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fewer and fewer gains can be expected from technical “silver bullets” without making serious improvements to the health systems of poor countries 17 and addressing structural poverty and human rights violations. 7. Many of the estimated 1 billion people living in the 50-60 countries caught in “development traps” of bad governance, wasted natural resource wealth, lack of trading partners or conflict have seen only limited gains in health and well-being since 1994, and some are poised to become poorer as the rest of the global population anticipates better livelihoods. 18 It is in these countries, and among poorer populations within wealthier countries, 19 that the status of women, maternal death, child marriage and many other concerns of the International Conference have seen minimal progress since 1994, and life expectancies continue to be unacceptably low. 20 The threats to women’s survival are especially acute in conditions of structural poverty, owing to their lack of access to health services, particularly sexual and reproductive health services, and the extreme physical burdens of food, production, water supply and unpaid labour that fall disproportionately on poor women. New challenges, realities and opportunities 8. The dramatic decline in global fertility since the International Conference has led to a decrease in the rate of population growth; nevertheless, owing in part to demographic inertia, the world’s population crossed the 7 billion mark in late 2011 and United Nations medium-variant fertility projections anticipate a population of 8.4 billion by 2030. 21 9. Population trends today are characterized by considerable diversity between different regions and countries. Most developed countries, and several developing countries, have ageing populations, with declining proportions of young people and working-age adults. Even in poor countries, declining fertility rates will eventually lead to an ageing population, and the high proportion of older persons that is evident in Europe and developed countries in Asia today will characterize much of the world by 2050. 22 10. At the opposite extreme, high total fertility rates of more than 3.5 children per woman are now confined to just 49 poor countries, mostly in Africa and South Asia, which make up less than 13 per cent of the world’s population. These and other developing countries are still characterized by increasing proportions of young and working-age persons, a situation which, under the right circumstances (including a decline in fertility), can lead to a temporary “demographic bonus” but which, at the same time, challenges Governments to ensure adequate access to education and employment. 23 __________________ 17
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WHO, Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes — WHO’s Framework for Action (Geneva, 2007). P. Collier, The Bottom Billion: Why the Poorest Countries Are Failing and What Can Be Done About It (New York, Oxford University Press, 2007). Paul Collier, op. cit.; State of World Population 2002: People, Poverty and Possibilities (United Nations publication, Sales No. E.02.III.H.1). UNFPA, Marrying too Young: End Child Marriage (see footnote 5 above); WHO and others, Trends in Maternal Mortality (see footnote 6 above). World Population Prospects: The 2012 Revision (see footnote 7 above). Ibid. World Population Prospects: The 2012 Revision — Highlights and Advance Tables (ESA/P/WP.228).
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