|Over the last 30 years, changing patterns of
fertility, mortality, education, and migration have profoundly affected peoples
lives. The family, the basic unit of all societies, is adapting itself to new challenges
and opportunities and changing its structure and activities to cope with new realities and
enhance the quality of life of its members.
numbers of people are living to older ages and higher proportions of most countries
populations have lived at least 60 years. At the same time, countries with historically
high levels of fertility are dealing with unprecedented numbers of children moving into
adolescence. Accelerating social and economic change is posing new challenges to societies
and families in preparing youth for productive social roles.
The emergence of "new generations" on a new scale
-- large numbers of young being prepared to enter into a rapidly changing social world and
growing numbers of women and men reaching older ages -- is a special distinguishing
feature of this time. These new generations are linked by more than a coincidence of time.
To a large extent the prospects of both groups depend on the strength, adaptability and
foresight of families.
Around the world, family support networks are in decline
and the proportion of single-parent-headed households is growing. In rural areas of
sub-Saharan Africa, urbanization often leads to young people being separated from their
grandparents, who previously played a special role in the traditional education and
socialization of the young. In the Middle East, traditional extended families are
gradually disappearing as is the case in Egypt, where 84 per cent of all households are
now nuclear families. In the United States, the growing number of female-headed
house-holds is one factor contributing to the feminization of poverty in that country. In
many countries, the HIV/AIDS epidemic is affecting the health and lives of young adults as
they reach their most productive years. In the absence of social services to bridge the
gap previously filled by other family members, the consequences of these changes are often
negative, especially for the poor. In the absence of a social "safety net," the
elderly and children have no choice but to work, parents are forced to leave their
children unsupervised and the birth of a child may result in a loss of pay or even in
unemployment. In addition, existing gender-based division of household labour places a
disproportionate burden on those women who either have to, or choose to, work outside the
In addressing these issues, the Programme of Action adopted
at the ICPD in 1994 recognized that despite recent declines in birth rates in many
countries, further large increases in population size are inevitable. Owing to the
youthful age structure, for numerous countries the coming decades will bring substantial
population increases in absolute numbers. Population movements within and between
countries, including very rapid growth of cities and the unbalanced regional distribution
of population, will continue and increase in the future. The Programme of Action also
recognized the need for policies that support the family, whatever its form, as it seeks
to do what families have always done: provide mutual support and protection for its
members, whether children, young adults, mature adults or the elderly.
A comparison of the working-age population to the combined
young and old populations in the more developed regions shows the impact of the baby boom.
In 1950, there were 1.85 working-age people for every old or young dependant, decreasing
to 1.72 in 1960-1965. This was followed by a period of sustained increase which is
expected to last until around 2005-2010. From that point on, however, as older populations
grow, the ratio will fall to 1.42 in 2050.
The Youth Factor
At the approach of 6 billion, world population continues to
grow at 77 million a year and will exceed 70 million more per year for the next two
decades. What happens after depends largely on decisions made now and over the next 10
years by the 1.04 billion young people who today are between 15 and 24 years of age.
What these young people, the largest generation ever to
enter adulthood, decide about the size and spacing of their families will determine how
many people will be on the planet by 2050.
Educating young people about the immediate and longer-term
effects of their behavioural choices enables them to make responsible decisions. Their
ability to make informed choices, to fulfil their individual potential and contribute to
economic development, will be shaped by the way families, communities, nations and the
world respond to their health, schooling and job needs.
Between now and 2010, 700 million young people will enter
the labour force in developing countries, an unprecedented "demographic bonus"
of human resources. The ILO projects that more than 1 billion jobs will be needed to
accommodate these new workers and reduce unemployment, a challenge that cannot be met
without continued progress in lowering birthrates and expanding education programmes.
Earlier sexual maturity, later marriage and changes in the
form of the family have contributed to the acceptance of adolescence as a distinct phase
of life. With puberty occurring earlier and average marriage age rising, young people
today face a longer period of time during which they are sexually mature and, perhaps,
Young peoples right to exercise their basic human
rights must be recognized and respected in helping them realize their full potential. In
the case of young women, this entails the right to exercise greater control over their
sexual and reproductive lives, free of coercion, discrimination and violence. The
development of more positive attitudes towards girls and women will remove many of the
barriers to better reproductive health.
Traditional practices such as expectation of early marriage
and pregnancy, the 2 million young girls who face female genital mutilation each year, the
fact that only 76 per cent of girls compared to 96 per cent of boys receive some level of
primary schooling and that among children who receive no schooling at all, girls outnumber
boys, are all symptoms of a wider prejudice against empowering girls to make their own
Young people have their own special needs for health care
and education, particularly in matters of sexual and reproductive health, an area where
adolescents can be especially at risk. But better communication about sexuality, about
gender relations, and about the avoidance of unwanted pregnancy and STDs is essential to
improving young peoples life options when:
- One in every 10 births worldwide is to teenage mothers -- 1
in every 6 to young women aged 15-19 in the least developed countries.
- Pregnancy before age 18 carries many health risks -- girls
aged 10-14 are five times more likely to die in pregnancy or childbirth than women aged
- Adolescent mothers will have more children than those who
start childbearing later.
- At least 1 in 10 abortions worldwide occurs among women aged
15-19 -- over 4.4 million young women in this age group have abortions every year (40 per
cent of which are performed under unsafe conditions).
- Ultimate population size depends not only on the size of
completed families but on decisions about when to start them -- raising mothers age
at first birth from 18 to 23 could reduce population momentum by over 40 per cent.
- Each day, 500,000 young people are infected with an STD --
most in the 20-24 age group, followed by the 15-19 age group.
- Those under age 25 account for half of all HIV infections --
8,000 a day.
Unintended pregnancy early in life is usually the
consequence of lack of access to information and services, unwanted sexual relations,
unprotected sex or ineffective use of contraception. Unmarried pregnancy is often
unintended. As reproductive health and family planning programmes become well established,
adolescents and young peoples unmet need for contraception remains greater
than that of any other age group.
More countries are recognizing the need to address the
unique needs of adolescents in the area of reproductive and sexual health concerns. Many
have made significant advances in meeting young peoples need for information and
services. But attitudes need to be changed and programmes better supported to sustain this
Integrated primary health services are the most effective
and cost-efficient way of meeting the multiple health needs of adolescents, including
their sexual and reproductive health concerns. Services and information should be
accessible as well as available, offering sensitive counselling in a youth friendly
Community leaders, parents and teachers should have input
in the design of programmes for adolescents, as should young people themselves. While
families are still the strongest influence on adolescent behaviour and choices, parents
are often uneasy about teenage sexuality, uncertain about what sort of information to
provide, and may need training to help adolescents deal with health and sexuality issues.
Education programmes are essential to address issues of
adolescent sexual and reproductive behaviour. Contrary to popular believe, sex education
does not lead to promiscuity.
A WHO survey of sex education studies found none that indicated increases in sexual
activity among participants and clear evidence in 21 studies of higher levels of
abstinence, a later start to sexual activity, higher use of contraceptives, fewer sexual
partners and/or reduced rates of unplanned pregnancy and STDs among participants.
A similar survey by UNAIDS of over 50 studies has shown
that sexual health programmes do not encourage sexual experimentation, that they can help
delay the age of first intercourse and, among adolescents who are sexually active, reduce
the instance of sexually transmitted diseases.
|Investing in young people
The large size and rapid growth of the adolescent and young age
group demands a considerable investment if their potential is to be fully realized. The
practical benefits are wide-reaching and include:
- Avoiding unwanted pregnancies and their consequences, especially for womens health
- Reducing recourse to abortion and the consequences of unsafe abortion.
- Fewer unwanted children.
- Prevention of teenage pregnancy, protecting girls from the health risks of too-early
childbearing and allowing them to complete their education and to marry later.
- Stronger primary and preventive health care systems and improvements in public health.
- Slowing the spread of sexually transmitted diseases, including HIV/AIDS.
- Longer generations, reduced population momentum, quicker transition to sustainable low
levels of population growth.
- Progress towards gender equity, social participation and grass-roots partnerships for
- Better integration of young people into responsible adult roles.
- Better preparation of the young for creating and responding to social change and
- Better communications and active partnerships between men and women and between the
Today there are more than 580 million people over 60 years
of age and their numbers are growing at over 11 million a year. More people are living to
older ages, with higher proportions of most countries populations aged 60 years and
above than at any time in history.
Better medical care is preserving life at both ends of the
age spectrum: infant mortality has fallen rapidly and more people are living longer.
Combined with lower fertility, the effect is to increase the proportion of older people.
This is what is meant by an "ageing" population.
All countries will experience some change in their age
structures in the next several decades. Adaptation to the new realities will change
relationships between generations, as well as approaches to work, health care and
Increasing numbers of elderly people and the erosion of
family support systems will call for new arrangements for elder care. A majority of the
elderly are female, underscoring the need to address womens health needs throughout
the life cycle. Most of the burden of caring for older family members has fallen on women
-- as the burden grows heavier, national policies must respond.
The proportion of peoples lives in which they can
expect to have either elderly relatives or a child in the household is growing, though at
different rates in different regions. Countries at different stages of the demographic
transition and under different social and economic conditions face different scenarios.
Improving health, financial security and comfort in later
life will become a higher priority as populations grow older, issues that should be
assessed as an integral part of the formulation of social development policy, programmes
The health of older people depends on the quality of
available health care, on income and living conditions and on health status in earlier
years, itself the result of a wide range of economic, social, political and cultural
conditions. These include:
- Ensuring the right to health, particularly basic primary
health care, including sexual and reproductive health;
- Emphasizing public health measures and preventive health
care to reduce the cost of curative medicine;
- Giving special attention to the health needs of older women,
which have so far been neglected by policy makers (older populations and particularly the
oldest old in most parts of the world are predominantly female, because of womens
longer life expectancy).
Public systems for old-age, disability or survivor support
are now a feature of some 155 countries and territories, though their coverage varies
greatly. It is estimated that formal public programmes cover only 30 per cent of the
worlds population over the age of 60. Some 40 per cent of the worlds
working-age population are making contributions to that support. Higher levels of coverage
obtain in more developed settings.
Projections of the increases in population at older ages
and of their needs for services challenge the ability of public, private and community
institutions to respond with a commitment to equity among social groups over time.
Decisions about the allocation of public services and the burden of financing them are
fundamentally political and moral decisions.
|Support for the ageing
Better health, social and financial support services for ageing
populations, and policy choices that support intergenerational equity will:
- Promote the role of families and other informal support providers;
- Enable older people to remain healthy, independent and productive for longer;
- Promote the participation of elders in local institutions for self-help, mutual
assistance and outreach to others in their communities and thereby strengthen civil
- Encourage the re-evaluation of cultural traditions, to preserve beneficial practices and
eliminate harmful ones;
- Facilitate the reorientation of health services to concentrate on prevention rather than
medication and surgery to address conditions related to ageing, and focus attention on the
impacts of other social programmes on different age groups;
- Take the place of large families in providing for old age, and encourage smaller,
healthier, better-educated families;
- Lead to balanced investment in the full range of basic social services (in health,
education, sanitation and nutrition) in order to improve the quality of life and future
potentials for all segments of the population.