UN: Stop fretting about fertility

The ideas and innovators shaping health care

Apr 20, 2023 View in browser   By Carmen Paun, Ben Leonard, Ruth Reader and Erin Schumaker WORLD VIEW South Korea's birth rate is .79 children per woman and its population is aging rapidly. | Getty Images Forget declining fertility rates. Focus instead on gender equality. And embrace migration. That’s the message to governments from a new United Nations Population Fund report released Wednesday. Policies designed to influence people, especially women, to have more or fewer children don’t usually work, the report says. The better way to deal with the problems of an aging population is to permit more orderly immigration from growing countries. Why it matters: Most of the world’s population live in countries with low fertility where people face a future in which the elderly outnumber younger, working-age citizens. Without more immigration, they’ll struggle to provide health care for elderly people, fund government pension programs and have enough soldiers to fight wars. Europe is feeling this firsthand. In the next three decades, its population will decrease by 7 percent, according to the report. Populations in North America and other regions will continue to grow but peak by 2100. Japan is projected to experience a 15 percent decrease by 2050, from 123 million people to 103 million, according to Our World In Data. China’s population will also decline by some 120 million people by 2050. Policy responses: The U.N. isn’t against policies to make having kids easier, such as parental leave for men and women and child tax credits. But countries that have offered financial incentives to encourage women to have children haven’t seen great results. South Korea, for example, has spent more than $200 billion to promote child-bearing over the last 16 years and still has the world’s lowest fertility rate. So countries like Poland and Russia that are adopting similar strategies are unlikely to succeed in increasing their populations, UNFPA Executive Director Natalia Kanem told Carmen. Limiting access to abortion, as in the United States, isn’t a solution to demographic changes either, she said. What’s left? Migration will drive population growth in rich countries over the next decades, the report says. And that’s a good thing, according to Kanem: “The receiving country gets huge benefits once the incoming person is integrated properly, once there are plans in place to address barriers they face."   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     WELCOME TO FUTURE PULSE Hull, Mass. | Shawn Zeller This is where we explore the ideas and innovators shaping health care. Ozempic users report having bizarre dreams since starting the anti-obesity drug, many of them featuring celebrities, the Wall Street Journal reports. A few of our Ozempic-fueled favorites: Arguing with Kathie Lee Gifford over how to set up a tent, ordering kitchen cabinets from Home Depot salesperson Clint Eastwood and being rescued by a go-kart-driving Oprah Winfrey. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, your host Ruth talks with Katherine Ellen Foley about the FDA's new, simplified Covid vaccination regimen, including what it means for people who have never been vaccinated, have a compromised immune system or are over age 65. Listen to today’s Pulse Check podcast TECH MAZE Oracle, the contractor in charge of the VA's new health records system, is trying to fix system problems. | Justin Sullivan/Getty Images The VA is willing to accept more oversight of its troubled health records system. The department’s effort to upgrade its EHR system at its 171 medical centers, which serve 9 million veterans, could improve care by ensuring VA doctors have easy access to patient data in a more modern system. But the system, from contractor Oracle Cerner, has faced safety issues — the VA recently told Ben that the system had played a role in “catastrophic” harm to six veterans, four of whom died — and its cost projection and time frame have ballooned to $50 billion and 28 years, according to one estimate. What’s next: On Wednesday, VA officials told the House Veterans’ Affairs Oversight and Investigations Subcommittee they could provisionally support a Republican-led bill that would bar the department from continuing to roll out a new electronic health records system without “significant improvements.” VA officials said the agency could offer provisional support to legislation by House Veterans’ Affairs Committee ranking member Mark Takano (D-Calif.) that would require the VA to have an “independent verification and validation assessment” of the project. That could increase momentum for Congress to act.   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     WASHINGTON WATCH Booker thinks PEPFAR is working well as it is. | AP Photo/Mel Evans The next five years at the President’s Emergency Plan for AIDS Relief could look a lot like the past five. The 20-year-old program to combat HIV and AIDS in the developing world is up for congressional reauthorization this year. That presents an opportunity to make policy changes, but top members of the Senate Foreign Relations Committee said Wednesday they were content with the status quo. Idaho’s Jim Risch, the committee’s top Republican, and Cory Booker (D-N.J.), the chair of the Africa and Global Health Policy Subcommittee, said they wanted a “clean reauthorization” during a committee hearing Wednesday. “Let’s not bog down the process by wordsmithing what already exists. This program is too important for that,” Risch said. The focus instead should be on “rigorous oversight, including close scrutiny of PEPFAR’s local implementing partners,” he said. Booker agreed, adding that a clean reauthorization is urgent “given the progress we made and the challenges we still have.” Why it matters: PEPFAR is widely considered the most successful global health program in history, saving 25 million lives. But setbacks in prevention and access to treatment, as well as a perception that HIV is not the serious health threat it was 20 years ago, still lead to more than a million infections annually and hundreds of thousands of deaths. President Joe Biden proposed a $25 million cut to the 2024 PEPFAR budget compared with the $4.7 billion the program received in 2023. Even so: Senate Foreign Relations Chair Bob Menendez (D-N.J.) said he still wasn’t ready to put the chance to make policy changes aside if there are ideas to improve PEPFAR.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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