to keep up. Larger European nations such as Britain, France and Germany would barely register on the economic map, while smaller ones such as Switzerland and Finland would be invisible. Nigeria and DR Congo would be African powerhouses. Brazil, Indonesia and the Philippines would be the shining stars of their continents. Read more →

Advocate of Early Detection: Podcast with Cardiologist Dr. Michel Accad

Editors

22 April 2015

Cardiologist Michel Accad advocates early testing for detection of heart disease.

“We do have very robust technology, non-invasive technology that is simple to use and reliable and that has been established for a long time, to try to detect heart disease before it actually causes any problems. Most of the time when heart disease becomes manifest with symptoms or sudden cardiac arrest or a heart attack, it has been present for many many years before that time. So there is an opportunity to make a diagnosis that is very specific.”   Dr. Michel Accad, Athletic Heart of San Francisco.

Demography is one of the recurrent themes at populyst. In America Heading towards Zero Population Growth, I wrote that the population of the United States is growing at a slowing rate and that, except for immigration, it will not grow at all in the 2030s and 2040s. This prediction may however come into question if US life expectancy increases significantly in the next 20 years.

For this and other reasons, it is useful to periodically examine the progress being made in health and medical practice.

Heart disease remains the number one killer in the United States, accounting for 611,000 of the 2.6 million deaths in 2013. Strokes were responsible for an additional 129,000 fatalities, which means that cardio-vascular ailments led to 29% of all US deaths. By way of comparison, cancer in its various forms accounted for 23% of US deaths.

Death by heart attack is largely an older person phenomenon. According to the Center for Disease Control (CDC), as many as 40% of fatal heart attacks strike people aged over 85 and only 8% strike people aged under 55. This means that a hypothetical increase in US life expectancy, which currently stands at 79 years of age, must probably be accompanied by a measurable reduction in heart disease.

The table, compiled from CDC data, shows the percentage of heart disease and cancer fatalities per age group.

Heart v Cancer

Detection and prevention are seen as essential ways to fight back against cancer. It has become widely accepted that after a certain age, people should undergo routine testing for detection of some cancers even if they appear on the surface to be completely asymptomatic. Some such tests are mammograms and colonoscopies. It is important to note that these tests are most often covered by insurance, a factor which certainly raised their adoption among patients and their doctors.

By contrast, historically, the approach to detection of heart disease has relied primarily on a nebulous review of the usual risk factors, mainly diabetes, blood pressure, cholesterol, smoking, and their frequently attendant obesity. More recently however, a growing number of cardiologists have started advocating proactive testing via CT Scans (aka CAT Scans) of all people over 45 or 50.

MichelAccadPhoto
Michel Accad, MD.

One of the most vocal among this group is San Francisco-based Dr. Michel Accad, a practicing cardiologist who is also the founder and medical director of Athletic Heart of San Francisco.

In addition to early detection of coronary heart disease and other heart ailments, Dr. Accad also champions a more proactive approach to early detection of any risk of sudden cardiac arrest. Although relatively rare compared to coronary heart disease, sudden cardiac arrest can strike any person of any age during strenuous physical activity.

Dr. Accad’s years of experience coincided with rapid advances in technology and the two have converged today into the following messages:

1- It is a good idea for any person over the age of 45 to get a CT Scan. Because the first manifestation of heart disease can be catastrophic (one third of all heart attacks are fatal), it makes sense to try to detect the presence of any plaque in the arteries.

2- It is a good idea for any person of any age who is active in high-intensity physical activity to undergo tests designed to detect early any risk of sudden cardiac arrest.

As noted above, insurance typically covers cancer tests such as mammograms and colonoscopies. But CT scans designed to detect plaque in the arteries are not generally covered. Perhaps this is due to the fact that treatment of cancer can be far more expensive than treatment of heart disease, at least in its milder form. Dr. Accad notes nonetheless that the cost of CT scans is not prohibitive for a vast majority of patients.

I discussed all of these issues and questions of life expectancy with Dr. Accad in a podcast which you can hear through this link or by clicking the timeline below.

TO HEAR THE PODCAST, CLICK HERE OR ON THE TIMELINE BELOW:

Dr. Accad may be reached through Athletic Heart of San Francisco or through his blog.

Disclosure: Sami Karam and populyst have no business dealings with, and receive no compensation from, Dr. Michel Accad, Athletic Heart of San Francisco or any other parties named in the podcast.

Plans to Tame Kenya’s Exploding Population

Editors

The government has plans to reduce the total fertility rate from 4.6 to 2.6 children per woman.

EDITH FORTUNATE writes in AFRICA REVIEW:

Ann Wafula, 30, patiently waits to see the gynaecologist at Gilead Medical Centre, situated in the upmarket Upper Hill area of Nairobi.

The mother of a three-month-old baby boy, who is also her first born, is here to consult with the doctor on what contraceptives she should use, based on a hormonal test carried at the hospital.

In Hagadera, three hundred kilometres away to the east of Nairobi, 21-year-old Asha Abdalla is a proud mother of twin girls, delivered just a few days ago at a local dispensary. The twins are her second and third born, while her first born is aged barely two years. “I conceived when he was just nine months,” she explains.  READ MORE.