Continuing my discussion of the recent upsurge in pro-natalism, I want to talk about the idea that, unless birth rates rise, society will face a big problem caring for old people. In this post, I’m going to focus on aged care in the narrow sense, rather than issues like retirement income, which depend crucially on social policy.
Looking at Australian data on location of death, I found that <a href=”https://www.abs.gov.au/statistics/research/classifying-place-death-australian-mortality-statistics”>around 30 per cent of people die in aged care</a>, and that the mean time spent in aged care is around three years, implying an average of one year per person.
Staffing requirements in Australia amount to aroundone full-time staff member per residents. So the “average” Australian requires about one full-time working year of aged care in their lifetime, or about 2.5 per cent of a working life. This is, as it happens, about the proportion of the Australian workforce currently engaged in aged care.But what if each generation were only half the size of the preceding one? In that case, the share of the labour force required for aged care would double, to around 5 per cent.
If you find this scary, you might want to consider that children aged 0-5 require more care than old people, and for a much longer time. Because this care is provided within the family, and without any monetary return, it doesn’t appear in national accounts.
But a pro-natalist policy requires that people have more children than they choose to at present. To the extent that this is achieved by subsidising the associated labour costs (for example, through publicly funded childcare), it will rapidly offset the eventual benefit in having more workers available to provide aged care.
And that’s only preschool children. There’s a significant childcare element in school education, as we saw when schools closed at the beginning of the pandemic. And school-age children still require plenty of parental care. (I’ll talk about education more generally in a later post, I hope).
Repeating myself, none of this is a problem when people choose to have children, more or less aware of the work this will involve (though, as everyone who has been through it knows, new parents are in for a big shock). But it’s clear by now that voluntary choices will produce a below-replacement birth rate. Policies aimed at changing those choices will have costs that exceed their benefits.
John Quiggin 
In furious agreement I only want to add that population boosting for the purpose of looking after the elderly always suggests to me an obvious question – does this boost strategy – continuously applied over the decades – mean endless population growth? It seems to me that this question is never addressed by the boosters.
I furiously agree. The only thing I would like to add is that boosting population growth in order to provide a work force for the future to look after the elderly in their final years always causes me to mentally scream with frustrated rage – are we expected to continue this strategy ad infinitum? This is as silly as perpetual motion machine theory.
Surely a substantial proportion of RACF residents are admitted to hospital before they die?
Off-topic comment deleted. I will write about migration later, but I don’t want this discussion derailed – JQ
(cross-commented)
The analysis could do with extension to medical costs. These are also concentrated in the first first and last years of life, and show the same swings-and-roundabouts pattern as those of care: with an ageing population, they go up for the aged and down for infants. But the nightmare cases are I suspect very asymmetric. Only a few disturbed or disabled children need the sort of continuous attention of a sufferer from Alzheimer’s.
The prevalence of this plague has shot up, from 19.7m cases worldwide in 1990 to 51.6m in 2019 (+161%) (https://www.frontiersin.org/articles/10.3389/fnagi.2022.937486/full). “An estimated 6.7 million Americans age 65 and older are living with Alzheimer’s dementia today[2023]. https://pubmed.ncbi.nlm.nih.gov/36918389/
The general expectation is that this growth will continue. There is the usual hope that like cancer, this recalcitrant non-infectious disease will finally yield to the large-scale research being thrown at it, and/or to the drop in air pollution we can confidently expect from the energy transition.
If you are looking for some thing less conventional, yours truly floated an oddball hypothesis in a blog post back in the High and Far-Off Times of 2011: http://www.jameswimberley.es/Blog%20posts/2011/Easy%20lies%20the%20head%20%C2%AB%20The%20Reality-Based%20Community.htm
SFIK nobody picked it up, for confirmation or refutation. However, the initial observation holds up: European royalty stay healthy as they age. Elizabeth II of the UK died at one of her many homes at age 96, following her husband who died at age 99 and her mother at 101. Two days before her death Elizabeth received Liz Truss as incoming PM, an important constitutional requirement. Queen Margarethe of Denmark has just abdicated at her own initiative at age 83. She walks with a stick. Queen Beatrix of the Netherlands abdicated at merely 75. And so on.
In the post I asked why they are so healthy and keep working long after most of their subjects. The glowing health of royalty presumably translates to low lifetime medical expenditure. They seem to be reasonably active physically – only a few like Anne of the UK (equestrian) and King Harald of Norway (sailing) have competed in any sport at a high level. The work is light and not very stressful, though it does require constant self-control to interact civilly with the assorted psychopaths, fans, flatterers, conmen, paparazzi and random citizens they are paid to face on a daily basis. They are well off, more securely so than most rich people. Since royal titles, unlike capitalist fortunes, are entirely a matter of luck, and the inbreeding stopped a century ago, it’s unlikely there is a genetic secret sauce.
Here’s my additional pennyworth. From before birth, they all got the very best preventative medicine and advice available at the time, which trickles down to the general population after a lag. That component of a healthy and low-cost age is now available to everybody, and some but not all of the other environmental factors can be made so in future. I still think it would be worthwhile to spend a little to research the anomaly properly.
omment deleted. I will write about migration later, but I don’t want this discussion derailed – JQ
As you say, my rules rule. They clearly state no disputes on my decisions. You’re blocked for a week
we already face a big problem.
the lady who was tazed for being aggressive with a knife.
and died.
was she reacting to sexual abuse?
molestation of helpless elderly in “care”homes (very expensive for profit “care”homes)
well we don’t talk about that.
James Wimberley: – “The general expectation is that this growth will continue. There is the usual hope that like cancer, this recalcitrant non-infectious disease will finally yield to the large-scale research being thrown at it, and/or to the drop in air pollution we can confidently expect from the energy transition.”
The worsening climate crisis will soon prevent further population growth. Professor Johan Rockström, Director, Potsdam Institute for Climate Impact Research, said at 44th TB Macaulay Lecture, from time interval 0:21:28 (bold text my emphasis):
“So, dear friends, what, what tends to be forgotten is that we’re in the middle of a climate crisis and that the only way to have a safe landing, to hold the 1.5 °Celsius, is a global sustainability transformation. Phasing out coal, oil and gas is actually – and I know this comes across often as a provocative statement – but that’s the easy part of the challenge. That’s the easy part of the challenge. We need to transform the food system, keep nature intact, and scale negative emission technologies in an unprecedented way. All of this has to occur, simultaneously, to have a safe landing. That’s where we are at, and this requires – which I will be kind of arguing in the continued part of this talk – a planetary boundary approach, because we have to have the checks and balances across all the systems of the planet, even if we only care about holding 1.5 °Celsius – one of the nine planetary boundaries. So, that’s where we are. And unfortunately, if you take the latest IPCC and UNFCCC assessment of the journey we’re following, even after the last stock-take on the Nationally Determined Contributions that were performed just before the New York climate week in September this year, we’re following a pathway that takes us to 2.7 °Celsius by the end of this century. And let me just be very clear from the outset, that is, without any hesitation in science, a path to disaster, That’s a path to disaster. We have no evidence, whatsoever, that we can support in a dignified and responsible way, eight, soon to be 9 billion people in the world as we know it, at anything above 2 °Celsius. Actually, we’ve not been at that point for the past 4 million years, at the 2.7 °Celsius level. So this is why we are talking about urgency – that we really need to move this around very fast. Now, is this only me standing here saying this? Well, actually no. The scientific communities now today, are very well, has a very strong consensus here.”
If we don’t solve the climate crisis then nothing else will matter, because there likely won’t be a civilisation beyond this century to deal with any of these other important issues.
Test.
James, perhaps the book “Man’s Search for Meaning” had the answer, way back when. Being treated like you’re important seems to affect health, as does having a sense of purpose. (Although, if any royals were born introverts, that might work against this.) Well also since most of them don’t have actual power, I guess the stress is lower than it used to be for them.
Alzheimers - I wonder which of the poisons in our environment here is doing this to us. We’ve got to clean up our act!