A population is demographically trapped if it has exceeded, or is projected to exceed, the combination of : (a)the carrying capacity of its own ecosystem; (b) its ability to obtain the products, and especially the food, produced by other ecosystems except as food aid; and (c) its ability to migrate to other ecosystems in a manner that preserves (or improves) its standard of living (voluntary migration). Items (b) and (c) describe the links that a population has with other ecosystems. Since these items are crucial, they are discussed here as 'connectedness' vs 'disconnectedness'. For the purposes of this paper an ecosystem is one that supports a human community on a certain area of land.
The main connections or flows in and out across the boundaries of such an ecosystem are food, migration of people ('mouths to cat the food'), and the exchange of goods and services for food and other products. Connectedness ensures that most communities are able to live off the products of more than one ecosystem. Consequently, Singapore is not trapped, even though it has long exceeded the carrying capacity of its tiny island, whereas Nepal, having almost nothing to exchange, probably is.
Thus entrapment is a disorder of the carrying capacity of one's own ecosystem
and of its connection to other ecosystems. The end of entrapment is that
people migrate in misery to some urban slum (forced migration); or they
hope to be supported indefinitely by food aid; or they die where they are.
We argue that the International community must expect to have to provide
food aid on an increasing scale.
There are four main arguments against entrapment as a valid demographic concept: [2]
(1) Carrying capacity, which is mainly applicable
to ecosystems such as farms and ranches that are managed commercially to
raise crops and animals. has no validity for man.
(2) There are immense difficulties in specifying
a 'welfare referenced standard of living' for man.
(3) The the products of certain ecosystems,
especially food, are traded between ecosystems.
(4) Were carrying capacity valid, malthusian
rises in mortality should already be occurring somewhere.
For simplicity, we will avoid the need to specify a standard of living by considering death as the endpoint. Moreover, we argue that our notion of connectedness takes account of trade.
The reasons why rises in mortality have yet to be reported include:
(a) Enhanced agricultural productivity.
(b) The effect of socio-economic development on birth rates.
(c) Trade and migration between ecosystems (connectedness).
(d) The effect of aggregated data hiding rises in mortality in subgroups.
(e) Poor data from areas where mortality might now be rising.
(f) Confounding factors such as drought.
(g) Recent medical advances such as re-hydration and food aid may be preventing
a rise in mortality in those communities where it might otherwise now be
occurring. If food aid is adequate indefinitely, the expected rises in
mortality may never occur. If carrying capacity is invalid, what do aid-agency
observers mean when they discuss entrapment?
All four ways of determining the existence and severity of entrapment have limitations:
Calculation is
the only way of detecting the early stages. The necessary data include
projections of population growth, especially demographic momentum; local
food
production and food imports; the probability
of technological breakthroughs in agriculture; the extent of migration;
and the effect of epidemic disease, particularly AIDS.
Persistent need for food aid over several years, to the extent that limitations of carrying capacity and connectedness are responsible for this (a late sign).
Observed ecological degradation (another late sign), either directly, or when decreased productivity forces people to migrate.
Opinions of aid-agency observers. Entrapment has been discussed informally in aid-agency circles for several years. Their opinions are surprisingly consistent, although there is an understandable reluctance for any observer publicly to name an individual trapped country.
The trapped countries countries sometimes mentioned include: India, Bangladesh, Pakistan, Nepal, Eastern Indonesia, the Philippines, Vietnam, Haiti, the Maldives, Kenya, Nigeria, Rwanda, Malawi, the Gambia, and Zanzibar. The basis for these opinions is unclear; it is presumably a combination of increasing population densities, progressive imiseration, and pessimistic projections of food supplies. Since early entrapment can be recognized only by calculation, the aid agency observers are probably recognizing the later stages.
Ethical dilemmas: child vs community
The ecological constraints on mankind take no account of our ethics. This grim fact, combined with the special place of the child in contemporary ethics, is behind most of the ethical dilemmas that arise during entrapment. The quandaries concern both fertility (notably in relation to abortion and one-child families) and mortality, particularly child mortality. There is a conflict between the interests of the present child and his community, and between him and his future community (and its future children).
These dilemmas change during the process of entrapment. There is also a conflict between the interests of the present child, and that child saved for the moment, but only for malnutrition and an early death. Is his life really worth saving if this is so soon to be his fate? This is the child vividly described by Scheper-Hughes. [3] Lowering fertility in a trapped community is vastly preferable ethically, and far more effective demographically, than not doing everything possible to lower mortality. But what should the policy towards mortality be if the fertility response is inadequate or absent entirely?
These dilemmas (except the particular UNICEF dilemma in stage two below) are most pronounced when child mortality is high, either early or late in the process of entrapment. For aid agencies they only exist at all if it is assumed that we, the aid agency, do the deciding and if we expect that what we do will have a significant effect in lowering child mortality. The alternative is to give great weight to the premise of local autonomy and let the local community make the decisions.
Ethical stage one: start of the modern period with child mortality about 500 per thousand
All communities entered the modem period with a child mortality that was
high enough for a reduction, by whatever means, to raise population trajectories
considerably. Complex and only partly quantifiable and predictable interactions
between child death rate and birth rate start in this stage, and continue
into the next one. Unfortunately, the effect of declining mortality is
not invariable and can be delayed. This delay is unimportant if a country
is not trapped but serious if it is. Thus, it would have been in the future
demographic interests of a community that subsequently became trapped,
though not, alas, of its then children, to have reduced its child mortality
only just enough to have triggered a fertility decline.
Ethical
stage two: child mortality about 250 per thousand
No countries remain with a child mortality of 500 per thousand, but some
are sufficiently near it for the dilemma of stage one to remain in some
degree. Malawi, for example, has a child mortality of 253 and a total fertility
of 7.6. If fertility were to be maintained (it has recently been rising),
halving child mortality would add the equivalent of 30% of the present
population to its population in 25 years. If fertility were to fall to
4 over this time, the increase would be 24%; if it fell to 2 the increase
would still be 20%.
Ethical stage three: child mortality
less than 150 per thousand
As Lithell et all point out, by the time child mortality has fallen to about 140 per thousand (the present Indian rate) depressing it further hardly raises the population trajectory, so the dilemmas of the first stage barely operate. Thus, halving India's child mortality would add only the equivalent of 11 % of its present population to its population in 25 years. Were its total fertility to fall to 2 (it is presently 4.2), the addition would be only 8%.
However, if a population is in danger of entrapment, there is another serious dilemma in this stage, especially for UNICEF. Should one try to halve child mortality with technical fixes for child survival, or institute an urgent programme of 'emergency disentrapment' in a desperate attempt to avoid the next stage? This is partly a matter of priority in allocation of resources, partly a matter of time horizons, and partly a question of priorities for the UNICEF publicity machine, which is far stronger in this aid agency than in others.
Ethical stage four: rising child mortality en route to the malthusian ceiling
This stage is theoretical because it has yet to be reported at the community level. The long-term trajectory-influencing factors of earlier stages would no longer operate, and family planning, even one-child families, would be too late. If one assumes a constant or decreasing food supply, there would be acute pressure on food, such that one more (child) mouth to feed would mean less food for someone else. To the extent that child survival interventions would be possible at all, they would increase the dilemma as the malthusian ceiling was reached and exceeded and the population started to fall. Since human communities are not uniform there can be subgroups who have reached this stage (such as is the family in our opening poem) when most of the community are still in an earlier one.
Failure to discuss entrapment openly means that its dilemmas, especially those between the interests of the child and of the community, are repressed. When aid-agency executives have to make decisions that are subject to these conflicting premises, severe stress results, and is made worse if an executive happens to have special knowledge of a certain community and therefore identifies with it. One way to escape this stress is to deny disconnectedness. Unfortunately, however much disconnectedness ought not to exist, and must be fought against, it does exist.
Consequently, plans have to be made, not on the basis of what ought
to happen in an ideal world, but what will probably happen in the real
one.
Is it the dilemmas, or is it the dissonance in world view that causes so much stress in aid-agency executives? In practice, the dilemmas may not be as severe as is suggested above for two main reasons:
(i) they are significant only when child mortality is high; and
(ii) the practical decision is where to apply limited resources, especially new resources ("Shall we try to eradicate poliomyelitis or shall we put the resources into family planning"). So why does entrapment stress aid-agency executives? We believe it is not so much the decisions but more the pessimistic and radical change in world view that is needed to encompass entrapment. Changes m direction cause immense emotional and administrative difficulties, all the more so if a costly publicity position has been built up that is difficult to alter. For example, UNICEF's "child survival revolution" contrasts starkly with the grim reality that seems to be looming ahead in some trapped communities.
Who makes the difficult ethical decisions - "we", the agency or "they", the community? There are various possibilities:
(i) Not to admit that there are any ethical decisions to be made, by refusing to admit that the dilemmas exist because entrapment does not exist; dilemmas are then settled by default.
(ii) To admit that there are ethical decisions to be made, and for an aid agency to make them in its headquarters.
(iii) To leave the ministry of health to resolve matters; in practice, this may be the least unsatisfactory place to resolve them, although the ministry is likely to be a poor representative of the community.
(iv) To let the communities themselves make the ethical decisions;
undoubtedly the best solution from the standpoint of local autonomy, but
nevertheless fraught with theoretical and practical difficulties.
Whereas UNICEF seeks, often successfully, to control the investment in children for other people, Save the Children Fund (SCF) has a much less tangible and more adaptable policy image and is therefore less vulnerable and less stressed by the dilemmas of entrapment. In practice, SCF gives more weight to the 'community' and less to 'the child'; it is much more they that do the deciding and much less we. Although UNICEF officials may say that their organization also pays attention to the wishes of the local community, we feel bound to remind them that the 'child survival revolution' originated in New York, that a new battery of technological interventions is now being planned, and that UNICEF has never yet mentioned entrapment in any of its publications. What about the argument that UN agencies are merely the servants of member states? True, but in practice they do have considerable autonomy.
Unlike UNICEF, SCF tacitly assumes severe entrapment when necessary, and argues that in most locations it does not necessarily do 'everything possible to reduce child mortality', although it is better placed technically to do so than are most agencies. It finds itself without any dilemmas if it starts from the premise that they the community will determine what happens, and we will support it. What they do is held to be ethically right for them. Any dilemmas that arise are settled by the community, difficult though this is. SCF argues that no human group, and especially one short of resources, would freely invest everything in 'child survival', and that communities from their own very different points of view see child 'survival' holistically - deriving as much from economic development, and therefore from education, as from health care.
There are problems - e.g., infanticide of disabled children by nomads, to whom they would be an impossible burden, or the decision facing the Indian mother in our opening poem. Such practices are acutely distasteful to a community, which commonly has special cultural devices for distancing its members from them. We can only commiserate e with those, who in their extremity are called upon to practise them, and accept that it is they who must decide; were we in their unhappy shoes, we should probably decide similarly. Another difficulty is the perception of entrapment, especially early entrapment, by the community. In practice, when a community is in its own way aware of entrapment, as is the mother in the opening poem, it is likely to be late.
Although
SCF would not claim that it has completely resolved the dilemmas -
for example, in resolving the conflicts between national, community, and
family priorities - this organization has evolved a strategy that mitigates
them. We urgently need detailed studies to tell us how certain communities
cope, or fail to cope, and how they perceive entrapment and can be encouraged
to respond to it.
The reluctance of late western liberalism to recognize entrapment and its remedies is partly due to its 'romanticisation' of the child, one underlying reason being economic - children represent the best investment for society's resources. Consequently, we do not even challenge the priority given to the care of children in the allocation of desperately scarce resources. On the macro level, there is a United Nations fund for children but no equivalent institution for other vulnerable groups such as women, the aged, or the handicapped. On the micro level, public and family resources are directed to children at the cost of other needy groups. We do not suggest that children should be ignored, but that the assumption that they have an ethically prior claim to consideration needs to be inspected more critically than has been our cultural pattern during the past 150 years - interestingly, the present high ethical status of the child is a comparatively recent development.
Precisely because society is so 'hung up' on children, the suggestion that they have no greater claim to scarce resources than other vulnerable groups is unusually repugnant. At a stage in 'western' intellectual history when there is extreme uncertainty about the foundations and content of ethics, people are bound to react nervously to the suggestion that the one thing they feel reasonably certain about - the sanctity of the life of children and the need to protect them at almost any cost - should come under critical scrutiny. Some claim that to raise such questions is to play with fire. But when this fire licks round the whole metaphysical and ethical system of late western capitalism and threatens to engulf it, the mature response is surely not to deny or ignore it, in the hope that the ultimate horror of 'letting children die' can be avoided.
What is wanted is a full onslaught on the ethical presuppositions of late capitalism:
(i) That the west has the right to go on consuming the world's resources
at a disproportionate rate.
(ii) that migratory population flows from areas of ecological breakdown
can and should be stopped.
(iii) That a complex form of aid-by-triage
is morally acceptable.
(iv) That, as long as children do not suffer
too much, we can use a full but largely invisible battery of financial
and economic devices to extract wealth and welfare from poor countries
to buttress western standards of living.
The
ethic of global solidarity that we urge should now be mandatory
makes huge demands of western society. Is that why western nations back
away with the pretence of protecting children? To do so is to use the emotional
smoke screen of present children as a means of denying the one ethic that
could in the longer term actually save those children, and especially future
children.
Although we argue that entrapment is already in progress, the scale on which it is presently obvious makes it just possible for the UN agencies to maintain the illusion that it does not exist. Some time during the next 10-15 years this bubble will probably burst. However, a useful if unacknowledged beginning is being made, in that the United Nations Development Programme now gives annual food security data for each country, although it does not discuss their future implications. [5] The Food and Agriculture Organization and the United Nations Fund for Population Activities are sufficiently unthreatened to be able to discuss carrying capacity, and sometimes even population projections in relation to it, but stop short of considering what happens when the relation is unfavourable and adequate migration becomes impossible. Although entrapment has, it seems, been mentioned only once in any UN publications there is much private discussion among World Health Organization staff.
There are good reasons why the UN agencies should discuss entrapment:
(i) There can be no escape from what seems to be the unhappy truth
(ii) Only if the truth is recognized can anything
be done about it
(iii) Denying entrapment denies communities
and the world a critical stimulus for effective action.
(iv) Failure to decide the dilemmas actively
merely decides them by default
(v) Even the intelligentsia in a trapped community
are usually unaware of its entrapment
(vi) Recognizing entrapment would be a great
stimulus to ordinary family planning, both by encouraging aid for family
planning by the north and by promoting its uptake in the south; by definition,
this would not disentrap the severely trapped, but it would at least ameliorate
their plight.
(vii) For those countries on the borderline
of entrapment more ordinary family planning might be all that was necessary,
so the importance of recognizing entrapment is critical for this reason
alone.
(viii) There might be some communities that
would accept one-child families
(ix) The realization that parts of the south
were trapped might encourage lifestyle changes in the north.
Are the dilemmas to be decided by default because the aid agencies and
the international public health establishment cannot bring themselves to
discuss entrapment officially, despite the buzz of the hornets? Or, are
they to be resolved by open discussion, and particularly by the communities
most involved? Unfortunately, the political tensions surrounding entrapment
are at present so great that agency executives must not be pressed to recognize
entrapment. Although there are those who claim that there are no absolutely
irrefutable data confirming that any particular country is trapped, there
is surely no reasonable doubt that entrapment exists, so the rest of us
have to recognize it. Consequently we are faced with a period of legitimate
double-think - legitimate because we have to recognize it, and double-think
because we have to accept that the agencies cannot yet do so.
1. King MH. Health is a sustainable state. Lancet 1990; 336: 664-67.
2. Scoones
I, Zaba B. Is carrying capacity a useful
concept applied to human
populations? In: Zaba B, ed. Environment
and population change. Liege: Ordina (in press).
3. Scheper-Hughes. Social indifference to child health. Lancet 1991; 337: 1144-47.
4. Lithell U-B, Rosling H, Hofvander V. Children's deaths and population growth. Lancet 1992; 339.377-78.
5. United Nations Development Programme. Human development report Table 13. New York: Oxford University Press, 1992.
6. World Health Organization. From Alma -Ata to the year 2000: reflections at the mid-point. Geneva: WHO, 1988.